Group-based Cognitive Behavioral Therapy Research Articles

Facilitating adaptive coping with fear of recurrence among breast cancer survivors: Feasibility and acceptability outcomes from a three-arm randomized controlled trial.

1630 Background: Fear of cancer recurrence (FCR) is one of the most prevalent and disruptive problems for breast cancer survivors (BCS). Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) have shown promising effects for FCR in a recent meta-analysis, yet head-to-head comparisons of these interventions are rare. We present feasibility and acceptability outcomes from a randomized controlled trial comparing ACT to CBT and enhanced usual care (EUC) for BCS with clinically significant FCR. Methods: Eligible women were ≥18 years old, diagnosed with stage I-IIIA breast cancer, within 5 years of completing cancer treatment (ongoing endocrine therapy was allowed), and reported clinical FCR at enrollment. Participants were randomly assigned to group-based ACT, CBT, or EUC, all delivered via videoconference. ACT and CBT consisted of 6 weekly 1.5-hour sessions; EUC was a single 1.5-hour survivorship coaching session. Outcomes included accrual, session attendance and engagement, intervention helpfulness, and retention. Variables were summarized by mean (SD) if numerical or relative frequency if categorical. At significance level α = 0.05, the Kruskal-Wallis test was used to compare overall differences between the three groups, and two-sample T-tests with unequal variances were used for pairwise comparisons between the groups with Bonferroni multiple-comparison adjustment. Results: Of 446 BCS who screened eligible, 390 (87.4%) enrolled. Most participants were white (81.8%), not Hispanic (98.4%), partnered (68.4%), and college-educated (71.3%). Most were within 2 years of completing cancer treatment (55.7%), and mean age was 55.8 (SD = 12.0) years. Among those assigned to a 6-session intervention, participants attended a mean of 5.0 (ACT) and 5.2 (CBT) sessions; 96.1% of EUC participants attended the single session. Mean session engagement (rated per participant per session by interventionists on a 0-10 scale) was significantly different across the three groups (p < .0001), with mean (SD) of 9.3 (0.8) for ACT, 9.5 (1.0) for CBT, and 7.9 (1.3) for EUC. Pairwise comparisons showed higher engagement ratings in ACT (p < .0001) and CBT (p < .0001) over EUC, with no significant difference between ACT and CBT (p = .14). At post-intervention, participants rated mean (SD) helpfulness on a 0-10 scale as 7.2 (2.6) for ACT, 7.9 (2.0) for CBT, and 5.5 (2.7) for EUC. Overall, mean helpfulness was significantly different across the groups (p < .0001) and favored CBT over ACT (p = .0109) and EUC (p < .001) and favored ACT over EUC (p < 0.001). Outcome data retention was 93.8% through the 6-month follow-up. Conclusions: High accrual and attendance rates suggest that BCS are receptive to FCR interventions and may find ACT or CBT more engaging and helpful than a single session of survivorship coaching. Clinical trial information: NCT05364450 .

Reducing stigma and promoting HIV wellness/mental health of sexual and gender minorities: RCT results from a group-based programme in Nigeria.

High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence-based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group-based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. The intervention comprised four weekly in-person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April-September 2022), with pre-post surveys plus 3-month follow-up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre-exposure prophylaxis (PrEP)/HIV treatment use. Mean age of the 240 participants was 26 years (range 18-42). Seventy-seven percent self-identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre-post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3-month follow-up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever-PrEP use were the same, 75% of immediate-group participants reported currently using PrEP at 3 months post-intervention versus 53% of delayed-group participants right after the intervention (p<0.01). Participants post-intervention described (in qualitative interviews) less self-blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre-intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. This study demonstrated the feasibility and acceptability of a group-based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment.

Group-based cognitive behavioural therapy and bright light therapy in youths with insomnia and evening chronotype: interim analysis of a randomised controlled trial

Group-based cognitive behavioural therapy and bright light therapy in youths with insomnia and evening chronotype: interim analysis of a randomised controlled trial

Feasibility of a virtual group-based cognitive behavioral therapy intervention for adolescents with disorders of gut–brain interaction.

Feasibility of a virtual group-based cognitive behavioral therapy intervention for adolescents with disorders of gut–brain interaction.

Effectiveness of group cognitive behavioral intervention in reducing test anxiety among psychology undergraduates in Kathmandu, Nepal

Background: High test anxiety negatively impacts students, affecting academic performance, well-being, focus, and retention rates. Cognitive Behavioral Therapy (CBT) is a promising approach to reducing test anxiety, and we aimed to assess the effectiveness of group-based CBT in reducing test anxiety among undergraduate students. Material and Method: This experimental, independent two-group design enrolled 80 test-anxious participants, randomly assigning them to a control or intervention group (40 participants each). Westside Test Anxiety Scale was the primary outcome measure, and participant's feedback was collected. The intervention group received ten sessions of group-based CBT. Baseline and endline data were analyzed, and effect size was reported. Results: Participant feedback was analyzed qualitatively. The intervention group demonstrated 16% reduction in test anxiety score from their baseline, while the control group showed only 5.54% reduction from their baseline. In contrast, the control group showed a 2-point reduction, representing a 5.54% decrease. This difference was statistically significant (effect size= -0.53), supporting moderate effectiveness. Further, scores in specific test anxiety areas, such as worry about forgetting during the study and performance after exams, showed notable improvement. Participant feedback highlighted improved stress management, self-awareness, and understanding of emotions. Suggestions incorporating visual aids and increasing interactivity for the future. Conclusion: This study demonstrates utility of group-based CBT in reducing test anxiety among undergraduate students. A larger scale randomized controlled trial is needed to evaluate the effectiveness of group CBT in a larger population, and future studies can focus on examining the effect of group CBT delivered by non-specialists in a broader population.

The effects of group-based cognitive behavioral therapy in the rehabilitation of patients with chronic schizophrenia with more than two years of community-based mental health group rehabilitation.

Studies have shown that community-based group rehabilitation activities can have a positive impact on patients. This study attempted to improve schizophrenia patients' social and self-cognition through short-term group-based cognitive behavioral therapy (G-CBT), break negative coping styles, and improve the patients' quality of life. The patients with schizophrenia who participated in long-term community-based group rehabilitation were treated with G-CBT. Training on coping styles was conducted to improve their self-cognition and social cognition, and the rehabilitation effects of G-CBT on these patients were evaluated. Compared with the control group, patient scores for self-esteem, self-efficacy, and positive coping in the G-CBT group increased, while patient scores for negative coping decreased. Compared with the control group, the differences in the total scores for mental health and the five dimensions of physical functioning, general health, vitality, social functioning, and emotional role function in the short-form (SF-12) survey were statistically significant. Compared with the baseline data, the differences in self-esteem, self-efficacy, positive coping, negative coping, and quality of life scores were statistically significant. Short-term G-CBT had a good effect on patients with chronic schizophrenia who participated in community-based group rehabilitation for the long-term.

Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness.

Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.

Optimising Anxiety Treatment for Autistic Children: a Narrative Review

AbstractAnxiety disorders occurs at a high rate amongst autistic children. Cognitive behaviour therapy (CBT) is a reasonably well-established multi-component intervention used to reduce anxiety in this population. Whilst there are known effective intervention components in CBT for treating anxiety among autistic children, there are few guidelines for how to weight these intervention components to maximise positive outcomes. The objective of this study is to evaluate whether CBT is an effective intervention for autistic children, and if so, what the key components of effective CBT programs are for autistic children. A review of studies using manualised group-based CBT programs with family involvement was completed. The key finding was that the exposure-focused CBT (EF-CBT) studies reviewed showed a greater improvement in anxiety symptoms compared with CBT studies with fewer or no exposure-focused sessions. Compared to CBT without an exposure focus, EF-CBT may better fit the profiles of autistic children, potentially resulting in greater client and family engagement, and possibly greater intervention efficacy.

The effect of cognitive behavioral therapy on chemotherapy-induced side effects and immune function in colorectal cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial.

Colorectal cancer (CRC) was one of the most widely diagnosed cancers in the United States in 2021. CRC patients may experience significant psychological stress and are susceptible to depression and anxiety. Previous studies have shown that cognitive behavioral therapy (CBT) can reduce fatigue and improve quality of life among breast cancer patients. However, as a non-pharmaceutical treatment, it remains unclear whether CBT improves chemotherapy-induced side effects and immune function in CRC patients. In this study, we will conduct a randomized controlled trial (RCT) among CRC patients undergoing chemotherapy to determine whether CBT can reduce the side effects of chemotherapy and improve the immune function of CRC patients. The study will be a single-center RCT. CRC patients undergoing chemotherapy will receive either eight sessions of group-based CBT (every 2-3 weeks) or usual care (usual oncology care). Each participant will undergo assessments at baseline (T0), immediately post-intervention (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The primary outcome will include chemotherapy-induced side effects in CRC patients. The secondary outcome will be immune function (measured by levels of inflammatory cytokines). Other outcomes will include the levels of tumor markers, assessments of psychological status (perception of stress, depression and anxiety, self-efficacy, sleep quality, quality of life, social support condition, and cognitive function), and necessary laboratory examinations (biochemical index and blood cell counts) among CRC patients undergoing chemotherapy. Our study will provide clinical evidence regarding whether CBT should be generalized in clinical treatment and the extent to which CBT reduces chemotherapy-induced side effects for CRC patients. ClinicalTrials.gov registration number NCT04741308.

The Feasibility and Efficacy of a Group-Based, Brief Transdiagnostic Cognitive-Behavioral Treatment for Adolescents with Internalizing Problems.

The present study aimed to assess the efficacy of a group-based, brief transdiagnostic cognitive-behavioral therapy (CBT) program for adolescents with internalizing problems, such as anxiety and depressive disorders, seeking help in a primary health care clinic in Iceland. The group-based CBT program consisted of eight weekly 110-min sessions covering psychoeducation, cognitive restructuring, behavioral activation, exposure, problem-solving, social skills, and mindfulness. The study recruited 53 participants, who were randomly assigned to either receive the group treatment or be placed on a wait-list for monitoring purposes. Measures were taken at baseline, during treatment (week 4), at posttreatment (week 8), and at 2-, 4-month, and 1-year follow-ups. The primary outcome measures were the self-reported total scores of total anxiety and depression using the Revised Children's Anxiety and Depression Scale (RCADS). The study found a significant effect of time and time * treatment interaction on the depression and anxiety total scores. The secondary outcome measures, RCADS parent-rated depression and anxiety total scores, did not show significant effects of time * treatment interaction. However, during naturalistic follow-up, a significant reduction in parent-reported depression and anxiety total scores was observed. The study also observed good treatment adherence, as well as high satisfaction among parents and youth. The results suggest that this group-based, brief transdiagnostic CBT group treatment is feasible and effective in reducing depressive and anxiety symptoms in adolescents with internalizing problems and highlights the importance of addressing comorbidity in treatment.

Association between Intention to Quit School and Youth Depression: A Cluster Randomized Controlled Trial of the Effects of a Group CBT Course

ABSTRACT We investigated changes in youths’ intentions to quit school after following a group-based cognitive behaviour therapy (CBT) based intervention for depressed adolescents in upper secondary school: the Adolescent Coping with Depression Course (ACDC). Data were collected from 228 youths, 133 of whom received the 14-week ACDC intervention and 95 who received usual care (UC). Structural equation models showed that symptoms of depression at post-test positively predicted intention to quit school at six-month follow-up after the intervention ended (β = .291, p < .001). Furthermore, ACDC, which showed a decrease in depressive symptoms post-test, had an indirect effect on adolescents’ intention to quit school at six-month follow-up (indirect β = −0.117 p = .018). Hence, targeting depression and implementing effective preventive programmes may prevent dropout from upper secondary school. Such interventions should thus be investigated in future studies.

Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis.

Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Experiences of group-based cognitive behavioural therapy for insomnia among patients with rheumatoid arthritis: a qualitative study

ObjectiveRheumatoid arthritis (RA) is a chronic autoimmune disease, with a prevalence of insomnia disorders in up to 70%. Patients’ experiences of participating in group-based cognitive behavioural therapy for insomnia (CBT-I)...

Conversion From In-Person to Remote Delivery of Neuromuscular Training to Treat Chronic Pain in Adolescents

ABSTRACT Juvenile fibromyalgia (JFM) is a chronic, disabling, and widespread musculoskeletal pain condition accompanied by many comorbid symptoms. Current guidelines recommend multidisciplinary care, including physical therapy and cognitive behavioral therapy (CBT). Regular aerobic training and strengthening exercises are useful in treating fibromyalgia and are often recommended under the care of trained professionals. In 2020, COVID-19 caused nationwide disruption in health care, requiring health care practices to allow for treatment through telehealth platforms. The Fibromyalgia Integrative Training (FIT Teens) program used in-person, group-based CBT combined with neuromuscular training (NMT) for adolescents with fibromyalgia and suspended treatment sessions under COVID-19 restrictions. The behavioral and exercise components were converted to a remotely delivered program to maintain treatment options. This article reviews the process of modifying the NMT protocol, including practical and clinical considerations, and highlights the benefits and limitations of remote delivery. The remote NMT program maintains the principal components of the in-person program and allows continued access to treatment during the pandemic. Many aspects of health care that have been converted to telehealth may likely offer these types of treatment in the future. Hence, the learnings of the FIT Teens project may be useful in designing future remote exercise interventions.

Cognitive Behavioral Therapy among Ghana's Rural Poor Is Effective Regardless of Baseline Mental Distress

We study the impact of group-based cognitive behavioral therapy (CBT ) for individuals selected from the general population of poor households in rural Ghana (N = 7,227). Results from one to three months after the program show strong impacts on mental and perceived physical health, cognitive and socioemotional skills, and economic self-perceptions. These effects hold regardless of baseline mental distress. We argue that this is because CBT can improve well-being for a general population of poor individuals through two pathways: reducing vulnerability to deteriorating mental health and directly increasing cognitive capacity and socioemotional skills. (JEL D12, I12, I15, I31, I32, O12, O18)

Brief, intensive group-based cognitive therapy integrated in cardiac rehabilitation reduces psychological distress in cardiac patients with anxiety and depression a randomized controlled

Abstract Background/Introduction Patients with coronary artery disease (CAD) and valvular heart disease (VHD) often suffer from psychological distress, which in turn leads to impaired quality of life, delayed return to work, and increased morbidity and mortality. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. Manageable interventions addressing psychological distress in cardiac patients are needed. Purpose To develop an efficient and cost-effective model for cardiac patients to reduce psychological distress. Methods A multi-center randomized clinical trial in patients with newly diagnosed CAD and/or surgically treated VHD, part of the workforce and concomitant psychological distress (defined as Hospital Anxiety and Depression scale (HADS) Anxiety ≥8 or Depression ≥8). The patients were randomized to five sessions of group-based cognitive-behavioral therapy plus cardiac rehabilitation (Intervention, I) or cardiac rehabilitation alone (Control, C). Furthermore, 41 cardiac patients (male gender 85.4%, age 57±6.4 years) without psychological distress (background, B) participated as reference group to follow the natural course. The primary outcome was a total HADS score at three months. Secondary outcomes were return to work, adherence to CR (participation in &amp;gt;80% of planned training sessions), adherence to lifestyle interventions for CVD risk factor goals, HeartQoL (is a disease-specific questionnaire that measures cardiac quality of life), and cardiovascular readmissions after 12 months. Results 148 patients were included, 67% men, mean age 54±7.5 years and median HADS score at baseline 15 (IQR 10–19) (Table 1). At 3 months HADS score improved significantly more in the intervention group (p&amp;lt;0.001) and this difference persisted at 6 months (p&amp;lt;0.001, Figure). Similar results were seen for HADS anxiety and HADS depression (Figure 1). HeartQol also improved more in the intervention group. 78% had returned to work at 6 months in the intervention group versus 67% in the control (p=0.11). There were no differences in other secondary outcomes Conclusion Brief cognitive-behavioral therapy provided by cardiac nurses to patients with CAD/VHD and a high HADS score significantly reduced psychological distress and quality of life. The program is simple and can be integrated with existing CR programs at low costs. Larger trials are needed to confirm the effect of the program on retaining cardiac patients in the workforce. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The trial is fonded by TrygFonden

Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder

Intolerance of uncertainty (IU) is a key construct in generalized anxiety disorder (GAD), but little is known about the concurrent and temporal patterns of associations between IU and GAD symptom severity during treatment. In addition, most of the extant literature focuses on IU as a unidimensional construct, whereas some researchers conceptualize IU as being comprised of two dimensions, inhibitory and prospective IU. Ninety individuals with GAD completed measures of IU and worry severity at pre-treatment, session 4, session 8, and end of treatment (session 12), during group-based cognitive behavior therapy (CBT) for GAD. Longitudinal multilevel modeling showed that IU predicted worry severity concurrently, but not prospectively over time; this pattern of associations was found with the total IUS score and the inhibitory (but not prospective) subscale score. Further, the relationship between IU total scores and worry severity became stronger over time. The relationship between inhibitory (but not prospective) IU and worry also became stronger over time. When the order of the variables in the model was reversed, worry severity also predicted concurrent but not future IU. Therefore, change in IU is associated with change in worry throughout the course of CBT, particularly as treatment progresses, though its directional association as a cause and/or effect remains unclear.

A cognitive-behavioral approach to teacher burnout: A randomized controlled trial of a group therapy program

ABSTRACT Background and Objectives: As a well-known phenomenon with significant social, biological, and psychological impacts, burnout syndrome has been viewed and treated from different therapeutic perspectives. However, few studies have evaluated interventions to prevent and alleviate teacher burnout. Design: This study comprised a randomized controlled trial (RCT) of a group-based cognitive–behavioral therapy (CBT) program for teacher burnout, with assessments at pre-treatment, post-treatment, and 6-month follow-up. Methods: The Maslach Burnout Inventory-Educators Survey (MBI-ES) was administered to 242 English language teachers with diverse professional profiles in Iran. Of these, 62 teachers with burnout symptoms were randomly assigned to either a group-based eight-week CBT treatment program or a waiting list control condition. Results: The results of a series of mixed factorial ANOVAs demonstrated significantly greater improvements for the treatment compared to the control condition on the total score and three subscales of the MBI-ES (teachers’ emotional exhaustion, depersonalization, and reduced personal accomplishment) at post-treatment, with treatment effects maintained at 6-month follow-up. Conclusions: This CBT intervention has promise for supporting teachers in stressful occupational conditions and reducing their burnout.

The global return on investment from preventing and treating adolescent mental disorders and suicide: a modelling study

IntroductionDespite the high burden of mental disorders among adolescents and the potentially lifelong consequences of these conditions, access to mental health services remains insufficient for adolescents in low-income and middle-income...