Maximizing the non-specific factors in brief cognitive behavioral therapy for panic disorder and agoraphobia: A multiple baseline case series documenting feasibility and initial efficacy

Research on psychotherapy in India: A systematic review

We systematically reviewed empirical studies of psychotherapy with Indian clients. We defined psychotherapy as an intervention aimed at treating mental disorders using "talk," which, in a professional medical setting, along with the therapeutic relationship, acquires medicinal value. Besides manual searches in three leading Indian psychiatry journals, we conducted digital searches in PubMed, Google Scholar, and Scopus databases. We found that the commonly practiced evidence-based psychotherapy in India follows the cognitive-behavioral model. Our findings suggest several replication studies which claimed to have used the well-established western models of cognitive behavioural paradigm but have mostly focused on basic behavioural techniques in their protocol. A few innovations were observed, and several essential errors were noted. Innovations include contextual modifications to address the difficulties and challenges faced in service delivery, while errors include deviations from protocol without adequate rationale.

A systematic review of Culturally Adapted Cognitive Behavioral Therapy (CA-CBT) for anxiety disorders in Southeast Asia

BACKGROUND

Cognitive Behavioral Therapy (CBT) has been proven an effective treatment for anxiety disorders. However, CBT still dominantly uses concepts and constructs rooted in Western cultures, and most research focuses on Western populations. It is unsure how this translates to non-Western cultures like Southeast Asia.

AIMS

Our objective is to explore which types of cultural adaptations in CBT have been implemented for anxiety disorders in Southeast Asia and their effectiveness.

METHODS

We systematically searched PubMed, PsycINFO, Embase, CENTRAL, GARUDA, and Google Scholar for CA-CBT for anxiety disorders in local communities in Southeast Asian countries. Data were analyzed using a narrative approach distinguishing between peripheral and core component adaptations. PROSPERO database preregistration number was CRD42022336376.

RESULTS

Seven studies (one randomized controlled trial, three quasi-experimental studies, and three case reports) were selected. Two studies made cultural adaptations in multiple components. Two studies modified core treatment components by incorporating local values in the CBT restructuring process. Three studies conducted cultural adaptation on peripheral treatment components: adaptation to materials and semantics, cultural examples and themes, and session structure. Three studies did not provide detailed information. One RCT study showed better improvement for those who got CA-CBT than those in treatment as usual (TAU).

CONCLUSION

The findings suggest some components to consider when conducting cultural adaptation. We could not establish the degree of superiority of CA-CBT over non-CA-CBT nor identify components with the most influence due to the limited number of studies found. Employing standard documentation in reporting trials is also important to increase transparency.

Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting

OBJECTIVE

We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD).

METHOD

The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session.

RESULTS

The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes.

CONCLUSIONS

AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.