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Hasani J, Emadi Chashmi SJ, Zakiniaeiz Y, Potenza MN. Psychometric properties of the Persian version of the cognitive emotion regulation questionnaire-short (CERQ-P-short): Reliability, validity, factor structure, treatment sensitivity, and measurement invariance. J Psychiatr Res 2024; 170:1-10. [PMID: 38096672 PMCID: PMC11131131 DOI: 10.1016/j.jpsychires.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/26/2023] [Accepted: 11/15/2023] [Indexed: 02/02/2024]
Abstract
AIMS This study aimed to examine the psychometric properties of a widely-used measure of emotion regulation, the short version of the Cognitive Emotion Regulation Questionnaire (CERQ-short), in the Persian language (CERQ-P-short) among Iranian populations. METHODS The CERQ-P-short was administered to 1825 participants (female = 974) including 436 adolescents, 834 adults from the general population, 45 patients each with generalized anxiety and obsessive-compulsive disorders, an additional 30 patients each with generalized anxiety and obsessive-compulsive disorders receiving treatment, 45 patients with substance use disorders (SUDs) and an additional 360 adult psychiatric patients. We tested reliability, factor structure, measurement invariance, convergent and discriminant validity, and treatment sensitivity (i.e., intervention response) by age, sex, and diagnostic group. The Depression Anxiety Stress Scale-21 was also administered. RESULTS Cronbach's alpha coefficient and test-retest coefficients suggested good reliability. Fit indices suggested that the 9-factor CERQ-P-Short model was good across groups. The CERQ-P-Short showed good measurement invariance in all four models (configural, metric, scalar, and strict) in all groups. Both adaptive and maladaptive cognitive emotion-regulation strategies demonstrated convergent and discriminant validity. Finally, treatment sensitivity of the CERQ-P-Short scale before and after the completion of treatment sessions was suggested for patients with generalized anxiety and obsessive-compulsive disorders. CONCLUSIONS While the present study has some limitations, it represents a significant contribution because it supports CERQ-P-Short scales usefulness, validity, and reliability in the general population and among psychiatric patients. The results of the current study can be beneficial to the both clinicians and researchers.
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Affiliation(s)
- Jafar Hasani
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran.
| | | | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Marc N Potenza
- Departments of Psychiatry and Neuroscience, The Child Study Center and the Wu Tsai Institute, Yale University and Yale University School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA
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Vasiliadis HM, Lamoureux-Lamarche C, Chapdelaine A, Provencher MD, Norton PJ, Berbiche D, Roberge P. Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:43-53. [PMID: 37461378 PMCID: PMC10867409 DOI: 10.1177/07067437231187459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIM To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Lamoureux-Lamarche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Alexandra Chapdelaine
- PRIMUS Research Group, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d’urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Shahmoradi N, Davarinejad O, Brühl AB, Brand S. Effects of Aphrodite (an Herbal Compound) on SSRI-Induced Sexual Dysfunctions and Depression in Females with Major Depressive Disorder: Findings from a Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1663. [PMID: 37763782 PMCID: PMC10538161 DOI: 10.3390/medicina59091663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Almost by default, people with major depression disorder (MDD) also report sexual health issues. This holds even more true when sexual dysfunctions are SSRI-induced. Herbal compounds may have the power to counterbalance such sexual dysfunctions, though research is still scarce. Therefore, we assessed females with diagnosed MDD treated with a standard SSRI (sertraline) and reporting SSRI-induced sexual dysfunctions, and we asked whether compared to placebo, Aphrodite (a blend of ginger, saffron, cinnamon, thistle, and Tribulus terrestris) may favorably impact on sexual dysfunctions, and on symptoms of depression, anxiety, and sleep disturbances. Materials and Methods: A total of 41 females (mean age: 35.05 years) with diagnosed MDD, treated with sertraline (a standard SSRI) at therapeutic dosages, and reporting SSRI-induced sexual dysfunction, were randomly assigned either to Aphrodite or to the placebo condition. At baseline and four and eight weeks later (study end), participants completed a series of self-rating questionnaires covering symptoms of sexual dysfunction, depression, anxiety, and sleep complaints. Results: Symptoms of sexual dysfunction, depression, and anxiety decreased over time, but more so in the Aphrodite condition, compared to the placebo condition (significant p-values and large effect sizes). Over time, sleep disturbances decreased irrespective of the study condition. Conclusions: The pattern of results suggests that compared to placebo, Aphrodite appeared to improve symptoms of sexual dysfunction, depression, and anxiety among females with diagnosed MDD and SSRI-induced sexual dysfunction. Further and similar studies should investigate the underlying psychophysiological mechanisms.
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Affiliation(s)
- Nasrin Shahmoradi
- Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714673159, Iran; (O.D.); (A.B.B.)
| | - Omran Davarinejad
- Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714673159, Iran; (O.D.); (A.B.B.)
| | - Annette Beatrix Brühl
- Department of Psychiatry, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714673159, Iran; (O.D.); (A.B.B.)
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
| | - Serge Brand
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714673159, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1417466191, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714673159, Iran
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
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Abdoli N, Sadeghi-Bahmani D, Salari N, Khodamoradi M, Farnia V, Jahangiri S, Brühl AB, Dürsteler KM, Stanga Z, Brand S. Nomophobia (No Mobile Phone Phobia) and Psychological Health Issues among Young Adult Students. Eur J Investig Health Psychol Educ 2023; 13:1762-1775. [PMID: 37754467 PMCID: PMC10527744 DOI: 10.3390/ejihpe13090128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Smart phone use has become a part of people's everyday life. However, when the lack of using the smart phone to establish and maintain electronic communication is related to psychological distress, such a behavior may be considered a modern-age phobia, or nomophobia (no mobile phone phobia). The aims of the present study were to investigate among a sample of young adults the associations between scores for nomophobia and symptoms of depression, anxiety, stress, insomnia, and obsessive-compulsive disorders. METHODS A total of 537 students (mean age: 25.52 years; 42.3% females) participated in the study. They completed a booklet of self-rating questionnaires covering sociodemographic information and symptoms of nomophobia, depression, anxiety, stress, insomnia, and obsessive-compulsive disorders. RESULTS Higher scores for nomophobia were associated with higher scores for depression, anxiety, and stress, but not with scores for insomnia and obsessive-compulsive disorders. The regression model confirmed that symptoms of anxiety predicted nomophobia. CONCLUSIONS The present results support the assumption that nomophobia appears to be a mood disturbance related to stronger associations with symptoms of anxiety and, to a lesser extent, with symptoms of depression and stress. By contrast, nomophobia appeared to be unrelated to insomnia and symptoms of obsessive-compulsive disorders.
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Affiliation(s)
- Nasrin Abdoli
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (N.A.); (M.K.); (V.F.); (S.J.)
| | - Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA 94305, USA;
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran;
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
| | - Mehdi Khodamoradi
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (N.A.); (M.K.); (V.F.); (S.J.)
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (N.A.); (M.K.); (V.F.); (S.J.)
| | - Somayeh Jahangiri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (N.A.); (M.K.); (V.F.); (S.J.)
| | - Annette Beatrix Brühl
- Center for Affective, Stress and Sleep Disturbances, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
| | - Kenneth M. Dürsteler
- Division of Substance Use Disorders, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
- Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, 8001 Zurich, Switzerland
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Bern, Switzerland;
| | - Serge Brand
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (N.A.); (M.K.); (V.F.); (S.J.)
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA
- Center for Affective, Stress and Sleep Disturbances, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, Faculty of Medicine, University of Basel, 4052 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Teheran 1417466191, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
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Sadeghi-Bahmani D, Parhoon H, Esmaeili M, Parhoon K, Sadeghi Bahmani L, Khazaie H, Becker SP, Burns GL, Brand S. Validation of the Farsi Version of the Adult Concentration Inventory for Assessing Cognitive Disengagement Syndrome. J Clin Med 2023; 12:4607. [PMID: 37510724 PMCID: PMC10380426 DOI: 10.3390/jcm12144607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The internal and external validity of cognitive disengagement syndrome (CDS) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated herein with Farsi-speaking adults. A total of 837 Iranian adults assessed throughout the whole country (54.72% women, Mage = 23.85; SD = 7.05; age range = 18 to 58 years; 75% between 18 and 24 years old; reporting higher educational training) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), depression, anxiety, and stress. Seven of the fifteen CDS symptoms showed a good convergent (high loadings on the CDS factor) and discriminant (higher loadings on the CDS factor than the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations with depression than ADHD-IN, whereas ADHD-IN showed stronger first-order and unique associations with ADHD-HI and anxiety than CDS. The first-order and unique associations of CDS and ADHD-IN did not differ in relation to stress. This study is the first to support the validity of the self-report of assessing CDS symptoms with the Adult Concentration Inventory with Farsi-speaking individuals residing in Iran, thus further strengthening the transcultural validity of the CDS, and paving the way for further transcultural research in the field of CDS among adults.
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Affiliation(s)
- Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Department of Epidemiology & Population Health, Stanford University, Stanford, CA 94305, USA
| | - Hadi Parhoon
- Department of Psychology, Razi University, Kermanshah 6714414971, Iran;
| | - Maryam Esmaeili
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan 8174673441, Iran;
| | - Kamal Parhoon
- Department of Psychology, Kharazmi University, Tehran 1571914911, Iran;
| | - Laleh Sadeghi Bahmani
- Department of Education and Psychology, Shahid Ashrafi Esfahani University, Isfahan 8179949999, Iran;
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714415185, Iran;
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA 99164, USA;
| | - Serge Brand
- Center for Affective, Sleep and Stress Disorders, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland;
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, 4052 Basel, Switzerland
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 6714415185, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1441987566, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework. BMC Health Serv Res 2023; 23:596. [PMID: 37291599 DOI: 10.1186/s12913-023-09468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). METHODS This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. RESULTS Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. CONCLUSIONS The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458, 23/06/2016.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus de Longueuil, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Martin D Provencher
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 All. des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Road, Hawthorn East, Victoria, VIC, 3123, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
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Gros DF, Allan NP, Koscinski B, Keller S, Acierno R. Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD. J Clin Psychol 2023; 79:1039-1050. [PMID: 36399326 DOI: 10.1002/jclp.23456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/14/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. METHODS One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. RESULTS Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. CONCLUSION Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System Canandaigua, New York, USA
| | | | - Stephanie Keller
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Acierno
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Louis Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, USA
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Rodriguez-Moreno S, Guillén AI, Tirpak JW, Marín C, Cardona ND, Eustis EH, Farchione TJ, Barlow DH, Panadero S. Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Zemestani M, Davoudi F, Farhadi A, Gallagher MW. A preliminary examination of unified protocol for transdiagnostic treatment of emotional disorders in patients with panic disorder: a single-case experimental design in Iran. ANXIETY, STRESS, AND COPING 2022; 35:701-718. [PMID: 34632890 DOI: 10.1080/10615806.2021.1990269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The majority of patients suffering from anxiety disorders in low- and middle-income countries do not receive evidence-based treatments. The Unified Protocol (UP) for the Transdiagnostic Treatment of Emotional Disorders is an evidence-based cognitive-behavioral intervention designed to treat the range of emotional disorders. DESIGN AND METHODS Using a single-case experimental design five patients with panic disorder were assigned to a 3-week baselines assessment phase followed by eight sessions of UP treatment and 4-week follow-up phases. Multiple outcome measures of panic severity, anxiety sensitivity, affectivity, and overall anxiety severity and impairment were administered weekly during the baseline, intervention, and follow-up phases. RESULTS At post treatment, all participants showed significant reductions in outcome measures, with changes functionally related to treatment and most improvements maintained at 4-week follow-up. CONCLUSION Findings provide preliminary cross-cultural support for UP and add to the growing body of literature showing UP can be useful for patients with anxiety disorders in low- and middle-income countries with non-Western cultures.
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Affiliation(s)
- Mehdi Zemestani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Fatemeh Davoudi
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Ali Farhadi
- Department of Social Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
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Coyne AE, Gros DF. Comorbidity as a moderator of the differential efficacy of transdiagnostic behavior therapy and behavioral activation for affective disorders. Psychother Res 2022; 32:886-897. [PMID: 34996343 PMCID: PMC10028601 DOI: 10.1080/10503307.2021.2022236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Transdiagnostic psychotherapies have been proposed as an effective means for addressing the needs of patients with multiple, comorbid disorders. Yet, it remains unknown whether transdiagnostic approaches empirically outperform disorder-specific psychotherapies for patients with comorbid disorders. Thus, this study tested whether comorbidity moderated the efficacy of transdiagnostic behavior therapy (TBT) and behavioral activation (BA) for patients with various affective disorders. METHODS Data derived from a randomized controlled trial in which 93 treatment-seeking veterans received 12 sessions of TBT (n = 46) or BA (n = 47). Baseline comorbidity was assessed with a diagnostic interview. Patients rated their symptoms and functioning throughout treatment, and therapists recorded premature treatment discontinuation. RESULTS Multilevel models revealed significant interactive effects on changes in symptoms and functioning, but not on the posttreatment levels of these outcomes; whereas patients with more comorbidity experienced greater reductions in distress and symptom interference in TBT compared to BA, those with one disorder had better outcomes in BA. Similarly, whereas patients with more comorbidity were less likely to prematurely discontinue TBT compared to BA, those with one disorder were less likely to prematurely discontinue BA. CONCLUSIONS The results lend empirical support to previously untested hypotheses for potential benefits of transdiagnostic psychotherapies.Trial registration: ClinicalTrials.gov identifier: NCT01947647.
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Affiliation(s)
- Alice E Coyne
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Gros DF, Coyne AE. A comparison of transdiagnostic behavior therapy (TBT) and behavioral activation treatment for depression (BATD) in veterans with major depressive disorder. J Clin Psychol 2022; 78:1009-1019. [PMID: 34935138 PMCID: PMC10034572 DOI: 10.1002/jclp.23298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/28/2021] [Accepted: 11/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although frequently discussed within the scope of transdiagnostic psychotherapy protocols, limited data are available on their efficacy in patients with a principal diagnosis of major depressive disorder. The present study attempted to address that gap in the literature through a randomized clinical trial comparing transdiagnostic behavior therapy (TBT) to behavioral activation treatment for depression (BATD). METHODS Forty veterans with principal major depressive disorder were randomized into either 12 sessions of individual TBT or BATD, with symptom measures collected at baseline and posttreatment. Process variables for treatment engagement and completion also were recorded. RESULTS Participants reported similar symptom improvements in depression, stress, anhedonia, and impairment across both treatments. Clinician-rated treatment improvements favored TBT. Participants in TBT also attended more appointments, canceled or missed fewer appointments, and completed the protocol at a higher rate than participants that received BATD. CONCLUSIONS The present findings support TBT as an efficacious treatment for principal major depressive disorder, with potentially superior coverage of comorbid anxiety symptomatology and improved treatment adherence and completion compared to BATD. Pending replication in larger samples, TBT and other similar transdiagnostic psychotherapies should be considered for implementation across the anxiety and depressive disorders to simplify dissemination efforts for evidence-based psychotherapies and potentially improve coverage of comorbidity.
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Affiliation(s)
- Daniel F Gros
- Department of Psychiatry and Behavioral Sciences, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alice E Coyne
- Department of Psychiatry and Behavioral Sciences, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, South Carolina, USA
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12
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Qanbari Alaee E, Saed O, Khakpoor S, Ahmadi R, Ali Mohammadi M, Yoosefi Afrashteh M, Morovati Z. The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35532025 PMCID: PMC9153761 DOI: 10.4081/ripppo.2022.588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/08/2022] [Indexed: 01/04/2023]
Abstract
In response to the high rate of comorbidity among different types of emotional disorders in children, Transdiagnostic Unified Protocol of Emotional disorder in children (UP-C) was developed to address common underlying mechanisms in the development and maintenance of emotional disorders using empirically supported cognitive and behavioural strategies. Although, studies supported the effectiveness of this protocol in the treatment of wide range of emotional disorders, further studies are needed to examine its effect on transdiagnostic factors. The present study aimed to investigate the efficacy of the UP-C on negative affect, anxiety sensitivity and perceived control in children with emotional disorders. During this randomized controlled trial, 34 children aged 7 to 13 with emotional disorders were randomly assigned to treatment (n=18) and control (n=16) groups. The treatment group and their parents received 15 sessions of UP-C. Negative Affect Schedule for Children (PANASNA- C), Children’s Anxiety Sensitivity Index (CASI), Anxiety Control Questionnaire-Children (ACQ-C) were carried out in all phases (pre-treatment, post-treatment, 3 and 8 months follow- up). The results showed that following UP-C, negative affect (hedges’g=2.01) and anxiety sensitivity (hedges’g=1.05) were significantly reduced, and perceived control (hedges’g= –2.36) was significantly improved. The results remained relatively constant during the follow-ups. Findings provide evidence that the UP-C has significant effect on negative affect, anxiety sensitivity and perceived control as roots of emotional disorders.
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13
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Muñoz-Navarro R, Medrano LA, Limonero JT, González-Blanch C, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial. J Affect Disord 2022; 303:206-215. [PMID: 34998804 DOI: 10.1016/j.jad.2022.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. Transdiagnostic cognitive behavior therapy (TD-CBT) is a promising treatment of emotional disorders. In this study, we evaluated several emotion regulation strategies as potential mediators of treatment outcomes in a clinical sample of primary care. METHODS A total of 1061 primary care patients were included in a randomized clinical trial comparing treatment-as-usual (TAU) to TD-CBT+TAU. Of these, 631 (TAU=316; TD-CBT+TAU=315) completed the full treatment and all pre- and post-treatment scales to assess symptoms (anxiety, depression, somatization), emotion regulation strategies (worry, rumination, negative metacognition, suppression, cognitive reappraisal), overall functioning, and quality of life (QoL). RESULTS Treatment and direct effects showed that TD-CBT+TAU was superior to TAU alone. On the multivariate mediation analysis of indirect effects, three maladaptive strategies (worry, rumination and negative metacognition) had significant effects on all emotional symptoms. Suppression was also significant for depression. Rumination and negative metacognition were significant mediators of functioning, while only negative metacognition was significant for QoL. Reappraisal had no effect on any outcome. LIMITATIONS We focused mainly on maladaptive cognitive emotion regulation strategies and only studied one behavioural strategy (suppression) and one adaptive strategy (reappraisal). CONCLUSIONS Targeting certain maladaptive emotion regulation strategies (worry, rumination, suppression, negative metacognition) as mediators for treatment with TD-CBT could reduce emotional symptoms and improve well-being. Negative metacognition was the most transdiagnostic strategy, whereas an adaptive strategy such as reappraisal was not a mediator. Thus, maladaptive emotion regulation strategies are key mediators in transdiagnostic therapy for emotional disorders in primary care.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments Faculty of Psychology. University of Valencia, Av. Blasco Ibáñez, 10. 46010. Valencia, Spain.
| | - Leonardo Adrián Medrano
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Autopista Duarte Km 1 1/2, Santiago De Los Caballeros 51000, Dominican Republic.
| | - Joaquín T Limonero
- Department of Basic Psychology, University Autonoma of Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL. Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
| | - Juan A Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital. Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid. Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain.
| | - Antonio Cano-Vindel
- Department of Experimental Psychology. Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain.
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14
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Exploring the concurrent use of standardised and idiographic measures to assess cognitive behavioural therapy in a university student with autistic spectrum condition – a single case experimental design. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Limited research has directly addressed the challenges of higher education for students with autism, who face additional difficulties in navigating social, personal and academic obstacles. With more students experiencing mental health difficulties whilst at university, therapeutic interventions on offer need to be suitable for those accessing support. Cognitive behavioural therapy (CBT) is widely used to support university students, as it is firmly established as an effective treatment for a range of issues, including social and generalised anxiety in typically developing populations (NICE, 2013; NICE, 2019). However, the efficacy of CBT for individuals with autistic spectrum condition (ASC) is less well known, despite the high prevalence rates of anxiety in this population. This paper seeks to address a gap in the literature and uses a single-case (A-B) experimental design over 16 sessions to reduce co-morbid social and generalised anxiety in a university student with high-functioning ASC. Clark’s (2001) cognitive model of social anxiety and Wells’ (1997) cognitive model of generalised anxiety were employed to formulate anxiety experienced in this case. Standardised outcome measures were used for social anxiety, i.e. the Social Phobia Inventory (SPIN), and generalised anxiety, i.e. the Generalised Anxiety Disorder-7 (GAD-7), in conjunction with idiographic ratings to assess the impact of therapy. Findings indicate that CBT was an acceptable and useful intervention with mixed results; discrepancies were found between clinical change recorded on standardised measures compared with idiographic ratings. This paper discusses the use of standardised measures of anxiety for individuals with ASC and identifies directions for further research.
Key learning aims
(1)
To appreciate the unique mental health challenges of university students with ASC.
(2)
To identify psychological interventions that are suitable for individuals with ASC.
(3)
To consider the value in employing more than one evidence-based cognitive model of anxiety when clients present with co-morbid mental health issues.
(4)
To question the utility of using standardised outcome measures compared with idiographic measures in therapy.
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15
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Norton PJ, Provencher MD, Kilby CJ, Roberge P. Impact of group transdiagnostic cognitive-behavior therapy for anxiety disorders on comorbid diagnoses: Results from a pragmatic randomized clinical trial in primary care. Depress Anxiety 2021; 38:749-756. [PMID: 34142748 DOI: 10.1002/da.23184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anxiety and depressive disorders are the most common mental illnesses worldwide, with most individuals meeting criteria for more than one diagnosis. Most cognitive-behavioral therapy (CBT) approaches target only one disorder at a time, resulting in the need to treat comorbid diagnoses sequentially. Transdiagnostic CBT protocols have been developed that simultaneously treat principal and comorbid disorders. METHOD The current study reports on a secondary analysis of data from a pragmatic effectiveness randomized trial of group tCBT in comparison to treatment-as-usual (TAU) in primary care. Of the trial sample of 231 patients, 191 had at least one comorbid diagnosis of clinical severity at T0. RESULTS Overall rates of comorbidity decreased over time (82.0% at T0, 45.0% at T1, 45.7% at T3) and those receiving tCBT showed a significantly lower rate of comorbidity at T1 (33.7%) than TAU (55.7%) and at T3 (tCBT: 27.9%, TAU: 60.2%). Comorbid diagnosis severity ratings reduced to a significantly greater extent in tCBT than in TAU. CONCLUSIONS tCBT is effective in promoting remission of and reducing the severity of comorbid diagnoses. Implications for the treatment of whole persons as opposed to specific diagnoses is discussed.
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16
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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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17
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Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [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: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
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Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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18
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Jiang MYW, Kandris E, El-Masry Y, Drobny J, St. Clare T, Chen JTH. Effectiveness of transdiagnostic group cognitive-behavioural therapy for anxiety disorders in a naturalistic clinical setting. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1913048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Michelle Y. W. Jiang
- Anxiety Treatment and Research Unit, Western Sydney Local Health District, Sydney, Australia
| | - Evelyn Kandris
- Anxiety Treatment and Research Unit, Western Sydney Local Health District, Sydney, Australia
| | - Yasmeen El-Masry
- Anxiety Treatment and Research Unit, Western Sydney Local Health District, Sydney, Australia
| | - Juliette Drobny
- Discipline of Psychiatry, University of Sydney, Sydney, Australia
| | - Tamsen St. Clare
- Anxiety Treatment and Research Unit, Western Sydney Local Health District, Sydney, Australia
| | - Jessamine T. H. Chen
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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19
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Clarke E, Kiropoulos LA. Mediating the relationship between neuroticism and depressive, anxiety and eating disorder symptoms: The role of intolerance of uncertainty and cognitive flexibility. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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20
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Bjorvatn B, Jernelöv S, Pallesen S. Insomnia - A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges. Front Psychol 2021; 12:639198. [PMID: 33643170 PMCID: PMC7904898 DOI: 10.3389/fpsyg.2021.639198] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Susanna Jernelöv
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
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21
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Acceptance and Commitment Therapy (ACT) Improves Sleep Quality, Experiential Avoidance, and Emotion Regulation in Individuals with Insomnia-Results from a Randomized Interventional Study. Life (Basel) 2021; 11:life11020133. [PMID: 33572330 PMCID: PMC7916154 DOI: 10.3390/life11020133] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Insomnia is a common problem in the general population. To treat insomnia, medication therapies and insomnia-related cognitive-behavioral interventions are often applied. The aim of the present study was to investigate the influence of acceptance and commitment therapy (ACT) on sleep quality, dysfunctional sleep beliefs and attitudes, experiential avoidance, and acceptance of sleep problems in individuals with insomnia, compared to a control condition. A total of 35 participants with diagnosed insomnia (mean age: 41.46 years old; 62.9% females) were randomly assigned to the ACT intervention (weekly group therapy for 60-70 min) or to the active control condition (weekly group meetings for 60-70 min without interventional and psychotherapeutic character). At baseline and after eight weeks (end of the study), and again 12 weeks later at follow-up, participants completed self-rating questionnaires on sleep quality, dysfunctional beliefs and attitudes about sleep, emotion regulation, and experiential avoidance. Furthermore, participants in the intervention condition kept a weekly sleep log for eight consecutive weeks (micro-analysis). Every morning, participants completed the daily sleep log, which consisted of items regarding subjective sleep duration, sleep quality, and the feeling of being restored. Sleep quality, dysfunctional beliefs and attitudes towards sleep, emotion regulation, and experiential avoidance improved over time, but only in the ACT condition compared to the control condition. Improvements remained stable until follow-up. Improvements in experiential avoidance were related to a favorable change in sleep and cognitive-emotional processing. Micro-analyses showed that improvements occurred within the first three weeks of treatment. The pattern of results suggests that ACT appeared to have improved experiential avoidance, which in turn improved both sleep quality and sleep-related cognitive-emotional processes at longer-term in adults with insomnia.
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22
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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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The Effect of Comorbid Depression on Sudden Gains During Transdiagnostic Cognitive-Behavioural Therapy for Anxiety Disorders. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2020.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractDuring psychotherapy some patients experience large symptom improvements between sessions, termed sudden gains. Most commonly, sudden gains are observed during treatment for depression (40–50% of participants), but these are occasionally also observed in treatment for anxiety (15–20%). This study investigated the impact of comorbid depression on sudden gains in a primary anxiety sample. It was hypothesised that sudden gains would occur more frequently in participants with anxiety and comorbid depression than anxiety-only participants. The sample consisted of 58 adults who participated in a 12-week transdiagnostic cognitive-behavioural therapy (tCBT) programme. Sudden gains were more frequent in the comorbid depression group than in the anxiety-only group. Sudden gains may be predominantly a function of depressive disorders, which supports the higher rates seen in depressive disorders compared with anxiety disorders. Future research should endeavour to replicate these findings, as this was the first study designed to specifically investigate comorbidity in sudden gains.
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24
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Transdiagnostic Cognitive Behavioural Therapy for Individuals with Anxiety Disorders: An Open Trial. BEHAVIOUR CHANGE 2020. [DOI: 10.1017/bec.2020.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AbstractObjective:To evaluate the effect of a transdiagnostic cognitive behavioural therapy (tCBT) protocol in an individual delivery format, adapted from a protocol that has been extensively evaluated in a group delivery format.Method:tCBT was provided to a cohort (N = 18) of adults with a range of anxiety disorders (55.6% male; M age = 40.6, SD = 17.6), at a speciality anxiety disorder research clinic. A within-subjects repeated measures design was employed. Pre-to-post-treatment diagnostic assessments were analysed through repeated measures analysis of variance, and session-by-session self-reported measures of anxiety, depression, and quality of life were modelled through mixed-effect regression modelling (MRM) to maximise the sample of treatment initiators.Results:Significant and large reductions for clinician-rated primary diagnosis severity (Hedges g = 1.63), and overall clinical global impressions (g = 1.43) were observed, and self-reported anxiety and depression symptoms showed significant reductions over the course of treatment with medium-to-large effect sizes (g = 0.66 and 0.74, respectively). Significant improvement to quality of life was also observed with medium effect size (g = 0.53).Conclusions:There is now preliminary support for the use of an adaptation of an established group-based tCBT protocol for use with individuals. Implications and recommendations for future investigations are provided.
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25
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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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Effects of treatment of sleep disorders on sleep, psychological and cognitive functioning and biomarkers in individuals with HIV/AIDS and under methadone maintenance therapy. J Psychiatr Res 2020; 130:260-272. [PMID: 32858346 DOI: 10.1016/j.jpsychires.2020.07.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Poor sleep is a major complaint of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and undergoing methadone maintenance therapy (MMT). We tested the impact of three different sleep-improving interventions (trazodone; sleep hygiene training; sleep hygiene training + trazodone) on sleep, psychological functioning and biomarkers in males with HIV and undergoing MMT. METHODS A total of 75 male outpatients (mean age: 39.6 years) participated in a 12 week intervention. Participants were randomly assigned to one of the following conditions: trazodone 50 mg/d (TRAZ); sleep hygiene training (SHT); sleep hygiene training and trazodone (SHT + TRAZ). At baseline, and six and 12 weeks later, participants completed questionnaires covering subjective sleep and daytime sleepiness, and symptoms of depression and anxiety. In parallel, their cognitive performance (working memory; sustained attention) was assessed. Biomarkers (cortisol, BNDF, CD4+) were assessed at baseline and at the end of the study. RESULTS Over time, sleep disturbances decreased and daytime functioning and overall sleep quality improved. More specifically, both sleep disturbances and daytime functioning improved in the two SHT conditions from baseline to week 6. Daytime functioning remained stable from week 6 to week 12. Over time, in all conditions symptoms of depression and anxiety declined from baseline to week 6 and remained lower from week 6 to week 12. Daytime sleepiness, symptoms of insomnia and sleep-disordered breathing remained unchanged. Sustained attention performance improved over time from baseline to week 6 and remained high through to week 12. Biomarkers remained unchanged. CONCLUSIONS In males with HIV and undergoing MMT, treating sleep disturbances over a period of six to 12 weeks had a positive impact on aspects of sleep disturbance, symptoms of depression and anxiety, and cognitive performance. The results indicate that sleep hygiene training, either as stand-alone or in combination with trazodone, can produce positive results.
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Harris KR, Norton PJ. Transdiagnostic cognitive behavioral therapy for the treatment of emotional disorders: A preliminary open trial. J Behav Ther Exp Psychiatry 2019; 65:101487. [PMID: 31132511 DOI: 10.1016/j.jbtep.2019.101487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the efficacy of a transdiagnostic cognitive behavioral therapy (tCBT) protocol for the treatment of emotional disorders with individuals that have a principal or comorbid depressive diagnosis. METHODS Treatment-seeking adults meeting diagnostic criteria for a depressive disorder were enrolled in a 12-week tCBT open trial aimed at addressing the underlying core pathology of emotional disorders. Clinician severity ratings (CSRs) regarding principal and comorbid diagnoses, and overall severity as well as clinical global impression-severity (CGI-S) ratings were assessed at pre- and post-treatment and 4-month follow-up. Clinician's provided a clinical global impression-improvement (CGI-I) rating post-treatment and at 4-month follow-up. Depressive and anxiety symptoms were measured at pre-treatment and session-by-session using self-report measures (BDI-II and ADDQ). RESULTS Repeated measure ANOVAs indicated a reduction in principal diagnosis severity, overall severity, and CGI-S with large effects observed post-treatment (Cohen's ds = 1.29-1.92) and at 4-month follow-up (Cohen's ds = 0.77-1.04). Mixed-effect regression modelling demonstrated a decrease in depressive and anxiety symptoms over the course of treatment. CGI-I ratings identified 63.64% participants as treatment responders both post-treatment and at 4-month follow-up. LIMITATIONS The uncontrolled nature of the trial and small sample size are the main limitations to generalizability of the findings. CONCLUSIONS The findings, although preliminary, provide additional evidence for the utilization of tCBT in the effective treatment of emotional disorders. Further research into the implementation of the tCBT for emotional disorders protocol through a randomized controlled trial involving groups of participants with a range of emotional disorder diagnoses is warranted.
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Abstract
This study supports the efficacy of transdiagnostic behavior therapy across various affective disorders, including depression and PTSD. These findings suggest a possible reduction in the number of treatment protocols providers need to learn in order to treat patients with affective disorders.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Fusar‐Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P, Borgwardt S, Lawrie SM, Parnas J, McGuire P. Transdiagnostic psychiatry: a systematic review. World Psychiatry 2019; 18:192-207. [PMID: 31059629 PMCID: PMC6502428 DOI: 10.1002/wps.20631] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Neuroscience Department, Psychiatry UnitUniversity of PaduaPaduaItaly
| | - Natascia Brondino
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Chungil Chae
- Applied Cognitive Science Lab, Department of Information Science and TechnologyPennsylvania State University, University ParkPAUSA
| | - Pierluigi Politi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | | | | | - Josef Parnas
- Center for Subjectivity ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Philip McGuire
- OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Maudsley Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
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Marker I, Norton PJ. Intermittent Motivational Interviewing and Transdiagnostic CBT for Anxiety: A Case Study. Clin Case Stud 2019. [DOI: 10.1177/1534650119849104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent meta-analytic findings have revealed that the addition of motivational interviewing (MI) to cognitive behavior therapy (CBT) for anxiety disorders improves treatment outcome. However, for the most part, previous research has limited MI as a prelude to CBT. This article explored the benefits and complications of a more integrated approach by adapting and examining an already established transdiagnostic CBT protocol to include intermittent MI strategies. The presented protocol is described and illustrated using a case study of a woman meeting criteria for four anxiety disorder diagnoses. This study presents session-by-session treatment accounts, as well as pre, post, and follow-up data. Results indicated clinically significant improvement, supporting the utility of intermittent MI strategies within CBT. Implementation recommendations and future research directions are discussed.
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Hebert EA, Dugas MJ. Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Morrison KL, Smith BM, Ong CW, Lee EB, Friedel JE, Odum A, Madden GJ, Ledermann T, Rung J, Twohig MP. Effects of Acceptance and Commitment Therapy on Impulsive Decision-Making. Behav Modif 2019; 44:600-623. [PMID: 30854874 DOI: 10.1177/0145445519833041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study examined the transdiagnostic effect of acceptance and commitment therapy (ACT) on impulsive decision-making in a community sample. A total of 40 adults were randomized to eight individual sessions of ACT or an inactive control. Participants completed pre-, mid-, and post-assessments for psychological symptoms; overall behavior change; valued living; delay discounting; psychological flexibility; and distress tolerance. Data were analyzed with multilevel modeling of growth curves. Significant interaction effects of time and condition were observed for psychological flexibility, distress tolerance, psychological symptoms, and the obstruction subscale of valued living. No significant interaction effect was found for two delay discounting tasks nor the progress subscale of valued living. The ACT condition had a significantly larger reduction of problem behavior at post-assessment. The results support use of ACT as a transdiagnostic treatment for impulsive behaviors. The lack of change in delay discounting contrasts previous research.
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Affiliation(s)
- Kate L Morrison
- Utah Center for Evidence Based Treatment, Salt Lake City, UT, USA.,Utah State University, Logan, USA
| | | | | | | | | | - Amy Odum
- Utah State University, Logan, USA
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Jahangard L, Sadeghi A, Ahmadpanah M, Holsboer-Trachsler E, Sadeghi Bahmani D, Haghighi M, Brand S. Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders - Results from a double-blind, randomized and placebo-controlled clinical trial. J Psychiatr Res 2018; 107:48-56. [PMID: 30317101 DOI: 10.1016/j.jpsychires.2018.09.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Extant literature shows that adjuvant omega-3-polyunsaturated fatty acids (O3PUFAs) to a standard antidepressant medication impacts favorably on symptoms of depression in participants with major depressive disorders (MDD). The aim of the present study was to investigate, if and to what extent compared to placebo adjuvant O3PUFAs had a favorable impact on symptoms of depression, anxiety, sleep and emotion regulation among outpatients with MDD. METHOD A total of 50 outpatients (mean age: M = 42.46; 68% females) took part in this randomized, double-blind and placebo-controlled study. They were randomly assigned either to the O3PUFA- or to the placebo-condition. Standard medication was sertraline at therapeutic dosages. At baseline, six weeks and 12 weeks later at study completion participants completed questionnaires covering symptoms of depression, anxiety sensitivity, intolerance of uncertainty, sleep disturbances, and emotion regulation. In parallel, experts blind to participants' group assignment rated participants' depression with the Montgomery-Asberg Depression Scale. RESULTS Symptoms of depression (self- and experts' ratings) decreased over time, but more so in the O3PUFA condition, compared to the placebo condition. Likewise, anxiety sensitivity, intolerance of uncertainty and sleep disturbances improved, but again more so in the O3PUFA condition. Further, regulation and control of emotions and perception of other's emotions improved over time, but more so in the O3PUFA condition. CONCLUSIONS Among outpatients with MDD, and compared to placebo, adjuvant O3PUFAs to a standard medication improved not only symptoms of depression, but also dimensions of anxiety and sleep, and above all patients' competencies to regulate their emotions.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Sadeghi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Dena Sadeghi Bahmani
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Substance Abuse Prevention Research Center, Kermanshah, Iran; University of Basel, Department of Sport, Exercise and Health, Division of Sport Sciences and Psychosocial Health, Basel, Switzerland.
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Roberge P, Provencher MD, Gosselin P, Vasiliadis HM, Gaboury I, Benoit A, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol. BMC Psychiatry 2018; 18:320. [PMID: 30285672 PMCID: PMC6169021 DOI: 10.1186/s12888-018-1898-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. METHODS/DESIGN The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. STATISTICAL ANALYSIS Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. DISCUSSION This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458 .
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Affiliation(s)
- Pasquale Roberge
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, QC G1V 0A6 Canada
| | - Patrick Gosselin
- Institut universitaire de première ligne en santé et services sociaux (CIUSSS de l’Estrie- CHUS), Department of Psychology, Université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, QC J1K 2R1 Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Centre de recherche Hôpital Charles LeMoyne, 3120, boul. Taschereau, Greenfield Park, QC J4V 2H1 Canada
| | - Isabelle Gaboury
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Annie Benoit
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, 2705, boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC H3C 3P8 Canada
| | - Catherine Hudon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Peter J Norton
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC 3800 Australia
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Psychometric Properties of the Response to Anxiety Questionnaire. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Harris KR, Norton PJ. Transdiagnostic Cognitive Behavioral Therapy for the Treatment of Emotional Disorders: A Group Case Study. Clin Case Stud 2018. [DOI: 10.1177/1534650118793938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A recent shift in the conceptualization of both depressive and anxiety disorders supports the notion that these disorders may best fall under a single classification of “emotional disorders.” This understanding has resulted in the development of various transdiagnostic cognitive behavioral therapy (tCBT) protocols to address underlying core pathology shared by emotional disorders. While there is evidence to suggest tCBT is effective in reducing co-occurring depression, research into the efficacy of face-to-face tCBT has generally focused on the delivery of tCBT to individuals with predominantly anxiety diagnoses. The current case study aims to expand the research by examining the impact of group tCBT for individuals with a principal depressive diagnosis. A session-by-session explanation of a 12-week group tCBT protocol designed to treat a heterogeneous group of individuals diagnosed with an emotional disorder is provided in detail and accompanied by a quantitative case study of a recently delivered treatment group. The case study demonstrates the feasibility and pragmatic application of the group tCBT treatment approach. Data presented support the continued research of transdiagnostic interventions for the treatment of emotional disorders and justify future randomized controlled trials to further evaluate the presented intervention.
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Talkovsky AM, Norton PJ. Negative affect and intolerance of uncertainty as potential mediators of change in comorbid depression in transdiagnostic CBT for anxiety. J Affect Disord 2018; 236:259-265. [PMID: 29751241 DOI: 10.1016/j.jad.2018.04.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/05/2018] [Accepted: 04/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transdiagnostic group cognitive behavioral therapy for anxiety (TGCBT) has demonstrated effectiveness in improving comorbid conditions, including depression. Mediators of change in reductions in comorbid depression have yet to be established following this anxiety-focused treatment. Negative affect (NA) and intolerance of uncertainty (IU) have demonstrated contributions to anxiety reduction in TGCBT, as has positive affect (PA) on depression reductions in other cognitive behavioral treatments. IU is also associated with depression and anxiety as a transdiagnostic vulnerability. This study evaluated the mediational effect of NA, IU, and PA on reduction in comorbid depressive symptoms in TGCBT. We hypothesized the indirect effect of the treatment through IU would be significant even when controlling for indirect effects through NA, PA, anxiety symptoms, and diagnostic severity. METHOD Data collected as a part of previous clinical trials at a clinic at a large university in the southwestern United States were used. Participants included 61 individuals from a mixed anxiety-disordered sample for whom pre- and post-treatment data were available. Mediation analyses were conducted using ordinary least squares regression in path-analytic form. RESULTS The total effect of the model was significant (F(10, 50) = 8.40, p < .001). When controlling for potential mediators, the direct effect of treatment was not significant (B = -1.01, t = -0.40, p = .688). Analysis of indirect effects revealed significant effects of NA (B = 0.50, SE = 0.17, p = .005, 95%CI [0.02, 0.83]) and IU (B = 0.13, SE = 0.05, p = .010, 95%CI [0.03, 0.23]), but not diagnostic severity (B = 1.39, SE = 0.86, p = .114, 95%CI [-0.35, 3.12]), anxiety symptoms (B = 0.19, SE = 0.12, p = .136, 95%CI [-0.06, 0.44]), or PA (B = -0.25, SE = 0.13, p = .051, 95%CI [-0.51, 0.01] on depression symptoms when modeled with TGCBT). CONCLUSION These results suggest IU contributes uniquely to the improvement of comorbid depression in TGCBT above negative affect, an established change process. Implications for treatment and theory are discussed.
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Affiliation(s)
- Alexander M Talkovsky
- Center of Excellence for Stress and Mental Health, VA San Diego Health Care System, San Diego, CA, United States; University of California, San Diego, San Diego, CA, United States.
| | - Peter J Norton
- School of Psychological Sciences, Monash University, Melbourne, Victoria Australia
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Murray LK, Haroz EE, Doty SB, Singh NS, Bogdanov S, Bass J, Dorsey S, Bolton P. Testing the effectiveness and implementation of a brief version of the Common Elements Treatment Approach (CETA) in Ukraine: a study protocol for a randomized controlled trial. Trials 2018; 19:418. [PMID: 30075806 PMCID: PMC6090833 DOI: 10.1186/s13063-018-2752-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mental illness is a major public health concern. Despite progress understanding which treatments work, a significant treatment gap remains. An ongoing concern is treatment length. Modular, flexible, transdiagnostic approaches have been offered as one solution to scalability challenges. The Common Elements Treatment Approach (CETA) is one such approach and offers the ability to treat a wide range of common mental health problems. CETA is supported by two randomized trials from low- and middle-income countries showing strong effectiveness and implementation outcomes. METHODS/DESIGN This trial evaluates the effectiveness and implementation of two versions of CETA using a non-inferiority design to test two primary hypotheses: (1) a brief five-session version of CETA (Brief CETA) will provide similar effectiveness for reducing the severity of common mental health problems such as depression, post-traumatic stress, impaired functioning, anxiety, and substance use problems compared with the standard 8-12-session version of CETA (Standard CETA); and (2) both Brief and Standard CETA will have superior impact on the outcomes compared to a wait-list control condition. For both hypotheses, the main effect will be assessed using longitudinal data and mixed-effects regression models over a 6-month period post baseline. A secondary aim includes exploration of implementation factors. Additional planned analyses will include exploration of: moderators of treatment impact by disorder severity and comorbidity; the impact of individual therapeutic components; and trends in symptom change between end of treatment and 6-month assessment for all participants. DISCUSSION This trial is the first rigorous study comparing a standard-length (8-12 sessions) modular, flexible, transdiagnostic, cognitive-behavioral approach to a shortened version of the approach (five sessions). Brief CETA entails "front-loading" with elements that research suggests are strong mechanisms of change. The study design will allow us to draw conclusions about the effects of both Brief and Standard CETA as well as which elements are integral to their mechanisms of action, informing future implementation and fidelity efforts. The results from this trial will inform future dissemination, implementation and scale-up of CETA in Ukraine and contribute to our understanding of the effects of modular, flexible, transdiagnostic approaches in similar contexts. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03058302 (U.S. National Library of Medicine). Registered on 20 February 2017.
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Affiliation(s)
- Laura K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Emily E. Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - S. Benjamin Doty
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Namrita S. Singh
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sergey Bogdanov
- Centre for Mental Health and Psychosocial Support, National University Kyiv-Mohyla Academy, Glasunova str 2/4, Kyiv, 01042 Ukraine
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA 98105 USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Wolfe Street, Baltimore, MD 21205 USA
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40
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Abstract
BACKGROUND In psychotherapy research unified, transdiagnostic and modular treatments have emerged. This is true for both cognitive-behavioral therapy and psychodynamic therapy. Recently, two unified psychodynamic protocols were presented, one for anxiety disorders, another for depressive disorders. Integrating the treatment principles for these two highly prevalent disorder groups into one protocol for "emotional disorders" may be useful for both clinical practice and training in psychotherapy. METHODS After updating the evidence for psychodynamic therapy in anxiety and depressive disorders in terms of randomized controlled trials (RCTs) by a systematic search, the treatment elements applied in those RCTs providing evidence for the efficacy of psychodynamic therapy in depressive or anxiety disorders were reviewed and compared. RESULTS Twenty-seven RCTs for anxiety or depressive disorders were identified. A review revealed a high overlap between the principles used for the psychodynamic treatment of anxiety and depressive disorders, reflecting the transdiagnostic nature of psychodynamic therapy. The overlap suggested to integrate the identified treatment principles into one unified psychodynamic protocol for "emotional disorders" (UPP-EMO). As a result, seven treatment principles or modules were distilled which can be flexibly applied depending on the patient´s symptoms and needs. In addition, a separate module addresses diagnostic assessment. Across modules, a focus on resources has been included. LIMITATIONS Despite being based on RCTs, UPP-EMO has not yet been examined in an RCT - which is planned as a next step. CONCLUSIONS As psychodynamic therapy is transdiagnostic in origin focusing on core underlying processes of mental disorders, acceptability of UPP-EMO among psychodynamic psychotherapists is likely to be high.
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Affiliation(s)
- Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Germany.
| | - Christiane Steinert
- Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Germany; MSB Medical School Berlin, Department of Psychology, Germany
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Brand S, Colledge F, Ludyga S, Emmenegger R, Kalak N, Sadeghi Bahmani D, Holsboer-Trachsler E, Pühse U, Gerber M. Acute Bouts of Exercising Improved Mood, Rumination and Social Interaction in Inpatients With Mental Disorders. Front Psychol 2018; 9:249. [PMID: 29593592 PMCID: PMC5859016 DOI: 10.3389/fpsyg.2018.00249] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Studies at the macro level (such as longer-term interventions) showed that physical activity impacts positively on cognitive-emotional processes of patients with mental disorders. However, research focusing on the immediate impact of acute bouts of exercise (micro level) are missing. The aim of the present study was therefore to investigate whether and to what extent single bouts of moderately intense exercise can influence dimensions of psychological functioning in inpatients with mental disorders. Method: 129 inpatients (mean age: 38.16 years; 50.4% females) took part and completed a questionnaire both immediately before and immediately after exercising. Thirty inpatients completed the questionnaires a second time in the same week. The questionnaire covered socio-demographic and illness-related information. Further, the questionnaire asked about current psychological states such as mood, rumination, social interactions, and attention, tiredness, and physical strengths as a proxy of physiological states. Results: Psychological states improved from pre- to post-session. Improvements were observed for mood, social interactions, attention, and physical strengths. Likewise, rumination and tiredness decreased. Mood, rumination, and tiredness further improved, when patients completed the questionnaires the second time in the same week. Conclusion: At micro level, single bouts of exercise impacted positively on cognitive-emotional processes such as mood, rumination, attention and social interactions, and physiological states of tiredness and physical strengths among inpatients with mental disorders. In addition, further improvements were observed, if patients participated in physical activities a second time.
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Affiliation(s)
- Serge Brand
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
- Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Flora Colledge
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Raphael Emmenegger
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nadeem Kalak
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
- Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Edith Holsboer-Trachsler
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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42
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Abstract
Transdiagnostic cognitive-behavioral (CBT) therapy is a modified form of CBT designed to be applicable with patients across the range of anxiety and related emotional disorders. Based on emerging genetic, neurologic, developmental, cognitive, and behavioral science, transdiagnostic CBT may alleviate barriers to dissemination and accessibility by providing a single treatment approach across diagnoses. Data from clinical trials and metaanalyses suggest treatment efficacy that is comparable with traditional CBT approaches, with possibly superior efficacy among patients with multiple comorbid anxiety and emotional diagnoses. Limitations in the evidence base and remaining areas for future research are discussed.
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43
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Rathbone AL, Clarry L, Prescott J. Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review. J Med Internet Res 2017; 19:e399. [PMID: 29187342 PMCID: PMC5727354 DOI: 10.2196/jmir.8598] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. OBJECTIVE The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. METHODS A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. RESULTS A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=-0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. CONCLUSIONS The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.
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Affiliation(s)
- Amy Leigh Rathbone
- Department of Education and Psychology, University of Bolton, Bolton, United Kingdom
| | - Laura Clarry
- Department of Education and Psychology, University of Bolton, Bolton, United Kingdom
| | - Julie Prescott
- Department of Education and Psychology, University of Bolton, Bolton, United Kingdom
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44
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Neudeck P, Brahm CI, Hamm AO. Transdiagnostische expositionsbasierte Behandlung von Angststörungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Neben störungsspezifischen Behandlungskonzepten werden in den letzten Jahren vermehrt transdiagnostische Behandlungsmanuale in der expositionsbasierten Behandlung von Ängsten und komorbiden Störungen eingesetzt. Die vorliegende narrative systematische Übersichtsarbeit beschreibt den Stand der Forschung zu transdiagnostischen Behandlungskonzepten in Hinsicht auf Angst- und komorbide Störungen. Methode: Die Literaturrecherche und die Datenanalyse wurden angelehnt an die PRISMA Guidelines vorgenommen. Die Ergebnisse von 17 Untersuchungen zu expositionsbasierten transdiagnostischen Behandlungskonzepten der letzten fünfzehn Jahre werden beschrieben. Ergebnisse: Die Resultate der referierten Studien zeigen, dass expositionsbasierte transdiagnostische Behandlungen die Symptome, sowohl der primären als auch der komorbiden Störungen, signifikant reduzieren. Expositionsbasierte transdiagnostische Konzepte sind effektiv zur Behandlungen von Angststörungen und komorbider Störungen. Sie stellen eine geeignete Alternative zu störungsspezifischen Behandlungen dar. Diskussion: Die Implikationen transdiagnostischer Konzepte für das praktische Vorgehen bei der individualisierten Diagnostik, der Vorbereitung und Durchführung von Expositionen werden erörtert. Schließlich werden Vorschläge für die Konzeptualisierung einer störungsübergreifenden Behandlung von Angststörungen, insbesondere solcher mit komorbider Symptomatik, vorgestellt.
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Affiliation(s)
| | | | - Alfons O. Hamm
- Institut für Psychologie, Ernst-Moritz-Arndt-Universität Greifswald
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45
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Norton PJ, Paulus DJ. Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings. Clin Psychol Rev 2017; 56:122-137. [DOI: 10.1016/j.cpr.2017.03.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/07/2017] [Accepted: 03/21/2017] [Indexed: 01/18/2023]
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46
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Johnson SU, Hoffart A, Nordahl HM, Wampold BE. Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord 2017. [PMID: 28651207 DOI: 10.1016/j.janxdis.2017.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems-64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders.
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Affiliation(s)
- Sverre Urnes Johnson
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Asle Hoffart
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Hans M Nordahl
- Norwegian University of Science and Technology, Institute of Mental Health, Norway; St. Olavs Hospital, Div of Psychiatry, Nidaros DPS, 7006 Trondheim.
| | - Bruce E Wampold
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Wisconsin-Madison, USA.
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47
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Talkovsky AM, Paulus DJ, Kuang F, Norton PJ. Quality of Life Outcomes Following Transdiagnostic Group Cognitive-Behavioral Therapy for Anxiety. Int J Cogn Ther 2017. [DOI: 10.1521/ijct_2017_10_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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48
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Broicher T, Gerlach AL, Neudeck P. Die Relevanz der Ausbildung für den späteren Einsatz von Expositionsverfahren in der therapeutischen Praxis. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Obwohl empirische Belege für Expositionsmethoden sprechen, werden diese in der Praxis zu wenig eingesetzt. Fragestellung: Es wurden Faktoren auf individueller und institutioneller Ebene identifiziert, welche für eine spätere Anwendung von Expositionsmethoden in der Praxis relevant sind und im deutschen Ausbildungssystem untersucht. Methode: Insgesamt wurden 20 Ausbildungsinstitute und 398 Absolvent_innen befragt. Mit einer Multilevelanalyse wurde die Relevanz verschiedener Faktoren geprüft. Ergebnisse: Auf individueller Ebene waren Ausbildungstyp (KiJu vs. Erwachsene) und inhaltliche Aspekte (z. B. die Einstellung zu Expositionsmethoden) für den späteren Expositionseinsatz wichtig. Auf institutioneller Ebene war eine universitäre Anbindung der Ausbildungsinstitute relevant. Schlussfolgerungen: Innerhalb der Ausbildung trägt die vermehrte Vermittlung von sowohl störungs- als auch methodenspezifischem Wissen zur Verwendung von Expositionsverfahren bei. Absolventen und deren spätere Patienten profitieren von praktischer Übung der Methodik, vor allem dann, wenn realistische Überzeugungen hinsichtlich der Wirksamkeit und Umsetzbarkeit der Methode entwickelt werden.
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49
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Brandt CP, Paulus DJ, Garza M, Lemaire C, Norton PJ, Zvolensky MJ. A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 25:105-118. [PMID: 29750006 DOI: 10.1016/j.cbpra.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.
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50
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Pearl SB, Norton PJ. Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. J Anxiety Disord 2017; 46:11-24. [PMID: 27466074 DOI: 10.1016/j.janxdis.2016.07.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
Research evaluating transdiagnostic CBT (tCBT) demonstrates its efficacy. Some evidence suggests equivalence between tCBT and diagnosis-specific CBT (dxCBT), however more investigations are necessary to clarify any difference in efficacy. This meta-analysis was conducted to compare tCBT and dxCBT, and to investigate the differential impact of comorbidity on effect sizes. Pre and post scores from primary anxiety measures in 83 treatment conditions, taken from studies primarily targeting anxiety disorders, were summarised and compared. Meta-regression analyses were then used to test the effects of comorbidity. DxCBT and tCBT meta-effects were found to be large, where g=0.951, 95% CI: 0.874-1.027, and g=1.059, 95% CI: 0.876-1.242, respectively. While statistically different (p=0.008), overlap of confidence intervals indicated a lack of clinical significance. Furthermore, no relationship between comorbidity rate and tCBT outcome was observed. These results were discussed in the context of previous findings in the transdiagnostic CBT literature.
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Affiliation(s)
- Shaun B Pearl
- School of Psychological Sciences, Clayton, Victoria, Australia
| | - Peter J Norton
- School of Psychological Sciences, Clayton, Victoria, Australia.
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