Sessions Of Behavioral Therapy Research Articles

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.

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 & 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.

0330 Blinded Verses Open-Label Hypnotic Tapering for Hypnotic Discontinuation: A Randomized Clinical Trial

Abstract Introduction Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study is testing a blinded tapering approach designed to reduce patients’ anxiety during the hypnotic tapering process. Methods Thus far, a sample of 44 (M age = 59.1±14.1 yrs.; 61.4% women) users of benzodiazepine (BZD) or newer generation benzodiazepine receptor agonists (BZRA) have enrolled in this trial and completed a 3-month post-tapering follow-up. Following baseline assessments that included completion of the insomnia severity index (ISI), these enrollees completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of two 10-week, tapering protocols wherein their medication dosage was reduced by 25% every two weeks either in a blinded or open-label manner. Medication usage was assessed and ISI scores were obtained at the end of the tapering phase and at a 3-month follow-up. Results A linear mixed model analysis showed only an effect for time in study on ISI scores with both tapering groups showing a significant (F = 36.89; p = .0001) decline in these scores from baseline through the 3-month follow-up. By the 3-month follow-up, a slightly, albeit non-significantly, higher proportion of the blinded tapering group (76.2%) were no longer using their BZD/BZRA hypnotics than in the open label group (60.9%). However, there was a significantly higher BZD/BZRA discontinuation rate by the 3-month follow-up among those who achieved ISI score-determined insomnia remission than among unremitted participants both for the sample as a whole (85% vs. 54.2%; p = .05) and for the open label group (88.9% vs. 42.9%; p = .0397) considered separately. This difference between remitted and unremitted participants was not seen in the blinded tapering group. Conclusion Early findings in this trial suggest a slight advantage to blinded over open label hypnotic tapering in achieving hypnotic discontinuation. Moreover, insomnia remission may not be essential for hypnotic discontinuation when blinded tapering is conducted. Support (if any) National Institute of Drug Abuse, Grant # 1R01DA047341-01A1

0318 Early Sleep Intervention Mitigates Poor Sleep and Improves Mood in the COVID-19 Pandemic

Abstract Introduction Rates of sleep disturbance and depressed mood increased during the COVID-19 pandemic. Acute symptoms of sleep disturbance may develop into chronic insomnia if left untreated and constitute a risk for depression. However, the impact of early treatment of insomnia symptoms on the development of chronic insomnia and depressive symptoms remains unknown. Here we present the primary outcome results from a pre-registered, 2-arm randomized controlled feasibility trial launched early in the pandemic, investigating whether a brief telehealth insomnia intervention targeting acute insomnia symptoms prevents the subsequent deterioration of insomnia and depression. Methods Forty-nine participants with pandemic-onset insomnia symptoms were randomized to receive four telehealth sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Primary outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 excluding the sleep item collected at weeks 0, 6, 12, and 28. Linear mixed-effects models tested the hypotheses that early insomnia intervention improves the 28-week trajectory of insomnia and depressive symptoms relative to the control group. The MacArthur framework tested if improvement of insomnia mediates subsequent improvement in depression. Results The two linear mixed-effects models revealed significant time-by-intervention interactions, indicating improved trajectories of insomnia and depressive symptoms across the 28-weeks in the CBT-I group compared to the control group (Insomnia: B=-1.03, p<.001; Depression: B=-0.52, p=0.009). The rate of improvement in insomnia during treatment (0-5 weeks) mediated the subsequent improvement in depressive symptoms following treatment (6-weeks; B=2.31, p=0.005), but not at 12- or 28-weeks (all B’s <=1.44, all p’s>0.203). In contrast, depression symptom improvement during treatment was not associated with insomnia symptoms (all timepoint p's>=0.132). The percentage of participants with insomnia diagnosis was lower in the CBT-I vs control group at both timepoints (short-term: 21.7% vs. 50%; long-term: 22.7% vs. 50%). Conclusion These are the first findings establishing that brief telehealth CBT-I significantly improved both acute pandemic-onset insomnia symptoms and subsequent trajectory of insomnia and depression. Although the sample size was small and pandemic conditions may never fully be replicated, these results support treatment of acute sleep disturbance in the context of stressors for improved long-term sleep and mood symptoms. Support (if any)

Group trauma focused cognitive behavior therapy for parents of premature infants compared to individual therapy intervention

BackgroundThe current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants with a prior study using an individual version of the treatment manual. Methods26 mothers of preterm infants (25–34 weeks' gestational age; >600 g) received 6 sessions of trauma-focused cognitive behavior therapy (CBT). Outcomes were compared with those of a previously published RCT, which tested an individual therapy based on the same model in a group of 62 mothers. Results were also compared across in-person and telehealth treatment. ResultsFrom baseline to follow up, the individual intervention showed greater improvement in trauma symptoms assessed with the Davidson Trauma Scale (d = 0.48, p = 0.016), although both conditions showed clinically significant improvement. Similar patterns were found for maternal depression and anxiety. In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant. ConclusionsGroup-based trauma focused CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress but not as effective as individual therapy using the same treatment model.

Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study.

Blended cognitive behavioral therapy (bCBT) programs have been proposed to increase the acceptance and adoption of digital therapeutics (DTx) such as digital health apps. These programs allow for more personalized care by combining regular face-to-face therapy sessions with DTx. However, facilitators of and barriers to the use of DTx in bCBT programs have rarely been examined among students, who are particularly at risk for developing symptoms of depression and anxiety disorders. This study aimed to evaluate the facilitators of and barriers to the use of a bCBT program with the elona therapy app among university students with mild to moderate depression or anxiety symptoms. Semistructured interviews were conducted via videoconference between January 2022 and April 2022 with 102 students (mean age 23.93, SD 3.63 years; 89/102, 87.2% female) from universities in North Rhine-Westphalia, Germany, after they had completed weekly individual cognitive behavioral therapy sessions (25 minutes each) via videoconference for 6 weeks and regularly used the depression (n=67, 65.7%) or anxiety (n=35, 34.3%) module of the app. The interviews were coded based on grounded theory. Many participants highlighted the intuitive handling of the app and indicated that they perceived it as a supportive tool between face-to-face sessions. Participants listed other benefits, such as increased self-reflection and disorder-specific knowledge as well as the transfer of the content of therapy sessions into their daily lives. Some stated that they would have benefited from more personalized and interactive tasks. In general, participants mentioned the time requirement, increased use of the smartphone, and the feeling of being left alone with potentially arising emotions while working on tasks for the next therapy session as possible barriers to the use of the app. Data security was not considered a major concern. Students mostly had positive attitudes toward elona therapy as part of the bCBT program. Our study shows that DTx complementing face-to-face therapy sessions can be perceived as a helpful tool for university students with mild to moderate anxiety or depression symptoms in their daily lives. Future research could elaborate on whether bCBT programs might also be suitable for students with more severe symptoms of mental disorders. In addition, the methods by which such bCBT programs could be incorporated into the university context to reach students in need of psychological support should be explored.

Phenotype tailored lifestyle intervention on weight loss and cardiometabolic risk factors in adults with obesity: a single-centre, non-randomised, proof-of-concept study

Lifestyle interventions for weight loss are currently not individualised to underlying pathophysiology and behavioral traits in obesity. We aim to compare the outcome of a standard lifestyle intervention (SLI) to phenotype-tailored lifestyle interventions (PLI) on weight loss, cardiometabolic risk factors and physiologic variables contributing to obesity. This 12-week, single-centre non-randomised proof-of-concept clinical trial including men and women aged 18-65 years with a body mass index (BMI) greater than 30 without history of any bariatric procedure, and current use of any medication known to affect weight. Participants lived anywhere in the United States, and underwent in-person testing in Rochester, MN at a teaching hospital. All participants completed in-person phenotype testing at baseline and after 12 weeks. Participants were assigned to their intervention based on their period of enrollment. In the first phase, participants were assigned to SLI with a low-calorie diet (LCD), moderate physical activity, and weekly behavioral therapy sessions. In the second phase, other participants were assigned to PLI according to phenotype: abnormal satiation (time-restricted volumetric LCD); abnormal postprandial satiety (LCD with pre-meal protein supplementation); emotional eating (LCD with intensive behavioral therapy); and abnormal resting energy expenditure (LCD with post-workout protein supplementation and high-intensity interval training). The primary outcome was total body weight loss in kg at 12 weeks using multiple imputation for missing data. Linear models estimated the association of study group allocation and study endpoints adjusting for age, sex, and baseline weight. This study was registered with ClinicalTrials.gov, NCT04073394. Between July 2020 and August 2021, 211 participants were screened, and 165 were assigned to one of the two treatments in the two phases: 81 SLI (mean [SD] age 42.9 [12] years; 79% women; BMI 38.0 [6.0]) and 84 PLI (age 44.8 [12.2] years; 83% women; BMI 38.7 [6.9]); 146 completed the 12-week programs. The weight loss was-7.4kg (95%CI,-8.8,-6.0) with PLI vs.-4.3kg (95%CI,-5.8,-2.7) with SLI (difference,-3.1kg [95%CI,-5.1 to-1.1]; P=0.004). No adverse events were reported in any group. Phenotype-tailored lifestyle interventions may result in significant weight loss, but a randomised controlled trial is required to confirm causality. Mayo Clinic; NIH (K23-DK114460).

Sleep Effort and Insomnia Severity: The Role of Bedtime Procrastination

Background and Objective We aimed to investigate the mediating role of bedtime procrastination in the relationship between sleep effort and insomnia severity in this study.Methods We included 497 university students in this study. All the participants completed the sociodemographic data form, Glasgow Sleep Effort Scale (GSES), Insomnia Severity Index (ISI), Depression-Anxiety-Stress Scale-21 (DASS-21), and Bedtime Procrastination Scale (BPS). We divided the participants into groups, according to their GSES and BPS scores, those with high-low sleep effort and those with BP (+) and BP (-), respectively. We compared the variables in these groups. Finally, we analyzed the mediating role of bedtime procrastination in the relationship between sleep effort and insomnia severity.Results The mean age of the participants was 20.41 ± 1.83 years. ISI, BPS, and DASS-21 were statistically significant in the group with high sleep effort (p < 0.01). Among the psychometric instrument scores, the highest correlation with GSES was with ISI, and then there was a statistically significant positive correlation with DASS-21. In addition, there was a statistically significant positive correlation between GSES and BPS. Bedtime procrastination played a partial mediation role in the relationship between sleep effort and insomnia severity.Conclusions Bedtime procrastination partially mediated the relationship between sleep effort and insomnia severity. Therapists should consider sleep effort and bedtime procrastination on their agenda in cognitive behavioral therapy sessions for insomnia.

Pretreatment changes in drinking: A test of a tailored treatment approach.

Pretreatment reductions in drinking are welldocumented and have been demonstrated to predict posttreatment drinking outcomes. Making use of the predictive value of pretreatment change has great appeal in settings thatplace a premium on efficient clinical decisions regarding appropriate type and intensity of treatment. This study investigates whether different types and intensities of treatment are appropriate and beneficial for individuals entering treatment for an alcohol use disorder (AUD; N=201) who make more vs. less pretreatment change in their drinking during a 2-month pretreatment period. Based on an algorithm derived from pilot research, we derived two independent pretreatment change arms that we called Substantial Change and Minimal Change. Each arm was a parallel, sequentially randomized design consisting of a treatment group and an active control. The Substantial Change arm compared six sessions of relapse prevention treatment (RPT) with 12 sessions of cognitive behavioral therapy for AUD (CBT) as an active control. Both CBT and RPT occurred over a 12-week period. The Minimal Change arm compared 12 sessions of an integrated motivational intervention combined with CBT (MI/CBT) with 12 sessions of CBT as an active control. The outcome variables were changes in number of days abstinent (NDA) and number of days heavy drinking (NDH) per week. For the Substantial Change arm, a noninferiority analysis revealed that six sessions of RPT were noninferior to 12 sessions of CBT at each posttreatment assessment for both NDA and NDH. For the Minimal Change arm, a superiority analysis failed to detect that MI/CBT was superior to CBT at any posttreatment assessment for both NDA and NDH. In the substantial change arm, results suggest that offering a less intensive initial treatment, like RPT, may lower costs and conserve clinical resources. In the Minimal Change arm, results indicate the need to continue searching for a treatment or treatment enhancements to improve alcohol outcomes.

Effectiveness of Cognitive Behavioral Therapy (CBT) on Emotional Regulation and Quality of Life in Divorced Women

Objective: Separation and divorce are the most significant factors in the collapse and disintegration of the most fundamental part of society, the family. The current research was conducted with the aim of determining the impact of Cognitive Behavioral Therapy on emotional self-regulation and the quality of life of divorced women. Methods and Materials: The study was a quasi-experimental investigation with a pre-test-post-test design involving two groups. The research population consisted of all divorced women who visited counseling centers in the city of Karaj. Using a convenience sampling method, four centers were selected, and among those who were willing to participate in the study and had low scores in emotional self-regulation and quality of life, 30 individuals were randomly chosen as the sample. Subsequently, these individuals were divided into two groups of 15 and randomly assigned to either the experimental or control group. The experimental group underwent 12 sessions of 90-minute Cognitive Behavioral Therapy, while the control group continued with their usual routine. Both groups were post-tested at the end of the period. The instruments used in this research were the Gross and John (2003) Emotion Regulation Questionnaire and the World Health Organization Quality of Life (WHOQOL) Questionnaire (1989). For data analysis, Multivariate Analysis of Covariance (MANCOVA) and SPSS version 22 software were utilized. Findings: The results indicated that Cognitive Behavioral Therapy had a significant effect on emotional self-regulation (F=24.22, P<0.001) and quality of life (F=28.93, P<0.001) of divorced women. Conclusion: It can be concluded that Cognitive Behavioral Therapy is effective in improving emotional self-regulation and quality of life in divorced women.

Protocol for a randomized controlled study examining the role of rapid eye movement sleep in fear-related mechanisms: rapid eye movement fragmentation and fear inhibition in adults with insomnia disorders before and after cognitive behavioral therapy for insomnia.

Insomnia confers a 2.5-to-3-fold risk of developing posttraumatic stress disorder (PTSD) after a traumatic event. The mechanism underlying this increased risk, however, remains unknown. We postulate insomnia may contribute to PTSD by disrupting rapid eye movement (REM) sleep, as REM sleep disruption has been shown to impair fear inhibitory processes, which are central to the natural recovery from trauma. To test this hypothesis, the following protocol aims to: (1) examine the relationship between REM sleep and fear inhibition in insomnia, and (2) examine whether reducing REM fragmentation by treating insomnia, in turn, improves fear inhibition. Ninety-two adults with Insomnia Disorder will be block randomized (1:1; stratified by sex) to an active treatment (7 weekly sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) via telehealth) or waitlist control condition. REM sleep (latent variable derived from REM %, REM efficiency, and REM latency) and fear inhibition (i.e. safety signal and extinction recall) will be assessed pre- and post-treatment in a 4 night/3 day testing protocol via at-home polysomnography and the fear-potentiated startle paradigm, respectively. Fear extinction recall will serve as the primary outcome, while safety signal recall will serve as the secondary outcome. In summary, this study aims to test an underlying mechanism potentially explaining why insomnia greatly increases PTSD risk, while demonstrating an existing clinical intervention (CBT-I) can be used to improve this mechanism. Findings will have potential clinical implications for novel approaches in the prevention, early intervention, and treatment of PTSD.

Comparison of the Effectiveness of Couple Therapy in the Way of Psychodrama and Integrative Behavioral Couple Therapy (IBCT) on Improving Conflict Resolution Tactics in Contradictory Couples

Aim: The aim of the present study was to compare the effectiveness of Psychodrama Couple Therapy and Integrated Behavioral Couple Therapy (IBCT) on improving conflict resolution tactics of contradictory couples. Method: The method of this semi-experimental study is pre-test/post-test with a control group and a follow-up phase. The statistical population included all conflicting couples who referred to Dramatherapy Center of Iran in 2019. The sample of this study includes 36 persons (18 couples) who referred to Dramatherapy Center of Iran who were selected by the available sampling method. Then they were assigned in 3 groups of 12 persons including two experimental groups and one control group. The first experimental group underwent 12 sessions of Psychodrama Couple Therapy by Moreno (1969) and the second experimental group underwent 12 sessions of Integrative Behavioral Couple Therapy by Christensen et al. (2014). Data were obtained by using Conflict Tactics Scale (CTS2) by Straus (1996) and analyzed by methods of repeated measure analysis of variance using spss22 software. Results: The results of this study showed that Psychodrama Couple Therapy reduced physical assault (F=11.52 and p=0.001) and psychological violence (F=12.74 and p=0.001) and increased non-violent negotiation (F=58.84 and p=0.001) in the victim form and respectively physical assault (F=17.96 and p=0.001), psychological violence (F=17.08 and p=0.001) and non-violent negotiation (F=89.45 and p=0.001) in the aggressive form. Conclusion: The results indicated the effectiveness of Psychodrama Couple Therapy on reducing physical assault and psychological violence and increasing non-violent negotiation in conflicting couples and its durability over time. Therefore, health professionals and therapists can use Psychodrama Couple Therapy along with other treatment methods to improve couples' conflict resolution tactics.

Adapting cognitive behavioural therapy for depression in later life for Irish Travellers: a case example and considerations for practice

Abstract Gypsies and Travellers are at significantly increased risk of poor physical and mental health compared with the general population. Barriers to accessing mental health services include fear of stigma and discrimination from services, difficulties with signing up to services due to poor educational levels, and the taboo nature of mental health difficulties within the community. To the authors’ knowledge, no research has identified best practice for adapting psychological therapy to meet the needs of this community. This paper presents the case of John (pseudonym), an 80-year-old Irish Traveller, whose respiratory team referred him for psychological intervention for depression and anxiety symptoms. The psychology service was embedded within the respiratory team which enabled easy access to therapy services via an already trusted service. He received 10 sessions of cognitive behavioural therapy for depression, adapted to his age, physical health, and cultural background. His low mood was maintained by withdrawal from activities, rumination of losses, lack of confidence and avoidance of help-seeking. Treatment consisted of culturally adapted psychoeducation, behavioural activation, cognitive restructuring, and behavioural experiments to increase his activity, mood and confidence. The Patient Health Questionnaire and Generalised Anxiety Disorder Scale demonstrated improvements in both depressive and anxious symptoms at the end of therapy. The paper presents an overview of relevant literature before describing John’s case, formulation, culturally adapted intervention techniques and outcomes. Considerations to support best practice for clinicians working with Irish Travellers are made. Key learning aims (1) Integrating psychological services into physical health services has the potential to improve access to psychological support for minority groups facing multi-morbidity, such as Irish Travellers. This approach offers a less stigmatised route for individuals to receive help and involves fewer administrative processes, which may pose challenges for those with varying levels of literacy ability. (2) This case example presents initial evidence that short-term transdiagnostic cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety symptoms in older people from an Irish Traveller background. (3) Successful outcomes in this case example hinged on: (a) A comprehensive formulation that considered the client’s full identity (e.g. cultural identity, intergenerational connections, cohort beliefs, physical health needs) in addition to their presenting problem. (b) Adapting the intervention to accommodate for culturally relevant aspects of the individual’s presentation. This involved modifying homework to reduce the literacy requirements, involving a trusted family member as a co-therapist, and integrating culturally relevant language into the therapy. (4) This case report underscores the scarcity of rigorous research involving Irish Traveller populations and emphasises the need for further exploration of their experiences of mental health difficulties and engagement with mental health services. Further research should actively involve Irish Travellers to identify unmet needs and explore potential adaptations for therapeutic interventions. This would help to ensure accurate representation and prevent the homogenisation of this diverse group of individuals.