Multicomponent Cognitive Behavioral Intervention Research Articles

Predictors of treatment outcome in cognitive behavioral therapy for intermittent explosive disorder: A preliminary analysis.

The present study examined potential treatment outcome predictors of a multicomponent cognitive behavioral intervention for intermittent explosive disorder (IED). The sample (n = 64; 22 female) consisted of individuals with a current diagnosis of IED that completed treatment across three study trials. Treatment outcome predictors assessed included demographic variables, psychiatric comorbidity, symptom severity, and treatment motivation/engagement. Treatment outcomes were (a) change in number of past-week aggressive acts from pretreatment to posttreatment and (b) presence of IED diagnosis at posttreatment. Results indicated those who endorsed lower trait anger were more likely to remit from IED diagnosis at posttreatment. No other variables were found to significantly predict treatment outcome. These findings support the notion that cognitive behavioral therapy can be effective for a wide range of individuals with IED, with little variation in efficaciousness based on presence of demographic characteristics, comorbid disorders, or treatment motivation/engagement. This seems to be particularly the case for individuals with lower levels of trait anger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial

Few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). The present study tested the efficacy of a cognitive behavioral intervention (versus supportive psychotherapy) among adults with IED. In this randomized clinical trial, 44 participants with IED (22 men and 22 women) aged 20–55 years completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n = 19) or a time equated supportive psychotherapy (n = 25). At baseline, posttreatment, and 3-month follow-up, all participants received the Overt Aggression Scale–Modified, which was conducted by an interviewer who was blind to the participant’s study condition. During these visits, participants also completed self-report measures of relational aggression (Self-Report of Relational Aggression and Social Behavior), anger (State-Trait Anger Expression Inventory-2), cognitive biases (e.g., Social Information Processing Questionnaire Attribution and Emotional Response Questionnaire), and associated symptoms (e.g., Beck Depression Inventory). Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multicomponent cognitive behavioral intervention in treating aggression in IED.

Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention

BackgroundThis study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This ‘FIT-HIP intervention’ is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention.MethodsThis process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients’ adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists).ResultsThirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients’ adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0–10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists’ limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol.ConclusionsThe FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention’s feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring.Trial registrationNetherlands Trial Register: NTR5695 (7 March 2016).

Not Just Tools to Handle It: A Qualitative Study of Nursing Students' Experiences From Participating in a Cognitive Behavioral Stress Management Intervention.

Background. Stress-related problems are an increasing challenge within nurse education since it affects learning, professional development, and mental health negatively. Despite this, knowledge is scarce regarding nursing students' experiences of being in stress management interventions. Aim. This study aimed to describe how nursing students experienced a preventive cognitive behavioral therapy-based stress management intervention. Method. Data were collected through 14 semistructured interviews with nursing students who had participated in a stress management intervention, and analyzed using inductive qualitative content analysis. Results. The analysis yielded one theme, Turning points, which consisted of four categories: (1) more in touch with reality, (2) increased self-confidence, (3) improved communication skills, and (4) a new way of reflecting. Discussion. Findings emphasize the importance of both theoretical and structural aspects when planning a stress management training intervention. A group format delivery in combination with a multicomponent cognitive behavioral intervention can be interrelated elements for positive stress-related changes. Conclusion. Our findings indicate that participants developed new and more adaptive coping strategies, which were attributed to the intervention. The participants expressed that they had increased their ability to reflect, which led to increased insight and self-reflection. The intervention constitutes an example of a contribution to stress management research and provides information for stress management training initiatives in nurse education.

Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: A Cluster-Randomized Controlled Trial in Geriatric Rehabilitation

ObjectivesFear of falling (FoF) is common after hip fracture and can impede functional recovery because of activity restriction. The Fear of falling InTervention in HIP fracture geriatric rehabilitation (FIT-HIP intervention) was designed to target FoF and consequently to improve mobility. The aim of this study was to evaluate the effect of the FIT-HIP intervention in patients with FoF in geriatric rehabilitation (GR) after hip fracture. Design, setting, and participantsThis cluster-randomized controlled trial was performed in 11 post-acute GR units in the Netherlands (2016-2017). Six clusters were assigned to the intervention group, 5 to the usual care group. We included 78 patients with hip fracture and FoF (aged ≥65 years; 39 per group). Intervention(s)The FIT-HIP intervention is a multicomponent cognitive behavioral intervention conducted by physiotherapists, embedded in usual care in GR. The FIT-HIP intervention was compared to usual care in GR. MeasurementsFoF was assessed with the Falls Efficacy Scale–International (FES-I) and mobility, with the Performance Oriented Mobility Assessment (POMA). Data were collected at baseline, discharge, and 3 and 6 months postdischarge from GR. Primary endpoints were change scores at discharge. Linear mixed models were used to evaluate the treatment effect. ResultsNo significant between-group differences were observed for primary outcome measures. With the usual care group as reference, the FES-I estimated difference between mean change scores was 3.3 [95% confidence interval (CI) −1.0, 7.5, P = .13] at discharge from GR; −4.1 (95% CI –11.8, 3.6, P = .29) after 3 months; and −2.8 (95% CI –10.0, 4.4, P = .44) after 6 months. POMA estimated difference was −0.3 (95% CI –6.5, 5.8, P = .90). Conclusion/ImplicationsThe FIT-HIP intervention was not effective in reducing FoF. Possibly FoF (shortly) after hip fracture can to some extent be appropriate. This may imply the study was not able to accurately identify and accordingly treat FoF that is maladaptive (reflective of disproportionate anxiety).

A Multi-Component Cognitive-Behavioral Intervention for Sleep Disturbance in Veterans with PTSD: A Pilot Study

A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances. Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group. Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms. Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.

Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention

Objectives: Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. Method: The study sample comprised 540 community-dwelling adults aged 70 years or older, with concerns about falling and associated activity avoidance, who participated in a randomized controlled trial evaluating this intervention. Control beliefs, self-efficacy beliefs, outcome expectations, and social interactions, as potential mediators, and concerns about falling and daily activity, as outcome variables, were assessed at baseline, and at two, eight, and 14 months. Data were analyzed with mixed-effects regression models. Results: Small to moderate statistically significant effects of the intervention on the potential mediators were found at nearly all follow-up assessments. Separate psychosocial factors showed modest mediating effects on the outcomes. When all mediators were taken into account simultaneously, 44–76% of the association between the intervention and the outcomes was explained. Conclusion: This study showed that the multicomponent cognitive behavioral intervention improved control beliefs, self-efficacy, outcome expectations, and social interactions. These variables mediated the association between the intervention and concerns about falling or daily activity in community-dwelling older adults. This knowledge may facilitate further improvement and development of interventions to reduce concerns about falling and to increase daily activity.

Therapist fidelity with an exposure‐based treatment of ptsd in adults with schizophrenia or schizoaffective disorder

This study examined therapists' fidelity to a manualized, multicomponent cognitive-behavioral intervention for posttraumatic stress disorder (PTSD), including exposure therapy, among public sector patients with a psychotic disorder. Independent raters assessed therapists' competence and adherence, rating 20% of randomly selected audio taped sessions (n=57 sessions, coded by two raters, with strong interrater agreement). Adherence ratings indicated that therapists complied well with the protocol, and competency ratings typically averaged "very good" or higher (6 on 7-point Likert scale). Findings suggest that therapists can effectively deliver a manualized cognitive-behavioral intervention for PTSD, with exposure therapy, to patients with severe mental illness without compromise to the structure of sessions and/or the therapeutic relationship.

Effects of a Multicomponent Cognitive Behavioral Group Intervention on Fear of Falling and Activity Avoidance in Community‐Dwelling Older Adults: Results of a Randomized Controlled Trial

To evaluate the effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in older adults. Randomized controlled trial. Community-dwelling adults in the Netherlands. Five hundred forty adults aged 70 and older who reported fear of falling and fear-induced activity avoidance (280 intervention, 260 control). A multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling adaptive and realistic views on falls, reducing fall risk, and increasing activity and safe behavior. Data on fear of falling, activity avoidance, concerns about falling, perceived control over falling, and daily activity were collected at baseline and at 2, 8, and 14 months. At 2 months, there were significant between-group differences in fear of falling (odds ratio (OR)=0.11; P<.001), activity avoidance (OR=0.26; P<.001), concerns about falling (adjusted mean difference=-1.51; P=.02), and daily activity (adjusted mean difference=0.95; P=.01). At 8 months, there were significant between-group differences in all outcomes and at 14 months in fear of falling (P=.001), perceived control over falling (P=.001), and recurrent fallers (P=.02) but not in activity avoidance (P=.07), concerns about falling (P=.07), daily activity (P=.24), or fallers (P=.08). This multicomponent cognitive behavioral intervention showed positive and durable effects on fear of falling and associated activity avoidance in community-dwelling older adults. Future research should focus on improving intervention uptake and adherence, reaching frailer populations, and determining potential intervention effects on functional outcomes.

Context-Sensitive Cognitive-Behavioral Supports for Young Children With TBI

This study produced a second replication of an investigation of the effects of a multicomponent cognitive-behavioral intervention on the challenging behavior of young children with growing behavioral concerns after traumatic brain injury (TBI). The participants were two young elementary-age children with escalating behavior problems after severe TBI. Single-subject reversal designs were used to document the effects of the combined behavioral, cognitive, and executive function intervention on the following: frequency and intensity of aggressive behaviors and amount of work accomplished. The intervention included integrated components of positive behavior supports, cognitive supports (e.g., graphic organizers), and an executive function routine (goal-plan-do-review). Results included reduced frequency and intensity of challenging behaviors and increased quantity of work completed. These two successful single-subject experiments replicated four previously published single-subject experiments demonstrating the potential for successfully treating behavior disorders in young children with TBI using a support-oriented intervention that combines behavioral, cognitive, and executive function components.

A multi-component cognitive-behavioral intervention is associated with a reduction in aggressive behavior and an increase in classroom work productivity of two children with traumatic brain injury1

A multi-component cognitive-behavioral intervention is associated with a reduction in aggressive behavior and an increase in classroom work productivity of two children with traumatic brain injury1

Process Evaluation of a Nurse-Delivered Smoking Relapse Prevention Programfor New Mothers

The objective of this study1 is to evaluate the feasibility, recall, and acceptability of an evidence-based intervention using home-health nurses to provide smoking relapse prevention skills to new mothers. The design of this study is process evaluation. Setting and participants include women who had delivered a normal newborn at a university hospital, who quit smoking during pregnancy, were smoke free for 7 days, and had saliva cotinine of less than or equal to 14 nanogram/ml. The intervention is a multicomponent cognitive-behavioral intervention, including inpatient contact, a home-health visit, and 2 follow-up phone calls. Results are as follows: 121 participants enrolled, and the intervention was implemented in 78 home visits. Nurses discussed tobacco issues for an average of 12.0 min. Almost all participants recalled the home visit; nearly two thirds recalled discussing tobacco use. Only 4% reported negative feelings toward discussing tobacco issues. In 87% of home visits, nurses implemented all 5 intervention components with self-reported nonsmokers. The conclusion is as follows: A nurse-delivered smoking relapse prevention intervention for new mothers was feasible and acceptable.

Hypnotic Analgesia and Stress Inoculation Training: Individual and Combined Effects in Analog Treatment of Experimental Pain

The individual and combined effects of hypnotic analgesia and a multicomponent cognitive–behavioral intervention were compared in the analog treatment of experimental pain. Eighty-three participants previously assessed for hypnotic suggestibility were randomly assigned to hypnotic analgesia, Stress Inoculation Training, combined (analgesia plus Stress Inoculation procedures delivered in a hypnotic context), or control conditions. Participants in the 3 treatment conditions reported more reduction of finger pressure pain than did control participants. However, there was no difference among the 3 treatments in pain reduction. More pain reduction was associated with greater suggestibility. Decreases in pain were correlated with expected pain reduction in the hypnotic analgesia and combined conditions, but not in the cognitive–behavioral condition. Therefore, response expectancies may play a larger mediational role in hypnotic treatments for experimental pain than in cognitive–behavioral interventions.