Therapist Effects in Guided Internet-Delivered CBT for Anxiety Disorders

Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.

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Cost-effectiveness and cost-utility evaluation of the individual vs. group transdiagnostic psychological treatment for emotional disorders in Primary Care (PsicAP-Costs) v2

10.17504/protocols.io.bx2npqde ◽

2021 ◽

Author(s):

Angel Aguilera-Martin ◽

Mario Gálvez-Lara ◽

Fátima Cuadrado ◽

Eliana Moreno ◽

Francisco García-Torres ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Emotional Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Cost Utility ◽

Cognitive Behavioural ◽

Utility Evaluation ◽

The Individual

The aim of this study is to compare, in cost-effectiveness and cost-utility terms, a brief transdiagnostic cognitive-behavioural therapy in two different modes, individual and group, with the treatment usually administered in primary care (TAU). Participants between 18 and 65 years old and with, according to the pretreatment evaluation, mild to moderate emotional disorders will be randomly allocated to the three clusters. They will be assessed again immediately after treatment and 6 and 12 months later. ClinicalTrials.gov: NCT04847310

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Anxiety disorders in children and adolescents: aetiology, diagnosis and treatment

BJPsych Advances ◽

10.1192/apt.bp.114.014183 ◽

2016 ◽

Vol 22 (5) ◽

pp. 335-344 ◽

Cited By ~ 2

Author(s):

Aaron K. Vallance ◽

Victoria Fernandez

Keyword(s):

Anxiety Disorders ◽

Children And Adolescents ◽

Depressive Disorders ◽

Developmentally Appropriate ◽

Childhood Anxiety ◽

Behavioural Therapy ◽

Childhood Anxiety Disorders ◽

Cognitive Behavioural ◽

Increased Risk ◽

The Individual

SummaryThe presentation of anxiety disorders in children and adolescents shares similarities and differences with that in adults, and may vary significantly, depending on the age of the individual. Assessment must differentiate anxiety disorders from developmentally appropriate fears as well as medical conditions and drugs that can mimic anxiety states. Aetiology of anxiety disorders in this group encompasses complex genetic and environmental influences. Additional insight into causation is provided by neuroimaging and research into temperament. Recommended interventions include both cognitive-behavioural therapy and pharmacology. Although childhood anxiety disorders generally remit, there remains an increased risk for anxiety and depressive disorders to emerge in adulthood, most likely through heterotypical continuity.

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Physical exercise as an add-on treatment to cognitive behavioural therapy for anxiety: a systematic review

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465821000126 ◽

2021 ◽

pp. 1-15

Author(s):

Kristian Pihl Frederiksen ◽

Silje Haukenes Stavestrand ◽

Simen Kildahl Venemyr ◽

Kristine Sirevåg ◽

Anders Hovland

Keyword(s):

Systematic Review ◽

Physical Exercise ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Meta Analysis ◽

Behavioural Therapy ◽

Control Group ◽

Cognitive Behavioural ◽

Combined Interventions

Abstract Background: Cognitive behavioural therapy (CBT) is currently the treatment of choice for most anxiety disorders. Yet, with recovery rates of approximately 50%, many patients fail to achieve complete remission. This has led to increased efforts to enhance treatment efficacy. Physical exercise (PE) has in recent years been advocated as means to augment the effects of CBT for anxiety disorders. PE appears to reduce anxiety through other mechanisms than CBT, some of which might also have the potential to augment the effects of psychological treatment. Aims: The current review aimed to summarize and discuss the current research status on CBT augmented with PE for anxiety. Method: A systematic literature search was conducted in the databases PsychInfo, Medline and Web of Science to evaluate the potential augmentative effect of combining PE with CBT for anxiety disorders. These effects were intended to be evaluated in a meta-analysis, but findings from the few and diverse studies were better summarized in a systematic review. Results: Eight articles were included in this review, of which two had no control group, while six had from two to four experimental arms. Six of the studies concluded in favour of benefits of add-on PE, while two studies found no added benefits of the combined interventions. Conclusions: The combination of PE and CBT appears feasible. Add-on PE seems to be more beneficial for clinical populations, when administered regularly several times per week, across several weeks. Future studies should investigate further how and for whom to best combine PE and CBT.

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Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies

The British Journal of Psychiatry ◽

10.1192/bjp.2018.49 ◽

2018 ◽

Vol 212 (6) ◽

pp. 333-338 ◽

Cited By ~ 13

Author(s):

Borwin Bandelow ◽

Anne Sagebiel ◽

Michael Belz ◽

Yvonne Görlich ◽

Sophie Michaelis ◽

...

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Meta Analysis ◽

Behavioural Therapy ◽

Control Groups ◽

Cognitive Behavioural ◽

Significant Difference

BackgroundIt is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination.AimsWe aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups.MethodWe searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive–behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms).ResultsGains with psychotherapy were maintained for up to 24 months. For cognitive–behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive–behavioural therapy.ConclusionsNot only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean.Declaration of interestIn the past 12 months and in the near future, Dr Bandelow has been/will be on the speakers/advisory board for Hexal, Mundipharma, Lilly, Lundbeck, Pfizer and Servier. Dr Wedekind was on the speakers' board of AstraZeneca, Essex Pharma, Lundbeck and Servier. All other authors have nothing to declare.

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Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Behavioral Sciences ◽

10.3390/bs11100140 ◽

2021 ◽

Vol 11 (10) ◽

pp. 140

Author(s):

Claudia Rigutto ◽

Adegboyega O. Sapara ◽

Vincent I. O. Agyapong

Keyword(s):

Posttraumatic Stress Disorder ◽

Mental Illness ◽

Anxiety Disorders ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Behavioural Therapy ◽

Terrorist Attacks ◽

Policy And Practice ◽

Cognitive Behavioural ◽

The Impact

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

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The Effect of Comorbid Depression on Sudden Gains During Transdiagnostic Cognitive-Behavioural Therapy for Anxiety Disorders

Behaviour Change ◽

10.1017/bec.2020.20 ◽

2021 ◽

pp. 1-11

Author(s):

Sasha D'Arcy ◽

Peter J. Norton

Keyword(s):

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Depressive Disorders ◽

Behavioural Therapy ◽

Future Research ◽

Comorbid Depression ◽

Sudden Gains ◽

Cognitive Behavioural ◽

Patients Experience ◽

The Impact

Abstract During psychotherapy some patients experience large symptom improvements between sessions, termed sudden gains. Most commonly, sudden gains are observed during treatment for depression (40–50% of participants), but these are occasionally also observed in treatment for anxiety (15–20%). This study investigated the impact of comorbid depression on sudden gains in a primary anxiety sample. It was hypothesised that sudden gains would occur more frequently in participants with anxiety and comorbid depression than anxiety-only participants. The sample consisted of 58 adults who participated in a 12-week transdiagnostic cognitive-behavioural therapy (tCBT) programme. Sudden gains were more frequent in the comorbid depression group than in the anxiety-only group. Sudden gains may be predominantly a function of depressive disorders, which supports the higher rates seen in depressive disorders compared with anxiety disorders. Future research should endeavour to replicate these findings, as this was the first study designed to specifically investigate comorbidity in sudden gains.

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Is there an excess of significant findings in published studies of psychotherapy for depression?

Psychological Medicine ◽

10.1017/s0033291714001421 ◽

2014 ◽

Vol 45 (2) ◽

pp. 439-446 ◽

Cited By ~ 28

Author(s):

J. Flint ◽

P. Cuijpers ◽

J. Horder ◽

S. L. Koole ◽

M. R. Munafò

Keyword(s):

Publication Bias ◽

Statistical Power ◽

Psychological Treatment ◽

Meta Analysis ◽

Average Power ◽

Behavioural Therapy ◽

Null Results ◽

Cognitive Behavioural ◽

Significant Difference ◽

Average Size

BackgroundMany studies have examined the efficacy of psychotherapy for major depressive disorder (MDD) but publication bias against null results may exist in this literature. However, to date, the presence of an excess of significant findings in this literature has not been explicitly tested.MethodWe used a database of 1344 articles on the psychological treatment of depression, identified through systematic search in PubMed, PsycINFO, EMBASE and the Cochrane database of randomized trials. From these we identified 149 studies eligible for inclusion that provided 212 comparisons. We tested for an excess of significant findings using the method developed by Ioannidis and Trikalinos (2007), and compared the distribution of p values in this literature with the distribution in the antidepressant literature, where publication bias is known to be operating.ResultsThe average statistical power to detect the effect size indicated by the meta-analysis was 49%. A total of 123 comparisons (58%) reported a statistically significant difference between treatment and control groups, but on the basis of the average power observed, we would only have expected 104 (i.e. 49%) to do so. There was therefore evidence of an excess of significance in this literature (p = 0.010). Similar results were obtained when these analyses were restricted to studies including a cognitive behavioural therapy (CBT) arm. Finally, the distribution of p values for psychotherapy studies resembled that for published antidepressant studies, where publication bias against null results has already been established.ConclusionsThe small average size of individual psychotherapy studies is only sufficient to detect large effects. Our results indicate an excess of significant findings relative to what would be expected, given the average statistical power of studies of psychotherapy for major depression.

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Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Psychological Medicine ◽

10.1017/s0033291713000871 ◽

2013 ◽

Vol 44 (2) ◽

pp. 325-336 ◽

Cited By ~ 30

Author(s):

J. T. W. Wigman ◽

J. van Os ◽

L. Abidi ◽

M. J. H. Huibers ◽

J. Roelofs ◽

...

Keyword(s):

Negative Impact ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Bipolar Spectrum ◽

Naturalistic Study ◽

Psychotic Experiences ◽

Major Depressive ◽

Cognitive Behavioural ◽

The Impact ◽

Time Point

BackgroundSubthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.MethodIn a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.ResultsSubclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).ConclusionsIn general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

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Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison: Thérapie cognitivo-comportementale de groupe en personne contre par vidéo téléconférence pour l’anxiété et les troubles connexes: une comparaison préliminaire

The Canadian Journal of Psychiatry ◽

10.1177/07067437211027319 ◽

2021 ◽

pp. 070674372110273

Author(s):

Irena Milosevic ◽

Duncan H. Cameron ◽

Melissa Milanovic ◽

Randi E. McCabe ◽

Karen Rowa

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Symptom Improvement ◽

Face To Face ◽

Compulsive Disorder ◽

Cognitive Behavioural ◽

Group Cbt ◽

Delivery Formats

Objective: Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. Method: Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. Results: Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. Conclusions: Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.

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