Combined Cognitive Behavioral Therapy Research Articles

Using a combination of cognitive behavioral therapy, case management and eHealth components for patients with depression or panic disorders in primary care practices in Hesse, Germany: an exploration of healthcare professionals’ lived experiences

BackgroundDepression and panic disorders have high prevalence rates in primary care. Given the crucial role of general practitioners in diagnosing and treating mental disorders, the two-arm cluster-randomized, controlled PREMA trial was designed. PREMA was aimed at investigating a new intervention combining cognitive behavioral therapy, case management and eHealth components for patients with depression and/or panic disorder with or without agoraphobia in primary care practices in Germany. This qualitative study, embedded in the PREMA trial, explores primary healthcare professionals’ lived experiences in using the new treatment program. Using a qualitative design, we conducted eleven interviews with general practitioners and medical assistants from Hesse, Germany, between July 2021 and March 2022. For both groups we relied on a semi-structured interview guide covering the following subjects: study procedures, implementation, practicality, and individual components of the treatment program. Interviews were audio-recorded, transcribed verbatim and analyzed by two researchers using content analysis. A deductive-inductive approach was used for the analysis according to Kuckartz.ResultsWe narratively summarized the facilitators and barriers from two different stakeholders across five key themes regarding experiences of feasibility and practicability of the new treatment program: study instruction materials, individual components of the treatment program, practicality, target population, and benefits of the treatment program. Facilitators to become familiar with the study include study instruction materials that are easy to understand and not too complex, considering the limited time resources available; barriers included text-heavy instruction materials, lack of collegial exchange, and issues especially with digital materials also involved access and log-in difficulties on the online platform. Facilitators for using the treatment program include the combination of face-to-face consultations and the use of an online platform, enabling a structured approach and regularity; barriers included patients feeling unsupported in performing anxiety exercises independently at home. For practicality, the professional skills of medical assistants and their central role as points of contact for patients facilitated the implementation; barriers included time-intensive organization and planning of monitoring phone calls and consultations. Regarding the target population, general practitioners and medical assistants state that the treatment program would be most appropriate for patients with mild to moderate depression and for those waiting for psychotherapeutic treatment; it would be less suitable for older patients, and those with negative attitudes towards technological tools. For benefits of the program, facilitating factors included free and low-threshold access to the online platform and strengthening the relationship between medical assistants and patients; barriers included a preference for in-person conversations and the inability of some people to use online applications.ConclusionsThe complexity of the new treatment program and the associated high workload underline the need for further adjustments to the treatment approach. Team-based care and the expanded responsibilities of medical assistants demonstrated promising results.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS00016622) on February 22, 2019.

The Relationship Between Exercise Frequency and Cognitive Flexibility in Anxiety Disorder Patients Undergoing Combined Exercise and Cognitive Behavioral Therapy

This study investigates the relationship between exercise frequency and cognitive flexibility in patients with anxiety disorders undergoing combined Cognitive Behavioral Therapy (CBT) and exercise interventions. A longitudinal follow-up design was employed, with 80 participants randomized into four groups: low-frequency exercise, moderate-frequency exercise, high-frequency exercise, and a control group receiving CBT without exercise. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and anxiety levels were measured by the Hamilton Anxiety Rating Scale (HAM-A) at baseline, post-intervention, and during 3-month and 6-month follow-ups. Results demonstrated a significant dose-response relationship, with higher exercise frequencies leading to greater improvements in cognitive flexibility and reductions in anxiety symptoms. The high-frequency exercise group exhibited the most substantial and sustained cognitive and emotional benefits, suggesting the importance of frequent exercise in enhancing and maintaining therapeutic outcomes in anxiety disorder treatment. These findings have critical implications for optimizing treatment strategies that integrate physical exercise with CBT to improve cognitive and emotional health in anxiety disorder patients.

A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea.

Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8weeks of relaxation training (RE) followed by 8weeks of combined cognitive-behavioral therapy and exercise(CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group × Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p = .007, and EX increased peak oxygen consumption (p = .03, g' = -0.41) and reduced ISI (p = .001, g' = 0.82) compared with RE (p = .49, g = 0.16) post-8weeks. Post-16weeks, there was a significant Group × Time interaction (p = .014) driven by RE + CBTiEX yielding a larger improvement in ISI (p = .023, g' = 1.48) than EX + EX (p = .88, g' < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea.

A Combined Kundalini Yoga and Cognitive Behavioral Therapy Program for Posttraumatic Stress Disorder: A Pilot Study.

Cognitive behavioral therapy (CBT) is one of the standard conventional treatments for posttraumatic stress disorder (PTSD). However, recent studies have reported the benefits of yoga for reducing PTSD symptoms including a Kundalini Yoga (KY) intervention. The purpose of this study was to test the efficacy of a novel combined 8-week CBT and KY program for treating PTSD symptoms and improving sleep quality in a single group trial of 26 adults with PTSD. PTSD symptoms (PTSD checklist-5) and sleep quality (Pittsburgh Sleep Quality Index) were assessed at baseline, post intervention, and at 2-month follow-up. Both CBT and yoga homework compliance were also measured. Total PTSD symptom scores as well as the cluster symptoms (intrusion, avoidance, arousal/reactivity, and negative alterations in cognitions and mood) were significantly improved following the program, all p < .01. The improvements in total PTSD scores, intrusion, avoidance, arousal/reactivity were maintained at follow-up, with all values still less (p < .01) than baseline. The negative alterations in cognitions and mood symptom cluster continued to improve further at follow-up compared to post-intervention values (p < .05). Total sleep score (p < .05) and the subscales of sleep disturbance (p < .01), daytime dysfunction (p < .05), and sleep quality (p < .01) were significantly improved after the program and these improvements were maintained at follow-up compared to baseline. Sleep medication use was decreased (p < .05) and sleep latency was improved (p < .01) at follow-up only compared to baseline. There was a significant positive correlation (p < .05) between the completion of the yoga home practice and post change in total sleep scores. These results show that a combined KY and CBT intervention resulted in decreased PTSD symptoms and improved sleep quality and suggest this program may constitute an additional treatment option for PTSD.

Cognitive–behavioral therapy for patients with somatoform disorders: A pilot preliminary randomized controlled trial

Background and objective: Cognitive–behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was −18.87 points and −9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, −9.18 points; 95% confidence interval, −15.72 to −2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

A combined EMDR/CBT-based approach for the successful management of cyclical vomiting syndrome: a case study

Abstract Cyclical vomiting syndrome (CVS) is an extremely debilitating condition that can have an adverse impact on physical health and can significantly disrupt social and occupational functioning. It is a poorly understood illness in terms of aetiology, and most research has focused on the pharmacological management of the condition. This article describes a case study of a combined cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR)-based intervention with an adult with past trauma who had a 20-year history of CVS accompanied by high cannabis use. Therapy led to improvements in physical health and social functioning, reduced use of cannabis, and a significant reduction in the frequency and severity of vomiting episodes and associated hospital admission. Implications for future research and management of the illness are discussed. Key learning aims (1) To understand how the presence of co-morbid untreated trauma in individuals with CVS may result in unhelpful coping strategies that can worsen the course of the illness. (2) To explore how the addition of psychological therapy to routine care of gastrointestinal disorders such as CVS can improve treatment outcome. (3) To consider how offering an individualised and flexible approach to appointments may benefit individuals who find it more difficult to engage in psychological therapy.

Hybrid dizziness counseling with vestibular rehabilitation in participants with chronic dizziness: a comparison of dizziness handicap

IntroductionPatients with chronic dizziness often have an unremarkable laboratory vestibular examination and have medical clearance from other specialties. However, functional impairments are still significant and affect patients' quality of life. Recent diagnostic criteria and identification of persistent postural perceptual dizziness (PPPD) have helped us to better understand the psychological-somatic manifestations of organic disorders. As the literature suggests good efficacy using a combination of cognitive behavior therapy (CBT) and vestibular rehabilitation, we compared the efficacy of a hybrid protocol using dizziness handicap inventory (DHI) as an outcome measure amongst the different sub-types of chronic dizziness.MethodsThis was an observational study with 35 participants allocated to three different groups: those who strictly fulfilled the PPPD criteria, those with spontaneous episodic vestibular syndrome, and participants with non-specific dizziness. We compared the DHI total and sub-domain scores at baseline and 6 months post-intervention for differences. All participants undertook three sessions in 6 months.ResultsThe total DHI scores were reduced in all three groups. However, the DHI total on average was 11 points higher in the episodic vestibular syndrome group. The emotional sub-domain scores were also reduced in all three groups, but the functional and physical scores were significantly higher in the episodic vestibular group.ConclusionA hybrid protocol worked best for typical PPPD patients who strictly fulfilled the criteria followed by participants in the non-specific dizziness group. When symptoms were episodic in spontaneous vestibular syndrome, only emotional handicap was reduced at 6 months, but functional and physical handicap scores remained high. Regardless, the DHI total scores in all groups were significantly reduced, possibly due to CBT reducing the anxiety that results from a lack of understanding of the clinical diagnoses.

Treatment of Depression With Psychotic Features in Maltreated Adolescents: Evidence-Based Case Report

Introductions: Depressive disorders are expected consequences of experiencing child maltreatment. Many depressive disorders can occur with or without psychosis, which has different implications for treatment and prognosis. This condition raises the challenge of treating depression in maltreated adolescents because the patient has inadequate family and social support. Consequently, it is difficult for the patient to undergo psychotherapy that involves family. Case: A 17-year-old female was diagnosed with psychotic depression. The patient had symptoms of depression, accompanied by hallucinations, since five years ago. The patient was hospitalized for suicidal ideation and food refusal for days. Patient had a history of child maltreatment by family and experienced bullying since elementary school. Patient believes that her family, especially her mother, had hated her from the beginning. Discussions: After stabilization of the patient’s general condition, psychopathology exploration was done together with selection of appropriate treatment. Combined Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitor (SSRI) and atypical antipsychotic treatment are the evidence-based treatments for psychotic depression in maltreated adolescents. Studies involving patients with psychotic depression which were treated by combination of sertraline and olanzapine showed significant improvement of depression and psychotic symptoms and reduced the risk of relapse over 36 weeks, compared to sertraline plus placebo. Conclusion: Combination of SSRI, atypical antipsychotic and CBT with a trauma-informed approach should be considered as treatment for psychotic depression in maltreated adolescents.

Treatment of mental anxiety disorders in students by combining cognitive behavioral therapy with college student management strategies

BackgroundCollege students often experience mental anxiety due to academic pressure, employment pressure, and environmental pressure. Conventional drug therapy can easily develop resistance under sustained action. Therefore, research has combined cognitive behavioral therapy with university student management strategies to treat college students’ mental anxiety through a combination approach.Subjects and MethodsA total of 120 students with mental anxiety disorder in their third and fourth years of a certain major in a certain university were selected as the research subjects. According to different treatment methods, the two groups of student patients were divided into Group E and Group F. Group E used traditional treatment methods, while Group F used a combination of cognitive behavioral therapy and university student management strategies. After treatment, Hamilton’s anxiety of 200 hours was used to quantify the mental state of students, and SPSS 21.0 statistical software was used for data analysis.ResultsThe overall effective rate of treatment in Group F was as high as 96.15%, higher than 76.92% in Group E; After treatment, the Hamilton score of Group F was 13.21 ± 2.07, which was lower than the 27.18 ± 4.62 score before treatment, and also significantly lower than the 19.28 ± 3.49 score of Group E. Meanwhile, the incidence of adverse reactions in Group F after treatment was 1.15%, lower than Group E’s 6.58%.ConclusionsThe combination of cognitive behavioral therapy and university student management strategies is effective in treating students’ mental anxiety disorder.

Intervention analysis of CBT and entrepreneurship training for college students’ social anxiety

BackgroundSocial Anxiety Disorder (SAD) is a common mental disorder characterized by intense fear and anxiety in social situations. Social anxiety may prevent college students from actively participating in social activities and innovative entrepreneurial practices, thus affecting their personal growth and career development. The combination of cognitive behavioral therapy and college innovation and entrepreneurship training is expected to provide a comprehensive and effective method for the intervention of college students with social anxiety disorder.Subjects and Methods120 college students with social anxiety disorder were randomly divided into an experimental group and a control group, with 60 people in each group. The experimental group received 10 weeks of cognitive behavior therapy (CBT) combined innovation and entrepreneurship training, while the control group only received innovation and entrepreneurship training. Social anxiety and cognitive status were assessed using the Stanford Acute Stress Response Questionnaire and the 3-Minute Disorder Assessment Scale. SPSS23.0 was used for descriptive statistics, analysis of variance and correlation analysis.Results The social anxiety of the experimental group was significantly reduced, and the SASRQ score was significantly reduced compared with the control group. The experimental group performed better on the 3D-CAM score, indicating improved cognitive status.ConclusionsCognitive behavioral therapy combined with innovation and entrepreneurship training has a significant intervention effect on the social anxiety disorder of college students, which is helpful in improving their social ability and innovation and entrepreneurship potential. This comprehensive intervention strategy has a positive significance in promoting the overall development and mental health of college students.

Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study.

Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.

Integrating Group Cognitive Behavioural, Art Psychotherapy for women following childhood sexual abuse

ABSTRACT Background Despite the prevalence of childhood sexual abuse, and the number of adults referred to secondary mental services with symptoms of mental distress or disorder who report such a history, there is little in the way of specific recommendations for treatment approaches. Aims We wanted to consider the effectiveness of a combined Cognitive Behavioural Therapy (CBT) and Art Psychotherapy (ApT)* group therapy model (GCB-ApT) for women with experience of childhood sexual abuse. Methods GCB-ApT was delivered to seven groups of female survivors of childhood sexual abuse (n = 41) in community mental health team settings, using a standardised model. There were 32 participants who completed the group, and full data is available for 30 participants. Each group was facilitated by two female therapists – a clinical psychologist and an art psychotherapist. The study was registered with the employing Trust (BSMHFT) as a retrospective evaluation of validated clinical outcome measures routinely administered pre – and post-intervention. Results Results showed significant post-intervention improvement in the domains of global distress, depression and self-esteem. Conclusions Results were promising, although numbers were small. Implications for practice/policy/future research Results suggested that group provision using the GCB-ApT model could be a helpful addition to clinical interventions provided for women who have experienced childhood sexual abuse. Further research is recommended. *Some texts referenced may use ‘art therapy’ rather than ‘art psychotherapy’. The abbreviation ApT is used for either throughout. Plain-language summary We looked at how we could provide specific ways to help those women referred to Psychological Services who had experienced childhood sexual abuse. There weren’t many suggestions from previous research that gave us a confident idea about what specific approach works best. We found evidence that Cognitive Behavioural Therapy and Art Psychotherapy can be useful, and we wanted to combine them in a group setting to see how helpful this was. Cognitive Behavioural Therapy looks at how our thoughts might affect our behaviours and feelings, while Art Psychotherapy uses and explores image-making as a way of helping with distressing experiences and emotions. We organised seven groups with a total of forty-one women. Two therapists (one specialist in each therapy) led each group, held over twenty sessions. There were three parts to the group: firstly we covered coping strategies, then we looked in more detail at each person's account of what they had been through. Finally, we supported women to review what had happened for them in the group and to plan for after it had ended. Each week we began by looking at a topic or theme relevant to this group (e.g. flashbacks) through information giving and discussion. The theme provided a starting point for using the art materials, followed by group members being invited to share the images they had made and how that had felt, and to explore any thoughts and feelings that arose in the group in response. We gave each woman three questionnaires to complete at the beginning and the end of the groups, and compared the results. These showed that there had been improvements in mood, self-esteem and psychological well-being. There are limitations with these results, partly because the numbers are small. However, they suggest that more research would be worthwhile.

Frontoamygdalar Effective Connectivity in Youth Depression and Treatment Response

BackgroundEmotion regulation deficits are characteristic of youth depression and are underpinned by altered frontoamygdalar function. However, the causal dynamics of frontoamygdalar pathways in depression and how these dynamics relate to treatment prognosis remain unexplored. This study aimed to assess frontoamygdalar effective connectivity during cognitive reappraisal in youths with depression and to test whether pathway dynamics are predictive of individual response to combined cognitive behavioral therapy plus treatment with fluoxetine or placebo. MethodsOne hundred seven young people with moderate to severe depression and 94 healthy control participants completed a functional magnetic resonance imaging cognitive reappraisal task. After the task, 87 participants with depression were randomized and received 12 weeks of cognitive behavioral therapy plus either fluoxetine or placebo. Dynamic causal modeling was used to map frontoamygdalar effective connectivity during reappraisal and to assess the predictive capacity of baseline frontoamygdalar effective connectivity on depression diagnosis and posttreatment depression remission. ResultsYoung people with depression showed weaker inhibitory modulation of ventrolateral prefrontal cortex to amygdala connectivity during reappraisal (0.29 Hz, posterior probability = 1.00). Leave-one-out cross-validation demonstrated that this effect was sufficiently large to predict individual diagnostic status (r = 0.20, p = .003). Posttreatment depression remission was associated with weaker excitatory ventromedial prefrontal cortex to amygdala connectivity (−0.56 Hz, posterior probability = 1.00) during reappraisal at baseline, though this effect did not predict individual remission status (r = −0.02, p = .561). ConclusionsFrontoamygdalar effective connectivity shows promise in identifying youth depression diagnosis, and circuits responsible for negative affect regulation are implicated in responsiveness to first-line depression treatments.

A comparison between the Effectiveness of Cognitive-behavioral Therapy and a Combination of Cognitive-behavioral Therapy and Medication in Patients With Improved Panic Attacks from the Covid-19

Background and Objective: Cognitive-Behavioral Therapy (CBT) is used as one of the main treatments for panic disorder, yet fewer people with panic disorder receive medication-based treatment. The present study aimed to determine the difference between the effectiveness of cognitive-behavioral therapy and a combination of cognitive-behavioral therapy and medication in patients with panic attacks who have recovered from Covid-19 in Ramsar, Iran. Materials and Methods: This quasi-experimental study was conducted based on a pre-test and post-test design with a control group. The statistical population included patients who were referred to hospitals and medical centers in Ramsar in 2022. A total of 30 cases were randomly selected using the Albanian Panic and Phobia Questionnaire and structural clinical interview. One group received 12 sessions of CBT, one group received a combination of medication and CBT, and the other group received no training. The obtained data were analyzed using the statistical methods of univariate and multivariate analysis of covariance. Results: The significant difference in the post-test between the CBT and the control group (P&lt;0.001) in the variable of the combination of CBT and medication with the control group, there is a significant difference in the post-test (P&lt;0.001). The results of the post hoc test demonstrated that the effectiveness of the combination of CBT and medication was significantly higher than that of the CBT and the control group (P&lt;0.001(. Conclusion: As evidenced by the results of this study, combined CBT and medication in the short term effectively improved and reduced panic symptoms of patients with panic disorder.

Preventing Disordered Eating in Teenage Ballet Students: Evaluation of DancExcellent, a Combined CBT and Nutrition Education Intervention.

Disordered eating (DE) behaviors are relatively common among high-level dancers, especially in classical ballet. At the same time, interventions aimed at reducing DE behaviors in this population are scarce. An 8-week exploratory preventive intervention for DE behaviors was carried out in a high-level ballet school for 40 teenagers aged 12-15 years (77.5% female). Both risk factors (perfectionism) and potentially protective factors (self-esteem, self-compassion) for the development of DE behaviors were considered. The intervention was created specifically for this study and consisted of five cognitive behavior therapy (CBT) workshops and four nutrition workshops. Additional components included newsletters for pupils and educational sessions and social media interactions with staff and parents. The intervention comprised two phases (control and intervention periods), with students acting as their own controls. Standardized questionnaires were completed before and after both phases. Questionnaire results did not indicate any changes in reported perfectionism, self-esteem, or self-compassion, nor were symptoms of DE affected during either the control or intervention periods. The intervention did not yield any discernible impact. However, it was affected by the onset of the COVID-19 pandemic, which limits our ability to draw conclusions about intervention effectiveness. Evaluations with pupils offer several considerations for future improvements.

(111) Cognitive Behavioral Therapy and Mindfulness-Based Interventions to Address Sexual Functioning in Women with Cancer: A Systematic Review

Abstract Introduction Research suggests that over 60% of women with cancer report sexual functioning difficulties. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) have been used to treat sexual functioning difficulties in women with cancer. Objective The purpose of the current systematic review is to examine the state of the science with regard to the clinical efficacy of these interventions and the mechanisms by which they exert their effects. Methods Following PRISMA guidelines, we conducted a systematic review of randomized controlled trials (RCTs), published in English, testing CBT or MBI to improve sexual functioning in women diagnosed with cancer. Articles were identified using PubMed, Scopus, Cochrane, and PsycInfo using keywords and MeSH terms. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. Results Our search resulted in 1,056 articles, nine of which were eligible for inclusion in the review (6 studied CBT, 2 studied MBI, and 1 combined both CBT and MBI techniques). Sample sizes ranged from 21 to 304. One study included an active psychoeducational control group, while the rest were usual care, wait list control, or provided educational materials. Eight focused on breast cancer, and one on gynecologic cancer. All nine studies reported significant improvements in a measure of sexual functioning. Specifically, 8/9 studies found a difference in overall sexual functioning (e.g., Female Sexual Functioning Index (FSFI), PROMIS Sexual Function and Satisfaction Scale, etc.) relative to control. 4/9 studies tested specific domains of the FSFI (arousal, desire, lubrication, orgasm, satisfaction, and pain). Results varied such that relative to controls: 4/4 studies found significant improvement in arousal, 3/4 studies found significant improvement in desire, 3/4 studies found significant improvement in lubrication, 2/4 studies found significant improvement in orgasm, 2/4 studies found significant improvement in satisfaction, and 1/4 studies found significant improvement in pain. The one study that did find improvement in pain employed an MBI for women with breast cancer at any stage. No studies formally tested mechanisms of change. Conclusions Relatively few studies have assessed CBT and MBIs for sexual function in cancer, despite the large body of research on those interventions for cancer supportive care. However, the majority of the 9 CBT/MBI studies demonstrated efficacy for a range of sexual function outcomes. There was little support for improvement in FSFI pain frequency and severity, suggesting more research is needed to develop interventions to target these dimensions of pain. Additionally, given that both CBT and MBIs often work to change pain-related interference, bother, and distress, future studies should take a more in depth approach to pain assessment. Finally, future studies should aim to include active control groups (e.g., attention control) and test for mechanisms of change. Disclosure No

Comparting the effectiveness of combined cognitive-behavioral couple therapy and integrated behavioral couple therapy in improving family functioning in couples with extramarital affairs

Introduction: Extramarital affairs disrupt family functioning and have serious negative consequences for the family members. Aim: The present study aimed to compare the effectiveness of combined cognitive-behavioral couple therapy and integrated behavioral couple therapy in improving family functioning in couples with extramarital affairs. Method: In this quasi-experimental study, with a pretest-posttest control group design, the statistical population consisted of all couples, referred to the counseling centers of Mashhad, Iran in 2021. Thirty nine couples were selected using the convenience sampling method among people with extramarital relationships and randomly assigned to three groups: control group (13 couples), combined cognitive-behavioral couple therapy (13 couples), and integrative behavioral couple therapy (13 couples). The experimental and control groups completed the Family Functioning Scale by Epstein et al. (1983) before and after the interventions. In order to data analysis covariance analysis was performed in SPSS version 20. Results: Results indicated that the scores of all family functioning components significantly decreased in the intervention groups compared to the control group (P&lt;0.05). Combined cognitive-behavioral couple therapy was more effective in the dimensions of problem-solving and communication, while integrated behavioral couple therapy was more effective in emotional companionship (P&lt;0.05). Conclusion: According to the present results, both combined cognitive-behavioral therapy and integrated behavioral couple therapy had positive effects on improving family functioning. Therefore, depending on the conditions and type of marital problems, therapists are suggested to use a combination of these two methods to improve family functioning in couples with extramarital relationships.

Effectiveness of Neuropsychoeducation, Intrinsic Motivation, and Metaphoric Content Integrated with Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study.

Obsessive-compulsive disorder (OCD) is considered frequent, unnecessary thoughts that lead to repetitive actions to lessen the apprehension provoked by thoughts; this repetitive sequence may further influence trouble in one's daily activities. The remedial procedure for OCD includes medication (such as SSRIs, anxiolytics, and antidepressants) with psychotherapy [such as cognitive behavioral therapy (CBT) and exposure response prevention (ERP)]. Previous investigations indicated that regardless of the trend of adopting CBT and ERP to treat OCD, only around half of the patients experienced a full reduction in symptoms. The ERP component in CBT has been termed as a challenging treatment as it contains threatening anxiety-provoking indications, and it has been reflected that between 25-30% of OCD patients reject the ERP treatment, and the refusal and dropout rates for ERP in OCD are higher than other interventions. Thus, in the present investigation, researchers developed a proposed therapy that includes neuropsychoeducation, intrinsic motivation, and metaphoric content integrated with CBT in addition to regular pharmacological management to treat OCD patients and validated the efficacy of the proposed therapy through psychometric ratings (Y-BOCS). In this pilot study, 10 cases of OCD received a 12-week proposed therapy program. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), which was assessed at baseline and post-treatment. The present study's results revealed a significant decrease in scores on the obsessions and compulsions domains and overall total scores on Y-BOCS among OCD patients. The findings show that this proposed therapy, which includes neuropsychoeducation, intrinsic motivation, and metaphors contents integrated with CBT in combination with pharmacological management, is effective in the treatment of OCD. Therefore, the proposed therapy may be beneficial in the treatment of OCD. It has far-reaching implications in the areas of clinical, psychiatry, and mental health.

Journal Digest: CBT With Cardiac Rehab, PMDD Neurochemistry, and More

Journal Digest: CBT With Cardiac Rehab, PMDD Neurochemistry, and More

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review.

The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients' oral hygiene (OH) behavioral change were screened. 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal's self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.