Form Of Cognitive Behavioral Therapy Research Articles

Associations Between Sleep Disorders and Treatment Response in Service Members With Post-traumatic Stress Symptoms: A Secondary Outcome Analysis

ABSTRACT Introduction Compared with the civilian population, a higher rate of reported sleep apnea exists among military service members resulting in inadequate sleep. Those who experience chronic sleep deprivation may suffer from debilitating problems that may compromise military mission readiness and unit safety. The purpose of the study on which this secondary outcome analysis was based was to evaluate the effect of manual standardized stress acupuncture as an adjunct therapy to an abbreviated form of cognitive behavioral therapy for insomnia for sleep disturbances in post-deployment service members. The aim of this secondary outcome analysis was 2-fold: (1) to assess the relationship between sleep disorder symptoms and post-traumatic stress symptoms (PSS) and (2) to determine if the presence of sleep disorder symptoms influenced the effects of acupuncture and cognitive behavioral therapy as compared to cognitive behavior therapy only on PSS) in post-deployment military service members. Materials and Methods The study was a 2-arm, single-center, randomized controlled trial approved by the Naval Medical Center San Diego and the Vanderbilt University Institutional Review Board. It was conducted at the U.S. Naval Hospital in Okinawa, Japan. Participants were active duty service members from all military branches who were stationed in Okinawa. Two measures were used to analyze the data: the Global Sleep Assessment Questionnaire (GSAQ) and the Post-traumatic Stress Disorder Checklist. A Pearson correlation coefficient was calculated to determine the relationship between sleep disorder symptoms (i.e., 11 pre-intervention GSAQ symptoms) and PSS treatment outcomes (i.e., PCL and PTSD clusters). Results Results indicated associations between the GSAQ components and PCL total and PTSD cluster scores. Findings showed that the presence of sleep disorder symptoms influenced PSS treatment response in post-deployment military service members. Conclusions Results from this secondary outcome analysis showed associations between GSAQ components (i.e., excessive daytime sleepiness, working conditions causing inadequate sleep, involuntary movements in sleep, and sadness or anxiousness) and PCL total and PTSD cluster scores (i.e., avoidance, negative cognition and mood, avoidance, and hyperarousal). Furthermore, sleep disorder symptoms such as having stressful working conditions (e.g., shift work), probable obstructive sleep apnea, insomnia, anxiety, and depression influenced PSS treatment responses. This study provided information on the major contribution of sleep disorder symptoms in the treatment of PSS through self-report. Future researchers should consider the use of physiologic measures to further understand the mechanisms of how sleep disorder symptoms affect treatment responses in service members with PSS. Implications for this study may assist clinicians in determining effective PSS treatments for those with OSA and insomnia.

Mental Imagery and Social Phobia: What Form of Mental Imagery – Based Cognitive Behavioral Therapy is Most Effective?

Mental imagery is the internal experience of representing sensory information that is normally perceived through the senses, entirely in the mind. Visual mental imagery, which is the most studied type of imagery, is commonly referred to as “visualization,” or “seeing through the mind’s eye.” One of the defining features of imagery is that it does not require an external stimulus for the creation of a mental image. Imagery can also be either voluntary or involuntary. Involuntary mental imagery is important as it is the essential element of many psychological disorders, such as post-traumatic stress disorder, which is characterized by intrusive “flashbacks” of traumatizing memories in the form of imagery. Mental imagery has general significance in our lives as it is often used as a tool for remembering information, and it is increasingly being used in clinical fields both to study and to help treat mental health disorders. The purpose of this paper is to review literature on the neuroscience of mental imagery, emotion, and its clinical applications. This paper will also discuss different forms of cognitive-behavioral therapy (CBT) and their effectiveness in treating anxiety and mental health disorders, specifically social phobia. Additionally, this paper will attempt to fill in the gap in previous studies by providing insight into which form of CBT may be most effective for treating social phobia.

Feasibility and Acceptability of Implementing a Transdiagnostic Cognitive Behavioral Therapy for Children Impacted by Trauma Within a Residential Treatment Facility

The Unified Protocol (UP) is a flexible, transdiagnostic form of cognitive behavioral therapy that effectively treats diverse psychiatric conditions in children, adolescents and adults. However, the UP has not been rigorously evaluated among children who have experienced severe trauma and may have limited caregiver involvement in their life. The present research project was a single arm, open trial examining the feasibility of utilizing the UP within a residential treatment facility in Calgary, Canada for children involved with child welfare authorities who often have limited caregiver involvement. Children (n = 19; age 9–13) and their caregivers (n = 18; age 32–60) participated in 15 weekly therapy sessions of the UP for Children with minor structural and content modifications. Trauma exposure was high among children, especially physical neglect and emotional abuse (89% exposed to each). Fidelity to the manualized intervention was high (88% for children; 89% for caregivers), indicating the intervention was feasible to deliver and that the adaptations did not interfere with fidelity. All children and caregivers completed the intervention, suggesting high acceptability for recipients. Improvements over time in maladaptive cognitions and behaviors (among children and caregivers) provide preliminary evidence for efficacy. The present study provides support for the notion that the UP for Children can be utilized for children who live in residential care and/or those who have experienced high levels of trauma.

Headache Specialists' Perceptions of the Role of Health Psychologists in Headache Management: A Qualitative Study.

Background Since headache specialists cannot treat all the patients with headache disorders, multidisciplinary teams that include health psychologists are becoming more prevalent. Health psychologists mainly use a form of cognitive-behavioral therapy (CBT), along with biofeedback on occasion, to effectively address patients' pain and headache disorders. The Veterans Health Administration (VHA) is one setting that routinely includes a health psychologist with advanced training in pain disorders in their pain care to its veterans. The VHA has established Headache Centers of Excellence (HCoE) around the country to provide multidisciplinary treatment for patients with headache disorders, which enables headache specialists to regularly interact with health psychologists. Objective The study's objective is to evaluate headache specialists' views of health psychologists in the treatment of patients with headache disorders. Method Semi-structured interviews were conducted with headache specialists in academic-based healthcare settings, the community, and VHA HCoE sites. The interviews were audio-recorded and de-identified so they could be transcribed and analyzed using content matrix analysis. Results Four themes emerged: headache specialists desired to work with health psychologists and included them as members of multidisciplinary teams; valued health psychologists because they provided non-pharmacological treatments, such as CBTand biofeedback; preferred in-person communication with health psychologists; and used multiple titles when referring to health psychologists. Conclusion Headache specialists valued health psychologists as providers of behavioral and non-pharmacological treatments and considered them essential members of multidisciplinary teams. Headache specialists should strive to work with a headache psychologist, not just a general health psychologist. By committing to this, headache specialists can foster changes in the quality of care, resource allocation, and training experiences related to health psychologists.

Repetitive Transcranial Magnetic Stimulation With and Without Text4Support for the Treatment of Resistant Depression: Protocol for a Patient-Centered Multicenter Randomized Controlled Pilot Trial.

Treatment-resistant depression (TRD) is the inability of a patient with major depressive disorder (MDD) to accomplish or achieve remission after an adequate trial of antidepressant treatments. Several combinations and augmentation treatment strategies for TRD exist, including the use of repetitive transcranial magnetic stimulation (rTMS), and new therapeutic options are being introduced. Text4Support, a text message-based form of cognitive behavioral therapy that allows patients with MDD to receive daily supportive text messages for correcting or altering negative thought patterns through positive reinforcement, may be a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance the response of patients with TRD to rTMS treatment. This study aims to assess the initial comparative clinical effectiveness of rTMS with and without the Text4Support program as an innovative patient-centered intervention for the management of patients diagnosed with TRD. This study is a multicenter, prospective, parallel-design, 2-arm, rater-blinded randomized controlled pilot trial. The recruitment process is scheduled to last 12 months. It will involve active treatment for 6 weeks, observation, and a follow-up period of 6 months for participants in the study arms. In total, 200 participants diagnosed with TRD at rTMS care clinics in Edmonton, Alberta, and rTMS clinics in Halifax, Nova Scotia will be randomized to 1 of 2 treatment arms (rTMS sessions alone or rTMS sessions plus Text4Support intervention). Participants in each group will be made to complete evaluation measures at baseline, and 1, 3, and 6 months. The primary outcome measure will be the mean change in the scores of the Patient Health Questionnaire-9 (PHQ-9). The secondary outcome measures will involve the scores of the 7-item Generalized Anxiety Disorders Scale (GAD-7), Columbia-Suicide Severity Rating Scale (CSSRS), and World Health Organization-Five Well-Being Index (WHO-5). Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. Qualitative data will be analyzed using the thematic analysis framework. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention treatment arm of the study will achieve superior outcomes compared with the outcomes of participants enrolled in the rTMS alone arm. The application of the combination of rTMS and Text4Support has not been investigated previously. Therefore, we hope that this study will provide a concrete base of data to evaluate the practical application and efficacy of using the novel combination of these 2 treatment modalities. PRR1-10.2196/46830.

A targeted strategic peer support intervention to increase adherence to video teletherapy exposure and response prevention treatment for obsessive-compulsive disorder: a retrospective observational analysis.

Exposure and response prevention (ERP) therapy, a form of cognitive-behavioral therapy, is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD) for adults and children. It is effective for the majority of those who engage in it, but treatment adherence can be challenging for some due to the stress involved in the treatment as well as different life circumstances that arise. To help improve treatment adherence, NOCD, a provider of video teletherapy ERP, identifies those at risk of non-adherence using a prediction algorithm trained on a data set of N = 13,809 and provides targeted peer support interventions by individuals ("Member Advocates") who successfully completed ERP treatment for OCD. Member Advocates, using lived OCD experience as well as experience with ERP, engage at-risk patients through digital messaging to engage, educate, and encourage patients in the early stages of treatment. From June 2022 to August 2022, N = 815 patients deemed at risk were reached out to and n = 251 responded and engaged with the Member Advocates. In the at-risk patients who engaged, the intervention resulted in a significant mean 30.4% more therapy hours completed compared to those who did not engage. Additionally, engaged patients had greater reductions in OCD severity. These results have implications for how data science, digital interventions, and strategic peer-to-peer communication and support can be combined to enhance the effectiveness of treatment.

A Novel Prescription Digital Therapeutic Option for the Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis are pressing public health problems occurring alongside the rising prevalence of obesity and diabetes. This feasibility study explored the use of a novel prescription digital therapeutic (PDT) in this patient population. A prospective, open-label study was conducted at two hepatology clinics. Eligible patients had a baseline FibroScan controlled attenuation parameter >274 dB/m. Participants were given access to a PDT containing a novel form of cognitive behavioral therapy designed to treat cardiometabolic disease. Laboratory assessments, FibroScan, and magnetic resonance imaging proton density fat fraction (MRI-PDFF) imaging were conducted preintervention and postintervention. Twenty-two participants were enrolled. Mean baseline fat fraction on MRI-PDFF was 18.7%. After the 90-day intervention, the mean relative reduction in MRI-PDFF was-16.2% (P= .011) in those with baseline PDFF ≥10%. Mean alanine transaminase decreased by-17.1 IU/L (P= .002). Participants achieved an average total body weight loss of-2.9% (P= .008) and controlled attenuation parameter score was reduced by-18.8 dB/m (P= .021). No serious or device-related adverse events were reported. An average improvement in health-related quality of life of+2.2 Healthy Days per month (P= .500) and high treatment satisfaction (mean Net Promoter Score of+75) were reported. After 90 days of digitally delivered cognitive behavioral therapy, improvements were observed in multiple endpoints without any adverse device effects. The safety, efficacy, and usability data observed strengthen the hypothesis that PDTs provide a scalable tool to address unmet behavioral treatment needs in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis (ClinicalTrials.gov number, NCT05357248).

Conceptual, Psychometric, Methodological and Value Problems in Acceptance and Commitment Therapy: Introduction to the Special Section, “A Critical Appraisal of Acceptance and Commitment Therapy”

There is a voluminous and expanding literature regarding ACT, from descriptions of its theory to its stated roots in relational frame theory, the particulars of its therapy techniques and exercises, favored metaphors, randomized controlled trials, to many self-help books for a wide variety of problems. The therapy is widely marketed through workshops and many self-help books. ACT is associated with its own journal and its own professional organization, the Association for Contextual Behavioral Science (ACBS). This literature is interpreted by ACT proponents as demonstrating the causal efficacy of ACT for a wide range of problems and, at times, even being superior to treatment as usual, which are often more traditional forms of cognitive behavior therapy (CBT). This special section contains a series of 6 papers examining these claims. Correctly understanding and evaluating the claims of ACT proponents is warranted because these can have direct implications for treatment decisions by therapists attempting to deliver the most effective treatment for their clients' problems. The papers, individually and as a whole, urge considerable caution, particularly because much of its research has involved serious measurement problems, problematic research designs, and a unique and problematic conceptualization and perhaps the practice of values and ethics. These papers call for methodological improvements and a commitment to more traditional values associated with science so that ACT can be more fairly evaluated to accurately understand its assets and limitations.

Using cognitive and behavioural strategies to support a man with mild–moderate learning disabilities navigate the dual process model of grief: A clinical case study

AbstractBackgroundPeople with learning disabilities experience bereavement in the same emotionally overwhelming way as the general population. The Dual‐Process Model of grief is characterised by the oscillation between Loss‐Orientation and Restoration‐Orientation. These processes involve experiencing and accepting the emotional pain of grief (Loss‐Orientation) and adapting to a new world without the deceased person (Restoration‐Orientation).MethodsA single case study sought to explore how Cognitive Behavioural Therapy (CBT) and Compassion Focused Therapy (CFT) principles can be used to support people with a learning disability to navigate the grieving process, as understood by the Dual‐Process Model.FindingsThis case study describes CBT formulation and assessment, and implementation of CBT and CFT strategies in a man with Williams syndrome, demonstrating improvements in mood, and a greater ability to turn towards suffering and experience both Loss‐ and Restoration‐Oriented processing.ConclusionCBT and CFT may be useful and appropriate modalities for clinicians to consider when supporting people with a learning disability to navigate loss, as understood through the Dual Process Model.

0634 An RCT of Brief CBT for Insomnia among Primary Care Patients with Suicidal Ideation

Abstract Introduction There is an established association between insomnia and suicide. As with many conditions, the preponderance of patients with either insomnia or with suicidal ideation (SI) are seen in primary care settings. Brief forms of cognitive behavioral therapy for insomnia (bCBTi) have been delivered in primary care including to patients with mental health conditions. We sought to test the efficacy of bCBTi among primary care insomnia patients endorsing SI. Methods A sample of 194 participants endorsing SI and meeting criteria for insomnia disorder along with depression and/or posttraumatic stress disorder (PTSD) were randomly assigned to receive either four weekly sessions of bCBTi (n=98) or Sleep Hygiene (n=96). Participants engaged in suicide safety planning or a review of their existing safety plan. To be consistent with the primary care milieu, intervention sessions averaged < 30 minutes in duration with all intervention sessions audio-recorded and subjected to fidelity ratings. Outcome measures include the: Insomnia Severity Index (ISI; primary endpoint): Scale for Suicidal Ideation (SSI); Patient Health Questionnaire-Depression (PHQ-9); and PTSD Symptom Checklist-DSM 5 (PCL-5) administered at baseline and 6, 12, 18, 24, and 30-week follow-ups. Mixed effect analyses will test for linear change in each outcome over time, as well as examining intervention effects on these trajectories. The study also gathers initial data on barriers and facilitators to aid future implementation efforts. Results The study sample consists of 194 U.S. Military Veterans with a mean (sd) age of 51.5 (13.7) years, 23% of whom are female, 17% racial minorities and 9% ethnic minorities. Mean baseline values for the outcome measures are: ISI 19.1 (4.1); SSI 3.5 (5.3); PHQ-9 15.2 (5.1); and PCL-5 43.4 (14.3). Data collection will be completed in Spring 2023. In addition to complete enrollment and retention data, we will present results of analyses on primary (ISI) and secondary (SSI, PHQ-9, PCL-5) outcomes across all time points. Conclusion This randomized trial was designed to establish the feasibility and effectiveness of treating insomnia in primary care environments as a suicide prevention strategy while gathering data to facilitate implementation if the findings warrant. Support (if any) U.S. Department of Veterans Affairs Office of Research & Develpment (I01 HX002183)

Assessment and Treatment Programs for addressing the Mental Health Needs of Justice Involved Children in Nairobi County, Kenya


 
 
 
 Mental health screening, assessment and subsequent treatment is increasingly becoming necessary and fundamental in juvenile justice settings. Recent systematic reviews have reported an increase in the population of children with mental disorders (Beandry et al., 2021). Conversely, many children pass through the justice system without being assessed and end up being subjected to treatment interventions that do not match their mental health needs (Snehil & Sagar, 2020). The aim of this study was to explore the landscape of assessment and treatment of justice involved children with a focus on available tools and procedures for screening and assessment and to find out if there existed any evidence- based programs for addressing the mental health needs of children. This was a mixed methods study involving 193 child justice practitioners in Nairobi County sampled from courts, police, prosecution probation, prisons and children services. The study found that only one risk/need assessment tool (YLS/CMI) was being used by probation and children services and only with children committed to statutory institutions. Counseling and some forms of cognitive behavioral therapy were the only mental health interventions. Respondents cited various barriers to assessment and treatment and these included; lack of training, feeling incompetent, language barriers, high caseloads, non-prioritization of child clients, and limited resources. The findings of this study can be used by all agencies and child justice policy-making bodies to streamline assessment and treatment so as to ensure access to justice and mental health service for children.
 
 
 

Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. Trial numberNCT04140838. PerspectiveGroup videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.

The case for remote supervision

AbstractAs the necessity of meeting state regulations has continued to mount in the public mental health sector, and insurance companies limit the number of therapy sessions covered in a year, the emphasis on evidence‐based treatments, most often in the guise of some form of Cognitive Behavioral Therapy, continues unabated. Meanwhile, knowledge about and the ability to practice psychodynamically have all but vanished from most community mental health clinics in the United States. With shrinking funds, increasing demand for services, and increasing costs, therapists and their supervisors in these settings are expected to meet productivity and documentation requirements imposed by state and federal regulations and by the clinics themselves. These demands leave little time for therapists to discuss actual cases with their supervisors, to reflect on their experiences with patients and to wonder about the patient's experience with them, skills that are in themselves among the essential tools of psychodynamic clinical training and are crucial to patient care. This paper summarizes the qualitative data collected at the conclusion of a pilot study in which a dozen staff therapists in a community mental health center met weekly individually with psychodynamic supervisor/consultant volunteers to discuss their ongoing cases.

Do ADHD Treatments Improve Executive Behavior Beyond Core ADHD Symptoms in Adults? Evidence From Systematic Analysis of Clinical Trials.

We sought to understand the effect of current treatments for attention deficit hyperactivity disorder (ADHD) on executive functioning deficits, which are often comorbid with ADHD, via a systematic analysis of adult ADHD treatment studies evaluating change in behavioral measures beyond the core symptoms of Diagnostic and Statistical Manual of Mental Disorders ADHD. The standardized mean difference for behavioral measures of executive functioning was determined from controlled trials of adults with ADHD and compared with effects on core ADHD symptoms. Several studies of atomoxetine revealed small to large standardized mean differences. Nonreplicated studies revealed small to medium effects for triple-bead mixed amphetamine salts, lisdexamfetamine, and forms of cognitive behavioral therapy. Proportional effect versus core ADHD symptoms ranged from 0.78 to 1.16 for atomoxetine, and from 0.65 to 1.44 across all the studies. ADHD treatments have effects on executive functioning behavior beyond core ADHD symptoms in adults. Clinicians can measure and treat this morbidity using available clinical tools.

Adjunctive Therapy of Text4Support for Treatment-Resistant Depression Patients Receiving Repetitive Transcranial Magnetic Stimulation. A Multicenter Randomized Controlled Pilot Trial

IntroductionDespite several treatment strategies for treatment-resistant depression (TRD) exist, including the use of repetitive transcranial magnetic stimulation (rTMS), new therapeutic options are being introduced. Text4Support is a form of cognitive behavior therapy that allows patients with depression to receive daily supportive text messages that seek to correct or alter negative thought patterns through positive reinforcement. Text4Support is deemed a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance patients with TRD’s response to rTMS treatmentsObjectivesThis study aims to assess the initial comparative clinical effectiveness of rTMS when used with and without the Text4Support program as an innovative patient-centered intervention for the management of participants diagnosed with TRD.MethodsThis study is a multicentered prospective, parallel-design, two-arm, rater-blinded randomized controlled pilot trial. In total, 200 participants diagnosed with TRD will be randomized to one of two treatment arms (rTMS alone and rTMS with Text4Support). Participants in each arm will be made to complete evaluation measures at baseline, 1,3, and 6 months. The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale. Patient service utilization data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses.ResultsThe result of the study is expected to be available 18 months after the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention will achieve superior outcomes compared with participants enrolled in the rTMS treatment alone.ConclusionsThe concomitant application of the combination of these two treatment techniques has not been investigated previously. Therefore, we hope that this project will provide a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities.Disclosure of InterestNone Declared

Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials.

Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.

Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial.

Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population. This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT. Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment. Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods. This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy. ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210. PRR1-10.2196/44694.

Exploratory study of threat sensitivity as a moderator of positive affect treatment and negative affect treatment for depression and anxiety

Cognitive behavioral therapy (CBT) focuses on decreasing negative affect rather than increasing positive affect and is ineffective for some individuals. A trial comparing novel Positive Affect Treatment (PAT) to Negative Affect Treatment (NAT; a form of CBT) showed that PAT more effectively increased positive affect and decreased negative affect, depression, and anxiety (Craske et al., 2019). The present exploratory study examined threat sensitivity as a treatment moderator. Threat sensitivity was operationalized as pre-treatment skin conductance response and unconditional stimulus (US) expectancy rating during extinction recall. Participants ( N = 43) then received 15 sessions of PAT or NAT. Growth curve models were tested to explore interactions between extinction recall and treatment condition over time. For skin conductance, weaker extinction recall predicted faster improvement in depression and anxiety in NAT than PAT, whereas stronger extinction recall predicted faster improvement in symptoms in PAT than NAT. Reduced US expectancy ratings predicted a faster decrease in symptoms, regardless of treatment condition. Individuals showing greater threat sensitivity, indexed by weaker extinction recall, may benefit more from a treatment that targets threat sensitivity than a treatment that targets reward sensitivity. Individuals showing the converse may benefit more quickly from a treatment that targets reward sensitivity than threat sensitivity.

Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing

Background: Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing. Aim: To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff. Design: A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up. Setting/participants: Participants were recruited from Marie Curie hospice and nursing services in Scotland. Results: Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen’s d = 0.7) and mental wellbeing (Cohen’s d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction. Conclusion: Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.

Mental Health Issues of Adolescents In Pakistan: A Cry For Help

Globally, Anxiety and Depression are leading contributors affecting adolescents’ mental health. 1 in 4 adolescent goes through mental health issues that require immediate attention. 1 It is also well documented that many mental health disorders emerge in late childhood and early adolescence and they exacerbate to the burden of these disorders in youth and later in life. 2 In severe cases of anxiety and depression sufferer may commit suicide, it is reported that every 40 seconds one person dies of suicide.3 Globally, suicide is the fourth leading cause of mortality among youth between the ages of 15 to 29 after road traffic accidents. Among teens between 15-19 years, suicide is the second leading cause of death among girls (after maternal and reproductive issues) and the third leading cause of death in boys (after road traffic accidents and interpersonal violence). 4 Pakistan is a developing country with an estimated population of 220 million, of which 50% of the population is between 12- 25 years. A recent study conducted in Pakistan, on 400 high school going adolescents (15-18 years), identified the prevalence of anxiety and depression around 53% among the adolescents enrolled in high school going in Pakistan. 5 The rates of anxiety and depression among adolescent population are alarming in the context of Pakistan; where the mental health human resources are scare. There are only few child and adolescents’ psychiatrists, and hardly any specialized mental health nurses and formalized mental health services for children and adolescents in Pakistan that can be considered at par with the developed world. However, the encouraging news is that if an early preventive intervention in the forms of cognitive behavior therapy are done, it can help and empower children and adolescents to identify their triggers and manage anxiety and depression effectively. 6 Non-specialist preventive mental health strategies may work as alternate options for reducing anxiety and depression, in resource constrained settings like Pakistan. The effectiveness of Cognitive Behaviour Therapy based intervention are already established by non-specialists (Community Health Workers) to reduce postpartum depression among women. 7 These evidences are encouraging and can be replicated to reduce Anxiety and Depression among children and adolescents at schools. Schools are vital pillar to promote children’ cognitive, social, emotional, behavioral and intellectual attainment. Academic institutions are well positioned to implement preventive mental health strategies. Thus, school-based mental health prevention programme can be cost effective well positioned interventions for a LMIC country like Pakistan. 8 Mental health issues of young people require immediate attention. Many of these issues are easily manageable. However, it is challenging to access and provide them mental health services at their convenience. Therefore, it is important to engage main stream academic institutions, to access children and youth to include them for early interventions to address their mental health issues such as anxiety and depression. There is also a need to establish evidence-based interventions to promote mental health and prevent anxiety, depression, and suicidal ideation among youth.