Patient Workbook Research Articles

Interactive CBT for headache and relaxation training (iCHART): Study protocol of a single-arm trial of interactive voice response technology delivery of cognitive-behavioral therapy for Veterans with post-traumatic headache

Background: Post-traumatic headache (PTH) is persistent and highly disabling. Cognitive-behavioral therapy for headache (CBT-HA) reduces headache frequency and severity and improves people’s quality of life, yet it is underutilized and inaccessible to many. Leveraging technology to deliver evidence-based psychological treatments for headache may address barriers to treatment engagement. Methods/design: This single-arm, single-site pilot trial aims to test the feasibility, acceptability, clinical signal, and cost of a five-session CBT-HA intervention delivered via interactive voice response technology (IVR). Participants will include 35 Veterans with PTH receiving care within VA Connecticut Healthcare System. Participants will complete an intake interview and a 9-item, 30-day electronic headache diary during a baseline run-in period. The same diary will be done again by participants immediately after treatment completion. Following the baseline assessment period, eligible participants will receive CBT-HA via IVR for 10 weeks, including an automated daily assessment of patient-reported outcomes and retrieval of biweekly tailored feedback from a study therapist. In addition, participants will access an electronic patient workbook, and study therapists will visualize patient-reported data through a secure provider dashboard. Participants will complete validated and reliable assessment measures at baseline, immediately post-treatment completion (week 10), and 1-month post-treatment completion (week 14). The primary clinical signal outcome is the change in self-reported headache days from the 30-day baseline run-in period before treatment (weeks −4 to 0) to the 30-day post-treatment completion (weeks 10–14). Paired-samples t-tests will explore changes in outcomes from baseline. All cost analyses will be exploratory and will use micro-costing techniques. Trial Registration: Clinical Trials.gov: NCT05093556. Registered October 26, 2021.

Patient engagement in the development of CF-CBT: A cystic fibrosis-specific cognitive-behavioral intervention for adults.

Individuals with cystic fibrosis (CF) are at high risk for depression and anxiety, with negative consequences for health and quality of life. Cystic Fibrosis Foundation/European Cystic Fibrosis Society guidelines recommend routine screening, treatment, and preventative efforts. Cognitive-behavioral therapy (CBT) has a large evidence-base for depression/anxiety prevention and treatment. However, traditional CBT protocols require adaptation to address the emotional challenges of coping with CF, stressors related to disease management, and barriers to access to care. The goal of this study was to partner with the CF community to develop an innovative CBT-based intervention for the prevention and treatment of depression and anxiety tailored to CF-specific needs. In-depth feedback was collected via audio-recorded telephone interviews with 16 adults with CF from 3 U.S. CF centers, with purposive sampling across gender, age, ethnicity, and disease severity. A semi-structured interview guide elicited discussion of patient experiences of coping with CF, and perspectives on the acceptability of the content, structure, and delivery model of the proposed intervention. Qualitative analysis utilized a content analytic approach. Participants ranged from 21 to 53 years (M = 35); eight were female; three were Hispanic. Patient-reported most recent FEV1, a measure of lung function based on forced expiratory volume in in one second, ranged from 25 to 113% predicted (M = 72). One participant was post-double lung transplant. Qualitative interviews were analyzed thematically revealing core themes related to the experience of coping with CF. The most frequently cited CF-related stressors were Treatment Burden, Illness Uncertainty, and Financial/Insurance Stress. Participants talked about the interaction of physical symptoms and emotional distress in their daily lives, a topic not typically discussed in routine CF care. Resilience was also a major theme with participants describing strategies they use to cope with CF and hospitalizations. Description of patients’ experiences was incorporated into the program’s intervention manual and patient workbook. Participants also provided direct feedback on the proposed program. Feedback was largely positive regarding program content and structure, suggesting the acceptability of a CF-specific CBT-based intervention for adults with CF. Features to increase accessibility of care including telehealth, inpatient delivery, and team-based care were perceived as advantageous, and participants emphasized the value of a CF-specific mental health intervention. Qualitative findings directly informed the development of CF-CBT, a cognitive-behavioral skills-based program to promote emotional well-being for adults with CF.

The feasibility and acceptability of a brief psychological intervention for adults with long-term health conditions and subthreshold depression delivered via community pharmacies: a mixed methods evaluation\u2014the Community Pharmacies Mood Intervention Study (CHEMIST)

BackgroundAdults with long-term health conditions (LTCs) are more likely to experience depressive symptoms which can worsen health outcomes and quality of life, and increase healthcare costs. Subthreshold depression may go undetected and/or untreated.The Community Pharmacies Mood Intervention Study (CHEMIST) explored whether community pharmacies represent a suitable setting to offer brief psychological support to people with LTCs and comorbid subthreshold depression.MethodsA feasibility intervention study with a nested mixed methods evaluation was employed. Adults with subthreshold depression and a minimum of one LTC were recruited from community pharmacies/local general practices and offered a brief psychological support intervention (‘Enhanced Support Intervention’ (ESI)), based on behavioural activation within a Collaborative Care framework. The intervention included up to six sessions supported by pharmacy staff (‘ESI facilitators’) trained to deliver the ESI within the community pharmacy setting.Recruitment, retention rates and engagement with the ESI were assessed. Semi-structured, one-to-one interviews with pharmacy staff and study participants, and a focus group with pharmacy staff, explored experiences and acceptability of the study and the ESI. Themes were mapped onto constructs of the Theoretical Framework of Acceptability.ResultsRecruitment of ESI participants was challenging and slower than anticipated despite the varied methods of recruitment employed; although, this was useful in identifying barriers and enabling factors for participation. Engagament with the ESI was good with n=17 (71%) recruited participants commencing the ESI. The ESI was found to be acceptable to participants and ESI facilitators. Retention rate at 4 months was good n=20 (87.0%).The main barriers to identifying potential participants for pharmacy staff were lack of time, resources and limited experience in research. The ESI training and support manual were acceptable to ESI facilitators. The ESI and supporting patient workbook were acceptable to people with LTCs and subthreshold depression.ConclusionsCommunity pharmacies were viewed as an acceptable setting in which to deliver preventative brief psychological support to people with LTCs at risk of depression.This feasibility study provided important data to inform the design of a pilot randomised controlled trial in this setting and highlighted important considerations for future pharmacy-based research.Trial registrationISRCTN11290592

A method for co-creation of an evidence-based patient workbook to address alcohol use when quitting smoking in primary care: a case study

Plain English summaryThe purpose of this paper is to describe a patient engagement event designed to create an educational workbook with smokers who drink alcohol at harmful levels. The goal was to create a workbook that combined scientific evidence with patients’ values, preferences, and needs. Fourteen adult smokers who drink alcohol were invited to the Centre for Addiction and Mental Health (CAMH) to take part in a four-hour event to help design the workbook with the CAMH research team. Participants provided their opinions and ideas to create an outline for the workbook, including activities, images, and titles. The workbook – called Self-Awareness – is currently being offered in a smoking cessation program in 221 primary care clinics across Ontario to help smokers quit or reduce their harmful alcohol use. The patient engagement event was a useful way to co-create educational materials that incorporate both scientific research and patient needs.BackgroundEvidence-based medicine is the integration of best research evidence with clinical expertise and patient values. There are few methodologies on how to design evidence-based programs and resources to include patient values. The latter is an important aspect of patient-centered care, and is essential for patients to trust the recommendations and empower them as consumers to make informed choices. This manuscript describes a participatory research approach to design patient-facing educational materials that incorporate both evidence-based and community-sensitive principles. These materials are intended to support smokers to reduce or stop harmful alcohol consumption.MethodsAdult smokers who report consuming alcohol were invited to a co-creation meeting at the Centre for Addiction and Mental Health’s Nicotine Dependence Service to guide the adaptation of evidence-based materials. The four-hour event consisted of individual reflections, group discussions, and consensus-building interactions. Detailed notes were taken and then incorporated into the material.ResultsFourteen individuals participated in the event. The end product was a descriptive outline of an educational resource – entitled Self-Awareness – incorporating material from evidence-based workbooks and patient-driven features. Participants collaboratively selected the resource’s content, structure, and titles.ConclusionsThis model describes a participatory research method that emphasizes the value of the patient perspective; preliminary evidence finds this adaptation approach can increase the adoption of resources. The process described in this article could be replicated in other settings to co-create evidence-based resources, interventions, and programs that reflect the needs of the community.Trial registrationClinicalTrials.gov NCT03108144. Retrospectively registered 11 April 2017.

(532) Initial feasibility reports of a novel cognitive behavioral therapy (CBT) pain self-management treatment modality

s The Journal of Pain S109 (532) Initial feasibility reports of a novel cognitive behavioral therapy (CBT) pain self-management treatment modality C Egan, D Higgins, K LaChappelle, R Czlapinski, J Kirlin, K Spreyer, D Cervone, R Kerns, and A Heapy; VA Connecticut Healthcare System, West Haven, CT In light of the high prevalence of chronic pain in the US, a recent Institute of Medicine report recommended the promotion and wider availability of pain self-management interventions. However, many patients experience barriers to accessing in-person treatment due to travel and schedule limitations. Interactive voice response (IVR) is a computerized telephone-based technology that allows patients to receive pre-recorded information and answer automated questions, thereby facilitating at-home treatment. The Co-Operative Pain Education Self-management (COPES) study is a randomized non-inferiority trial of IVR-delivered CBT for chronic low back pain versus standard face to face (F2F) CBT. IVR treatment consisted of a patient workbook supplemented by 10 weeks of daily IVR calls that provided pre-recorded didactic information and weekly, pre-recorded personalized therapist feedback. F2F treatment consisted of ten weekly, 30-minute treatment sessions. Both conditions included daily IVR calls to collect pain-related symptoms, adherence to pain coping skill practice and pedometer-measured step counts. We examined the feasibility of IVR-delivered treatment in the domains of treatment retention, IVR call completion, skill practice adherence, and treatment satisfaction. The sample included the first 34 participants entered into the trial (IVR: n=15, F2F: n=19). Mean age was 58.6 (SD=11.13); 83% were male; 56.5% were White, and mean pain intensity was 6.5 (SD=1.59) on a 0-10 numeric rating scale. Participants in the IVR condition demonstrated high retention rates (IVR 86.67% v. F2F 68.42%), completed the majority of the 77 daily IVR calls (IVR 90.16% v. F2F 83.03) and reported high levels of skill practice adherence (7.61/10 v. F2F 6.64/10). IVR participants indicated satisfaction with treatment length, therapist interaction, and overall treatment at equivalent or higher levels than F2F participants. Preliminary results from this ongoing trial indicate that IVR-delivered CBT for pain self-management is feasible and that participants actively engaged in the intervention despite receiving no direct therapist contact. (533) Control over catastrophizing: development of a singlesession psychobehavioral intervention to reduce pain catastrophizing B Darnall, J Sturgeon, M Kao, and S Mackey; Stanford University, Palo Alto, CA Pain catastrophizing is a distressing pattern of rumination, magnification, and feelings of helpless about pain that negatively impacts pain intensity and treatment response. Catastrophizing is often treated across multiple individual psychotherapy visits or within a general pain class that typically spans 6-8 weeks. To reduce patient burden and speed access to low-cost pain care, we developed andpilot tested a single-session, 2-hour CBT-based class solely designed to treat catastrophizing. Content included psychoeducation on pain, catastrophizing and mind-body science. Participants developed a personal plan for daily use of the skills learned (relaxation response, thought stopping, reframing, and self-soothing). The classwas free andno compensationwas offered for completion of follow ups. Fifty-seven mixed etiology chronic pain patients (Women=42; 74%) receiving care in a multidisciplinary pain clinic attended the class. The Pain Catastrophizing Scale (PCS) was administered at class baseline and post-class at 2 and 4weeks via email link. Post-class anonymous acceptability and satisfaction ratings were sufficient (97%). The 48 (84%) participants that completed at least one follow up PCS were included in the analyses. Week 2 PCS was completed by 43 (90%) and 26 (54%) completed week 4 PCS. PCS means were 24.31 (SD=11.09) at baseline, 16.95 (SD=10.71) at week 2 and 13.88 (SD =10.02) at week 4. Within subjects repeated measures ANOVA revealed omnibus changes (F=45.97), and paired T-test contrasts revealed reduced PCS scores at weeks 2 and 4 compared to baseline (both p<.001). Effect sizes were medium (Cohen’s d = 0.68) and large (Cohen’s d = 0.99) for weeks 2 and 4 respectively. Preliminary findings suggest that this brief, focusedCBTclass may reduce catastrophizing about pain. Controlled studies are needed and should include patient characteristics to determine moderator and mediators, and longer latency periods to determine the stability of treatment effects. (534) Exploring suicide risk factors in a veteran chronic pain sample S Miller, M Clark, R Gironda, and J Murphy; James A Haley Veterans Hospital,

Exposure-Based CBT for Older Adults After Fall Injury: Description of a Manualized, Time-Limited Intervention for Anxiety

Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents “Back on My Feet,” an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources.

Literacy and cultural adaptations for cognitive behavioral therapy in a rural pain population

Low literacy and chronic pain have been identified as significant problems in the rural USA. Cognitive behavioral therapy (CBT) is a widely used efficacious psychosocial treatment for chronic pain; adaptations for low-literacy rural populations are lacking. This paper reports on preparatory steps implemented to address this deficit. Adapting an existing group, CBT patient workbook for rural adults with low literacy is described, and adaptations to reduce cognitive demand inherent in CBT are explained via cognitive load theory. Adhering to health literacy guidelines, the patient workbook readability was lowered to the fifth grade. Two key informant interviews and four focus groups provided the impetus for structural and procedural adaptations. Using health literacy guidelines and participant feedback, the patient workbook and treatment approach were adapted for implementation in low-literacy rural adult chronic pain populations, setting the stage for proceeding with a larger trial using the adapted materials.

The Development of an Integrated Treatment for Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder

The purpose of this article is to describe the development of the first integrated treatment for Veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). Descriptive, including pre- and posttreatment assessment results from a pilot study of six veterans with comorbid chronic pain and PTSD. Northeastern Department of Veterans Affairs Medical Center. Using components of cognitive processing therapy (CPT) for PTSD and cognitive behavioral therapy (CBT) for chronic pain management, a 12-session integrated treatment for veterans with comorbid chronic pain and PTSD was developed. A therapist manual and patient workbook that included weekly readings and homework assignments were created. Participants received pre- and posttreatment evaluations using measures of pain, PTSD, physical disability, and psychological distress. The treatment development process is reviewed and the benefits and challenges of implementing this integrated treatment are presented. Several themes emerged over the course of implementing the treatment, including the importance of establishing participant trust, regular therapy attendance, and addressing participant avoidance. Of the six participants recruited for the pilot study, three withdrew from the study and three completed the integrated treatment. Participants reported that they generally liked the format of treatment, appreciated learning about the ways that chronic pain and PTSD share some common symptoms, and ways that the two disorders can interact with one another. The assessment results of those who completed treatment suggest that this treatment approach is feasible and may have clinical benefit. Participants appeared to benefit from receiving the integrated treatment for pain and PTSD. A randomized clinical trial is currently being conducted to evaluate the efficacy of this treatment approach.

Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome

Psychosocial factors reported by patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) promote greater pain, disability, and ultimately poorer quality of life (QOL). We targeted those parameters in the development of a cognitive-behavioral (CB) program designed specifically for CP/CPPS. Five NIH sponsored biopsychosocial studies examined predictors of pain, disability, and QOL in CP/CPPS men. Pain, urinary symptoms, QOL, depressive symptoms, catastrophic thinking about pain, perceived control over pain, pain-contingent resting as a pain coping measure, social support and interaction, sexual functioning, and relationship issues were assessed. These data showed that CB intervention for pain catastrophizing, pain contingent rest, social support and depressive symptoms is warranted for men with CP/CPPS RESULTS: An evidence based 8-week CB program was developed. The content of the CB sessions are defined in an instructional patient workbook for each of the weekly 1-h sessions. The CB program guides patients in examining the relationship between their symptom-based distress, their thinking at such times and the emotions linked with those thoughts, and their behavioral responses to their particular thinking style (e.g., illness vs. wellness focused). Patients complete such analyses by using a Reaction Record format, which also delineates new thinking/behavioral responses. The CB program developed for CP/CPPS is the first comprehensive attempt to target specific evidence supported biopsychosocial variables for both symptom and QOL improvement in CP/CPPS and is expected to provide a useful tool for the clinical management of this chronic condition.

Borderline Personality Disorder: A therapist’s guide to taking control Borderline Personality Disorder: A patient’s guide to taking control Arthur Freeman and Gina MFusco WW Norton250; 275 respectively £14.99 each 039370352; 03937035330393703520393703533

These publications use the DSM IV criteria for borderline personality disorder (BPD) as a framework to explore a structured approach to working effectively with this challenging client group. They provide a set of interventions within a theoretically congruent CBT model which the authors refer to as the ‘taking control programme’. The accompanying patient workbook contains a series of exercises and self-evaluation tools.

Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary risk.

To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk. Pilot study, with post-study physician and patient interviews. Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire. Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook. It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1-80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment.

Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis.

This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy (CBT) for the treatment of depressive symptomatology in multiple sclerosis (MS) patients. The treatment, Coping with MS (CMS), included a patient workbook designed to structure the treatment, provide visual aids, and help with homework assignments. Thirty-two patients with MS, who scored at least 15 on the Profile of Mood States Depression-Dejection scale, were randomly assigned to either the telephone CMS or to a usual-care control (UCC) condition. Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition. Furthermore, adherence to interferon beta-1a, a disease-modifying medication for the treatment of MS, was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition.

Treatment of inpatients with bipolar disorders: a role for self-management groups.

1. Group therapy for outpatients with bipolar disorders is perceived as an effective adjunct to psychopharmacotherapy. Although medications to treat bipolar disorders have been well characterized and compliance usually results in good control of symptoms, the value of a group intervention program focusing on self-management has been ignored in inpatient treatment. 2. A patient workbook is being planned. This workbook is intended to impart additional information concerning self-management and free the therapist from devoting group time to individual didactic instruction. 3. Inpatients with bipolar disorders have responded favorably to diagnostically homogeneous group therapy. The data accumulated from their reports helped to formulate the Self-Management of Bipolar Disorder Group Model and this new model must be compared with the original model to ascertain effectiveness.

Essential Competencies for Patient Care and Workbook

Essential Competencies for Patient Care and Workbook

Essential Competencies for Patient Care and Workbook

Essential Competencies for Patient Care and Workbook