Cognitive behavioral therapy and pharmacotherapy for anxiety: Treatment preferences and credibility among pregnant and non-pregnant women

BACKGROUND The internet has the potential to increase individuals’ access to cognitive behavioral therapy (CBT) for insomnia at low cost. However, treatment preferences regarding internet-based computerized CBT for insomnia have not been fully examined. OBJECTIVE The aim was to conduct an anonymous online survey to evaluate treatment preferences for insomnia among patients with insomnia and individuals without insomnia. METHODS We developed an online survey to recruit a total of 600 participants living in the Kanto district in Japan. There were three subgroups: 200 medicated individuals with insomnia, 200 unmedicated individuals with insomnia, and 200 individuals without insomnia. The survey asked questions about the severity of the respondent’s insomnia (using the Athens Insomnia Scale), the frequency of sleep medication use and the level of satisfaction with sleep medication use, the respondent’s knowledge of CBT, his or her preference for CBT for insomnia before drug therapy, preference for CBT versus drug therapy, and preference for internet-based CBT versus face-to-face CBT. RESULTS Of the 600 respondents, 47.7% (286/600) indicated that they received CBT before drug therapy, and 57.2% (343/600) preferred CBT for insomnia to drug therapy. In addition, 47.0% (282/600) preferred internet-based CBT for insomnia to face-to-face CBT. Although the respondents with insomnia who were taking an insomnia medication had a relatively lower preference for internet-based CBT (40.5%, 81/200), the respondents with insomnia who were not taking an insomnia medication had a relatively higher preference for internet-based CBT (55.5%, 111/200). CONCLUSIONS The results of our online survey suggest that approximately half of the people queried preferred CBT for insomnia to drug therapy, and half of the respondents preferred internet-based CBT for insomnia to face-to-face CBT.

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Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial

JMIR Mental Health ◽

10.2196/10420 ◽

2018 ◽

Vol 5 (3) ◽

pp. e10420 ◽

Cited By ~ 8

Author(s):

Elisabet Rondung ◽

Elin Ternström ◽

Ingegerd Hildingsson ◽

Helen M Haines ◽

Örjan Sundin ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cognitive Behavioral Therapy ◽

Pregnant Women ◽

Standard Care ◽

Behavioral Therapy ◽

Controlled Trial ◽

Cognitive Behavioral ◽

Randomized Controlled ◽

Over Time

Background Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. Results We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI –0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). Conclusions Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. Trial Registration ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat)

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Cognitive–behavioral therapy-based intervention to treat symptoms of anxiety in pregnancy in a prenatal clinic using non-specialist providers in Pakistan: design of a randomised trial

BMJ Open ◽

10.1136/bmjopen-2020-037590 ◽

2020 ◽

Vol 10 (4) ◽

pp. e037590 ◽

Cited By ~ 1

Author(s):

Pamela J Surkan ◽

Syed Usman Hamdani ◽

Zill-e Huma ◽

Huma Nazir ◽

Najia Atif ◽

...

Keyword(s):

Mental Health ◽

Cognitive Behavioral Therapy ◽

Pregnant Women ◽

Early Pregnancy ◽

Low Income ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Relaxation Techniques ◽

Third Trimester ◽

The Third

IntroductionPrenatal anxiety is a prevalent condition that is harmful for women and a strong predictor of postpartum depression. This trial assesses an intervention initiated in early pregnancy to mid pregnancy among women with clinical or subclinical symptoms of anxiety in Pakistan.Methods and analysisHappy Mother, Healthy Baby(HMHB) is a phase three, two-arm, single-blind, individual randomised clinical trial conducted in the outpatient department of Holy Family Hospital, a large public tertiary care facility affiliated with Rawalpindi Medical University (RMU). Pregnant women (enrolled at ≤22 weeks of gestation) receive six individual HMHB sessions based on cognitive–behavioral therapy (CBT) and relaxation techniques that are administered by non-specialist providers and tailored to address anxiety symptoms. Two to six booster sessions are given between the fifth consecutive weekly core session and the sixth core session that occurs in the third trimester. Apart from baseline data, data are collected in the third trimester, at birth and at 6-weeks postpartum. Primary outcomes include diagnoses of postpartum common mental disorders. Secondary outcomes include symptoms of anxiety and of depression, and birth outcomes including small-for-gestational age, low birth weight and preterm birth. An economic analysis will determine the cost effectiveness of the intervention.EthicsEthics approval was obtained from the Johns Hopkins Bloomberg School of Health Institutional Review Board (Baltimore, USA), the Human Development Research Foundation Ethics Committee (Islamabad, Pakistan), the RMU Institutional Research Forum (Rawalpindi, Pakistan) and the National Institute of Mental Health-appointed Global Mental Health Data Safety and Monitoring Board.DisseminationResults from this trial will build evidence for the efficacy of a CBT-based intervention for pregnant women delivered by non-specialised providers. Identification of an evidence-based intervention for anxiety starting in early pregnancy to mid pregnancy may be transferable for use and scale-up in other low-income and middle-income countries.Trial registration numberNCT03880032.

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Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women

JAMA Psychiatry ◽

10.1001/jamapsychiatry.2019.4491 ◽

2020 ◽

Vol 77 (5) ◽

pp. 484 ◽

Cited By ~ 9

Author(s):

Jennifer N. Felder ◽

Elissa S. Epel ◽

John Neuhaus ◽

Andrew D. Krystal ◽

Aric A. Prather

Keyword(s):

Cognitive Behavioral Therapy ◽

Pregnant Women ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Insomnia Symptoms

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Treatment Preferences for Internet-Based Cognitive Behavioral Therapy for Insomnia in Japan: Online Survey

JMIR Formative Research ◽

10.2196/12635 ◽

2019 ◽

Vol 3 (2) ◽

pp. e12635

Author(s):

Daisuke Sato ◽

Chihiro Sutoh ◽

Yoichi Seki ◽

Eiichi Nagai ◽

Eiji Shimizu

Keyword(s):

Cognitive Behavioral Therapy ◽

Online Survey ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Treatment Preferences

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Effectiveness of cognitive-behavioral therapy on sexual function and sexual self-efficacy in pregnant women: An RCT

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v13i8.7504 ◽

2020 ◽

Author(s):

Mina Nezamnia ◽

Mina Iravani ◽

Mehdi Sayah Bargard ◽

Mahmood Latify

Keyword(s):

Cognitive Behavioral Therapy ◽

Sexual Function ◽

Pregnant Women ◽

Self Efficacy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Control Groups ◽

Significant Difference ◽

The Mean ◽

And Control

Background: Cognitive-behavioral therapy (CBT) is one of the ways to improve an undesirable sexual function. Objective: The purpose of this study was to investigate the effect of CBT on the sexual function and sexual self-efficacy of pregnant women. Materials and Methods: In this randomized clinical trial, 36 pregnant women referred to five healthcare centers in Ahvaz, Iran, from December 2016 to January 2017 were enrolled through stratified random sampling in two groups. The case group received counseling based on cognitive behavioral therapy for eight consecutive weeks and the control group received the routine training provided by healthcare staff. Two and four weeks after the end of sessions, both groups completed the Female Sexual Function Index and self-efficacy questionnaires again. Results: The mean of sexual function and self-efficacy scores in pregnant women in the case and control groups before the intervention did not show a significant difference (p = 0.56). The mean of sexual function and self-efficacy scores of pregnant women in the case and control groups was statistically significant two and four weeks, respectively, after the intervention (p ≤ 0.0001). Conclusion: The results of this study showed that counseling based on CBT in comparison with the routine training during pregnancy improves the sexual performance and self-efficacy of pregnant women. Key words: Cognitive behavioral therapy, Pregnant women, Sexual dysfunction, Sexual self-efficacy, Sex counseling.

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Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women

Trials ◽

10.1186/s13063-021-05498-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anna L. MacKinnon ◽

Joshua W. Madsen ◽

Ashley Dhillon ◽

Elizabeth Keys ◽

Gerald F. Giesbrecht ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cognitive Behavioral Therapy ◽

Pregnant Women ◽

Sleep Problems ◽

Behavioral Therapy ◽

Controlled Trial ◽

Cognitive Behavioral ◽

Randomized Controlled ◽

The Impact ◽

In Pregnancy

Abstract Background Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes). Methods A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12–28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3). Discussion CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children. Trial registration ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.

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Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial (Preprint)

10.2196/preprints.8902 ◽

2017 ◽

Author(s):

Gede Pramana ◽

Bambang Parmanto ◽

James Lomas ◽

Oliver Lindhiem ◽

Philip C Kendall ◽

...

Keyword(s):

Clinical Trial ◽

Cognitive Behavioral Therapy ◽

Mobile Health ◽

Behavioral Therapy ◽

Child Anxiety ◽

Cognitive Behavioral ◽

User Engagement ◽

Significance Level ◽

Anxiety Treatment

BACKGROUND Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). OBJECTIVE The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. METHODS We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. RESULTS Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). CONCLUSIONS The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment.

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