Course Of CBT Research Articles

Probing Neurophysiological Processes Related to Self-Referential Processing to Predict Improvement for Depressed Adolescents Receiving Cognitive Behavioral Therapy

BACKGROUNDCognitive Behavior Therapy (CBT) is a gold standard approach for treating major depressive disorder (MDD) among adolescents. However, nearly half of adolescents receiving CBT do not improve. In order to personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. Toward addressing this aim, this study investigated neurophysiological processes related to self-referential processing that predicted CBT response among depressed, female adolescents. METHODSAt baseline, female adolescents ages 13-18-years-old (N=80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalogram (EEG) data were recorded. Baseline EEG data were utilized to identify oscillatory differences between healthy (HC, n=38) and depressed (MDD, n=42) adolescents. Following the baseline assessment, depressed youth received up to 12-weeks of CBT. Baseline differences in EEG oscillations between healthy and depressed youth were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis (ERSP) probed theta and alpha event-related synchronization/desynchronization (ERS/ERD) response to negative and positive words. RESULTSBaseline analyses showed that, relative to the healthy adolescents, depressed youth exhibited higher levels of frontal theta ERS and a greater posterior alpha ERD. Multilevel modeling identified primary neural pre-treatment predictors of treatment response: greater theta ERS in the right prefrontal cortex (PFC) after the onset of negative words and lower alpha ERD in both the right PFC and posterior cingulate cortex (PCC). ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses. CONCLUSIONSConsistent with prior research, results highlighted that relative to healthy youth, depressed adolescents are characterized by prominent theta synchronization and alpha desynchronization over PFC and PCC, respectively. Cluster-based ERSP analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the CBT course. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.

Obesity and depression: the course of depressive disorders depending on the body mass index, the role of physical activity and cognitive-behavioral therapy for their correction

Purpose: to establish the relationship between the severity of the course of depressive disorders and body mass index in patients with non-alcoholic fatty liver disease on the background of abdominal obesity, the role of physical activity and cognitive-behavioral therapy for their correction.
 Materials and methods. 272 people (136 women and 136 men) were examined. The patients were divided into two clinical groups: 1st group – 90 people with non-alcoholic fatty liver disease and overweight (average body mass index =27.5±1.31 kg/m2), who followed only dietary recommendations and a complex physical exercises; 2nd group - 92 people with non-alcoholic fatty liver disease and abdominal obesity of the 1st degree (average body mass index =31.74±1.03 kg/m2), who additional underwent a 6-month course of cognitive-behavioral therapy. The control group consisted of 90 people with normal body weight (average body mass index =22.41±1.43 kg/m2). The Beck scale was used to assess the presence of depression.
 Results. Depression in patients of the 1st and 2nd groups was registered in 2.3 times (x2=28.105, p=4.762e-10<0.05) and 2.6 times more often (x2=12.019, p=0.007<0.05), than in the control group. Mild depressive disorders in 1.9 times (D=0.304, p=0.032<0.005) more often recorded in young women (up to 45 years old). Patients of the 2nd group, who additionally received a course of CBT, recorded a decrease in the number of depressive disorders of moderate severity by 3.33 times (D=0.1837, p=0.0133), compared to the patients of the 1st group.
 Conclusions. Gender-age characteristics and weight affect the severity of depressive disorders in obese patients. To reduce the number of depressive disorders and optimize body mass index, it is mandatory to use combined treatment in the form of aerobic exercises and cognitive-behavioral training.

THE EFFECT OF COGNITIVE-BEHAVIORAL THERAPY ON INDICATORS OF LIPID AND CARBOHYDRATE METABOLISM IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE ON THE BACKGROUND OF ABDOMINAL OBESITY.

The aim: Analyse the impact and effectiveness of cognitive-behavioural therapy in patients with NAFLD on the background of AO on indicators of lipid and carbohydrate metabolism. Materials and methods: 85 patients with NAFLD and obesity of the 1st degree (42 women, 43 men) were examined. All patients were divided into two clinical groups: 1st group (research) - 48 people, who underwent a course of CBT for 6 months; the control group - 37 people, who followed only diet therapy, recommended physical activity, without involvement in CBT. The general clinical examination of patients consisted of the measurement of anthropometric and physiological indicators, the study of lipid and carbohydrate profile indicators. Results: After a 6-month course of CBT, a decrease in the atherogenic coefficient (AC) was recorded in the patients of the 1st group in 2.29 times (p=0.037<0.05), the number of patients with hypertension of the 1st degree decreased in 1.8 times (p=0.0047<0.05) in comparison with the initial indicators (on the 1st day) and amount of patients with normal blood pressure of the 1st group increased by 2.4 times (p=0.0115<0.05) compared to the control group. Conclusions: The course of CBT should be an integral component in the program for the management of obese patients to optimize not only the psycho-emo¬tional condition, but also to correct lipid and carbohydrate metabolism indicators, reduce the risk of developing cardiovascular and neurological complications.

Assessing in-session rumination and its effects on CBT for depression

The study evaluated if rumination of patients during therapy (i.e., in-session rumination) relates to whether or not they do less well in CBT treatment. We developed a reliably assessed in-session rumination observational measure and evaluated its relationship to depression over the course of CBT. Rated sessions came from 63 treatment-naïve patients with major depressive disorder who participated in CBT in the PReDICT study (Dunlop et al., 2017). In-session rumination was operationalized as repetitive, negative, and passive talking about depressive topics. Trained undergraduates rated the intensity and duration of in-session rumination occurring during 57 initial therapy sessions (i.e., session one) and 45 sessions in the middle of treatment (i.e., session eight). The observational ratings were sufficiently reliable (all ICCs > 0.69). Mixed model results indicated that greater intensity of in-session rumination during the initial treatment session predicted higher levels of subsequent clinician-rated depressive symptoms (p < .023). Regression results indicated that greater intensity and duration of in-session rumination at session 8 significantly predicted higher clinician-rated symptoms at end of treatment (p's < 0.02). In-session rumination intensity and duration were not, however, related to subsequent self-reported depressive symptoms. The results support efforts to identify which patients might benefit from rumination-specific interventions.

Beyond burnout: medicine must find a way to navigate the new terrains of need.

Medics learn that signalling stress, that is, an inability to cope, is failure. Where does this leave us when faced with untenable circumstances? Suffering from severe burnout before COVID-19, I fell into a void, hopeless, guilt ridden, and angry. The term ‘resilience’ fanned the simmering embers of my self-perceived inadequacy. Clinical work became unendurable as anxiety spiralled. I felt overwhelmingly alone, and yet I know that cannot be. To learn from each other, we must talk honestly about challenging experiences, and map out how we found a way through. When I eventually sought medical help, long postponed by disillusionment and self-blame, my expectation of hopelessness was confirmed. I was advised to relax. My body had no physical memory of relaxation, my mind no blueprints. I was offered a short course of CBT and encouraged to take medication. CBT is …

Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)

ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA...

Internet-based cognitive behavioural therapy for treating symptoms of obsessive compulsive disorder in routine care

A growing evidence base supports the efficacy of Internet-based cognitive behavior therapy (iCBT) for obsessive compulsive disorder (OCD). However, very few studies have evaluated the effectiveness of iCBT for OCD in routine care settings which service the bulk of a population's health needs. This study evaluated the treatment outcomes of 309 adults who enrolled in an online CBT course for their symptoms of OCD. Most patients (62.8%) enrolled in a self-help or unguided iCBT course, and the remainder were supported by a routine care, community clinician. The entire iCBT course was completed by 39.3% of participants, with 61.2% completing the majority of iCBT lessons. Higher baseline depression symptom severity predicted poorer adherence, while the presence of a supervising clinician was associated with greater adherence. Medium effect size reductions in OCD symptom severity (g = 0.61), depression symptom severity (g = 0.56), and psychological distress (g = 0.69) were observed from pre-to post-treatment. Pre-treatment OCD and depression symptom severity predicted post-treatment OCD symptom severity. Current results support the use of iCBT for OCD in routine care settings, and as health care resources are finite, iCBT for OCD may serve as a useful, low-intensity, and scalable addition to the existing healthcare infrastructure.

Interdisciplinary rehabilitation of a patient with right brain injury and recurrent depression

IntroductionRehabilitaton of concurrent psychiatric disorder and brain injury is a major challenge. E. underwent neurosurgery for right fronto-parietal astrocytoma. Before illness he was managing automatization of big companies, but was fired after the operation. E. felt into severe depression and anxiety with catastrofization of his illness, suicidal ideation. He resisted multiple prescriptions for SSRI, admitting a sect pretending to “treat” oncology by “psychological” methods. Half a year after operation he attended our center.Objectives and aimTo help E. return to paid employment.MethodsE. was evaluated by neurologists, psychiatrist, neuropsychologists. Current depressive episode appeared to be the second one with underlying schizoid and perfectionist characteristics. He had moderate text comprehension difficulties, confabulations, slight executive dysfunction. Neuropsychologist educated patient on his difficulties and developed compensatory strategies – an alternative to catastrofisation. After psychoeducational session E. agreed to receive fluvoxamine. However, he deformed the received information due to brain injury, so psychotherapy had only minor effects. Infra-low frequency neurofeedback at T4P4 and T4Fp2 sites was started to promote restoration of right brain functions. E. gradually did better, and 3 months later was able to complete CBT course along with relaxation training.ResultsImprovements in emotional status along with ability to cope with cognitive difficulties allowed E. to return to a job similar to the previous. Six month after the start of treatment medications are tapered off, E. has no signs of depression and only slight anxiety.ConclusionsInterdisciplinary holistic rehabilitation may be effective in concurrent psychiatric disorder and brain injury.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Becoming a more mindful practitioner: the effectiveness of a Mindfulness-based CBT course in meeting training needs for clinical staff in adult mental health Urgent Care services

AbstractThis paper describes a service development which arose from an adult mental health inpatient ward team who wanted to be able to work more effectively to help patients who had major difficulties with emotion regulation. It was proposed that enhancing mindfulness through a Mindfulness-based Cognitive Therapy (MBCT) programme within the core staff team would enhance therapeutic milieu and therefore general outcomes associated with engagement and recovery. The training delivered was an adapted 8-week MBCT programme. A double baseline design was used with measures taken at 1 month before training and immediately before the programme started. Standardized and non-standardized measures were administered at pre-, mid-, post-, and 1-month follow-up points. Workshops and interviews supported the investigation of staff experience and impact of MBCT training. Participants in the training were nursing and occupational therapy staff. The trainer was the first author (C.M.), who is a cognitive behavioural therapist and mindfulness teacher at Newcastle Cognitive and Behavioural Therapies Centre, specializing in emotion regulation and stabilization. Results showed that staff reported a significant increase in mindfulness which had a positive impact upon their wellbeing and perceived ability to respond skilfully to challenging situations at work and at home. Gains were mostly in the first half of training but were maintained to the end and to follow-up. This adapted mindfulness training course appeared to be effective in meeting the need for a group of clinical staff to develop mindfulness. The potential impact upon patient engagement has been identified but further research into this area is indicated.

CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression

Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.

Motivation and Social Relations in School Following a CBT Course for Adolescents With Depressive Symptoms: An Effectiveness Study

The present study aimed to investigate changes in school functioning, including motivation, intentions to quit school and social relations in school, following an early group based CBT intervention implemented for depressed adolescents. The “Adolescent Coping with Depression Course” (ACDC) is such an early group intervention. The primary target group in the present study was 16–20 years old adolescents with subclinical or mild-to-moderate depression. The research design implemented was a pre-post design. Results indicated a strong reduction in depressive symptoms among study participants according to Cohen's criteria, a small to medium improvement in perceived social relations in school, but no change in school motivation and intentions to quit school.

The role of brief CBT in the treatment of anxiety and depression for young adults at a UK university: a pilot prospective audit study

AbstractCognitive behaviour therapy (CBT) has rarely been offered to students seeking professional psychological help at universities in the UK. Here, we aimed to investigate whether a brief course of CBT would improve anxious and depressive symptoms. Forty-eight student patients received a brief course of CBT at a university National Health Service, Student Health Centre in England. Patients completed weekly self-report measures of anxiety and depression at the commencement of each CBT session. Student patients receiving CBT showed significant decreases in anxiety and depression. These effects remained after controlling for a range of potential covariates (e.g. primary problem, total time in treatment, therapist qualifications). Findings suggest CBT is effective in reducing anxiety and depressive symptoms in a ‘real-world’ university clinic.

Standardized treatment manuals: Does adherence matter?

Objective: The importance and utility of treatment manuals is controversial, especially with respect to how rigidly they should be implemented. This study examined therapist adherence across the course of CBT and how several patient characteristics influence the association between adherence and outcome. Methods: Patients diagnosed with panic disorder with agoraphobia (n = 220, 72,7 % female, average age of 34.9 years) were treated in one of two CBT variations: with (T+) and without (T-) explicit therapist-guided exposure. Results: Although adherence did not crucially influence outcome at a global level, results suggest that patients’ intent to continue treatment interacted with adherence to predict outcome. Importantly, these effects differed across timing, treatment conditions, and levels of global clinical functioning. Conclusion: Our findings showed the benefits of individualizing the implementation of the treatment manual.

Paediatric Obsessive-Compulsive Disorder and Depressive Symptoms: Clinical Correlates and CBT Treatment Outcomes

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 – 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 – 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms.Electronic supplementary materialThe online version of this article (doi:10.1007/s10802-014-9943-0) contains supplementary material, which is available to authorized users.

Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging

Cognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers. In order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images. As expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r 2 = 0.67, p < 0.001). Haemodynamic response to the task was located in the anterior cingulate and orbitofrontal cortices and was stronger during exposure to personalized obsession-inducing images. In addition, both the anxiety ratings and the haemodynamic response to the obsession-inducing images in the anterior cingulate and the left but not the right orbitofrontal clusters decreased with symptom improvement. Interestingly, haemodynamic activity continued to decrease after stabilization of clinical symptoms. Using an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.

This is CBT (I’m still waiting for magic therapy to put things right)

The following report explains how attending a CBT course enabled people to experience solidarity and the alleviation of distress and isolation, although it did not lead to significant changes in scores of well-being.

Attentional Bias in Adolescents with Panic Disorder: Changes over an 8-day Intensive Treatment Program

The present study evaluated attentional bias in adolescents diagnosed with panic disorder. Although a large body of research exists in the area of attentional bias in adults, this feature of panic disorder is not well understood in adolescents. Twenty-five adolescents, aged 12-17, with a panic disorder diagnosis were included in the study. An emotional Stroop task was utilized to assess whether: (1) adolescents with panic disorder exhibit an attentional bias to panic-relevant stimuli; (2) this bias diminishes after completing a course of CBT; and (3) a specific attentional bias towards disorder-relevant stimuli exists. An attentional bias to panic-relevant stimuli was found at pre-treatment but was no longer present following an intensive CBT intervention. Contrary to some findings in the adult literature, no significant differences were found between panic-relevant versus other threatening stimuli. These results suggest that adolescents with panic disorder, similar to adults, do exhibit an attentional bias towards panic-relevant stimuli, and treatment seems to normalize this cognitive process.

Randomized Controlled Trial of Clozapine and CBT for First-Episode Psychosis with Enduring Positive Symptoms: A Pilot Study.

Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria (n = 48) were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52%) of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time.

Post-Event Processing in Social Anxiety Disorder: Idiosyncratic Priming in the Course of CBT

Post-event processing (PEP) is the cognitive rumination that follows social events for patients with social anxiety. The PEP period was examined in relation to two anxiety provoking tasks in cognitive behavioural group therapy for social anxiety disorder: (1) Attending the first group therapy session (n = 75), and (2) An individually tailored in-session exposure task (n = 50). An assessment of PEP was conducted the week following each task as an indication of the extent of rumination over that event during the subsequent week. Significant PEP occurred after both events, and greater baseline social anxiety predicted greater levels of PEP related to both tasks. Anxiety ratings, as conceptualized by SUDS, were positively correlated with the severity of subsequent PEP related to the exposure task. There was also support for the stability of PEP across the two tasks and for the specificity of the content of PEP as rumination related to social failure, rather than rumination related to depressive symptoms. This study provides additional empirical support for the role of PEP in the cognitive model of social anxiety disorder.

Computer supported and controlled learning with the aid of internet technologies

In this paper, the role and some possibilities of computer-based teaching, CBT, in embedded software education are presented and analysed. CBT utilising internet and other telematic facilities is the most relevant form of technology in Northern Finland and the Oulu area, where distances are long, but the telecommunication infrastructure is well developed. The scale and complexity of embedded systems has meant that the focus in the teaching of their development methods should also be changed. The teaching of embedded software engineering is at present fragmented; borders between various subjects should be lowered by means of large projects applying teamwork and utilising cooperative learning through telematics. In teaching, the best result is achieved by the &quot;learning-by-doing&quot; method. The representative demonstration course of the Raahe Laboratory of the University of Oulu, RATOL, is based on the earlier CBT course versions produced, and on the IDEALS methodology. The evaluation of the course indicates no critical limitations regarding learning that are independent of time and place, or the amount or type of courseware and students. The evaluation indicates excellent learning efficiency.