scholarly journals Brief cognitive behavioural therapy for post-stroke ‘delusional infestation’ in a 71-year-old man: a single case experimental design

2020 ◽  
Vol 48 (6) ◽  
pp. 717-724
Author(s):  
Aimee I. McKinnon ◽  
Rebecca Dow
Keyword(s):  
Experimental Design ◽  
Cognitive Behavioural Therapy ◽  
Single Case ◽  
Baseline Period ◽  
Behavioural Therapy ◽  
Future Research ◽  
Post Intervention ◽  
Post Stroke ◽  
Psychological Therapies ◽  
Cognitive Behavioural

AbstractBackground:Delusional infestation is a condition at the interface of tactile and visual hallucinations and delusions. Individuals with this condition hold the fixed and false belief that their body or their environment is infested with parasites, insects or other organisms.Aims:There are no guidelines or publications detailing the psychological assessment, formulation, intervention and evaluation of this presentation. This paper aims to address this gap.Method:Single case experimental design methodology was employed to evaluate the use of cognitive behavioural therapy (CBT) for delusional infestation in a 70-year-old male who was intolerant of anti-psychotic medication. ‘Tom’ had a large, mature infarct in the middle cerebral artery territory as well as a left posterior parietal infarct post-stroke, which may have precipitated his symptoms. After a baseline period of 3 weeks, Tom received eight sessions of CBT based on the model by Collerton and Dudley (2004).Results:Post-intervention, there was a reliable improvement on clinical measures as well as a large reduction in distress levels, which was maintained at 3-month follow-up. The conviction in the belief that the infestation was real did not shift.Conclusion:This case demonstrated the potential for the use of CBT to address distress related to delusional infestation. This work is discussed in relation to post-stroke psychosis, psychological therapies with older adults, and suggestions are made for future research.

scholarly journals O005 Cognitive behavioural therapy and light dark therapy for postpartum insomnia symptoms: a randomised controlled trial

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A2-A3
Author(s):  
S Verma ◽  
N Quin ◽  
L Astbury ◽  
C Wellecke ◽  
J Wiley ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Future Research ◽  
Depression And Anxiety ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled ◽  
Insomnia Symptoms

Abstract Introduction Symptoms of postpartum insomnia are common however interventions remain scarce. Cognitive Behavioural Therapy (CBT) and Light Dark Therapy (LDT) target distinct mechanisms to improve sleep. This randomised controlled superiority trial compared CBT and LDT against treatment-as-usual (TAU) in reducing maternal postpartum insomnia symptoms. Methods Nulliparous females 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores >7) were included; excluded were those at risk or with high medical/psychiatric needs. Eligible participants were randomised 1:1:1 to 6 weeks of CBT, LDT (gaining light upon awakening, night-time light avoidance) or TAU. Interventions were therapist-assisted through two telephone calls and included automated self-help emails over six weeks. Symptoms of insomnia (ISI; primary outcome), sleep disturbance, fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Latent growth models were used. Results 114 participants (mean age=32.2±4.6 years) were randomised. There were significantly greater reductions in insomnia and sleep disturbance in both intervention groups with very large effect sizes (d>1·4, p<0·0001) from baseline to post-intervention compared to TAU; improvements were maintained at one-month follow-up. There were greater reductions in fatigue symptoms in the CBT group (d=0.85, p<.0001) but not LDT (p=0.11) compared to TAU; gains were maintained for CBT at follow-up. Changes in sleepiness, depression and anxiety over time were non-significant compared to TAU (p-values>0.08). Conclusion Therapist-assisted CBT and LDT are both efficacious for reducing postpartum insomnia symptoms. Findings were mixed for fatigue, sleepiness and mood. Future research is needed on predictors of treatment response.

scholarly journals Evaluating the Outcomes of Transactional Analysis and Integrative Counselling Psychology within UK Primary Care Settings

2011 ◽  
Vol 2 (2) ◽  
Author(s):  
Biljana Van Rijn ◽  
Ciara Wild ◽  
Patricia Moran
Keyword(s):  
Primary Care ◽  
Working Alliance ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Future Research ◽  
Transactional Analysis ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Uk National Health Service ◽  
Counselling Psychology

The paper reports on a naturalistic study that replicated the evaluative design associated with the UK National Health Service initiative IAPT − Improving Access to Psychological Therapies (CSIP 2008, NHS 2011), as previously used to assess Cognitive Behavioural Therapy (CBT), with the aim of evaluating 12-session treatments for anxiety and depression, applying Transactional Analysis and Integrative Counselling Psychology approaches within real clinical settings in primary care. Standard outcome measures were used in line with the IAPT model (CORE 10 and 34, GAD-7, PHQ-9), supplemented with measurement of the working alliance (WAI Horvath 1986) and an additional depression inventory BDI-II (Beck, 1996), and ad-herence to the therapeutic model using newly designed questionnaires. Results indicated that severity of problems was reduced using either approach, comparative to Cognitive Behavioural Therapy; that initial severity was predictive of outcome; and that working alliance increased as therapy progressed but was not directly related to outcomes. Adherence was high for both approaches. Several areas for enhance-ments to future research are suggested.

Exploring the concurrent use of standardised and idiographic measures to assess cognitive behavioural therapy in a university student with autistic spectrum condition – a single case experimental design

2021 ◽  
Vol 14 ◽  
Author(s):  
Nicola Birdsey ◽  
Linda Walz
Keyword(s):  
Mental Health ◽  
Experimental Design ◽  
Social Anxiety ◽  
University Students ◽  
Single Case ◽  
Cognitive Model ◽  
Behavioural Therapy ◽  
University Student ◽  
Cognitive Behavioural ◽  
Spectrum Condition

Abstract Limited research has directly addressed the challenges of higher education for students with autism, who face additional difficulties in navigating social, personal and academic obstacles. With more students experiencing mental health difficulties whilst at university, therapeutic interventions on offer need to be suitable for those accessing support. Cognitive behavioural therapy (CBT) is widely used to support university students, as it is firmly established as an effective treatment for a range of issues, including social and generalised anxiety in typically developing populations (NICE, 2013; NICE, 2019). However, the efficacy of CBT for individuals with autistic spectrum condition (ASC) is less well known, despite the high prevalence rates of anxiety in this population. This paper seeks to address a gap in the literature and uses a single-case (A-B) experimental design over 16 sessions to reduce co-morbid social and generalised anxiety in a university student with high-functioning ASC. Clark’s (2001) cognitive model of social anxiety and Wells’ (1997) cognitive model of generalised anxiety were employed to formulate anxiety experienced in this case. Standardised outcome measures were used for social anxiety, i.e. the Social Phobia Inventory (SPIN), and generalised anxiety, i.e. the Generalised Anxiety Disorder-7 (GAD-7), in conjunction with idiographic ratings to assess the impact of therapy. Findings indicate that CBT was an acceptable and useful intervention with mixed results; discrepancies were found between clinical change recorded on standardised measures compared with idiographic ratings. This paper discusses the use of standardised measures of anxiety for individuals with ASC and identifies directions for further research. Key learning aims (1) To appreciate the unique mental health challenges of university students with ASC. (2) To identify psychological interventions that are suitable for individuals with ASC. (3) To consider the value in employing more than one evidence-based cognitive model of anxiety when clients present with co-morbid mental health issues. (4) To question the utility of using standardised outcome measures compared with idiographic measures in therapy.

scholarly journals Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050661
Author(s):  
Håvard Kallestad ◽  
Simen Saksvik ◽  
Øystein Vedaa ◽  
Knut Langsrud ◽  
Gunnar Morken ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Patient Education ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Differences ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

scholarly journals An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol

2014 ◽  
Vol 29 (9) ◽  
pp. 833-843 ◽  
Author(s):  
Joyce A Kootker ◽  
Sascha MC Rasquin ◽  
Peter Smits ◽  
Alexander C Geurts ◽  
Caroline M van Heugten ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Treatment Protocol ◽  
Behavioural Therapy ◽  
Post Stroke ◽  
Cognitive Behavioural ◽  
Post Stroke Depression

Geographic Inequity in the Availability of Cognitive Behavioural Therapy in England and Wales: A 10-Year Update

2013 ◽  
Vol 42 (4) ◽  
pp. 497-501 ◽  
Author(s):  
Kate Cavanagh
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Geographic Distribution ◽  
Fold Increase ◽  
Behavioural Therapy ◽  
England And Wales ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Proxy Measure ◽  
Scarcity Of Resources ◽  
Made In

Background: Improving access to psychological therapies, and in particular cognitive behavioural therapy (CBT), has been a health service priority in England and Wales over the past decade. The delivery of CBT has been limited by a scarcity of resources and further limited by the inequitable geographic distribution of CBT therapists. Aims: The current study replicates and extends our previous analysis of the geography of British Association of Behavioural and Cognitive Psychotherapies (BABCP) membership (Shapiro, Cavanagh and Lomas, 2003) 10 years later in order to evaluate the progress made in improving equitable access to CBT. Method: This paper presents the absolute and comparative geographic distribution of current BABCP members, accredited CBT practitioners, and BABCP members who are nurses or clinical psychologists in England and Wales. Results: Efforts to improve the availability of CBT in England and Wales are reflected in the doubling of total membership, and a 4.5 fold increase in accredited membership over the last 10 years. There is evidence that the magnitude of inequity in the geographic availability of CBT therapists has decreased, but that inequity is still evident. Limitations of using BABCP membership data as a proxy measure of CBT availability are acknowledged. Conclusions: A five-fold discrepancy in accredited CBT practitioners between the best and least well-served population decile indicates ongoing “postcode availability” of the best qualified CBT practitioners. Possible strategies to improve the availability of CBT and remedy this inequity are discussed.

scholarly journals A Complex Interplay: Cognitive Behavioural Therapy for Severe Health Anxiety in Addison's Disease to Reduce Emergency Department Admissions

2017 ◽  
Vol 45 (4) ◽  
pp. 419-426 ◽  
Author(s):  
Jo Daniels ◽  
Elizabeth Sheils
Keyword(s):  
Emergency Department ◽  
Cognitive Behavioural Therapy ◽  
Single Case ◽  
Health Anxiety ◽  
Addison’S Disease ◽  
Behavioural Therapy ◽  
Adrenal Crisis ◽  
Addison's Disease ◽  
Complex Interplay ◽  
Cognitive Behavioural

Background: Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. Aims: This paper describes a single case study of a patient with severe health anxiety and co-morbid AD. The aims of the study were to establish if standard cognitive behavioural therapy for health anxiety in AD can lead to a reduction in psychological distress, and whether this approach is an effective intervention for the reduction of Emergency Department admissions. Method: A single case design was used, with pre- and post-measures of health anxiety, general anxiety and depression. Data on Emergency Department admissions prior to and following treatment were used to assess change in this domain. Results: Reliable and clinically significant reductions were seen across all measures, from severe to sub-clinical levels. There was a complete amelioration of Emergency Department admissions in the 12 months following completion of treatment. Conclusions: This preliminary study provides a sound rationale for further research into AD complicated by anxiety. Findings support the clinical utility of the cognitive behavioural therapy model for complex presentations of AD, offering a potential treatment option where anxiety is elevated and interfering with self-management and leading to high levels of health service use.

scholarly journals A Pragmatic Pilot Study Of Cognitive Behavioural Therapy For Insomnia Among People Living With HIV

2021 ◽  
Author(s):  
Tyler Gordon Tulloch
Keyword(s):  
Pilot Study ◽  
Sleep Disturbance ◽  
Cognitive Behavioural Therapy ◽  
Thematic Analysis ◽  
Behavioural Therapy ◽  
Future Research ◽  
People Living With Hiv ◽  
Cognitive Behavioural ◽  
Living With Hiv ◽  
Insomnia Severity

The prevalence of insomnia among people living with HIV (PWH) is considerably higher than in the general population. Cognitive, behavioural, and biopsychosocial explanations for this elevated prevalence have been proposed, but there is a lack of consensus in the literature. Sleep disturbance is associated with disrupted immune functioning at the cellular level and increased risk of contracting infectious diseases; therefore, insomnia may be particularly problematic for PWH. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment for insomnia, and is effective at treating insomnia among individuals with comorbid medical disorders. Surprisingly, no study has examined its efficacy among PWH. This pragmatic pilot study examined features of insomnia among 48 PWH and was the first study to examine sleep disturbance among PWH using American Academy of Sleep Medicine guidelines for evaluating chronic insomnia. On average, insomnia chronicity was 8.2 years and was of moderate severity. Psychiatric comorbidity was common, as were comorbid sleep disorders. Insomnia severity was associated with psychosocial variables including sleep effort, self-efficacy for sleep, depression, anxiety, stress, and social functioning-related quality of life. This study was also the first to examine safety, feasibility, acceptability, and intervention effects of CBT-I. These were examined among a subsample of 10 PWH using single-case interrupted time-series design. Thematic analysis was used to explore participant perceptions of CBT-I. Large effect sizes were observed for improvement in insomnia severity, sleep efficiency, and total wake time. Reliable and clinically significant reduction in insomnia severity was observed for all but one participant, and half met criteria for insomnia remission. Overall, CBT-I was an efficacious treatment for insomnia, and participant feedback was consistent with quantitative results. Participants viewed CBT-I as a safe and acceptable treatment for insomnia. Participant feedback identified preexisting needs, positive impacts and challenges of CBT-I, perceived mechanisms of change, and suggested modifications to tailor CBT-I for PWH. Given this preliminary support for the efficacy of CBT-I among PWH, future research should seek to demonstrate generalizability of these effects. Partnering with HIV community organizations may be important next step in conducting future research and increasing accessibility of CBT-I to PWH. Keywords: HIV, insomnia, cognitive behavioural therapy, pilot study, pragmatic trial, thematic analysis

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