Sessions Of Behavioral Therapy Research Articles

601-P: Participation in Diabefly Program and Significant Reduction in Diabetes Distress and Improvement in Motivation and Attitude towards Changing Health among People with Type 2 Diabetes

Introduction: Diabetes distress is a unique, often hidden, emotional burden and worry that an individual experiences while managing diabetes. Enhanced motivation and willingness are important components of one’s ability to manage the increasing demands of diabetes. Aim of this study is to analyse the effectiveness of digital therapeutics programs in providing evidence-based care that can help in better management of diabetes through long-term behaviour change. Methods: This study was conducted with 100 participants diagnosed with type 2 DM across India. They were enrolled in the Diabefly® digital therapeutics program for 90 days. Highly customized virtual stress management and behaviour therapy sessions were given to each participant along with nutrition and fitness sessions. Various digital interventions were shared at regular intervals. Initial and final assessment was done using Diabetes Distress Scale and Motivation and Attitude towards Changing Health. t - test was used to analyse the data. Results: Motivation levels among participants improved significantly by 9.39% from a baseline score of 33.70±4.24 to 37.42±4.50 (p=0.001) . Distress levels among participants decreased significantly by 24.21% from a baseline score of 1.90±0.77 to 1.35±0.45 (p=0.001) . Participants from joint families have higher interpersonal distress as compared to nuclear families (p=0.008) . Participants having diabetes for more than 5 years have higher physician distress (p=0.001) and interpersonal distress (p=0.005) as compared to newly diagnosed ones. Participants who are on insulin along with medications have higher physician distress (p=0.031) and interpersonal distress (p=0.020) in comparison to those who are just on medication or not on any medication. Conclusion: Remote behavioural interventions as part of a comprehensive 90 days Diabefly® program can be very effective in managing diabetes adequately. Disclosure N.Verma: Employee; Fitterfly HealthTech Private Limited. K.Samudra: None. T.Lathia: Advisory Panel; Abbott, AstraZeneca, Biocon, Boehringer Ingelheim International GmbH, Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi. P.Vasan: Employee; Fitterfly Health Tech Pvt Ltd. N.Gupta: Employee; Fitterfly HealthTech Pvt Ltd. R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. S.Kalra: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. M.V.Padsalge: None. V.Methil: None. A.K.Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd.

Exploratory study on the effectiveness of integrative neurocognitive remediation therapy (iNCRT) for cancer survivors

IntroductionCancer survivors frequently report suffering from neurocognitive impairment, that persists after physical recovery from their disease. Cognitive impairment is associated with important emotional disturbances, socio-professional consequences and diminished quality of life.ObjectivesThis observational study aims to assess the effectives of an integrative neurocognitive remediation therapy (iNRCT), offered as a 12-week program (1day/week), organized within our Cognitive Remediation Clinic. The iNCRT combines personalized computerized cognitive training and neurocognitive strategy training, with group sessions of physical exercise, mindfulness, and cognitive behavior therapy (CBT).MethodsThe assessment before and after NCRT includes neuropsychological testing (10 subtests), assessment of daily functioning and subjective neurocognitive function (NCF).ResultsOut of 16 eligible cancer survivors, 12 patients were recruited and 11 completed the iNCRT; median age 53 years [range, 41-71]; 3 patients had a prior history of a central nervous system tumor, 5 patients of breast cancer, 2 patients of stage-IV melanoma, and 1 patient of gastric cancer. After iNCRT subjective NCF did not improve significantly (p=0.13) according to the Cognitive Failure Questionnaire. However neuropsychological assessment revealed an improvement on ≥ 1 impaired subtest in all patients; 6 patients improved on ≥ 4 impaired subtests. Improvement was most prominent in long-term verbal and visual memory, working memory and executive function. All patients reported a clinical benefit in their daily function after completion of iNCRT.ConclusionsOur iNRCT, which combines personalized neurocognitive training with physical exercise, mindfulness and CBT can be an effective therapeutic model for treating neurocognitive impairment in cancer survivors, with a clinically relevant impact on their daily function.DisclosureNo significant relationships.

Behavioral sex therapy and medications associated in the treatment of provoked vulvodynia: efficacy on pain and sexuality in three illustrative cases.

This paper tests the hypothesis that medications combined with behavioral sex therapy might lessen pain and restore sexuality in women with provoked vulvodynia. Three women affected by vulvodynia, otherwise healthy, in heterosexual relationship were treated at the Department of Obstetrics and Gynecology in a university hospital. In consecutive sessions of behavioral sex therapy, oral tricyclic antidepressants and vulvar applications of estrogen and hydrocortisone creams were prescribed in association with vaginal dilators and sensate focus exercises. The outcome supports the hypothesis that combined medications and sexual behavior interventions may be effective in lessening pain and restoring sexuality in women with provoked vulvodynia. The different dyadic balances observed in this small case series suggest how to best use this protocol. The positive results appear to be mostly due to behavioral sex therapy that was the new element added to the combination of pharmacological agents commonly used to treat provoked vulvodynia.

P320. Waiting for the Payoff: Electrical Anticipation Response in Individuals With Depression/Anxiety Disorders

Reward processing dysfunction is considered a core characteristic of depression and anxiety disorder (DEP/ANX). However, research in DEP/ANX has focused mainly on reward receipt as opposed to anticipation. The stimulus preceding negativity (SPN) is a slow event-related potential recorded during electroencephalography (EEG), thought to reflect anticipatory brain activity. We aimed to examine the effect of MDD on SPN amplitude and its relationship with future treatment completion (>7 sessions of behavioral activation or exposure therapy).

Viability of an Early Sleep Intervention to Mitigate Poor Sleep and Improve Well-being in the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial.

BackgroundThe COVID-19 pandemic has led to drastic increases in the prevalence and severity of insomnia symptoms. These increases in insomnia complaints have been paralleled by significant decreases in well-being, including increased symptoms of depression, anxiety, and suicidality and decreased quality of life. However, the efficacy and impact of early treatment of insomnia symptoms on future sleep and well-being remain unknown.ObjectiveHere, we present the framework and protocol for a novel feasibility, pilot study that aims to investigate whether a brief telehealth insomnia intervention targeting new insomnia that developed during the pandemic prevents deterioration of well-being, including symptoms of insomnia, depression, anxiety, suicidality, and quality of life.MethodsThe protocol details a 2-arm randomized controlled feasibility trial to investigate the efficacy of a brief, telehealth-delivered, early treatment of insomnia and evaluate its potential to prevent deterioration of well-being. Participants with clinically significant insomnia symptoms that began during the pandemic were randomized to either a treatment group or a 28-week waitlist control group. Treatment consists of 4 telehealth sessions of cognitive behavioral therapy for insomnia (CBT-I) delivered over 5 weeks. All participants will complete assessments of insomnia symptom severity, well-being, and daily habits checklist at baseline (week 0) and at weeks 1-6, 12, 28, and 56.ResultsThe trial began enrollment on June 3, 2020 and closed enrollment on June 17, 2021. As of October 2021, 49 participants had been randomized to either immediate treatment or a 28-week waitlist; 23 participants were still active in the protocol.ConclusionsTo our knowledge, this protocol would represent the first study to test an early sleep intervention for improving insomnia that emerged during the COVID-19 pandemic. The findings of this feasibility study could provide information about the utility of CBT-I for symptoms that emerge in the context of other stressors before they develop a chronic course and deepen understanding of the relationship between sleep and well-being.Trial RegistrationClinicalTrials.gov NCT04409743; https://clinicaltrials.gov/ct2/show/NCT04409743International Registered Report Identifier (IRRID)DERR1-10.2196/34409

The Incidence of Suicide in Pakistan Day by Day, Especially the Educated Youth Trying to Commit Suicide in 2022 - 2023

The focus of this study the Incidence of Suicide in Pakistan Day by Day, Especially the Educated Youth Trying to Commit Suicide in 2022 2023 is to provide understanding for human nature, the societal impact of suicides, to explore the trend and causes of suicide, and to create awareness about this sensitive and unlawful act. The main theme is a try to stop this inhuman act by helping the needed people by approaching the related authorities. This report is an effort to stop this sinful act by explaining the bad effects because this act can never eliminate the problems but on the other hand give rise to them. This whole effort can only bring about change, if everyone really wants to help others and contribute to get rid of this evil and unlawful act. This study discovers that suicide is an indication of the problems in the lives of many people such as financial, social or medical. The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression, no matter which strata of society they belong to. A suicide attempt is often a cry for help that ends in tragedy. The research paper is an analytical study of adverse effect of criminalization of Attempt to Suicide in Pakistan in Section 325 of PPC 1860. Criminalization of attempted suicide is one of the major reasons that have made people reluctant to get help for the psychological problem that causes such act. This study aims to provide significant reasons for decriminalizing attempted suicide in Pakistan. Quantitative and Qualitative research method was used to gather, analyse and abridge the data. This paper focuses on the problem of criminalization of attempted suicide and tends to provide a new framework in the replacement of existing one. It is pertinent to mention that committing suicide is an illness not a crime, so the one who attempts to commit suicide must be treated as a „patient‟ not as a „culprit‟. The existing law provides punishment for the person who attempted suicide but failed, this represents the harshness of the state as it prescribes „punishment‟ for the person suffering from mental disorder, instead of „treatment‟. The analysis includes problems of criminalizing attempted suicide and challenges of the applicability of relevant law as well as negative impacts of it. Moreover, this paper deliberates upon the introduction of new practice in law. According to this practice, state institutions will provide rehabilitation/treatment to those persons who attempted suicide but failed under the law. Suicidal behavior is one of the serious consequences of depression. Depression disrupts the daily life functioning including ability to think properly, planning, problem solving and decision-making. This happens because of excessively experiencing the negative emotions. Dialectical behavior therapy sessions were planned including skills training for emotional stability, obsessions and impulse control. Evaluation of the behavior at the end of this intervention had fruitful outcomes and better change in the patient’s condition. Columbia Suicide Severity Rating Scale was used to measure the change after ten sessions, once a week of one hour each.

Effectiveness of Internet-Based Cognitive Behavioral Therapy With Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial.

BackgroundNoncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain.ObjectiveIn this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain.MethodsWe conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes.ResultsIn the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions.ConclusionsThis study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain.Trial RegistrationClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925

Targeting maladaptive reactivity to negative affect in emerging adults with cannabis use disorder: A preliminary test and proof of concept

IntroductionCannabis use disorder (CUD) is a growing public health concern, and is highly comorbid with negative affective conditions such as anxiety and depression. Late adolescence and early adulthood represents a time of rapid emotion regulation development, as well as the onset of anxiety, mood, and substance use disorders, especially CUD. Maladaptive cognitive, behavioral, and emotional responding to one's own negative affect (in an effort to eliminate it) is associated with substance use, and represents a novel treatment target to improve outcomes of treatment for substance misuse. Method: After development of a manual for a novel intervention, Affect Management Treatment (AMT) for CUD, a pilot randomized clinical trial was conducted in 18–25 year-old participants with CUD to evaluate the impact of this approach on negative affect, constructs (e.g., distress intolerance) representing maladaptive reactivity to negative affect, and cannabis use. Participants (N = 52) received either 12 sessions of standard cognitive behavioral therapy (CBT) for CUD or 12 sessions of AMT and were assessed on measures of negative affect, reactivity to negative affect, cannabis use, and cannabis use problems at baseline, throughout treatment, post-treatment, and 6-mo follow-up. Results: AMT outperformed CBT in reducing negative affect and reactivity to negative affect, and it had a significant impact on cannabis use and cannabis use problems. There were no statistically significant between-group differences on cannabis outcomes. Conclusions: AMT offers a novel, successful approach to the treatment of CUD.

Comparison of the Effectiveness of group Dialectical Behavior Therapy with group Schema Therapy on Psychological Distress in Women with Coronary Heart Disease

Aim: This study aimed to compare the effectiveness of group dialectical behavior therapy with group schema therapy on psychological distress in women with coronary heart disease. Method: This was a quasi-experimental study using a pre-test-post-test design with a control group. The statistical population included women suffering from coronary heart disease referred to Azadi Hospital in Tehran in 2018-2019, 45 people were selected as a statistical sample by available sampling method and divided into two experimental groups, and one control group (15 people for each group) were replaced. The research measurement tools included psychological distress (Kessler et al., 2002). After completing eight sessions of dialectical behavioral therapy (two sessions per week for 4 weeks) and eight sessions of group schema therapy (two sessions per week for 4 weeks) in the experimental groups, the questionnaires were repeated immediately and after three months. The sequence was completed as a post-test and follow-up in groups. The results were analyzed using descriptive statistics and inferential (repeated measures analysis of variance) in SPSS.23 software. Results: The results of repeated measures analysis of variance showed that both treatments were effective on psychological distress in women with coronary heart disease from pre-test to post-test and follow-up (p=0.001). The Bonferroni post hoc test results also showed that group dialectical behavior therapy has a more significant effect on reducing psychological distress in women with coronary heart disease than group schema therapy from pre-test to post-test and follow-up (p=0.001). Conclusion: Therefore, group dialectical behavior therapy training is recommended as an effective intervention method for reducing psychological distress in women with coronary heart disease.

Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial.

BackgroundCognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated.ObjectiveThis study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing.MethodsThis study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility.ResultsIn the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained.ConclusionsThe findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size.Trial RegistrationUniversity Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

Improved symptoms of complex regional pain syndrome after novel lymphatic treatment and interdisciplinary pain management

IntroductionComplex regional pain syndrome (CRPS) is a pain syndrome with no singular mechanism and no specific cure. The aim of this case report is to study the impact of Lymphatic Enhancement Technology (LET) treatment on CRPS-related symptoms. MethodsA 51 year-old female presented with a chief complaint of severe, refractory ankle pain and CRPS related to a tibial and fibular fracture sustained three years earlier. The patient completed twelve cognitive behavioral therapy sessions over a 4-week period, and eleven physical therapy sessions over a four-month period, six of which utilized LET. ResultsPain and swelling were largely unchanged with interdisciplinary treatment before the introduction of LET. A within-session change of 37.5% in pain intensity and 87.5% in ankle girth was observed immediately after the first application of LET. Three months after beginning LET treatment, the patient maintained a 43.8% improvement in pain intensity and 100% improvement in measurements of lower extremity girth and ankle range of motion. No side effects or adverse events were associated with the LET treatment. ConclusionSwelling, pain, and mobility loss are common symptoms and features of CRPS. LET is a novel, non-invasive treatment that appears to be quite safe and effective for improving pain, swelling, and mobility loss related to CRPS.

Effects of competence feedback on therapist competence and patient outcome: A randomized controlled trial.

Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome. Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions. (a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy. Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Automated quality assessment of cognitive behavioral therapy sessions through highly contextualized language representations.

During a psychotherapy session, the counselor typically adopts techniques which are codified along specific dimensions (e.g., 'displays warmth and confidence', or 'attempts to set up collaboration') to facilitate the evaluation of the session. Those constructs, traditionally scored by trained human raters, reflect the complex nature of psychotherapy and highly depend on the context of the interaction. Recent advances in deep contextualized language models offer an avenue for accurate in-domain linguistic representations which can lead to robust recognition and scoring of such psychotherapy-relevant behavioral constructs, and support quality assurance and supervision. In this work, we propose a BERT-based model for automatic behavioral scoring of a specific type of psychotherapy, called Cognitive Behavioral Therapy (CBT), where prior work is limited to frequency-based language features and/or short text excerpts which do not capture the unique elements involved in a spontaneous long conversational interaction. The model focuses on the classification of therapy sessions with respect to the overall score achieved on the widely-used Cognitive Therapy Rating Scale (CTRS), but is trained in a multi-task manner in order to achieve higher interpretability. BERT-based representations are further augmented with available therapy metadata, providing relevant non-linguistic context and leading to consistent performance improvements. We train and evaluate our models on a set of 1,118 real-world therapy sessions, recorded and automatically transcribed. Our best model achieves an F1 score equal to 72.61% on the binary classification task of low vs. high total CTRS.

The Effect of Cognitive Behaviour Therapy on Sleep and Circadian Rhythm in Young College Students

The present study is to study the effect of cognitive behaviour therapy on various sleep parameters and circadian phase rhythmic in young college going adults. Fifty young college going adults were chosen from the MBBS and BDS students of King George's Medical University Lucknow, their polysomnography was conducted along with it salivary melatonin estimation was conducted to find the time of Dim light melatonin onset (DLMO), the subjects were administered cognitive behaviour therapy (CBT),after completing the sessions of cognitive behaviour therapy another Polysomnographic study and DLMO estimation was conducted, various sleep parameters were compared before and after the CBT. The study showed an improvement in the steep quality, a decrease in daytime sleepiness along with this total sleep time significantly increased, sleep efficiency also improved and there was a decrease in the REM sleep latency. The Dim light melatonin onset advanced for the subjects and the chronotype showed an inclination towards an earlier timings.

Cost-effectiveness of telephone cognitive behavioral therapy for osteoarthritis-related insomnia.

Osteoarthritis-related insomnia is the most common form of comorbid insomnia among older Americans. A randomized clinical trial found that six sessions of telephone-delivered cognitive behavioral therapy for insomnia (CBT-I) improved sleep outcomes in this population. Using these data, we evaluated the incremental cost-effectiveness of CBT-I from a healthcare sector perspective. The study was based on 325 community-dwelling older adults with insomnia and osteoarthritis pain enrolled with Kaiser Permanente of Washington State. We measured quality-adjusted life years (QALYs) using the EuroQol 5-dimension scale. Arthritis-specific quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Insomnia-specific quality of life was measured using the Insomnia Severity Index (ISI) and nights without clinical insomnia (i.e., "insomnia-free nights"). Total healthcare costs included intervention and healthcare utilization costs. Over the 12 months after randomization, CBT-I improved ISI and WOMAC by -2.6 points (95% CI: -2.9 to -2.4) and -2.6 points (95% CI: -3.4 to -1.8), respectively. The ISI improvement translated into 89 additional insomnia-free nights (95% CI: 79 to 98) over the 12 months. CBT-I did not significantly reduce total healthcare costs (-$1072 [95% CI: -$1968 to $92]). Improvements in condition-specific measures were not reflected in QALYs gained (-0.01 [95% CI: -0.01 to 0.01]); at a willingness-to-pay of $150,000 per QALY, CBT-I resulted in a positive net monetary benefit of $369 with substantial uncertainty (95% CI: -$1737 to $2270). CBT-I improved sleep and arthritis function without increasing costs. These findings support the consideration of telephone CBT-I for treating insomnia among older adults with comorbid OA. Our findings also suggest potential limitations of the general quality of life measures in assessing interventions designed to improve sleep and arthritis outcomes.

From symptomology to resilience: Case illustrations of recovery from OCD using CBT

ABSTRACT Over the years, many researchers have studied outcomes of mental illness through deficit-based approaches such as vulnerability, suffering, and symptoms among individuals diagnosed with mental illness. Such an approach, though useful in the clinical area has failed to adequately explore positive adaptation among such individuals. The present study is a strength-based approach that aims to address this gap in literature by investigating how individuals despite the diagnosis of OCD, can display resilience and positive outcomes by leading a productive life. Resilience was explored by analyzing life experiences of two OCD patients who received Cognitive Behavior Therapy (CBT) sessions. Resilience, challenges, and protective factors were examined using a semi-structured interview and Connor-Davidson’s Resilience Scale-10 after CBT sessions. Both participants displayed resilience through unique coping mechanisms derived from internal and external protective factors that helped them to overcome the symptoms of OCD and other challenges faced in day-to-day living. Resilience was exhibited through adaptation and improved life outcomes. Case study approaches may be useful in understanding unique resilience mechanisms in a variety of contexts, which are otherwise difficult to identify through large-scale surveys. Further, a discussion on future implications provides crucial insights for mental health professionals.

Efficacy of Cognitive Behaviour Therapy in Gambling Disorder (A Case study)

Context: Gambling disorder is a mental health condition in which a person repeatedly engages in gambling behaviour despite various negative consequences. The condition is also known as gambling addiction, pathological gambling or compulsive gambling. Recent studies have demonstrated the efficacy of Cognitive Behaviour Therapy in treating gambling disorder. Aim: In the present study, the efficacy of cognitive behaviour therapy in treatment of an adult patient with gambling disorder was examined. Settings and Designs: A single case design with pre- and post-assessments on clinician-rated scales were adopted. Materials and Methods: Fourteen bi-weekly sessions of Cognitive Behaviour Therapy were conducted on an inpatient basis. Assessments were carried out on Gambling Symptom Assessment Scale and Hamilton Anxiety Rating Scale, at pre- and post-therapy points. Analysis: Pre- and post-therapy changes were examined using the method of clinical significance. Results: A significant decline was seen on the Gambling Symptom Assessment Scale, and Hamilton Anxiety Rating Scale Conclusion: Application of CBT was effective in treating the anxiety, and gambling symptoms in the patient with Gambling Disorder

Non‐aggression commitments and domestic violence margins

AbstractDomestic violence is a highly prevalent phenomenon around the world. The emotional behaviour of partners, which often culminates in verbal and physical violence, has emerged as one of the main explanations for its occurrence. The main objective of the present paper was to explain, through a dynamic general equilibrium model, the impact of non‐aggression commitments between intimate partners on reducing domestic violence incidents. More specifically, we theoretically evaluate the impact of a non‐aggression contract composed of sin taxes and participation in cognitive behavioural therapy sessions both in reducing incidents of intimate partner violence and in reducing the dynamics of divorce. We show that non‐aggression commitments lead to a reduction in domestic violence at its intensive margin, with no impact at the extensive margin of intimate partner violence. Therefore, this contractual mechanism needs to be combined with other policies to be effective.

The Effectiveness of Cognitive Behavioral Therapy for Managing Body Image Dissatisfaction

The aim of study wasto test effectiveness of cognitive behavioral therapy(CBT)in managing body image dissatisfaction(BID). The sample of N=16 participants (Woman:n=10 &amp; Man:n= 6)was selected (M=20.0, SD=2.5) and divided into two groups;anexperimental group and a waiting list control group, having8 participants in each group. A baseline score was taken by using Body Dissatisfaction Scale (BDS; Tariq &amp; Ijaz, 2015). Eight sessions of cognitive behavioral therapy(CBT), adapted from CBT manual for depression (Naee, &amp; Ayub, 2013), were conducted inanindividual setting on a weekly basis. The results suggested asignificant contribution of CBT in decreasing the level ofdissatisfaction related tobody image. The scores of pre and posttesting (p&lt;.05)of experimental group verified the efficacy of CBT in treatingdissatisfaction associated withbody image.Thus, it can be concluded that CBT is effective in treating dissatisfaction related to the body image among adolescents and adults. The study helped in drawing attention towards treatment of body image dissatisfaction (BID) in the Pakistani population and contributed tothe empirical basis of effectiveness of CBT in managing body image anxiety.

Impact of Art as A Therapeutic Intervention in Improving the Quality of Life among Geriatric Population

Objective: To study the impact of art as therapeutic intervention in improving the quality of life among geriatric population. Method: Quasi experimental pre-post test study design was used to allocate geriatric population in experimental group (n=5) and control group (n=5). Sequential session of 15 minutes of Mandala art coloring sheets followed by 15 minutes of personal counseling session and another 15 minutes of projective art time where the person can choose between creative writing or projective art, with transition of activities between the session the client was given with breaks of 5 minutes each in the experimental group. Only personal counseling sessions of cognitive behavior therapy were given to the control group. Results: All participants in both groups who began treatment completed the therapy program SF-36 was used both as screening method as well as outcome measure and showed significant changes in the quality of life in the experimental group. Conclusion: Art as therapeutic intervention for geriatric population shows positive effects on the mental health and wellness which in turn improves their quality of life.