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Clinical wisdom in the age of computer apps: a systematic review of four functions that may complement clinical treatment. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps.
Key learning aims
(1)
To understand what apps are currently available to treat clinical-level psychiatric problems.
(2)
To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations.
(3)
To understand how mental health services can be complemented by utilizing computer processing power within apps.
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Patterson VC, Rossi MA, Pencer A, Wozney L. Tranquility: An adaptation co-design and fidelity evaluation of an internet-based cognitive-behavioural therapy (iCBT) program for anxiety and depression. JMIR Form Res 2021; 6:e33374. [PMID: 34910660 PMCID: PMC8851319 DOI: 10.2196/33374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 01/26/2023] Open
Abstract
Background Internet-based cognitive behavioral therapy (iCBT) is a necessary step toward increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to the therapeutic principles of cognitive behavioral therapy (CBT) or usability standards. In addition, many existing iCBT programs do not include treatments targeting both anxiety and depression, which are commonly co-occurring conditions. Objective This study aims to evaluate the usability of Tranquility—a novel iCBT program for anxiety—and its fidelity to CBT principles. This study also aims to engage in a co-design process to adapt Tranquility to include treatment elements for depression. Methods CBT experts (n=6) and mental health–informed peers (n=6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression by using 2 simulated client case examples. Mental health–informed peers engaged in 2 co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed web-based surveys assessing the usability of Tranquility and the likelihood that they would recommend the program. Results The CBT experts’ mean rating of Tranquility’s fidelity to CBT principles was 91%, indicating a high fidelity to CBT. Further, 5 out of 6 CBT experts and all mental health–informed peers (all participants: 11/12, 88%) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (mean 76.56, SD 14.07). Mental health–informed peers provided suggestions on how to leverage engagement with Tranquility (eg, adding incentives and notification control). Conclusions This preliminary study demonstrated the strong fidelity of Tranquility to CBT and usability standards. The results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement.
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Affiliation(s)
- Victoria C Patterson
- Dalhousie University, P.O. Box 15000Department of Psychology & Neuroscience, Dalhousie University, Halifax, CA
| | - Meghan A Rossi
- Dalhousie University, P.O. Box 15000Department of Psychology & Neuroscience, Dalhousie University, Halifax, CA
| | - Alissa Pencer
- Dalhousie University, P.O. Box 15000Department of Psychology & Neuroscience, Dalhousie University, Halifax, CA
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Kannis-Dymand L, Myers A, Human B, Love S, Lovell GP. Evaluation of collaborative cognitive-behavioural case formulations in a clinical psychology program: a client perspective. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1981745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Aleisha Myers
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Berquin Human
- Cooinda Mental Health Service, The Sunshine Coast Private Hospital, Buderim, Australia
| | - Steven Love
- Road Safety Research Collaboration, University of the Sunshine Coast, Sippy Downs, Australia
| | - Geoff P. Lovell
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
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Schønning A, Nordgreen T. Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders-The Role of Treatment Self-Efficacy. Front Psychol 2021; 12:712421. [PMID: 34744872 PMCID: PMC8566333 DOI: 10.3389/fpsyg.2021.712421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction. Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis. Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects. Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
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Affiliation(s)
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Soll D, Fuchs R, Mehl S. Teaching Cognitive Behavior Therapy to Postgraduate Health Care Professionals in Times of COVID 19 - An Asynchronous Blended Learning Environment Proved to Be Non-inferior to In-Person Training. Front Psychol 2021; 12:657234. [PMID: 34646190 PMCID: PMC8504537 DOI: 10.3389/fpsyg.2021.657234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022] Open
Abstract
Training of postgraduate health professionals on their way to becoming licensed therapists for Cognitive Behavior Therapy (CBT) came to a halt in Germany in March 2020 when social distancing regulations came into effect. Since the German healthcare system almost exclusively relies on this profession when it comes to the implementation of CBT and 80% of those therapists active in 2010 will have retired at the end of 2030, it is critical to assess whether online CBT training is as satisfactory as classroom on-site CBT training. An asynchronous, blended, inverted-classroom online learning environment for CBT training (CBT for psychosis) was developed as an emergency solution. It consisted of pre-recorded CBT video lectures, exercises to train interventions in online role-plays, and regular web conferences. Training was provided at five different training institutes in Germany (duration 8–16 h). Postgraduate health care professionals (psychiatrists and psychologists) (n = 43) who received the online CBT training filled out standard self-report evaluations that assessed satisfaction and didactic quality. These evaluations were compared to those evaluations of students (n = 142) who had received in-person CBT training with identical content offered by the same CBT trainer at the same training institutes before the COVID-19 crisis. Both groups were comparable with respect to interest in the subject and prior knowledge. We tested non-inferiority hypotheses using Wilcoxon-Mann-Whitney ROC-curve analyses with an equivalence margin corresponding to a small-to-medium effect size (d = 0.35). The online training evaluations were non-inferior concerning information content, conception of content, didactic presentation, assessment of the trainer as a suitable role-model, working atmosphere, own commitment, and practical relevance. In contrast, we could not exclude a small effect in favor of in-person training in professional benefit and room for active participation. Our results suggest that delivering substantial CBT knowledge online to postgraduate health-professionals is sufficient, and at most incurs minimal loss to the learning experience. These encouraging findings indicate that integrating online elements in CBT teaching is an acceptable option even beyond social distancing requirements.
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Affiliation(s)
- Daniel Soll
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University Marburg, Marburg, Germany
| | - Raphael Fuchs
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University Marburg, Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.,Department of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
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Crane ME, Atkins MS, Becker SJ, Purtle J, Olino TM, Kendall PC. The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial. Implement Sci Commun 2021; 2:107. [PMID: 34556182 PMCID: PMC8460198 DOI: 10.1186/s43058-021-00213-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments. Method Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT. Discussion This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments. Trial registration This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00213-x.
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Affiliation(s)
- Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Marc S Atkins
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois, Chicago, 1747 West Roosevelt Road, Suite 155, Chicago, IL, 60608, USA
| | - Sara J Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, Room 351, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, 19122, USA
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Wade TD, Egan SJ, Wleklinski M, O'Brien A, Fitzallen G, Shafran R. A realist synthesis of websites containing content on perfectionism: Are the descriptions and advice empirically supported? BMC Psychol 2021; 9:119. [PMID: 34429163 PMCID: PMC8384458 DOI: 10.1186/s40359-021-00620-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/25/2021] [Indexed: 12/01/2022] Open
Abstract
Background Perfectionism is a risk factor for depression and anxiety and is increasing in young people. It is important to understand the information that youth are exposed to about perfectionism on the internet and what may be required to make this more helpful in terms of accessing empirically supported descriptions and advice. Methods This research used novel methodology to investigate content about perfectionism on websites by conducting a realist synthesis of the definitions of perfectionism, and the degree to which websites contain empirically supported strategies and recognise the advantages and disadvantages of perfectionism. The results were presented to people aged 18 to 24 (N = 18) with a lived experience of anxiety/depression for feedback. Results The search yielded 992 websites, 266 of which were included in the synthesis; only one met the criteria for excellent quality with most (56%) judged as moderate. The feelings, thoughts, and behaviours that accompany perfectionism were commonly described, and strategies included identifying cognitions and developing alternatives, moving from self-criticism to self-compassion, normalising mistakes, adjusting goals, receiving practical support, and strategies for procrastination. The young people wanted further emphasis on depression and anxiety as consequences of perfectionism that contributed to a vicious cycle. They identified interventions were difficult, with greater levels of support needed. Conclusions While most websites contained empirically supported information, the quality needs to improve, and further information needs to be provided on the links with anxiety and depression. Interventions for perfectionism need to have more focus on helping young people develop support networks.
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Affiliation(s)
- Tracey D Wade
- Órama Institute and Blackbird Initiative, Flinders University, Adelaide, SA, Australia.
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Maggie Wleklinski
- Órama Institute and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Amy O'Brien
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Grace Fitzallen
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Roz Shafran
- University College London, Great Ormond Street Institute of Child Health, London, England
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Wade T, Calvert S, Thompson E, Wild CA, Mitchison D, Hay P. A co-designed consumer checklist to support people with eating disorders to locate evidence-based treatment. Int J Eat Disord 2021; 54:1400-1404. [PMID: 33928663 DOI: 10.1002/eat.23529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/06/2022]
Abstract
Identifying a therapist with expertise in treating eating disorders (EDs) can be a daunting process for a consumer, resulting in delayed access to evidence-based treatment, prolonging unnecessary suffering. We developed a consumer checklist designed to empower consumers to locate evidence-based treatment earlier. We co-designed (researchers and people with lived experience of an ED) a 15-item consumer checklist, for use in a meeting with a potential therapist. A survey about the checklist was sent out to people with lived experience and clinicians, seeking quantitative endorsement of each item's helpfulness in the checklist, and inviting qualitative feedback. Seventeen people with lived experience and 11 clinicians gave feedback. The items were rated as being helpful, with overlap between the two groups as to the most helpful items. Both groups rated the checklist as likely to help locate effective treatment earlier. The checklist forms a basis for a useful consumer tool in their treatment journey. Examination of its uptake and impact on outcomes for consumers seeking treatment is recommended.
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Affiliation(s)
- Tracey Wade
- Blackbird Initiative, Órama Institute for Mental Health and Well-Being, Flinders University, Adelaide, South Australia, Australia
| | | | - Elise Thompson
- Breakthrough Mental Health Research Foundation Ambassador, South Australia, Australia
| | - Cie-Ayn Wild
- Blackbird Initiative, Órama Institute for Mental Health and Well-Being, Flinders University, Adelaide, South Australia, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University School of Medicine, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University School of Medicine, Sydney, NSW, Australia
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Improving social functioning in people with schizophrenia-spectrum disorders via mobile experimental interventions: Results from the CLIMB pilot trial. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 26:100211. [PMID: 34381699 PMCID: PMC8340304 DOI: 10.1016/j.scog.2021.100211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 12/02/2022]
Abstract
Background Patients with Schizophrenia Spectrum Disorders (SSD) demonstrate poor social functioning. While group-based approaches show long-term improvements, access to treatments is limited. Digital platforms hold promise to overcome barriers to treatment delivery and improve outcomes. Objective In a parallel arm, double-blind RCT, we tested CLIMB, a clinician-assisted, adjunct to treatment that includes computerized social cognition training (SCT), ecological momentary assessments (EMAs), group tele-therapy, and moderated messaging. CLIMB was compared to an active control that includes computerized general cognitive training (GCT), unstructured support groups, and unmoderated messaging. Methods The primary outcome was social functioning. Secondary outcomes were negative symptoms and quality of life (QoL). Given the sample size, Propensity Score Models were used to ensure balanced baseline covariates. Mixed-effects models examined change over time. Results 24 participants completed the study (12 per arm). No significant between-group differences emerged in engagement. CLIMB participants engaged in a median of 8 sessions (IQR = 2), 2.8 h of SCT (IQR = 7.5), and 2710 EMAs; control participants engaged in a median of 9 sessions (IQR = 3) and 2.2 h of GCT (IQR = 7.9). As a group, participants showed significant improvements in social functioning (p = .046), with no between-group differences. Intent-to-treat analyses indicated greater improvements in QoL (p = .025) for the active control. Conclusions Delivering group-based mobile interventions to individuals with SSD is feasible. EMAs allow clinicians to maintain inter-session engagement, build participant self-awareness, and tailor treatment delivery. In this treatment model, whether SCT or GCT is more effective remains unclear. Further research will evaluate group-based mobile interventions to improve outcomes in SSD.
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Alavi N, Stephenson C, Omrani M, Gerritsen C, Martin MS, Knyahnytskyi A, Zhu Y, Kumar A, Jagayat J, Shirazi A, Moghimi E, Patel C, Knyahnytska Y, Simpson AIF, Zaheer J, Andersen J, Munshi A, Groll D. Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e30845. [PMID: 34088656 PMCID: PMC8367142 DOI: 10.2196/30845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. OBJECTIVE This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers' mental health problems. METHODS This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. RESULTS The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. CONCLUSIONS If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. TRIAL REGISTRATION ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30845.
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Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- OPTT Inc, Toronto, ON, Canada
| | - Cory Gerritsen
- Forensic Early Intervention Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
| | - Michael S Martin
- Health Services Sector, Correctional Service Canada, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alex Knyahnytskyi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yiran Zhu
- Faculty of Health Sciences, Queen's Unviersity, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Amirhossein Shirazi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- OPTT Inc, Toronto, ON, Canada
| | - Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexander I F Simpson
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Judith Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Alpna Munshi
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Dianne Groll
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Canadian Institute for Military and Veteran Health Research, Kingston, ON, Canada
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Mountford VA, Allen KL, Tchanturia K, Eilender C, Schmidt U. Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting. Int J Eat Disord 2021; 54:1238-1249. [PMID: 33719036 DOI: 10.1002/eat.23504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. METHOD Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. RESULTS Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT-ED. DISCUSSION These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.
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Affiliation(s)
- Victoria A Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Cara Eilender
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Clinical Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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63
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The quality of research exploring in-session measures of CBT competence: a systematic review. Behav Cogn Psychother 2021; 50:40-56. [PMID: 34158144 DOI: 10.1017/s1352465821000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is in high demand due to its strong evidence base and cost effectiveness. To ensure CBT is delivered as intended in research, training and practice, fidelity assessment is needed. Fidelity is commonly measured by assessors rating treatment sessions, using CBT competence scales (CCSs). AIMS The current review assessed the quality of the literature examining the measurement properties of CCSs and makes recommendations for future research, training and practice. METHOD Medline, PsychINFO, Scopus and Web of Science databases were systematically searched to identify relevant peer-reviewed, English language studies from 1980 onwards. Relevant studies were those that were primarily examining the measurement properties of CCSs used to assess adult 1:1 CBT treatment sessions. The quality of studies was assessed using a novel tool created for this study, following which a narrative synthesis is presented. RESULTS Ten studies met inclusion criteria, most of which were assessed as being 'fair' methodological quality, primarily due to small sample sizes. Construct validity and responsiveness definitions were applied inconsistently in the studies, leading to confusion over what was being measured. CONCLUSIONS Although CCSs are widely used, we need to pay careful attention to the quality of research exploring their measurement properties. Consistent definitions of measurement properties, consensus about adequate sample sizes and improved reporting of individual properties are required to ensure the quality of future research.
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Phillips R, McSherry P, Pinto C, Maguire T. Exploring Therapists' Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-21-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known of the usability of eye movement desensitization and reprocessing (EMDR) as an intervention for those experiencing psychosis. This study aimed to explore therapists' experience of using EMDR with this population. A qualitative design was employed using an inductive approach and a thematic analysis. Twenty therapists, who had used EMDR with this client group, took part in a semi-structured interview to explore their experiences of the intervention. Key themes were generated from the data: (a) familiarity with psychosis and EMDR, (b) acceptability of EMDR, (c) the importance of systemic factors, and (d) keeping key therapy principles in mind. Findings highlighted the importance of supervision to build therapist confidence, the value of the multidisciplinary team, and the need for a shift in beliefs surrounding the usefulness of EMDR to the wider system. Recommendations for individuals and services are provided.
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The linkage between negative affectivity with emotional distress in college student: The mediator and moderator role of difficulty in emotion regulation, repetitive negative thinking, and emotional invalidation. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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66
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Lampe EW, Forman EM, Juarascio AS, Manasse SM. Feasibility, Acceptability, and Preliminary Target Engagement of a Healthy Physical Activity Promotion Intervention for Bulimia Nervosa: Development and Evaluation via Case Series Design. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 29:598-613. [PMID: 36171804 PMCID: PMC9512260 DOI: 10.1016/j.cbpra.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bulimia nervosa (BN) is characterized by a pattern of binge eating and compensatory behaviors as well as an overemphasis on body weight and shape in self-evaluation. Although cognitive behavioral therapy (CBT) is efficacious, recent reviews suggest that only 30% of patients reach abstinence at posttreatment. One potential reason for these poor outcomes is that CBT fails to adequately reduce elevated negative affect (NA) and shape and weight concern, which have been shown to be correlated with poorer treatment outcomes in BN. Therefore, novel treatment components that focus on improving NA and shape and weight concern are needed in order to enhance outcomes. Promoting physical activity (PA) is a promising avenue through which to reduce NA and improve body image in healthy individuals, other clinical populations (e.g., individuals with depression or anxiety), and individuals with eating disorders. While prescribing PA for individuals with BN has been controversial (due to concerns that exercise maybe be used to compensate for binge episodes or become driven or compulsive), this approach may have many benefits, including promoting healthy lifetime exercise habits that reduce likelihood of relapse through the improvement of emotion regulation skills and weight regulation. Given the promise of PA for targeting key maintenance factors of BN, we developed a 12-session healthy PA promotion intervention for BN and tested initial feasibility, acceptability, and preliminary target engagement in an iterative case series design (n = 3). The treatment provided cognitive-behavioral skills designed to identify, practice, and achieve behavioral goals while asking patients to engage in up to 150 minutes of moderate-to-vigorous PA per week, which was preplanned during each session with the client's therapist. Results suggested that the healthy PA promotion intervention was both feasible and acceptable to deliver. In addition, the intervention resulted in a clinically significant decrease in BN symptom frequency in each participant. Further, participants showed clinically significant decreases in NA and shape and weight concern. The current study demonstrates that healthy PA interventions can have beneficial effects on BN symptoms, NA, and shape and weight concern. However, due to the small sample size, conclusions must be treated with caution. Future research should investigate additional approaches for promoting healthy PA and include a larger sample in order to further test initial efficacy of this treatment approach.
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67
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Seow LLY, Collins KRL, Page AC, Hooke GR. Outcomes of brief versions of Dialectical Behaviour Therapy for diagnostically heterogeneous groups in a routine care setting. Psychother Res 2021; 32:179-194. [PMID: 34053405 DOI: 10.1080/10503307.2021.1933240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Brief versions of Dialectical Behaviour Therapy (DBT) may enhance patient outcomes in diverse service settings. This study examined the effectiveness of two DBT-informed treatments for diagnostically heterogeneous groups in routine practice: 5-day group training in DBT skills (DBT-5) and a 12-week DBT program (DBT-12). METHODS : Depression, anxiety, stress, borderline symptoms, self-esteem, and general mental wellbeing were measured at pre-and post-treatment in a sample of inpatients and outpatients (N=395). Rates of clinically significant change on these measures were calculated and effect sizes benchmarked against prior DBT outcome studies. Readmission rates were used to measure treatment response maintenance. RESULTS : Scores on all measures improved significantly from pre- to post-treatment. DBT-5 and DBT-12 yielded similar effect sizes compared to prior DBT outcome studies. At least 43.5% of patients were classified as recovered or improved regarding borderline symptoms at the end of both DBT-5 and DBT-12. Readmission rates were also low (5%-6.8%). CONCLUSIONS Brief DBT-informed treatments may offer a fast reduction in symptoms and quicker return to functioning.
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Affiliation(s)
- Lillian L Y Seow
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Khan R L Collins
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Andrew C Page
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Geoff R Hooke
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia.,Perth Clinic, West Perth, Western Australia, Australia
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68
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Smith S, Paparo J, Wootton BM. Understanding psychological treatment barriers, preferences and histories of individuals with clinically significant depressive symptoms in Australia: a preliminary study. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sinead Smith
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Josephine Paparo
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
- Discipline of Psychological Sciences, Australian College of Applied Psychology, Sydney, Australia
| | - Bethany M. Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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69
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Alavi N, Stephenson C, Rivera M. Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial. JMIR Ment Health 2021; 8:e27308. [PMID: 33835936 PMCID: PMC8122286 DOI: 10.2196/27308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. OBJECTIVE We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder. METHODS Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week's homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS). RESULTS There were significant increases in SAQ scores from pre- to posttreatment in the electronic delivery group (F1,92=69.32, P<.001) and in-person group (F1,92=60.97, P<.001). There were no significant differences observed between the groups at pre- and posttreatment for SAQ scores (F1,92=.05, P=.83). There were significant decreases in DERS scores observed between pre- and posttreatment in the electronic delivery group (F1,91=30.15, P<.001) and the in-person group (F1,91=58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre- and posttreatment (F1,91=.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001). CONCLUSIONS Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care. TRIAL REGISTRATION ClinicalTrials.gov NCT04493580; https://clinicaltrials.gov/ct2/show/NCT04493580.
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Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Margo Rivera
- Personality Disorder Services, Queen's University, Kingston, ON, Canada
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70
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Newby J, Mason E, Kladnistki N, Murphy M, Millard M, Haskelberg H, Allen A, Mahoney A. Integrating internet CBT into clinical practice: a practical guide for clinicians. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2020.1843968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jill Newby
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Natalie Kladnistki
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Michael Murphy
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Adrian Allen
- Hyde Park Clinical Psychology, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
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Abstract
This study examined the psychometric properties of the Intention Scale for Providers-Direct Items (ISP-D; 16 items), a questionnaire for assessing therapists' evidence-based practice attitudes, subjective norms, perceived behavioral control, and behavioral intentions. Participants were community mental health providers from the State of Hawaii. A confirmatory factor analysis provided support for a revised 14-item ISP-D measure that fits the data reasonably well. Subscales of this revised ISP-D demonstrated acceptable to good internal consistency, with the exception of the Perceived Behavioral Control subscale. The majority of convergent validity correlation patterns between the ISP-D and related constructs were significant and in predicted directions.
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72
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A Pilot Study of Transdiagnostic Group Cognitive-behavior Therapy for Anxiety: An Intensive Weekend Intervention. J Psychiatr Pract 2021; 27:65-74. [PMID: 33370006 DOI: 10.1097/pra.0000000000000501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anxiety disorders are highly prevalent and can cause serious functional impairment. Cognitive-behavioral treatments are effective but they are not always readily available. One factor contributing to this problem is the large number of disorder-specific treatments that require a high level of clinician training and resources, despite the similarity in the mechanisms underlying the various anxiety disorders and their treatments. Group-based, transdiagnostic cognitive-behavioral therapy (TCBT) has been shown to reduce the burden on clinicians while maintaining strong positive treatment outcomes. Furthermore, long courses of treatment may limit some individuals' ability to participate because of issues related to transportation, work, or childcare. Research has supported the efficacy of brief, intensive treatment for anxiety. The goal of the study presented here was to combine these 2 innovative treatment modalities by examining the feasibility and acceptability of TCBT provided in an intensive weekend format. The results of this pilot study indicated that this format was acceptable to a sample of Veterans (N=13) based on their feedback. This pilot study also demonstrated that the format was feasible, as all Veterans who initiated treatment completed the entire program (N=8). Preliminary outcome data suggested that TCBT delivered in an intensive weekend format may have positive effects for individuals with anxiety, including reduction in symptoms of anxiety and depression as well as improved overall functioning. Clinical implications and directions for future research are discussed.
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73
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Grilo CM, White MA, Masheb RM, Ivezaj V, Morgan PT, Gueorguieva R. Randomized controlled trial testing the effectiveness of adaptive "SMART" stepped-care treatment for adults with binge-eating disorder comorbid with obesity. ACTA ACUST UNITED AC 2021; 75:204-218. [PMID: 32052995 DOI: 10.1037/amp0000534] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This randomized controlled trial (RCT) tested effectiveness of adaptive SMART stepped-care treatment to "standard" behavioral weight loss (BWL [standard]) for patients with binge-eating disorder (BED) and obesity. One hundred ninety-one patients were randomly assigned to 6 months of BWL (standard; n = 39) or stepped care (n = 152). Within stepped care, patients started with BWL for 1 month; treatment responders continued BWL, whereas nonresponders switched to cognitive-behavioral therapy (CBT), and patients receiving stepped care were additionally randomized to weight-loss medication or placebo (double-blind) for the remaining 5 months. Independent assessments were performed reliably at baseline, throughout treatment, and posttreatment. Intent-to-treat (ITT) analyses of remission rates (zero binges/month) revealed that BWL (standard) and stepped care did not differ (74.4% vs. 66.5%); within stepped care, remission rates ranged 40.0% to 83.3%, with medication significantly superior to placebo (overall) and among nonresponders switched to CBT. Mixed-models analyses of binge-eating frequency revealed significant time effects, but BWL (standard) and stepped care did not differ; within stepped care, medication was significantly superior to placebo and among nonresponders switched to CBT. Mixed models revealed significant weight loss, but BWL (standard; 5.1% weight-loss) and stepped care (5.8% weight-loss) did not differ; within stepped care (range = 0.4% to 8.8% weight-loss), medication was significantly superior to placebo and among both responders continued on BWL and nonresponders switched to CBT. In summary, BWL (standard) and adaptive stepped-care treatments produced robust improvements in binge eating and weight loss in patients with BED/obesity. Within adaptive stepped care, weight-loss medication enhanced outcomes for BED/obesity. Implications for clinical practice and future adaptive designs are offered. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A White
- Department of Social and Behavioral Sciences, Yale University School of Public Health
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine
| | | | - Peter T Morgan
- Department of Psychiatry, Yale University School of Medicine
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Creed TA, Crane ME, Calloway A, Olino TM, Kendall PC, Stirman SW. Changes in Community Clinicians' Attitudes and Competence following a Transdiagnostic Cognitive Behavioral Therapy Training. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34541540 PMCID: PMC8444627 DOI: 10.1177/26334895211030220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Although the literature suggest that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training. Methods Program evaluation data was collected during implementation of an EBP in a large community mental health network. Clinicians (N=891) received intensive training in cognitive behavioral therapy followed by six months of consultation. Attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase). Results Latent change models identified significant improvement in attitudes (Ms latent change≥1.03, SEs≤ 0.18, zs≥6.55, ps< .001) and competence (Ms latent change ≥14.16, SEs≤3.10, zs≥2.82, ps<.001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop and across training (bs≥1.62, SEs≤0.90, z≥1.09, p<.04, β≥0.10); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in consultation (b=1.62, SE=0.86, z=1.87, p=.06, β=0.09). Change in attitudes and change in competence in the training period and within the two phases were not significantly correlated. Conclusions Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in in itial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence through consultation.
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Affiliation(s)
- Torrey A Creed
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Amber Calloway
- Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 3046, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, USA
| | - Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA, 94025, USA
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Lawford BJ, Hinman RS, Nelligan RK, Keefe F, Rini C, Bennell KL. "I Could Do It in My Own Time and When I Really Needed It": Perceptions of Online Pain Coping Skills Training For People With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:1736-1746. [PMID: 31628723 DOI: 10.1002/acr.24093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/15/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To qualitatively explore the perceptions and experiences of people with knee osteoarthritis (OA) who used an online automated pain coping skills training program (PCST). METHODS This was a descriptive qualitative study (based on interpretivist methodology) embedded within a randomized controlled trial. Individual semistructured interviews were conducted with 12 people with knee OA who had participated in an 8-week automated online PCST program while also receiving exercise advice and support from a physical therapist via Skype. Interviews in this study focused specifically on the online PCST program, rather than the physical therapy component. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed. RESULTS Five themes arose: 1) easy to understand and follow (clearly explained, presented well), 2) better able to cope with pain (controlling pain, helping relax, pacing self, incorporating skills into exercise program), 3) anonymity and flexibility (no judgement by clinician, work at own pace, accessibility), 4) not always relatable or engaging (some techniques not useful, Americanization of the program, annoying character examples, time consuming and slow-paced), and 5) support from clinician desirable (follow-up from a clinician would be beneficial, worked in tandem with physical therapist-prescribed exercise, desire referral to the program by a trusted source). CONCLUSION People with knee OA had generally positive experiences using an online PCST program, suggesting that online PCST is a broadly acceptable and accessible way to help people with OA to manage their pain. User engagement may be enhanced by redesigning some aspects of the program and by provision of support from a clinician.
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Affiliation(s)
| | - Rana S Hinman
- The University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Christine Rini
- Hackensack University Medical Center, Hackensack, New Jersey, and Georgetown University School of Medicine, Washington, DC
| | - Kim L Bennell
- The University of Melbourne, Parkville, Victoria, Australia
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76
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Effectiveness of Group Cognitive Therapy for Social Anxiety Disorder in Routine Care. BEHAVIOUR CHANGE 2020. [DOI: 10.1017/bec.2020.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractSocial anxiety disorder (SAD) is a prevalent chronic condition with a large demand for treatment. This community outpatient study examined the effectiveness of a group intervention version of the established one-to-one cognitive therapy derived from the Clark and Wells model for SAD. Questionnaires were completed pre-treatment and post-treatment for SAD symptoms (Social Phobia Scale, Social Interaction Anxiety Scale), depressive symptoms (BDI-II), self-focused attention, safety behaviours (Social Phobia Weekly Summary Scale and Subtle Avoidance Frequency Examination), and impaired functioning (Work and Social Adjustment Scale). From an initial sample of 159 participants, 101 completed at least seven of the nine weekly group sessions (Mage = 34.1 years, SDage = 10.8 years, 53% female). Significant improvements were demonstrated on all measures. Large effect sizes were found for social anxiety symptoms and safety behaviour use. Self-focused attention, depressive symptoms, and impaired functioning had moderate effect sizes. Effect sizes for anxiety (d = 1.00 and 1.32) and mood measures (d = 0.71) were as high, or in some cases, higher than previous group treatment studies. Results suggest group cognitive therapy for SAD based on the Clark and Wells model is effective in a clinical setting for individuals with moderate/severe and treatment-resistant social anxiety.
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77
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Roberge P, Provencher MD, Gaboury I, Gosselin P, Vasiliadis HM, Benoît A, Carrier N, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial. Psychol Med 2020; 52:1-11. [PMID: 33261700 PMCID: PMC9647541 DOI: 10.1017/s0033291720004316] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/03/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care. METHODS In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis. RESULTS A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79]. CONCLUSIONS Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | | | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke (Québec), Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Québec (Québec), Canada
| | - Annie Benoît
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Nathalie Carrier
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
| | - Martin M. Antony
- Department of Psychology, Ryerson University, Toronto (Ontario), Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, Québec (Québec), Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal (Québec), Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (Québec), Canada
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Clark GI, Hanstock TL, Clark LH. Psychological Treatment of Co‐occurring Anxiety Disorders in Clinical Practice: A Vignette Study. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gavin I. Clark
- School of Behavioural, Cognitive and Social Sciences, University of New England,
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Hurst K, Heruc G, Thornton C, Freeman J, Fursland A, Knight R, Roberts M, Shelton B, Wallis A, Wade T. ANZAED practice and training standards for mental health professionals providing eating disorder treatment. J Eat Disord 2020; 8:58. [PMID: 33292542 PMCID: PMC7604958 DOI: 10.1186/s40337-020-00333-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/02/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The Australia & New Zealand Academy for Eating Disorders (ANZAED) recently developed general principles and clinical practice standards recommended for mental health clinicians and dietitians providing treatment for people with eating disorders. Separate mental health practice and training standards were then devised as a foundation for strengthening the workforce and providing guidance to professional training programs and service providers on the minimal standards required for practice in the eating disorder field. RECOMMENDATIONS The present recommendations for mental health professionals providing eating disorder treatment describe the following practice and training standards: eating disorder treatment foundations (including co-ordination of services, establishing a positive therapeutic alliance, professional responsibility and knowledge of levels of care), assessment, diagnosis, intervention (including evidence-based intervention, managing psychiatric risk and managing co-morbid mental health problems), and monitoring and evaluation. CONCLUSIONS Further work is required to disseminate these standards to clinicians providing services across Australia to people with eating disorders, and to support adherence in the clinic room where they can translate to improved outcomes for clients. Pathways to supporting adherence include expert supervision of practice, incorporation in training and supervised practice in university settings, and support with checklists that can be used by consumers and referring professionals.
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Affiliation(s)
- Kim Hurst
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia.
- Eating Disorder Service, Robina Private Hospital, Robina, Australia.
- School of Psychology, Griffith University, Gold Coast, Australia.
| | - Gabriella Heruc
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Eating Disorder Service, Northern Sydney Local Health District, Sydney, Australia
| | | | - Jeremy Freeman
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
| | - Anthea Fursland
- Western Australia Eating Disorders Outreach & Consultation Service, Nedlands, Australia
| | - Rachel Knight
- Occupational Therapy, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- The Victorian Centre of Excellence in Eating Disorders, Melbourne, Australia
| | - Marion Roberts
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Beth Shelton
- National Eating Disorders Collaboration, Melbourne, Australia
| | - Andrew Wallis
- Eating Disorder Service, Sydney Children's Hospital Network, Sydney, Australia
| | - Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, Australia
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80
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What to Do When Evidence-Based Treatment Manuals Are Not Enough? Adapting Evidence-Based Psychological Interventions for Primary Care. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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81
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Schneider RA, Grasso JR, Chen SY, Chen C, Reilly ED, Kocher B. Beyond the Lab: Empirically Supported Treatments in the Real World. Front Psychol 2020; 11:1969. [PMID: 32849153 PMCID: PMC7432146 DOI: 10.3389/fpsyg.2020.01969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Laboratory studies of empirically supported treatments (ESTs) for mental health problems achieve much higher rates of clinical improvement than has been observed following treatment in the community. This discrepancy is likely to due to limited reliance on ESTs by therapists outside of academia. Concerns about the generalizability of ESTs to patients in the community, who may have comorbid problems, likely limit rates of adoption. The present study examined the impact of ESTs delivered in the real-world for 1,256 adults who received services through an employee assistance program specializing in the delivery of ESTs. Rates of anxiety and depression decreased significantly, following treatment with an EST, and 898 (71.5%) patients demonstrated reliable improvement. Even among patients comorbid for depression and anxiety at baseline, over half reported reliable improvement in both disorders. Findings suggest ESTs can be effectively delivered outside of academic RCTs. However, additional research is needed to understand and overcome barriers to disseminating ESTs to the broader community.
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Affiliation(s)
| | | | | | - Connie Chen
- Lyra Health, Burlingame, CA, United States.,Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Erin D Reilly
- Department of Psychiatry, University of Massachusetts System, Boston, MA, United States
| | - Bob Kocher
- Lyra Health, Burlingame, CA, United States.,School of Medicine, Stanford University, Stanford, CA, United States
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Cromarty P, Gallagher D, Watson J. Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e33. [PMID: 34191942 PMCID: PMC7468679 DOI: 10.1017/s1754470x20000343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/05/2022]
Abstract
The worldwide coronavirus pandemic has forced health services to adapt their delivery to protect the health of all concerned, and avoid service users facing severe disruption. Improving Access to Psychological Therapies (IAPT) services in particular are having to explore remote working methods to continue functioning. Australian IAPT services have utilised remote delivery methods and disruptive technologies at their core from inception. This was to maintain fidelity and clinical governance across vast distances but has allowed training, supervision and service delivery to continue virtually uninterrupted through coronavirus restrictions. On this basis, key recommendations for remote working are outlined. Remote methods are defined as (1) real time delivery, (2) independent delivery and (3) blended delivery. These are applied across three broad areas of remote training, remote clinical supervision and remote service delivery. Recommendations may be of great benefit to IAPT training institutions, clinical supervisors and service providers considering a move towards remote delivery. Challenges, adaptations and examples of applying remote methods are outlined, including case examples of methods applied to low-intensity and high-intensity cognitive behavioural therapy. Remote methods can safeguard service continuity in times of worldwide crisis and can contribute to reducing the impact of increased mental health presentations post-COVID-19. KEY LEARNING AIMS To understand the core areas of remote training, clinical supervision and service delivery.To review and distinguish between three broad methods of remote working.To understand how to plan remote working via key recommendations and case examples.
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83
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Using technology to understand how therapist variables are associated with clinical outcomes in IAPT. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
The UK’s Improving Access to Psychological Therapy Programme (IAPT) has improved transparency of primary mental health care in relation to the mandatory reporting of clinical outcomes. However, the data reveal a significant variance in outcomes. These findings have led to a growing body of research investigating to what extent therapist variables account for the difference in clinical outcomes. Previous studies have not had access to sufficient recordings or transcripts of therapy sessions in order to fully address this question. The purpose of this study was to use therapy transcripts derived from internet enabled cognitive behavioural therapy (CBT) treatment sessions in order to investigate whether and how therapist variables are associated with clinical outcome. A hierarchical log-linear analysis examined the relationship between therapist/patient variables and clinical outcome. Therapist fidelity to the CBT model and associated adherence to an evidence-based protocol were significantly related to clinical outcome. A graphical representation of the statistical model suggests that patient recovery is directly linked with fidelity and indirectly with adherence, after adjusting for patient attributes of age, gender and clinical presentation. Corroborating previous research, therapist competence and adherence to an evidence-based treatment protocol appear to be important in improving outcomes. These findings have implications for the continuing professional development of qualified therapists, potentially reinforcing the importance of reducing therapist drift.
Key learning aims
(1)
To develop an understanding in relation to which therapist variables are associated with clinical outcome in IAPT.
(2)
To reflect on how fidelity to the CBT model and adherence to evidence-based treatment protocols may affect clinical outcomes.
(3)
To exemplify use of a statistical method for enhanced visual understanding of complex multi-factorial data.
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84
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Gupta A, Ocker G, Chow PI. Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study. Clin Trials 2020; 17:675-683. [PMID: 32660354 DOI: 10.1177/1740774520939247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies. METHODS This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule. RESULTS Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge. CONCLUSION Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.
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Affiliation(s)
- Alisha Gupta
- University of Virginia, Charlottesville, VA, USA
| | | | - Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
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González-Robles A, Díaz-García A, García-Palacios A, Roca P, Ramos-Quiroga JA, Botella C. Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial. J Med Internet Res 2020; 22:e18220. [PMID: 32673226 PMCID: PMC7381075 DOI: 10.2196/18220] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Anxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT. Objective This study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings. Methods A 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up. Results The results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=−0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants. Conclusions EmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed. Trial Registration ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668
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Affiliation(s)
- Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | - Pablo Roca
- Department of Personality, Assessment, and Clinical Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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Payne L, Flannery H, Kambakara Gedara C, Daniilidi X, Hitchcock M, Lambert D, Taylor C, Christie D. Business as usual? Psychological support at a distance. Clin Child Psychol Psychiatry 2020; 25:672-686. [PMID: 32594756 PMCID: PMC7370649 DOI: 10.1177/1359104520937378] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The impact of COVID-19 has challenged the long accepted 'norm' in delivery of psychological therapy. Public policies designed to reduce transmission have made it extremely difficult to meet with service-users safely in the traditional face-to-face context. E-therapies have existed in theory and practice since technological progress has made them possible. They can offer a host of advantages over face-to-face equivalents, including improved access, greater flexibility for service-users and professionals, and cost savings. However, despite the emerging evidence and anticipated positive value, implementation has been slower than anticipated. Concerns have been raised by service-users, clinicians, and public health organisations, identifying significant barriers to the wide spread use of e-therapies. In the current climate, many clinicians are offering e-therapies for the first time, without prior arrangement or training, as the only viable option to continue to support their clients. This paper offers a clinically relevant review of the e-therapies literature, including effectiveness and acceptability dilemmas and challenges that need to be addressed to support the safe use and growth of e-therapies in psychology services. Further research is needed to better understand what might be lost and what gained in comparison to face-to-face therapy, and for which client groups and settings it might be most effective.
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Affiliation(s)
- Lara Payne
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Halina Flannery
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | | | - Xeni Daniilidi
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Megan Hitchcock
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Danielle Lambert
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Charlotte Taylor
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
| | - Deborah Christie
- Child and Adolescent Psychology Service, University College London Hospital, London, UK
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87
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Are you sitting (un)comfortably? Action-based supervision and supervisory drift. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractAction-based methods such as behavioural experiments, role-play and (by extension) ‘chairwork’ are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a ‘doing process’ to a ‘talking process’. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees’ technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods.Key learning aimsAs a result of reading this paper, readers should:(1)Understand why supervision sometimes drifts from being a ‘doing’ process.(2)Appreciate the value of experiential, action-based supervisory methods.(3)Feel competent using action-based methods to enhance supervisees’ clinical skills.
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What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative.
Key learning aims
(1)
To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service.
(2)
To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions.
(3)
To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.
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Launes G, Hagen K, Öst LG, Solem S, Hansen B, Kvale G. The Bergen 4-Day Treatment (B4DT) for Obsessive-Compulsive Disorder: Outcomes for Patients Treated After Initial Waiting List or Self-Help Intervention. Front Psychol 2020; 11:982. [PMID: 32528372 PMCID: PMC7266968 DOI: 10.3389/fpsyg.2020.00982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/20/2020] [Indexed: 01/18/2023] Open
Abstract
The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) was recently tested in a randomized controlled trial, where the results showed that the B4DT was more effective than a self-help intervention (SH) and a waiting list condition (WL). Patients in the SH and WL condition still in need of treatment after the first intervention (N = 26; 13 from each condition) were offered the B4DT. None of the patients declined participation, and there were no dropouts. At post-treatment 59.5% were in remission, 31.0% had treatment response, and 9.5% showed no change. At 3-month follow-up 71.4% were in remission, 19.0% had treatment response, and 9.5% showed no change. There were also significant improvement in self-reported symptoms of OCD, generalized anxiety symptoms, and depressive symptoms. The results are in line with what we previously have found for the B4DT in a number of effectiveness studies. In addition, the results indicate that the patients who previously had received an unsuccessful SH intervention and patients who had first been in a WL condition, profited as much as patients who had received the B4DT as the initial intervention. Implications for clinical guidelines and for dissemination of the B4DT are discussed.
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Affiliation(s)
- Gunvor Launes
- Sørlandet Sykehus, Kristiansand, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Møre and Romsdal Hospital Trust, Molde, Norway
| | - Lars-Göran Öst
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
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90
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Perlini C, Donisi V, Del Piccolo L. From research to clinical practice: a systematic review of the implementation of psychological interventions for chronic headache in adults. BMC Health Serv Res 2020; 20:459. [PMID: 32450871 PMCID: PMC7247180 DOI: 10.1186/s12913-020-05172-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychological interventions have been proved to be effective in chronic headache (CH) in adults. Nevertheless, no data exist about their actual implementation into standard clinical settings. We aimed at critically depicting the current application of psychological interventions for CH into standard care exploring barriers and facilitators to their implementation. Secondarily, main outcomes of the most recent psychological interventions for CH in adults have been summarized. METHODS We conducted a systematic review through PubMed and PsycINFO in the time range 2008-2018. A quality analysis according to the QATSDD tool and a narrative synthesis were performed. We integrated results by: contacting the corresponding author of each paper; exploring the website of the clinical centers cited in the papers. RESULTS Of the 938 identified studies, 28 papers were selected, whose quality largely varied with an average %QATSDD quality score of 64.88%. Interventions included CBT (42.85%), multi-disciplinary treatments (22.43%), relaxation training (17.86%), biofeedback (7.14%), or other interventions (10.72%). Treatments duration (1 day-9 months) and intensity varied, with a prevalence of individual-basis implementation. The majority of the studies focused on all primary headaches; 4 studies focused on medication-overuse headache. Most of the studies suggest interventions as effective, with the reduction in frequency of attacks as the most reported outcome (46.43%). Studies were distributed in different countries, with a prevalent and balanced distribution in USA and Europe. Ten researches (35.71%) were performed in academic contexts, 11 (39.28%) in clinical settings, 7 (25%) in pain/headache centres. Interventions providers were professionals with certified experience. Most of the studies were funded with private or public funding. Two contacted authors answered to our e-mail survey, with only one intervention implemented in the routine clinical practice. Only in three out of the 16 available websites a reference to the implementation into the clinical setting was reported. CONCLUSION Analysis of contextual barriers/facilitators and cost-effectiveness should be included in future studies, and contents regarding dissemination/implementation of interventions should be incorporated in the professional training of clinical scientists. This can help in filling the gap between the existing published research and treatments actually offered to people with CH.
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Affiliation(s)
- Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- USD Clinical Psychology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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91
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Lake JK, Tablon Modica P, Chan V, Weiss JA. Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1590-1606. [PMID: 32423224 DOI: 10.1177/1362361320918754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Affiliation(s)
- Johanna K Lake
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
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92
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Hayashi Y, Yoshinaga N, Sasaki Y, Tanoue H, Yoshimura K, Kadowaki Y, Arimura Y, Yanagita T, Ishida Y. How was cognitive behavioural therapy for mood disorder implemented in Japan? A retrospective observational study using the nationwide claims database from FY2010 to FY2015. BMJ Open 2020; 10:e033365. [PMID: 32376747 PMCID: PMC7223011 DOI: 10.1136/bmjopen-2019-033365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme. DESIGN Retrospective observational study. SETTING National Database of Health Insurance Claims and Specific Health Checkups of Japan. PARTICIPANTS Patients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors. RESULTS We found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (-1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT. CONCLUSIONS The provision of CBT did not increase in the first 6 years (FY2010-2015) after its coverage in Japan's national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.
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Affiliation(s)
- Yuta Hayashi
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
- Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yosuke Sasaki
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
- Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - Hiroki Tanoue
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kensuke Yoshimura
- Center for Next Generation of Community Health, Chiba University Hospital, Chiba, Japan
| | - Yuko Kadowaki
- Division of Biostatistics, Kurume University School of Medicine, Kurume, Japan
| | - Yasuji Arimura
- Clinical Research Support Center, University of Miyazaki Hospital, Miyazaki, Japan
| | - Toshihiko Yanagita
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Clinical Research Support Center, University of Miyazaki Hospital, Miyazaki, Japan
| | - Yasushi Ishida
- Division of Psychiatry, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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93
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Ruzek JI, Landes SJ, McGee-Vincent P, Rosen CS, Crowley J, Calhoun PS, McGraw K, Walser RD, Smith JL, Barry DS, Schmidt J, Simon E, Runnals J, Liu NH, Shaw RK, Zimmerman L, Nottis D, Tiet QQ, Juhasz KM, Kirchner JE. Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems. J Behav Health Serv Res 2020; 47:449-463. [DOI: 10.1007/s11414-020-09696-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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94
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van den Berg E, Melisse B, Koenders J, de Jonge M, Blankers M, de Beurs E, Dekker J. Online cognitive behavioral therapy enhanced for binge eating disorder: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:190. [PMID: 32349692 PMCID: PMC7189605 DOI: 10.1186/s12888-020-02604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge eating disorder is characterized by recurrent episodes of binge eating accompanied by a sense of lack of control. Of the different treatments available, Cognitive Behavioral Therapy-Enhanced and guided self-help treatment are recommended. As online treatment offers several additional advantages, we have developed a CBT-Enhanced online guided self-help intervention. The aim of this study is to determine whether this intervention reduces eating disorder pathology and increases the amount of binge free days in adults classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder, compared to an untreated waiting list condition. The experimental condition is hypothesized to be superior to the waiting list condition. METHODS The efficacy of an online guided self-help intervention for binge eating disorder will be assessed by conducting a randomized controlled trial. The trial will target adult individuals classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder with a body mass index between 19.5 and 40, referred to an eating disorder treatment center. Dual arm allotment will be performed in a 1:1 ratio stratified for BMI above or below 30. Randomization will be blinded to the online intervention (n = 90), or to the control waiting list condition (n = 90). Assessors will be blinded and assessments will be administered at baseline, week 5, at end-of-treatment, and at 12 and 24 weeks follow-up. Primary outcome will be eating disorder pathology, operationalized as number of days on which binge eating occurred between the two conditions during the period of the intervention. Secondary outcome measures will be differences in other eating disorder pathology, clinical impairment and in quality of life, while therapeutic alliance, demographic characteristics and followed treatment module will serve as effect moderators. Several types of costs will be assessed. DISCUSSION This paper presents an online guided self-help Cognitive Behavioral Therapy- Enhanced study protocol for individuals classified with binge eating disorder or other specified feeding or eating disorder. Efficacy will be examined through a Randomized Controlled Trial. TRIAL REGISTRATION The study protocol is registered with the Netherlands Trial Registry NTR (NTR 7994) since 6 September 2019.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071, KR, Amsterdam, the Netherlands.
| | - Jitske Koenders
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands
| | - Edwin de Beurs
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands ,grid.5132.50000 0001 2312 1970Section Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands
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95
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Chow PI. Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process. JMIR Mhealth Uhealth 2020; 8:e15561. [PMID: 32310143 PMCID: PMC7199142 DOI: 10.2196/15561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/01/2019] [Accepted: 01/24/2020] [Indexed: 01/23/2023] Open
Abstract
Background Behavioral health researchers are increasingly recognizing the potential of mobile phone apps to deliver empirically supported treatments. However, current options for developing apps typically require large amounts of expertise or money. Objective This paper aims to describe a pragmatic do-it-yourself approach for researchers to create and pilot an Android mobile phone app using existing survey software (eg, Qualtrics survey platform). Methods This study was conducted at an academic research center in the United States focused on developing and evaluating behavioral health technologies. The process outlined in this paper was derived and condensed from the steps to building an existing app intervention, iCanThrive, which was developed to enhance mental well-being in women cancer survivors. Results This paper describes an inexpensive, practical process that uses a widely available survey software, such as Qualtrics, to create and pilot a mobile phone intervention that is presented to participants as a Web viewer app that is downloaded from the Google Play store. Health researchers who are interested in using this process to pilot apps are encouraged to inquire about the survey platforms available to them, the level of security those survey platforms provide, and the regulatory guidelines set forth by their institution. Conclusions As app interventions continue to gain interest among researchers and consumers alike, it is important to find new ways to efficiently develop and pilot app interventions before committing a large amount of resources. Mobile phone app interventions are an important component to discovering new ways to reach and support individuals with behavioral or mental health disorders.
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Affiliation(s)
- Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
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96
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Combined Neurocognitive And Metacognitive Rehabilitation In Schizophrenia: Effects On Bias Against Disconfirmatory Evidence. Eur Psychiatry 2020; 30:615-21. [DOI: 10.1016/j.eurpsy.2015.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022] Open
Abstract
AbstractBackgroundA Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement.MethodsFifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE.ResultsAfter MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures.ConclusionsThis study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients.
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97
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Chow PI, Showalter SL, Gerber M, Kennedy EM, Brenin D, Mohr DC, Lattie EG, Gupta A, Ocker G, Cohn WF. Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study. JMIR Cancer 2020; 6:e16476. [PMID: 32293570 PMCID: PMC7191345 DOI: 10.2196/16476] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
Background Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute–designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone–delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID) RR2-10.2196/11452
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Affiliation(s)
- Philip I Chow
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shayna L Showalter
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - Matthew Gerber
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - David Brenin
- Department of Surgery, University of Virginia, Charlottesville, VA, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Alisha Gupta
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Gabrielle Ocker
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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98
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Hoge EA, Bui E, Mete M, Philip SR, Gabriel C, Ward MJ, Suzuki R, Dutton MA, Simon NM. Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial. Contemp Clin Trials 2020; 91:105965. [PMID: 32087339 DOI: 10.1016/j.cct.2020.105965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Anxiety disorders (generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia) are common, distressing, and impairing. While pharmacotherapy and psychotherapy are first-line treatment strategies for anxiety disorders, many patients are reluctant to take psychiatric medication, and many prefer to avoid any kind of mental health treatment due to stigma or distrust of traditional medical care. We present the trial protocol for the first study comparing first-line medication treatment with Mindfulness-Based Stress Reduction (MBSR), a popular mindfulness meditation training program, for the treatment of anxiety disorders. We will use a non-inferiority, comparative effectiveness trial design, in which individuals with diagnosed anxiety disorders will be randomized to either pharmacotherapy with escitalopram or MBSR for 8 weeks of treatment. Treatment outcome will be based on gold standard symptom severity measures assessed by trained independent evaluators blind to treatment allocation. Secondary outcomes will include key symptom and function measures, as well as tolerability and satisfaction with treatment. Findings will provide crucial information to inform decision making about the relative benefits of MBSR versus a first line medication for anxiety disorders by patients, medical care providers, healthcare insurers and other stakeholders.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA.
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mihriye Mete
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA; MedStar Health Research Institute, Hyattsville, MD, USA
| | - Samantha R Philip
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Caroline Gabriel
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Meredith J Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca Suzuki
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine, New York, NY, USA
| | - Mary Ann Dutton
- Department of Psychiatry, Georgetown University Medical Center, Washington D.C, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine, New York, NY, USA
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99
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Ong CW, Levin ME, Twohig MP. Beyond Acceptance and Commitment Therapy: Process-Based Therapy. PSYCHOLOGICAL RECORD 2020. [DOI: 10.1007/s40732-020-00397-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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100
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The Efficacy of PowerPoint-based CBT Delivered Through Email: Breaking the Barriers to Treatment for Generalized Anxiety Disorder. J Psychiatr Pract 2020; 26:89-100. [PMID: 32134882 DOI: 10.1097/pra.0000000000000455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A lack of resources and cultural stigma associated with mental health treatment necessitate the development of innovative and economical individualized treatments. This study evaluated the efficacy of delivering computer-based cognitive behavioral therapy (e-CBT) presented through Microsoft PowerPoint and delivered via email in the treatment of generalized anxiety disorder (GAD) to Iranian patients, as a means of overcoming treatment barriers. METHODS Participants (N=80) of Iranian descent were recruited through announcements on psychology websites, Iranian organization websites, weblogs, and in flyers. Participants were randomly assigned to either an e-CBT or a control group. The e-CBT group received 12 weekly modules and homework assignments through email, presented using PowerPoint. The control group received no treatment (individuals in the control group were able to pursue another treatment, but would then be excluded from the study although they could continue with the program). All emails were sent by an attending or resident psychiatrist, who also provided feedback on weekly homework via email. The Beck Anxiety Inventory was used to measure levels of anxiety before study onset and changes in levels of anxiety upon completion of the program at 12 weeks, and at 6-month and 1-year follow-up in both groups. RESULTS Beck Anxiety Inventory scores were significantly reduced in the group who received PowerPoint e-CBT modules delivered via email, compared with the control group, following 12 weeks of treatment, and the reductions were maintained at both follow-up points. CONCLUSIONS Delivery of PowerPoint e-CBT modules via email was found to be a viable method for delivering CBT to individuals with GAD and a simple method for overcoming language, cultural, and travel barriers to accessing mental health resources. This simplified approach to the individualization and delivery of treatment modules has the potential to improve access to CBT as a treatment option throughout the world.
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