Telephone-administered CBT Versus Face-to-Face CBT for Depressed Patients with Co-occurring Problematic Alcohol Use in Primary Care

This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy (T-CBT) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use. To our knowledge, T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients. Participants were randomized in a 1:1 ratio to face-to-face CBT or T-CBT for depression. Participants receiving T-CBT (n = 50) and face-to-face CBT (n = 53) were compared at baseline, end of treatment (week 18), and three-month and six-month follow-ups. Face-to-face CBT and T-CBT groups did not significantly differ in age, sex, ethnicity, marital status, educational level, severity of depression, antidepressant use, and total score on the Alcohol Use Disorders Identification Test. Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all time points. T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use. When targeting patients who might have difficulties in accessing care, primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use.

Kalapatapu, R. K., Ho, J., Cai, X., Vinogradov, S., Batki, S. L., & Mohr, D. C. (2014). Cognitive-Behavioral Therapy in Depressed Primary Care Patients with Co-Occurring Problematic Alcohol Use: Effect of Telephone-Administered vs. Face-to-Face Treatment-A Secondary Analysis. Journal of Psychoactive Drugs, 46, 2, 85-92.

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CBT Alleviates Treatment-Induced Menopausal Symptoms in Breast Cancer Patients

OBJECTIVE:Many breast cancer patients experience (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The aim of this study was to assess the cost-effectiveness of cognitive behavioral therapy (CBT) and physical exercise (PE), compared to a waiting list control                          group (WLC).

METHODS: We performed a cost-effectiveness analysis from a healthcare system perspective, using a Markov model. Effectiveness data came from a recent randomized controlled trial that evaluated the efficacy of CBT and PE. Cost data were obtained from relevant Dutch sources. Outcome measures were incremental treatment costs (ITCs) per patient with a clinically relevant improvement on a measure of endocrine symptoms, the Functional Assessment of Cancer Therapy questionnaire (FACT-ES), and on a measure of hot flushes, the Hot Flush Rating Scale (HFRS), and costs per quality-adjusted life years (QALY) gained over a 5-year time period.

RESULTS: ITCs for achieving a clinically relevant decline on the FACT-ES for one patient were 1,051 for CBT and 1,315 for PE, compared to the WLC. The corresponding value for the HFRS was 1,067 for CBT, while PE was not more effective than the WLC. Incremental cost-utility ratios were 22,502/QALY for CBT and 28,078/QALY for PE.

CONCLUSION: CBT is likely the most cost-effective strategy for alleviating treatment-induced menopausal symptoms in this population, followed by PE. The outcomes are sensitive to a reduction of the assumed duration of the treatment effect from 5 to 3 and 1.5 years.

IMPLICATIONS FOR CANCER SURVIVORS: Patients can be prescribed CBT or, based on individual preferences, PE.

Mewes, J. C., Steuten, L. M. G., Duijts, S. F. A., Oldenburg, H. S. S., Van, B. M., Stuiver, M. M., Hunter, M. S., … Aaronson, N. K. (2014). Cost-Effectiveness of Cognitive-Behavioral Therapy and Physical Exercise for Alleviating Treatment-Induced Menopausal Symptoms in Breast Cancer Patients. Journal of Cancer Survivorship: Research and Practice. Epub ahead of print.

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Preexposure Prophylaxis Adherence Intervention in HIV-Serodiscordant Couples in Uganda

OBJECTIVE: Daily preexposure prophylaxis (PrEP) is an effective HIV prevention strategy, but adherence is required for maximum benefit. To date, there are no empirically supported PrEP adherence interventions. This article describes the process of developing a PrEP adherence intervention and presents results on its impact on adherence.

METHODS: The Partners PrEP Study was a placebo-controlled efficacy trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among uninfected members of HIV-serodiscordant couples. An ancillary adherence study was conducted at 3 study sites in Uganda. Participants with <80% adherence as measured by unannounced pill count received an additional adherence counseling intervention based on Lifesteps, an evidence-based HIV treatment adherence intervention, based on principles of cognitive-behavioral theory.

FINDINGS: Of the 1147 HIV-seronegative participants enrolled in the ancillary adherence study, 168 (14.6%) triggered the adherence intervention. Of participants triggering the intervention, 62% were men; median age was 32.5 years. The median number of adherence counseling sessions was 10. Mean adherence during the month before the intervention was 75.7% and increased significantly to 84.1% in the month after the first intervention session (P < 0.001). The most frequently endorsed adherence barriers at session 1 were travel and forgetting.

INTERPRETATION: A PrEP adherence intervention was feasible in a clinical trial of PrEP in Uganda and PrEP adherence increased after the intervention. Future research should identify PrEP users with low adherence for enhanced adherence counseling and determine optimal implementation strategies for interventions to maximize PrEP effectiveness.

Psaros, C., Haberer, J. E., Katabira, E., Ronald, A., Tumwesigye, E., Campbell, J. D., Wangisi, J., … Safren, S. A. (January 01, 2014). An Intervention to Support HIV Preexposure Prophylaxis Adherence in HIV-Serodiscordant Couples in Uganda. Journal of Acquired Immune Deficiency Syndromes (1999), 66, 5, 522-9.

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Specific Phobia Versus Panic Disorder in CBT

In this video from a recent Beck Institute workshop, Dr. Judith Beck and Dr. Aaron Beck describe the important distinction between specific phobia and panic disorder. Dr. Aaron Beck then provides an example illustrating a safety behavior utilized by a panic disorder patient.

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Internet-Based CBT is Effective for Panic Disorder

OBJECTIVE: Guided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care.

METHOD: We conducted a cohort study investigating all patients (n = 570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR).

RESULTS: Participants made large improvements from screening and pretreatment assessments to posttreatment (Cohen’s d range on the PDSS-SR = 1.07-1.55). Improvements were sustained at 6-month follow-up.

CONCLUSIONS: This study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

Hedman, E., Ljo?tsson, B., Ru?ck, C., Bergstro?m, J., Andersson, G., Kaldo, V., Jansson, L., … Lindefors, N. (January 01, 2013). Effectiveness of internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatrica Scandinavica, 128, 6, 457-67.

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Group CBT for Social Anxiety Disorder: A Meta-Analysis

OBJECTIVE: A few meta-analyses have examined psychological treatments for a social anxiety disorder (SAD). This is the first meta-analysis that examines the effects of cognitive behavioural group therapies (CBGT) for SAD compared to control on symptoms of anxiety.

METHOD: After a systematic literature search in PubMed, Cochrane, PsychINFO and Embase was conducted; eleven studies were identified that met the inclusion criteria. The studies had to be randomized controlled studies in which individuals with a diagnosed SAD were treated with cognitive-behavioural group therapy (CBGT) and compared with a control group. The overall quality of the studies was moderate.

RESULTS: The pooled effect size indicated that the difference between intervention and control conditions was 0.53 (96% CI: 0.33-0.73), in favour of the intervention. This corresponds to a NNT 3.24. Heterogeneity was low to moderately high in all analyses. There was some indication of publication bias.

CONCLUSIONS: It was found that psychological group-treatments CBGT are more effective than control conditions in patients with SAD. Since heterogeneity between studies was high, more research comparing group psychotherapies for SAD to control is needed.

Wersebe, H., Sijbrandij, M., & Cuijpers, P. (January 01, 2013). Psychological group-treatments of social anxiety disorder: a meta-analysis. Plos One, 8, 11.)

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CBT Methods with Unassimilated Immigrants

During a recent Beck Institute Workshop, Dr. Aaron Beck comments on the challenges unassimilated immigrants and their second generation offspring may face, as well as their susceptibility to mental illness. Dr. Beck cites research conducted in Great Britain and discusses the effectiveness of Cognitive Behavior Therapy (CBT) among this population.

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CBT is Effective for Pathological Gambling

OBJECTIVE: Clinicians lack adequate data on the effectiveness of treatment for pathological gambling in low- and middle-income countries.

METHODS: We evaluated a manualized treatment program that included components of cognitive-behavioral therapy, motivational interviewing, and imaginal exposure in a sample of 128 participants diagnosed with pathological gambling. Our team recruited participants via the helpline of the National Responsible Gambling Program (NRGP) of South Africa between May 2011 and February 2012. Eligible participants, who met the DSM-IV-TR criteria for pathological gambling as assessed by the Structured Clinical Interview for Pathological Gambling (SCI-PG), were referred to practitioners who had been trained in the intervention technique. We then compared pre- and post-treatment scores obtained on the Yale-Brown Obsessive-Compulsive Scale Adapted for Pathological Gambling (PG-YBOCS), the primary outcome measure, and the Sheehan Disability Scale (SDS), the secondary outcome measure.

RESULTS: Scores obtained on the PG-YBOCS and the SDS both decreased significantly from the first to the final session (t[127] = 23.74, P < .001, r = .9; t[127] = 19.23, P < .001, r = .86, respectively).

CONCLUSIONS: The urges and disability symptoms related to pathological gambling were significantly reduced among participants completing treatment. These preliminary results hold promise for individuals with pathological gambling in South Africa and other low- and middle-income countries.

Pasche, S. C., Stein, D. J., Sinclair, H., Sinclair, H., Collins, P., Pretorius, A., & Grant, J. E. (January 01, 2013). The effectiveness of a cognitive-behavioral intervention for pathological gambling: A country-wide study. Annals of Clinical Psychiatry, 25, 4, 250-256.

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Origins of Dr. Aaron Beck’s Theory of Depression

During a recent Beck Institute Workshop, Dr. Aaron Beck discusses the origins of his theory of depression. He then describes several research techniques he employed to test the psychoanalytic hypothesis that depression is caused by inverted hostility.

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Modified Illness Perceptions Questionnaire Predicts Response to CBT for Psychosis

OBJECTIVE: Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp.

METHODS: Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later.

RESULTS: The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects.

LIMITATIONS: We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample.

CONCLUSIONS: The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.

Marcus, E., Garety, P., Weinman, J., Emsley, R., Dunn, G., Bebbington, P., Freeman, D., … Jolley, S. (December 01, 2014). A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis. Journal of Behavior Therapy and Experimental Psychiatry, 45, 4, 459-466.

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