Cognitive-behavioral Treatment Intervention Research Articles

Executive Functioning and Self-Management Processes Mediate the Relationship Between Insomnia and Pain-Related Disability

Insomnia has been identified as a predictor of reduced benefit from cognitive-behavioral treatment (CBT) for adolescent chronic pain; however, it is not well understood how insomnia leads to reduced treatment response. The purpose of this study was to evaluate executive function and self-management processes as 2 potential mediators of the relationship between insomnia symptoms and pain-related disability outcomes from internet-delivered CBT using a single-arm clinical trial design. Eighty-five adolescents with chronic pain (77% female, ages 12–17 years) and their caregiver received an 8-week internet-delivered CBT intervention. Youth completed validated measures of insomnia symptoms, executive function, self-management processes, and pain-related disability at baseline, mid-treatment, immediate post-treatment, and 3-month follow-up. Results from multilevel structural equation modeling indicated that more severe insomnia symptoms were associated with greater problems with executive function, which, in turn, led to lower engagement in self-management processes and less improvement in pain-related disability. These findings identify 2 mediators by which higher insomnia symptoms may lead to reduced benefit from CBT intervention for chronic pain. Research is needed to understand whether psychological treatments for chronic pain may be optimized by strategies targeting insomnia, executive function, and/or engagement in self-management. This trial was registered at clinicaltrials.gov (NCT04043962). PerspectiveOur study suggests that executive functioning and self-management processes mediate the relationship between insomnia and treatment outcomes for pediatric chronic pain, highlighting the impact of insomnia on youth learning and implementation of self-management strategies and the critical need for targeted sleep interventions in this population.

A Mobile Application to Help Self-Manage Pain Severity, Anxiety, and Depressive Symptoms in Patients with Fibromyalgia Syndrome: A Pilot Study.

Treatment for individuals with fibromyalgia syndrome (FMS) is complex and is not always accessible to those who could benefit. The aim of this study was to conduct a preliminary evaluation of a mobile-app-delivered, cognitive behavioral treatment (CBT)-based intervention in helping adults self-manage fibromyalgia symptoms. A total of 100 adults with FMS (M [SD] age = 49.81, [9.99] years; 94% women) were given access to the digital treatment program and downloaded the app. Pain severity, anxiety symptoms, depression symptoms, fatigue, and sleep quality were assessed at pre-treatment, post-treatment, and 3-month follow-up. Fifty-three of the potential participants completed the 47-day treatment. Data showed significant improvements in pain severity (p = 0.007, d = 0.43), anxiety (p = 0.011, d = 0.40) and depressive symptoms (p = 0.001, d = 0.50) from pre-treatment to post-treatment. The effect sizes associated with app use are consistent with improvements seen in previously published clinical trials of CBT for FMS. Improvements were generally maintained, although there was some decrease in the outcomes from post-treatment to the 3-month follow-up. Most participants reported that they were very satisfied with the app. The use of the app was associated with similar levels of improvements found with in-person CBT treatment for FMS. Research to evaluate the effectiveness of the app in a controlled trial is warranted.

Rural residence and adherence to continuous positive airway pressure therapy: have we overcome a barrier?

Rural residence and adherence to continuous positive airway pressure therapy: have we overcome a barrier?

A Comparison of Interactions Among Children, Parents, and Therapists in Cognitive Behavior Therapy for Anxiety Disorders in Australia and Japan

Despite growing attention to the efficacy of culturally adapted cognitive-behavioral treatment (CBT) programs for children and adolescents, there is still little empirical and practical information available to therapists who adapt original treatment protocols to suit clients of a specific culture. The current study aimed to compare therapeutic interactions across CBT treatment delivered with two different cultural groups. We developed an observational coding system to examine behaviors exhibited by child, parent, and therapist during CBT sessions conducted in Australia and Japan for children with anxiety disorders. Our results demonstrated significant differences between the two countries with respect to the treatment readiness of children, the proportion of talking during the sessions by parents and children, therapists’ laughter, length of silence during the first session, and parent indices of accommodation. In terms of transitions over time (i.e., first to last CBT session), parents in both countries tended to talk more during the last CBT session, whereas only Australian therapists talked less over time. The proportion of silence decreased over time during the Japanese sessions, and the amount of interruptions by parents increased over time for Australian sessions. Finally, our exploratory analyses demonstrated that a number of behavioral observations were correlated with anxiety treatment outcome at posttreatment. This study suggests that interactions between a child, parent, and therapist during CBT sessions may be affected by the culture in which the CBT session occurs, which could have implications for culturally adapted CBT programs.

ImaginYouth-A Therapist-Guided Internet-Based Cognitive-Behavioral Program for Adolescents and Young Adults With Body Dysmorphic Disorder: Study Protocol for a Two-Arm Randomized Controlled Trial.

Background: Body dysmorphic disorder (BDD) is a relatively common mental disorder in adolescents and young adults, and is characterized by severe negative psychosocial consequences and high comorbidity as well as high mortality rates, mainly due to suicides. While patients in Germany have health insurance-financed access to evidence-based outpatient treatments, that is, cognitive-behavioral treatment (CBT), waiting lists are long. Furthermore, patients with BDD report diverse treatment barriers, primarily feelings of shame and the belief that they would be better off with treatments that would alter the perceived flaw(s). Given adolescents' and young adults' high affinity to electronic media, the accessibility of evidence-based care for this severe mental disorder could be improved by providing an internet-based therapist-guided CBT intervention.Methods: In a two-arm randomized controlled trial (N = 40), adolescents and young adults (15–21 years) with a primary diagnosis of BDD based on a semi-structured clinical expert interview will be randomly allocated to an internet-based therapist-guided CBT intervention or a supportive internet-based therapy intervention. Assessments will take place at baseline, after mid-intervention (after 6 weeks), post-intervention, and at 4-week follow-up. The primary outcome is expert-rated BDD symptom severity at the primary endpoint post-intervention. Secondary outcomes include responder and remission rates based on expert rating, self-reported BDD symptoms, and psychosocial variables associated with BDD.Interventions: The CBT-based intervention consists of six modules each comprising one to three sessions, which focus on psychoeducation, cognitive restructuring, work on self-esteem, exposure and ritual prevention, mirror retraining, and relapse prevention. A study therapist provides feedback after each session. The supportive therapy intervention consists of access to psychoeducational materials for the same 12-week period and at least one weekly supportive interaction with the study therapist.Conclusions: This is the first study to examine the feasibility and efficacy of an internet-based therapist-guided CBT intervention in adolescents and young adults with BDD. It could be an important first step to increase accessibility of care in this age group and for this severe and debilitating mental disorder.Clinical Trial Registration: German Register of Clinical Studies, DRKS00022055.

Efficacy and acceptability of parent-only group cognitive behavioral intervention for treatment of anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials

BackgroundAnxiety disorder is the most prevalent mental disorder among children and adolescents, causing significant psychosocial problems and physical health conditions. Cognitive behavioral therapy (CBT) is an effective treatment for anxiety disorder in children and adolescents. And parent-only CBT is an alternative treatment for childhood anxiety disorder, which includes psychologists and parents rather than children in the treatment. As a new type of CBT, parent-only CBT has some advantages. However, it remains unclear whether parent-only CBT interventions are effective for treating children and adolescents with anxiety disorder.MethodsIn this study, we evaluated the efficacy (the mean change scores of the anxiety rating scale from baseline to post-treatment, standardized mean difference SMD) and acceptability (the proportion of patients in the treatment group who withdrew from treatment early for any reason, risk ratios RRs) of parent-only cognitive behavioral therapy (CBT) for children and adolescents with anxiety disorder. We searched electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, ProQuest, and PsycINFO from inception to June 2019. We included randomized controlled trials (RCTs) comparing parent-only CBT either with waitlist (WL), or CBT with parents in children and adolescents with anxiety disorder.ResultsFinally, six RCTs with 407 participants were included in the meta-analyses. In terms of efficacy, pooled analyses indicated that parent-only CBT was significantly more effective than WL for reducing anxiety symptoms with SMD of − 0.72 (95% CI − 1.41 to − 0.03, p = 0.04), and more remission rate with RR of 4.33 (37.96% vs. 6.85, 95% CI 1.82 to 10.27, p = 0.0009) at post-treatment. And our analyses showed no evidence that parent-only CBT had significantly greater efficacy than CBT with parents with SMD of 0.21 (95% CI − 0.09 to 0.50, p = 0.17). Acceptability in the parent-only CBT group was not significantly different to the WL group with RR of 0.92 (95% CI 0.52 to 1.62, p = 0.77), and was significantly worse than in the CBT with parents group with RR of 1.93 (95% CI 1.05 to 3.57, p = 0.03).ConclusionsCurrent evidence indicates that parent-only CBT can be an alternative and acceptable intervention for treating children and adolescents with anxiety disorder.

Lessons from the nursery: The role of childcare in a cognitive behavioral treatment intervention for Latinas

Providing childcare along with interventions for disadvantaged mothers increases the benefit. However, program designers rarely focus on the implementation of that care and how it affects program participants. Using the common factors model as a lens, this paper explores the challenges that arose in the third year of an intervention that provided childcare to Spanish-speaking immigrant mothers enrolled in a Cognitive Behavioral Treatment (CBT) group when the socioeconomic status of beneficiaries and the population of children needing care changed. We used data collected by the childcare coordinator—participant observation, field notes, and administrative documentation—to examine the meanings participants assigned to problems in the childcare program, their resolution, and how it affected the therapeutic alliance. Data analysis focuses on the extent emerging themes were consistent with the concepts from the common factors approach. Four lessons for providers of interventions with similar supports emerge: attend to the physical environment, anticipate that learning from and rectifying mistakes can improve the therapeutic relationship, select and train childcare providers to understand they are clinical helpers, and recognize that participants view the childcare service as an extension of the intervention. Findings underscore the importance of support services in fostering the success of social work interventions in community settings.

Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder?

Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.

An RCT of brief cognitive therapy versus treatment as usual in patients with non-cardiac chest pain

BackgroundNon-cardiac chest pain (NCCP) is a common reason for presenting to an emergency department (ED). Many patients re-present with similar symptoms despite reassurance. ObjectiveTo investigate the clinical value of a brief cognitive behavioural treatment (CBT) in reducing re-presentations of patients who present with NCCP. MethodA randomised controlled trial (RCT) comparing three or four sessions of NCCP directed CBT with treatment as usual (TAU). The primary outcome measure was reducing health service use measured as re-presentations to the ED and hospitalisations for NCCP over 12 months of follow-up. Secondary outcomes were chest pain, health anxiety, depression, anxiety, quality of life and social functioning. Results214 patients received CBT and 210 TAU. There was no difference in ED visits or hospitalisation at three months or 12 months follow-up. Those with prior ED presentations for NCCP were significantly less likely to present with NCCP at three months follow-up but not at 12 months. Health anxiety was less at three months in those who received CBT but this effect was not present at 12 months. No other differences in secondary outcome measures were present. ConclusionsA brief CBT intervention for NCCP failed to reduce representations or improve psychological health over 12 months. We do not recommend such an intervention to unselected patients with NCCP. Patients presenting with prior episodes of NCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile.

A randomized clinical trial of cue exposure treatment through virtual reality for smoking cessation

IntroductionCue-induced craving is a major motivator of smoking behavior, and, more importantly, a predictor of relapse. Previous studies demonstrated that cue exposure treatment (CET) reduces both cue-induced craving and daily nicotine intake in smokers. However, the efficacy of CET for smoking cessation has rarely been tested in controlled trials. This two-site randomized clinical trial explored the effectiveness of a CET procedure in combination with a Cognitive-Behavioral Treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. MethodsOne hundred and two smokers were randomly assigned to one of two treatment conditions: CBT (n = 52) or CBT + CET (n = 50). The CBT intervention involved group-based sessions over the course of 6 weeks. In addition to CBT, participants in the CBT + CET condition received 5 individual sessions of CET through virtual reality. ResultsThe CBT + CET group showed a significant reduction in cue-induced craving. However, there were no significant differences in either retention nor abstinence rates between CBT and CBT + CET in any assessment period (end-of-treatment, 1-, 6-, and 12-month follow-up). Moreover, a higher rate of relapse over a 12-month follow-up period was found in the CBT + CET group compared to the CBT group (Wald χ2 = 4.796, p = .029). ConclusionsFindings support and expand previous evidence by showing that a CET protocol does not increase the effectiveness of a CBT intervention for smoking cessation among treatment-seeking smokers. Moreover, this study also reveals that CET may increase risk of relapse among nicotine-dependent individuals who successfully achieve abstinence. Until the mechanisms underlying the effect of CET are identified, researchers and clinicians should be cautious when utilizing this protocol.

Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder.

Given the particular relevance of arousal and alerting in panic disorder (PD), here the alerting network was investigated (1) contrasting patients with PD and healthy controls, (2) as a function of anxiety sensitivity constituting a dimensional measure of panic-related anxiety, and (3) as a possible correlate of treatment response. Using functional magnetic resonance imaging (fMRI), 45 out-patients with PD (f = 34) and 51 matched healthy controls were investigated for brain activation patterns and effective connectivity (Dynamic Causal Modeling, DCM) while performing the Attention Network Task (ANT). Anxiety sensitivity was ascertained by the Anxiety Sensitivity Index (ASI). Forty patients and 48 controls were re-scanned after a 6weeks cognitive-behavioral treatment (CBT) or an equivalent waiting time, respectively. In the alerting condition, patients showed decreased activation in fronto-parietal pathways including the middle frontal gyrus and the superior parietal lobule (MFG, SPL). In addition, ASI scores were negatively correlated with connectivity emerging from the SPL, the SFB and the LC and going to the MFG in patients but not in healthy controls. CBT resulted in an increase in middle frontal and parietal activation along with increased connectivity going from the MFG to the SPL. This change in connectivity was positively correlated with reduction in ASI scores. There were no changes in controls. The present findings point to a pathological disintegration of the MFG in a fronto-parietal pathway in the alerting network in PD which was observed to be reversible by a successful CBT intervention.

"Meta-analysis of cognitive-behavioral treatments for adult ADHD": Correction to Knouse, Teller, and Brooks (2017).

Eligible studies tested adults meeting criteria for Diagnostic and Statistical Manual of Mental Disorders ADHD as determined by interview or using a standardized rating scale and measured ADHD symptoms or related impairment at baseline and posttreatment. We analyzed data from 32 studies from published and unpublished sources available through December 2015. Effect size calculations included up to 896 participants. Using a random effects model, we found that CBTs had medium-to-large effects from pre- to posttreatment (self-reported ADHD symptoms: g = 1.00; 95% confidence interval [CI: 0.84, 1.16]; self-reported functioning g = .73; 95% CI [0.46, 1.00]) and small-to-medium effects versus control (g = .65; 95% CI [0.44, 0.86] for symptoms, .51; 95% CI [0.23, 0.79] for functioning). Effect sizes were heterogeneous for most outcome measures. Studies with active control groups showed smaller effect sizes. Neither participant medication status nor treatment format moderated pre-to-post treatment effects, and longer treatments were not associated with better outcomes. Current CBTs for adult ADHD show comparable effect sizes to behavioral treatments for children with ADHD, which are considered well-established treatments. Future treatment development could focus on identifying empirically supported principles of treatment-related change for adults with ADHD. We encourage researchers to report future findings in a way that is amenable to meta-analytic review. (PsycINFO Database Record

Mom-net: Evaluation of an internet-facilitated cognitive behavioral intervention for low-income depressed mothers.

Evaluate an Internet-facilitated cognitive-behavioral treatment intervention for depression, tailored to economically disadvantaged mothers of young children. Economically disadvantaged mothers (N = 266) of preschool aged children, who reported elevated levels of depressive symptoms, were randomized to either the 8-session, Internet-facilitated intervention (Mom-Net) or to Motivational Interviewing and Referral to Services (MIRS). Outcomes were measured using the Patient Health Questionnaire 9 (PHQ-9; Spitzer et al., 1999), the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR) Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 2002), and the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960). Relative to participants in the MIRS condition, participants in Mom-Net demonstrated significantly greater reduction in depression as indexed by self-report questionnaire (primary outcome), interviewer-rated symptoms, and diagnostic outcomes. Results suggest that the Mom-Net intervention is effective as a remotely delivered intervention for economically disadvantaged mothers. (PsycINFO Database Record

A Case Series Evaluation of a Pilot Group Cognitive Behavioural Treatment for Children With Asthma and Anxiety

Anxiety disorders occur at an increased rate in children with asthma; however, there is only a small evidence base to support specific psychological treatments for these children. The current study evaluated the efficacy of a pilot cognitive behavioural treatment (CBT) group intervention for children with asthma and a comorbid anxiety disorder in a case series design. Five children (aged 8–11 years old) with asthma and a comorbid anxiety disorder and their mothers took part in eight 1-hour group treatment sessions. Primary outcomes measures were anxiety diagnosis and asthma-related quality of life. Secondary outcome measures were asthma symptom control and parent quality of life associated with caring for a child with asthma. Three of the participants no longer met diagnostic criteria for an anxiety disorder following treatment and three different participants reported a reliable improvement in asthma-related quality of life. Two participants reported a reliable improvement in asthma symptom control. Three mothers reported an improvement in caregiver quality of life. The findings provide preliminary proof of concept evidence for the efficacy of a CBT intervention for children with asthma and clinical anxiety.

Effect of Cognitive Behavioral Treatment Program on Anxiety and Self-Esteem among Secondary School Students

Aim of this study was to investigate the effect of cognitive behavioral treatment program on anxiety level and self-esteem among secondary school students. A Quasi-experimental pre-post non-equivalent group design was used for this study. The study was conducted at El Manial National Language Schools. A convenient sample of thirty secondary school students was selected. The sample was divided into two groups, fifteen students as the study group and fifteen students as control group. Three tools were used to collect the data for the present study; a) Personal Data Sheet; b) Hamilton Rating Scale of Anxiety; and c) Self-esteem Inventory. A constructed cognitive behavioral treatment intervention was developed by the researcher and implemented to the study group in ten sessions that were held twice weekly, and each session ranged from 60 to 90 minutes. The main study findings revealed that, there was a statistically significant difference between study and control groups in the reduction of anxiety level; however, there was no significant change in self-esteem for both groups. The study concluded that, cognitive behavioral treatment program was effective with secondary school students concerning the reduction of the anxiety level. The study recommended that, there is a great need for continuous follow-up of secondary school students who participated in cognitive behavioral treatment program to support and boost their coping strategies with anxiety.

A Review of the Diagnosis and Management of Hoarding Disorder

Hoarding disorder (HD) is a severe psychiatric and public health problem characterized by extreme challenges with discarding possessions and severe acquisition resulting in excessive clutter that impairs daily functioning and may cause substantial health and safety risks. Over the past 20 years, research on HD has grown substantially and lead to its recent designation in the DSM-5 as a discrete disorder. The key features of the cognitive behavioral etiological model of hoarding include core vulnerabilities, information processing deficits, cognitions and meaning of possessions, and emotionally driven reinforcement patterns. This model has served as the theoretical foundation for efficacious, specialized cognitive behavioral treatment (CBT) for hoarding and validated hoarding assessment measures. The individual manualized CBT treatment has been adapted for delivery through various modalities (e.g., group, web-based, self-help), populations (e.g., geriatric), and providers (e.g., clinicians, peer support, case managers). While CBT is associated with significant reductions in hoarding severity, clinical levels of hoarding symptoms persist for greater than half of treatment completers; thus, more efficacious treatments need to be developed. Further research is necessary to elucidate components of the CBT model and their interaction, in order to inform treatment targets. Although research on pharmacological treatments for HD is in the nascent stages and extant results are somewhat mixed, future studies may assess medication as a standalone treatment or combined with CBT. Family-focused hoarding interventions may also be important given that persons with hoarding behaviors may have limited insight and motivation and its negative effects on the family. Current data indicate a cost-effective and coordinated response that combines community-based and individualized interventions for hoarding may be optimal in order to (1) reach the broadest group of clients with hoarding (e.g., beyond those who voluntarily seek treatment), (2) maximize incentives and motivation through housing, health services, and safety laws, (3) enhance communication and coordination between diverse teams of providers, (4) provide sustainable comprehensive services in a stepped care approach, and (5) reduce stigma.

Pathways to anxiety-depression comorbidity: A longitudinal examination of childhood anxiety disorders.

Anxiety disorders are prevalent in youth and associated with later depressive disorders. A recent model posits three distinct anxiety-depression pathways. Pathway 1 represents youth with a diathesis to anxiety that increases risk for depressive disorders; Pathway 2 describes youth with a shared anxiety-depression diathesis; and Pathway 3 consists of youth with a diathesis for depression who develop anxiety as a consequence of depression impairment. This is the first partial test of this model following cognitive-behavioral treatment (CBT) for child anxiety. The present study included individuals (N = 66; M age = 27.23 years, SD = 3.54) treated with CBT for childhood anxiety disorders 7-19 years (M = 16.24; SD = 3.56) earlier. Information regarding anxiety (i.e., social phobia (SoP), separation anxiety disorder (SAD), generalized anxiety disorder (GAD)) and mood disorders (i.e., major depressive disorder (MDD) and dysthymic disorders) was obtained at pretreatment, posttreatment, and one or more follow-up intervals via interviews and self-reports. Evidence of pathways from SoP, SAD, and GAD to later depressive disorders was not observed. Treatment responders evidenced reduced GAD and SoP over time, although SoP was observed to have a more chronic and enduring pattern. Evidence for typically observed pathways from childhood anxiety disorders was not observed. Future research should prospectively examine if CBT treatment response disrupts commonly observed pathways.

Adjunctive cognitive behavioural treatment for chronic pain couples improves marital satisfaction but not pain management outcomes.

Data have consistently shown that patient coping with chronic pain can be affected by various factors associated with the primary relationship, and hence efforts to include the patient's partner in the treatment process have merit. This study evaluated the benefit of adding an adjunctive, couples-based, cognitive behavioural treatment (CBT) for chronic pain to a standard cognitive behavioural pain management programme. Forty-five couples were randomly assigned to either an adjunctive couples intervention (n=19) or the pain programme only (n=26). All patient participants completed a 3-week multi-disciplinary pain management programme, to which their partners were invited to attend one full day. In addition, partners in the adjunctive condition received four, one hour treatment sessions focusing on pain education, patient-partner communication, operant behavioural principles and relapse prevention strategies. Partner sessions for the adjunctive intervention were provided over the telephone. By the completion of the pain programme the adjunctive couples intervention demonstrated significant improvements in maritalsatisfaction for the spouses over and above attendance at the pain management programme alone (p=0.003). However, spouse involvement did not facilitate any additional response to treatment for pain patients on marital satisfaction, pain, disability or any indices of distress. All treatment gains were maintained at 1month follow-up. These data demonstrate that a brief CBT intervention can significantly improve marital satisfaction for spouses of chronic pain patients, but the treatment does not translate to improvements in function on any outcomes, including marital satisfaction, for patients of chronic pain. WHAT DOES THIS STUDY ADD?: A brief, telephone-based intervention for couples living with chronic pain is an acceptable format for intervention. This intervention can significantly improve marital satisfaction for partners of chronic pain patients. Patients who are already participating in a multidisciplinary pain programme will not obtain further benefit.

Comparison of a Cognitive-Behavioral Coping Skills Group to a Peer Support Group in a Brain Injury Population

ObjectiveTo compare the efficacy of 2 group treatments for persons with brain injury (BI) and their caregivers in promoting perceived self-efficacy (PSE) and emotional and neurobehavioral functioning. DesignRandomized controlled trial. SettingOutpatient BI rehabilitation. ParticipantsSubjects (N=38), including 19 with BI and 19 caregivers, participated in a BI coping skills group or a support group. InterventionsBI coping skills is a manualized cognitive-behavioral treatment (CBT). CBT was compared with a structurally equivalent support group. Main Outcome MeasuresBrain Injury Coping Skills Questionnaire (PSE), Brief Symptom Inventory-18 ([BSI-18]; emotional distress), and Frontal Systems Behavior Scale (neurobehavioral functions). ResultsThere were no significant differences between survivors and caregivers on the Brain Injury Coping Skills Questionnaire and BSI-18; therefore, groups were combined during final analyses. Frontal Systems Behavior Scale caregiver data were used for analysis. Both groups showed significantly improved PSE between baseline and follow-up on repeated-measures analysis of variance, with the CBT group showing greater stabilization of change. There was no significant group by time interaction on measures of neurobehavioral functions, but the CBT group showed significant improvements at 3-month follow-up. No significant effects were found on the BSI-18. ConclusionsTo our knowledge, no studies to date have been published comparing a CBT intervention with a support group in a BI population with caregiver participation. This study showed that given equivalent group structure, individuals with BI and caregivers may benefit from either type of intervention in enhancing PSE or maintaining emotional stability. However, there was a trend for individuals who received CBT to maintain the effects of improved PSE, whereas support group participants showed a trend for decline. This study offers a new conceptualization that with certain group dynamics and support, individuals with BI and caregivers may benefit similarly from either a support group or CBT intervention. However, because our sample did not include individuals in clinically significant emotional distress, we cannot rule out the possibility that those with more significant challenges in PSE or emotional functions may show greater benefits with a CBT group.

Does cue exposure treatment improve outcomes in smoking cessation treatment? A controlled trial

Aims: Cue exposure techniques (CET) consist of controlled and repeated exposure to cues that provoke craving in order to extinguish the urge to smoke. Previous studies showed that cigarette craving can be reduced through CET. However, very few studies have explored the efficacy of CET for smoking cessation. This randomized clinical trial explored the effectiveness of a CET procedure when added to a Cognitive Behavioral Treatment (CBT) for smoking cessation among treatment-seeking smokers. Methods: The sample was made up of 102 treatment-seeking smokers with current DSM-IV nicotine dependence. Participants were randomly assigned to oneof two treatment conditions: CBTor CBT+CET. The CBT intervention involved group-based sessions during 6 weeks. In addition to CBT, participants in CBT+CET condition received 5 individual sessions of CET through virtual reality. Results: Of the patients in the CBT+CET group, 78% attended all treatment sessions compared to 73.1% in the CBT group (p = .56). At the end of the treatment, 56% of the patients in the CBT+CET condition achieved abstinence, versus 51.9% in the CBT condition (p = .68). At one month follow-up, 38% in the CBT+CET condition were abstinent compared to 38.5% in the CBT condition (p = .87). Lastly, 24% of patients treatedwith CBT+ CETwere abstinent at sixmonth follow-up compared to 25% who received CBT alone (p = .90). Conclusions: Results showed that neither abstinence levels nor treatment retention rates were better in the CET+CBT compared to CBTalone. TheCETproceduredoesnot appear to improveoutcomes in a smoking cessation program. Results from this randomized clinical trial suggest that CET is not an effective strategy for smoking cessation. Financial support: This work was supported by the Spanish Ministry of Science and Innovation (MICIIN) (Ref. PSI200805938/PSIC) and the predoctoral grant from the Spanish Ministry of Economy and Competitiveness (Ref. BES-2012-053988).