Comprehensive Cognitive Behavioral Therapy Research Articles

Relationship between self-handicapping and academic buoyancy among final year students in secondary schools

The study examined the relationship between self-handicapping and academic buoyancy among final year students in secondary schools in Nsukka education zone of Enugu State of Nigeria. This study adopted the cross-sectional survey research design. Through multistage sampling technique, 120 final year students were selected. The questionnaires, such as Academic Buoyancy Scale (ABS) and Self-handicapping Scale were used to collect data. The internal validity of self-handicapping and academic buoyancy scales were ascertained using the Bartlett’s tests for Sphericity and it was reported to be highly significant (p< 0.05). The internal consistency of the questionnaires was ensured by using the Cronbach's alpha and a value of 0.844 and 0.867 was reported for the self-handicapping and academic buoyancy scales respectively. The quantitative data from questionnaires was analyzed using both descriptive and inferential statistics. The results showed that there was low negative insignificant relationship between the two variables (Beta=-.105; R=-.105; p < .253), indicating that high level self-handicapping is negatively associated with academic buoyancy among final year students in secondary schools. The study recommends that student counselors should develop structured and comprehensive cognitive behavioral therapy sessions to enhance the self-handicapping of final year students in secondary schools.

Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence.

BackgroundMental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces.ObjectiveThis study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores.MethodsWe conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics.ResultsThe initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19–related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers.ConclusionsOnly a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users’ data security.

Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial.

BackgroundPatients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety, which can result in reduced productivity and impaired health-related quality of life (HRQL). Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have potential to increase access to guided CBT at scale, but require careful study to assess their benefits and risks.ObjectiveThe aim of this study was to test the efficacy of a novel app, Zemedy, as a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS.MethodsThis was a crossover randomized controlled trial. Participants were recruited online and randomly allocated to either immediate treatment (n=62) or waitlist control (n=59) groups. The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet. Users interact with a chatbot that presents the information and encourages specific plans, homework, and exercises. The treatment was fully automated, with no therapist involvement or communication. At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life [IBS-QOL], Gastrointestinal Symptom Rating Scale [GSRS]) and secondary (Fear of Food Questionnaire [FFQ], Visceral Sensitivity Index [VSI], Gastrointestinal Cognition Questionnaire [GI-COG], Depression Anxiety Stress Scale [DASS], and Patient Health Questionnaire-9 [PHQ-9]) outcome measures. Waitlist controls were then offered the opportunity to crossover to treatment. All participants were assessed once more at 3 months posttreatment.ResultsBoth intention-to-treat and completer analyses at posttreatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months posttreatment. Scores on the GSRS, IBS-QoL, GI-COG, VSI, and FFQ all improved significantly more in the treatment group (F1,79=20.49, P<.001, Cohen d=1.01; F1,79=20.12, P<.001, d=1.25; F1,79=34.71, P<.001, d=1.47; F1,79=18.7, P<.001, d=1.07; and F1,79=12.13, P=.001, d=0.62, respectively). Depression improved significantly as measured by the PHQ-9 (F1,79=10.5, P=.002, d=1.07), and the DASS Depression (F1,79=6.03, P=.02, d=.83) and Stress (F1,79=4.47, P=.04, d=0.65) subscales in the completer analysis but not in the intention-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity.ConclusionsDespite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence-based treatment.Trial RegistrationClinicalTrials.gov NCT04170686; https://www.clinicaltrials.gov/ct2/show/NCT04170686

Judging the Book by Its Cover: What Comprises a Cognitive Behavioral Intervention Program for Perpetrators of Intimate Partner Violence?

Substantial literature has examined the effectiveness of intimate partner violence (IPV) interventions, and cognitive behavioral therapy (CBT) is noted as the second most common approach used in group interventions for partner violent men. However, as little research has examined how CBT principles are operationalized across program curricula, there is currently insufficient information from which to make recommendations for model CBT approaches in IPV interventions. In the current study, we review the literature to determine a set of core elements for comprehensive CBT interventions and use session-level curriculum data from 10 community-based programs to examine the presence of 14 components reflecting 4 CBT factors. Results suggest heterogeneity in the emphasis on CBT elements across programs, despite almost all managers listing CBT as a theoretical approach. Implications are discussed with a call for evaluators and meta-analysts to code for actual curriculum content as opposed to stated program labels.

Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention

ABSTRACTObjectives: Evaluation of long-term effects of an individualized short-term telephone intervention (seven sessions), based on a comprehensive cognitive behavioral therapy (CBT) approach. The study goal was to evaluate the maintenance of intervention effects regarding well-being, quality of life, and health at two years post treatment.Method: Participants (n = 105) were (partly) randomized after baseline assessment in a two-arm study (intervention, control group/usual care). Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale (CES-D). Caregivers’ physical complaints were measured with the Gießener Beschwerdebogen (GBB-24), and quality of life with the World Health Organization quality of life -BREF (WHOQOL-BREF). Emotional well-being and perceived health status were assessed using thermometer scaling. Data were analyzed by intention-to-treat analyses, including for those who terminated the intervention prematurely but still delivered data, using ANCOVAs.Results: Long-term intervention effects were found for emotional well-being (p = 0.019). For the subgroup of caregivers who were still caring at home at follow-up, the intervention led to an increased health status (p = 0.023), fewer bodily complaints (global measure p= 0.014, rheumatic pain p = 0.027, heart trouble p = 0.042), and a higher quality of life (overall p = 0.044 and subscale environment p = 0.030).Conclusion: The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being, health status, bodily complaints, and quality of life.

D-Cycloserine as an Augmentation Strategy With Cognitive-Behavioral Therapy for Social Anxiety Disorder

The authors examined whether D-cycloserine, a partial agonist at the glutamatergic N-methyl-d-aspartate receptor, augments and accelerates a full course of comprehensive cognitive-behavioral therapy (CBT) in adults with generalized social anxiety disorder. This was a multisite randomized placebo-controlled efficacy study with 169 medication-free adults with generalized social anxiety disorder, of whom 144 completed the 12-week treatment and 131 completed the three follow-up assessments. Patients were randomly assigned to receive 50 mg of D-cycloserine or placebo 1 hour before each of five exposure sessions that were part of a 12-session cognitive-behavioral group treatment. Response and remission status was determined at baseline, throughout treatment, at end of treatment, and at 1-, 3-, and 6-month follow-up assessments by assessors who were blind to treatment condition. D-Cycloserine-augmented and placebo-augmented CBT were associated with similar completion rates (87% and 82%), response rates (79.3% and 73.3%), and remission rates (34.5% and 24.4%) at the posttreatment assessment; response and remission rates were largely maintained at the follow-up assessments. Although D-cycloserine was associated with a 24%-33% faster rate of improvement in symptom severity and remission rates relative to placebo during the treatment phase, the groups did not differ in response and remission rates. D-Cycloserine did not augment a full course of comprehensive CBT for social anxiety disorder.

Cognitive Behavioral Therapy for Schizophrenia

Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention.

Social phobia among Al Qadissya medical student: prevalence, Academic performance and response to different treatments

Background: Social phobia (SP) is an inappropriate anxiety; experienced in social situations in which the person feels observed by others and could be criticized by them so he/she attempts to avoid such situations.Objectives: This study aims to identify the prevalence of (SP) among the medical students, as well as the socio- demographic characters will be investigated.The effect of (SP) on the students that is; their academic performance and the response to different type of treatments.Methods: Three hundred eighty students of both genders were selected randomly from Al-Qadissia Medical College in Al- Diwania city. These students were interviewed using the International Diagnostic Checklist of ICD.10 Social Phobia. The academic performance of subjects meeting a diagnosis of (SP) was studied. Their response to selective serotonin reuptake inhibitor (Fluoxetine) and comprehensive cognitive behavioral therapy were evaluated.Results: The result showed that the prevalence of (SP) among the medical student is (12.6 %). female students had higher rates than males (17.4%, 7.9%) respectively. positive family history of any psychiatric disorder was found more in students having (SP) . Eating or speaking in public appeared to be the most common feared situations avoided by the diagnosed students. (SP) appeared to have no effect on the students academic performance. Both treatment (Fluoxetine, Comprehensive Cognitive Behavioral Therapy) had good response (48%, 52.8%) respectively.Conclusions: Significant differences are found between the rate of SP and different sexes. SP appeared to have no effect on the students academic performance. Both active treatments had good response; in addition they have nearly equal result.

Premature Conclusions About Psychotherapy for Dysthymia

3on later-life depression reported that pharmacotherapy was less effective than psychotherapy for dysthymia. The strength of conclusions derived from meta-analyses stems directly from the quality and quantity of data available to address the research question. Unfortunately, the scientific literature on comparative trials of psychotherapy for dysthymia is not well enough established at this point to answer this question. Cuijpers and colleagues’ conclusion about psychotherapy for dysthymic patients was based on just 5 clinical trials of psychological interventions that differed in content, length, and treatment setting. Two trials 4,5 compared problem-solving therapy (PST) versus paroxetine for primary care patients with dysthymia. Psychotherapy in these trials consisted of just 4 to 6 sessions of PST delivered for 30 minutes each using a highly structured protocol that quite likely does not generalize well to psychotherapy delivered in the community. In the Williams et al 4 study, patients receiving PST showed an increasing rate of improvement over the course of the 11-week trial. Thus, the length or frequency of PST may not have been adequate to determine its full benefits. Furthermore, as most primary care patients report a treatment preference for psychotherapy over antidepressants, 6 medication trials in these settings may suffer from sample selection bias. Two other trials 7,8 reported that interpersonal psychotherapy (IPT) was significantly less effective than sertraline at posttreatment. The poorer outcomes for IPT may stem from the fact that IPT was originally designed for acute depressive illness and may require further adaptation for chronically depressed patients. 8 The last trial 9 included in the meta-analysis was the only one of cognitive-behavioral therapy (CBT) for dysthymia. Although the sample size was small and differences were not significant, retention in the CBT condition was 91% versus only 67% in the medication condition. If nonresponders are more likely than responders to drop out, the higher discontinuation rate in the medication arm may have made this condition appear more efficacious than it actually was. Previous reports suggest that psychotherapy for dysthymia may require a greater number of sessions than typically used in acute depression treatment and specific adaptation for chronic illness. 10 Adapted CBT appears effective: in another large trial, 11 the cognitive-behavioral analysis system of psychotherapy for chronic depression was found to be as effective as medication alone for patients with co-occurring major depression and dysthymia. A more appropriate interpretation of the evidence to date is that comprehensive CBT adapted for chronic depression is a promising treatment for dysthymia and that brief psychotherapy or IPT specifically may be less effective than antidepressants during acute treatment. Further research is needed to determine the efficacy of different types of psychotherapy versus antidepressants for dysthymia, especially for longer-term outcomes. Until such trials are conducted, meta-analyses of these data are premature, and definitive conclusions about the efficacy of “psychotherapy” for dysthymia appear unwarranted.

Recent Advances in the Treatment of Social Phobia: Introduction to the Special Issue

Social phobia (social anxiety disorder) is the most common anxiety disorder and the third most common mental disorder in the population. If untreated, the disorder typically follows a chronic, unremitting course, leading to substantial impairments in vocational and social functioning. Despite its high prevalence and degree of interference, social phobia has only recently become the focus of clinical research. Contemporary treatment protocols for social phobia include cognitive-behavioral group therapy (CBGT), exposure therapy, and social skills training. Of these interventions, CBGT is the most validated approach (e.g., Heimberg & Becker, 1991). The efficacy of CBGT has been shown in a number of earlier studies (Gelernter et al., 1991; Hofmann, Moscovitch, Kim, & Taylor, 2004; Heimberg, Salzman, Holt, & Blendell, 1993; Heimberg et al., 1998; Hofmann, 2004) and is currently considered to be the "gold standard" psychological treatment approach for social phobia. The treatment protocol was developed based on Beck and Emery's (1985) cognitive therapy for anxiety disorders. Although well-controlled clinical trials suggest that CBGT is statistically more effective than no treatment or a placebo-control condition, a significant subset of patients fail to achieve optimal benefit from this treatment. For example, in the most recent study on the efficacy of CBGT, 133 patients with generalized social phobia were randomly assigned to phenelzine (Nardil, an MAOI commonly used to treat social phobia), educational support group therapy (ESGT), a pill placebo, or CBGT (Heimberg et al., 1998). After 12 weeks, both the phenelzine (65%) and the CBGT conditions (58%) had higher proportions of responders than the pill placebo (33%) or ESGT (27%), which served as a psychotherapy placebo condition. The criterion for treatment response was based on a 7-point rating of change on the Social Phobic Disorders Severity Change Form (Liebowitz et al., 1992). Patients rated as markedly or moderately improved were classified as responders. Using a stricter improvement criterion, Mattick and Peters (1988) had found that only 38% of individuals with social phobia who completed a treatment very similar to Heimberg's protocol achieved "high end state functioning." More recent cognitive-behavioral therapy protocols include comprehensive cognitive-behavioral therapy (CCBT), Edna Foa and colleagues, and a cognitive therapy protocol developed by David Clark and colleagues. The treatment protocol by Foa was included as a treatment condition in a recently published clinical trial (Davidson et al., 2004). The treatment protocol is derived in part from CBGT (Heimberg & Becker, 1991) and combines exposure techniques, Beckian cognitive restructuring therapy, and social skills training. It is conducted in the form of 14 weekly group sessions. The treatment differs from CBGT primarily in that it includes specific social skills training. Furthermore, the role-plays are shorter and the treatment is 2 sessions longer than CBGT. The study by Davidson and associates (2004) suggests that CCBT shows efficacy rates that are similar to CBGT. Specifically, the study randomized 295 patients with generalized social phobia to one of 5 groups: (1) fluoxetine, (2) CCBT, (3) placebo, (4) CCBT combined with fluoxetine, or (5) CCBT combined with placebo. The results showed that all active treatments were superior to placebo, and the combined treatment was not superior to the other treatments. The response rates in the intention-to-treat sample (using the Clinical Global Impressions scale) were 50.9% (fluoxetine), 51.7% (CCBT), 54.2% (CCBT/fluoxeline), 50.8% (CCBT/placebo), and 31.7% (placebo). These findings are comparable to other clinical trials using conventional cognitive-behavioral therapy and suggest that many participants remain symptomatic after standard cognitive behavioral intervention. The authors, therefore, wondered whether changes in the delivery of cognitive-behavioral therapy would improve the results. …

Behavioral activation for anxiety disorders.

Abstract Accumulating data suggest that behavioral activation interventions may be an effective approach to treating clinical depression. Given the high comorbidity and construct overlap between anxiety and mood disorders, a conceptually and methodologically integrated intervention that addresses symptoms of both conditions is indicated. As a means to this end, two questions are addressed. First, is the construct overlap and functional similarities of anxiety and mood disorders substantial enough to warrant an integrated intervention? Second, are behavioral activation treatments conceptually compatible with traditional behavioral interventions for anxiety disorders? To address these questions, behavioral activation interventions and their underlying principles briefly are described, followed by a functional analytic framework in which depressive and anxiety based symptom patterns are viewed as conceptually parallel in the context of a general negative affective syndrome. Finally, practical applications of behavioral activation for anxiety are discussed, and a case illustration is presented to highlight how behavioral activation may be used to treat a patient with coexistent anxiety and depressive pathology. Key Words: Behavioral Activation, Anxiety, Depression, Emotional Disorders. ********** Behavioral activation may be defined as a therapeutic process that emphasizes structured attempts at engendering increases in overt behaviors that are likely to bring patients into contact with reinforcing environmental contingencies and produce corresponding improvements in thoughts, mood, and overall quality of life (Hopko, Lejuez, Ruggiero, & Eifert, 2003). Traditional behavior therapy for depressive disorders included an activation component whereby the objective was to increase access to pleasant events and positive reinforcers and simultaneously decrease the intensity and frequency of aversive events and consequences (Lewinsohn & Atwood, 1969; Lewinsohn & Graf, 1973; Zeiss, Lewinsohn, & Munoz, 1979). Empirical support for these interventions generally was favorable, with such approaches deemed as effective in attenuating depressive behaviors as cognitive and interpersonal skills training methods (Zeiss et al., 1979). Other researchers were less supportive of conventional behavior therapy, however, and it was demonstrated that mildly to moderately depressed college students did not become less depressed following participation in events and behaviors rated as highly pleasurable (Hammen & Glass, 1975). Given equivocal support for pure behavioral interventions, paradigmatic undercurrents associated with the cognitive revolution, and the contention that more multi-faceted interventions that included cognitive restructuring rendered superior outcomes to pure behavioral approaches (Blaney, 1981; McLean & Hakstian, 1979), these pioneering behavioral therapies for depression gradually were replaced by more integrative cognitive-behavioral therapies (Beck, Rush, Shaw, & Emery, 1979; Lewinsohn, Antonuccio, Breckenridge, & Teri, 1984; Lewinsohn, Munoz, Youngren, & Zeiss, 1986; Lewinsohn, Sullivan, & Grosscup, 1980; Rehm, 1977). Following the publication of a component analysis study indicating that comprehensive cognitive-behavioral therapy was no more effective than a behavioral intervention in treating depression, interest in pure behavioral approaches was revitalized (Gortner, Gollan, Dobson, & Jacobson, 1998; Jacobson et al., 1996). Subsequent to this study, substantial preliminary data have accumulated that support the utility of two new interventions: Behavioral Activation (BA; Addis & Martell, 2004; Martell, Addis, & Jacobson, 2001) and the Brief Behavioral Activation Treatment for Depression (BATD; Lejuez, Hopko, & Hopko, 2001, 2002). These approaches have been effectively used with depressed patients in a community mental health center (Lejuez, Hopko, LePage, Hopko, & McNeil, 2001), an inpatient psychiatric facility (Hopko, Lejuez, LePage, Hopko, & McNeil, 2003), as a supplemental intervention for patients with co-existent Axis I (Hopko, Hopko, & Lejuez, 2004; Jakupak et al. …

Cognitive-behavioral therapy in the pre-psychotic phase: An exploratory study

Although the efficacy of cognitive-behavioral therapy (CBT) in schizophrenia has been established for persistent psychotic symptoms, little information is available on the effects of CBT in the pre-psychotic phase. We developed a comprehensive CBT program for clients in the early initial prodromal state that showed good feasibility and promising treatment effects in an uncontrolled prospective study. The specificity of these effects needs to be explored in a controlled trial.

Study refusal and exclusion from a randomized treatment study of generalized social phobia

We examine treatment exclusion and refusal rates as well as reasons for non-participation in a sub-sample of phone interviews conducted to determine eligibility for a randomized study of treatments for generalized social phobia (GSP). This study compared group comprehensive cognitive behavioral therapy (CCBT) to fluoxetine (FLU), placebo (PLA), or their combination. Results suggest that the major exclusion for the study was due to comorbid depression, followed by having a different diagnosis as primary. Patient refusal to enter the study was also common, with the most frequently reported reason being not wanting to take medication. Notably, few people who refused stated an objection to entering CCBT or PLA. These results suggest that there is a need to develop and evaluate a treatment for social anxiety with comorbid depression and to systematically study reasons for reluctance to take medication among individuals with GSP.

Cognitive behavioral therapy for schizophrenia: an empirical review.

Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention.