Efficacy Of Cognitive-behavioral Intervention Research Articles

Practice makes perfect: The effect of cognitive behavioral interventions during IVF treatments on women's perceived stress, plasma cortisol and pregnancy rates

Background/objectives/introductionPerceived stress and stress reduction interventions have a mixed relationship with fecundity. The objective of this study is to attempt and disentangle these relationships by looking at practicing stress reduction techniques and fecundity and examining their relationship to a behavioral and a neuroendocrine measure of stress. Materials and methodsFifty nulliparous-infertile women participated in a randomized prospective pilot study with repeated measures to examine the efficacy of cognitive behavioral interventions (CBI) in reducing perceived stress and improving pregnancy rates. Stress measures were taken at T0 (before CBI), T2 (ovum pick up) and T3 (time of pregnancy test). ResultsWe found that women who reported low perceived stress at the beginning of treatment (T0) had a twofold increased chance of becoming pregnant (βhCG >7mIU/mL) compared to those who reported high-perceived stress, regardless of CBI. Women who received CBI reported reduced perceived stress at the time of the pregnancy test (T3). Women who engaged in daily practice of CBI had significantly higher pregnancy rates compared to those who did not practice. ConclusionsIt may be beneficial for women who have high perceived stress levels to learn and practice stress reduction techniques before beginning IVF treatment, and continue to practice daily during IVF treatment.

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

THE EFFECTS OF COGNITIVE BEHAVIORAL INTERVENTIONS ON REMOVING BARRIERS TO TREATMENT ADHERENCE IN HEMODIALYSIS PATIENTS

ABSTRACTObjective: Treatment adherence in chronic patients results in favorable treatment outcomes. Today, one of the main causes of mortality in hemodialysispatients is that of lack of treatment adherence. Identifying barriers to adherence to treatment is the first step to help these patients. The purpose ofthis study is to determine the effects of cognitive behavioral interventions on removing barriers to treatment adherence in hemodialysis patients.Methods: This clinical study was carried out in the hemodialysis wards of Imam Reza Hospital of Larand Vali-e-Asr Hospital of Lamerd. The sampleincluded 70 patients who were randomly assigned into two groups of intervention (n=35 for even days)and control (n=35 for odd days). Theintervention group received a six-step cognitive behavioral treatment. The level of barriers to treatment adherence was assessed using a self-reportquestionnaire in two stages (pre-intervention and post-intervention). Data were analyzed using SPSS via independent t-test.Results: Before the intervention, the two groups were not significantly different in terms of barriers to treatment adherence (p=0.68). However, afterthe treatment regimen, the barriers significantly decreased for the intervention group. There was a significant difference between the two groups interms of barriers to treatment adherence (p<0.001).Conclusion: Given the efficacy of cognitive behavioral intervention, it can be used to identify barriers to adherence and design individualizededucation programs based on barriers to adherence in hemodialysis patients to increase their treatment adherence.Keywords: Cognitive behavioral, Barriers to treatment adherence, Hemodialysis patients.

The efficacy of cognitive-behavioral intervention on anxiety and oral health-related quality of life in adult orthodontic patients

Objective To explore the influence of cognitive-behavioral intervention on the anxiety and oral health-related quality of life in adult orthodontic patients. Methods 152 adult orthodontic patients whose MDAS scores were greater than 11 were divided into the intervention group and the control group according Multistage Grouping Process. The former were treated with MBT appliance combined with cognitive-behavioral intervention, and the latter were treated with MBT appliance only. The State-Trait Anxiety Inventory(STAI) was adopted to evaluate anxiety in all patients during orthodontic treatment, and the UK oral health-related quality of life questionnaire(OHRQoL-UK) was adopted to evaluate the oral health-related quality of life in all patients before and after orthodontic treatment, respectively. Results 1.After 3 and 6 months cognitive-behavioral intervention, the scores of SAI in the intervention group(50.37±9.18, 35.65±8.92) were significantly reduced compared to the control group(56.62±10.52, 54.13±10.03) (P<0.01). After 6 months cognitive-behavioral intervention, the scores of TAI in the intervention group(47.92±6.82) were significantly reduced compared to the control group(51.52±7.41) (P<0.05). 2. After the orthodontic treatment, the scores of OHRQoL-UK in the intervention group(58.27±13.43) were significantly improved compared to the control group(51.99±11.69) (P<0.01). 3. The oral health-related quality of life after the orthodontic treatment were significantly related to post-treatment anxiety of adult orthodontic patients(r=-0.192~-0.459, P<0.05 ). Conclusion Cognitive-behavioral intervention can effectively reduce anxiety and improve the oral health-related life quality in the adult orthodontic patients. Key words: Cognitive-behavioral intervention; Adult orthodontic patients; Anxiety; Oral health-related quality of life

The Efficacy of Cognitive-behavioral Intervention in Pathological Gambling Treatment

Pathological gambling is a mental disorder characterized by a continuous or periodic loss of control over gambling, a preoccupation with gambling and with obtaining money which to gamble, irrational thinking and a continuation of the behavior despite adverse consequences. It can negatively influence the gambler's physical and mental health. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome.The purpose of the study is to evaluate a new model of cognitive-behavioral therapy for pathological gambling and to see if it is effective even after a three month follow-up.

Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain

BackgroundPsychological treatments have been successful in treating chronic low back pain (CLBP). However, the effect sizes are still modest and there is room for improvement. A way to progress is by enhancing treatment adherence and self-management using information and communication technologies (ICTs). Therefore, the objective of this study was to design a trial investigating the short- and long-term efficacy of cognitive behavioural treatment (CBT) for CLBP using or not ICTs. A secondary objective of this trial will be to evaluate the influence of relevant variables on treatment response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.MethodsA randomised controlled trial with 180 CLBP patients recruited from specialised care will be conducted. Participants will be randomly assigned to three conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to the three conditions will receive a conventional rehabilitation program (back school). The CBT group program will last six sessions. The CBT + ICT group will use the internet and SMS to practice the therapeutic strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be self-reported disability and pain intensity. Assessment will be carried out by blinded assessors in five moments: pre-treatment, post-treatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs, anxiety and depression in response to treatment in the primary outcomes will also be analysed.DiscussionThis study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP.Trial registrationClinicalTrials.gov, NCT01802671

Pluralistic counselling and HIV-positive clients: The importance of shared understanding

The emotional and psychological impact of a human immunodeficiency Virus (HIV)-positive diagnosis is widely recognised. Research into the role of counselling and psychotherapy with this client group has largely focused on studies of the efficacy of cognitive-behavioural interventions. The aim of this study was to explore the process of a flexible, pluralistic approach to counselling with HIV-positive clients. Three participants were recruited from a specialist HIV service. Rich case study data were collected, using therapy transcripts and end of therapy feedback sessions with clients, and analysed using grounded theory methodology. A common element for all three clients was the importance of creating a shared understanding within the therapeutic relationship. The findings of this study are discussed in terms of the further development of pluralistic practice with this client group.

Psychological advances in chronic pain: a concise selective review of research from 2010

It is difficult to hold an organized view of psychological research related to chronic pain. There are many different theories and variables and the volume of literature is vast. The purpose of this review is to highlight some key trends in this research in 2010. We conducted a search of the output of four prominent scientific journals in the field of chronic pain management. Five research topics from among those identified are summarized. Identified topics include psychological factors related to analgesic use, efficacy of cognitive behavioral treatments, and contextual approaches (including acceptance and mindfulness). The largest number of psychological studies categorized for this review focused on psychological factors in relation to opioid use. These studies include ones to identify risk factors for aberrant drug behavior. This result seems to reflect that the dominant approach to chronic pain remains a pharmacological one. At the same time treatment from within a broadly cognitive behavioral approach seems to have reached a level of relative maturity with questions frequently being addressed with meta-analysis. Otherwise, there are developing and promising trends, such as in new treatment models and uses of information technology.

Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania

Not all hair pullers improve acutely with cognitive-behavioral treatment (CBT) and few maintain their gains over time. We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM-IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)-enhanced CBT consisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self-report measures of hair pulling severity and emotion regulation. Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. This study offers preliminary evidence for the efficacy of DBT-enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment.

Carer reports of the efficacy of cognitive behavioral interventions for anger

Anger resulting in Aggression can be a significant problem for some people with Intellectual Disabilities. Carers were asked to complete a provocation inventory and an attribution scale before and after a group cognitive behavioral intervention aimed for anger and at similar points in time for a waiting list control. When compared using an analysis of variance results suggest that staff perceive a significant reduction in aggressive responses for participants who took part in the intervention. A regression analysis of factors that may influence the amount of change observed suggests that greater change was achieved if participants were accompanied by carers and had been attributed by carers as having an emotional cause for their behavior.

Learning to change a way of being: An interpretative phenomenological perspective on cognitive therapy for social phobia

Social phobia (SP) is a common and disabling condition for which cognitive-behavioral treatments (CBT) have demonstrated efficacy. However, there remains room for improvement. Hence, further exploration of the means by which CBT helps patients with SP is warranted. Studies examining patients’ perspectives on which aspects of treatment were most or least helpful may augment other established methodologies for identifying the more or less effective components and thus help to increase the efficacy and cost-effectiveness of CBT for SP. The current study used interpretive phenomenological analysis to analyze the transcripts of interviews with eight patients who had completed cognitive therapy (CT) for SP. Four related themes were identified: (i) social phobia as a way of being; (ii) learning to challenge social phobia as a way of being: transformative mechanisms of therapy; (iii) challenges faced in the pursuit of change; (iv) a whole new world: new ways of being. This analysis of patients’ experiences of CT for SP confirmed that the factors hypothesized to be important in maintaining SP in cognitive-behavioral models of the disorder are evident in patients’ descriptions of the processes of change in CT for SP (e.g., reducing internal focus of attention and reducing safety behaviors and avoidance). Helpful components of CT for SP were identified as areas where the protocol could be enhanced. Recommendations for the way in which CT for SP is implemented are made.

Is mindfulness‐based therapy an effective intervention for obsessive–intrusive thoughts: a case series

Despite the efficacy of cognitive-behavioural interventions in improving the experience of obsessions and compulsions, some people do not benefit from this approach. The present research uses a case series design to establish whether mindfulness-based therapy could benefit those experiencing obsessive-intrusive thoughts by targeting thought-action fusion and thought suppression. Three participants received a relaxation control intervention followed by a six-session mindfulness-based intervention which emphasized daily practice. Following therapy all participants demonstrated reductions in Yale-Brown Obsessive-Compulsive Scale scores to below clinical levels, with two participants maintaining this at follow-up. Qualitative analysis of post-therapy feedback suggested that mindfulness skills such as observation, awareness and acceptance were seen as helpful in managing thought-action fusion and suppression. Despite being limited by small participant numbers, these results suggest that mindfulness may be beneficial to some people experiencing intrusive unwanted thoughts and that further research could establish the possible efficacy of this approach in larger samples.

Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects

To evaluate the efficacy of adding cognitive behavioural treatment (CBT) to either a low-carbohydrate (LC) diet or a low-fat (LF) diet in the treatment of weight loss of obese women, a randomised clinical intervention study was performed. A total of 105 healthy non-pregnant obese women (average age and BMI of 45.4 (sd 10.4) years and 36 (sd 4.3) kg/m2) were randomly allocated to the CBT or control (C) groups; within each group, women were randomly selected to receive either the LC or LF diet during 6 months. The pre-planned primary trial end-point was the weight loss. Differences between the groups were assessed using one-way ANOVA. There were three women (2.8 %) who dropped out, all of them in the CBT group. No differences in the anthropometric and laboratory characteristics at baseline were noted between women in the CBT (n 52) and control groups (n 50). Intention-to-treat analysis showed that weight loss in the CBT-LC (90 (sd 12.3) to 82.1 (sd 12.1) kg) and C-LC (89.4 (sd 10.0) to 85.8 (sd 9.8) kg) groups reached 8.7 and 4.0 %, respectively (P < 0.0001), and in the CBT-LF (87.9 (sd 11.4) to 79.4 (sd 11.8) kg) and C-LF (88.8 (sd 14.5) to 85.3 (sd 14.3) kg) groups it was 9.7 and 3.9 %, respectively (P < 0.05). Weight loss was higher in the CBT-LF group than in the CBT-LC groups (P = 0.049). The present results showed that adding CBT to either the LF or LC diet produced significantly greater short-term weight loss in obese women compared with diet alone. These finding support the efficacy of CBT in breaking previous dietary patterns and in developing healthier attitudes that reinforce a healthier lifestyle.

Combining Acceptance and Commitment Therapy and Cognitive Behavioral Therapy for the Treatment of Chronic Pain in Older Adults

The article discusses a combination of cognitive-behavioral therapy (CBT) for chronic pain and acceptance and commitment therapy (ACT) that was applied to an older adult. Findings reveal that a brief intervention of 8 weeks was effective in producing a clinically significant change in pain experience, as well as an increase in sleep quality/sleep maintenance and acceptance of pain. It is suggested that a central ACT component such as mindfulness skills as well as the focus on values may contribute to efficacy of cognitive behavioral treatment for chronic pain.

Cognitive-Behavior Therapy for Low Self-Esteem: A Case Example

Low self-esteem is a common, disabling, and distressing problem that has been shown to be involved in the etiology and maintenance of a range of Axis I disorders. Hence, it is a priority to develop effective treatments for low self-esteem. A cognitive-behavioral conceptualization of low self-esteem has been proposed and a cognitive-behavioral treatment (CBT) program described (Fennell, 1997, 1999). As yet there has been no systematic evaluation of this treatment with routine clinical populations. The current case report describes the assessment, formulation, and treatment of a patient with low self-esteem, depression, and anxiety symptoms. At the end of treatment (12 sessions over 6 months), and at 1-year follow-up, the treatment showed large effect sizes on measures of depression, anxiety, and self-esteem. The patient no longer met diagnostic criteria for any psychiatric disorder, and showed reliable and clinically significant change on all measures. As far as we are aware, there are no other published case studies of CBT for low self-esteem that report pre- and posttreatment evaluations, or follow-up data. Hence, this case provides an initial contribution to the evidence base for the efficacy of CBT for low self-esteem. However, further research is needed to confirm the efficacy of CBT for low self-esteem and to compare its efficacy and effectiveness to alternative treatments, including diagnosis-specific CBT protocols.

Cognitive behavior therapy in the treatment of panic disorder

Background:Comprehensive cognitive behavior therapies have been proved to be more effective than behavioral interventions. However, the efficacy of CBT is not studied in the Indian context and also, the amount of change brought about by CBT is not known. Aims: This study aims to examine the efficacy of cognitive behavioral intervention (CBI) in the treatment of panic disorder. Our specific objectives were to assess the effectiveness of CBI in reducing symptom severity as well as cognitions related to panic and panic-related behaviors. Design: The study adopted a two-group comparison with pre- and postassessments design.Materials and Methods:The sample consisted of 30 patients sequentially allotted to the CBI (n = 15) and behavioral intervention (BI, n = 15) groups. Assessment was done using a semistructured interview schedule, panic disorder severity scale, Texas panic attack record form, Anxiety Sensitivity Index, Agoraphobic cognitions questionnaire, Behavioral avoidance checklist, and Panic appraisal inventory. The CBI group was provided with comprehensive cognitive behavior therapy and the BI group with psycho-education and applied relaxation.Results:CBI was found to be superior to BI in the reduction of panic symptoms, behavioral avoidance, safety behaviors, and cognitions. A large percentage of the CBI group patients met the criteria for clinically significant change with a large magnitude of change.Conclusion:Multicomponent CBI is superior to BI in terms of the amount of change it brings about with respect to panic symptoms, avoidance, safety behaviors, and cognitions.

A Meta-Analytic Review of Adult Cognitive-Behavioral Treatment Outcome Across the Anxiety Disorders

The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.

Managing Congestive Heart Failure Patient Factors in the Device Era

Device-based care such as implantable cardioverter-defibrillators and cardiac resynchronization therapy extends congestive heart failure (CHF) care into a new era. The purpose of this paper is 2-fold: (1) to review the development of device-based CHF management and the implications from a medical and patient management perspective, and (2) to provide assessment and treatment approaches on how to clinically manage patient outcomes optimally. Quality of life, depression, and anxiety are targeted as concerns for patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators. Brief clinic-based interview questions and formal assessment tools are reviewed. Furthermore, a cognitive-behavioral paradigm using the "Appropriate Education, Behavioral Support, and Cognitive Coping" (ABC) model is proposed to aid health care professionals in addressing patients' device-specific concerns. Available research suggests the need for future studies assessing the efficacy of cognitive-behavioral treatments in patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators.

Efficacy and utility of computer-assisted cognitive behavioural therapy for anxiety disorders

Despite the efficacy of cognitive behavioural treatment for anxiety disorders, more than 70% of individuals with anxiety disorders go untreated every year. This is partially due to obstacles to treatment including limited access to mental health services for rural residents, the expense of treatment and the inconvenience of attending weekly therapy sessions. Computer-assisted therapy may be a means of providing cost-effective psychological services to individuals experiencing barriers to treatment. To date, computers have been applied to therapy for anxiety disorder using various formats including Internet treatment, virtual reality treatment, videoconferencing and more standard computer-assisted or computer-guided packages that are implemented on palmtop computers or desktop computers. The current paper reviews trials evaluating the efficacy of these technology-based treatments for anxiety disorders and discusses implications for future research.

Cognitive behavior therapy for menopausal hot flashes: Two case reports

Two case reports of women treated with an individual cognitive behavioral treatment (CBT) for menopausal hot flashes are presented. Both women reported substantial improvements in the number of hot flashes experienced as well as in their quality of life as measured by the Menopause Quality of Life Scale (MENQOL), the Hamilton Rating Scale for Depression (HAM-D), and the Hamilton Rating Scale for Anxiety (HAM-A). Improvements in hot flashes and quality of life were maintained 6 months after treatment ended. It is hypothesized that CBT reduces hot flashes by reducing central sympathetic activation, perceptions of stress, and self-critical thoughts. The long-term efficacy of CBT for hot flashes should be examined in large controlled clinical trials.