Multimodal Cognitive-behavioral Therapy Research Articles

Emotional Behavioural Styles in Violent and Non-violent Juvenile Offenders

Previous studies have found emotional behavioural problems among school children in Pakistan and their impact on academic achievement (Javed et al., 1992; Samad et al., 2005; Soomro & Clarbour 2012; Syed et al., 2007; Syed & Hussein, 2009). The main purpose of the study was to extend the investigation to the juvenile offenders to assess the emotional behavioural problems among violent and non-violent juvenile offenders located in the different prisons of Khyber Pakhtunkhwa (KP), Pakistan. T-test and Binary Logistic Regression were used to analyse the data. T-test revealed that there were significant differences among violent and non-violent juvenile offenders on three emotional style factors: malevolent aggression, social self-esteem, and social anxiety. Binary Logistic Regression analysis indicated that violent juvenile offenders exhibited higher levels of malevolent aggression and low levels of social self-esteem and social anxiety than non-violent juvenile offenders. These results may provide empirical evidences for distinguishing between the violent and non-violent juvenile offenders on the basis of emotional behavioural problems and suggest intensive multimodal Cognitive Behavioural Therapy (CBT) and anger management program to modify the behaviour of violent juvenile offenders.

Effectiveness of multi-modal cognitive behavioural therapy in improving mental well-being among caregivers of children with disabilities in urban Uganda: A cluster-randomized controlled trial

In Sub-Saharan Africa, 41 to 58% of the caregivers of children with disabilities experience psychological distress and have poor mental well-being. Cognitive behavioural therapy (CBT) has a moderate effect on improving mental well-being. However, no study has examined its effects among caregivers of children with disabilities at home and in schools. This study evaluated the effectiveness of CBT in improving mental well-being among caregivers of children with disabilities in urban Uganda. We conducted a two-arm cluster-randomized controlled trial in 11 schools across the Kampala district of Uganda. The intervention was a multi-modal CBT training program conducted for six months among 392 home and school caregivers of children with disabilities. In the first three months, caregivers received group-based CBT, and in the next three months, they received phone-based CBT. We used generalized linear mixed-effects regression to examine the differences in the mental well-being of caregivers in the control group vs those in the intervention group. Home caregivers' mental well-being was significantly higher after phone-based CBT (unstandardized coefficient of the estimate (B) = 4.31, 95% CI = 1.18-6.82; P < 0.001, Cohen's D (d) = 0.27). School caregivers' mental well-being was significantly higher after group-based CBT (B = 3.98, 95% CI = 0.22-7.47; P = 0.038, d = 0.25). Group-based CBT improved mental well-being among school caregivers, and phone-based CBT improved mental well-being among home caregivers. Interventions targeting school caregivers of children with disabilities should employ group settings and those targeting home caregivers should utilize peer-to-peer networks to enhance the caregivers' mental well-being. The study protocol was registered with UMIN Clinical Trials Registry (UMIN-CTR). Trial ID: UMIN000040912.

Extended treatment of multimodal cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder improves symptom reduction: a within-subject design.

Based on the current state of research regarding the treatment in pediatric obsessive-compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients' characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research. This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6-20years) with OCD (n = 38) within routine care. Effects on obsessive-compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons. During the standard treatment and extended treatment, obsessive-compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided. These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030050 ).

Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder

IntroductionGeneralized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR).Materials and methodsThis study included 66 participants (Mage = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ).ResultsBoth interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen’s d = 2.76) and worries (Cohen’s d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes.ConclusionThis research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.

Cognitive Behavioural Therapy for children and adolescents with intellectual disability and anxiety: a therapist manual

Up to 50% of children with intellectual disability (ID) have a comorbid mental illness, yet to date, there has been a lack of evidence-based treatments for this population. This paper discusses the development and application of the Fearless Me! © treatment program, a multimodal Cognitive Behavioural Therapy (CBT) intervention for children with mild to moderate ID and anxiety. The program development involved a review of the literature to identify the neuropsychological deficits present for children with ID and suggested ways in which therapy could be adapted for their needs. This was followed by gathering feedback from parents and mental health practitioners. From this, the Fearless Me! © program was developed, involving face-to-face sessions and an online component to support the practice of CBT skills. The program has been trialed among children and adolescents with ID, and shows promise in reducing anxiety in children with mild to moderate ID.

Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics

Chronic pain is a prevalent, disabling, and expensive pediatric condition. Specific treatment options have limited evidence and are often extrapolated from adult care. This review evaluates pain outcome measures, psychological treatment, pharmacologic management, multidisciplinary treatment models, and emerging topics in pediatric pain medicine. Multimodal cognitive behavioral therapy and intensive interdisciplinary pain treatment have the strongest evidence for improving pain and function while decreasing healthcare utilization. There is emerging evidence that parental involvement in care is an important factor in pediatric outcomes. While there is increased interest in emerging topics such as use of marijuana-derived products, acupuncture, and virtual reality, the evidence behind such interventions remains limited. Pediatric chronic pain treatment centers on the biopsychosocial model of pain and multidisciplinary treatment. Recent research shows that intensive interdisciplinary pain treatment can improve pain, function, and healthcare utilization. Long-term benefits and risks of emerging treatments in pediatric chronic pain remain poorly understood.

E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions.

E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions.

The rehabilitative role of motor imagery in the treatment of pain in fibromyalgia syndrome: Preliminary results

FM is a prototypical form of central sensitization syndrome that affects the dysregulation of mechanisms that normally govern pain sensation and should have to be treated in a multidisciplinary approach, which entails physical exercise, multimodal cognitive behavioral therapy, and pharmacological therapy. The aim of this research is to investigate whether a neurocognitive rehabilitative approach based on the use of motor imagery (MI) could be efficacy in reducing chronic pain in FM. Furthermore, as a secondary outcome, we assess the efficacy of MI on the improvement in the recognition and awareness respect pain by EEG. Ten females (mean age 51 ± 6.1 years) with FM were recruited and performed ten rehabilitation sessions, twice a week lasting one hour, using the motor imagery. The following evaluation scales were used at the baseline (T0), after treatment (T1) and after two months of follow-up (T2): the Fibromyalgia Impact Questionnaire (FIQ), the Visual Analogue Scale (VAS), the Fibromyalgia Assessment Status (FAS) and the Health Assessment Questionnaire (HAQ), the SF-12 was administered to assess the quality of life. The EEG was used to record cortical activation with respect to recognize pictures divided into “algic” and “non-algic”, versus a control group of healthy women. By Mann–Whitney test, at baseline, by EEG there is a statistically significant difference in the recognition of “algic” images compared to “non-algic” ones between the FM group and the healthy group ( P < 0.05): this difference is not found after the rehabilitative treatment. In the FM group there is a statistically significant improvement for FIQ, FAS, VAS ( P < 0.05) and SF-12. Follow-up dates are still ongoing. A neurocognitive rehabilitation approach with motor imagery improves the recognition and perception of pain in the FM patient and is efficacy in reducing pain and improving related symptoms.

The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness.

5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders. 112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life. In both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, p< 0.001; OR for MT versus TAU 1.05, 95% CI 0.58-1.90, p = 0.875). The improvement persisted 12 months after inclusion. In accordance with earlier studies, we found that manual-based multimodal treatment did not improve school avoidance to any greater extent than treatment as usual. Future studies should focus on the conditions for successful reintegration in school and on the differential indicators for outpatient versus inpatient treatment.

Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis.

Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT's effectiveness across delivery formats in primary care. To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care. A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants. Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multi-modal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37). The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT's economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.

Psychological therapies for the management of co-morbid depression following a spinal cord injury: A systematic review

The evidence about psychological therapies used to manage co-morbid depression after a spinal cord injury is presented here. A comprehensive search of five electronic databases identified nine studies (participants, n = 591) meeting inclusion criteria. Pooled statistical analyses were conducted in combination with narrative synthesis. Overall, multimodal cognitive behavioural therapy was found to be moderately effective (standardised mean difference = -0.52; 95% confidence interval = -0.85, -0.19). Activity scheduling, psychoeducation, problem solving and cognitive therapy may be particularly beneficial therapies within cognitive behavioural therapy. Further high-quality randomised controlled trials are needed to better substantiate these findings.

A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients

Head and neck cancer (HNC) patients have a high incidence of cancer-related posttraumatic stress disorder (PTSD) and other anxiety and depressive disorders. We report the results from the first pilot randomized controlled trial in which the efficacy of an early cognitive-behavioral therapy (CBT) program was compared with a non-directive supportive counseling (SC) intervention in reducing PTSD, general anxiety and depressive symptoms, and improving perceived quality of life in newly diagnosed, distressed HNC patients undergoing radiotherapy. Thirty-five HNC patients (mean age=54.8 years; 80% males) with elevated levels of PTSD, depression or anxiety were randomized to seven individual sessions of a multi-modal CBT or non-directive SC, concurrent with patients' radiotherapy. The SC intervention provided non-directive counseling support. PTSD, anxiety and depressive symptoms (primary outcomes), and cancer-related appraisals and quality of life (secondary outcomes) were assessed pre-intervention (baseline), 1 month, 6 months and 12 months post-intervention by diagnostic clinical interviews and validated self-report questionnaires. The CBT and SC interventions were found to be equal in their effects in reducing PTSD and anxiety symptoms both in the short and longer term. However, up to 67% of patients in the CBT program no longer met clinical or sub-clinical PTSD, anxiety and/or depression by 12 months post-treatment compared with 25% of patients who received SC. Findings indicate that the early provision of psychotherapy has utility in reducing PTSD, anxiety and depressive symptoms, and preventing chronic psychopathology in distressed HNC patients.

Update on fibromyalgia

IntroductionFibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep alterations, and distress. It affects at least 2% of the adult population. The etiology of FM is not completely understood, and the syndrome is influenced by stress, physical illness, and a variety of pain conditions. Emerging evidence indicates that augmented pain processing within the central nervous system plays a primary role in the pathophysiology of this disorder. Diagnosis may be difficult because of the multifaceted nature of the syndrome and its overlap with other chronically painful conditions. This article reviews the most recent data in the literature on FM.Materials and methodsThere are currently no instrumental tests or specific diagnostic markers for FM. In fact, many of the existing indicators are regarded as significant for research purposes only.ResultsDifferential diagnosis requires an extensive clinical examination and complete patient history. Chest-X-rays and abdominal ultrasonography are the first steps in the general evaluation of a patient with suspected FM.ConclusionsA variety of pharmacological treatments have been used to treat FM, including antidepressants, nonsteroidal anti-inflammatory drugs, opioids, sedatives, muscle relaxants, and antiepileptics. Physical exercise and multimodal cognitive-behavioral therapy seem to be the most widely accepted and beneficial forms of non-pharmacological therapy.

Update sulla fibromialgia

Summary Introduction Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep alterations, and distress. It affects at least 2% of the adult population. The etiology of FM is not completely understood, and the syndrome is influenced by stress, physical illness, and a variety of pain conditions. Emerging evidence indicates that augmented pain processing within the central nervous system plays a primary role in the pathophysiology of this disorder. Diagnosis may be difficult because of the multifaceted nature of the syndrome and its overlap with other chronically painful conditions. This article reviews the most recent data in the literature on FM. Materials and methods There are currently no instrumental tests or specific diagnostic markers for FM. In fact, many of the existing indicators are regarded as significant for research purposes only. Results Differential diagnosis requires an extensive clinical examination and complete patient history. Chest-X-rays and abdominal ultrasonography are the first steps in the general evaluation of a patient with suspected FM. Conclusions A variety of pharmacological treatments have been used to treat FM, including antidepressants, nonsteroidal anti-inflammatory drugs, opioids, sedatives, muscle relaxants, and antiepileptics. Physical exercise and multimodal cognitive-behavioral therapy seem to be the most widely accepted and beneficial forms of non-pharmacological therapy.

Multidisciplinary approach to fibromyalgia: What is the teaching?

Fibromyalgia (FM) is a rheumatic disease that is characterised by chronic musculoskeletal pain, stiffness, fatigue, sleep and mood disorder. FM patients demonstrate dysregulation of pain neurotransmitter function and experience a neurohormone-mediated association with sleep irregularities. There are currently no instrumental tests or specific diagnostic markers for FM, and many of the existing indicators are only significant for research purposes. Anti-depressants, non-steroidal anti-inflammatory drugs (NSAIDS), opioids, sedatives, muscle relaxants and antiepileptics have all been used to treat FM with varying results. It has been shown that interdisciplinary treatment programmes lead to greater improvements in subjective pain and function than monotherapies. Physical exercise and multimodal cognitive behavioural therapy are the most widely accepted and beneficial forms of non-pharmacological therapy.

Psychological treatments for pediatric headache

Headache is the most common pain problem in children and adolescents and, in a considerable proportion, a source of suffering and disability. Medical intervention mainly relies on abortive pharmacological agents (analgesics and antimigraine drugs). Psychological therapies aim at the prevention of headache episodes and the modifications of cognitive–emotional and cognitive–behavioral processes influencing pain. Three main forms of therapy have been evaluated in randomized controlled trials and reviewed in meta-analyses: relaxation training, biofeedback and multimodal cognitive–behavioral therapy. So far there is only scarce evidence on hypnosis and acceptance and commitment therapy, although they seem to be promising. Evidence demonstrates that psychological therapies are efficacious, and that clinically relevant improvement is found in approximately 70% of the treated children at follow-up examination. Future research needs to focus on mechanisms of change, and to extend its view of effects induced by therapy beyond headache improvement to indicators of quality of life.

Treatment of insomnia in adults and children: a practice‐friendly review of research

Chronic insomnia affects nearly 16% of adults and up to 25% of children. Many clinicians are unfamiliar with the research and practice of psychological treatments of insomnia and thus do not use them with their patients. The primary goals of this article were to (a) review the research support for psychological treatments of adult and child insomnia, and (b) describe those treatments with the highest level of research support in enough detail to allow practitioners to begin to utilize them with their own patients. The adult psychological treatments with the best research support are stimulus control, progressive muscle relaxation, and multimodal cognitive-behavioral therapy, followed by multimodal behavioral therapy, sleep restriction, biofeedback, and paradoxical intention. The child psychological treatments with the highest level of research support are preventive parent education, unmodified extinction, and extinction with parental presence, followed by graduated extinction, bedtime fading/positive routines, and scheduled awakenings.

Neuroendocrine therapy of fibromyalgia syndrome: an update

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep alterations, and distress. Emerging evidence points toward augmented pain processing within the central nervous system as having a primary role in the pathophysiology of this disorder. Recent studies have identified distinct FM subgroups on the basis of clinical, neurochemical, and neuroendocrinological abnormalities, including increased cerebrospinal fluid levels of substance P and excitatory amino acids and functional abnormalities in the hypothalamic-pituitary-adrenal axis, and sympathoadrenal (autonomic nervous) system. Pharmacological treatments have been gradually enriched by a variety of compounds. Antidepressants, nonsteroidal anti-inflammatory drugs, opioids, sedatives, muscle relaxants, and alpha2-delta agonists have all been used to treat FM with varying results. Physical exercise and multimodal cognitive-behavioral therapy seem to be the most widely accepted and beneficial forms of nonpharmacological therapy. Studies predicting treatment response indicate that it is useful if not essential to tailor the choice of treatment components to the needs of individual patients.

The Effectiveness of Geropsychological Treatment in Improving Pain, Depression, Behavioral Disturbances, Functional Disability, and Health Care Utilization in Long-Term Care

Geropsychological interventions have become a necessary component of quality long-term care (LTC) designed to address residents' co-morbidities involving emotional, functional, and behavioral difficulties. However, there are few empirical studies of the efficacy of comprehensive geropsychological treatment in LTC. This two-part study was conducted to investigate the impact of Multimodal Cognitive-Behavioral Therapy (MCBT) for the treatment of pain, depression, behavioral dysfunction, functional disability, and health care utilization in a sample of cognitively impaired LTC residents who were suffering from persistent pain. In Study 1, forty-four consecutive new patients received a comprehensive psychological evaluation, eight sessions of cognitive-behavioral therapy, and follow-up psychological evaluation over a five-week period. Analyses indicated that patients exhibited significant reductions in pain, activity interference due to pain, emotional distress due to pain, depression, and significant increases in most activities of daily living. They also exhibited significant reductions in the intensity, frequency, and duration of their behavioral disturbances, but not the number of behavioral disturbances. In Study 2, as a follow-up to Study 1, a retrospective chart review was conducted to compare the treatment group with a matched-control group on post-treatment health care utilization. Comparisons between the two groups on Minimum Data Set (MDS) ratings indicated that the treatment group required significantly fewer physician visits and change orders than the control group. Implications of these collective findings are that geropsychological treatment is likely to improve certain aspects of residents' quality of life in LTC. Further research and development of assessment instruments that are designed specifically for the LTC population would enhance the outcome measurement procedures currently in place in LTC settings.

Treatment of Compulsive Hoarding

Compulsive hoarding and saving symptoms, found in many patients who have obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to antiobsessional medications and cognitive-behavioral therapy (CBT). Specific CBT strategies targeting the characteristic features of the compulsive hoarding syndrome have had better results. This article provides an overview of the compulsive hoarding syndrome, a review of treatment approaches and their efficacy, a case presentation, and a detailed discussion of intensive, multimodal CBT for compulsive hoarding. New insights into the neurobiological characteristics of compulsive hoarding that might direct future treatment development are also presented. (Reprinted with permission from the Journal of Clinical Psychology 2004; 60(11): 1143–1154)