Modular Cognitive Behavioral Therapy Research Articles

The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial.

School attendance problems (SAPs) are associated with negative short- and long-term outcomes. Despite high prevalence of SAPs, there is a shortage of evidence-based interventions. Existing approaches often target either school refusal or truancy, leaving a gap in effective interventions addressing both types of SAPs. This randomized controlled trial (RCT) assessed the effectiveness of Back2School (B2S), a modular transdiagnostic cognitive behavioral therapy (CBT) for SAPs, compared to treatment as usual (TAU). Outcomes included youths' school attendance and mental health. A group (B2S, TAU) × time (Pre, Post, 3-Month Follow-Up) design involving 152 youths (B2S; n = 74, TAU; n = 78) with SAPs (i.e., ≥ 10% absence in the past three months), aged 6-16 years (M = 12.2, SD = 2.2, males = 60%) were used. B2S comprised three months of CBT with youths, parents, and school involvement, while TAU comprised public and/or private intervention services. On average, youths in B2S received 15.0, (SD = 3.9) hours of intervention, while those in TAU received 13.4, (SD = 21.6). Intervention effects were investigated using mixed linear models. Both B2S and TAU exhibited significant within-group improvements in school attendance, with no significant differences between them. However, the B2S group significantly outperformed TAU in reducing youths' emotional problems, conduct problems, problems with peers, the overall impact of problems, and increasing youths self-efficacy for attending school and parent self-efficacy for dealing with a SAP. This RCT represents the first evaluation of a modular transdiagnostic CBT for youths displaying SAPs, showing significant mental health and self-efficacy benefits. (Clinical trial registration: ClinicalTrials.gov: NCT03459677).

Clinician and Consultation Factors Associated with CBT Fidelity Growth: Independent Observers vs. Consultant Fidelity Raters

ABSTRACT Post-training consultation support is linked to improvements in evidence-based treatment fidelity following initial training, but little is known about what makes it work, and how clinician-level factors may moderate its effects. This study examined the adherence and competence of N = 33 school-based clinicians trained to provide modular Cognitive Behavioral Therapy to youth, while receiving ongoing consultation. We examined two aspects of consultation as predictors of growth in adherence and competence, consultation dosage and use of session audio review. We also examined several clinician-level predictors of fidelity growth, including education, years of experience, burnout, and self-efficacy. Fidelity was rated by both independent observers and consultants, with differing findings. Independent observer ratings of adherence and competence did not change during consultation, and were not associated with any predictors. Consultant ratings of competence showed a trend toward growth during consultation. Greater clinician self-efficacy and years of experience were associated with lower initial consultant-rated competence, but more rapid growth over time. Higher consultation dosage and use of session audio review were negatively associated with growth in consultant-rated competence. These findings reinforce the need for further study of the active ingredients of consultation (i.e. consultation practices that help clinicians improve their treatment implementation), and the factors associated with perceptions of consultant fidelity raters.

What CBT Modules Work Best for Whom? Identifying Subgroups of Depressed Youths by Their Differential Response to Specific Modules

Prior research suggests that the effects of specific cognitive-behavioral therapy (CBT) modules on symptom outcomes can be estimated. We conducted a study utilizing idiographic and nomothetic methods to clarify which CBT modules are most effective for youth depression, and for whom they are most effective. Thirty-five youths received modular CBT for depression. Interrupted time series models estimated whether the introduction of each module was associated with changes in internalizing symptoms, whereby significant symptom reduction would suggest a therapeutic response to the module. Regression models were used to explore whether participant characteristics predicted subgroups of youths based on their estimated response to certain types (e.g., cognitive) of modules, and whether group membership was associated with posttreatment outcomes. Thirty youths (86%) had at least one module associated with a significant change in internalizing symptoms from premodule delivery to postmodule delivery. The specific modules associated with these changes varied across youths. Behavioral activation was most frequently associated with symptom decreases (34% of youths). No participant characteristics predicted estimated response to module type, and group membership was not significantly associated with posttreatment outcomes. Youths display highly heterogeneous responses to treatment modules, indicating multiple pathways to symptom improvement for depressed youths.

Do specific modules of cognitive behavioral therapy for depression have measurable effects on youth internalizing symptoms? An idiographic analysis

Objective Understanding the efficacy of each module of cognitive behavioral therapy (CBT) may inform efforts to improve outcomes for youth depression, but effects of specific modules have been difficult to examine. Idiographic interrupted time series models offer a robust way to estimate module effects on an individual’s symptoms. This study examined the association of specific CBT modules for depression on internalizing symptoms among depressed youths who received modular CBT in a randomized trial. Methods Individual models were created for three youths who met study criteria. Youths completed weekly symptom reports, and clinicians completed records of modules delivered. First order auto-regressive models quantified the change in average internalizing symptom severity between pre- and post-module delivery. Results All youths had 1–3 modules that were significantly associated with symptom reduction and 1–3 modules associated with deterioration. The 5 modules associated with improvement in at least one youth also lacked association (engagement, relaxation, cognitive reframing), or were associated with worsening (activity selection, parent psychoeducation) in others. Seven modules showed no measurable benefit, or detriment to any youth. Conclusion This study demonstrated that specific modules have measurable effects, but more work is needed to build an evidence base of specific module effects to inform treatment personalization for youth depression.

Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors.

This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7-17years), and parents. Assessments were pre-, mid-, post-test, and 10weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers' and mothers' anxious/depressive symptoms, and parental involvement (based on parents' presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.

Therapist- and therapy-related predictors of outcomes in a randomized controlled trial of school-based treatments for pediatric anxiety

The current study examined predictors of outcomes across two school clinician-delivered treatments (i.e., treatment as usual [TAU] or modular cognitive-behavioral therapy [M-CBT]) for youth with anxiety disorders. Predictors reflected two broad domains—therapist factors (i.e., education, years of experience, therapeutic orientation, work related stressors/barriers, self-efficacy, and attitudes towards evidence-based practices) and treatment-related factors (i.e., dosage, child compliance with treatment, therapeutic alliance, therapeutic nonspecifics, and proportion and quality of evidence-based structure elements). One hundred and ninety-five youth (mean age 10.98; 50.3% female, 53.5% non-Hispanic Caucasian) and 54 therapists (90.7% female, 72.2% non-Hispanic Caucasian) that were enrolled and randomized in a previous study (Ginsburg et al., 2020) participated. Results showed that incorporation of more evidence-based structure elements (e.g., agenda setting, assigning homework) and higher child compliance with treatment significantly increased odds of response to treatment. These findings provide important information about key ingredients to successful treatments, regardless of treatment condition/modality, and can be used to inform future training and implementation of school-based treatments for youth with anxiety disorders.

“A greatest hits compilation of mental health support”: A qualitative study of health professionals’ perceptions of modular CBT in pediatric epilepsy services

ObjectivesThe primary aim of this qualitative study was to explore the views of health professionals, with little previous clinical mental health training, of an adapted modular cognitive-behavioral intervention (MATCH-ADTC) for common mental health problems in children and young people with epilepsy. MethodsHealthcare Professionals (HCPs) and their supervisors were interviewed at the start (n = 23) and end (n = 15) of the six-month training period. The interviews were transcribed verbatim and analyzed using thematic analysis. ResultsThree higher order themes with sub-themes were identified: (1) strengths of the MATCH-ADTC content and manual; (2) expectations of the treatment; and (3) improving practice with MATCH-ADTC. Overall impressions of the training and treatment were largely positive, with HCPs viewing MATCH-ADTC as an acceptable treatment for the families that they worked with. HCPs highlighted some challenges in delivering an integrated service, particularly relating to the time commitment involved and their own confidence in delivering the intervention, as many participants did not have a mental health background. ConclusionsThe findings suggested that the intervention and training was acceptable to HCPs working in pediatric epilepsy services, and confidence grew over the six-month training period. Further research is needed to understand how to best train, supervise, and support HCPs in pediatric epilepsy services to deliver mental health treatments.

اثر بخشی درمان شناختی رفتاری واحدپردازه‌ای بر سوگیری تعبیر چهره و ترس از ارزیابی منفی در دانشجویان دارای خصیصه پارانوئید

The purpose of this research was to investigate the effectiveness of Modular Cognitive-‎Behavioral Therapy on facial expression bias and fear of negative evaluation in paranoid ‎students. The research method was quasi-experimental with pre-test-post-test with control group.‎‏ ‏The research community was composed of all students referring to the counseling center of kashmar University of Medical Sciences in the year 2017-16, who were diagnosed according to ‎Multidimensional Clinical Questionnaire-3 and DSM-‎‏5‏‎ criteria with paranoid attribution disorder ‎‎(According to statistics obtained from the center 60 people)‎‏.‏‎ Of these, 20 students with paranoid ‎characteristics were selected through purposeful sampling and were randomly assigned to ‎experimental and control groups. The experimental group received 16 sessions of Modular ‎Cognitive-Behavioral Therapy (HRT), Chuppita and did not receive interventional ‎control.Multidimensional Clinical Questionnaire and Objective Fear Scale , were completed ‎before and after the intervention by both groups. The collected data were analyzed by SPSS-22 ‎software and inferential statistics of covariance analysis. The results of analysis of covariance ‎showed that by eliminating the effect of pre-test scores on facial expression bias and fear of ‎negative evaluation as a scattering variable, the main effect of Modular cognitive-behavioral ‎therapy on facial expression bias and fear of negative evaluation in post-test is significant ‎‎(P‎‏>‏‎0/05). Therefore, Modular cognitive behavioral therapy can be used as an effective method to ‎reduce interpretation bias and fear of negative evaluation of people with paranoid traits.‎

Modular cognitive behavioral therapy for autism-related symptoms in children: A randomized controlled trial.

To date, no one-on-one psychotherapy protocol for elementary and middle school-aged children with autism spectrum disorder (ASD) has been found to be efficacious for treating autism-related symptoms such as failure to initiate social interactions. This study compared modular cognitive behavioral therapy (CBT) with enhanced standard community treatment (ESCT) in terms of impact on the severity of autism-related symptoms. Children with ASD (N = 107; aged 6-13 years) were randomly assigned to a treatment condition (CBT or ESCT). Both treatments provided 32 therapy sessions. The CBT condition utilized a modular design, matching specific evidence-based treatment elements to each child's clinical needs (e.g., social-communication symptoms). The ESCT condition provided social skills training and cognitive behavioral training in a structured and linear group therapy format. The primary outcome measure was independent evaluator ratings of peer engagement during school recess using a structured and validated observation system. Parents also made session-by-session ratings on personalized autism-related symptom profiles throughout treatment. CBT outperformed ESCT on the primary outcome measure (p < .001; d = .50; 95% CI [.06, .93]) and the secondary outcome measure (p = .003; d = .87; 95% CI [.45, 1.27]). The modular one-on-one CBT program evaluated in this study may be beneficial for reducing the severity of autism-related symptoms in some children with ASD. Further research is needed to clarify the extent of the treatment effect and the feasibility of implementation for therapists in the community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Supplemental Material for Modular Cognitive Behavioral Therapy for Autism-Related Symptoms in Children: A Randomized Controlled Trial

Supplemental Material for Modular Cognitive Behavioral Therapy for Autism-Related Symptoms in Children: A Randomized Controlled Trial

اثر بخشی درمان شناختی رفتاری واحدپردازه ای بر حساسیت اضطرابی ،تحریف های شناختی در دختران مبتلا به نشانگان بالینی اضطراب اجتماعی

مقدمه: پژوهش حاضر با هدف بررسی اثربخشی درمان شناختی رفتاری واحدپردازه ای بر حساسیت اضطرابی و تحریف های شناختی در دختران مبتلا به اضطراب اجتماعی انجام شد. روش: پژوهش حاضر از نوع نیمه آزمایشی با طرح پیش آزمون - پس آزمون با گروه کنترل بود. جامعه آماری پژوهش را کلیه دانش آموزان دختر مبتلا به اضطراب اجتماعی شهر مشهد و نمونه آماری شامل 24 نفر از دانش آموزان مبتلا به اضطراب اجتماعی بودند، که با روش نمونه گیری در دسترس انتخاب شدند.برای جمع آوری داده ها از پرسشنامه حساسیت اضطرابی تجدید نظر شده کوکس و تیلور، تحریف های شناختی بک و وایسمن استفاده شد. گروه آزمایش به مدت 10جلسه 90 دقیقه ای تحت مداخله قرار گرفتند. یافته ها: نتایج تحلیل کوواریانس نشان داد که با کنترل اثر پیش آزمون در مرحله پس آزمون بین دو گروه کنترل و آزمایش در متغیرهای حساسیت اضطرابی و تحریف های شناختی تفاوت معناداری وجود دارد. به طوری که گروه آزمایش در مقایسه با گروه کنترل کاهش معناداری نشان داد. همچنین نتایج پژوهش کاهش در زیر مقیاس های ترس از واکنش های اضطرابی، ترس از نشانه های قلبی عروقی و تنفسی و عدم مهار شناختی حساسیت اضطرابی او زیر مقیاس نیاز به تأیید دیگران و آسیب پذیری-ارزشیابی عملکرد تحریف های شناختی را نشان داد. نتیجه گیری: از آنجا که مبتلایان به اضطراب اجتماعی علایم حساسیت اضطرابی و تحریف های شناختی دارند، لذا استنفاده از مداخله شناختی رفتاری واحدپردازه ای به عنوان درمانی اثربخش در مبتلایان به اضطراب اجتماعی پیشنهاد می گردد.

Methodological Biases in CBT Trial-Commentary: Modular Cognitive-Behavioral Therapy for Affective Symptoms in Young Individuals at Ultra-High Risk of First Episode of Psychosis: Randomized Controlled Trial.

Methodological Biases in CBT Trial-Commentary: Modular Cognitive-Behavioral Therapy for Affective Symptoms in Young Individuals at Ultra-High Risk of First Episode of Psychosis: Randomized Controlled Trial.

School-Based Clinicians Sustained Use of a Cognitive Behavioral Treatment for Anxiety Disorders

Dissemination and use of cognitive behavioral therapy (CBT), the primary evidence-based psychosocial treatment for pediatric anxiety disorders, in school settings has been slow, occurring primarily in the context of randomized controlled trials (RCT). No data are available on the sustained use of CBT by school clinicians after research support ends. Filling this gap, the current study examined clinicians: (1) recall and attitudes toward a modular CBT (M-CBT), (2) sustained use of anxiety screening measures, (3) sustained use of M-CBT and modifications made, (4) perceived reasons and barriers to sustained use and (5) an exploratory examination of predictors of the sustained use of M-CBT. Participants included 43 school-based clinicians (77% of those originally trained in an RCT; 90% female, 73% White) who were contacted 3.43 years after their initial training to complete an online sustainability questionnaire. The results indicated that while most clinicians recalled and had positive attitudes about the M-CBT training (90%), 63% reported they continued to use M-CBT and a majority made modifications to the content, length and format. Predictors of the sustained use, based on 22 single predictor regression models, included greater perceived acceptability and benefits (for youth and clinicians) of the intervention and lower perceived difficulty of administering M-CBT components. Fewer administrative demands were also associated with greater sustained use. Findings suggest that additional efforts are needed to enhance the sustained use of M-CBT for anxiety in school settings. Targeting specific aspects of the intervention materials (difficulty, benefits) as well as lowering administrative demands might facilitate the sustained use of M-CBT by school clinicians.

Motivational Interviewing to Promote the Effectiveness of Selective Prevention: an Integrated School-Based Approach

School Mental Health prevention approaches that use multi-tiered systems are advancing rapidly. However, there is a relative shortage of effective selective prevention programs feasible to implement within the school context. To optimize the effectiveness of selective prevention in this context, a Motivational Interviewing (MI)-based prevention program for an adolescent student population was developed and tested. Footprints utilizes MI to increase engagement in modular Cognitive-Behavioral Therapy and to promote academic protective factors. In this study, forty-three adolescents were randomly assigned to Footprints or a treatment-as-usual waitlist control. Participants in the experimental condition demonstrated significant increases in behavioral and emotional functioning, self-efficacy to regulate behaviors, positive expectations for success, academic motivation, and grades in mathematics. Simultaneously, Footprints received high ratings for feasibility and acceptability within a dynamic school context. This exploratory efficacy evaluation provides initial support for MI's potential to promote the effectiveness of school-based prevention programs and warrants further study.

The Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Youth with Anxiety and Autism Spectrum Disorder.

The impact of externalizing comorbidity on treatment outcome was examined in 104 youth ages 7-16 (M = 11.09years) with autism spectrum disorder and primary anxiety/obsessive compulsive disorder who completed modular cognitive behavioral therapy (CBT) for anxiety/OCD. Three comorbidity profiles were utilized for group comparisons: participants with oppositional defiant or conduct disorder with attention-deficit hyperactivity disorder (ODD; CD; ADHD; group EXT, n = 25); those without ODD/CD and only ADHD (group ADHD, n = 46); and those without externalizing comorbidity (NO-EXT, n = 33). Post-treatment outcomes were measured continuously (Pediatric Anxiety Rating Scale, Clinical Global Impression-Severity) and categorically (treatment response, remission). The ADHD group was four times more likely of being a treatment responder compared to NO-EXT (OR 4.05). Comorbidity group did not impact remission. After controlling for pre-treatment scores, there was a significantly greater reduction of the CGI-S for ADHD versus NO-EXT and EXT versus NO-EXT, but results did not significantly differ for the PARS. Results suggest that a modular CBT approach yields positive impact for treatment outcomes in youth with comorbid externalizing problems, particularly among those with comorbid ADHD.

Modular CBT for Youth Social Anxiety Disorder: A Case Series Examining Initial Effectiveness

ABSTRACTCognitive Behavioral Therapy (CBT) is the most efficacious treatment for childhood anxiety disorders. At the same time, several studies showed that for children and adolescents with social anxiety disorder (SAD), standard protocolized CBT seems to be less efficacious than for youth with other types of anxiety disorders, suggesting that children with SAD need a different approach. The purpose of this study was to examine the effectiveness of a modularized cognitive behavioral therapy (CBT) for children with SAD, including mindfulness. Ten children and adolescents (50% girls, aged 8–17 years) referred for SAD were measured at pretreatment, posttreatment and 10 weeks follow-up. Results showed that 5 youths (50%) were free of their SAD posttreatment, and 8 (80%) at follow-up. Clinically meaningful improvements from pretest to follow-up were found in 90% and 60% of the cases, for the total anxiety symptom score and social anxiety symptom score, respectively. Pre-post-follow-up group analyses revealed significant improvements in SAD severity (combined parent and child report) and social anxiety symptoms across child, mother, and father report. The remission rate of 80% and substantial social anxiety symptom decline is promising, providing a starting point for improving treatments of youth with SAD.

Comparison of modular cognitive-behavioral therapy and behavioral activation on the intolerance of uncertainty in students with generalized anxiety disorder

Context: Generalized anxiety disorder (GAD) is one of the most common psychological disorders. The prevalence of GAD among students is higher than the general population. Aims: The purpose of this study was to compare the effect of modular cognitive-behavioral therapy (MCBT) and behavioral activation (BA) on the intolerance of uncertainty of students with GAD. Setting and Design: This research was a semi-experimental design with pre- and post-test design with follow-up conducted for two groups in counseling center of Neyshabur University during the period of January–April 2019.Materials and Methods: The study population included all students of Neyshabur University. The samples recruited from students who referred to the counseling center of Neyshabur University (45 cases) based on the purposive sampling method. The students who diagnosed with GAD based on Spitzer general anxiety questionnaire and met criteria (45 cases) randomly assigned into three groups of MCBT (15 cases), BA (15 cases), and control group (15 cases). Statistical Analysis Used: Data were collected using Spitzer general anxiety questionnaire (2006) and Freeston Intolerance of Uncertainty Scale (1994). Data were analyzed using the SPSS version 24 software through repeated measure analysis. Results: The findings revealed both intervention groups in reduction of the intolerance of uncertainty in comparison to the control group (P > 0.05). Results reported by participants in the MCBT group showed greater mean scores as compared to the BA group. However, no significant difference found between groups (P > 0.05). Conclusion: It can be concluded that MCBT implies decreasing the uncertainty severity of students with general anxiety than BA therapy, although the stability of BA therapy was longer. Therefore, it is suggested to use integrated therapeutic approaches.

Concordance between clinician, supervisor and observer ratings of therapeutic competence in CBT and treatment as usual: does clinician competence or supervisor session observation improve agreement?

Lowering the cost of assessing clinicians' competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT). This study examined the concordance between clinicians', supervisors' and independent observers' session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement. Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians' competence after each supervision session (n = 613). Independent observers rated clinicians' competence from audio recordings (n = 395). Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians. These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.

Modular cognitive-behavioral therapy for affective symptoms in young individuals at ultra-high risk of first episode of psychosis: Randomized controlled trial.

Individuals at ultra-high risk of psychosis often present concurrent affective symptoms (depression/anxiety). This study investigated whether modular cognitive-behavioral therapy (CBT) targeting both ultra-high risk and affective symptoms (a) reduced/delayed risk of a first psychotic episode at posttreatment and 14-month follow-up compared with a supportive intervention, (b) was more effective than control condition in producing remission on depression/anxiety. Fifty-eight ultrahigh risk individuals were randomly assigned to CBT or control condition. CBT consisted of 30 sessions, including CBT for psychotic experiences and depression/anxiety. In the CBT group, the cumulative number of participants who developed a first psychotic episode (n = 3, 10.34%) at follow-up was lower than in the control group (n = 8, 27.60%; logrankχ2(1) = 3.68, p = .05). In the CBT group, a higher number of participants achieved remission than in control condition on affective symptoms at posttreatment/follow-up. CBT can prevent psychosis risk and produce better outcomes on depression/anxiety than supportive intervention.

2.65 Preliminary Evidence for a Modified Modular Cbt Approach to the Treatment of Depression and Anxiety in Adolescent Inpatients

2.65 Preliminary Evidence for a Modified Modular Cbt Approach to the Treatment of Depression and Anxiety in Adolescent Inpatients