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Johnson AL, Ecker AH, Fletcher TL, Hundt N, Kauth MR, Martin LA, Curran GM, Cully JA. Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness-implementation design in psychotherapy research. Transl Behav Med 2021; 10:629-636. [PMID: 30476315 DOI: 10.1093/tbm/iby116] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness-implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness-implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.
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Affiliation(s)
- Adrienne L Johnson
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anthony H Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Terri L Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Natalie Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Lindsey A Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Geoffrey M Curran
- Department of Veterans Affairs, Center for Mental Health Care and Outcomes Research, Central Arkansas Veterans Health Care System, North Little Rock, AR, USA.,Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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2
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Ecker AH, O'Leary K, Fletcher TL, Hundt NE, York-Ward KM, Kauth MR, Kunik ME, Cully JA. Training and supporting mental health providers to implement evidence-based psychotherapies in frontline practice. Transl Behav Med 2021; 12:6309388. [PMID: 34170325 DOI: 10.1093/tbm/ibab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anthony H Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Kimberly O'Leary
- Department of Health Psychology, University of Missouri, 115 Business Loop, 70W, Columbia, MO, USA
| | - Terri L Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Natalie E Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Kaki M York-Ward
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
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3
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Nejati M, Sharifinia A, Maleki M, Bayazi MH. Comparison of the effectiveness of cognitive-behavioral group intervention for coronary heart disease and cognitive therapy in groups on type D personality and psychological distress on coronary heart patients- a randomized clinical trial. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00917-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Williams MT, Johnston KN, Paquet C. Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review. Int J Chron Obstruct Pulmon Dis 2020; 15:903-919. [PMID: 32425516 PMCID: PMC7186773 DOI: 10.2147/copd.s178049] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 12/30/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from -0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from -0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resource-intensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.
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Affiliation(s)
- Marie T Williams
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Catherine Paquet
- Australian Centre of Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
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Cognitive behavioural therapy for co-morbid anxiety and depression in heart failure: a case report. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000197] [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
Abstract
Heart failure increases the likelihood of an individual experiencing co-morbid anxiety and depression, which can affect their physical as well as mental health. There is a need to develop non-pharmacological interventions for the psychological consequences of heart failure. Evidence shows that cognitive behavioural therapy (CBT) can be helpful, but there is less clarity about CBT’s effectiveness for people with heart failure who have complex multi-morbid difficulties.
This paper presents a case report of a man with heart failure. He was part of a research trial for cardiac resynchronisation therapy with defibrillation (CRT-D), after other physical procedures had been unsuccessful, and was experiencing severe anxiety and moderately severe depression. The intervention used was based on transdiagnostic CBT, provided at home over six sessions. Self-report measures were completed at each session and at 3-month follow-up. A measure of his use of clinical services was also carried out at pre-, post- and 3-month follow up. Post-intervention, the client showed non-clinical levels of depression and anxiety and these improvements were maintained at 3 months. Use of clinical services also reduced, with fewer admissions to hospital and fewer visits by specialist nurses and GPs.
This case suggests that CBT, and particularly transdiagnostic CBT, can be helpful in reducing anxiety and depression in people with heart failure. Further work evaluating the impact on quality of life and the utility of this approach with a wider group of people with heart failure and psychological distress would be advantageous.
Key learning aims
(1)
Depression and anxiety are prevalent in people with heart failure.
(2)
Cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety in people living with heart failure.
(3)
There are benefits to integrating care with this population because they present with interlinked physical and psychological needs.
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Oates LL, Moghaddam N, Evangelou N, das Nair R. Behavioural activation treatment for depression in individuals with neurological conditions: a systematic review. Clin Rehabil 2019; 34:310-319. [PMID: 31875690 DOI: 10.1177/0269215519896404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of behavioural activation interventions for people with neurological conditions with comorbid depression, and explore content and adaptations. DATA SOURCES PsycINFO, MEDLINE, CINAHL, AMED, and EMBASE databases were searched on the 19 November 2019. Reference lists of selected full-texts were screened by title. REVIEW METHODS We included peer-reviewed studies published in English that used behavioural activation for treatment of depression in adults with a neurological condition. Single-case reports, reviews, and grey literature were excluded. Methodological quality was assessed by two authors independently, and quality was appraised using Critical Appraisal Skills Programme checklists. RESULTS From 2714 citations, 10 articles were included comprising 590 participants. Behavioural activation was used to treat depression in people with dementia (n = 4), stroke (n = 3), epilepsy (n = 1), Parkinson's disease (n = 1), and brain injury (n = 1). Sample size ranged from 4 to 105 participants. There were seven randomized controlled studies; however, no studies compared behavioural activation to an alternative psychological therapy. The effect sizes varied between small and large in the studies where effect size could be calculated (d = 0.24-1.7). Methodological quality of the included studies was variable. Intervention components were identifying and engaging in pleasurable activities, psychoeducation, and problem-solving. Adaptations included delivering sessions via telephone, delivering interventions via primary caregivers, and giving psychoeducation to caregivers. CONCLUSION The effectiveness of behavioural activation in randomized controlled trials varied from small to large (d = 0.24-1.7) in reducing depression. The content of behavioural activation was comparable to established treatment manuals. Adaptations appeared to support individuals to engage in therapy. REVIEW REGISTRATION PROSPERO 2018, CRD42018102604.
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Affiliation(s)
- Lloyd L Oates
- University of Lincoln, Lincoln, UK.,Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | | | - Nikos Evangelou
- Division of Neurosciences, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Renn BN, Hundt NE, Sansgiry S, Petersen NJ, Kauth MR, Kunik ME, Cully JA. Integrated Brief Cognitive Behavioral Therapy Improves Illness Intrusiveness in Veterans With Chronic Obstructive Pulmonary Disease. Ann Behav Med 2019; 52:686-696. [PMID: 29860524 DOI: 10.1093/abm/kax045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Progressive illnesses such as chronic obstructive pulmonary disease (COPD) impart a high level of physical and psychological burden. Evidence-based psychotherapies hold the potential to improve perceptions of physical health impairment, yet few studies have documented these effects. Purpose To evaluate the effect of brief cognitive behavioral therapy (bCBT) on disease-related illness intrusiveness. Methods Participants were 175 Veterans with COPD and clinically elevated symptoms of depression and/or anxiety enrolled in a larger randomized trial (n = 99 randomized to bCBT, n = 76 to enhanced usual care; EUC). bCBT included up to six treatment sessions and optional booster sessions over a 4-month period. EUC entailed an assessment with documentation in the medical record. Primary outcomes focused on posttreatment changes on the Illness Intrusiveness Rating Scale (IIRS), an established measure of perceived impairment from a chronic health condition. Results Illness intrusiveness improved for bCBT participants relative to EUC, after controlling for baseline IIRS scores, depression, and anxiety (p = .03, partial η2 = .03). Specific improvement was observed in the Instrumental subscale (p = .02), encompassing improved intrusiveness of COPD on daily activities and daily functioning. IIRS scores improved in the absence of changes in physical functioning. Conclusions Illness intrusiveness was high among Veterans with COPD but improved over the course of bCBT. Integrated behavioral health interventions hold the potential to reduce disease intrusiveness. The IIRS may be a valuable tool to augment traditional assessment and measurement-based care approaches of behavioral health interventions for medically ill patients.
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Affiliation(s)
- Brenna N Renn
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Natalie E Hundt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Shubhada Sansgiry
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Nancy J Petersen
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Mark E Kunik
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Brandt CP, Deavers F, Hundt NE, Fletcher TL, Cully JA. The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans. J Clin Psychol Med Settings 2019; 27:285-294. [PMID: 31201653 DOI: 10.1007/s10880-019-09634-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the "physical health" and "thoughts" modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.
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Affiliation(s)
- Charles P Brandt
- The Houston OCD Program, 708 E. 19th Street, Houston, TX, 77008, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Frances Deavers
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX, 77030, USA
| | - Natalie E Hundt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.,Houston VA HSR &D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA.,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
| | - Terri L Fletcher
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.,Houston VA HSR &D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA.,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
| | - Jeffrey A Cully
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA. .,Houston VA HSR &D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA. .,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA.
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9
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Ecker AH, Johnson AL, Sansgiry S, Fletcher TL, Hundt N, Petersen NJ, Sweeney AC, Chaison AD, York-Ward KM, Kauth MR, Kunik ME, Cully JA. Brief cognitive behavioral therapy reduces suicidal ideation in veterans with chronic illnesses. Gen Hosp Psychiatry 2019; 58:27-32. [PMID: 30844639 DOI: 10.1016/j.genhosppsych.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We evaluated the effect of brief cognitive behavioral therapy (bCBT) on suicidal ideation among medically ill veterans receiving mental health treatment in primary care. METHODS Secondary analysis was conducted on data collected during a multisite, patient-randomized trial investigating the impact of bCBT (n = 180) on depression and anxiety symptoms, relative to enhanced usual care (EUC; n = 122), in patients with congestive heart failure and/or chronic obstructive pulmonary disease. BCBT was delivered by primary care mental health providers over 4 months, with follow-up posttreatment assessments of suicidal ideation, measured by the Patient Health Questionnaire-9 (item 9) at 4, 8, and 12 months. Suicidal ideation was the primary outcome examined in the current analysis. Generalized estimating equations modeling suicidal ideation were used to compare the study arms. RESULTS Participants receiving bCBT were less likely to have high suicidal ideation than participants receiving EUC posttreatment and at 8-month follow-up after accounting for baseline suicidal ideation. Within-group comparisons suggest participants receiving bCBT were less likely to have high suicidal ideation at 4, 8, and 12 months when compared with baseline. High suicidal ideation for EUC participants did not differ at 4, or 8 months, but they were less likely to have high suicidal ideation at 12 months. CONCLUSION bCBT in primary care reduces suicidal ideation and may help prevent future suicidal ideation.
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Affiliation(s)
- Anthony H Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Adrienne L Johnson
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA
| | - Shubhada Sansgiry
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Terri L Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Natalie Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Alison C Sweeney
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Angelic D Chaison
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Kaki M York-Ward
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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10
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Ramos K, Hastings SN, Bosworth HB, Fulton JJ. Life Program: Pilot Testing a Palliative Psychology Group Intervention. J Palliat Med 2018; 21:1641-1645. [DOI: 10.1089/jpm.2017.0454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Katherine Ramos
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - S. Nicole Hastings
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
| | - Hayden B. Bosworth
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Jessica J. Fulton
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Rehabilitation, Geriatric, Palliative, and Hospice Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
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11
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Mignogna J, Martin LA, Harik J, Hundt NE, Kauth M, Naik AD, Sorocco K, Benzer J, Cully J. "I had to somehow still be flexible": exploring adaptations during implementation of brief cognitive behavioral therapy in primary care. Implement Sci 2018; 13:76. [PMID: 29866141 PMCID: PMC5987469 DOI: 10.1186/s13012-018-0768-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/21/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary care clinics present challenges to implementing evidence-based psychotherapies (EBPs) for depression and anxiety, and frontline providers infrequently adopt these treatments. The current study explored providers' perspectives on fidelity to a manualized brief cognitive behavioral therapy (CBT) as delivered in primary care clinics as part of a pragmatic randomized trial. Data from the primary study demonstrated the clinical effectiveness of the treatment and indicated that providers delivered brief CBT with high fidelity, as evaluated by experts using a standardized rating form. Data presented here explore challenges providers faced during implementation and how they adapted nonessential intervention components to make the protocol "fit" into their clinical practice. METHODS A multiprofessional group of providers (n = 18) completed a one-time semi-structured interview documenting their experiences using brief CBT in the primary care setting. Data were analyzed via directed content analysis, followed by inductive sorting of interview excerpts to identify key themes agreed upon by consensus. The Dynamic Adaptation Process model provided an overarching framework to allow better understanding and contextualization of emergent themes. RESULTS Providers described a variety of adaptations to the brief CBT to better enable its implementation. Adaptations were driven by provider skills and abilities (i.e., using flexible content and delivery options to promote treatment engagement), patient-emergent issues (i.e., addressing patients' broader life and clinical concerns), and system-level resources (i.e., maximizing the time available to provide treatment). CONCLUSIONS The therapeutic relationship, individual patient factors, and system-level factors were critical drivers guiding how providers adapted EBP delivery to improve the "fit" into their clinical practice. Adaptations were generally informed by tensions between the EBP protocol and patient and system needs and were largely not addressed in the EBP protocol itself. Adaptations were generally viewed as acceptable by study fidelity experts and helped to more clearly define delivery procedures to improve future implementation efforts. It is recommended that future EBP implementation efforts examine the concept of fidelity on a continuum rather than dichotomized as adherent/not adherent with focused efforts to understand the context of EBP delivery. TRIAL REGISTRATION ClinicalTrials.gov, NCT01149772.
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Affiliation(s)
- Joseph Mignogna
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA Health Care System, 4800 Memorial Drive (151C), Waco, TX, 76711, USA.
- Department of Psychiatry and Behavioral Sciences, Texas A&M University Health Science Center, Temple, TX, USA.
| | - Lindsey Ann Martin
- Houston VA Health Services Research and Development Center of Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), Houston, TX, USA
| | - Juliette Harik
- National Center for Posttraumatic Stress Disorder, Executive Division, White River Junction, VT, USA
| | - Natalie E Hundt
- Houston VA Health Services Research and Development Center of Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael Kauth
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Aanand D Naik
- Houston VA Health Services Research and Development Center of Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kristen Sorocco
- Oklahoma City VA Health Care System, Oklahoma City, OK, USA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Justin Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA Health Care System, 4800 Memorial Drive (151C), Waco, TX, 76711, USA
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA
| | - Jeffrey Cully
- Houston VA Health Services Research and Development Center of Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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12
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Cully JA, Stanley MA, Petersen NJ, Hundt NE, Kauth MR, Naik AD, Sorocco K, Sansgiry S, Zeno D, Kunik ME. Delivery of Brief Cognitive Behavioral Therapy for Medically Ill Patients in Primary Care: A Pragmatic Randomized Clinical Trial. J Gen Intern Med 2017; 32. [PMID: 28634906 PMCID: PMC5570751 DOI: 10.1007/s11606-017-4101-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have examined the practical effectiveness and implementation potential of brief psychotherapies that integrate mental and physical health. OBJECTIVE To determine whether an integrated brief cognitive behavioral therapy (bCBT), delivered by mental health providers in primary care, would improve depression, anxiety and quality of life for medically ill veterans. DESIGN Pragmatic patient-randomized trial comparing bCBT to enhanced usual care (EUC). PARTICIPANTS A total of 302 participants with heart failure and/or chronic obstructive pulmonary disease (COPD) with elevated symptoms of depression and/or anxiety were enrolled from two Veterans Health Administration primary care clinics. INTERVENTION bCBT was delivered to 180 participants by staff mental health providers (n = 19). bCBT addressed physical and emotional health using a modular, skill-based approach. bCBT was delivered in person or by telephone over 4 months. Participants randomized to EUC (n = 122) received a mental health assessment documented in their medical record. MAIN MEASURES Primary outcomes included depression (Patient Health Questionnaire) and anxiety (Beck Anxiety Inventory). Secondary outcomes included health-related quality of life. Assessments occurred at baseline, posttreatment (4 months), and 8- and 12-month follow-up. KEY RESULTS Participants received, on average, 3.9 bCBT sessions with 63.3% completing treatment (4+ sessions). bCBT improved symptoms of depression (p = 0.004; effect size, d = 0.33) and anxiety (p < 0.001; d = 0.37) relative to EUC at posttreatment, with effects maintained at 8 and 12 months. Health-related quality of life improved posttreatment for bCBT participants with COPD but not for heart failure. Health-related quality of life outcomes were not maintained at 12 months. CONCLUSIONS Integrated bCBT is acceptable to participants and providers, appears feasible for delivery in primary care settings and is effective for medically ill veterans with depression and anxiety. Improvements for both depression and anxiety were modest but persistent, and the impact on physical health outcomes was limited to shorter-term effects and COPD participants. Clinical trials.Gov identifier: NCT01149772.
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Affiliation(s)
- Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA. .,Baylor College of Medicine, Houston, TX, USA. .,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA.
| | - Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Natalie E Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Aanand D Naik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Kristen Sorocco
- Oklahoma City VA Healthcare System, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shubhada Sansgiry
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
| | - Darrell Zeno
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
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A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, Rycroft-Malone J, Meissner P, Murray E, Patel A, Sheikh A, Taylor SJC. Standards for Reporting Implementation Studies (StaRI): explanation and elaboration document. BMJ Open 2017; 7:e013318. [PMID: 28373250 PMCID: PMC5387970 DOI: 10.1136/bmjopen-2016-013318] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Implementation studies are often poorly reported and indexed, reducing their potential to inform the provision of healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aims to develop guidelines for transparent and accurate reporting of implementation studies. METHODS An international working group developed the StaRI guideline informed by a systematic literature review and e-Delphi prioritisation exercise. Following a face-to-face meeting, the checklist was developed iteratively by email discussion and critical review by international experts. RESULTS The 27 items of the checklist are applicable to the broad range of study designs employed in implementation science. A key concept is the dual strands, represented as 2 columns in the checklist, describing, on the one hand, the implementation strategy and, on the other, the clinical, healthcare or public health intervention being implemented. This explanation and elaboration document details each of the items, explains the rationale and provides examples of good reporting practice. CONCLUSIONS Previously published reporting statements have been instrumental in improving reporting standards; adoption by journals and authors may achieve a similar improvement in the reporting of implementation strategies that will facilitate translation of effective interventions into routine practice.
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Melanie Barwick
- Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R Carpenter
- Division of Emergency Medicine, Washington University School of Medicine in St Louis, St Louis, USA
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service, Bilbao, Spain
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jo Rycroft-Malone
- Bangor Institute for Health and Medical Research, Bangor University, Bangor, UK
| | - Paul Meissner
- Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, New York, USA
| | - Elizabeth Murray
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anita Patel
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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15
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Breland JY, Hundt NE, Barrera TL, Mignogna J, Petersen NJ, Stanley MA, Cully JA. Identification of Anxiety Symptom Clusters in Patients with COPD: Implications for Assessment and Treatment. Int J Behav Med 2016; 22:590-6. [PMID: 25622813 DOI: 10.1007/s12529-014-9450-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment of chronic obstructive pulmonary disease (COPD) is palliative, and quality of life is important. Increased understanding of correlates of quality of life and its domains could help clinicians and researchers better tailor COPD treatments and better support patients engaging in those treatments or other important self-management behaviors. PURPOSE Anxiety is common in those with COPD; however, overlap of physical and emotional symptoms complicates its assessment. The current study aimed to identify anxiety symptom clusters and to assess the association of these symptom clusters with COPD-related quality of life. METHODS Participants (N = 162) with COPD completed the Beck Anxiety Inventory (BAI), Chronic Respiratory Disease Questionnaire, Patient Health Questionnaire-9, and Medical Research Council dyspnea scale. Anxiety clusters were identified, using principal component analysis (PCA) on the BAI's 21 items. Anxiety clusters, along with factors previously associated with quality of life, were entered into a multiple regression designed to predict COPD-related quality of life. RESULTS PCA identified four symptom clusters related to (1) general somatic distress, (2) fear, (3) nervousness, and (4) respiration-related distress. Multiple regression analyses indicated that greater fear was associated with less perceived mastery over COPD (β = -0.19, t(149) = -2.69, p < 0.01). CONCLUSION Anxiety symptoms associated with fear appear to be an important indicator of anxiety in patients with COPD. In particular, fear was associated with perceptions of mastery, an important psychological construct linked to disease self-management. Assessing the BAI symptom cluster associated with fear (five items) may be a valuable rapid assessment tool to improve COPD treatment and physical health outcomes.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, USA
| | - Natalie E Hundt
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Terri L Barrera
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Joseph Mignogna
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Nancy J Petersen
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Melinda A Stanley
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA.,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Jeffery A Cully
- Houston VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX, 77030, USA. .,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM 350, Houston, TX, 77030, USA. .,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA.
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16
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Wright A, Hurt CS, Gorniak S, Brown RG. An exploration of worry content and catastrophic thinking in middle-aged and older-aged adults with and without Parkinson's disease. Int J Geriatr Psychiatry 2015; 30:376-83. [PMID: 24931116 DOI: 10.1002/gps.4146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/25/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Worry is a common and distressing problem in Parkinson's disease (PD). However, little is known about the nature and content of worry in PD and how it might differ to non-PD populations. The study aimed to explore the content and nature of worry in middle-aged and older-aged adults with and without PD. METHOD Four groups of participants, 20 PD patients (10 high worry and 10 low worry) and 19 middle-aged and older-aged adults (10 high worry and nine low worry), completed the catastrophising interview (CI) for three worry topics. Worriers were classified (high/low) on the basis of Penn State Worry Questionnaire scores. Data were analysed using framework analysis. RESULTS High worriers showed a greater diversity of worry topics than low worriers. Health worries differentiated high and low worriers in the non-PD sample but were common across all PD participants. The CI revealed that the root concern of worry was often different to that initially described. In particular, PD high worriers were more likely to express underlying concerns about negative self-perception and death/severe incapacity. CONCLUSION The CI was able to identify the root cause of worry, demonstrating the value of this technique in the exploration and treatment of worry and psychological distress. Exploring worry content may help to distinguish patients with problematic worry, with worries about self-perception and death/severe incapacity characteristic of high worriers. Therapeutic interventions designed to alleviate problematic worry and distress in PD need to take account of the realities of living with PD and the potentially realistic nature of worries that may appear catastrophic in a healthy population.
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Affiliation(s)
- Anwen Wright
- School of Medicine, University of Nottingham, UK
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17
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Cummings JP, Carson CS, Shrestha S, Kunik ME, Armento ME, Stanley MA, Amspoker AB. Santa Clara Strength of Religious Faith Questionnaire: psychometric analysis in older adults. Aging Ment Health 2015; 19:86-97. [PMID: 24892461 PMCID: PMC4233001 DOI: 10.1080/13607863.2014.917606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assist researchers and clinicians considering using the Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ) with older-adult samples, the current study analyzed the psychometrics of SCSRFQ scores in two older-adult samples. METHOD Adults of age 55 or older who had formerly participated in studies of cognitive-behavioral therapy for anxiety and/or depression were recruited to complete questionnaires. In Study 1 (N = 66), the authors assessed the relations between the SCSRFQ and other measures of religiousness/spirituality, mental health, and demographic variables, using bivariate correlations and nonparametric tests. In Study 2 (N = 223), the authors also conducted confirmatory and exploratory factor analyses of the SCSRFQ, as well as an item response theory analysis. RESULTS The SCSRFQ was moderately to highly positively correlated with all measures of religiousness/spirituality. Relations with mental health were weak and differed across samples. Ethnic minorities scored higher than White participants on the SCSRFQ, but only in Study 2. Factor analyses showed that a single-factor model fit the SCSRFQ best. According to item response theory analysis, SCSRFQ items discriminated well between participants with low-to-moderate levels of the construct but provided little information at higher levels. CONCLUSION Although the SCSRFQ scores had adequate psychometric characteristics, the measure's usefulness may be limited in samples of older adults.
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Affiliation(s)
- Jeremy P. Cummings
- Houston VA Health Service Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
| | - Cody S. Carson
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Marquette University, Milwaukee, WI
| | - Srijana Shrestha
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
- University of St. Thomas, Houston, TX
| | - Mark E. Kunik
- Houston VA Health Service Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
- South Central Mental Illness Research, Education & Clinical Center, Houston, TX
| | - Maria E. Armento
- Houston VA Health Service Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
- South Central Mental Illness Research, Education & Clinical Center, Houston, TX
| | - Melinda A. Stanley
- Houston VA Health Service Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
- South Central Mental Illness Research, Education & Clinical Center, Houston, TX
| | - Amber B. Amspoker
- Houston VA Health Service Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
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Mignogna J, Hundt NE, Kauth MR, Kunik ME, Sorocco KH, Naik AD, Stanley MA, York KM, Cully JA. Implementing brief cognitive behavioral therapy in primary care: A pilot study. Transl Behav Med 2014; 4:175-83. [PMID: 24904701 DOI: 10.1007/s13142-013-0248-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Effective implementation strategies are needed to improve the adoption of evidence-based psychotherapy in primary care settings. This study provides pilot data on the test of an implementation strategy conducted as part of a multisite randomized controlled trial examining a brief cognitive-behavioral therapy versus usual care for medically ill patients in primary care, using a hybrid (type II) effectiveness/implementation design. The implementation strategy was multifaceted and included (1) modular-based online clinician training, (2) treatment fidelity auditing with expert feedback, and (3) internal and external facilitation to provide ongoing consultation and support of practice. Outcomes included descriptive and qualitative data on the feasibility and acceptability of the implementation strategy, as well as initial indicators of clinician adoption and treatment fidelity. Results suggest that a comprehensive implementation strategy to improve clinician adoption of a brief cognitive-behavioral therapy in primary care is feasible and effective for reaching high levels of adoption and fidelity.
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Affiliation(s)
- Joseph Mignogna
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
| | - Natalie E Hundt
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
| | - Michael R Kauth
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
| | - Mark E Kunik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
| | - Kristen H Sorocco
- Oklahoma Veterans Affairs Medical Center, Oklahoma City, OK USA ; University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA
| | - Melinda A Stanley
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
| | - Kaki M York
- Michael E. DeBakey VA Medical Center, Houston, TX USA
| | - Jeffrey A Cully
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030 USA ; Baylor College of Medicine, Houston, TX USA ; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX USA
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Miller CJ, Abraham KM, Bajor LA, Lai Z, Kim HM, Nord KM, Goodrich DE, Bauer MS, Kilbourne AM. Quality of life among patients with bipolar disorder in primary care versus community mental health settings. J Affect Disord 2013; 146:100-5. [PMID: 22981021 PMCID: PMC3554842 DOI: 10.1016/j.jad.2012.08.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. METHODS HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) composite scale scores. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. RESULTS A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p=0.98 and p=0.49, respectively). Depressive symptoms were associated with lower MCS scores (B=-0.68, p<0.001) while arthritis/chronic pain was strongly related to lower PCS scores (B=-5.23, p<0.001). LIMITATIONS This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. DISCUSSION Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment.
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Affiliation(s)
- Christopher J Miller
- Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S. Huntington Ave. 152M, Boston, MA 02130, United States.
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Cully JA, Armento MEA, Mott J, Nadorff MR, Naik AD, Stanley MA, Sorocco KH, Kunik ME, Petersen NJ, Kauth MR. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design. Implement Sci 2012; 7:64. [PMID: 22784436 PMCID: PMC3503767 DOI: 10.1186/1748-5908-7-64] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. METHODS This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. CONCLUSIONS Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. TRIAL REGISTRATION NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772.
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Affiliation(s)
- Jeffrey A Cully
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Maria E A Armento
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Juliette Mott
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Nadorff
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Aanand D Naik
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Melinda A Stanley
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Kristen H Sorocco
- Oklahoma Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Geriatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mark E Kunik
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Abstract
Vor allem für prognostisch ungünstige Störungen (ADHS, Autismus-Spektrum-Störung, Störung des Sozialverhaltens), aber auch für die Angststörungen im Kindes- und Jugendalter liegen intensivtherapeutische Ansätze vor. Diese verhaltenstherapeutischen Ansätze versuchen in den letzten Jahren in sehr unterschiedlicher Weise (z. B. intensive Frühförderung, Summer-Camp-Ansätze, intensive Einzeltherapie) neue Wege zu gehen. Vielfach liegen erste Erfahrungen auf der Ebene von Einzelfällen oder erste Berichte zur prinzipiellen Machbarkeit einen solchen Ansatzes vor. Vor allem bei der Behandlung der Autismus-Spektrum-Störung existieren bereits umfassende Wirksamkeitsstudien.
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Fritzsche A, Clamor A, von Leupoldt A. Effects of medical and psychological treatment of depression in patients with COPD--a review. Respir Med 2011; 105:1422-33. [PMID: 21680167 DOI: 10.1016/j.rmed.2011.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/05/2011] [Accepted: 05/24/2011] [Indexed: 11/30/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms and by considerable negative consequences such as reductions in functional status and quality of life. Comorbid depression is highly prevalent in patients with COPD and related to a worse course of the disease. Despite its negative impact, depression often remains unrecognized and untreated in COPD patients. This review summarizes the current state of findings from studies examining the effects of antidepressant treatments in patients with COPD. Reviewed treatment options are antidepressant medical therapy and cognitive-behavioral therapy (CBT). Antidepressant medical trials include treatments with selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants (TCA); CBT was applied using various components. Across both treatment types, the majority of studies included patients with a wide range of psychiatric conditions and especially comorbid symptoms of anxiety were often not controlled. Furthermore, greatly varying instruments and methods for assessing depressive symptoms, small sample sizes and rather heterogeneous results were observed. This makes the comparison of treatment options rather difficult and prevents definite conclusions. However, some important implications valuable for further research were obtained. Some limited data suggested that SSRI might show fewer side effects than TCA. A few antidepressants as well as beneficial effects in other outcomes were observed after antidepressant medical treatment. More clearly, CBT showed some potential in terms of improvements in depressive symptoms, and also in other outcome measures. Patient compliance seems more promising for CBT than for antidepressant medical treatment. Overall, the reviewed studies suggest some promising effects for both treatment types and effect sizes in studies with significant antidepressant effects were reasonable. However, future randomized controlled trials comparing antidepressant medical and cognitive-behavioral therapy will be essential to assess distinct and most favorable treatment effects. Because recent data is often limited, sound diagnostic criteria of depression and adequate sample sizes are necessary to draw firm conclusions on the effects of these antidepressant treatment options in patients with COPD and comorbid depression.
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Affiliation(s)
- Anja Fritzsche
- Department of Psychology, University of Hamburg, Von-Melle-Park 5, Hamburg, Germany.
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Stanley MA, Bush AL, Camp ME, Jameson JP, Phillips LL, Barber CR, Zeno D, Lomax JW, Cully JA. Older adults' preferences for religion/spirituality in treatment for anxiety and depression. Aging Ment Health 2011; 15:334-43. [PMID: 21491218 DOI: 10.1080/13607863.2010.519326] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. METHOD Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearman's rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. RESULTS Most participants (77-83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. CONCLUSION For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.
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Affiliation(s)
- Melinda A Stanley
- Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), Houston, TX, USA.
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