Telephone-Delivered Cognitive-Behavioral Therapy for Older, Rural Veterans with Depression and Anxiety in Home-Based Primary Care

2016 ◽  
Vol 40 (2) ◽  
pp. 114-123 ◽  
Author(s):  
Terri L. Barrera ◽  
Jeremy P. Cummings ◽  
Maria Armento ◽  
Jeffrey A. Cully ◽  
Amber Bush Amspoker ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden

10.2196/18033 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e18033
Author(s):  
Anders Brantnell ◽  
Joanne Woodford ◽  
Enrico Baraldi ◽  
Theo van Achterberg ◽  
Louise von Essen
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Decision Makers ◽  
Barriers And Facilitators ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
National Guidelines ◽  
Technical Problems ◽  
Number Of Patients

Background Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. Objective The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers’ (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). Methods An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. Results The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P<.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (P<.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (P<.001). Conclusions Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT.

scholarly journals Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden (Preprint)

2020 ◽  
Author(s):  
Anders Brantnell ◽  
Joanne Woodford ◽  
Enrico Baraldi ◽  
Theo van Achterberg ◽  
Louise von Essen
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Decision Makers ◽  
Barriers And Facilitators ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
National Guidelines ◽  
Technical Problems ◽  
Number Of Patients

BACKGROUND Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. OBJECTIVE The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers’ (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). METHODS An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. RESULTS The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (<i>P</i>&lt;.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (<i>P</i>&lt;.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (<i>P</i>&lt;.001). CONCLUSIONS Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT.

scholarly journals Effects of Cognitive Behavioral Therapy for Depression and Anxiety, Response Rates and Adverse Events in Patients with Locoregional Advanced Nasopharyngeal Carcinoma

2021 ◽  
Vol 20 ◽  
pp. 153473542110061
Author(s):  
Feng Liu ◽  
Sheng-nan Fu ◽  
Yan-zhu Chen ◽  
Ou-ying Yan ◽  
Fei Tong ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Adverse Events ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Response Rates ◽  
Cognitive Behavioral ◽  
Toxic Effects ◽  
Depression And Anxiety ◽  
Small Effect Size ◽  
Anxiety Response

Purpose: This retrospective study investigated the effects of cognitive behavioral therapy (CBT) on depression, anxiety, response rates, and adverse events in patients with locoregional advanced nasopharyngeal carcinoma (NPC). Methods: A total of 269 patients with diagnosis of stage III-IVA NPC received either CBT plus chemoradiotherapy (CBT group, n = 136) or treatment as usual (TAU) plus chemoradiotherapy (TAU group, n = 133). Patients in the CBT group received a series of 6 CBT sessions for 6 weeks during concurrent chemoradiotherapy. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) score at baseline, the completion of radiotherapy, and 6, 12, and 24 months after radiotherapy. Response rates and adverse events were also evaluated. Results: Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group after the completion of radiotherapy ( P < .05). Complete response rates were 99.3% (135/136) and 92.5% (123/133) in the CBT group and TAU group with a small effect size (Phi coefficient = .171), respectively ( P = .005). Compared with the TAU group, the CBT group showed a significantly lower incidence of acute adverse events and late toxic effects. Conclusions: The addition of CBT to chemoradiotherapy significantly reduced depressive and anxiety symptoms. CBT combined with chemoradiotherapy is associated with improved response rates, with reduced incidence of toxic effects in patients with locoregional advanced NPC. Based on this study, we registered a randomized controlled clinical trials to better define the role of CBT in patients with locoregional advanced NPC (Registration number: ChiCTR2000034701).

Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice

2021 ◽  
Vol 78 ◽  
pp. 102345
Author(s):  
Olivia E. Bogucki ◽  
Julia R. Craner ◽  
Summer L. Berg ◽  
Megan K. Wolsey ◽  
Stephanie J. Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Anxiety Disorders ◽  
Primary Care Practice ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Care Practice

scholarly journals Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Anita Lungu ◽  
Janie Jihee Jun ◽  
Okhtay Azarmanesh ◽  
Yan Leykin ◽  
Connie E-Jean Chen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Real World ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Care Intervention ◽  
Blended Care ◽  
Over Time

BACKGROUND The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. OBJECTIVE This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. METHODS This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. RESULTS The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, <i>P</i>&lt;.001 and β=–.64, <i>P</i>&lt;.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P&lt;.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). CONCLUSIONS Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

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