Form Of Cognitive Behavioral Therapy Research Articles

A randomised controlled study of face-to-face versus internet-based teaching of CBT skills for healthcare professionals in Sudan.

A need has been identified for affordable and scalable methods for disseminating cognitive-behavioural therapy (CBT) to countries with barriers to traditional methods of teaching. This study evaluated the effectiveness of internet-based teaching versus face-to-face teaching in improving the CBT theory, assessment, and formulation skills of a group of mental health practitioners in Khartoum, Sudan. Participants (N = 36) were randomly assigned to (a) a 3 h live lecture, or (b) a computer-based multimedia recorded lecture of the same duration. Participants were rated before and after training for their ability to assess a simulated patient and construct a CBT formulation of the presenting difficulties. Participants also rated the feasibility and acceptability of the training they had received. Both teaching methods resulted in significant improvements in participants' abilities to carry out the assessment and formulation tasks. However, participants allocated to computer-based teaching performed better than those allocated to live teaching (between-groups effect size d = 0.26-0.74). Both teaching methods were rated as highly acceptable and feasible by participants. Computer-based teaching could offer a cheaper and effective method to help disseminate CBT to countries with limited resources and expertise, replacing and supplementing other costly traditional methods such as face-to-face teaching.

Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis.

Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Five databases (PsycINFO, Web of Science, PubMed, Embase, Medline) were searched for randomised controlled trials of generic CBT for child and/or adolescent anxiety. Ten trials met criteria for inclusion in the systematic review, six of which presented sufficient data for inclusion in the meta-analysis. Sixty-seven did not report data on recovery rates relative to primary diagnosis. While most individual studies included in the systematic review were not sufficiently powered to detect a difference in recovery rates between diagnoses, there was a pattern of lower recovery rates for youth with primary SoAD. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). Recovery from primary SoAD is significantly less likely than recovery from any other primary anxiety disorder following generic CBT in youth. This suggests a need for research to enhance the efficacy of CBT for youth SoAD.

The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

Introduction: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. Objective: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. Methods: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. Results: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, –0.64; 95% confidence interval, CI, –1.02 to –0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27–0.98). There was no allocation by treatment type interaction (SMD –0.57; 95% CI –1.31 to 0.17). Conclusions: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.

The therapeutic effect of habit reversal training for Tourette syndrome: a meta-analysis of randomized control trials

ABSTRACT Objectives Comprehensive behavioral intervention for tics (CBIT) and habit reversal training (HRT) are forms of cognitive behavioral therapy that can effectively reduce tic symptoms in patients with tic disorders, but their efficacies and potential moderators were needed to be clarified. Methods In the present study, a meta-analysis was performed to identify the efficacy of HRT and CBIT for individuals with tic disorders. The standard mean difference (SMD) was calculated to assess the effect size of the efficacy of HRT. Subgroup analysis and meta-regression analysis were performed to identify the potential heterogeneity of the SMD of HRT. Results A total of 10 randomized controlled trials (RCTs) including 586 patients with tic disorders were identified. The pooled SMD was −0.43 (95% CI: −0.71, −0.16). The effect size of HRT was moderated by different ‘Comparison Conditions’ (it means the different behavioral therapies in the control group). Conclusion Overall, the authors found a small to medium effect size for the efficacy of HRT. As the most promising behavioral therapy, they conclude that HRT is effective for the treatment of patients with tic disorders. Further high-quality RCTs are needed to determine the efficacy of HRT compared with that of medications.

Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial.

It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those with personality disorder adhered more closely to CBT-HA, and after 8years, they had a significantly better outcome than those with personality difficulty and no personality disorder (p<0.002). Similar results were found in those scoring high on the Dependent Personality Questionnaire. All these differences increased over the follow-up period. Costs were similar in all groups but were somewhat higher in the CBT-HA one; this finding is hypothesised to be due to fuller hospital treatment once health anxiety is discounted. Personality disorder in people with health anxiety, particularly in those who have anxious and dependent traits, reinforces the benefits of cognitive behaviour therapy, particularly in the longer term. © 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

A behavioural intervention for young adults with dental caries, using acceptance and commitment therapy (ACT): treatment manual and case illustration

BackgroundThere is a need for effective behavioural interventions in dentistry. This paper presents an innovative behavioural intervention for young adults with dental caries, in an interdisciplinary collaboration between dental personnel and licensed psychologist in general dental care. The intervention has been evaluated in an RCT, with positive effects on oral health behaviour.MethodThe intervention, Acceptance and Commitment Therapy (ACT), a recent form of cognitive behaviour therapy (CBT), was adapted to young adult patients (18–25 years of age) with high dental caries activity.ResultsThe intervention included two individual sessions, provided by a clinical psychologist at general dental clinics. The rationale for selecting ACT as the theory base is presented, together with the treatment manual and a case illustration.ConclusionsACT may be a promising alternative for behavioural interventions in dentistry for patients with oral diseases, specifically dental caries. Interprofessional collaboration between psychologists and dental personnel opens up for new possibilities to help and treat patients with various health issues in public dental care.Trial registrationTRN ISRCTN15009620www.isrctn.com, retrospectively registered 14/03/2018.

Research Review: The relationship between social anxiety and social cognition in children and adolescents: a systematic review and meta-analysis.

Childhood Social Anxiety Disorder (SAD) is common and impairing. The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, particularly given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent. This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). An alternative approach is to examine the association between social anxiety and the social cognitive capacities that underpin social skills. This paper aims to examine the association between social anxiety and social cognition in children and adolescents, and examine conceptual and methodological moderators of this relationship. Papers published between 1980 and 2019 were screened systematically. Fifty studies were identified from which an effect size could be calculated for the relationship between social anxiety and social cognition, including 15,411 children and adolescents. An overall significant, but moderate effect (r=-.15) was identified, where increased social anxiety was associated with lower social cognitive ability. Moderation analyses revealed specific associations within studies examining social anxiety among participants with and without ASD who were older than 7 years old, and studies assessing the relationship between social anxiety and specific aspects of Theory of Mind (ToM). No significant association was identified between social anxiety and emotion recognition. Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition. This reinforces the importance of accurately identifying and treating social anxiety within ASD populations. In addition, treatments for social anxiety among neurotypical populations may benefit from targeting particular aspects of ToM rather than emotion recognition and other broad social skills.

Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study

BackgroundCurrent guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating.MethodsSeventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation.ResultsOverall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen’s d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).ConclusionsThe results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome.Trial registrationNederlands Trial Register: NL3982 (NTR4154). Date of registration: 2013 August 28, retrospectively registered,

Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond

Introduction: There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. Objective: To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). Methods: A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. Results: In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced the adjusted cost of treatment by USD 945 per patient. Conclusions: A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery.

Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes: a systematic review.

The aim of this review was to summarize and identify the variations in the effectiveness of psychological interventions on adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes (T1D). An electronic search of literature was performed using PubMed (NLM), Embase (Ovid), CINAHL Plus (EBSCOhost), PsycINFO (Ovid), and Google Scholar. The search was limited to include articles reported the effect of one of the psychological interventions: cognitive behavioral therapy (CBT), coping skills training (CST), stress management, or psychotherapy intervention. The report included peer-reviewed articles published in English from January 1990 until May 2019 in adolescents with T1D, and summarizes the results of 24 studies that met the inclusion criteria. Psychological interventions showed differential effects on adherence, metabolic control, and coping with stress in adolescents with T1D. Behavioral interventions using principles of CBT appear to have a superior positive effect on regimen adherence compared with other types of psychological protocols. In contrast, metabolic control was significantly improved with the implementation of CST and some forms of CBT. Stress management and psychotherapy interventions showed significant promises for adolescents to cope with their diabetes-related daily stressors. However, the findings may add some promises to diabetes management in adolescents, additional research to understand the effect of these interventions is needed.

Maultsby\u2019s Rational Behavior Therapy: Background, Description, Practical Applications, and Recent Developments

In this article we present Maultsby’s Rational Behavior Therapy (RBT) as a unique and distinct, but underutilized form of cognitive-behavior therapy, including its origins, theory (with psychosomatic learning theory), basic concepts, and practical applications, as well as never before published recent developments. As readers will see, many of Maultsby’s concepts, while pioneering and beckoning the third wave, still remain fresh, validated by current cognitive neuroscience, and are very relevant to modern psychotherapeutic practice. We describe RBT’s valuable concepts and effective techniques in such a way that readers may readily start using them to complement and enhance any other form of cognitive behavior therapy. An article comparing RBT with REBT and CBT will follow.

Effectiveness of enhanced cognitive behavior therapy for bulimia nervosa in Japan: a randomized controlled trial protocol

BackgroundThe effectiveness of psychotherapeutic interventions for eating disorders (EDs) is widely studied in Europe, North America, and Australia/New Zealand. However, few controlled studies and no randomized controlled trials (RCTs) have been conducted in Japan despite the relatively high prevalence of EDs in the Japanese population. The aim of this study is to evaluate the effect of enhanced cognitive behavior therapy (CBT-E), an evidence-supported ED-focused form of cognitive behavior therapy (CBT), for the treatment of bulimia nervosa (BN) in Japan.Methods/designThis multicenter RCT will compare CBT-E with treatment as usual (TAU), which is widely used in Japan. A group of 140 adult outpatients with a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) diagnosis of BN, ≥18 years of age, a body mass index (BMI) > 17.5 and < 40 kg/m2 will be randomly assigned to CBT-E or TAU. Participants will be stratified by intervention site and BN severity. CBT-E participants will receive 20 sessions of focused form CBT-E for 20 weeks. Those in the TAU group will receive routine treatment provided by specialists. Assessment will be performed in a blinded manner prior to the start of treatment, after 6 weeks of treatment, at the end of treatment (20 weeks), and at follow-up at 40 and 80 weeks after the start of treatment. The primary outcome is the remission of BN, defined by the absence, in the previous 4 weeks, of symptoms required to meet the DSM-5 criteria for a diagnosis of BN. Secondary outcomes include the levels of ED psychopathology and impairment due to the ED, anxiety, depression, family function, and satisfaction with treatment.DiscussionThis will be the first RCT conducted in Japan to compare CBT-E and TAU for the treatment of BN. If CBT-E is found to be more effective than TAU, then the evidence would support its wider use for patients with BN in Japan. Because it is possible to train therapists who do not possess extensive specialist experience, wider use is also likely to be practically feasible. In addition, demonstrating the effectiveness of CBT-E in Japan would demonstrate that it could be successfully extended to additional world cultures and regions.Trial registrationUMIN, UMIN000031625. Registered 7 Mar 2018.

Client-led culturally responsive CBT – integrating familism in the treatment of chronic depression: a case study

Abstract Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

Evaluating the "C" and "B" in brief cognitive behaviour therapy for distressing voices in routine clinical practice in an uncontrolled study.

Brief and single-symptom forms of cognitive behaviour therapy (CBT) for distressing voices may increase access to evidence-based psychological therapy and transcend diagnostic barriers. The current study evaluated the "C" and "B" in CBT for distressing voices in a transdiagnostic voices clinic. The B module (component of therapy) sought to enhance coping with voices, and the C module evaluated the accuracy of negative beliefs about the self and voices. The aims of the study were to investigate (a) whether modules B and/or C led to significant and clinically meaningful improvements on the primary outcome of voice-related distress, and (b) if changes in beliefs about self and voices (proposed change mechanisms) underpinned changes in voice distress across module C. Each module consisted of four sessions, individually tailored yet manualized, and designed with ease of staff training and delivery in mind. Assessment measures were administered at baseline (T1), post-module B (T2), and post-module C (T3). The results (N = 62) showed statistically significant medium-sized pre- and post-effects for voice-related distress from T1 to T2 and from T2 to T3, with large effects from T1 to T3. Just over half of the clients reported clinically meaningful improvements from T1 to T3. Neither beliefs about self nor voices were found to mediate improvements in voice distress during module C. The findings from this study suggest that both the B and C in CBT for voices can contribute to positive outcomes within routine clinical practice.

Supporting and promoting good mental health in the workplace: a service user perspective.

Many people with mental health issues are workless; and of the minority who do work, many are in elementary occupations. Despite this, good quality work is often promoted as beneficial for mental wellbeing. The discussion in this article explores my reflections about my experiences encountered as a person with schizophrenia managing mental distress in the workplace in the UK, whilst working as a senior lecturer in social work. The importance of a working identity is considered as central to my sense of wellbeing and recovery, although it is acknowledged that for some people, other activities that promote meaningful activity, rather than working, can best support their recovery. This first person narrative reflects on the difficulties caused by mental ill-health symptoms that impact on my wellbeing at work. The potential of Acceptance and Commitment Therapy (ACT), a form of Cognitive Behaviour Therapy, to support the improvement of my mental wellbeing in the work place is discussed alongside the central role of the therapist in delivering this intervention. The opportunities ACT offers to support a person with mental health issues to manage the disabling impact of mental health symptoms in the workplace are highlighted, and its potential for wider implementation across mental health services is considered.

Physiotherapy informed by Acceptance and Commitment Therapy (PACT) for people with chronic low back pain: a randomised controlled trial

Purpose: Chronic low back pain (CLBP) is the greatest cause of years lived with disability worldwide thus debilitating for patients, challenging for health care systems and costly for societies. Physiotherapy is moderately effective but might be improved by incorporating psychological models and techniques. Acceptance and Commitment Therapy (ACT), a form of cognitive-behavioural therapy, is effective for people with chronic pain when delivered by psychologists but is uncommon in physiotherapy. This trial aimed to test the efficacy of physiotherapy informed by ACT (PACT) against usual care (UC) physiotherapy for CLBP.

Economic evaluation of brief cognitive behavioural therapy for social activation in recent-onset psychosis.

BackgroundIn schizophrenia spectrum disorders, negative symptoms (e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve QOL in an economically sustainable way.MethodsA health-economic evaluation was conducted alongside a single-blind randomised controlled trial in two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal and the health sector perspective.ResultsBoth conditions showed improvement in the respective outcomes over the follow-up period of six months, but QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. ≥ 5-point decrease on the PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings.ConclusionsIn the Dutch context where TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still be evaluated if adjunct CBTsa therapy is a cost-effective alternative.Trial registrationClinicalTrials.gov registry under NCT03217955.

CDC Releases Suicide Prevention Guide for States, Communities

Back to table of contents Previous article Next article Professional NewsFull AccessCDC Releases Suicide Prevention Guide for States, CommunitiesMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Oct 2018https://doi.org/10.1176/appi.pn.2018.10b9AbstractPsychiatrists and mental health clinicians may have an especially important role in counseling patients and family members about safe storage of medications, firearms, and other household items that may be used in suicide.The Centers for Disease Control and Prevention (CDC) has published a “technical package” of suicide-prevention strategies that can be used at the state and community levels as well as by psychiatrists and mental health professionals.Christine Moutier, M.D., urges psychiatrists to seek extra training in suicide risk assessment and treatment.The 67-page document, titled “Preventing Suicide: A Technical Package of Policies, Programs and Practices,” describes a select group of strategies based on the best available evidence. These strategies are described in seven chapters that cover the topics of strengthening economic supports, strengthening access and delivery of suicide prevention care, creating protective environments, promoting connectedness, teaching coping and problem-solving skills, identifying and supporting people at risk, and lessening harms and preventing future risk.“States and communities already engaged in suicide prevention can use this technical package to assess their activities and see if there are areas in which to expand their efforts,” said Deb Stone, Sc.D., M.S.W., M.P.H., in comments to Psychiatric News. She is a behavioral scientist in the Division of Violence Prevention at the CDC’s National Center for Injury Prevention and Control. “For states and communities who have not begun work in the area of suicide prevention, this technical package can help guide decision making and prevention planning.”The strategies in the package include those with a focus on preventing suicide and reducing risk as well as approaches to lessen the immediate and long-term harms of suicidal behavior for individuals, families, communities, and society at large.Although primarily intended for policymakers, the technical package can be used by psychiatrists and mental health clinicians. “Psychiatrists may be able to use the package in several ways—by working with their local community organizations to make sure that evidence-based programs are being implemented and helping to raise awareness about the programs and policies described in the technical package,” Stone said. “The broad range of strategies in the technical package requires collaboration across community sectors. Psychiatrists and other health and mental health professionals are critical to the implementation of evidence-based treatments and practices such as Collaborative Assessment and Management of Suicidality, dialectical behavior therapy, and other forms of cognitive-behavioral therapy.” Among the experts who reviewed the CDC document was APA member Christine Moutier, M.D., chief medical officer of the American Foundation for Suicide Prevention (AFSP).In comments to Psychiatric News, Moutier said the technical package builds on a similar document produced by the AFSP’s Action Alliance, “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention.” The latter outlined very broad public health strategies—planning, communication with stakeholders in the community, aligning activities to the local culture, and ensuring sustainability for long-lasting change.She said the CDC technical package is a more detailed “toolkit” describing specific strategies that have been shown to reduce suicide.Moutier highlighted the need to reduce access to lethal means among people at risk for suicide. In the chapter titled “Create Protective Environments,” the technical package outlines the importance of safe storage of medications, firearms, and other household products that can be used in suicide.“Such practices may include education and counseling around storing firearms locked in a secure place (e.g., in a gun safe or lock box), unloaded and separate from the ammunition; and keeping medicines in a locked cabinet or other secure location away from people who may be at risk or who have made prior attempts,” according to the technical package.Moutier said psychiatrists and other physicians have a critical role in providing such counseling. “If we educate all gun owners that the presence of a gun in the home increases the risk of suicide and we also teach them basic prevention strategies such as safe storage, we have a logical reason to believe it will reduce suicide in the population,” she said.She urged psychiatrists to seek out extra training in suicide risk assessment and evidence-based treatments and to familiarize themselves with the CDC technical package.“It really represents how far we have advanced in community-based suicide prevention,” Moutier said. ■“Preventing Suicide: A Technical Package of Policies, Programs, and Practices” can be accessed here. “Transforming Communities: Key Elements for the Implementation of Comprehensive Community-Based Suicide Prevention” is available here. 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Can a brief psychological intervention improve oral health behaviour? A randomised controlled trial

BackgroundDental caries is a major public health issue affecting a large proportion of the general population. The disease is associated with behavioural factors and is thus preventable to a high degree. Individuals may need assistance to be able to change their oral health behaviour. There is a lack of such interventions for adults affected by severe caries. The aim of the study was to evaluate the effect of Acceptance and Commitment Therapy (ACT), a form of cognitive behavioural therapy, on oral health behaviour in young adults with poor oral health.MethodsThe study included a two group parallel randomised controlled trial at general dental clinics, with young adults, 18–25 years of age, ≥ two manifest proximal dental caries lesions (n = 135); 67 were treated with ACT and 68 with standard disease information only, respectively. Primary outcomes: oral health behaviours (tooth-brushing, flossing, use of toothpicks, and additional fluoride use). The CONSORT principles for RCTs were used, including intention-to-treat and per protocol analyses. The Chi-square, Mann-Whitney, and Wilcoxon Signed Rank tests were applied, including effect sizes.ResultsThe study groups did not differ with regard to oral health behaviour variables at baseline. The intervention group improved all their oral health behaviours significantly over time (effect sizes, 0.26–0.32), while the control group showed improved behaviours on two measures (flossing and additional use of fluoride, effect sizes, 0.22–0.23).ConclusionsBy testing a psychological intervention on young adults (18–25 years of age) with a high prevalence of caries, we found an immediate positive effect with improved oral health behaviours.Trial registrationTRN ISRCTN15009620, retrospectively registered 14/03/2018.

Current status of acceptance and commitment therapy for chronic pain: a narrative review.

It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.