Cognitive Behavioral Therapy Program Research Articles

Increasing the Efficacy of Treatment for Socially Anxious Youth Through Theoretically Derived Improvements: A Pilot Study.

Cognitive behavioural therapy is the first line of treatment for social anxiety disorder; however, children with social anxiety disorder do not respond as well to generic cognitive behavioural therapy programs, compared to children with other anxiety disorders. The aim of the study was to provide a preliminary examination of the efficacy and applicability of a new disorder specific intervention for children with social anxiety disorder. Five children aged 7-13years, with a primary or secondary DSM-5 diagnosis of social anxiety disorder were provided with an adapted version of the Cool Kids anxiety program. Three out of the five children were in remission from social anxiety disorder at the end of the intervention and at 3-month follow-up. Statistically significant improvements were also noted in overall anxiety symptoms and functioning. Preliminary evidence was found for the efficacy of a social anxiety version of the Cool Kids program.

Presence of Psychiatric Assistance Dogs and Relation to Post-Traumatic Stress Disorder Treatment Outcomes: A Nonrandomized, Observational Study in a Military Sample

The purpose of this study was to examine differences between military veterans and service members with and without a psychiatric assistance dog (PAD) who were receiving cognitive behavioral therapy (CBT) for post-traumatic stress disorder (PTSD). Six hundred eighty-two military veterans presented at a 2-week intensive, outpatient CBT program for PTSD from February 2016 to February 2020. Self-reports of symptoms and rates of treatment completion by PAD ownership were assessed. Patients with PADs ( n = 93) reported higher scores on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( P = .04; Cohen's d = 0.23) and Neurobehavioral Symptom Inventory ( P < .01; Cohen's d = 0.34) at baseline. PTSD symptom change was comparable between participants with and without PADs ( P > .05). Dropout was higher among owners of PADs, but this difference was not significant ( P = .11). Among military populations, those with PADs may experience more severe PTSD and neuro-cognitive symptoms, but having a PAD was not associated with treatment outcome in intensive CBT. [ Psychiatr Ann . 2022;52(5):191–198.]

Qualitative analysis of school children's experience of receiving “Coping Cat program”: A cognitive behavioral therapy program for high anxiety

AbstractCoping Cat‐cognitive behavior therapy (CBT) is a 16‐week program, which has been used widely and has proven its efficacy in helping children in overcoming anxiety disorders. This research study intends to explore its efficacy on Indian school children with high anxiety in Delhi. The study aims at qualitative assessment of the experience of children with anxiety after intervention with Coping Cat‐CBT. After the Coping Cat‐CBT intervention, semistructured interviews were conducted with the children. Participants: Children aged 11–13 years exhibiting the symptoms of high anxiety were enrolled in the study. They were asked to write down their experience after the Coping Cat‐CBT intervention. Data were analyzed using the inductive approach of qualitative content analysis. Participants expressed that the intervention was beneficial in terms of their ability to combat anxiety experienced in day‐to‐day life, and reported improvements in various domains of life such as scholastic performance, interpersonal relationships, and successful use of coping skills in handling fearful situations and relaxation techniques in overcoming anxiety. The data provided empirical evidence that Indian children with anxiety‐related problems could benefit from the therapy. Coping Cat‐CBT was efficacious in reducing their symptoms of anxiety.

Investigating the veracity of a sample of divergent published trial data in spinal pain.

Evidence-based medicine is replete with studies assessing quality and bias, but few evaluating research integrity or trustworthiness. A recent Cochrane review of psychological interventions for chronic pain identified trials with a shared lead author with highly divergent results. We sought to systematically identify all similar trials from this author to explore their risk of bias, governance procedures, and trustworthiness. We searched OVID MEDLINE, EMBASE, CENTRAL, and PEDro from 2010 to December 22, 2021 for trials. We contacted the authors requesting details of trial registration, ethical approval, protocol, and access to the trial data for verification. We used the Cochrane risk-of-bias tool and the Cochrane Pregnancy and Childbirth group's Trustworthiness Screening Tool to guide systematic exploration of trustworthiness. Ten trials were included: 9 compared cognitive behavioural therapy and physical exercise to usual care, exercise alone, or physiotherapy and 1 compared 2 brief cognitive behavioural therapy programmes. Eight trials reported results divergent from the evidence base. Assessment of risk of bias and participant characteristics identified no substantial concerns. Responses from the lead author did not satisfactorily explain this divergence. Trustworthiness screening identified concerns about research governance, data plausibility at baseline, the results, and apparent data duplication. We discuss the findings within the context of methods for establishing the trustworthiness of research findings generally. Important concerns regarding the trustworthiness of these trials reduce our confidence in them. They should probably not be used to inform the results and conclusions of systematic reviews, in clinical training, policy documents, or any relevant instruction regarding adult chronic pain management.

The experience of participating in an internet-based cognitive behavioral therapy program among patients with cardiovascular disease and depression: a qualitative interview study

BackgroundDepression in conjunction with cardiovascular disease (CVD) is associated with worsening in CVD, higher mortality, and poorer quality of life. Despite the poor outcomes there is a treatment gap of depression in CVD patients. Recently we found that an Internet-based cognitive behavioral therapy (iCBT) tailored for CVD patients led to reduced symptoms of depression. However, we still have little knowledge about CVD patients’ experiences of working with iCBT. The aim of this study was therefore to explore CVD patients’ experiences of engaging in a tailored iCBT program.MethodsA qualitative interview study using inductive thematic analysis. Data was obtained from 20 patients with CVD and depressive symptoms who had participated in a randomized controlled trial (RCT) evaluating the impact of a nine-week iCBT program on depression.ResultsThree main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The first theme included comments that the tailored program gave the patients a feeling of being active in the treatment process and helped them achieve changes in thoughts and behaviors necessary to take control of their CVD. The second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist created a feeling of being seen as an individual. The feeling of being acknowledged as a person also made it easier to continuously work with the changes necessary to improve their health.ConclusionsEngaging in an iCBT program tailored for patients with CVD and depression was by the patients perceived as helpful in the treatment of depression. They experienced positive changes in emotions, thoughts, and behaviors which a result of learning to take control of their CVD, being confirmed and getting support. The patients considered working with the iCBT program as demanding and emotionally challenging, but necessary to achieve changes in emotions, thoughts, and behaviors.

The Role of Intolerance of Uncertainty in Treatment for Pediatric Anxiety Disorders and Obsessive-Compulsive Disorder

ABSTRACT This study investigated the role of intolerance of uncertainty (IU) in an intensive group-based cognitive behavioral therapy (CBT) program with family involvement for children with anxiety disorders and obsessive-compulsive disorder (OCD). One hundred four children and adolescents, aged 8–19 years, who were patients in an intensive outpatient group-based treatment program and their parents participated in this intervention-based study. From both children’s and parents’ perspectives at admission, higher IU in children was associated with both higher levels of anxiety and functional impairment. Both children and parents reported significant reductions in children’s IU by discharge, and these reductions were associated with greater reductions in children’s anxiety and functional impairment. However, children who reported higher levels of IU at admission, reported fewer reductions in their anxiety and functional impairment. These findings demonstrate an association between IU and children’s anxiety and OCD intensive treatment outcomes. Those with higher levels of IU may benefit from more interventions that address tolerating uncertainty.

Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT

IntroductionCost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on...

Improving adherence to a web-based cognitive-behavioural therapy program for social anxiety with group sessions: A randomised control trial

Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.

Neoliberalism and Mental Health Care in Ontario: A Critique of Internet-Based Cognitive Behavioural Therapy


 
 
 In this paper, I offer a critical analysis of Ontario’s mental health strategy, “Roadmap to Wellness,” and the government’s investment in internet-based cognitive behavioural therapy (iCBT) programs as a frontline strategy to address the province’s mental health crisis. Though I acknowledge that publicly funded mental health care is a step in the right direction, I argue that the choice to provide cognitive behavioural therapy (CBT) as the only form of publicly funded therapy indicates a problematic commitment to the maintenance of neoliberal governance. To argue this point, I use discourse analysis to explore the language present in Ontario’s two current iCBT programs – AbilitiCBT and Mindbeacon – and demonstrate the ways in which they reinforce a neoliberal discourse of mental health by emphasizing the values of 1) individual responsibility, 2) productivity, and 3) recovery. More broadly, I argue that neoliberal forms of governance ultimately produce the mental health crises that they seek to address through neglecting the social determinants of health and defunding of social services and assert that critiques of mental health care must address the socioeconomic conditions within which they are implemented, given the intimate relationship between neoliberalism, managerialism, and public policy.
 
 

Assessment of Cognitive Behaviour Therapy utility on emotional and social well beingness among women with surgical menopause

BackgroundSurgical menopause is the emergency procedure to be carried out in a woman when it is essential due to reproductive pathology. The post-surgical consequences should be monitored and controlled effectively with various intervention protocols. Cognitive-behavioral therapy is one of the commendable protocols to improve the emotional and social profile in women with surgical menopause. ObjectiveTo find the effectiveness of Cognitive Behavioural Therapy on emotional and social wellbeing among women with surgical menopause. Material & methodsIt is a randomized controlled trial carried out in 230 women who have undergone surgical menopause. The participants were randomly allocated into the intervention and control groups. After obtaining demographics, CBT intervention was introduced - Cognitive Behaviour Therapy program-, which lasted seven months and included all six sessions. The pre and post-test questionnaires were obtained using the Emotional well-being scale and social concern scale respectively from both groups. ResultsThe scores were significantly improved after intervention, in the experiment group, in pretest, the mean score was 9.45 and the post-test mean score was 14.18, the mean difference is 4.73 whereas, in the control group, the mean score of 9.06 and the post-test mean score was 9.41, the mean difference is 0.35 for social wellness. Posttest emotional wellness level was increased to 23.65%. Whereas in the control group, the posttest increased to 2.25%. ConclusionThe CBT is an effective therapeutic intervention to improve social and emotional wellbeing among women with surgical menopause.

Efficacy of cognitive-behavioural therapy for lifestyle modification in metabolic syndrome: a randomised controlled trial with a 18-months follow-up

Objective To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS). Design 76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it’s associated cardiovascular risk. Main Outcome Measures Efficacy of (CBT) in (MetS) patients. Results Results showed reduction in weight (mean difference - MD −2.633, 95%CI [-4.322, −0.943]; p<.003), waist circumference (MD −2.944, 95%CI [-5.090, −0.798]; p<.008), body mass index (MD −0.915, 95%CI [-1.494, −0.335]; p<.003), systolic (MD −0.046, 95%CI [-0.685, −0.023]; p<.0002) diastolic blood pressure (MD −4.777, 95%CI [-7.750, −1.804]; p<.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences. Conclusion The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors. Trial Registration Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome)

Development of an Internet-delivered Cognitive Behavioral Program for Inflammatory Bowel Disease: A Pilot Study

This pilot study examined a new internet-delivered cognitive behavior therapy program (iCBT) for anxiety, depression and/or stress in adults with inflammatory bowel disease (IBD). Eighteen of 21 participants completed the 9-module program. Measures of anxiety, depression, and stress were administered at baseline, and at 6-, 12-, and 24-weeks post-baseline. The iCBT program resulted in significant decreases in anxiety and stress 12 weeks post enrollment, with no significant changes in depression.

Impact of an automated Internet-based cognitive behavioral therapy program on suicide thinking and risk among United States rural adults

Cognitive behavior therapy (CBT) is an evidence-based psychotherapy for mental disorders, including depression. Internet-based CBT (iCBT) programs increasingly are showing similar impact to clinician-delivered CBT. We assessed the impact of Thrive, a fully-automated iCBT depression treatment program on suicidal thinking. Participants were randomly assigned to the intervention (INT) group (n = 218) or a waitlist control group (WLC, n = 230). Intent-to-treat analyses tested for group differences at 8-weeks in suicidal thinking (CHRT-SR3 subscale, primary outcome), and secondary outcomes including depression symptoms (PHQ-9), anxiety symptoms (GADS-7), work and social adjustment (WSAS), and resilience (CD-RISC-10). Using self-reports, participants were evaluated at baseline, 4 and 8 weeks for each outcome. Thrive program adherence (n = 218) was assessed by number of lessons completed. Although not statistically significant, the INT group was 38.7% less likely than the control group to present with suicidal thinking at 8 weeks (odds ratio 0.61, p = 0.10). Comparison of 8-week depression symptom slopes showed statistically significant effects favoring the INT group (WLC = − 3.04 vs Thrive = − 4.32, p = 0.007) (d = 0.08); no other significant group differences were observed. Lessons completed were significantly related to lower PHQ-9 (p = 0.026) and GAD-7 scores (p < 0.01). Study results are consistent with a previous study showing nonsignificant effect of an automated iCBT program for reducing suicidal thinking, but a significant positive impact on depression symptoms among rural US adults. Future studies should test whether strategies for boosting lesson completion are successful in enhancing the efficacy of Thrive to reduce suicide risk.Trial Registration: National Institutes of Health Trial ID: NCT03595254.

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial.

BackgroundPosttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice.ObjectiveThis study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use.MethodsWe conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46).ResultsPre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=−0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice.ConclusionsWeb-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study.Trial RegistrationClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473

Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control.

Background and aimsOnline interventions for problem gambling are increasingly popular, but not everyone benefits from them. We describe 12 years of real-world data from an online intervention for gambling problems and aim to find out the extent to which depression, alcohol use, and sense of financial control influence the effectiveness of the program.MethodsWe analyzed treatment effectiveness and moderators in the Finnish “Peli Poikki” program (2007–2018)—an 8-week cognitive behavioral therapy and follow-up program for problem gambling. Participants were Finnish-speaking adults over 18 years of age (N = 2011, 66.9% males). We measured the self-reported level of problem gambling, depression, alcohol use, and sense of financial control across four treatment phases (baseline, post-treatment, 6-month follow-up, and 12-month follow-up), as well as the presence of gambling debt, psychological and physiological health, years suffered from gambling problems, and demographic variables.ResultsParticipation grew across years with retention rates of 55%, 30%, and 19% for post-treatment and the two follow-ups, respectively. The average problem gambling scores declined significantly following treatment and remained low throughout the follow-ups. However, this decline (the beneficial treatment effect) was reversed after the follow-ups for those with high depression scores and those who felt they had no control over their finances.Discussion and ConclusionsThe Peli Poikki program is a well-functioning online intervention but less effective in the long term for participants with persisting symptoms of depression or without a sense of financial control. More attention is needed to screen and direct people with comorbidities to the appropriate services.

High Plasma Oxytocin Levels in Men With Hypersexual Disorder.

ContextHypersexual disorder (HD) involves excessive, persistent sexual behaviors related to various mood states and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the 11th revision of the International Classification of Diseases. Although the neurobiology behind the disorder is not clear, some studies suggest dysregulated hypothalamic-pituitary-adrenal axis. Oxytocin acts as counterregulatory neuroendocrine hormone to cortisol and is also involved in sexual behavior.ObjectiveWe hypothesized that oxytocin may play a role in the pathophysiology of HD with compensatory actions to cortisol.DesignLongitudinal.SettingANOVA clinic (Karolinska University Hospital).Patients or other participants64 males with HD and 38 age-matched healthy volunteers.Main Outcome MeasuresPlasma oxytocin levels, measured with radioimmunoassay; Hypersexual Disorder Screening Inventory; and Hypersexual Disorder: Current Assessment Scale for assessing hypersexual symptoms.InterventionsA patient subgroup (n = 30) completed the manual-based group-administered cognitive-behavioral therapy (CBT) program for HD, and posttreatment oxytocin levels were measured.ResultsHypersexual men (n = 64) exhibited significantly higher oxytocin plasma levels (mean ± SD: 31.0 ± 9.9 pM) compared with healthy volunteers (16.9 ± 3.9 pM; P < 0.001). There were significant positive correlations between oxytocin levels and the rating scales measuring hypersexual behavior. Patients who completed CBT treatment (n = 30) had a significant reduction of oxytocin plasma levels from pretreatment (30.5 ± 10.1 pM) to posttreatment (20.2 ± 8.0 pM; P < 0.001).ConclusionsThe results suggest that the hyperactive oxytocinergic system in hypersexual men may be a compensatory mechanism to attenuate hyperactive stress.

An Internet-Based Cognitive Behavioral Therapy Program for Anxiety and Depression (Tranquility): Adaptation Co-design and Fidelity Evaluation Study.

BackgroundInternet-based cognitive behavioral therapy (iCBT) is a necessary step toward increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to the therapeutic principles of cognitive behavioral therapy (CBT) or usability standards. In addition, many existing iCBT programs do not include treatments targeting both anxiety and depression, which are commonly co-occurring conditions.ObjectiveThis study aims to evaluate the usability of Tranquility—a novel iCBT program for anxiety—and its fidelity to CBT principles. This study also aims to engage in a co-design process to adapt Tranquility to include treatment elements for depression.MethodsCBT experts (n=6) and mental health–informed peers (n=6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression by using 2 simulated client case examples. Mental health–informed peers engaged in 2 co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed web-based surveys assessing the usability of Tranquility and the likelihood that they would recommend the program.ResultsThe CBT experts’ mean rating of Tranquility’s fidelity to CBT principles was 91%, indicating a high fidelity to CBT. Further, 5 out of 6 CBT experts and all mental health–informed peers (all participants: 11/12, 88%) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (mean 76.56, SD 14.07). Mental health–informed peers provided suggestions on how to leverage engagement with Tranquility (eg, adding incentives and notification control).ConclusionsThis preliminary study demonstrated the strong fidelity of Tranquility to CBT and usability standards. The results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement.

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Special Report: Be Prepared to Address Technological Addictions in Psychiatric Practice

Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study.

This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5–11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents’ ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD

Brief Cognitive Behavioral Therapy for Patients with Comorbid Depression and Type 2 Diabetes in an Urban Primary Care Facility: Randomized Controlled Trial

Background: The relation between depression and diabetes is bidirectional and both can lead to morbidity and mortality. Despite the success of Cognitive Behavioral Therapy (CBT) in managing psychiatric comorbidities, research on its use in the treatment of comorbid diabetes and depression is limited and with varying results. The aim of the study is to assess the efficacy of CBT on depressed patients with type 2 diabetes.&#x0D; Methods: This randomized controlled trial was conducted at an urban primary healthcare center in Egypt from February 2019 to March 2020 and included 80 participants. Key inclusion criteria were uncontrolled type 2 diabetes (T2D) (HbA1c &gt;7.5%) and depression symptoms diagnosed by Beck’s Depression Index. Participants were assessed for all battery of instruments. Subsequently, participants were randomized to control and treatment groups. The treatment group received four CBT sessions. Both groups received a thirty-minute structured diabetes education and their usual diabetes treatment. Three months later, all participants were reassessed for depression and diabetes compliance and all labs were performed post intervention. Both the primary (the difference in HbA1c pre-post intervention) and secondary outcomes (the change in depressive symptoms assessed) were analyzed using ANCOVA.&#x0D; Results: Both groups were matching at baseline. Post intervention, the CBT group revealed a significant reduction in depressive symptoms while adjusting for Beck Depression Index (BDI) pre-intervention [F (1, 74) = 7.074, p = 0.010]. Moreover, HBA1c was improved significantly when controlling for pre-intervention BDI scores and BMI [F (1,73) = 4.27, p = 0.042] compared to the control group.&#x0D; Conclusions: The CBT program was both inexpensive and easily accessible. It could fit very well in primary care settings. The results indicated CBT intervention was effective in improving diabetes control and depression. However, a larger-scale study to test its effect on a larger scale population and its long-term impact is recommended.