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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Remmerswaal KC, Batelaan NM, van Oppen P, Scholten WD, van Balkom AJ. Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study. J Psychiatr Pract 2024; 30:297-307. [PMID: 39058530 PMCID: PMC11280449 DOI: 10.1097/pra.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. METHODS We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. RESULTS In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. CONCLUSIONS In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
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van Santen-Bauer PR, de Beurs E, Deen M, Korrelboom K, van der Heiden C. Goal-Directed Treatment of Patients With Anxiety and Mood Disorders in a Regular Curative Mental Health Care Setting. Clin Psychol Psychother 2024; 31:e2984. [PMID: 38706159 DOI: 10.1002/cpp.2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/07/2024]
Abstract
This study examined whether goal-directed treatment leads to improved treatment outcomes for patients with a primary mood or anxiety disorder and whether beneficial outcomes are achieved sooner compared to treatment as usual. In a quasi-experimental controlled study with a nested design, 17 therapists received training in goal-directed treatment and treated 105 patients with anxiety or mood disorders using principles of goal-directed treatment. Treatment results on a generic self-report instrument were compared with two control groups: a historical control group consisting of 16 of the 17 participating therapists, who provided treatment as usual to 97 patients before having received training in goal-directed treatment, and a parallel control group consisting of various therapists, who provided treatment as usual to 105 patients. Symptom reduction on a self-report measure was compared using multilevel analysis. A survival analysis was performed to assess whether a satisfactory end state had been reached sooner after goal-directed treatment. The results of this study show that goal-directed treatment only led to a significantly better overall treatment outcome compared to the parallel treatment as usual group. Furthermore, goal-directed treatment was significantly shorter than both treatment as usual groups. In conclusion, this research suggest that goal-directed treatment led to a similar or better treatment outcome in a shorter amount of time.
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Affiliation(s)
| | - Edwin de Beurs
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Research and Development, Arkin, Amsterdam, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Methodology and Statistics Department, Leiden University, Leiden, The Netherlands
| | - Kees Korrelboom
- Department of Anxiety Disorders, Outpatient Treatment Center PsyQ, The Hague, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Colin van der Heiden
- Department of Anxiety Disorders, Outpatient Treatment Center PsyQ, The Hague, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lord KA, Tolin DF. Symptom distress and psychosocial functioning improve bidirectionally during cognitive-behavioral therapy for anxiety disorders. J Anxiety Disord 2024; 103:102843. [PMID: 38310753 DOI: 10.1016/j.janxdis.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/30/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
The efficacy of cognitive-behavioral therapy (CBT) for reducing anxiety disorder symptoms is well documented. However, limited research has investigated how symptom amelioration is temporally associated with changes in psychosocial functioning, such as interpersonal and social role functioning, during CBT. Participants were 288 (M age = 37.00 [SD = 14.41]; 59.0% female; 69.0% White; 6.6% Hispanic/Latino) outpatients diagnosed with an anxiety disorder who received CBT at a specialized hospital-based clinic. Participants completed the Outcome Questionnaire-45, a measure of symptom distress, social role performance, and interpersonal problems, at initial assessment and prior to each treatment session. Symptom distress and indicators of psychosocial functioning were robustly related during 25 sessions of CBT. Cross-lagged analyses revealed that reductions in symptom distress predicted subsequent improvements in psychosocial functioning during treatment, and vice versa. Associations from symptom distress to subsequent psychosocial functioning evidenced larger effect sizes than the reverse. Lower levels of severity at intake and presence of comorbid depression attenuated the association between symptom reduction and subsequent social role performance improvement. In sum, anxiety symptoms and psychosocial functioning bidirectionally improve during CBT for anxiety disorders. Maximally effective treatments may be those that simultaneously ameliorate symptoms and focus on improving functioning in key domains.
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Affiliation(s)
- Kayla A Lord
- Anxiety Disorders Center, Institute of Living, Hartford, USA.
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, USA; Department of Psychiatry, Yale School of Medicine, New Haven, USA
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O'Brien B, Lee J, Kim S, Nandra GS, Pannu P, Tamman A, Amarneh D, Swann AC, Murphy N, Averill L, Jha M, Mathew SJ. Anti-suicidal effects of IV ketamine in a real-world setting. Psychiatry Res 2024; 331:115604. [PMID: 38064911 DOI: 10.1016/j.psychres.2023.115604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 01/02/2024]
Abstract
The current study evaluated the effectiveness of intravenous ketamine treatment for suicidality in a community-based clinical sample of 295 outpatients (mean age= 40.37; 58.6 % male). We conducted growth mixture modeling to estimate latent classes of changes in symptoms of suicidality measured by the Concise Health Risk Tracking - Self-Report (CHRT-SR) across five infusions in a two-week course of treatment. Best-fit indices indicated three trajectory groups demonstrating non-linear, quadratic changes in CHRT-SR scores during ketamine treatment. The largest group of patients (n= 170, 57.6 %) had moderate CHRT-SR scores at baseline and showed gradual improvement during treatment. The other two groups of patients had severe CHRT-SR scores at baseline and diverged into one group with no improvement throughout treatment (n = 63, 21 %) and one group with rapid improvement (n = 62, 21 %). Of the clinical and demographic variables available and tested, only higher scores pertaining to active thoughts of death and/or plan were found to predict which of the patients with severe CHRT-SR scores at baseline would not benefit from treatment. The present study provides an important contribution to the knowledge of ketamine's effects on symptoms related to suicide over time. providing support for the possible effectiveness of ketamine in a proportion of patients.
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Affiliation(s)
- Brittany O'Brien
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA. Brittany.O'
| | - Jaehoon Lee
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Tech University, Department of Educational Psychology and Leadership, 2500 Broadway, Lubbock, TX 79409, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX 77035, USA
| | - Seungman Kim
- Texas Tech University, Department of Educational Psychology and Leadership, 2500 Broadway, Lubbock, TX 79409, USA
| | - Guriqbal S Nandra
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Prabhneet Pannu
- IV Solution and Ketamine Centers of Chicago and Kansas City, 712 North Dearborn Street, Chicago, IL 60654, USA
| | - Amanda Tamman
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Dania Amarneh
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Alan C Swann
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Nicholas Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Lynnette Averill
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Manish Jha
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Sanjay J Mathew
- Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, 1977 Butler Boulevard, Houston, TX 77030, USA; The Menninger Clinic, 12301 S Main Street, Houston, TX 77035, USA
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Breen LJ, Greene D, Rees CS, Black A, Cawthorne M, Egan SJ. A co-designed systematic review and meta-analysis of the efficacy of grief interventions for anxiety and depression in young people. J Affect Disord 2023; 335:289-297. [PMID: 37196936 DOI: 10.1016/j.jad.2023.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched. METHOD We conducted a systematic review and meta-analysis to examine the efficacy of grief interventions in young people. The process was co-designed with young people and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PsycINFO, Medline, and Web of Science databases were searched in July 2021 (updated December 2022). RESULTS We extracted results from 28 studies of grief interventions with young people (14-24 years) that measured anxiety and/or depression (N = 2803 participants, 60 % girls/women). Cognitive behavior therapy (CBT) for grief demonstrated a large effect for anxiety and medium effect for depression. Meta-regression indicated that CBT for grief that included a higher degree of CBT strategies, was not trauma focused, had >10 sessions, offered on an individual basis, and did not involve parents, was associated with larger effect sizes for anxiety. Supportive therapy had a moderate effect for anxiety and a small-moderate effect for depression. Writing interventions were not effective for anxiety or depression. LIMITATIONS Studies are limited in number and there were few randomized controlled studies. CONCLUSIONS Findings indicate that CBT for grief is an effective intervention for reducing symptoms of anxiety and depression in young people experiencing grief. CBT for grief should be offered as the first line treatment for grieving young people experiencing anxiety and depression. PROTOCOL REGISTRATION PROSPERO (registration number CRD42021264856).
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Affiliation(s)
- Lauren J Breen
- enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Australia; Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia.
| | - Danyelle Greene
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | - Clare S Rees
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | - Amy Black
- Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
| | | | - Sarah J Egan
- enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Australia; Discipline of Psychology, Curtin School of Population Health, Curtin University, Australia
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Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations. Am J Lifestyle Med 2023; 17:374-385. [PMID: 37304739 PMCID: PMC10248368 DOI: 10.1177/15598276211073078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, USA
| | - Miranda P Kaye
- Survey Research Center, Penn State University, University Park, PA, USA
| | - Aubrey Faber
- Department of Psychology, St John's University, Queens, NY, USA
| | - Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA
- Institute of Coaching, McLean Hospital, Belmont, MA, USA
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Aafjes-van Doorn K, de Jong K. How to make the most of routine outcome monitoring (ROM): A multitude of clinical decisions and nuances to consider. J Clin Psychol 2022; 78:2054-2065. [PMID: 36041193 DOI: 10.1002/jclp.23438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022]
Abstract
Routine outcome monitoring (ROM) involves the use of patient-reported standardized outcome measures to monitor progress throughout the course of treatment, followed by feedback of the patient's scores to the therapist. The potential benefits of ROM have been established, however, from our own experiences, we know that the implementation in clinical practice can be challenging. We therefore wanted to explore in more detail exactly how we might be able to apply ROM in difficult clinical contexts. The inspiring case illustrations in this issue of Journal of Clinical Psychology: In Session highlight the heterogeneity in ROM systems, and the way in which ROM can be used in treatment. Just as there are many ways of interpreting a survey data-point, there are also many ways in which ROM may be used to complement the treatment and supervision. Whether or not ROM is implemented may partly be determined by clinic policies and routines, but there remain a multitude of clinical decisions that require careful consideration by the individual therapist. To complement the evidence supporting the benefits of using ROM, further empirical support and clinical guidance is needed on how exactly therapists are to use ROM in their work and how ROM may be used in evidence-based practice. We make suggestions for additional uses of ROM for deliberate practice, and teletherapy practice, and look toward novel ways of assessing progress in the near future.
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Affiliation(s)
| | - Kim de Jong
- Institute of Psychology, Leiden University, Leiden, the Netherlands
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Aafjes-Van Doorn K, Meisel J. Implementing routine outcome monitoring in a psychodynamic training clinic: it’s complicated. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2110451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | - Jordan Meisel
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
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10
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Kunst LE, Maas J, van Balkom AJLM, van Assen MALM, Kouwenhoven B, Bekker MHJ. Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial. Depress Anxiety 2022; 39:134-146. [PMID: 34951503 PMCID: PMC9303809 DOI: 10.1002/da.23231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 11/18/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. METHODS A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). RESULTS Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d = .16 or smaller at post-test). Anxiety reduction was similar across conditions (d = .059 at post-test) and neither therapy was superior on long term. CONCLUSION This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders.
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Affiliation(s)
- Laura E. Kunst
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands,Mentaal Beter BredaMentaal BeterBredaThe Netherlands
| | - Joyce Maas
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands,Center for Eating Disorders HelmondMental Health Center Region Oost‐BrabantHelmondThe Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije UniversiteitAmsterdamThe Netherlands,Psychiatry, Research & InnovationGGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Marcel A. L. M. van Assen
- Department of Methodology and StatisticsTilburg UniversityTilburgThe Netherlands,Department of SociologyUtrecht UniversityUtrechtThe Netherlands
| | - Brenda Kouwenhoven
- PEP NoordwijkRegional Health Organization RijncoepelNoordwijkThe Netherlands
| | - Marrie H. J. Bekker
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands,Faculty of Behavioral and Movement Sciences, Faculty of Clinical, Neuro‐ and Developmental PsychologyVU UniversityAmsterdamThe Netherlands,RINO AmsterdamRINOAmsterdamThe Netherlands
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Prudenzi A, Graham CD, Clancy F, Hill D, O'Driscoll R, Day F, O'Connor DB. Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals: A systematic review and meta-analysis. J Affect Disord 2021; 295:192-202. [PMID: 34479127 DOI: 10.1016/j.jad.2021.07.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/03/2021] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A large proportion of the healthcare workforce reports significant distress and burnout, which can lead to poor patient care. Several psychological interventions, such as Acceptance and Commitment Therapy (ACT), have been applied to improve general distress and work-related distress in healthcare professionals (HCPs). However, the overall efficacy of ACT in this context is unknown. This review and meta-analysis aimed to: 1) test the pooled efficacy of ACT trials for improving general distress and reducing work-related distress in HCPs; 2) evaluate the overall study quality and risk of bias; and 3) investigate potential moderators of intervention effectiveness. METHOD Four databases (Ovid MEDLINE, EMBASE, PsycINFO, CINHAL) were searched, with 22 pre-post design and randomised controlled trial (RCTs) studies meeting the inclusion criteria. 10 RCTs studies were included in the meta-analysis. RESULTS Two random effects meta-analyses on general distress and work-related distress found that ACT outperformed pooled control conditions with a small effect size for general distress at post-intervention (g = 0.394, CIs [.040; .748]) and for work-related distress (g = 0.301, CIs [.122; .480]) at follow-up. However, ACT was more effective than controls. The number of treatment sessions was a moderator of intervention efficacy for general distress. ACT process measures (psychological flexibility) did not show significantly greater improvements in those who received the intervention. LIMITATIONS The methodological quality of studies was poor and needs to be improved. CONCLUSIONS Overall, ACT interventions are effective in improving general distress and work-related distress in HCPs. These findings have implications for policymakers, healthcare organisations and clinicians.
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Affiliation(s)
- Arianna Prudenzi
- School of Psychology, University of Leeds, Leeds, United Kingdom.
| | | | - Faye Clancy
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Deborah Hill
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | | | - Fiona Day
- Fiona Day Consulting LTD, Leeds, United Kingdom
| | - Daryl B O'Connor
- School of Psychology, University of Leeds, Leeds, United Kingdom
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12
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Psychophysiological assessment of stress reactivity and recovery in anxiety disorders. J Anxiety Disord 2021; 82:102426. [PMID: 34022509 DOI: 10.1016/j.janxdis.2021.102426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/10/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Abstract
The present study aimed to examine changes in psychophysiological arousal from baseline to a stressor phase (reactivity) and from the stressor phase to a second resting phase (recovery) in patients with anxiety disorders. Fifty adult patients with DSM-5 anxiety disorders (panic disorder, generalized anxiety disorder, or social anxiety disorder) and 28 healthy control (HC) participants underwent psychophysiological monitoring including electrocardiogram, respiration rate, electrodermal activity, gastrocnemius electromyograph, and end-tidal CO2 for a 3-min resting phase, a 6-min mild stressor phase, and a 3-min recovery phase. Anxious patients then went on to receive naturalistic cognitive-behavioral therapy (CBT) in a specialty outpatient clinic. Results for the reactivity phase indicated that compared to HCs, patients with social anxiety disorder exhibited heightened psychophysiological reactivity while patients with panic disorder and generalized anxiety disorder exhibited attenuated reactivity. Results for physiological recovery (return to baseline after the stressor was withdrawn) were mixed, but provided some support for slower autonomic recovery in patients with generalized anxiety disorder and panic disorder compared to HCs. Participants with all anxiety disorders exhibited diminished change in high frequency heart rate variability compared to HCs. Generally, psychophysiological reactivity and recovery were not associated with CBT outcome, though exploratory analyses indicated that greater respiration rate reactivity and stronger respiration rate recovery were associated with better CBT outcomes in patients with panic disorder.
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Technology-Based Assessments and Treatments of Anxiety in Autistic Individuals: Systematic Review and Narrative Synthesis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThis systematic review (Prospero Registration Number: CRD42019142910) aimed to narratively synthesise technology-aided assessments and treatments of anxiety in individuals with autism spectrum disorder (ASD) for the first time. Sixteen studies were identified: 5 assessment studies and 11 treatment studies. Assessment studies targeted state anxiety using ecological momentary assessment, wearables, or computerised tasks. Treatment studies targeted specific fears/phobias using electronic screen media or transdiagnostic anxiety using telemedicine. Broadly, results indicated technology-aided assessments and treatments may be feasible and effective at targeting anxiety in ASD, except treatments involving social scripts or peer modelling. Assessment results further indicated that state anxiety in ASD has a distinct psychophysiological signature and is evoked by idiosyncratic triggers. However, larger scale studies with representative samples are needed.
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Cooper D, Champion SM, Stavropoulos L, Grisham JR. How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:8-30. [PMID: 33570762 DOI: 10.1111/bjc.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. METHODS A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. RESULTS Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. CONCLUSIONS Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. PRACTITIONER POINTS Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.
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Affiliation(s)
- David Cooper
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Stavropoulos
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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