Telephone-based Cognitive Behavioral Therapy Research Articles

Cultural and linguistic adaptation of a telephone-based cognitive-behavioral therapy (CBT) intervention to treat depression and anxiety in Hispanic cancer survivors

Purpose/Objectives The purpose of this study was to transcreate a manualized cognitive-behavioral therapy (CBT) intervention to address depression and anxiety among Hispanic cancer survivors. Design/Research Approach Stakeholders reviewed the CBT workbook for language, content, and cultural relevance. We designed semi-structured interview guides to elicit intervention feedback. Sample/Participants Stakeholder participants were Hispanic cancer survivors (n = 4), bilingual mental health providers (n = 2), and oncology professionals (n = 4). Methods Transcreation was conducted by initial translation of the workbook followed by incorporation of stakeholder feedback. A bilingual (Spanish and English) interviewer conducted stakeholder interviews. The study team discussed themes/suggestions before refining the workbook. Findings Stakeholders reported enthusiasm for the intervention. We gathered significant feedback regarding wording, images, and resources for the workbook. Conclusion Development of culturally appropriate mental health resources for Hispanic cancer survivors is critical. Implications for Psychosocial Providers or Policy By broadening research on psychosocial care to the Hispanic population, we increase the reach of evidence-based psychological care. Future research should fully evaluate the adapted CBT intervention among Hispanic survivors.

Perinatal interventions to reduce the severity of postpartum depression: A narrative review

Postpartum depression (PPD) is a mental disorder that can affect mothers and their families, with symptoms of fatigue, mood swings, frequent anger for no reason, and excessive worry for the baby. Several studies regarding interventions that can be given to postpartum women with PPD have been carried out. The purpose of this review is to assess evidence on the effectiveness of a broad range of perinatal interventions to reduce the severity of PPD. The review of the literature has been done through PubMed, for papers with Randomized Control Trial (RCT) design published in 2012-2021. The approach was to explore quantitative parameters which is the EPDS score. More than 300 papers were identified, but only 6 studies met the inclusion criteria. A narrative review was conducted due to the studies' significant heterogeneity. Six studies reported a decrease in EPDS score. Six interventions have been identified to reduce the severity of PPD, they are exercise, psychological intervention, telephone-based Cognitive Behavioral Therapy (CBT), iBA (internet Behavioral Activation), application-based Cognitive Behavioral Therapy (CBT) and psychoeducation. This review suggests that multiple intervention program may lead to better outcomes in terms of client’s satisfaction. There is also some indication that psychoeducation support Maternal Parental Self-efficacy (MPSE) and social support besides EPDS.

Between- and within-person effects of affective experiences on coping in CBT: Direct effects and interplay with therapeutic alliance and resource activation

Objective The role of affective experiences (AE) in cognitive–behavioral therapy (CBT) has rarely been investigated. We examined between- and within-person effects of AE on coping in CBT for family caregivers and interactions with therapeutic alliance and resource activation. Methods 67 family caregivers rated AE, therapeutic alliance, resource activation, and coping after each of 12 sessions of telephone-based CBT. We examined direct session-to-session effects of AE on coping in structural equation modeling and interactions of AE with therapeutic alliance and resource activation in multilevel models. Results AE did not directly predict coping. Instead, within-person effects of AE interacted with simultaneous within-person emotional bond. Given strong emotional bond, AE positively predicted coping, whereas given weak emotional bond, AE negatively predicted coping. Further, cross-level interactions of between-person AE and within-person agreement on collaboration and resource activation indicated that these positively predicted coping only in dyads with high between-person AE. Conclusion AE may enhance coping when complemented with strong emotional bond. Further, within-person effects of agreement on collaboration and resource activation seem to rely on a certain degree of between-person AE. Results are discussed in relation to current findings on emotional processing in CBT.

Telephone-Based Cognitive Behavioral Therapy for Post-Operative Bariatric Surgery Patients: Preliminary Results from a Randomized Controlled Trial

Telephone-Based Cognitive Behavioral Therapy for Post-Operative Bariatric Surgery Patients: Preliminary Results from a Randomized Controlled Trial

Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery

Weight regain after bariatric surgery is associated with recurrence of obesity-related medical comorbidities and deterioration in quality of life. Developing efficacious psychosocial interventions that target risk factors, prevent weight regain, and improve mental health is imperative. To determine the efficacy of a telephone-based cognitive behavioral therapy (tele-CBT) intervention at 1 year after bariatric surgery in improving weight loss, disordered eating, and psychological distress. This multisite randomized clinical trial was conducted at 3 hospital-based bariatric surgery programs, with recruitment between February 2018 and December 2021. Eligibility for participation was assessed among 314 adults at 1 year after bariatric surgery who were fluent in English and had access to a telephone and the internet. Patients with active suicidal ideation or poorly controlled severe psychiatric illness were excluded. Primary and secondary outcome measures were assessed at baseline (1 year after surgery), after the intervention (approximately 15 months after surgery), and at 3-month follow-up (approximately 18 months after surgery). Data were analyzed from January to February 2023. The tele-CBT intervention consisted of 6 weekly 1-hour sessions and a seventh booster session 1 month later. The control group received standard postoperative bariatric care. The primary outcome was postoperative percentage total weight loss. Secondary outcomes were disordered eating (Binge Eating Scale [BES] and Emotional Eating Scale [EES]) and psychological distress (Patient Health Questionnaire-9 item scale [PHQ-9] and Generalized Anxiety Disorder-7 item scale [GAD-7]). The hypotheses and data-analytic plan were developed prior to data collection. Among 306 patients 1 year after bariatric surgery (255 females [83.3%]; mean [SD] age, 47.55 [9.98] years), there were 152 patients in the tele-CBT group and 154 patients in the control group. The group by time interaction for percentage total weight loss was not significant (F1,160.61 = 2.09; P = .15). However, there were significant interactions for mean BES (F2,527.32 = 18.73; P < .001), EES total (F2,530.67 = 10.83; P < .001), PHQ-9 (F2,529.93 = 17.74; P < .001), and GAD-7 (F2,535.16 = 15.29; P < .001) scores between the tele-CBT group and control group across all times. This study found that tele-CBT delivered at 1 year after surgery resulted in no change in short-term weight outcomes but improved disordered eating and psychological distress. The impact of these psychosocial improvements on longer-term weight outcomes is currently being examined as part of this longitudinal multisite randomized clinical trial. ClinicalTrials.gov Identifier: NCT03315247.

Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression.

Innovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement. The therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models. The rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R2 = 0.05, p = 0.01). The results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments.

Telephone-Based Cognitive-Behavioral Therapy for Depression in Family Caregivers of Persons Living With Dementia: A Feasibility Study.

The current study aimed to examine the usefulness of a telephone-based cognitive-behavioral therapy program for depression in 11 family caregivers of persons living with dementia. Data were collected and analyzed before (Session 1), after (Session 6), and at 3-month follow up using the Zarit Caregiver Burden Interview, General Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and Self-Rating Depression Scale. Depression scores decreased significantly (p < 0.05) from Session 1 to Session 6. Results suggest that the program should address Proactivity of Action, a sub-item of self-efficacy, to reduce depression. In addition, the program enabled caregivers to reduce negative perceptions of their caregiving duty, which may lead to positive thinking and proactive behavior. Despite these findings, the program must be modified and research must continue, as this was a feasibility study with an intervention group only. [Journal of Psychosocial Nursing and Mental Health Services, 61(12), 37-45.].

Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers.

The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers. In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-sixtherapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models. Caregiver burden was significantly predicted by caregiver-rated emotional bond (β = -0.18) as well as therapist-rated resource activation (β = -0.26), problem actuation (β = -0.22), clarification of meaning (β = -0.18), and mastery (β = -0.18). None of the GCMs predicted depression from any perspective. The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.

Subthreshold Depression: A Systematic Review and Network Meta-Analysis of Non-Pharmacological Interventions.

Subthreshold depression (StD) is considered to be the "precursor" stage of major depressive disorder (MDD), which could cause higher risk of suicide, disease burden and functional impairment. There have been various non-pharmacological interventions for StD. However, the comparison of their effectiveness still lacks sufficient evidence. We performed a systematic review and network meta-analysis to evaluate and rank the efficacy of multiple non-pharmacological interventions targeting StD. We conducted a thorough search across various databases including PubMed, Medline, Embase, Web of Science and PsycINFO from inception to December 2022. All included studies were randomized controlled trials (RCTs) of non-pharmacological interventions for patients with StD compared with control group (CG). Several universal scales for measuring depression severity were used as efficacy outcomes. The surface under the cumulative ranking curve (SUCRA) was used to separately rank each intervention using the "Stata 17.0" software. A total of thirty-six trials were included, involving twenty-eight interventions and 7417 participants. The research found that most non-pharmacological interventions were superior to controls for StD. In each outcome evaluation by different scales for measuring depression, psychotherapy always ranked first in terms of treatment effectiveness, especially Problem-solving Therapy (PST), Behavioral Activation Therapy (BAT), Cognitive Behavioral Therapy (CBT)/Internet-based CBT (I-CBT)/Telephone-based CBT (T-CBT). Since different groups could not be directly compared, the total optimal intervention could not be determined. Here, we show that psychotherapy may be the better choice for the treatment of StD. This study provides some evidence on StD management selection for clinical workers. However, to establish its intervention effect more conclusively, the content, format and operators of psychotherapy still require extensive exploration to conduct more effective, convenient and cost-effective implementation in primary healthcare. Notably, further research is also urgently needed to find the biological and neural mechanisms of StD by examining whether psychotherapy alters neuroplasticity in patients with StD.

Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial

IntroductionBariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have...

A092 The Impact of Telephone-Based Cognitive Behavioural Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients during COVID-19: Preliminary Results from a Multi-Site Randomized Controlled Trial

A092 The Impact of Telephone-Based Cognitive Behavioural Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients during COVID-19: Preliminary Results from a Multi-Site Randomized Controlled Trial

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial.

BackgroundPatients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated.ObjectiveTo determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19.MethodsParticipants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome.ResultsEighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group.ConclusionTele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic.Graphical abstract

Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study

Objectives The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories. Methods Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline – T0, 6 months – T1, and 12 months – T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92). Results NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC. Conclusions The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .

The state of telemedicine for persons with Parkinson's disease.

Purpose of reviewThe COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders.Recent findingsTeleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment.SummaryThe availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.

Long-term effects of telephone-based cognitive-behavioral intervention for family caregivers of people with dementia: Findings at 3-year follow-up.

Long-term outcomes are of particular importance in evaluating interventions for family caregivers of people with dementia (PwD). So far, evidence for long-term effects (>6 months postintervention) is limited to four interventions. We examined the long-term effects of Tele.TAnDem, a telephone-based cognitive-behavioral therapy (CBT) intervention, on a variety of outcomes at 3-year follow-up, the longest follow-up of any intervention study for caregivers of PwD (without continuous support). Caregivers of PwD were randomly assigned to receive Tele.TAnDem consisting of 12 sessions over 6 months (intervention group [IG]) or usual care (control group [CG]). At 3-year follow-up (i.e., 2.5 years postintervention), 29 caregivers in the IG and 22 caregivers in the CG were still caring at home for a PwD. Caregivers in the IG reported significantly lower caregiver burden and higher quality of life regarding social relationships. Tele.TAnDem is successful in buffering detrimental effects of caregiving on caregiver burden and social relationships in the long term. The small- to medium-sized effects lie in the range of effect sizes reported in the few previous investigations. The findings add to the scant evidence that interventions yielding long-term outcomes have to date mostly been multicomponent interventions based on CBT principles with structured techniques and at least seven sessions over more than 2 months. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Editors' Note: Telephone-Based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial.

In “Telephone-Based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial,” Dobkin et al. reported that depressive symptoms (measured using the Hamilton Depression Rating Scale) improved significantly in patients with Parkinson disease who had weekly telephone-based cognitive behavioral therapy compared with those who had their usual treatment. Braillon commended the authors for independently designing a study that led to both significant and meaningful patient-centered results but lamented the fact that our healthcare systems are not able to facilitate routine care for psychosocial issues in a multidisciplinary manner outside of the clinical environment. Dobkin agreed that there are a number of reasons why patients with Parkinson disease need access to telephone-based cognitive behavioral therapy, many of which apply to patients with other neurologic diseases, too. Dobkin also reinforces the need to expand telehealth, with a particular emphasis on provision of mental health care to patients who do not have access to clinicians with the relevant expertise or prefer to be evaluated and treated while at home. In “Telephone-Based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial,” Dobkin et al. reported that depressive symptoms (measured using the Hamilton Depression Rating Scale) improved significantly in patients with Parkinson disease who had weekly telephone-based cognitive behavioral therapy compared with those who had their usual treatment. Braillon commended the authors for independently designing a study that led to both significant and meaningful patient-centered results but lamented the fact that our healthcare systems are not able to facilitate routine care for psychosocial issues in a multidisciplinary manner outside of the clinical environment. Dobkin agreed that there are a number of reasons why patients with Parkinson disease need access to telephone-based cognitive behavioral therapy, many of which apply to patients with other neurologic diseases, too. Dobkin also reinforces the need to expand telehealth, with a particular emphasis on provision of mental health care to patients who do not have access to clinicians with the relevant expertise or prefer to be evaluated and treated while at home.

Author Response: Telephone-based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial.

We thank Dr. Braillon for commenting on our article1 and for highlighting several advantages of increasing Parkinson disease (PD) patients' access to nonpharmacologic depression treatments. We share his interest in multidisciplinary PD care and his concern about the scarcity of such resources. Evidence-based, PD-informed depression treatment is critical to this approach, yet it remains largely inaccessible for several reasons, beyond considerable underdiagnosis of PD depression.2 People with PD (PWP) face a dearth of PD-informed mental health clinicians, often live far from specialized care centers, and contend with disability and transportation barriers to attending appointments.3,4 In studying PWPs' mental health care preferences (N = 769), we found that these factors contribute to strong interest in telehealth: 85% reported a preference for telehealth-to-home over clinic-based care, given the choice.4 We likewise view telehealth treatment not as a resource-poor alternative, but as a set of flexible, scalable, patient-centered modalities for extending the reach of specialized mental health care5 as it is in medicine.6 The large effects of telephone-based cognitive behavioral therapy—comparable with in-clinic treatment—suggest an exciting, near-term means of helping more patients alleviate depressive symptoms and improve PD self-management. We believe mental telehealth shows potential to begin countering inequities in community-based, interdisciplinary PD resources and thereby to advance personalized care by increasing patients' choice.

Reader Response: Telephone-Based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial.

Dobkin et al.1 deserve commendations for their well-designed trial in patients with depression and Parkinson disease showing telephone-based cognitive behavioral treatment improved by 7 points using the Hamilton Depression Rating Scale, over a 6-month follow-up.

"If you're offered help, take it": A qualitative study examining bariatric patients' experience of telephone-based cognitive behavioural therapy.

The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioural therapy (Tele-CBT) in this qualitative study. Ten participants from the Toronto Western Hospital Bariatric Surgery Program in Toronto, Canada who completed the Tele-CBT (ClinicalTrials.gov Identifier: NCT02920112) were individually interviewed from November 2014 to June 2016 until thematic saturation occurred (ie, no more new coding groups emerged). Interviews were transcribed, independently coded, checked for discrepancies, and analysed using grounded theory. Four themes emerged: (1) participants were generally satisfied with Tele-CBT (eg, therapeutic alliance, resources provided, relevance of therapy to their own bariatric journey), (2) participants noticed emotional, cognitive, and behavioural changes following therapy, (3) the optimal time to deliver the Tele-CBT was when weight loss plateaued, generally at one-year post-surgery, and (4) participants found the telephone modality convenient. CBT was generally found to be helpful and the telephone format increased convenience and accessibility. Patients reported learning skills and receiving resources that could help them improve their well-being following bariatric surgery.

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept.

This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies. We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays. We also examined time spent using ITS and relation with competency. The majority of students (81.8%) in Wave 1 and all of the students who submitted role-plays in Wave 2 passed the clinical skills role-play. Students advancing through the ITS more quickly had better tCBT competency ratings than those progressing more slowly. One of the most challenging aspects of training is how to competently deliver evidence-based practices. ITS has the potential to streamline and scale such training.