Cognitive Behavioral Therapy Outcome Research Articles

Moderators of outcome in self-guided internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder

Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). Currently there is limited research examining the predictors and moderators of outcome in ICBT for OCD. This study examined moderators of treatment outcome in a sample of 216 individuals who commenced a self-guided ICBT intervention for OCD (Mage = 34.00; SD = 12.57; 72.7% female). The results indicated that those with higher baseline OCD severity, depression severity, and neuroticism had less improvement at post-treatment and follow up (resulting in 40%, 24% and 12% higher symptom severity for every standard deviation increase on the measure at post-treatment and 33%, 17% and 20% higher symptoms at follow up respectively). However, participants with higher baseline treatment expectancy and readiness to reduce rituals and compulsions had better outcomes at post-treatment and three-month follow up (resulting in a 5% and 7% lower symptom severity for every standard deviation increase on the measure at post-treatment and 12% and 12% lower symptoms at follow up respectively). The results have important implications for who may respond best to self-guided ICBT.

Methodological choices and clinical usefulness for machine learning predictions of outcome in Internet-based cognitive behavioural therapy

BackgroundWhile psychological treatments are effective, a substantial portion of patients do not benefit enough. Early identification of those may allow for adaptive treatment strategies and improved outcomes. We aimed to evaluate the clinical usefulness of machine-learning (ML) models predicting outcomes in Internet-based Cognitive Behavioural Therapy, to compare ML-related methodological choices, and guide future use of these.MethodsEighty main models were compared. Baseline variables, weekly symptoms, and treatment activity were used to predict treatment outcomes in a dataset of 6695 patients from regular care.ResultsWe show that the best models use handpicked predictors and impute missing data. No ML algorithm shows clear superiority. They have a mean balanced accuracy of 78.1% at treatment week four, closely matched by regression (77.8%).ConclusionsML surpasses the benchmark for clinical usefulness (67%). Advanced and simple models perform equally, indicating a need for more data or smarter methodological designs to confirm advantages of ML.

A - 142 Exploratory Analysis of the Cognitive Outcomes of Cognitive Behavioral Therapy for Insomnia (CBT-I) in Patients with Primary Brain Tumor

Abstract Objective Patients with primary brain tumor (PBT) experience declines in cognitive functioning and frequently endorse sleep disturbance. Our single-arm proof-of-concept trial of Cognitive Behavioral Therapy for Insomnia (CBT-I) in patients with PBT demonstrated clinically significant improvements in self-reported insomnia symptoms. The present study explored changes in patients’ subjective and objective cognitive functioning following completion of the six-week CBT-I intervention. Methods Participants with PBT and clinical insomnia (N = 35; Mage = 51.6 ± 11 years; 54.03 female) enrolled in a 6-week group-based telehealth CBT-I intervention. Participants completed pre-post-intervention subjective and objective cognitive assessments (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]; Hopkins Verbal Learning Test–Revised [HVLT-R], Oral Trail Making Test-B [OTMT-B], and Controlled Word Association Test [COWAT]). Within-group cognitive change was examined using established minimally important differences and reliable change indices. Results All participants demonstrated clinically stable subjective cognitive functioning from pre-to-post intervention. Individual analyses showed that 32 participants (91.4%) demonstrated clinically stable or improved verbal memory, 30 participants (85.7%) demonstrated clinically stable or improved divided attention, and all participants (100%) demonstrated clinically stable or improved phonemic fluency. Few participants demonstrated clinically significant decline in verbal memory (n = 2, 5.7%) or divided attention (n = 5, 14.3%). Conclusions Changes in both subjective and objective cognitive functioning were predominantly positive following a behavioral intervention for insomnia (CBT-I) among patients with PBT; however, these results should be viewed as preliminary. We will more thoroughly examine cognitive outcomes with a longer follow-up period in an upcoming randomized pilot trial of CBT-I in PBT.

Hair cortisol and psychiatric symptomatology in children; outcomes of group CBT

The associations between hair cortisol concentration (HCC), a biomarker of chronic stress, and behavior and sleep disturbance symptoms have not been studied in children with psychiatric disorders. While cognitive behavioral therapy (CBT) has proven effective in treating psychiatric symptoms in children, its potential biological implications as determined by HCC have not been investigated. We explored associations between HCC, behavior and sleep disturbance symptoms, and different diagnostic groupings (depression/anxiety, ADHD, or other types of psychiatric disorders) in clinician-diagnosed 6-12-year-old children (n = 100) with mixed psychiatric disorders and comorbidities. In addition, we examined whether group CBT led to changes in HCC, behavior symptoms, and sleep disturbance symptoms and whether any fluctuations in HCC levels were associated with potential symptom change. We collected data on HCC, internalizing and externalizing symptoms (The Spence Children's Anxiety Self-Report, Child Behavior Checklist, and Teacher Report Form), and sleep disturbance symptoms (The Sleep Disturbance Scale for Children) at three time points (baseline, post-treatment, and seven-month follow-up). Baseline HCC was not associated with behavior or sleep disturbance symptoms, whereas behavior and sleep disturbance symptoms were mutually correlated. No changes in HCC levels were observed with group CBT. Moreover, potential variations in HCC levels over the course of the study did not appear to be associated with behavior symptom relief after group CBT. Our findings suggest that HCC may not be a methodologically relevant biomarker of behavior or sleep disturbance symptoms in children with diverse psychiatric disorders.

Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis.

Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.PROSPERO [CRD42023441794].

Online CBT Versus Standard CBT for Pediatric Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD), characterized by recurring obsessions and compulsions, affects 1-3% of the childhood population, often leading to severe impairment and reduced quality of life. Cognitive behavioral therapy (CBT) is well-documented as first choice treatment for pediatric OCD. Traditionally delivered face-to-face CBT has limitations in terms of accessibility, availability, and quality of delivery. Online CBT using video conferencing (online-CBT) at home aims to address some of these barriers. In this pilot study, we aimed to compare acceptability, feasibility and effectiveness of online CBT against face-to-face CBT. Online CBT outcomes of 29 children with OCD were analyzed benchmarked against outcomes of face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest CBT follow up study in pediatric OCD to date. Acceptability rated by online CBT participants and their parents was very high (Client Satisfaction Questionnaire total scores about 30, range 8-32). Feasibility assessed as dropout rate was comparable to NordLOTS (10.3% versus 9.7%). The online CBT group compared to NordLOTS showed a higher response rate (90% versus 60%; p = .002) and remission rate (81% versus 53%; p = .231). Our results suggest that the trusting therapeutic relationship necessary for demanding exposure-based treatment can be established by online CBT. Online CBT seems to be at least as effective in reducing OCD symptoms than standard CBT. Trial ID: ISRCTN37530113.

Group cohesion and alliance predict cognitive-behavioral group treatment outcomes for youth with anxiety disorders

ABSTRACT Knowledge about how to enhance group cognitive behavioral therapy (GCBT) outcomes is needed. In a randomized controlled effectiveness trial, we examined group cohesion (the bond between group members) and the alliance (the client-clinician bond) as predictors of GCBT outcomes. The sample was 88 youth (M age 11.7 years, SD = 2.1; 54.5% girls; 90.7% White) with anxiety disorders. Observers rated group cohesion and alliance in 32 sessions from 16 groups. We examined early group cohesion and alliance (r = .50, p < .001) and group cohesion and alliance change from early to late in treatment in relation to outcomes using generalized estimation equations accounting for nesting within groups (ICCs .31 to .55). The outcomes were diagnostic recovery, clinical severity, and parent- and youth-reported anxiety symptoms, each at post-treatment, 12-months, and 4-years follow-up. There were more significant associations with 4-years follow-up than earlier outcomes. Clinical severity and parent-reported anxiety symptoms were more frequently predicted than diagnostic recovery. Clinician- and parent-reported outcomes were far more frequently significantly predicted by cohesion and alliance than youth-rated outcomes. We conclude that group cohesion and alliance are related but distinct variables, both associated with some GCBT outcomes for as long as 4 years after treatment.

Benefits of Cognitive Behavior Therapy with Neuroscience-informed Psychoeducation in Young Adult Patients: A Preliminary Study

Background: Psychoeducation often is a recommended augmentation for cognitive behavior therapy (CBT) to enhance patients’ understanding of their clinical condition. But despite providing psychoeducation, there might be a lack of insightful engagement in the therapy process on the part of patients, affecting the therapy outcome. While there are neuroscience-informed psychoeducation models for addiction, there is rarely any literature on neuroscience-informed psychoeducation for CBT. It is postulated that a neuroscience-informed module of psychoeducation can bring better acceptance of CBT and improve its outcome. Methods: In this study, we used a pre- and poststudy design. Using purposive sampling, 30 consecutive young adult patients presented themselves with symptoms of depression and anxiety to receive standard CBT module. Fifteen of these received the CBT module with generic psychoeducation detailing the etiology, signs and symptoms, and treatment requirements for their condition. The other 15 received neuroscience-informed psychoeducation modules having specific inputs about the generic functioning of the human brain, the neuropsychological changes, and processes in the brain during and due to the psychotherapy (CBT) process. Acceptance and outcome of CBT were measured through changes in symptom rating as well as individual feedback, sentiment analysis of the feedback statements, and word cloud. Results: Participants of both the psychoeducation model groups – conventional psychoeducation (p &lt; 0.001) and neuroscience-informed psychoeducation group (p &lt; 0.001) – were found to have significant improvement in their clinical symptoms of the pre- and posttest scores. But the neuroscience-based psychoeducation group was better compliant to sessions and had better follow-up rates compared to conventional psychoeducation. Sentiment analysis of the feedback revealed a higher volume of sentiments in neuroscience-informed group. Conclusion: Neuroscience-based psychoeducation has the potential of changing perception and enhancing the credibility of CBT and can bring better acceptance and outcome for the CBT process.

The Association Between Individual Differences in Motivational Readiness at Entry to Treatment and Treatment Attendance and Outcome in Cognitive Behaviour Therapy: A Systematic Review

Abstract Background There is considerable interest in identifying factors that predict outcome from psychological treatment. This review examines the relationship between readiness / stage of change at entry to CBT treatment and treatment attendance or outcome in people with mental health problems other than addiction. Methods Four databases: PsycINFO; MEDLINE; Embase and CINAHL were searched to identify relevant studies published in English from 1st January 1980 onwards. Following title and abstract screening, and full text review of potentially eligible studies, a total of 22 eligible studies were identified, of which 21 were included in the narrative synthesis. The review was registered on PROSPERO REF: CRD42020209173. Results Nineteen studies explored the relationship between readiness and symptom outcome, with a majority (n = 13) identifying at least one statistically significant relationship between variables, either directly or in interaction with another measure. A number of these also tested other associations which were non-significant. In contrast, five studies explored the association between readiness and treatment attendance, and findings were inconclusive. Conclusions The systematic review found some evidence suggesting that readiness is linked to symptom outcome in CBT, regardless of the type of clinical problem or readiness measure used. The studies adopting an RCT design identified no evidence of differences in the relationship between readiness and outcome when comparing CBT to other psychotherapeutic interventions. Study quality was variable, and a range of methodological limitations and potential avenues for future work are discussed.

The relationship between Cognitive Behavior Therapy (CBT) and Depression treatment outcomes: A review of literature

Depression or depressive disorder is the common mental disorder. It affects the day-to-day life of the person and impact the outcomes at the workplace. As per WHO data, 3.8% of the world population experience depression. Suicidal attempts are also very high among depressed people. Around 75% of depression suffering population don’t receive any treatment. Due to social stigma, lack of mental health professionals and economical barriers only a few portions of the population receive psychotherapies. The current study reviews the literature related to cognitive behavior therapy outcomes analysis. No direct data collection methods are used in the study, it only reviews the literature to analyze the outcomes of CBT in depression treatment. The qualitative analysis methods were used to compare the data and draw conclusions. It concludes that CBT is efficacious in the acute treatment of depressive disorder.

Unraveling School Adolescent Depression: Insights into Cognitive Behavioral Therapy

Adolescent depression presents a significant global mental health concern, exerting profound impacts on various facets of young people's lives. Cognitive Behavioral Therapy (CBT) has emerged as a leading intervention for tackling adolescent depression, grounded in principles derived from cognitive theory. This review delves into the effectiveness, mechanisms, and outcomes of CBT in addressing adolescent depression, synthesizing findings from a range of empirical studies including randomized controlled trials, meta-analyses, and systematic reviews. The review underscores the consistent efficacy of CBT in diminishing depressive symptoms among adolescents, elucidating mechanisms such as cognitive restructuring and behavioral activation that underpin its therapeutic effects. Additionally, CBT yields favorable outcomes beyond mere symptom reduction, encompassing enhancements in social connections and academic performance. Nonetheless, challenges such as limited accessibility and hurdles in engaging adolescents persist in CBT implementation. To surmount these obstacles, forthcoming research ought to concentrate on devising innovative delivery approaches, such as internet-based interventions and school-centered programs. In essence, CBT stands as a pivotal component in the treatment of adolescent depression, furnishing a holistic framework to address the intricate interplay of cognitive, emotional, and behavioral elements, thereby fostering the mental well-being of adolescents on a global scale.

CBT Intervention Post-2023 Southeast Türkiye Quake: A Case Study

This case study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) in treating Post-Traumatic Stress Disorder (PTSD) in an individual survivor of the catastrophic 2023 Southeast Türkiye Earthquake. The study aims to provide detailed insights into the therapeutic process and outcomes of CBT applied in a post-disaster context. A 38-year-old female survivor, pseudonymously named Serpil, participated in an eight-week structured CBT program specifically tailored to address her severe PTSD symptoms following the earthquake. The therapeutic interventions included exposure therapy, cognitive restructuring, and relaxation techniques. Data collection was achieved using quantitative methods such as the Clinician-Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI), supplemented by qualitative assessments through detailed therapy session notes and Serpil’s personal reflections. The intervention led to significant improvements in Serpil's PTSD symptoms, particularly a reduction in the frequency and severity of nightmares and flashbacks. Serpil reported enhanced coping mechanisms, which improved her overall psychological resilience and functionality. The data illustrate a notable decrease in PTSD symptomatology, corroborated by scores from CAPS and BDI, indicating an overall improvement in mental health and quality of life. This case study underscores the potential of CBT as a potent intervention for managing PTSD in survivors of natural disasters. It highlights the necessity of integrating specialized psychotherapeutic techniques in disaster response initiatives to address the psychological impacts effectively. The findings advocate for broader implementation and evaluation of similar interventions across diverse post-disaster settings to confirm these results and optimize treatment protocols. Further research with larger sample sizes and longer follow-up periods is recommended to enhance the generalizability and understanding of CBT's long-term effectiveness in disaster-stricken populations.

Predictors of outcome in self-guided internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder: A preliminary investigation.

Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (Mage = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F(8, 148) = 15.844, p < .001) and completer sample (F(8, 101) = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.

The effect of sleep hygiene education for improving sleep quality among patients with stroke: A systematic review

Background: One of the problems experienced by stroke sufferers is sleep problems. Stroke patients report having difficulty sleeping about 50% of the time in the early months after a stroke. Cognitive behavioral therapy (CBT) including sleep hygiene, controlling environmental stimuli, sleep restriction, positioning therapy, and educational management are some of the methods used to treat sleep problems. Purpose: To determine sleep hygiene education on the outcomes of cognitive behavioral therapy in stroke patients with sleep disorders. Method: Systematic review research using the Covidence application in the data extraction process. The framework used in this paper uses PICO, so the researchers set the research question in this systematic review as "Is sleep hygiene more effective than no sleep hygiene for sleep disorders in stroke patients?". Literature searches were carried out from Scopus, Wiley, Sciencedirect, Sage, Embase, Pubmed, Proquest and Medline for articles published up to March 19, 2023. Results: Three articles were included in this systematic review. All three articles provide sleep hygiene education on sleep-related cognitive behavioral therapy to help improve sleep disorders after stroke. Conclusion: Sleep hygiene education in cognitive behavioral therapy significantly improves sleep quality in stroke patients, but long-term studies are needed to test further significance.

Lack of evidence for predictive utility from resting state fMRI data for individual exposure-based cognitive behavioral therapy outcomes: A machine learning study in two large multi-site samples in anxiety disorders

Data-based predictions of individual Cognitive Behavioral Therapy (CBT) treatment response are a fundamental step towards precision medicine. Past studies demonstrated only moderate prediction accuracy (i.e. ability to discriminate between responders and non-responders of a given treatment) when using clinical routine data such as demographic and questionnaire data, while neuroimaging data achieved superior prediction accuracy. However, these studies may be considerably biased due to very limited sample sizes and bias-prone methodology. Adequately powered and cross-validated samples are a prerequisite to evaluate predictive performance and to identify the most promising predictors. We therefore analyzed resting state functional magnet resonance imaging (rs-fMRI) data from two large clinical trials to test whether functional neuroimaging data continues to provide good prediction accuracy in much larger samples. Data came from two distinct German multicenter studies on exposure-based CBT for anxiety disorders, the Protect-AD and SpiderVR studies. We separately and independently preprocessed baseline rs-fMRI data from n = 220 patients (Protect-AD) and n = 190 patients (SpiderVR) and extracted a variety of features, including ROI-to-ROI and edge-functional connectivity, sliding-windows, and graph measures. Including these features in sophisticated machine learning pipelines, we found that predictions of individual outcomes never significantly differed from chance level, even when conducting a range of exploratory post-hoc analyses. Moreover, resting state data never provided prediction accuracy beyond the sociodemographic and clinical data. The analyses were independent of each other in terms of selecting methods to process resting state data for prediction input as well as in the used parameters of the machine learning pipelines, corroborating the external validity of the results. These similar findings in two independent studies, analyzed separately, urge caution regarding the interpretation of promising prediction results based on neuroimaging data from small samples and emphasizes that some of the prediction accuracies from previous studies may result from overestimation due to homogeneous data and weak cross-validation schemes. The promise of resting-state neuroimaging data to play an important role in the prediction of CBT treatment outcomes in patients with anxiety disorders remains yet to be delivered.

The influence of pretreatment respiratory sinus arrhythmia dimensions on trauma-focused cognitive behavioral therapy outcomes: Findings from a randomized controlled feasibility trial.

Child maltreatment is associated with respiratory sinus arrhythmia (RSA) dysregulation, a physiological indicator of emotion regulation that predicts elevated posttraumatic stress disorder (PTSD) symptoms and may be a mechanism of action for exposure-based therapies, such as trauma-focused cognitive behavioral therapy (TF-CBT). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT for improving emotion regulation following maltreatment. The current study reports findings from a randomized controlled feasibility trial (N = 33; Mage = 11.79 years, SD = 3.08; 63.6% White; 66.7% female) that measured youths' resting RSA, RSA reactivity, and RSA recovery in response to a pretreatment laboratory challenge. We tested whether (a) lower pretreatment resting RSA was associated with blunted RSA during the challenge; (b) either of the pretreatment RSA dimensions predicted more severe pretreatment PTSD symptoms; and (c) either of the pretreatment RSA dimensions predicted less severe posttreatment PTSD symptoms and, as an exploratory aim, whether this was moderated by treatment group (i.e., TF-CBT vs. TF-CBT + AAT). Results from multiple linear regression indicated that, after controlling for pretreatment symptom severity, there was a large effect size for higher resting RSA predicting less severe caregiver-reported posttreatment PTSD symptoms, β = -.52, p =.058, and higher RSA during recovery predicting less severe child-reported posttreatment PTSD symptoms, β = -.70, p =.056, although these findings were not significant. These preliminary results offer important insights for future studies to investigate how the ability to regulate RSA informs which children need additional support to benefit from psychotherapeutic treatment.

Partner symptom accommodation in generalized anxiety disorder: a preliminary examination of correlates with symptoms and cognitive behavioural therapy outcome.

Symptom accommodation is suggested to maintain anxiety pathology and interfere with treatment effectiveness for anxiety and related disorders. However, little is known about symptom accommodation in generalized anxiety disorder (GAD). This study investigated the associations between romantic partner symptom accommodation, GAD symptoms, intolerance of uncertainty (IU), relationship satisfaction, and cognitive behavioural therapy (CBT) outcomes from the perspective of the person with GAD. One hundred and twelve people with GAD participated in group CBT and completed measures at pre- and post-treatment. All participants endorsed that their partner engaged in symptom accommodation to some extent, and the most commonly endorsed type was providing reassurance. Greater self-reported partner symptom accommodation was associated with greater GAD symptoms, chronic worry severity, IU, and relationship satisfaction at baseline. Partner symptom accommodation was found to significantly decrease over treatment; however, less improvement in symptom accommodation from pre- to post-treatment was associated with worse treatment outcomes. This study is the first to show that partner symptom accommodation is prevalent in adults with GAD and to elucidate the presentation and frequency of behaviours. The findings provide preliminary evidence that targeting partner symptom accommodation in treatment may improve CBT outcomes.

The Current State of Evidence Regarding Audiologist-Provided Cognitive Behavioural Therapy for the Management of Tinnitus: A Scoping Review.

Cognitive behavioural therapy (CBT) for tinnitus management is effective and widely recommended by national and international practice guidelines. However, all the evidence for CBT so far has come from Psychologist-led programs, and the potential role of Audiologists in providing CBT for tinnitus remains an important consideration. This study sets out to systematically map the body of literature relating to Audiologist-provided CBT for tinnitus, in order to summarise the current state of evidence and determine directions for future research. Sources were eligible for inclusion if they addressed the concept of Audiologist-provided CBT. No restrictions were imposed on the date of publication. Only sources published in English were included. A wide range of primary and secondary literature sources were sought. Data from included sources were charted systematically using a pre-designed data charting form. Of the 267 identified sources, 30 were included in this review. This included both primary and secondary literature sources. Primary sources were compared and showed variation across Audiologist-provided CBT programs both in terms of procedural details and from a research standpoint. A growing body of evidence has addressed the concept of Audiologist-provided CBT. Directions for future research include further primary research with an increased focus on face-to-face Audiologist-provided CBT, and a comparison of the outcomes of Audiologist-provided vs. Psychologist-provided CBT.

Perceived Physical Health and Cognitive Behavioral Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression

Physical diseases co-occur with late-life depression (LLD). The influence of physical diseases and the subjective perception of physical health (PPH) on treatment outcome in LLD, however, is not well understood. To assess the association of physical diseases and PPH with the outcomes of 2 different types of psychotherapy in LLD. This post hoc secondary analysis of a multicenter, observer-blinded, controlled, parallel-group randomized clinical trial assessed participants 60 years or older with moderate to severe depression recruited at 7 psychiatric-psychotherapeutic outpatient trial sites in Germany from October 1, 2018, to November 11, 2020. Data analysis was performed from April 1 to October 31, 2023. Patients received LLD-specific cognitive behavioral therapy (LLD-CBT) or supportive unspecific intervention (SUI). Depression severity, response, and remission were measured during treatment and at 6-month follow-up by the change in the 30-item Geriatric Depression Scale (GDS) score. Physical health and PPH were assessed by the number of physical diseases, Charlson Comorbidity Index (CCI), and the World Health Organization Quality of Life Brief Version physical health subscale. A total of 251 patients were randomized to LLD-CBT (n = 126) or SUI (n = 125), of whom 229 (mean [SD] age, 70.2 [7.1] years; 151 [66%] female) were included in the intention-to-treat analysis. Patients with low and moderate PPH at baseline had significantly less reduction in the GDS score across both treatment groups than patients with high PPH (estimated marginal mean difference [EMMD], 2.67; 95% CI, 0.37-4.97; P = .02 for low PPH and EMMD, 1.82; 95% CI, 0.22-3.42; P = .03 for moderate vs high PPH). Higher PPH at baseline was associated with higher likelihood of response (odds ratio [OR], 1.04; 95% CI, 1.00-1.06; P = .009) and remission at the end of treatment (OR, 1.04; 95% CI, 1.02-1.08; P = .002) and response (OR, 1.05; 95% CI, 1.02-1.08; P < .001) and remission at follow-up (OR, 1.06; 95% CI, 1.03-1.10; P < .001) across both treatment groups. However, a significant interaction of PPH with treatment group was observed with low PPH at baseline being associated with significantly larger reduction in GDS scores in SUI compared with LLD-CBT at the end of treatment (EMMD, -6.48; 95% CI, -11.31 to -1.64; P = .009) and follow-up (EMMD, -6.49; 95% CI, -11.51 to -1.47; P = .01). In contrast, patients with high PPH at baseline had a significantly greater reduction in GDS scores in LLD-CBT compared with SUI at all time points (week 5: EMMD, -4.08; 95% CI, -6.49 to -1.67; P = .001; end-of-treatment: EMMD, -3.67; 95% CI, -6.72 to -0.61; P = .02; and follow-up: EMMD, -3.57; 95% CI, -6.63 to -0.51; P = .02). The number of physical diseases or CCI at baseline did not have an effect on the change in GDS score, response, or remission, neither across both groups nor within either group. In this secondary analysis of a randomized clinical trial, subjective PPH was associated with treatment outcome, response, and remission in psychotherapy of LLD. Patients with LLD responded differently to LLD-CBT and SUI, depending on their baseline PPH score. Treatment approaches for patients with LLD should address PPH in personalized interventions. ClinicalTrials.gov Identifier: NCT03735576; Deutsches Register Klinischer Studien Identifier: DRKS00013769.