Effectiveness of cognitive behavioral group therapy for depression in routine practice

Effectiveness of Focus Group Cognitive Behavioral Therapy in Ameliorating Risk of Depression in Mental Health Nurses

Mental health nurses care for patients with mental health and addiction problems. The particular nature of their job makes them prone to increased risk of depression. Timely use of cognitive behavioral therapy (CBT) in a focus group of nurses yields significant results when it comes to minimizing vulnerability to depression risk. Therefore, a structured cognitive behavioral therapy program was implemented for four weeks in a focus group of mental health male nurses who work in a specialized addiction and mental health care facility. A general survey was administered at baseline in addition to the depression scale. Depression risk was reassessed at the end of the program. Then, the risk assessment was repeated after one month to test for the reliability of the outcomes. The study adopted a one-group repeated measure design where a repeated measure ANOVA was used to examine the effect of cognitive behavioral therapy on depression risk. The study revealed that the depression level differed significantly between time points. Post hoc analysis with a Bonferroni adjustment showed that depression level was significantly decreased from pre-intervention to first post-intervention, and from pre-intervention to second post-intervention. One alarming red flag was the fact that 4 out of the 12 participants thought of committing suicide, at least once, in the past six months; thus, drawing attention, extra care, and vigilance. So, health authorities must maintain psychological surveillance of mental health nurses and offer them timely rehabilitation, help, and support. A promising measure in this domain is focus group cognitive behavioral therapy.

Inaudible airborne ultrasound affects emotional states in the olfactory bulbectomized rat depression model

Recently, exposure to sounds with ultrasound (US) components has been shown to modulate brain activity. However, the effects of US on emotional states remain poorly understood. We previously demonstrated that the olfactory bulbectomized (OBX) rat depression model is suitable for examining the effects of audible sounds on emotionality. Here, we investigated the impact of US exposure on the emotional state of OBX rats. In naive rats, exposure to 100 kHz US for 1 h did not increase the number of c-Fos-positive cells in auditory-related cortical areas, and US, as a tone cue, did not elicit a conditioned fear response in the auditory fear conditioning test. These results indicate that the frequency of 100 kHz is hard to hear for rats. However, US improved hyperemotionality (HE) scores and decreased plasma corticosterone levels in OBX rats, suggesting ameliorative effects on depression-like symptoms and stress. In contrast to HE scores, US exposure did not influence anxiety-like behaviors in the elevated plus maze. In conclusion, we demonstrated that exposure to airborne US can alleviate depressive-like symptoms in the OBX rat depression model. This is the first study to show that exposure to airborne US alone produces changes in emotional states in an animal model.

Group Psychological Therapy Program in Adult Patients with Congenital Heart Disease and Anxious-Depressive Symptoms

Introduction: Anxiety and depression are significant mental health concerns for individuals with congenital heart disease (CHD). As group therapy has proven to be a valuable and effective treatment option for managing anxiety and depression, the aim of this study was to determine its effects on patients with CHD and anxious-depressive symptoms. Methods: We used non-pharmacological psychological group intervention, of six weekly sessions of 90 min each, administered by trained personnel, in adult patients with CHD. Measurement tools included quality of life (Euro quality of life-5D questionnaire), self-esteem (Rosenberg Self-Esteem Scale), anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory-II), and satisfaction surveys. Results: A total of 18 out of 21 CHD patients (mean age 35.8 ± 9.0 years old and 13 (72%) females) completed the program. According to CHD complexity, five (28%) patients had mild, six (33%) moderate, and seven (38%) great defects. Patients with CHD scored significantly higher in the Euro quality of life visual analogue scale (7.83 ± 1.4 vs. 7.14 ± 1.6, p = 0.012) and lower in the Beck Depression Inventory-II (12.3 ± 10.9 vs. 18.1 ± 12.1, p = 0.003) post-program than pre-intervention. Meanwhile, the Rosenberg Self-Esteem Scale score was close to reaching statistical significance (27.4 ± 6.0 vs. 25.1 ± 5.4, p = 0.051), while the State-Trait Anxiety Inventory did not. Finally, participants scored high in the satisfaction questionnaire at the end of the sessions, on a scale from 0 to 3, especially in the questions related to feeling comfortable with others (2.5 ± 0.6), recommending the program (2.3 ± 0.6), or being willing to attend future sessions (2.6 ± 0.8). Conclusions: Group psychological therapy proved to be a useful tool to reduce depressive symptomatology after a 6-week program, providing a comfortable environment to patients with CHD.

Brain Insights and Resolution of Youth Depression through Neurotechnology

As per United Nations, the youth constitute 16% of total population globally whereas World Health Organization reported that one in every seven young individual suffers from depression. Among various tested therapeutic solutions for depression management, the efficacy of transcranial Direct Current Stimulation (tDCS) is still unexplored specifically in young participants. Therefore, this study aims to investigate the cross hemispheric tDCS intervention with a smaller number of sessions in youth population by means of neurological, neuropsychological, and behavioural measures. A total of 50 young participants were recruited comprising of 25 healthy and 25 depressed individuals. The participants of depressed group were randomly assigned to active tDCS and sham tDCS sub groups and completed 150 min of training over 5 consecutive days. The active tDCS group received stimulation of 2 mA over dorsolateral prefrontal cortex. Unlike healthy individuals, depressed participants demonstrated reduced difference of brain activity between eyes opened and closed resting conditions which gets restored following the intervention in active group. Additionally, the tDCS intervention effectively modified the previously reduced alpha asymmetry observed in depressed participants compared to healthy individuals. These neurological outcomes may also be supported with enhanced neuropsychological score of depression (t = 5.47, P < .01) in active group. The attention score (t = 5.14, P < .01) and reaction time (t = 2.22, P = .02) evaluated through behavioural measure of Stroop task were also significantly improved in active group post tDCS intervention. The reported outcomes of the study highlighted the ability of tDCS for prompt and efficient youth depression management.

Virtual connection and real community: the qualitative experience of participating in a videoconferencing-based psychotherapy group for postpartum depression and anxiety

BACKGROUND

Group psychotherapy, an effective treatment for common postpartum mental disorders (e.g. depression, anxiety), has increasingly been delivered virtually since the pandemic. This study aims to understand experiential aspects of participating in videoconferencing-based group psychotherapy in the postpartum period.

METHODS

Our urban academic ambulatory hospital has delivered group psychotherapy for women (cis and trans) and non-binary individuals of female sex with postpartum depressive and anxiety symptomatology via videoconferencing since 2020. One therapist-facilitator conducts weekly 60-min group therapy sessions with 5-6 participants for eight weeks. Group participants were invited to complete a semi-structured qualitative interview on their experience. Using an interpretive description approach, we conducted reflexive thematic analysis to code anonymized transcripts and construct themes. Facilitator interviews were used for triangulation and additional context.

RESULTS

Of 134 patients in video psychotherapy groups over 11 months, 14 completed an interview, as did all group facilitators (n = 3). Overall, participants felt the experience with videoconferencing group therapy was beneficial for their mental health. Three themes were constructed: (1) "Moving Towards a New Normal": The group helped participants normalize feelings and experiences around transition to parenthood, and accessing health care virtually was now considered to be normal practice, although some wanted an element of choice. (2) "Virtual Connection, Real Community": Connections were made virtually, yet participants felt a real sense of community. Facilitators played an important role fostering an environment in which participants could create lasting bonds. Participants noted challenges with feeling comfortable virtually and provided pragmatic and structural suggestions for enhancing the creation of community. (3) "Trade-offs to Virtual Engagement": Participants made positive and negative trade-offs (e.g. no informal interactions, travel, isolation at home, childcare challenges) to maximize their experience and were able to be more authentic in their self-presentation to the group.

CONCLUSIONS

People with postpartum depression and anxiety who participated in videoconferencing-based group psychotherapy appreciated the sense of community within their groups to normalize their experience transitioning to parenthood. Participants had to make trade-offs to access virtual groups, but felt the experience was worthwhile and helped improve their mental health. Findings will help inform continued delivery of virtual group mental health services.

The impact of modified Cognitive-Behavioral Group Therapy in social adjustment functions of children with attention deficit hyperactivity disorder and their parents' stress levels: A nonrandomized clinical trial

This study aims to investigate the potential of a modified Cognitive-Behavioral Group Therapy (CBGT) intervention in promoting social adjustment and reducing their parental stress among children exhibiting symptoms of attention deficit hyperactivity disorder (ADHD). The research also highlights the mechanisms and advantages of employing modified CBGT to address negative symptoms associated with ADHD in children. The study was conducted at Fuzhou Children's Hospital of Fujian Province, with a total of 20 pairs of parents and children with ADHD participating. The assessment utilized measures including SNAP, Barratt Impulsivity, and Conners to evaluate changes in the children's social adjustment abilities and core/associated ADHD symptoms before and after CBGT intervention. Additionally, the Parental Stress Index was employed to gauge the level of stress experienced by the parents. Consequently, CBGT interventions have shown substantial improvements in children's social adjustment abilities and have proven to be a significant source of stress relief for parents.

A systematic review and network meta-analysis of psychological, psychosocial, pharmacological, physical and combined treatments for adults with a new episode of depression

Background

Various effective treatments for depression exist. We aimed to identify the most effective first-line treatments for new episodes of less and more severe depression (defined by depression scale cut-off scores), to update NICE guidance on the management of Depression in Adults in England.

Methods

Systematic review and network meta-analysis of randomised controlled trials (RCTs) published up to June 2020 (PROSPERO registration number CRD42019151328). We analysed interventions by class and individually. The primary efficacy outcome was depressive symptom change (expressed as standardised mean difference [SMD]). The review for this outcome was updated in November 2023.

Findings

We included 676 RCTs, 105,477 participants and 63 treatment classes. For less severe depression, group cognitive/cognitive behavioural therapy (CT/CBT) class was efficacious versus treatment as usual [TAU], the reference treatment for this population [SMD -1.01 (95% Credible Interval [CrI] -1.76; -0.06)]. For more severe depression, efficacious classes versus pill placebo (reference treatment for this population) included combined individual CT/CBT with antidepressants [-1.18 (-2.07; -0.44)], individual behavioural therapies [-0.86 (-1.65; -0.16)], combined light therapy with antidepressants [-0.86 (-1.59; -0.12)], combined acupuncture with antidepressants [-0.78 (-1.12; -0.44)], individual CT/CBT [-0.78 (-1.42; -0.33)], mirtazapine [-0.35 (-0.48; -0.22)], serotonin and norepinephrine reuptake inhibitors [-0.32 (-0.43; -0.22)], tricyclic antidepressants [-0.29 (-0.50; -0.05)], and selective serotonin reuptake inhibitors [-0.24 (-0.32; -0.16)]. Additional treatments showed evidence of efficacy at the intervention level. Evidence for less and more severe depression was of low and low-to-moderate quality, respectively. In the 2023 update, group yoga and self-help without support emerged as efficacious for less severe depression. For more severe depression, combined group exercise with antidepressants emerged as efficacious, whereas combined light therapy with antidepressants failed to remain efficacious.

Interpretation

Group CT/CBT (and possibly group yoga and self-help) appears efficacious in less severe depression, whereas antidepressants do not show evidence of effect. Combined antidepressants with individual CT/CBT, acupuncture and, possibly, group exercise, individual psychological therapies (behavioural therapies, CT/CBT) alone, and antidepressants alone appear efficacious in more severe depression. Quality of evidence, cost-effectiveness, applicability and implementation issues also need to be considered when formulating clinical practice recommendations.

Funding

National Institute for Health and Care Excellence.

The Healing Elements of an Eclectic Life Skills Programme: Clients' Perspectives

Introduction: The article reports the healing elements of an eclectic life skills programme (ELSP) from the perspective of group members. An ELSP utilising open groups was developed to manage clients with mixed diagnostic profiles and different stages of recovery simultaneously. The aim was to explore the healing elements of an ELSP. Methods: Maximum variation purposive sampling was used to select six participants for the phenomenological inquiry. Data collection is comprised of observations, semistructured interviews, and reflective journals. Data analysis comprised an inductive thematic analysis. Consumer Involvement: Participants all attended groups offered within the ELSP. They participated in two semistructured interviews: the first interview in the week following admission and the second just before discharge. In addition, they documented their experiences in reflective journals for the duration of their participation. Findings: The analogy of a kaleidoscope portrayed the four themes; three pertained to structural dynamics, namely, programme mirror, facilitator mirror, and mirror of other group members. The fourth theme, namely, the magical pattern, pertained to personal sense-making by individual group members. Conclusions: The dynamic interplay of healing factors, captured in the themes, facilitated healing. Self-reflection was integral to the creation of a bespoke, facilitated self-learning process with direct application in group members' own lives.

Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: A scoping review

INTRODUCTION

Major Depressive Disorder (MDD) is one of the most prevalent mental disorders worldwide with significant personal and public health consequences. After an episode of MDD, the likelihood of relapse is high. Therefore, there is a need for interventions that prevent relapse of depression when outpatient mental health care treatment has ended. This scoping review aimed to systematically map the evidence and identify knowledge gaps in interventions that aimed to promote recovery from MDD for patients transitioning from outpatient mental health services to primary care.

MATERIALS AND METHODS

We followed the guidance by Joanna Briggs Institute in tandem with the PRISMA extension for Scoping Reviews checklist. Four electronic databases were systematically searched using controlled index-or thesaurus terms and free text terms, as well as backward and forward citation tracking of included studies. The search strategy was based on the identification of any type of intervention, whether simple, multicomponent, or complex. Three authors independently screened for eligibility and extracted data.

RESULTS

18 studies were included for review. The studies had high heterogeneity in design, methods, sample size, recovery rating scales, and type of interventions. All studies used several elements in their interventions; however, the majority used cognitive behavioural therapy conducted in outpatient mental health services. No studies addressed the transitioning phase from outpatient mental health services to primary care. Most studies included patients during their outpatient mental health care treatment of MDD.

CONCLUSIONS

We identified several knowledge gaps. Recovery interventions for patients with MDD transitioning from outpatient mental health services to primary care are understudied. No studies addressed interventions in this transitioning phase or the patient's experience of the transitioning process. Research is needed to bridge this gap, both regarding interventions for patients transitioning from secondary to primary care, and patients' and health care professionals' experiences of the interventions and of what promotes recovery.

REGISTRATION

A protocol was prepared in advance and registered in Open Science Framework (https://osf.io/ah3sv), published in the medRxiv server (https://doi.org/10.1101/2022.10.06.22280499) and in PLOS ONE (https://doi.org/10.1371/journal.pone.0291559).

Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis

BACKGROUND

Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature.

METHODS

Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome.

RESULTS

Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT.

CONCLUSION

This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.

Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders: Enhancing Access and Tailoring Interventions in Diverse Settings

Depressive disorders are an enormous societal burden given their high prevalence and impact on all facets of being human (e.g., relationships, emotions, motivation). There is a variety of evidence-based psychological treatments, with cognitive behavioral therapy (CBT) being the gold standard for major depression. Research has shown that mindfulness-based interventions (MBIs) such as mindfulness-based cognitive therapy (MBCT) are an effective relapse prevention and treatment for depression and that MBIs can be integrated in individual therapy. Furthermore, various delivery modes (e.g., digital-delivered therapy) and settings are offered to best meet different needs and improve accessibility: Evidence suggests that therapist-guided digital CBT, blended therapy, and, to some degree, digitalized MBIs may be an efficacious supplement to traditional face-to-face therapy. This chapter provides an overview of the principles and evidence base for CBT and MBCT as well as different delivery modes for depressive disorders in adults. Finally, chances and challenges of integration are discussed as implications for practice, as well as recommendations and ideas for future research.

Treating depression in an outpatient setting: Predictors of patient response to bouldering psychotherapy, cognitive behavioural therapy or exercise alone

BACKGROUND

Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model.

METHODS

In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted.

RESULTS

There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner.

CONCLUSIONS

Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.

Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives

BACKGROUND

Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment.

METHODS

We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature.

RESULTS

Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models.

CONCLUSIONS

Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.

Cognitive Behavioral Therapy Enhances Survival in Cardiac Patients Aged Under 60: 14-YEAR OUTCOMES OF THE BEATING HEART PROBLEMS PROGRAM TRIAL

PURPOSE

To optimize recovery and improve prognosis, people who have had an acute cardiac event (ACE) need support to manage their cardiac risk. In 2008, we conducted a randomized controlled trial (RCT) of Beating Heart Problems (BHP) , an 8-wk group program based on cognitive behavioral therapy (CBT) and motivational interviewing (MI), designed to improve behavioral and mental health. This study investigated 14-yr mortality status for RCT participants in order to evaluate the survival impact of the BHP program.

METHODS

In 2021, mortality data on 275 participants from the earlier RCT were obtained from the Australian National Death Index. Survival analysis was undertaken to investigate differences in survival for participants in the treatment and control groups.

RESULTS

Over the 14-yr follow-up period, there were 52 deaths (18.9%). For those aged <60 yr, there was a significant survival benefit to program participation, with 3% deaths in the treatment group and 13% deaths in the control group ( P = .022). For those aged ≥60 yr, the death rate was identical in both groups (30%). Other significant predictors of mortality included older age, higher 2-yr risk score, lower functional capacity, lower self-rated health, and having no private health insurance.

CONCLUSIONS

Participation in the BHP conferred a survival benefit for patients aged <60 yr but not for participants overall. The findings highlight the long-term benefit of behavioral and psychosocial management of cardiac risk through CBT and MI for those who are younger at the time of their first ACE.

"We're the CHATS old-heads": Engaging with evidence-based practice in a reentry agency

Philadelphia has one of the country's largest populations re-entering society after incarceration. Reentry services have been critiqued for their ineffectiveness. Scholars note the lack of evidence-based practices (EBPs) in the field, and the challenges of translating them. Through a case study of one reentry agency implementing an EBP, we examine engagement with the intervention by clients and service providers. Qualitative interviews were conducted with clients and staff (n = 35). A grounded theory using sensitizing concepts approach was used to analyze the data. Productive engagement with the intervention was facilitated by: (1) translatability of the core EBP elements so that they addressed client and staff needs, (2) accessibility to the intervention by enhancing subjective ownership and successfully navigating logistical barriers, and (3) collectivity among participants and staff that helped them address societal and structural barriers. Productive engagement with an EBP can resist carceral processes in reentry service-provision.

The Effectiveness of Integrated Group Therapy on Prolonged Grief Disorder of Bereaved People from COVID-19 Randomized Controlled Trial

This study aimed to evaluate the integrated cognitive-behavioral group therapy and Gestalt empty chair technique on bereaved individuals with COVID-19-caused PGD (prolonged grief disease). Thirty-six patients with PGD resultant from COVID-19 were randomly assigned intervention and control groups. The intervention group underwent 16 90-minute integrated group therapy sessions twice a week. Both groups completed the BDI II depression, NAI anger, and GASP guilt scale before, after, and 2 months after the study's conclusion. The intervention and control groups significantly differed in the depression, anger, and guilt indices after the therapeutic intervention (p < .001). This difference remained in the follow-up phase. Integrated group therapy in treating could help with some of the symptoms of PGD resulting from the corona-caused loss of loved ones. This reduction in symptoms was also stable over time.

Cognitive-behavioral group therapy in major depressive disorder with focus on self-esteem and optimism: an interventional study

BACKGROUND

Major depressive disorder is a common psychological condition that can lead to negative individual and social consequences, the management of which is very important in treating the patients. The present study aimed to determine the effect of cognitive-behavioral group therapy on self-esteem and optimism in patients with major depressive disorder.

METHODS

This is a single-blinded, randomized controlled trial in which a total of 64 patients with major depressive disorder were recruited using convenience sampling and then randomly assigned to two groups of Cognitive-Behavioral Group Therapy (CBGT) and Treatment-As-Usual (TAU). Data collection tools consisted of a demographic questionnaire, the Rosenberg Self-Esteem Scale (RSES), and the Revised Life Orientation Test (LOT-R). In the pretest stage, participants in both groups completed the above questionnaires before the intervention. Patients in the CBGT group received eight 90-min sessions of cognitive-behavioral therapy during four weeks (two sessions a week). Then participants re-completed RSES and LOT-R immediately, three months, and six months after the intervention. Data were analyzed with SPSS software version 16.0 using chi-squared test, independent-samples t-test, and repeated measures Analysis of Variance. The significance level (p-value) was considered to be less than 0.05.

RESULTS

It was indicated that there was a statistically significant difference in the mean scores of self-esteem and optimism between the two groups immediately, three months, and six months after the intervention (p < .05). The mean scores of self-esteem and optimism in the CBGT group increased significantly after the intervention compared to before it, although these scores gradually decreased over the three measurement time points after the intervention.

CONCLUSIONS

Based upon the results, it was concluded that the level of optimism and self-esteem increased significantly in the CBGT group after the intervention, although the levels of the above variables dropped again in the long run after the intervention due to the discontinuity of CBGT sessions. Therefore, it is necessary to take particular measures to regularly hold the sessions of CBGT for patients with major depressive disorder.

TRIAL REGISTRATION NUMBER

IRCT20140212016564N15 , The date of registration: 20-09-2021, Retrospectively registered.

Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial

OBJECTIVES

Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT.

DESIGN

We conducted a randomized, controlled, assessor-blinded non-inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79).

METHODS

Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ-9) at the beginning and end of the treatment phase as well as one year after the end of treatment.

RESULT

In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT -8.06, 95% CI [-10.85, -5.27], p < .001; CBT -5.99, 95% CI [-8.55, -3.44], p < .001). The non-inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15).

CONCLUSION

Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression.

PRACTITIONER POINTS

Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body-related interventions are still underrepresented in current treatments for depression. Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall. The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT). Additionally the 10-weeks BPT-programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health-related quality of life, coping, body image, self-efficacy, and global self-esteem.

Effectiveness of Group Interpersonal Psychotherapy Among Women with Major Depression in Turkey

Depression is a common psychiatric disorder and the leading cause of disability worldwide. The purpose of this study was to investigate the effectiveness of group interpersonal psychotherapy (IPT-G) on the levels of depression and social adaptation among married Turkish women with interpersonal relationship problems and to determine whether the intervention was compatible with Turkish culture. A pretest-posttest nonequivalent-control-groups design was used. Twenty-two female participants who received a diagnosis of major depression at an outpatient psychiatry clinic were assigned to receive either IPT-G and pharmacotherapy or treatment as usual (pharmacotherapy) for 12 weeks. Quantitative data were collected from bogggth groups using the Beck Depression Inventory and Social Adaptation Self-Evaluation Scale before and after the interventions. Findings indicate statistically significant improvements on both outcome measures. IPT-G intervention used in this study was effective in decreasing the depression levels and increasing the social adaptation of women with major depression in the eastern part of Turkey.

Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative.

Key learning aims

(1)

Adapted Dialectical Behavior Therapy for Adolescents with a High Risk of Suicide in a Community Clinic: A Pragmatic Randomized Controlled Trial

OBJECTIVE

This study is a pragmatic randomized controlled trial, which compares the effectiveness of an adapted form of Dialectical Behavior Therapy for Adolescents (DBT-A) and treatment as usual plus group sessions (TAU + GS) to reduce suicidal risk for adolescents in a community health mental clinic.

METHOD

Thirty-five adolescents from a community outpatient clinic, with repetitive NSSI alone or with SA over the last 12 months and with current high suicide risk as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS), were enrolled. Participants were randomly assigned to undergo either DBT-A (n = 18) or TAU + GT (n = 17) treatments over a 16-week period. Primary outcomes were the difference between NSSI and SA recorded during the first 4 weeks and the final 4 weeks of treatment. Secondary outcomes included changes in Children's Global Assessment Scale (C-GAS), Suicidal Ideation Questionnaire (SIQ-JR), and Beck Depression Inventory-II (BDI-II).

RESULTS

Dialectical Behavior Therapy for Adolescents was more effective than TAU + GS at reducing NSSI, use of antipsychotics, and improving C-GAS. No SAs were reported in the two groups at the end of the treatment. Both treatments were equally effective in decreasing SIQ-JR and BDI-II scores.

CONCLUSIONS

These findings support the feasibility and effectiveness of DBT-A for adolescents at high risk of suicide in community settings.

Personalized prognostic prediction of treatment outcome for depressed patients in a naturalistic psychiatric hospital setting: A comparison of machine learning approaches

OBJECTIVE

Research on predictors of treatment outcome in depression has largely derived from randomized clinical trials involving strict standardization of treatments, stringent patient exclusion criteria, and careful selection and supervision of study clinicians. The extent to which findings from such studies generalize to naturalistic psychiatric settings is unclear. This study sought to predict depression outcomes for patients seeking treatment within an intensive psychiatric hospital setting and while comparing the performance of a range of machine learning approaches.

METHOD

Depressed patients (N = 484; ages 18-72; 89% White) receiving treatment within a psychiatric partial hospital program delivering pharmacotherapy and cognitive behavioral therapy were split into a training sample and holdout sample. First, within the training sample, 51 pretreatment variables were submitted to 13 machine learning algorithms to predict, via cross-validation, posttreatment Patient Health Questionnaire-9 depression scores. Second, the best performing modeling approach (lowest mean squared error; MSE) from the training sample was selected to predict outcome in the holdout sample.

RESULTS

The best performing model in the training sample was elastic net regularization (ENR; MSE = 20.49, R2 = .28), which had comparable performance in the holdout sample (MSE = 11.26; R2 = .38). There were 14 pretreatment variables that predicted outcome. To demonstrate the translation of an ENR model to personalized prediction of treatment outcome, a patient-specific prognosis calculator is presented.

CONCLUSIONS

Informed by pretreatment patient characteristics, such predictive models could be used to communicate prognosis to clinicians and to guide treatment planning. Identified predictors of poor prognosis may suggest important targets for intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Inpatient treatment decreases depression but antidepressants may not contribute. A prospective quasi-experimental study

OBJECTIVE

The aim of the study is the evaluation of psychiatric-psychotherapeutic inpatient treatment utilizing a naturalistic design.

METHODS

In a sample of 574 consecutively admitted patients, depression (64.5%), personality disorders (19.5%), schizophrenia (4.2%), bipolar disorder (3.3%), obsessive-compulsive disorder (2.3%) or other mental disorders (6.4%) were diagnosed. All patients were treated with psychotherapy, most with antidepressants. Depression was measured using the Beck Depression Inventory-II (BDI-II). 180 patients formed a waiting list control group. The regularly discharged patients (N = 489) were asked to participate in a six-month follow-up, with 62.6% taking part.

RESULTS

From the time of admission to discharge, there was a strong decline in depression (31.5 vs. 13.2 points on the BDI-II), as well as from admission to follow-up (31.2 vs. 18.3 points). In the control group, there was a weak symptom decline (34.6 vs. 32.1 points) until admission, which was independent of the waiting period duration. For the success of treatment, it did not matter whether the patients received antidepressants. In the follow-up, 81.0% of patients retrospectively considered psychotherapy to be important for treatment outcome, only 2.3% considered medications to be important.

CONCLUSIONS

Psychiatric inpatient treatment reduces depression significantly at discharge and follow-up; the decrease in depression is rather due to psychotherapy than to antidepressants.

Effects, Adherence, and Therapists' Perceptions of Web- and Mobile-Supported Group Therapy for Depression: Mixed-Methods Study

BACKGROUND

Blended group therapy (bGT) has been investigated a several times for anxiety and depression, but information on patients' adherence to and therapists' perception of the novel format is nonexistent. Furthermore, many studies investigated mainly female and highly educated populations, limiting the validity of previous findings.

OBJECTIVE

This study aimed to reduce the gaps and limitations of the previous findings by evaluating an integrated internet- and mobile-supported bGT format.

METHODS

A total of 27 patients diagnosed with major depression (14/27, 52% female and 7/27, 25.9% compulsory education) participated in a 7-week treatment at a university outpatient clinic. Furthermore, 8 novice therapists participated in semistructured interviews and a subsequent cross-validation survey.

RESULTS

Primary symptom reduction was high (d=1.31 to 1.51) and remained stable for the follow-up period. Therapists identified advantages (eg, patient engagement, treatment intensification, and improved therapeutic relation) and disadvantages (eg, increased workload, data issues, and undesired effects) of bGT. The required online guidance time was 10.3 min per patient and week, including guidance on exercises (67% or 6.9 min) and intimate communication (33% or 3.4 min). Concerning patients' adherence to bGT, tracked completion of all Web-based and mobile tasks was high and comparable with group attendance.

CONCLUSIONS

Results suggest high feasibility of bGT in a gender-balanced, moderately educated sample. bGT provides group therapists with tools for individual care, resulting in an optimization of the therapy process, and high completion rates of the implemented bGT elements. The limited work experience of the involved therapists restricts the study findings, and potential drawbacks need to be regarded in the development of future bGT interventions.

Nurse-led group cognitive behavioral therapy for major depressive disorder among adults in Japan: A preliminary single-group study

Objectives

The prevalence and burden of disease of depression necessitates effective and accessible treatment options worldwide. Since April 2016, Japanese national health insurance has covered nurse-administered cognitive behavioral therapy (CBT) for mood disorders. However, empirical support for nurse-led CBT for depression in Asian countries, especially in Japan, is still lacking. This preliminary study aimed to examine the feasibility and acceptability of nurse-led group CBT for Japanese patients with depression.

Methods

In this single-arm study, we evaluated the effects of a 6-week group CBT, led by trained nurses, on patients with major depression. The primary outcome was the Beck Depression Inventory-II (BDI-II). Assessments were conducted at the beginning and end of the intervention.

Results

Of 25 participants screened, 23 were eligible for the study (of these, three dropped out during the trial but were included in the analysis). Nurse-led group CBT led to significant improvements in the severity of depression (BDI-II, P < 0.001). The mean total BDI-II score improved from 23.1 (SD = 7.56) to 12.4 (SD = 8.57), and the pre-to post-effect size was large (Cohen's d = 1.33). After CBT, 45% of the participants were judged to be treatment responders, and 34% met the remission criteria.

Conclusions

Our preliminary findings indicate that 6 weeks of nurse-led group CBT produced a favorable treatment outcome for individuals with major depression in a Japanese clinical setting. The results of this study might encourage more Asian nurses to provide CBT as a part of their nursing practice. Further controlled trials that address the limitations of this study are required.

A Study of The Clinical Effect and Dropout Rate of Drugs Combined with Group Integrated Psychotherapy on Elderly Patients with Depression

Background

Relevant studies have shown that group cognitive behavioral therapy is effective in treating patients with depressive disorder, but the dropout rate is high. The present study is aimed to explore the patterns of integrated group psychotherapy.

Aims

This study investigated the clinical effects of integrated group psychotherapy for elderly patients with senile depression.

Methods

One hundred elderly patients with senile depression were divided into the experiment group (n=50) and the control group (n=50) randomly. The experiment group was given regular pharmacological treatments combined with integrated group psychotherapy, while the control group was given regular pharmacological treatments combined with integrated group cognitive behavioral therapy. These two groups were assessed with the Hamilton Depression Scale (HAMD-24) and Geriatric Depression Scale (GDS-15) before the study and at two weeks, four weeks and eight weeks after the treatments.

Results

According to the comparisons within these two groups, it was found that the HAMD and GDS total scores before treatments were all significantly higher than those after treatments (F=102.50, p=0.001; F=55.94, p<0.001). We found that the HAMD total scores after four weeks and eight weeks were significantly different between the two groups (F=3.82, p=0.021). The differences between two groups’ GDS total scores after two weeks, four weeks and eight weeks were also significantly different (F=4.49, p=0.009). Seven cases dropped out in the experiment group, while sixteen cases dropped out in the control group. The difference of dropout rates was statistically significant (x²=4.57, p=0.032).

Conclusion

Medication treatments combined with the group integrated psychotherapy significantly improve the clinical effect for elderly patients with senile depression. The compliance is improved and the dropout rate declines.

User Acceptance of Computerized Cognitive Behavioral Therapy for Depression: Systematic Review

Background

Computerized cognitive behavioral therapy (cCBT) has been proven to be effective in depression care. Moreover, cCBT packages are becoming increasingly popular. A central aspect concerning the take-up and success of any treatment is its user acceptance.

Objective

The aim of this study was to update and expand on earlier work on user acceptance of cCBT for depression.

Methods

This paper systematically reviewed quantitative and qualitative studies regarding the user acceptance of cCBT for depression. The initial search was conducted in January 2016 and involved the following databases: Web of Science, PubMed, the Cochrane Library, and PsycINFO. Studies were retained if they described the explicit examination of the user acceptance, experiences, or satisfaction related to a cCBT intervention, if they reported depression as a primary outcome, and if they were published in German or English from July 2007 onward.

Results

A total of 1736 studies were identified, of which 29 studies were eligible for review. User acceptance was operationalized and analyzed very heterogeneously. Eight studies reported a very high level of acceptance, 17 indicated a high level of acceptance, and one study showed a moderate level of acceptance. Two qualitative studies considered the positive and negative aspects concerning the user acceptance of cCBT. However, a substantial proportion of reviewed studies revealed several methodical shortcomings.

Conclusions

In general, people experience cCBT for depression as predominantly positive, which supports the potential role of these innovative treatments. However, methodological challenges do exist in terms of defining user acceptance, clear operationalization of concepts, and measurement.

Cognitive Behavioral Psychodrama Group Therapy

Cognitive Behavioral Psychodrama Group Therapy (CBPGT) is an effective model for working with the clinical example by Shay (this issue).The approach incorporates cognitive behavioral and psychodrama interventions, allowing group members to identify and modify negative thinking, behavior, and interpersonal patterns while increasing engagement in positive and success-based experiences (Treadwell, Dartnell, Travaglini, Staats & Devinney, 2016). The CBPGT environment creates a safe and supportive climate where clients can practice new thinking and behaviors and share their concerns freely with group members (Treadwell, Kumar, & Wright, 2004; Treadwell, Travaglini, Reisch, & Kumar, 2011). Students and clinical populations respond well to this approach and, as a result, are able to develop an awareness of their dysfunctional thought patterns and beliefs that play an important role in mood regulation. One of the most important elements of CBPGT is that it is data driven. CBPGT adds a new dimension to the fields of both cognitive behavior and group therapy and is built on a proven efficacious model. The integration of these methods may be beneficial for clients who have not responded to more traditional approaches.

The Effect of Group Cognitive Behavioral Therapy on Stress, Anxiety, and Depression of Women with Multiple Sclerosis

Background:

One of the factors that could influence the quality of life in patients with multiple sclerosis, which is usually overlooked, is its psychological aspects. Considering the increasing acceptance of complementary medicine in the health system, this study was designed and conducted to determine the effect of group cognitive therapy on the stress, anxiety, and depression of women suffering from multiple sclerosis.

Materials and Methods:

This clinical trial was conducted among 70 women suffering from multiple sclerosis who were referred to the health centers of Isfahan. Participants were randomly allocated into two groups of intervention and control, each containing 35 patients. The intervention group received cognitive behavioral therapy as 8 90-minute group sessions (a session per week), and the control group participated in 4 group sessions to express their feelings and experiences. Data were gathered using the Depression Anxiety Stress Scale (DASS-24).

Results:

There was a significant difference between the mean score of stress (P = 0.03), anxiety (P = 0.02), and depression (P = 0.03) of the intervention and the control group immediately after and 1 month after the intervention. Least squares difference test showed that the mean score of stress (P = 0.02), anxiety (P = 0.02), and depression (P = 0.03) immediately and 1 month after the intervention was significantly lower in the intervention group.

Conclusions:

According to the results of the present study, cognitive behavioral therapy could decrease stress, anxiety, and depression in patients suffering from multiple sclerosis.

Comparison of group cognitive behavioral therapy and interactive lectures in reducing anxiety during pregnancy: A quasi experimental trial

BACKGROUND

Anxiety during pregnancy and its adverse effects on mother and baby is a health concern worldwide. This study aimed to investigate the effects of group cognitive behavioral therapy (GCBT) compared with interactive lectures (IL) on anxiety during pregnancy.

METHODS

This quasi experimental trial was conducted in Sari city, in north Iran, from March to July 2015. Participants were 91 obstetrically and medically low-risk nulliparous women with a mild to moderate anxiety level, as assessed by Spielberger's State-Trait Anxiety Inventory. Participants were selected from the general population by cluster sampling and assigned to 3 groups: a cognitive behavioral therapy (CBT) group (n = 31), an IL group (n = 30), and a control group (n = 30). All participants completed a demographic characteristics form and the Speilberger State-Trait Anxiety Inventory. The inventory was completed again by the CBT and IL groups 4 weeks after the interventions, and 4 weeks after the initial questionnaire by the control group. Data were analyzed with chi-squared tests, independent t-tests, paired t-tests, ANOVA, and Dunnett post hoc test.

RESULTS

A significant decline in state and trait anxiety was found in the CBT and IL groups at 4 weeks (P < 0.001). GCBT was more effective than IL in reducing participants' anxiety, but the difference was not significant (P > 0.05).

CONCLUSION

GCBT and IL had beneficial effects in reducing anxiety in pregnancy. The psychological status of pregnant women in prenatal care services should be investigated and either of these methods used to manage maternal anxiety, depending on the available healthcare service resources.