Cognitive Behavioral Therapy Program Research Articles

Social Support and Parental Conflict as Predictors of Outcomes of Group Cognitive Behavioral Therapy for Adolescent Depression.

Group cognitive behavioral therapy (CBT) is an effective treatment for adolescent depression, but outcomes vary. Our goal was to examine interpersonal factors that predict response to group CBT for adolescent depression using a broad range of outcomes, including depressive symptoms, session attendance, treatment completion, engagement, and improvement. Seventy adolescents (age 14-18) with depression completed self-report measures of social support and parental conflict and were offeredan established 16-session group CBT program. Correlation and regression analyses were conducted for interpersonal predictors and CBT outcomes. Accounting for pre-treatment depressive symptoms, fewer social supports predicted lower likelihood of finishing treatment and less clinician-rated improvement. Greater pre-treatment parental conflict predicted fewer sessions attended, lower clinician-rated engagement, and less clinician-rated improvement. Results highlight the need to consider interpersonal difficulties in CBT, as they may present a barrier to treatment attendance, engagement, and improvement.

Intervention for modifying risk level of hypersexual behaviors among male parents with sexual offending history.

The increased sexual assault committed against women and young girls by people of the opposite gender has put their safety in danger in recent years. This has contributed to a growing number of adult sex offenders who have aggressive sexual attitudes. This study investigated the efficacy of cognitive behavior therapy (CBT) in reducing the risk level of hypersexual behaviors among male parents. A total of convicted 48 inmates participated in this study. In pursuance of this aim, 3 dependent measures were employed in evaluating the participants' violent sexual attitudes at 3 points. The simple random technique was adopted in selecting 24 participants who participated in the CBT program while 24 participants were used as the no-intervention control group. The ANCOVA analysis shows a positive treatment outcome in reducing the risk level of hypersexual behaviors among male parents who participated in the CBT program when compared to the no-intervention control group. This study found that cognitive behavioral therapy intervention is a coping strategy for reducing hypersexual behaviors among male parents with sexual offending history in favor of participants in the intervention group at the 3 levels of assessments. The study showed a significant difference between groups in the risk level of hypersexual behaviors among male parents with a sexual offending history. Also, the result showed a significant interaction between time and treatment. Regarding the moderating impact of sexual behavior on the risk level of hypersexual behaviors. Given this, this study suggests that CBT intervention reduces the risk level of hypersexual behaviors among male parents. Implications for protection agencies and policies were highlighted.

The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial

Postpartum depression (PPD) is treatable and preventable, but most women do not seek professional help for their perinatal depressive symptoms. One increasingly popular approach of improving access to care is the use of web-based intervention programs. The objective of this study was 2-fold: first, to assess the efficacy of Be a Mom, a brief web-based selective or indicated preventive intervention, in reducing depressive and anxiety symptoms of women at high risk for PPD; and second, to examine mechanisms of change linking modifiable self-regulatory skills (ie, emotion regulation, self-compassion, and psychological flexibility) to improved perinatal mental health outcomes. This 2-arm, open-label randomized controlled trial involved a sample of 1053 perinatal women presenting high risk for PPD who were allocated to the Be a Mom intervention group or a waitlist control group and completed self-report measures at baseline and postintervention assessments. Univariate latent change score models were computed to determine changes over time in adjustment processes and outcomes, with a multigroup-model approach to detect differences between the intervention and control groups and a 2-wave latent change score model to examine whether changes in processes were related to changes in outcomes. Be a Mom was found to be effective in reducing depressive (intervention group: µΔ=-3.35; P<.001 vs control group: µΔ=-1.48; P<.001) and anxiety symptoms (intervention group: µΔ=-2.24; P<.001 vs control group: µΔ=-0.43; P=.04) in comparison with the control group, where such changes were inexistent or much smaller. All 3 psychological processes under study improved statistically significantly in posttreatment assessments: emotion regulation ability (Δχ23=12.3; P=.007) and psychological flexibility (Δχ23=34.9; P<.001) improved only in the intervention group, and although self-compassion increased in both groups (Δχ23=65.6; P<.001), these improvements were considerably greater in the intervention group. These results suggest that Be a Mom, a low-intensity cognitive behavioral therapy program, is a promising first-line intervention for helping perinatal women, particularly those with early-onset PPD symptoms. ClinicalTrials.gov NCT03024645; https://clinicaltrials.gov/ct2/show/NCT03024645.

Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change

BackgroundBinge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED.MethodsEating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated).ResultsEDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated ‘neurotic’ scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that ‘neurotic’ personality functioning was a significant negative predictor of clinically significant change.ConclusionMaladaptive (‘neurotic’) personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, ‘neurotic’ personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients’ individual strengths and vulnerabilities.Trial registrationThis study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.

Layperson-Facilitated Internet-Delivered Cognitive Behavioral Therapy for Homebound Older Adults With Depression: Protocol for a Randomized Controlled Trial.

Depression in older adults has serious biological, psychological, and social consequences. Homebound older adults experience a high burden of depression and significant barriers to accessing mental health treatments. Few interventions to address their specific needs have been developed. Existing treatment modalities can be challenging to scale up, are not tailored to unique population concerns, and require significant staffing support. Technology-assisted, layperson-facilitated psychotherapy has the potential to overcome these challenges. The aim of this study is to assess the efficacy of a layperson-facilitated internet-delivered cognitive behavioral therapy program tailored for homebound older adults. The novel intervention, Empower@Home, was developed based on user-centered design principles and partnerships between researchers, social service agencies, care recipients, and other stakeholders serving low-income homebound older adults. This 2-arm, 20-week pilot randomized controlled trial (RCT) with a waitlist control crossover design aims to enroll 70 community-dwelling older adults with elevated depressive symptoms. The treatment group will receive the 10-week intervention immediately, whereas the waitlist control group will cross over and receive the intervention after 10 weeks. This pilot is part of a multiphase project involving a single-group feasibility study (completed in December 2022). This project consists of a pilot RCT (described in this protocol) and an implementation feasibility study running in parallel with the pilot RCT. The primary clinical outcome of the pilot is the change in depressive symptoms after the intervention and at the 20-week postrandomization follow-up. Additional outcomes include acceptability, adherence, and changes in anxiety, social isolation, and quality of life. Institutional review board approval was obtained for the proposed trial in April 2022. Recruitment for the pilot RCT began in January 2023 and is anticipated to end in September 2023. On completion of the pilot trial, we will examine the preliminary efficacy of the intervention on depression symptoms and other secondary clinical outcomes in an intention-to-treat analysis. Although web-based cognitive behavioral therapy programs are available, most programs have low adherence and very few are tailored for older adults. Our intervention addresses this gap. Older adults, particularly those with mobility difficulties and multiple chronic health conditions, could benefit from internet-based psychotherapy. This approach can serve a pressing need in society while being cost-effective, scalable, and convenient. This pilot RCT builds on a completed single-group feasibility study by determining the preliminary effects of the intervention compared with a control condition. The findings will provide a foundation for a future fully-powered randomized controlled efficacy trial. If our intervention is found to be effective, implications extend to other digital mental health interventions and populations with physical disabilities and access restrictions who face persistent disparities in mental health. ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276. PRR1-10.2196/44210.

The evaluation of a brief ICBT program with therapist support for individuals with gambling problems in the context of a gambling helpline: a randomized pilot trial

Background and aimsGambling helplines are a natural way of first contact for individuals with gambling problems. However, few studies have evaluated the feasibility and effectiveness of brief interventions in a gambling helpline. To reduce this knowledge gap, this study evaluated the feasibility of an online cognitive behavioral therapy (ICBT) program in the context of a gambling helpline as a first step towards a full-scale RCT.DesignThis is a two-group parallel randomized controlled pilot trial where the participants were randomized to either a brief four-module ICBT program (n = 22) or a control group (n = 21). Participants were followed up weekly during the intervention, post intervention, and 6 weeks upon completion of intervention.ParticipantsA total of 43 self-identified individuals with gambling problems (scoring 3 or more on the Problem Gambling Severity Index) were recruited via the Swedish national gambling helpline, 59% females, mean age 43.7 years.MeasurementsFeasibility of the procedure and intervention (i.e., recruitment pace, attrition, program engagement, and satisfaction) were the primary outcomes; treatment effect (net gambling losses) was the secondary outcome.ResultsApproximately 2 participants per week were randomized, and retention was low, with 47% lost to follow-up at the 6-week follow-up time-point. Most participants engaged in the online modules (86%) and rated their overall satisfaction with the program as high (7.5 out of 10). Both groups decreased their weekly gambling losses at both follow-up time-points, but the between-group comparisons were inconclusive.ConclusionIt is not advisable to conduct a full-scale RCT based on the results from this pilot study. Future studies in a gambling helpline should consider interventions that are more suited to be incorporated in a gambling helpline and identify ways to increase participant engagement.Trial registrationThe study was retrospectively registered on ClinicalTrials.gov (ID: NCT04609007, 29/10/2020).

Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown

Prior to the COVID-19 pandemic, we demonstrated the efficacy of a novel Cognitive Behavioural Therapy programme for the treatment of Non-Rapid Eye Movement Parasomnias (CBT-NREMP) in reducing NREM parasomnia events, insomnia and associated mood severities. Given the increased prevalence and worsening of sleep and affective disorders during the pandemic, we examined the sustainability of CBT-NREMP following the U.K.'s longest COVID-19 lockdown (6 January 2021-19 July 2021) by repeating the investigations via a mail survey in the same 46 patient cohort, of which 12 responded. The survey included validated clinical questionnaires relating to NREM parasomnia (Paris Arousal Disorder Severity Scale), insomnia (Insomnia Severity Index) and anxiety and depression (Hospital Anxiety and Depression Scale). Patients also completed a targeted questionnaire (i.e., Impact of COVID-19 Lockdown Questionnaire, ICLQ) to assess the impact of COVID-19 lockdown on NREM parasomnia severity, mental health, general well-being and lifestyle. Clinical measures of NREM parasomnia, insomnia, anxiety and depression remained stable, with no significant changes demonstrated in questionnaire scores by comparison to the previous investigatory period prior to the COVID-19 pandemic: p (ISI) = 1.0; p (HADS) = 0.816; p (PADSS) = 0.194. These findings support the longitudinal effectiveness of CBT-NREMP for up to three years following the clinical intervention, and despite of the COVID-19 pandemic.

Development and pilot testing of internet-delivered, family-based cognitive behavioral therapy for anxiety and obsessive-compulsive disorders in autistic youth

Cognitive behavioral therapy adapted for autistic youth with anxiety and/or OCD has a strong evidence base, but few have access. A 12-week family-based, Internet-delivered cognitive behavioral therapy (iCBT) program for 7-15 year-old autistic youth with anxiety and/or OCD was developed as a potential method to address this problem. Quantitative and qualitative feedback from stakeholders (parents, youth, clinicians) was gathered on an initial draft of content before conducting a pilot trial. This feedback suggested high quality, engagement, usability, and informativeness of the material. Suggestions were incorporated into the treatment program that was tested in a pilot trial. Eight families were randomized to the iCBT program with either 1) weekly email support or 2) weekly email support plus biweekly telehealth check-ins, and seven of these families completed pre- and post-treatment assessments. An average reduction of 39% in anxiety severity scores was found, with six of the seven being classified as responders. Preliminary evidence suggests that family-based iCBT is an acceptable and promising treatment for autistic youth with anxiety and/or obsessive-compulsive disorders that should be further modified and tested in future work.

Days between sessions predict attrition in text-based internet intervention of Binge Eating Disorder

BackgroundThe number of days between treatment sessions is often overlooked as a predictor of attrition in psychotherapy. In text-based Internet interventions, days between sessions may be a simple yet powerful predictor of attrition. ObjectiveWe hypothesized that a larger number of days between sessions increased the likelihood of attrition among participants with Binge Eating Disorder (BED) in a 12-session Internet-based cognitive behavioral therapy (iCBT) program. Participants could work on the sessions whenever convenient for them and received written support from a psychologist. Material and methodsWe compared 201 adult participants with mild to moderate BED (85 non-completers and 116 completers) on the number of days between sessions to predict attrition rates. ResultsMixed model binomial logistic regression showed that non-completers spent significantly more days between sessions across the first four treatment sessions (1–4) when controlling for age, gender, and intake measures of BMI, BED, overall health status (EQ VAS), and depression symptoms (MDI) (OR = 1.042, p < .001). Age (OR = 0.976, p < .001) and EQ VAS (OR = 0.984, p < .001) were also significant. The risk of attrition increased by 4.2 % for each additional day participants spent completing a session.A receiver operating characteristic (ROC) curve analysis showed that classification accuracy increased across sessions from 61.1 % in session 1 and 65.7 % in session 2 to 68.8 % in session 3 and 73.2 % in session 4. The optimal cut-off point in session 4 was 17.5 days, which detected 60.4 % of non-completers (sensitivity) and 78.4 % of completers (specificity).An exploratory repeated measures of ANOVA of days between sessions showed a significant within-subjects effect, where both non-completers and completers spent more days between sessions as they progressed from sessions 1 through 4 (F = 20.54, df = 3, p < .001). There was no interaction effect, suggesting that the increase in slope did not differ between non-completers and completers. ConclusionsParticipants spending more days between sessions are at increased risk of dropping out of treatment. This may have important implications for identifying measures to reduce attrition, e.g., intensifying interventions through automated reminders or therapist messages. Our findings may have important transdiagnostic implications for text-based Internet interventions. Further studies should investigate the predictive value of days between sessions in other diagnoses.

The role of gamification in digital mental health.

The role of gamification in digital mental health.

‘I almost felt like I can be a little bit more honest’: experiences of a telehealth group for bipolar disorder

Abstract Despite the increasing use of telehealth platforms to deliver cognitive behavioural group therapy programs, few studies have been conducted that explore the experience of using telehealth platforms for those living with bipolar disorder. The present study aimed to explore the impact of the telehealth platform on the delivery of a recovery-orientated well-being plan group program for participants living with bipolar disorder. A total of 19 participants completed the qualitative interviews (3 male, 16 female). Using content analysis, data were deductively coded in line with pre-existing codes and matrix categories with unexpected data that discussed the telehealth experience being coded using an inductive content analysis framework. Two themes were identified: (1) Social inclusion, which included the subthemes of (a) connection to others via telehealth and (b) feeling safe using telehealth; and (2) Barriers and engagement, which included the subthemes of (a) removing barriers by using telehealth and (b) symptom impacts to engagement using the telehealth platform. Participants reported increased connection with others using telehealth and feeling greater safety overall when using the telehealth platform; however, some noted that dominant personalities could contribute to feeling unsafe within the group at times. Overall, the platform reduced barriers and was easy to use with this being a convenient way to attend, even if in some instances the platform highlighted differences between the members. Key learning aims (1) Telehealth platforms provide a unique opportunity for connection for those living with bipolar disorder. (2) Telehealth platforms may increase feelings of personal safety but may also increase feelings of difference between group members. (3) Symptoms may impact on engagement with anxiety and mood symptoms playing a role; however, telehealth may also decrease barriers to engagement.

Virtual Delivery of Stepped-Care Cognitive Behaviour Therapy for Cancer Related Fatigue: A Feasibility Study.

About 1 in 3 people experience persistent fatigue after cancer treatment. People with severe fatigue describe a disabling lack of stamina, anxiety, depression and distressing cognitive changes. Cognitive behavior therapy (CBT) is recommended for people with severe fatigue after cancer treatment, however due to limited resources and lack of available clinicians very few people with cancer have access. This study explored feasibility of a virtual stepped-care CBT program. English speaking adults experiencing persistent fatigue who had either completed cancer treatment, or with stable disease on maintenance therapies were recruited. All participants engaged in a 6-week supported self-help program using a CBT workbook targeting fatigue (STEP 1). After the self-help program, participants with severe ongoing fatigue were stepped-up to a telehealth CBT group focused to fatigue led by a Clinical Psychologist (STEP 2). Feasibility and perceived changes were assessed at baseline, 6 and 12 weeks. Of 19 participants, 17 completed STEP 1 and 8 completed STEP 2. Remotely delivered CBT was feasible with high retention, adherence, participant feasibility and satisfaction scores. Cost to deliver STEP 1 was AUD $145 and STEP 2, AUD $280 per participant. Overall, fatigue and self-efficacy improved significantly following STEP 1. Participants with higher baseline fatigue achieved limited improvements with self-help alone, requiring guidance to set achievable goals and reframe cognitions. Fatigue, self-efficacy and mood improved with STEP 2. Remotely delivered CBT for cancer fatigue was feasible. The effectiveness of stratified rather than stepped CBT approach, based on fatigue severity should be trialed. Australian and New Zealand Clinical Trials Registry (ACTRN # 11 12622000420741).

An Unguided Computerized Cognitive Behavioral Therapy Program for Test Anxiety

Test anxiety, a particular manifestation of performance anxiety similar to sports anxiety or the anxiety experienced during public speaking, is characterized by emotional, behavioral, and physiological responses that lead to diminished performance and academic attainment. The primary objective of this paper is to scrutinize the effectiveness of the "No More Test Anxiety" program, an Unguided Computerized Cognitive Behavioural Therapy (cCBT) for Test Anxiety, an intervention not yet implemented in Turkey. The study was conducted in two phases: a pilot study and the main study. The pilot study examined the accessibility and feasibility of the program with 11 participants, while the main study evaluated the efficacy of the program with 34 participants using a pre-test post-test control group design. Participants were assigned to groups via convenience sampling, and the Test Anxiety Inventory (TAI) and the State and Trait Anxiety Inventory (STAI) were used for analysis. The results demonstrated significant reductions in TAI, STAI-State, and STAI-Trait scores in the treatment group at the end of the intervention (respectively, p &lt; 0.001). Power analysis revealed that the study achieved sufficient power to detect these effects, and effect size calculations highlighted the clinical significance of the findings. The unguided cCBT program for test anxiety was determined to be both feasible and effective, offering insights into the innovative and evolving field of digital psychotherapy

The experiences of depressed pregnant women participating in a cognitive behavioral therapy program via video communication: an exploratory qualitative study.

This study explored the experiences of pregnant women with depressed mood participating ina group cognitive behavioral therapy (CBT) program using video communication, based on Beck's cognitive theory. The participants were six pregnant women out of 13 women who had participated in an 8-session group CBT program using video communication for women with depressed mood (EdinburghPostnatal Depression score of ≥9). Data were collected from February 20 through March 25, 2021. Indepth individual interviews were conducted through a video conferencing platform at 1 month post-baseline. Thematic analysis was done. Three themes, 10 subthemes, and 38 concepts were derived from experiences of participating inthe 4-week group CBT program (twice a week). The first theme, entitled "continuing realization" hadsubthemes of "a negative and instable self," "a selfish judgment that excludes others," and "a strong beliefin self-control." The second theme, entitled "attempt to change for restoration" had subthemes of "shift torational thinking," "freedom from suppressed beliefs," "tolerance of other people," and "courage for self-expression." The third theme, entitled "departure for a positive life," had subthemes of "emotional healing,""faith in oneself," and "reestablishing the criteria for happiness." Pregnant women with depressed mood expressed that continuing realizations and attemptsto change supported their transition toward a positive direction of healing. Thus, they were able to changetheir distorted thinking into rational thinking through CBT using video communication. These findingssupport the use of group CBT using video communication with pregnant women who have depressedmood.

A therapist-guided internet-based cognitive behavioral therapy program for Hong Kong university students with psychological distress: A study protocol for a randomized controlled trial

BackgroundUniversity students are at high risk of various mental health problems due to high levels of psychological distress. However, university counseling services are often inadequate to meet their mental health needs due to shortage of mental health professionals, especially in Hong Kong. Internet-based cognitive behavioral therapy (iCBT) has shown similar effects as those of face-to-face CBT in addressing these mental health concerns, but few iCBT programs have been developed for Hong Kong university students. ObjectiveThis study protocol aims to develop and evaluate a culturally and linguistically appropriate iCBT program called “REST Online” to reduce the psychological distress and improve the mental health of Chinese university students in Hong Kong in a randomized controlled trial (RCT). MethodThe contents and functionality of the “REST Online” program which includes both web- and app-based versions, are described. A blended mode of service delivery is adopted, with 8 online modules and 2 counseling sessions. Therapist support will be provided by a CBT therapist. A total of 338 Chinese university students with mild to moderate levels of psychological distress will be openly recruited and randomized to three groups: the (1) web-based and (2) app-based “REST Online” groups, and (3) waitlist control group. The program effectiveness is evaluated in psychological distress, depression and anxiety symptoms, and positive and negative emotions and positive and negative thoughts at pre-, post- and 3-month follow-up tests. Linear mixed effect models will be conducted for data analysis. DiscussionThe “REST Online” program is among the first of its kind to address the mental health needs of Hong Kong university students by an internet intervention. Theoretically, this study will provide some empirical evidence for the effectiveness of this iCBT program in the Hong Kong context for Chinese clients. Practically, if proven effective, this program can be provided to local university counselors as an option for service delivery. Strengths and limitations are also discussed.

The Effect of Cognitive Behavioral Therapy Program Using Picture Books on the Reduction of Social Anxiety of 1st Graders Elementary School Students

The Effect of Cognitive Behavioral Therapy Program Using Picture Books on the Reduction of Social Anxiety of 1st Graders Elementary School Students

Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study.

Blended cognitive behavioral therapy (bCBT)-the combination of digital elements and face-to-face psychotherapy-has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.

A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury

ABSTRACT The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12–19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants’ anxiety and secondary outcomes were participants’ depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population.

Effectiveness of road safety prevention in schools.

The World Health Organization estimates that each year, 1.3 million people are killed and more than 50 million people worldwide are injured in road traffic accidents. According to a study conducted by the Allianz Center for Technology, more young people between the ages of 15 and 29 die in traffic accidents than as a result of illness, drugs, suicide, violence, or war events worldwide. That is about 400,000 per year, globally. Worldwide traffic accident prevention campaigns demonstrate the consequences of traffic accidents in an emotionalizing way in order to encourage drivers to adopt conscious safety behavior via adequate driving behavior. The consequences of traffic accidents are demonstrated by prevention campaigns often in an emotionalizing way to encourage drivers to adopt safety measurements through adequate driving behavior. Prior research suggests that the emotionalizing effect of the appeals must be accompanied by solution- as well as action-oriented and self-confidence-increasing measures, so that the instructive message is reinforced and does not lead to reactance. Thus, a strong need arose in the schools for a targeted training as the follow-up of emotional prevention campaigns. A suitable training for knowledge acquisition and knowledge transfer into everyday life was developed by means of the design-based research method. To create the targeted follow-up, various methods from cognitive behavioral therapy and common traffic safety programs were adapted. This publication is dedicated to a first explorative research approach in a non-standardized form of a social training. It approaches the question of negative emotional states immediately after a Crash Kurs NRW stage event, which is a prevention program in Germany that targets upper middle school and high school courses and originates from North Rhine-Westphalia. Changes in social behavior and development of participants' own norms, values, and attitudes were observed and documented and are discussed and presented in this article. The result of the survey confirmed prior research and showed visible effects of reactance after the Crash Curs NRW campaign. It was found that a structured follow-up training is suitable to gain reactive behavior from the stage event. Knowledge deficits about the cause and outcome of accidents were successfully addressed in the follow-up. This may have influence the reactance behavior and could be a key factor for successful prevention campaigns. Further publications will observe the connection between knowledge and reactance in subsequent iterative passes of modified follow-ups for the Crash Course NRW Campaign.

Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy.

Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated. 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements. Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL. Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.