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Fibromyalgia (FM) is a chronic disease characterized by a heterogeneous set of physical and psychological conditions. The chronic experience of disability felt by patients and the impact on quality of life (QoL) of the disease may worsen the cognitive reappraisal ability and contribute to maintaining an altered pain modulation mechanism. This paper presents the study protocol of an INTEGRated psychotherapeutic interventiOn on the management of chronic pain in patients with fibromyalgia (INTEGRO). The aim of the study is to investigate the efficacy of an integrated psychotherapeutic intervention focused on pain management on QoL and pain perception, in a pilot sample of 45 FM patients with idiopathic chronic pain. The contribution of perceived therapeutic relationship (alliance) and physiological attunement, in both the patient and therapist, will be considered as possible mediators of intervention efficacy. Attachment dimensions, traumatic experiences, difficulties in emotion regulation, mindfulness attitude and psychophysiological profile will also be considered as covariates. The objectives are to evaluate longitudinally if patients will experience an increase in QoL perception (primary endpoint), pain-managing self-efficacy and emotion-regulation abilities as well as a reduction in pain intensity (secondary endpoints), considering the mediating role of perceived therapeutic alliance and physiological attunement in both the patient and therapist.

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing CAI systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called “general” or “human-like” AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy.

ObjectiveOnline treatment for binge eating disorder (BED) is an easily available option for treatment compared to most standard treatment procedures. However, little is known about how motivation types characterize this population and how these impact treatment adherence and effect in an online setting. Therefore, we aimed to investigate a sample of written motivation statements from BED patients, to learn more about how treatment and online treatment in particular, presents in this population.MethodsUsing self-determination theory in a mixed methods context, we investigated which types of motivation were prevalent in our sample, how this was connected with patient sentiment, and how these constructs influence treatment and adherence.ResultsContrary to what most current literature suggests, we found that in our sample (n = 148), motivation type was not connected with treatment outcome. We did find a strong association between sentiment scores and motivation types, indicating the model is apt at detecting effects. We found that when comparing an adult and young adult population, they did not differ in motivation type and the treatment was equally effective in young adults and adults. In the sentiment scores there was a difference between sentiment score and adherence in the young adult group, as the more positive the young adults were, the less likely they were to complete the program.DiscussionBecause motivation type does not influence online treatment to the same degree as it would in face-to-face treatment it indicates that the typical barriers to treatment may be less crucial in an online setting. This should be considered during intake; as less motivated patients may be able to adhere better to online treatment, because the latter imposes fewer barriers of the kind that only strong motivation can overcome. The fact that motivation type and sentiment score of the written texts are strongly associated, indicate a potential for automated models to detect motivation based on sentiment.

Self-esteem – the evaluation of our own worth, talents and competencies – has been associated with numerous determinants of well-being. Although self-esteem is often considered a relatively stable trait, research findings suggest that it is malleable. In fact, cognitive behavioral therapy (CBT) interventions have been developed for dealing with individuals' beliefs about their own worth and abilities. Importantly, these can potentially be made available to broad audiences through computerized formats. GGApps, a mobile-computerized application of CBT techniques that we have developed, provides an effective and easy-to-use intervention to improve self-esteem. Since CBT is based on learning principles, conducting CBT interventions under conditions that optimize learning may maximize its effects. A novel way to enhance memory consolidation is suggested by findings regarding the important role of brain oscillations in mnemonic processes: we have demonstrated that post-learning theta rhythm modulation promotes consolidation of new learning. Therefore, theta enhancement may provide optimal conditions for stabilization of therapeutic learning and memory, including the enhancement of self-esteem using CBT techniques. In this research, we will compare the immediate and long-term effects of the GGApps Self Esteem module (GGSE) intervention when followed by theta vs. control groups. We predict that the value of the CBT intervention will be enhanced by theta upregulation. If the prediction is borne out, this would indicate that post-treatment theta upregulation might be a tool for increasing the efficacy not only of GGSE-type self-esteem and well-being interventions, but of a range of CBT techniques.

BackgroundAs treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.MethodsA randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m2), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6 months (time 3) and 9 months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device.To assess the effectiveness of the intervention, mixed between-within 3 (conditions) × 4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DiscussionThis study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.Trial registrationClinicalTrials.govNCT04474509. Registered on July 4, 2020

Background Around 20% of patients undergoing spinal fusion surgery have persistent back or leg pain despite surgery. Pain catastrophizing is the strongest psychological predictor for chronic postsurgical pain. Psychological variables are modifiable and could be target for intervention. However, randomized controlled trials evaluating the effectiveness of psychological interventions to reduce chronic pain and disability after spinal fusion in a population of patients with high preoperative pain catastrophizing scores are missing. The aim of our study is to examine whether an intervention targeting pain catastrophizing mitigates the risk of chronic postsurgical pain and disability. Our primary hypothesis is that targeted perioperative cognitive behavioral therapy decreases the risk of chronic postsurgical pain and disability after spinal fusion surgery in high catastrophizing patients. Methods We will perform a two-center prospective, single-blind, randomized, controlled study comparing lumbar spinal fusion surgery outcome between 2 cohorts. Adult patients selected for lumbar spinal fusion with decompression surgery and a minimum score of 24 on the pain catastrophizing scale will be randomized with 1:1 allocation for either perioperative cognitive behavioral therapy (intervention group) or a perioperative education plus progressive exercise program (control group). Patients randomized to the intervention group will receive six individual sessions of cognitive behavioral therapy, two sessions before the operation and four after. Primary outcome is the Core Outcome Measures Index at 12 months. Secondary outcomes include pain, disability, depression and quality of life. Discussion This is the first trial that evaluates the effectiveness of cognitive behavioral therapy as a perioperative tool to improve pain and disability after spinal fusion surgery in comparison with an educational/exercise control intervention, in patients with high levels of pain catastrophizing. If perioperative cognitive behavioral therapy proves to be effective, this might have important clinical implications, reducing the incidence of chronic postsurgical pain and improving outcome after spinal fusion surgery. Trial registration Clinicaltrials (NCT03969602). Registered 31 May 2019

Background and Aims: Nurses working in the intensive care units (ICU) are faced with numerous stressors that can pose a serious threat to their self-efficacy and affect the quality of care. The aim of this study was to evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) on the ICU nurses’ occupational stress. Methods: This interventional study was conducted in a hospital in southeast of Iran. The participants included 120 nurses, who were randomly assigned into the control (n = 60) and intervention (n = 60) groups. In the pre-test, the occupational stress was assessed using Osipow questionnaire. Later, the intervention group attended the CBT course conducted in six 90 minute sessions. One month after the intervention, the post-test data were collected from both groups. Results: The means of occupational stress and its dimensions were not significant before the intervention between the intervention and control groups (P = 0.47). The means of occupational stress and its dimensions were moderately high at pretest for all nurses. In the post-test, the stress level and all its dimensions reduced from moderate-high to moderate-low (P < 0.001), except for the physical environment dimension that remained at the moderate-high level (P = 0.32). Conclusion: The findings showed that CBT was effective on the nursing stress. Therefore, CBT training is suggested in in-service training programs for nurses.

Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI.

BackgroundCurrently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy.MethodsIn this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF.ResultsAt follow-up, a reduction in TQ (p < 0.001) and PSQ-20 scores (p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.).DiscussionWhile the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.

Antenatal depression (depression under graviditeten) drabbar 10–20% av gravida och innebär risker för både den gravida och barnet. Forskning visar att internetbaserad kognitiv beteendeterapi (IKBT) tycks vara effektivt jämfört med sedvanlig mödravård. Uppsatsen var en sambands- och prediktionsstudie som genomfördes inom den randomiserade DANA-studien för IKBT vid antenatal depression. En inomgruppsdesign med upprepade mätningar tillämpades där 40 kvinnor med antenatal depression deltog. Syftet var att undersöka (a) patientnöjdhet med bedömningssamtalet i relation till behandlingsföljsamhet, avhopp och minskning av depressionssymtom under IKBTbehandlingen, samt (b) jämföra förändring i depressionssymtom mot två tidigare studier. Resultatet visade att en högre patientnöjdhet med bedömningssamtalet signifikant predicerade en mindre minskning av depressionssymtom mellan screening och förmätning. Inga signifikanta samband hittades mellan patientnöjdhet med bedömningssamtalet och behandlingsföljsamhet eller avhopp. Slutsatser bör dras med stor försiktighet utifrån metodologiska begränsningar. Resultatet visade även att depressionssymtom jämfört med förmätningen signifikant minskade från andra veckomätningen i behandlingen till och med eftermätningen vecka tio. Detta bekräftade tidigare studiers resultat. Framtida randomiserade prövningar kan ge underlag till utvecklingen av bedömningssamtal och IKBT mot antenatal depression. Antenatal depression (depression during pregnancy) affects 10–20% of pregnant women and involves risks for both the pregnant woman and the child. Research shows that internet-based cognitive behavioral therapy (ICBT) seems to be effective compared to conventional maternity care. The thesis was a correlational predictive study that was conducted within the randomized DANAstudy for ICBT during antenatal depression. An in-group design with repeated measurements was applied in which 40 women with antenatal depression participated. The purpose was to examine (a) patient-satisfaction with the assessment interview in relation to adherence, dropouts and remissionof depressive symptoms during ICBT treatment, and (b) compare changes in depressive symptoms against two previous studies. The result showed that a higher patient-satisfaction with the assessment interview significantly predicted a lesser reduction of depressive symptoms between screening and pre-measurement. No significant correlations were found between patient-satisfaction with the assessment interview and treatment adherence or dropouts. Conclusions should be drawn with great caution based on methodological limitations. The result also showed that depressive symptoms compared with the pre-measurement decreased significantly from the second weekly measurement in the treatment until the post-measurement week ten. This confirmed the results of previous studies. Future randomized trials may provide a basis for the development of assessment interviews and ICBT for antenatal depression.

DTh (Pastoral Studies), North-West University, Potchefstroom Campus This thesis aims to argue that the Universal Christian Church has a responsibility to assist its congregants who struggle with mental health challenges. This assistance can be facilitated by considering ways in which the clergyman and the psychotherapist can collaborate to address this much-neglected spiritual task. Furthermore, this thesis aims to show that this ‘spiritual task’ can be accomplished using the practical skills of the Apologists, who in their dialectic process of worldview debate, would be able to redirect their expertise to defend against personal misbeliefs that suppress the spiritual transformation of those who struggle with mental health challenges. By integrating the ‘Apologist’ skills with those of the cognitive behavioral therapist, the tasks of identifying, challenging, and replacing misbeliefs could be accomplished using the admonition given in 1 Peter 3:15: “always being prepared to give a defense to everyone who asks you to give an account”. To correct worldview distortions, Apologists can use their skills within a ministerial church setting to help mental health sufferers alleviate emotional distress by correcting their misbeliefs. Just as the Apologist applies the practical skills (or praxis), in the dialectic process for worldview debate, the professional Christian Counselor applies the same praxis in the modality of Cognitive Behavioral Therapy (CBT). The major interventions used in CBT, such as ‘questioning the evidence’, ‘rational responding’, ‘examining the options’, ‘direct disputation’, and ‘labeling the distortion’, are interventions also used in the praxes of Apologists who use them intuitively from their training in the dialectical method. Methodologically, this research will be established on classical realism and the classical Christian approach to Apologetics. Practically, this work will be framed using Osmer’s fourfold model of practical theology: the descriptive/empirical task, ‘What is going on?’; the interpretive task, ‘Why is it going on?’; the normative task, ‘What ought to be going on?’; and the pragmatic task, ‘How might we respond?’. Doctoral

Background: Currently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy. Methods: In this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF. Results: At follow-up, a reduction in TQ (p < 0.001) and PSQ-20 scores (p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.). Discussion: While the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.

Цель исследования - оценка эффективности применения протоколов когнитивно - поведенческой индивидуальной и групповой терапии в сравнении с психофармакотерапией препаратом группы селективных ингибиторов обратного захвата серотонина (Сертралином) среди обучающихся медицинских ВУЗов, страдающих социофобией в коморбидности с проявлениями пищевых нарушений. Материалы и методы исследования. Исследование проводилось среди студентов ВГМУ им Н.Н. Бурденко. Участники исследования были рандомизированы и разделены на четыре группы (когнитивно - поведенческая терапия, фармакотерапия, когнитивно - поведенческая групповая терапия, сочетание когнитивной терапии и фармакотерапии. Оценка результатов терапии проходила с использованием Шкалы социальной тревоги Лейбовица, Шкалы тревоги Бека. Результаты и их обсуждение. Наилучшие результаты терапии были отмечены в первой и второй группах участников исследования, с применением методик индивидуальной конитивно - поведенческой терапии и сочетанием когнитивно - поведенческой терапии и фармакотерапии. Эффективность лечения в обеих группах является сопоставимой. Наименьшую эффективность показало применение фармакотерапии без психотерапии в третьей группе студентов. Выводы. Степень выраженности социальной тревоги положительно коррелирует с наличием признаков пищевых нарушений. Проблематика социальных страхов и пищевых нарушений у молодежи требует дальнейших исследований и более пристального внимания со стороны сотрудников здравоохранения., The research purpose is to assess the effectiveness of cognitive - behavioral individual and group therapy protocols in comparison with psychopharmacotherapy with a selective serotonin reuptake inhibitor (Sertraline) among medical students suffering from social anxiety and comorbidity with manifestations of eating disorders. Materials and research methods. The study participants were randomized and divided into four groups (cognitive behavioral therapy, pharmacotherapy, cognitive behavioral group therapy, a combination of cognitive therapy and pharmacotherapy. Authors used the Leibowitz Social Anxiety Scale and the Beck Anxiety Inventory in order to evaluate results of treatment. Results and its discussion. The best results of therapy were in the first and second groups of study participants, using individual cognitive - behavioral therapy and a combination of cognitive therapy and pharmacotherapy. Therapeutic outcomes in both groups are comparable. The use of pharmacotherapy without psychotherapy in the third (control) group of students showed the least effectiveness. Conclusions. Social anxiety of the severity degrees positively correlates with the eating disorders. The problems of social fears and eating disorders among young people require further research and attention from health officials.

Persistent postural perceptual dizziness (PPPD) is a common chronic vestibular disorder characterized by persistent vestibular symptoms, including postural instability and non-spinning vertigo, which is aggravated by motion, upright posture and moving or complex visual stimuli. In our review of 198 cases seen over a 5 year period, we have confirmed a number of common precipitating conditions for PPPD, including anxiety disorders and vestibular migraine. Vestibular abnormalities, including a unilateral loss of vestibular hypofunction and isolated otolith abnormalities, were found on investigation in just under half the cases. The use of cognitive behavioral therapy (CBT) as a treatment for PPPD resulted in impressive reductions in anxiety and measures of dizziness over follow up periods of up to 6 months.

Background: Face-to-face cognitive behavioral therapy (CBT) is one of the most widely used non-pharmacological treatment approaches for insomnia. The aim of this study is to assess the efficacy of face-to-face delivered CBT on health outcomes and to evaluate the effect of CBT components as subgroup variables to explain the efficacy of face-to-face delivered CBT on health outcomes in adults over 18 years old with insomnia.Methods: Relevant randomized controlled trial studies published in the past 22 years were searched through the electronic databases. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the 31 included studies. The mean difference and standard deviation of outcome variables and subgroup variables were analyzed using random effect model, and the heterogeneity among the articles was assessed with the Q-test and I2. Egger regression analysis was used to assess publication bias.Results: The meta-analysis showed a significant reduction in Insomnia Severity Index [standardized mean difference (SMD) = −2.56, 95% CI −3.81 to −1.30, p < 0.001], Pittsburgh Sleep Quality Index (SMD = −0.96, 95% CI −1.25 to −0.68, p < 0.001), sleep onset latency (SMD = −1.31, 95% CI −2.00 to −0.63, p < 0.001), wakening after sleep onset (SMD = −1.44, 95% CI −2.14 to −0.74, p < 0.001), number of awakenings (SMD = −1.18, 95% CI −2.10 to −0.26, p < 0.05), depression (SMD = −1.14, 95% CI −1.85 to −0.42, p < 0.01), and fatigue (SMD = −2.23, 95% CI −3.87 to −0.58, p < 0.01), and a significant increase in total sleep time (SMD = 0.63, 95% CI 0.28 to 0.98, p < 0.001), sleep efficiency (SMD = 1.61, 95% CI 0.92 to 2.29, p < 0.001), and physical health (SMD = 0.42, 95% CI 0.08 to 0.76, p < 0.05), in the CBT intervention group compared with the control group. There was no significant change in anxiety (SMD = −0.62, 95% CI −1.55 to 0.32, p > 0.05) and mental health (SMD = 1.09, 95% CI −0.59 to 2.77, p > 0.05) in CBT intervention group compared with control group. Group-delivered studies with larger number of intervention sessions and longer duration of single session provided a larger improvement in sleep quality.Conclusion: Face-to-face delivered CBT is effective in increasing total sleep time, sleep efficiency, and physical health, and reducing Insomnia Severity Index scores, Pittsburgh Sleep Quality Index scores, sleep onset latency, wakening after sleep onset, number of awakenings, depression, anxiety, and fatigue in patients with insomnia. Face-to-face delivered CBT is more effective when delivered through a larger number of sessions with longer duration of each session, and when delivered in groups. Face-to-face CBT is recommended to provide treatment to patients with insomnia in clinical settings.Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200091, identifier: CRD4202020009.

Introduction Obsessive–compulsive disorder (OCD) is a disabling mental health disorder affecting 1–3% of children and adolescents. Cognitive behavioral therapy (CBT) is recommended as the first-line treatment, but is limited by accessibility, availability, and, in some cases, response to treatment. Enhancement with Internet technologies may mitigate these challenges. Methods We developed an enhanced CBT (eCBT) treatment package for children and adolescents with OCD to improve treatment effect as well as user-friendliness. This study aims to explore the feasibility, acceptability, and preliminary effectiveness of the eCBT intervention. The eCBT protocol consists of 10 face-to-face and 12 webcam sessions delivered in 14 weeks. CBT is enhanced by a smartphone application (app) for children and parents to support and monitor treatment, psychoeducative videos, and therapist-guided webcam exposure exercises conducted at home. Assessments were performed at baseline, post-treatment, and at 3- and 6-month follow-up. Primary measures of outcomes were the the Client Satisfaction Questionnaire-8 (CSQ-8) (acceptability), treatment drop-out (feasibility) and the Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS) (preliminary effectiveness). Results This paper describes 25 patients with OCD (aged 8–17 years) treated with eCBT. Results indicated that children and parents were satisfied with eCBT, with CSQ-8 mean scores of 27.58 (SD 0.67) and 29.5 (SD 3.74), respectively (range 8–32). No patients dropped out from treatment. We found a mean of 63.8% symptom reduction on the CY-BOCS from baseline to post-treatment. CY-BOCS scores further decreased during 3-month and 6-month follow-up. Conclusion In this explorative study, eCBT for pediatric OCD was a feasible, acceptable intervention demonstrating positive treatment outcomes.

Objective Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women. Methods This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECTwas conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group. Results The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33±23.09) and after (88.08±10.51) counseling in the intervention group (p

Background and Objectives: While the consequences of the COVID-19 pandemic for general mental health and the increase in anxiety and depression are clear, less is known about the potential effect of the pandemic on OCD. The purpose of this study is to collect new data to monitor the symptomatic status of patients with OCD during the period of emergency due to COVID-19 and to make a comparison between two psychodiagnostic evaluations.Methods: Eleven OCD patients and their psychotherapists were recruited. All patients had a specific psychodiagnostic assessment for OCD (SCL-90; OCI-R; Y-BOCS self-report) performed between December 2019 and January 2020 (t0), and undertook cognitive behavioral therapy (CBT) and exposure and prevention of response protocol (ERP) before the lockdown. The psychodiagnostic assessment carried out at t0 was re-administered (t1) to all patients, together with a set of qualitative questions collected through an online survey. The respective therapists were asked to document the status of the therapy and the monitoring of symptoms through use of a semi-structured interview (Y-BOCS) and a qualitative interview. Non-parametric analyses were conducted.Results: Patients reported a significant decrease in OCD symptoms. Data analysis showed a decrease in the scores across t0 and at t1 on the Y-BOCS (SR) total self-report, and on OCD symptoms' severity assessed by means of the OCI-r and SCL-90 r OC subscale, for 11 participants. Relating to the measures detected by psychotherapists, marginally significant improvements and lower scores were found in the Y-BOCS (I). An improvement in symptoms was noticed by 90.9% of the clinical sample; this was confirmed by 45.4% of the therapists, who claimed moderate progress in their patients.Conclusions: The data collected through standardized measurements at two different times, albeit relative to a small sample, assume relevance from a clinical point of view. In the literature, some studies document the worsening of OCD. However, in many studies, the type of treatment, the detection time, and the intervention period are not well-specified. These results confirm the effectiveness of CBT/ERP as an elective treatment for OCD through a specific intervention procedure.

Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI.

Cognitive behavioral therapy (CBT) including exposure and response prevention is a well-established treatment for obsessive-compulsive disorder (OCD) and is based on the principles of fear extinction. Fear extinction is linked to structural and functional variability in the ventromedial prefrontal cortex (vmPFC) and has been consistently associated with glutamate neurotransmission. The relationship between vmPFC glutamate and fear extinction and its effects on CBT outcome have not yet been explored in adults with OCD. We assessed glutamate levels in the vmPFC using 3T magnetic resonance spectroscopy, and fear extinction (learning and recall) using skin conductance responses during a 2-day experimental paradigm in OCD patients (n = 17) and in healthy controls (HC; n = 13). Obsessive-compulsive patients (n = 12) then received manualized CBT. Glutamate in the vmPFC was negatively associated with fear extinction recall and positively associated with CBT outcome (with higher glutamate levels predicting a better outcome) in OCD patients. Glutamate levels in the vmPFC in OCD patients were not significantly different from those in HC, and were not associated with OCD severity. Our results suggest that glutamate in the vmPFC is associated with fear extinction recall and CBT outcome in adult OCD patients.

The study aimed to evaluate an integrated intensive cognitive behavioral therapy (CBT) group treatment for people with substance-related syndrome in outpatient care and to identify eventual gender differences. The study population consisted of 35 outpatients (18 male, 17 female) at a clinic in Western Sweden. The patients completed a four-month period of intensive group therapy and participated in the data collection at admission and discharge. The data were collected using the following inventories: Beck Depression and Anxiety Inventories, Rosenberg Self-Esteem Scale,Hopelessness Scale, and Trait Hope Scale. Results showed decreases in anxiety, depression and experience of hopelessness, and increases in self-esteem and hope. In females, the most dramatic improvement was measured for the anxiety and depression attributes, while in males the strongest effect was measured for hope and self-esteem. This study provides clinical evidence of the positive effects of integrated intensive CBT in outpatient care of people with substance-related syndrome. Funders:MeSHe Clinical https://meshe.se/meshe-clinical/

Background To develop and test the feasibility and initial effectiveness of the Treatment and Education Approach for Childhood-onset Lupus (TEACH) protocol, a 6-session cognitive behavioral therapy (CBT) intervention for adolescents and young adults (AYA) with childhood-onset systemic lupus erythematosus (cSLE). Methods Females with cSLE (n = 14; ages 13–19 years, M = 16.21 years) presenting to a pediatric rheumatology clinic subsequently completed the protocol, which was iteratively modified based on participant/interventionist feedback. Upon intervention completion, participants provided qualitative data on feasibility, acceptability, potential modifications, and perceived effectiveness of the program via a semi-structured interview, which was analyzed for shared themes. Participants also completed measures of fatigue, psychological distress, and pain intensity before and after the intervention. Nonparametric statistics were conducted to examine changes in outcome measures following the intervention. Results During the study, several protocol modifications were employed to better address the unique needs of individuals with cSLE (e.g., separate content for adolescents versus young adults). Results suggest that TEACH is feasible, acceptable, and potentially effective in the management of cSLE symptoms. Following the intervention, there was a statistically significant reduction in fatigue (Z = − 2.81, p

Traumatic life events are among the etiological factors that may trigger eating disorders (ED). In the present study, we examined the effects of Eye Movement Desensitization and Reprocessing (EMDR) therapy and Cognitive Behavioral Therapy (CBT) therapies combined on two young girls, who had symptoms of ED as a consequence of their traumatic experiences. Two Caucasian female patients arrived at the clinic with highly similar complaints about eating. They both were mutually holding the fear that food would get stuck in their throat, breathing would be impeded and their heart rate would increase; creating an inability to swallow while eating. This culminated in a fear of death through asphyxiation while eating. In the initial interviews, the clients revealed past traumatic events in which a food blockage in the throat led to a temporary inability to breathe. Therefore, we conducted EMDR therapy combined with CBT. Both were treated with seven sessions of EMDR therapy and nine sessions of CBT, after which symptoms were reduced to minimum. In this case study, EMDR therapy combined with CBT proved to be effective by neutralizing the impact of previous trauma on ED symptomatology.

Objective: Cancer is associated with some psychological problems that play an important role in the severity and continuity of cancer. Cancer may lead to maladaptive psychological reactions such as anxiety, depression, and fatigue. Depression and anxiety are highly prevalent in cancer patients. This study aimed to compare the efficacy of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) for anxiety, depression, and fatigue in cancer patients. Method: The present study was a randomized clinical trial (RCT). Of the 100 patients diagnosed with cancer, 60 patients were eligible to participate in this study according to the inclusion / exclusion criteria. They were randomly assigned into 3 groups: MBCT, CBT, and wait-list group (WLG). Afterward, the experimental groups received 8 weekly treatment sessions. All the participants fulfilled the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Cancer-Related Fatigue Scale (CFS) before and after the intervention. Data were analyzed using SPSS-16 software by Analysis of Covariance (ANCOVA). Results: The results indicated a significant reduction in depression, anxiety, and fatigue scores in CBT and MBCT groups. There was a significant difference between both treatment groups with WLG in the anxiety and depression, but no significant difference was found between MBCT and CBT groups. Additionally, there was only a significant difference between the CBT group and WLG in terms of fatigue (P = 0.01). Conclusion: CBT and MBCT performed equally well in decreasing anxiety and depression in cancer patients, and they were significantly better than WLG. It seems that MBCT is a good alternative to CBT for decreasing emotional symptoms in cancer patients. As a result, CBT and MBCT could be considered a good addition to pharmacological treatment of cancer patients with comorbid psychological symptoms. However, CBT was preferable to MBCT in decreasing fatigue. The study was registered at the irct.ir database under registration number IRCT20180503039509N1.

Depuis une vingtaine d’années, le champ psychothérapeutique, en France, en Angleterre et aux Pays-Bas, est engagé dans de profondes transformations. Dans une perspective socio-historique, cet article rend compte de trois temps : la formation d’un champ psychothérapeutique spécifique dans chacun des trois pays puis l’extension de la psychothérapie démédicalisée dans les années 1960-70 ; la constitution en priorité de santé publique des troubles courants devenus troubles de masse dans les années 1980-90, avec, à partir des années 2000, l’influence des politiques européennes ; enfin la redéfinition de la psychothérapie dans un contexte favorisant les thérapies fondées sur les preuves et le travail sur les capacités psychosociales. Si de semblables tendances s’observent, des spécificités nationales se maintiennent qui seront explicitées ici. For twenty years, the psychotherapeutic field in France, England and the Netherlands, has undergone significant transformations in relation to methods and professionals groups. In a socio-historical perspective, this paper brings describes three stages: in the 1960s and 1970s the formation of a specific psychotherapeutic field in these three countries, sharing a similar processes of extension and psychologization of psychotherapy; throughout the 1980s and 1990s, common mental health disorders which became mass disorders, have been elaborated as a public health priority with the influence of European policies since the 2000s; finally, psychotherapy has been redefined in a context that now emphasises evidence-based interventions that enhance psychosocial capacities and give precedence to Cognitive-Behavioural Therapies. While similar trends are observed in these countries, national characteristics nonetheless remain strong. Lógicas de las transformaciones en el ámbito psicoterapéutico en Inglaterra, Francia y en los Países Bajos: especificidades nacionales y tendencias comunesDesde hace dos décadas el ámbito psicoterapéutico en estos tres países ha experimentado profundas transformaciones. Dentro de una perspectiva sociohistórica el artículo pone en evidencia tres etapas : la formación de un ámbito psicoterapéutico específico en cada uno de esos tres países, la extensión de la psicoterapia desmedicalizada en los años sesenta y setenta y la toma de conciencia en tanto que problemas de salud pública de patologías cotidianas, consideradas como problemas de masa en los años ochenta y noventa con, a partir de la década del 2000, la influencia de las políticas europeas y finalmente la redefinición de la psicoterapia en un contexto que fervoriza las terapias probadas y el interés mostrado por las capacidades psicosociales. Si esta evolución es general las especificadas nacionales, descritas en el artículo, son evidentes.

Recent meta-analyses indicated differences in fear acquisition and extinction between patients with anxiety-related disorders and comparison subjects. However, these effects are small and may hold for only a subsample of patients. To investigate individual trajectories in fear acquisition and extinction across patients with anxiety-related disorders (N = 104; before treatment) and comparison subjects (N = 93), data from a previous study (Duits et al., 2017) were re-analyzed using data-driven latent class growth analyses. In this explorative study, subjective fear ratings, shock expectancy ratings and startle responses were used as outcome measures. Fear and expectancy ratings, but not startle data, yielded distinct fear conditioning trajectories across participants. Patients were, compared to controls, overrepresented in two distinct dysfunctional fear conditioning trajectories: impaired safety learning and poor fear extinction to danger cues. The profiling of individual patterns allowed to determine that whereas a subset of patients showed trajectories of dysfunctional fear conditioning, a significant proportion of patients (≥50 %) did not. The strength of trajectory analyses as opposed to group analyses is that it allows the identification of individuals with dysfunctional fear conditioning. Results suggested that dysfunctional fear learning may also be associated with poor treatment outcome, but further research in larger samples is needed to address this question.

Recent meta-analyses indicated differences in fear acquisition and extinction between patients with anxiety related disorders and comparison subjects. However, these effects are small and may hold for only a subsample of patients. To investigate individual trajectories in fear acquisition and extinction across patients with anxiety-related disorders (N = 104; before treatment) and comparison subjects (N = 93), data from a previous study (Duits et al., 2017) were re-analyzed using data-driven latent class growth analyses. In this explorative study, subjective fear ratings, shock expectancy ratings and startle responses were used as outcome measures. Fear and expectancy ratings, but not startle data, yielded distinct fear conditioning trajectories across participants. Patients were, compared to controls, overrepresented in two distinct dysfunctional fear conditioning trajectories: impaired safety learning and poor fear extinction to danger cues. The profiling of individual patterns allowed to determine that whereas a subset of patients showed trajectories of dysfunctional fear conditioning, a significant proportion of patients (?50 %) did not. The strength of trajectory analyses as opposed to group analyses is that it allows the identification of individuals with dysfunctional fear conditioning. Results suggested that dysfunctional fear learning may also be associated with poor treatment outcome, but further research in larger samples is needed to address this question.

Actualment, la Teràpia cognitivoconductual (TCC) gaudeix d'un fort període d'expansió i reconeixement, esdevenint la teràpia de referència. En el present article prenc una posició crítica davant aquesta realitat, plantejant la TCC com una pràctica hegemònica i analitzant les implicacions sociopolítiques que això comporta. Per tal de dur-ho a terme, he realitzat un estudi de cas de la teràpia, analitzant el model de subjecte sobre el qual la TCC opera. Una vegada analit-zat, m'he centrat en relacionar aquest subjecte amb el concepte foucaultià de l'"empresari de si mateix", establint que el model de subjecte que es construeix amb la teràpia és proper al model de subjecte neoliberal, plantejant així les re-percussions d'aquesta relació en termes de relacions de poder i hegemonia. Finalment, em qüestiono el paper de la universitat en aquest procés. Cognitive Behavioral Therapy (CBT) nowadays enjoys a strong period of strong expansion and recognition, becoming the most worldwide accepted therapy. In this article, I pretend to show a critical position against this fact, considering the CBT as a hegemonic practice and analyzing the socio-political implications that this entails. In order to carry out this analysis, I have conducted a case study of this therapy, analyzing the model subject on which it operates. Once analyzed, this work has focused on how this subject relates with the Foucaultian concept of "entrepreneur of himself ", setting that the subject built by the therapy is a neoliberal one. Next, I consider the implications of this relationship in terms of power relations and hegemony. Finally, I critically reflect on the role of universi-ties in this process.

This study investigates the effectiveness of the school-based Shine Through Any Roadblocks (STAR) CBT intervention, by a screening conducted on 634 students from eight secondary schools in Malaysia. Participants (n = 85) who fulfilled the eligibility criteria were assigned randomly to either the intervention group (n = 42) or the assessment-only waitlist control group (n = 43). The intervention consisted of eight group-based sessions over a period of 2 months. Sessions were 60-min each and conducted according to the STAR module. Outcome measures (depressive symptoms and automatic negative thoughts) were administered at five intervals: baseline/pre-intervention, mid-intervention, post-intervention, 1-month after intervention, and 3-months after intervention. Results showed significant and lasting lower levels of depressive symptoms and automatic negative thoughts in the intervention group, indicating that the STAR intervention could be an effective means of reducing depressive symptomatology among adolescents. Clinical implications for the Malaysian secondary school context are further discussed.

Introduction: Mental health issues are on an exponential rise in Kashmir due to varied reasons including political instability, eco fragility, the growing lag in the provision of education and employment, and several other reasons. Impediments such as the overwhelming stigma and the cultural sensitivity associated with mental health issues both sustain and perpetuate mental ill health and also prevent any treatment and rehabilitation. This article describes the protocol of a research project, funded by the Indian Council of Medical Research, which aims to address this issue. Aim: To screen the population for mental health issues and to provide community-based intervention for the identified cases also to train community health workers for sustainable mental health support. Methods: We will conduct a household survey using the Hopkins Symptom Checklist (HSCL-25) for the identification of the clients. A multi-stage random sampling shall be used to select the villages and the households from the marginalized communities. A sample of 500 respondents shall be screened using HSCL-25. Those who screen positive for mental health issues will be offered cognitive behavioral therapy (CBT) by a qualified clinical psychologist. The research will be able to address the diagnosis of depression and anxiety-related cases and the subsequent intervention. Additionally, we will utilize the facilitator’s manual for Mental Health Training Program for Community Health Workers to build sustainable mental health services in community settings. Discussion: The study shall present a roadmap focusing on the indispensability of a comprehensive community-based intervention on mental health utilizing a non-pharmacological method. Assessing and analyzing the dynamics of mental health illness first hand, the study shall move ahead to offer a culturally tailored counseling program at the community level. The study also aims to highlight the role of the indigenous human resource (community health workers) and how its participation leads to a more scientific and sustainable intervention for more effective results, with an increased level of awareness and sensitization in a conventional society like Kashmir.

BackgroundIndividuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues (including symptoms of stress, anxiety, and depression). The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention (Psychological Intervention tailored for Patients with Cognitive Impairment, PIPCI) manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial (RCT)-design and methods. The main hypothesis is that participants receiving PIPCI will increase their psychological flexibility (the ability to notice and accept interfering thoughts, emotions, and bodily sensations without acting on them, when this serves action in line with personal values) compared to participants in the active control (cognitive training) group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health (stress measures, quality of life, depression, and general health) compared to participants in the active control group and the waiting list control group.Materials and MethodsThis three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group (psychological intervention once a week for 10 weeks), an active control group (cognitive training once a week for 10 weeks) or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers (obtained from blood and saliva) and health care costs. Assessments will be performed at pre- (1 week before the interventions) and post-intervention (1 week after the interventions), as well as at a 6-month follow-up.DiscussionThe development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment (PIPCI) has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia.Clinical Trial RegistrationClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924.

Background Individuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues (including symptoms of stress, anxiety, and depression). The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention (Psychological Intervention tailored for Patients with Cognitive Impairment, PIPCI) manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial (RCT)-design and methods. The main hypothesis is that participants receiving PIPCI will increase their psychological flexibility (the ability to notice and accept interfering thoughts, emotions, and bodily sensations without acting on them, when this serves action in line with personal values) compared to participants in the active control (cognitive training) group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health (stress measures, quality of life, depression, and general health) compared to participants in the active control group and the waiting list control group. Materials and Methods This three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group (psychological intervention once a week for 10 weeks), an active control group (cognitive training once a week for 10 weeks) or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers (obtained from blood and saliva) and health care costs. Assessments will be performed at pre- (1 week before the interventions) and post-intervention (1 week after the interventions), as well as at a 6-month follow-up. Discussion The development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment (PIPCI) has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia. Clinical Trial Registration ClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924.

Background: As a public health emergency of international concern, the COVID-19 outbreak has had a tremendous impact on patients' psychological health. However, studies on psychological interventions in patients with COVID-19 are relatively rare.Objectives: This study examined the effectiveness of Cognitive Behavioral Therapy (CBT) in relieving patients' psychological distress during the COVID-19 epidemic.Methods: Ninety-three eligible participants selected by cluster sampling were randomized to an intervention group (N = 47) and a control group (N = 46). Participants in the control group received routine treatment according to the Chinese Management Guidelines for COVID-19, while participants in the intervention group received routine treatment with additional CBT. The Chinese Version of Depression Anxiety and Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress for all participants at baseline and post-intervention. Two-sided t-test, and proportion tests were used to examine the differences between the intervention and control group for each DASS-21 indicator. Univariate linear regression was used to examine the association between chronic disease status and change in each DASS-21 indicator after intervention. Two-way scatter plots were generated to show the association of the length of hospital stay and the changes of each DASS-21 indicator by intervention and control groups.Results: Significant decreases in means were found for scales of depression, anxiety, stress and total DASS-21 in both intervention (p < 0.001) and control group (p = 0.001), with participants in the intervention group having a bigger reduction in means. After the intervention, more participants in the intervention group had no depression or anxiety symptoms than in the control group, but no statistical differences were found (p > 0.05). Compared with participants with chronic disease, participants with no chronic disease had a significantly larger reduction of total DASS-21 scale (coefficient = −4.74, 95% CI: −9.31; −0.17).The length of hospital stay was significantly associated with a greater increase in anxiety scale in the intervention group (p = 0.005), whilst no significant association was found in the control group (p = 0.29).Conclusions: The patients with COVID-19 experienced high levels of anxiety, depression and stress. Our study result highlights the effectiveness of CBT in improving the psychological health among patients with COVID-19, also suggests that CBT should be focused on patients with chronic disease and those who have longer hospital stays. These results have important implications in clinical practice in improving psychological health in the context of COVID-19 pandemic.Trial Registration: ISRCTN68675756. Available at: http://www.isrctn.com/ISRCTN68675756.

In caring for persons with diabetes (PWD), healthcare professionals (HCP) have an important role to play when it comes to offering psychosocial support as integral part of ongoing diabetes care. Inquiring about and discussing emotional health with PWD is appreciated by them and can help to identify problem areas that require further assessment. For this purpose practical, validated self-report measures of well-being and diabetes distress are available for use in routine care. Based on a needs assessment, PWD may be offered psychosocial support by one of the team members (physician, nurse educator, dietitian) or a referral to a specialized mental health professional, preferably as part of team care. There is convincing evidence that cognitive behavioral therapy (CBT) is effective in reducing emotional distress and enhancing coping skills in PWD, with subsequent improvements of self-care and glycemic control, at least on the short term. Next to diabetes distress and depression, chronic fatigue has shown to be prevalent among PWD. Here too, CBT has been shown to be effective. Internet-based CBT is increasingly used, which allows for economic and patient-friendly delivery of psychotherapy while reaching a large audience. Further research is warranted to develop effective strategies for successful implementation of integral psychological support for PWD with psychological comorbidity, addressing the medical and the psychological needs of PWD.

Background:40% of people with dementia have disturbed sleep but there are currently no known effective treatments. Studies of sleep hygiene and light therapy have not been powered to indicate feasibility and acceptability and have shown 40–50% retention. We tested the feasibility and acceptability of a six-session manualized evidence-based non-pharmacological therapy; Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS-START) for sleep disturbance in people with dementia.Methods:We conducted a parallel, two-armed, single-blind randomized trial and randomized 2:1 to intervention: Treatment as Usual. Eligible participants had dementia and sleep disturbances (scoring ≥4 on one Sleep Disorders Inventory item) and a family carer and were recruited from two London memory services and Join Dementia Research. Participants wore an actiwatch for two weeks pre-randomization. Trained, clinically supervised psychology graduates delivered DREAMS-START to carers randomized to intervention; covering Understanding sleep and dementia; Making a plan (incorporating actiwatch information, light exposure using a light box); Daytime activity and routine; Difficult night-time behaviors; Taking care of your own (carer's) sleep; and What works? Strategies for the future. Carers kept their manual, light box, and relaxation recordings post-intervention. Outcome assessment was masked to allocation. The co-primary outcomes were feasibility (≥50% eligible people consenting to the study) and acceptability (≥75% of intervention group attending ≥4 intervention sessions).Results:In total, 63out of 95 (66%; 95% CI: 56–76%) eligible referrals consented between 04/08/2016 and 24/03/2017; 62 (65%; 95% CI: 55–75%) were randomized, and 37 out of 42 (88%; 95% CI: 75–96%) adhered to the intervention.Conclusions:DREAM-START for sleep disorders in dementia is feasible and acceptable.

Contains fulltext : 203503.pdf (Publisher’s version ) (Open Access) Introduction. Sentiment analysis may be a useful technique to derive a user’s emotional state from free text input, allowing for more empathic automated feedback in online cognitive behavioral therapy (iCBT) interventions for psychological disorders such as depression. As guided iCBT is considered more effective than unguided iCBT, such automated feedback may help close the gap between the two. The accuracy of automated sentiment analysis is domain dependent, and it is unclear how well the technology is applicable iCBT. This paper presents an empirical study in which automated sentiment analysis by an algorithm for the Dutch language is validated against human judgment. Method. A total of 493 iCBT user texts were evaluated on overall sentiment and the presence of five specific emotions by an algorithm, and by 52 psychology students who evaluated 75 randomly selected texts each, providing about eight human evaluations per text. Inter-rater agreement (IRR) between algorithm and humans, and humans among each other, was analyzed by calculating the intra-class correlation under a numerical interpretation of the data, and Cohen’s Kappa, and Krippendorff’s Alpha under a categorical interpretation. Results. All analyses indicated moderate agreement between the algorithm and average human judgement with respect to evaluating overall sentiment, and low agreement for the specific emotions. Somewhat surprisingly, the same was the case for the IRR among human judges, which means that the algorithm performed about as well as a randomly selected human judge. Thus, considering average human judgment as a benchmark for the applicability of automated sentiment analysis, the technique can be considered for practical application. Discussion/conclusion. The low human-human agreement on the presence of emotions may be due to the nature of the texts, it may simply be difficult for humans to agree on the presence of the selected emotions, or perhaps trained therapists would have reached more consensus. Future research may focus on validating the algorithm against a more solid benchmark, on applying the algorithm in an application in which empathic feedback is provided, for example, by an embodied conversational agent, or on improving the algorithm for the iCBT domain with a bottom-up machine learning approach. 12 p.

Atypical attention to potential social threats, such as emotional faces, may be one of the core mechanisms underlying social anxiety disorder (SAD). Pupil dilation is an index of locus coreuleus-noradrenergic activity, and closely linked to attention. In the present study, pupil dilation was studied in adolescents with SAD (N = 26; 22 Female) before the onset of a 12-week cognitive behavioral treatment, and in healthy controls (N = 23). Stimuli were faces with angry or happy emotional expressions. Contrary to our hypothesis, the SAD group did not show hyper-responsiveness to angry compared to happy faces. Instead, an atypical time course of the pupil dilation response was found, resulting in an attenuated response during late time stages. Larger pupil dilation amplitude to happy faces before treatment was related to worse treatment response. These results contribute significantly to our understanding of the mechanisms underlying adolescent SAD.

BACKGROUND: Research on which therapy processes are crucial for whom is necessary to optimize treatment outcomes for major depressive disorder (MDD) but may be impeded by a lack of variation in therapy quality and because of individual differences in therapy response. The present study used a dataset with large variation in therapy quality to investigate the impact of therapy quality on change in therapy processes and outcome. Machine-learning techniques were used to explore individual differences in these relationships.METHOD: Data come from a multicenter trial that randomized patients with MDD into weekly versus twice weekly sessions of cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT). Correlations between quality of therapy, change in therapy processes and depressive symptoms were calculated. Using elastic net regression, a prognostic model was developed that investigated individual differences.RESULTS: There were no significant correlations between therapy quality and change in therapy process variables or between therapy quality and therapy outcome, except between therapy quality and dysfunctional thinking and IPT skills. Improvement in therapy processes played a larger role in patients whose therapy outcome was poorly predicted by their baseline characteristics.CONCLUSIONS: In this study, in which therapy quality varied considerably, we found that therapy quality was not related to change in therapy processes or outcome. In addition, this study provides a first demonstration of proposed methods to identify individual responses to change in therapy processes. Results suggested that the importance of certain therapy processes might differ between patients. Future research into the relation between therapy quality, change in therapy processes and outcome should take into account the variation of therapy quality, focus on improved measurement of therapy quality and use a combination of machine learning techniques and experimental lab studies to determine to which extent and for whom therapy quality and change in therapy processes matter.

Background:Transcutaneous electrical acupoint stimulation (TEAS) is thought to have potential to treat obsessive-compulsive disorder (OCD). Objective:The purpose of this study was to determine whether adding TEAS to cognitive behavioral therapy (CBT) and clomipramine would improve the efficacy of these conventional treatments in OCD. Methods:In this randomized controlled trial, 360 OCD patients were assigned to receive TEAS combined with CBT plus clomipramine (Group A, n = 120), TEAS combined with CBT plus placebo (Group B, n = 120), and simulated (placebo) TEAS combined with CBT plus clomipramine (Group C, n = 120) for 12 weeks. The primary outcome was measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Results OCD symptoms in all patients reduced over time, however Groups A and B had a significantly greater reduction in Y-BOCS total score and the subscale for obsession and compulsion between week 2 and week 12 compared to Group C. Groups A and B had similar scores on these measures. Both groups had significantly higher rates of clinical response than Group C (88.3% and 81.7% vs. 67.5%, respectively, p Conclusions:TEAS enhances the efficacy of conventional OCD interventions and avoids the adverse effects associated with conventional pharmacological treatment. It can be considered as an effective adjunct intervention for OCD.

The purpose of the present pilot study was to explore the moderating role of basal inflammation on the effects of behavioral pain treatment in 41 patients with long-standing pain. Baseline pro-inflammatory status moderated behavioral treatment outcomes: higher pre-treatment levels of Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-6 were related to less improvement in pain intensity, psychological inflexibility and in mental health-related quality of life. The treatment outcomes improved in the subgroup that had low levels of pro-inflammatory cytokines at baseline, while the subjects with higher pro-inflammatory status did not. Altogether, results indicate that low-grade inflammation may influence the behavioral treatment outcomes and provide a possible explanation of the heterogeneity in treatment response. OA hybrid - CA extern

Introduction: Cognitive behavioral therapy (CBT) as the chosen therapy of social anxiety disorder (SAD) although received increased support, it has some fluctuations. Therefore, the purpose of current study is to determine and compare the effectiveness and durability of three CBT patterns based on "exposure to self”, “exposure to situation" and “exposure to self-situation" on treatment of SAD. Method: In this quasi-experimental research, 24 subjects with SAD were selected based on Social Phobia Inventory (SPIN) and Structured Clinical Interview for Diagnostic and Statistical Manual of mental disorders (SCID-IV). Eighteen subjects were randomly assigned to three experimental groups (each group consisted of 6 subjects) and six subjects were assigned to control group and four groups were demographically the same. Three experimental groups treated by one of the three CBT models and the control group waited. Subjects completed SPIN, LSAS-SR, BFNE, SIAS, SPS, and NSPS scales in addition to the scale of SPLN, before starting and after finishing in the period of a month and a half, four months and 1 year after ending of treatment/ waiting. Results: The comparison of four groups based on the difference mean of pre and post test showed that three CBT patterns have a meaningful difference with the control group but they have no meaningful difference with each other. Of course, the difference mean of the "exposure to self” group had a significant difference with control group in all dependent variables (the score of 6 scales of social anxiety), whereas, the difference mean of the “exposure to self-situation” and “exposure to situation” groups had a significant difference with control group in some of the six scales. The results show that all three aforementioned therapeutic models had effectiveness and durability but “exposure to self” group had superiorities over the other two groups. Discussion and Conclusion: The results show that all three CBT models are useful in Iranian clinical sample but, “exposure to self” group had superiorities than the two other groups in some evidences.

Research in clinical psycho-oncology is becoming an area of key importance in investigating the effects of the interventions of support and/or psychotherapy with patients. This study was conducted with the aim of evaluating the effectiveness of the eye movement desensitization and reprocessing (EMDR) approach compared to a non–trauma-focused cognitive behavioral therapy (CBT) intervention. There were 11 male and 46 female participants, with mixed cancer diagnoses. Thirty-one subjects received EMDR therapy, and 26 received CBT for 12 sessions of 60 minutes each. The Symptom Checklist-90-R (SCL-90-R), COPE inventory, and Davidson Trauma Scale (DTS) were administered at three different times (T0, before intervention; T1, after the sixth session; and T2, after the 12th session); the Karnofsky Performance Status was administered at T0 only. In the EMDR group, a significant improvement was reported for the following 11 of the 17 dependent variables: COPE subscales, Avoidance Strategies and Positive Attitude; all three DTS subscales, Intrusion, Avoidance, and Hyperarousal; and 6 SCL-90-R subscales. In the CBT group, a significant improvement was reported for the following 4 of the 17 dependent variables: COPE subscales Positive Attitude and Transcendent Orientation; two DTS subscales, Intrusion, and Avoidance, with no improvement on any of the SCL-90-R subscales. This innovative study shows the value of trauma-focused treatment for patients with cancer and allows important preliminary suggestions on the usefulness of applying EMDR therapy in an oncological setting, although further research in this context is still needed.

Background Post-traumatic stress disorder (PTSD) is prevalent in children, adolescents and adults. It can occur alone or in comorbidity with other disorders. A broad range of psychotherapies such as cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) have been developed for the treatment of PTSD. Aim Through quantitative meta-analysis, we aimed to compare the efficacy of CBT and EMDR: (i) relieving the post-traumatic symptoms, and (ii) alleviating anxiety and depression, in patients with PTSD. Methods We systematically searched EMBASE, Medline and Cochrane central register of controlled trials (CENTRAL) for articles published between 1999 and December 2017. Randomized clinical trials (RCTs) that compare CBT and EMDR in PTSD patients were included for quantitative meta-analysis using RevMan Version 5. Results Fourteen studies out of 714 were finally eligible. Meta-analysis of 11 studies (n = 547) showed that EMDR is better than CBT in reducing post-traumatic symptoms [SDM (95% CI) = -0.43 (-0.73 – -0.12), p = 0.006]. However, meta-analysis of four studies (n = 186) at three-month follow-up revealed no statistically significant difference [SDM (95% CI) = -0.21 (-0.50 – 0.08), p = 0.15]. The EMDR was also better than CBT in reducing anxiety [SDM (95% CI) = -0.71 (-1.21 – -0.21), p = 0.005]. Unfortunately, there was no difference between CBT and EMDR in reducing depression [SDM (95% CI) = -0.21 (-0.44 – 0.02), p = 0.08]. Conclusion The results of this meta-analysis suggested that EMDR is better than CBT in reducing post-traumatic symptoms and anxiety. However, there was no difference reported in reducing depression. Large population randomized trials with longer follow-up are recommended to build conclusive evidence.

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies—cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)—in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value

Öğrenen makineler, sürücüsüz otomobiller, "cankurtaran" dronlar, yemek siparişini alırken müşteri ile sohbet eden yazılımlar, duyguları analiz eden tarayıcılar, cerrahi operasyon yapan robotlar gibi unsurlarla gelen bilgi çağı, baş döndüren bir hızla hayatımızı şekillendirmektedir. Ancak dijitalleşen bu dünyanın başrolünde hala insan olduğunu göz önüne alarak davranmak gerekmektedir. Bilgiyi değere dönüştüren, hedefe sürece ve sonuca anlam katan insan, tüm zamanların en değerli kaynağı olmaya devam ederken dünya genelinde her yıl binlerce kişi iş kazaları ve meslek hastalıkları sonucu yaşamını ya da çalışma gücünün kaybetmektedir. Sürdürülebilirliği hedefleyen işletmeler, insan kaynağını işle bağlantılı risklerden korumak ve potansiyelinin performansa dönüşmesini engelleyen unsurları en aza indirgemek için, teknolojiye her geçen gün daha fazla yatırım yapmaktadır. Bu çalışmada, iş kazaları ve meslek hastalıkları ile ortaya çıkan travma ilişkili psikolojik bozuklukların tedavisinde kullanılan "kontrollü maruz bırakma" yönteminin, bu kaza ve hastalıkları oluşmadan önlemek amaçlı eğitimlerde "sanal gerçeklikle deneyimsel öğrenme" tekniği olarak kullanılması incelenmiştir. Stratejik insan kaynakları bakış açısı ile "tazmin edici" nitelikteki reaktif yaklaşım yerine "önleyici" nitelikteki proaktif yaklaşıma geçilmesinin, işletmelere sağlayacağı yönetsel, finansal, itibari katkılar ortaya konmaya çalışılmıştır., learning machines, self-driving cars, "lifeguard" drones, software chatting with the customer while taking meal order, emotions analyzing scanners, robots performing surgical operation, etc. Information age is shaping our life at a great pace. However, it is necessary to act in view of the fact that still human is leading the increasingly digital world. While human who transforms into value, adds meaning to the goal, the process and the result continues to be the most valuable source of all time, each year thousands of people in the world lose their lives or their working power as a consequence of occupational accidents or diseases. That's precisely why businesses targeting sustainability are investing more and more in technology every day to minimize business-related risks threatening human resources and the elements that prevent turning its potential into performance. This study investigates the implementation of "controlled exposure" whisch is used in the treatment of trauma realted psychological disorders caused by occupational accidents and occupational diseases to "experiential learning with virtual reality" technique in trainings aimed at preventing accidents and sieases nefore they occur. It is tried to put forward the managerial, financial and reputational contributions of the "preventive" proactive approach, instead of the "compensatory" reactive approach by the strategic human resources point of view.

One of the most prevalent chronic pain syndromes in the hospital and outpatient rheumatologyclinic is fibromyalgia (FM). The current psychological treatment programs that havebeen developed for patients suffering from FM are based on Cognitive Behavioral Therapy(CBT). Many of these treatments have shown efficacy in isolation in empirical studiesin laboratory settings. Therefore, it is necessary to test the effectiveness of these treatmentprograms in natural settings such as a Mental Health Unit (USM). For the presentstudy, an intervention program has been developed, applied at a USM, aimed not only atreducing pain but also at providing the patient with tools to achieve better acceptance ofit, increase their positive emotions and their quality of life, therefore addressing better theproblem of pain.A pilot study was conducted to assess the preliminary efficacy of a psychological treatmentprogram that integrates CBT techniques along with positive psychology, acceptance,mindfulness and hypnosis tools (which have shown evidence in the treatment of chronicpain). The study involved 5 patients (4 women and 1 man) who received an 8 sessionprogram. Post- treatment results indicate that patients significantly increased their levelsof pain acceptance, self-pity, and quality of life. There is also an improvement in moodaccompanied by a reduction in pain interference.Our work provides preliminary data that support the usefulness of including new componentswhen addressing FM. Uno de los síndromes de dolor crónico más prevalente en la consulta hospitalaria y ambulatoriade reumatología es la fibromialgia (FM). Los programas de tratamiento psicológicosactuales que se han desarrollado para los pacientes que sufren FM están basadosen la Terapia Cognitivo Conductual (TCC). Muchos de estos tratamientos han mostradoeficacia de forma aislada en estudios empíricos en entornos de laboratorio. Por esto, esnecesario probar la eficacia de estos programas de tratamiento en entornos naturalescomo es el caso de una Unidad de Salud Mental (USM). Para el presente estudio seha desarrollado un programa de intervención, aplicado en una USM, dirigido no sólo ala reducción del dolor sino también a dotar al paciente de herramientas para lograr unamejor aceptación del mismo, aumentar sus emociones positivas y su calidad de vida,afrontando así de mejor manera el problema del dolor.Se realizó un estudio piloto con el fin de valorar la eficacia preliminar de un programa detratamiento psicológico que integra técnicas de la TCC junto con herramientas de psicologíapositiva, aceptación, mindfulness e hipnosis (que han mostrado evidencia en eltratamiento del dolor crónico). En el estudio participaron 5 pacientes (4 mujeres y 1 hombre)que recibieron dicho programa en 8 sesiones. Los resultados en el post-tratamientoindicaron que los pacientes aumentaron de manera significativa sus niveles de aceptacióndel dolor, auto-compasión y calidad de vida. Se observa también una mejora en elestado de ánimo acompañada de una reducción en la interferencia del dolor.Nuestro trabajo aporta datos preliminares que apoyan la utilidad de incluir nuevos componentesa la hora de abordar la FM

Chronic pain is a commonly occurring and debilitating condition, and among the costliest health problems for both the individual and society at large. Cognitive behavioral therapy (CBT) is the most widely-disseminated psychological treatment for chronic pain. Even though it is recommended and evidence-based, it yields quite modest improvements in pain-related functioning and accompanying symptoms of emotional distress. It is now generally acknowledged that further efforts are needed to improve the efficacy of CBT for chronic pain. Specifically, pain researchers have called for studies to identify mechanisms that underlie changes in treatment outcomes (mediators) and characteristics of the individual that predict improvements in these mechanisms and treatment overall (predictors and moderators). To address this call, the primary aim of this research program was to study whether changes in psychological flexibility mediated outcomes in a multi-disciplinary, group-based CBT program delivered at a regional specialist unit for pain rehabilitation. The secondary aim was to identify possible predictors of outcome by focusing on facets of psychological flexibility as well as the understudied influence of posttraumatic stress disorder (PTSD). This aim also included investigation of the relationships between PTSD, pain presentation, and psychological flexibility. With these two aims, we hoped to shed further light on the validity of the psychological flexibility model as an integrating, overarching model that can help define relevant treatment processes for adults presenting with chronic pain and psychiatric problems. Study I investigated whether pain-related acceptance, from the psychological flexibility model, and other variables posited as potential mediators in standard CBT mediated changes in pain-related outcomes measured at post-treatment and 12-month follow-up from the CBT program. The results highlighted the mediating role of pain-related acceptance across different indices of outcome.Study II evaluated the psychometric properties of the Swedish-language versions of the full length and shortened version of the Committed Action Questionnaire, as well as the generalizability of previous results related to committed action. The results supported the validity and reliability of the Swedish-language versions of the measure, the generalizability of earlier findings, and the relevance of committed action to health and functioning in individuals with chronic pain.Study III focused on the prevalence of traumatic experiences, trauma types, and PTSD in patients referred for treatment of chronic pain, and the relationship between PTSD and pain-related functioning prior to treatment. High rates of traumatic exposure and PTSD were found for chronic pain patients. The presence of PTSD in these patients was associated with worse clinical characteristics and an increased need for treatment.Study IV examined whether various processes from the psychological flexibility model mediated the relationship between PTSD and chronic pain. Results indicated that the relationship was mediated by pain-related acceptance, committed action, and cognitive fusion, where pain-related acceptance constituted the most influential mediator from the psychological flexibility model. Study V analysed whether indices of emotional distress (including PTSD) and different facets of psychological flexibility predicted pain-related outcomes at 12-month follow-up from the CBT program. Furthermore, it examined whether changes in processes from the psychological flexibility model mediated changes in pain-related outcomes. The only significant predictors of outcomes turned out to be psychological inflexibility and committed action. All available facets of psychological flexibility had mediating effects on treatment outcomes.Based on the results from these studies, theoretical integration within the CBT field may be facilitated by a process-focused approach including the psychological flexibility model. This model seems to be transdiagnostically and trans-situationally applicable in several ways. Its processes span problem areas with diverse backgrounds from the somatic field and chronic pain to the psychiatric field and PTSD, and appear useful not only to treatments specifically built around targeting psychological flexibility but also more broadly in CBT treatments.

Background: The aim of this study was to evaluate the efficacy of spiritually augmented psychotherapy (SAPT) on the dysfunctional attitudes of patients with dysthymic disorder. Methods: A mixed qualitative and quantitative method was used in the present study. SAPT model was prepared in the first phase, and in the second phase, a double-blind randomized clinical trial was performed. The study subjects consisted of 62 patients with dysthymic disorder selected from several clinical centers of Isfahan University of Medical Sciences in Isfahan, Iran. The participants were randomly assigned to 3 experimental groups and 1 control group. The first group received 8 sessions of SAPT treatment, the second group also had 8 sessions of cognitive behavioral therapy (CBT) which was specific to dysthymic disorder, and third group were under antidepressant treatment. The Dysfunctional Attitudes Scale was used to evaluate all the participants in 4 measurement stages. The data were analyzed using repeated measures MANCOVA. Results: Findings showed that SAPT had higher efficacy on the modification of dysfunctional attitudes than CBT and medication (p < 0.05). Conclusion: These findings supported the efficacy of psychotherapy enriched with cultural structures and spiritual teachings.