Sessions Of Behavioral Therapy Research Articles

Testing a new model of telehealth-delivered treatment for primary care patients with alcohol use disorder: A randomized controlled trial protocol

BackgroundThe majority of adults suffering from alcohol use disorders (AUD) do not receive treatment. To address this gap in care, we must develop new models to increase identification, engagement and delivery of accessible and effective treatment. This paper describes the protocol for a randomized controlled trial (RCT) testing a novel telehealth treatment model for primary care patients with untreated AUD. MethodsWe aim to recruit 300 adults across 2 healthcare systems for this two-arm RCT. Participants, initially identified for recruitment based on AUD-related indicators in their electronic health record (EHR), are RCT-eligible if they meet AUD criteria (mild, moderate, severe), report ≥ 3 drinking days/week in past 30 days, and have not received AUD psychotherapy in the past 90 days. Participants are randomized to an intervention or enhanced usual care control (EUC) condition, both individually-delivered. The intervention includes a telephone-delivered motivational interviewing (MI) engagement session and 8 sessions of MI-Cognitive Behavioral Therapy (MI-CBT). EUC involves AUD psychoeducation, advice to reduce drinking and seek treatment, and provision of community resources. Outcomes will be measured at 3-, 6-, and 12-months; primary outcomes include: AUD psychotherapy initiation and engagement (within the study and external community) and alcohol consumption (percent drinking days and heavy drinking days). ConclusionsThis study addresses whether proactive patient identification and engagement and delivery of patient-centered telehealth psychotherapy to patients with untreated AUD is effective in increasing treatment use and improving alcohol outcomes. If effective, this could be a highly scalable model for reducing the public health impact of AUD. Trial RegistrationClinicalTrials.gov # NCT05410561. University of Michigan HUM00204315. Ann Arbor VA IRB #1655886.

Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder

Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. anzctr.org.au Identifier: ACTRN12612000307808.

Zelfopoffering, onderwerping en pleasing bij vrouwen met CVS in vergelijking met vrouwen met reumatoïde artritis: een observationele studie

Self-sacrifice, subjugation and approval-seeking in women with CFS in comparison to women with rheumatoid arthritis: an observational study CFS is a disorder with a multifactorial pathogenesis in which symptoms arise when precipitating factors combine with predisposing factors. An increasing body of research points to a dysfunction of the stress axis and finds evidence for a high prevalence of early childhood trauma, one of the most important vulnerability factors. Several pathways are conceivable through which early trauma may contribute to the vulnerability to or maintenance of the stress response and the symptoms. In this study, the authors used self-report questionnaires to identify maladaptive patterns that often stand out in clinical practice and may play both a predisposing and a maintaining role. These interpersonal patterns have often been adaptive in an early childhood context, but become harmful when they generalize and remain active in adult life. The authors investigated a group of 49 female CFS patients using 3 subscales of the Young Schema Questionnaire measuring the interpersonal styles of self-sacrifice, approval-seeking and subjugation. They included 45 women with a diagnosis of rheumatoid arthritis as a control group. The authors found significantly higher scores in the CFS group for the 3 variables, with a large effect size for each. The present findings have implications for the further research and treatment. These interpersonal patterns are usually very rigid and serve to protect self-esteem and sense of security. The standard treatment of graded exercise and a limited number of sessions of psychoeducation and cognitive behavioral therapy is often insufficient to allow recovery and prevent relapse. Further research is required to substantiate which is the most optimal treatment strategy to mitigate these patterns.

Comparison of the Effectiveness of Cognitive Behavioral Therapy and Schema Therapy on Cognitive Emotion Regulation in Patients with Major Depressive Disorder

Objective: The aim of this study was to compare the efficacy of cognitive behavioral therapy and schema therapy on cognitive emotion regulation in patients with major depressive disorder. Methods and Materials: The research employed a quasi-experimental pre-test-post-test design with a control group and a one-month follow-up. The study population included all patients visiting Entekhab-e No and Aryaz clinics in Tehran during the period from February 2021 to May 2021, who were diagnosed with major depressive disorder by a psychiatrist. Forty-five individuals were purposively selected and randomly assigned to two experimental groups and one control group (15 per group). The first and second experimental groups underwent 12 and 8 sessions of cognitive behavioral therapy based on the Rosello protocol (2015) and schema therapy based on Young's protocol (2003), respectively. The research instrument was the Cognitive Emotion Regulation Questionnaire (CERQ) (Garnefski & Kraaij, 2006). Data were analyzed using repeated measures ANOVA, Bonferroni test, and SPSS version 24. Findings: Results showed that both cognitive behavioral and schema therapy interventions significantly improved scores of adaptive emotion regulation and decreased scores of maladaptive emotion regulation compared to the control group (P<0.001), with these effects maintained up to the one-month follow-up period. Additionally, there was a difference in the efficacy of the two intervention methods in increasing adaptive emotion regulation scores and decreasing maladaptive emotion regulation scores (P<0.001), with cognitive behavioral therapy being more effective than schema therapy. Conclusion: Thus, utilizing cognitive behavioral therapy and schema therapy can take an important step in reducing the negative outcomes of emotion regulation deficits in depressed patients.

Comparing the Effectiveness of Solution-Focused Therapy and Dialectical Behavior Therapy on Self-Care and Quality of Life in Patients with Type 2 Diabetes

The objective of this study was to compare the effectiveness of solution-focused therapy and dialectical behavior therapy on self-care and quality of life in patients with type 2 diabetes. The present research was a semi-experimental pre-test, post-test with control group design including a follow-up period. The study population consisted of women with diabetes attending a health care center in District 6 of Tehran, of whom 45 were purposively selected and randomly assigned to two experimental groups (solution-focused therapy and dialectical behavior therapy) and one control group. The Self-Care Self-Efficacy Questionnaire by Lu (1996) and the WHOQOL BREF quality of life questionnaire were used. The first experimental group underwent seven 90-minute sessions of solution-focused therapy, and the second experimental group underwent eight 90-minute sessions of dialectical behavior therapy. Repeated measures analysis of variance was used for data analysis. Findings indicated that both solution-focused therapy and dialectical behavior therapy significantly improve self-care and quality of life (p < 0.05). Additionally, results showed that dialectical behavior therapy was more effective than solution-focused therapy in improving self-care and quality of life (p < 0.05). In conclusion, both solution-focused therapy and dialectical behavior therapy are effective in improving self-care and quality of life in patients with type 2 diabetes, with dialectical behavior therapy being more effective. Therefore, these approaches can be utilized alongside medical interventions in clinical settings.

To Evaluate the Efficacy of Internet De-addiction Programme on Perceived Stress and Autonomic Functions in Young Adults

Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding computer use and internet access that lead to impairment or distress. The present study was conducted to evaluate the efficacy of internet de-addiction programme on stress and autonomic functions in young adults. 500 young adults (age group 18-35 years), using smartphones and other gadget frequently were asked to answer Kimberley Young’s Internet addiction test (IAT) questionnaire. As per their responses 31 moderates to severely addicted to internet addiction (IAT score 64.51 ± 16.94) were motivated to participate in a comprehensive internet de-addiction programme, based on repeated sessions of psychological counselling and behavioral therapy as advised by an expert clinical Psychologist. Baseline and follow up (after 6 weeks) recording of Heart rate, Blood pressure, Perceived stress scale, IAT, Autonomic functions based on frequency domain HRV were done. There was significant increase in total power of HRV whereas significant reduction in LF/HF ratio, Perceived stress scores (PSS), Internet addiction scores and average daily mobile usage time after 6 weeks of follow up. It can be concluded from this study that after six weeks of comprehensive sessions based on cognitive behaviour therapy and guiding for self-help approach there were significant decrease in the total daily mobile usages time, internet addiction score, perceived stress score and also simultaneous improvement in symptho-vagal tone and overall autonomic health of participants.

Autonomic nervous system function before and after trauma-focused psychotherapy in youth with (partial) posttraumatic stress disorder

While trauma-focused psychotherapies have been shown effective in youth with PTSD, the relationship between treatment response and alterations in the autonomic nervous system (ANS) associated with PTSD, remains incompletely understood. During neutral and personalized trauma script imagery heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) were recorded in youth aged 8–18 with PTSD or partial PTSD (n = 76) and trauma-exposed controls (TEC) (n = 27) to determine ANS activity and stress reactivity. Within the patient group, 77.6% met the full DSM-IV diagnostic criteria for PTSD, the remaining 22.4% met the criteria for partial PTSD. Youth with (partial) PTSD were subsequently treated with eight sessions of either trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing. PTSD severity was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide patients into responders and non-responders. Youth with (partial) PTSD relative to TEC had higher overall HR during both neutral and trauma imagery (p = .05). Youth with (partial) PTSD showed RSA decrease during trauma imagery relative to neutral imagery, the reverse of TEC (p = .01). Relative to non-responders, responders demonstrated a significant baseline to posttreatment increase of RSA response to stress only when employing a ≥ 50% response criterion (p = .05) and not with the primary ≥ 30% criterion (p = .12). Our results suggest overall higher HR and sympathetic nervous system activity as well as vagal withdrawal in response to stress in youth with (partial) PTSD and only provide partial support for normalization of the latter with successful trauma-focused psychotherapy.

Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder

ObjectivesWe report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND).MethodsThe program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman’s ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up).ResultsAnalyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.DiscussionThis outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.

The effect of compression on repetitive behaviors and task participation in children with autism spectrum disorder.

Compression clothes are marketed to relieve anxiety and decrease hyperactivity in children with autism. However, few studies have examined the impact of compression for individuals with autism spectrum disorder (ASD). In this study, nine children with autism were observed during Applied Behavioral Analysis therapy sessions while wearing compression clothing. The participants were randomly assigned to wear compression clothing for either their first five sessions or their last five sessions. Videos of the therapy sessions were reviewed and each child's "off task" behavior was identified in the following domains: motor, verbal, and visual. In addition, frequency of the child's repetitive behaviors and external visual stimuli were recorded. The compression clothes failed to increase task participation or reduce the participants' repetitive behavior suggesting that the clothing may not contribute to professional practice of ABA therapy.

The design and baseline characteristics for the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis

The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial) is a multicenter randomized trial addressing chronic pain among patients receiving maintenance hemodialysis for end-stage kidney disease. The trial uses a sequential, multiple assignment design with a randomized component for all participants (Phase 1) and a non-randomized component for a subset of participants (Phase 2). During Phase 1, participants are randomized to Pain Coping Skills Training (PCST), an intervention designed to increase self-efficacy for managing pain, or Usual Care. PCST consists of weekly, live, coach-led cognitive behavioral therapy sessions delivered by video- or tele-conferencing for 12 weeks followed by daily interactive voice response sessions delivered by telephone for an additional 12 weeks. At 24 weeks (Phase 2), participants in both the PCST and Usual Care groups taking prescription opioid medications at an average dose of ≥20 morphine milligram equivalents per day are offered buprenorphine, a partial opioid agonist with a more favorable safety profile than full-agonist opioids. All participants are followed for 36 weeks. The primary outcome is pain interference ascertained, for the primary analysis, at 12 weeks. Secondary outcomes include additional patient-reported measures and clinical outcomes including falls, hospitalizations, and death. Exploratory outcomes include acceptability, tolerability, and efficacy of buprenorphine. The enrollment target of 640 participants was met 27 months after trial initiation. The findings of the trial will inform the management of chronic pain, a common and challenging issue for patients treated with maintenance hemodialysis. NCT04571619

Evaluating the effectiveness of dialectical behavior and motor perception training on the symptoms of attention deficit, cognitive avoidance and working memory of female students with attention deficit/hyperactivity disorder

Objective: Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders that is observed in early childhood. The aim of this study was to investigate the effectiveness of dialectical behavior and cognitive motor training on attention deficit, cognitive avoidance and working memory in female students with attention deficit/hyperactivity disorder. Materials and Methods: The present study was quasi-experimental with pretest-posttest design. The statistical population consisted of 257 elementary school girls with attention deficit hyperactivity disorder and resident in district 2 of Tehran. Each meeting was given to participants. Data were collected using Cognitive Avoidance Questionnaire, Attention Deficit Disorder Scale and Wechsler Working Memory Test. Dialectical behavioral therapy sessions were held in 10 sessions and 12 sessions of cognitive and motor training were held in 12 one-hour sessions each week. For dialectical behavior therapy sessions, protocol therapy (Linehan, 1993) and McGinn Cognition and Motor Training (1970) were used. Data were analyzed using multivariate analysis of covariance and SPSS 27 software. Findings: The results showed that there was no significant difference between the experimental and control groups of cognitive avoidance, attention deficit and working memory including cognitive avoidance (P=0.672, F=0.40), attention deficit (F=0.04, P=0.442), working memory (P=0.477, F=0.75). Conclusion: It can be concluded that there is no significant difference between dialectical behavior therapy and cognitive and motor training on cognitive avoidance, attention deficit and working memory.

The Impact of Cognitive Behavioral Therapy for Substance Use Disorders on Veterans’ Interpersonal Difficulties

Background: Substance use disorders (SUDs) negatively impact veterans and their relationships with others. Although there are several evidence-based treatments for SUD symptoms, there is less research on whether reduction in SUD symptoms coincides with reduction in interpersonal difficulties. Methods: In this study we examined the relationship between SUD and relationships in a national sample of 458 veterans who received approximately 12 sessions of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) through the Veterans Health Administration (VHA). Results: Parallel latent growth curve modeling (LGCM) indicated that self-reported alcohol use, drug use, and interpersonal difficulties decreased over the course of treatment. Alcohol and drug use were positively associated with each other and with interpersonal difficulties at each time point, and baseline alcohol and drug use were negatively associated with the reduction of use over time. However, there was little evidence that reductions in substance use led to a reduction in interpersonal difficulties (or vice-versa). Conclusions: Findings highlight promising strategies to further understand how CBT-SUD may enhance reductions in substance use as well as improve relationships with family and friends.

Management of post-COVID-19 depression among patients of Western Uttar Pradesh of Northern India

Background: Coronavirus disease 2019 (COVID-19) affects not only individual's physical health but also their well-being and makes them vulnerable in different ways. Post-COVID-19 depression is dependent on the dynamic interaction between social, medical, economic, geographical, and political factors determining the availability, vulnerability, and distribution of pandemic outbreaks that create fear apprehension and instability among the population. Aim: To evaluate the level of depression (pre and post) and the management of depression among patients from Western Uttar Pradesh of Northern India after the pandemic of COVID-19. Materials and Methods: It was a longitudinal study involving a total of 156 patients with depression. Through chit randomization methods, patients are allocated into two groups, that is, experimental (n=92) and control (n=64). Both groups received appropriate pharmacotherapy. The experimental group in addition also underwent eight therapeutic sessions of cognitive behavior therapy (CBT) (relaxation breathing exercise, activity scheduling, and cognitive restructuring). The period of study was from July 2021 to January 2022. Depression was assessed by applying the Beck Depression Inventory (BDI-II) pre- and post-intervention. Results: According to BDI II, 59.78% of patients report severe levels, 25% of patients report moderate levels, and 15.21% report mild levels of depression. Patients who received medications plus CBT showed significantly better improvement than the patients who received only medications. Conclusion: Patients with post-COVID-19 depression showed better improvement with medications plus CBT than medications alone. The finding of this study underline the importance of CBT in the treatment of depression.

The Effect of Cognitive Behavioral Group Therapy on the Improvement of Postmenopausal Women’s Body Image: A Randomized Clinical Trial

Background: The physiological changes in postmenopausal women, especially age-related physical changes, may lead to negative experiences in body image among these women. Objectives: This study aimed to determine the effectiveness of cognitive behavioral group therapy on the negative body image of postmenopausal women. Methods: This parallel randomized clinical trial study was conducted on 22 eligible postmenopausal women attending a health care center in Ahvaz, Iran, in 2018. They were randomly selected and assigned to intervention and control groups (n = 11 per group). The intervention group attended eight 90-minute sessions of cognitive behavioral therapy (CBT) based on the Cash 8-step model. All participants completed the body image concern inventory (BICI) and Multidimensional Body-Self Relations Questionnaire (MBSRQ) before, immediately after, and 1 month after the intervention. The chi-square test, independent t-test, and repeated measures test were used to investigate the trend of changes in BICI and MBSRQ and their domains over time in both groups. P values less than 0.05 were considered statistically significant for all tests. Results: Before the intervention, there were no statistically significant differences in demographic characteristics (such as age, age of menopause, and body mass index (BMI)) between the 2 groups; also, there were no statistically significant differences in the mean scores of MBSRQ and BICI between the 2 groups (P < 0.05). After the intervention, a significant increase was observed in the mean scores of MBSRQ and its 3 out of 6 domains (appearance evaluation (AE), appearance orientation (AO), and body areas satisfaction (BAS); P < 0.05), while a significant decrease was observed in the mean scores of BICI in the intervention group compared with the control group (P < 0.05). Conclusions: Cognitive behavioral group therapy based on the Cash 8-step model in postmenopausal women can promote satisfaction with their body image.

Effects of Emotional Schema Therapy and Dialectical Behavior Therapy on Cognitive Emotion Regulation in Patients with Bipolar II Disorder

Background: Patients with bipolar disorder suffer from different problems, including emotional disorders, e.g., the loss of emotional self-regulation. Objectives: This study aimed to investigate the effects of emotional schema therapy and dialectical behavior therapy on emotional self-regulation in patients with bipolar II disorder (BP-II). Methods: This was an experimental study with a pretest-posttest design and a control group. The research population comprised patients with BP-II who visited the counseling and psychology centers of Dezful (Iran) in 2022. A sample of 45 eligible patients was purposively selected and randomly allocated to three groups. Each of the two experimental groups received twelve 90-minute sessions of emotional schema therapy and eleven 90-minute sessions of dialectical behavior therapy, while the control group was on the waiting list. The data were collected using the Cognitive Emotion Regulation Questionnaire (CERQ) and analyzed using the analysis of covariance with the Bonferroni post-hoc test in SPSS v. 26. Results: In the emotional schema therapy group, the mean ± standard deviation (SD) of the post-test scores of adaptive and maladaptive emotional self-regulation were 20.60 ± 2.99 and 12.66 ± 2.22, respectively. Moreover, in the dialectical behavior therapy group, the mean ± SD of the post-test scores of adaptive and maladaptive emotional self-regulation were 21.60 ± 3.33 and 14.13 ± 2.35, respectively. Both interventions significantly reduced maladaptive emotional self-regulation and significantly increased adaptive emotional self-regulation in the patients with BP-II, compared to the control group (P < 0.001). Conclusions: Emotional schema therapy and dialectical behavior therapy improved emotional self-regulation in patients with BP-II. Therapists and healthcare professionals can thus administer both methods and other effective methods to improve health-related traits, especially self-regulation, in patients with BP-II.

Twelve-month follow-up: Comparative efficacy of cognitive therapy, behavior therapy, and cognitive behavior therapy for patients with insomnia.

Treatments that alleviate insomnia over the long term are critical. We evaluated the relative long-term efficacy of cognitive therapy (CT), behavior therapy (BT), and cognitive behavior therapy (CBT) for insomnia. Patients (N = 188, 62.2% female, 81.1% White, 6.5% Hispanic or Latinx, Mage = 47.4 years) with insomnia were randomized to eight sessions of CT, BT, or CBT for insomnia. Assessments at pretreatment and 12-month follow-up measured insomnia severity, insomnia response/remission, sleep diary parameters, and daytime functioning. Patients in all three treatment groups improved on insomnia severity, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, work and social adjustment, and mental health (ps < .05). Moreover, in each treatment group, a substantial proportion of patients achieved remission and response. CBT was associated with larger improvements in insomnia severity relative to CT as well as greater remission and improvements in physical health, relative to CT and BT (ps < .05). For patients with a psychiatric comorbidity, CBT was associated with greater improvements in work and social adjustment and mental health, relative to CT (ps < 0.05). CT was not associated with change in time in bed, and none of the treatment conditions were associated with change in daytime fatigue (ps > .05). These encouraging results suggest that therapists may be able to offer CBT, BT, or CT to improve nighttime and daytime symptoms of insomnia over the long-term, with CBT offering a relative advantage for select outcomes and subgroups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Long-term outcomes of once weekly v. twice weekly sessions of cognitive behavioral therapy and interpersonal psychotherapy for depression.

Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.

Efficacy of digital cognitive behavior therapy intervention on adults enrolled in mental wellness care program on Mfine Application

The 2020 pandemic witnessed a surge in mental health cases in India which undoubtedly paved the way for mass adherence of digital health and digital mental health services. Traditional mental health services have issues of scalability, accessibility, stigma &amp; cost effectiveness, and this can be resolved by digitizing these services. Since CBT is an evidence based therapeutic intervention validated by several research in the past, the current study aims to evaluate the efficacy of a Digital Cognitive Behavior Therapy (dCBT) intervention delivered via Mfine application, on adults, using Depression, Anxiety, Stress Scale (DASS21) before and after the intervention. For this purpose, a total of 150 adults who enrolled in the Mfine mental wellness program, from a time period of February 2021-September 2022 were selected. Data was collected via Mfine App. on video call by Rehabilitation Council of India certified clinical psychologists. 5 structured, 1-hour cognitive behavior therapy sessions were provided over a period of 2 months with an additional extension of 1 month for missed sessions, spaced between a gap of 10 days. Pre and post assessment scores were statistically analyzed using SPSS version 20 for all the completers in the program (N=95). The results proved that the dCBT intervention was significantly effective in improving mental health outcomes in adults (p=.000 ). Our study holds the potential to support the development of evidence-based digital mental health interventions and address the barriers of scalability and stigma in mental health services.

Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis

Patients with end-stage kidney disease (ESKD) undergoing long-term hemodialysis often experience a high burden of debilitating symptoms for which effective treatment options are limited. To compare the effectiveness of a stepped collaborative care intervention vs attention control for reducing fatigue, pain, and depression among patients with ESKD undergoing long-term hemodialysis. Technology Assisted Stepped Collaborative Care (TĀCcare) was a parallel-group, single-blinded, randomized clinical trial of adult (≥18 years) patients undergoing long-term hemodialysis and experiencing clinically significant levels of fatigue, pain, and/or depression for which they were considering treatment. The trial took place in 2 US states (New Mexico and Pennsylvania) from March 1, 2018, to June 31, 2022. Data analyses were performed from July 1, 2022, to April 10, 2023. The intervention group received 12 weekly sessions of cognitive behavioral therapy delivered via telehealth in the hemodialysis unit or patient home, and/or pharmacotherapy using a stepped approach in collaboration with dialysis and primary care teams. The attention control group received 6 telehealth sessions of health education. The coprimary outcomes were changes in fatigue (measured using the Functional Assessment of Chronic Illness Therapy Fatigue), average pain severity (Brief Pain Inventory), and/or depression (Beck Depression Inventory-II) scores at 3 months. Patients were followed up for 12 months to assess maintenance of intervention effects. There were 160 participants (mean [SD] age, 58 [14] years; 72 [45%] women and 88 [55%] men; 21 [13%] American Indian, 45 [28%] Black, 28 [18%] Hispanic, and 83 [52%] White individuals) randomized, 83 to the intervention and 77 to the control group. In the intention-to-treat analyses, when compared with controls, patients in the intervention group experienced statistically and clinically significant reductions in fatigue (mean difference [md], 2.81; 95% CI, 0.86 to 4.75; P = .01) and pain severity (md, -0.96; 95% CI, -1.70 to -0.23; P = .02) at 3 months. These effects were sustained at 6 months (md, 3.73; 95% CI, 0.87 to 6.60; P = .03; and BPI, -1.49; 95% CI, -2.58 to -0.40; P = .02). Improvement in depression at 3 months was statistically significant but small (md -1.73; 95% CI, -3.18 to -0.28; P = .02). Adverse events were similar in both groups. This randomized clinical trial found that a technology assisted stepped collaborative care intervention delivered during hemodialysis led to modest but clinically meaningful improvements in fatigue and pain at 3 months vs the control group, with effects sustained until 6 months. ClinicalTrials.gov Identifier: NCT03440853.

N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial

BackgroundTobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. MethodIn a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. ConclusionResults will inform smoking cessation treatment among dual users of tobacco and cannabis.ClinicalTrials.gov Identifier: NCT04627922.