scholarly journals Effects of Treatment Preference on Adherence, Attrition, and Process Measures Among Older Adult Worriers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 370-370
Author(s):  
Gretchen Brenes ◽  
Heidi Munger Clary ◽  
Michael Miller ◽  
Jasmin Divers ◽  
Andrea Anderson ◽  
...  
Keyword(s):  
Working Alliance ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Treatment Preference ◽  
Process Measures ◽  
Treatment Expectancies ◽  
Intervention Adherence ◽  
The Stability ◽  
The Impact ◽  
Preference Trial

Abstract Patient preference may be related to treatment outcomes through decreased rates of attrition and higher rates of adherence and patient satisfaction. We present findings from a 2-stage randomized preference trial of cognitive-behavioral therapy (CBT) and yoga for the treatment of late-life worry. We examine rates of preference for CBT and yoga, as well as the stability of these preferences over time. We also examine the impact of preference on adherence, attrition, and process measures (satisfaction, treatment expectancies, and working alliance). Five hundred participants were randomized to either the randomized controlled trial (RCT; N=250) or the preference trial (participants chose the treatment; N=250). All participants received 10 weeks of an intervention. Among those in the preference trial, 48% chose CBT and 52% chose yoga (p>.05). Strength of preference was similar between the groups; 73.3% and 76.2% reported a strong preference for CBT and yoga, respectively (p>.05). Fourteen percent of those who preferred CBT at baseline preferred yoga upon completion of the intervention, while 12.2% of those who preferred yoga at baseline preferred CBT upon completion of the intervention (p>.05). There were no significant differences between participants in the RCT and preference trial on intervention adherence, attrition, satisfaction, or working alliance (p’s>.05). Treatment expectancies were higher for the preferred intervention (p’s<.0001). Results suggest that older adults prefer CBT and yoga at similar rates, and these preferences are stable. Receiving a preferred treatment had no effect on adherence, attrition, satisfaction, or working alliance.

The conceptual invariance, trajectory, and outcome associations of working alliance in unguided and guided internet-based psychological interventions: A randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Xiaochen Luo ◽  
Matteo Bugatti ◽  
Lucero Molina ◽  
Jacqueline L. Tilley ◽  
Brittain Mahaffey ◽  
...  
Keyword(s):  
Working Alliance ◽  
Support Group ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Post Treatment ◽  
Depression Symptoms ◽  
Therapy Program ◽  
Initial Sessions ◽  
Clinician Support

BACKGROUND The role of working alliance is largely unknown for internet-based interventions (IBI), an effective alternative for traditional psychotherapy. OBJECTIVE This study examined the conceptual invariance, trajectory, and outcome associations of working alliance in internet-based interventions incorporating or excluding clinician support via text or video. METHODS One hundred and forty-three adults with subclinical anxiety, stress, and/or depression symptoms were randomized to one of three treatment conditions for 7 weeks. All participants received access to MyCompass, an internet-delivered Cognitive Behavioral Therapy program. Participants in Condition 1 did not receive clinician support. Participants in Condition 2 and 3 received supplemental asynchronous clinician support via text or video respectively. Working alliance was measured weekly. Symptom outcomes were assessed at baseline, post-treatment, and 1-month follow-up. RESULTS We found scalar invariance of working alliance, indicating that working alliance was conceptually invariant across three conditions. Working alliance decreased significantly over time only in the text support group. Stronger baseline level and Faster increases in alliance predicted better outcomes at both post-treatment and follow-up only in the video support group. CONCLUSIONS Working alliance is methodologically comparable with or without clinician support and is generally established at initial sessions of IBI. Better alliance contributed to better outcomes only when clinician support is available via videos. CLINICALTRIAL clinicaltrials.gov ID: NCT05122429

scholarly journals The Impact of Matching to Psychotherapy Preference on Engagement in a Randomized Controlled Trial for Patients With Advanced Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Allison Marziliano ◽  
Allison Applebaum ◽  
Anne Moyer ◽  
Hayley Pessin ◽  
Barry Rosenfeld ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Controlled Trial ◽  
Treatment Preference ◽  
The Novel ◽  
Advanced Cancer Patients ◽  
Novel Therapy ◽  
Supportive Psychotherapy ◽  
Randomized Controlled ◽  
The Impact ◽  
Therapy Sessions

Objective: This study examined whether patients who were randomly assigned to their preferred therapy arm had stronger engagement with their treatment than those who were randomly assigned to a non-preferred therapy arm.Method: Data were drawn from a RCT comparing Individual Meaning-Centered Psychotherapy (IMCP), with Individual Supportive Psychotherapy (ISP), in patients with advanced cancer. Treatment engagement was operationalized as patients' perceptions of the therapeutic alliance with their therapist and therapy sessions attended. Two 2 by 2 Analysis of Variance (ANOVA) models were used, with treatment preference (IMCP vs. ISP) and treatment assignment (IMCP vs. ISP) as the independent variables and working alliance and number of sessions attended as outcome variables.Results: Patients who preferred and were assigned to IMCP reported a significantly stronger alliance than those who preferred IMCP but were assigned to ISP.Conclusions: The findings from this study have broader implications for research on psychotherapy beyond the appeal of IMCP in advanced cancer patients. Patients who prefer a novel psychotherapy that they cannot engage in elsewhere, but receive the standard treatment may experience weaker alliance than patients who prefer the standard but receive the novel therapy.Trial registration:Clinicaltrial.gov ID: NCT01323309

scholarly journals The Experience of Participating in an Internet-Based Cognitive Behavioral Therapy Program Among Patients with Cardiovascular Disease and Depression: A Qualitative Interview Study

2022 ◽  
Author(s):  
Mats Westas ◽  
Ghassan Mourad ◽  
Gerhard Andersson ◽  
Margit Neher ◽  
Johan Lundgren ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Qualitative Interview ◽  
Interview Study ◽  
Cognitive Behavioral ◽  
Qualitative Interview Study ◽  
And Behaviors ◽  
The Impact

Abstract Background Depression in cardiovascular disease (CVD) is associated with poor outcomes and there is a treatment gap of depression in CVD patients. Recently we found that an Internet-based cognitive behavioral therapy (iCBT) tailored for CVD patients led to reduced symptoms of depression. However, we still have little knowledge about CVD patients’ experiences of working with iCBT. The aim of this study was therefore to explore CVD patients experience of engaging with a tailored iCBT program. Methods A qualitative interview study using inductive thematic analysis. Data was obtained from 20 patients with CVD and depressive symptoms who had participated in a randomized controlled trial (RCT) evaluating the impact of a nine-week iCBT program on depression. Results Three main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The first theme included comments that the tailored program gave the patients a feeling of being active in the treatment process and helped them achieve changes in thoughts and behaviors necessary to take control of their CVD. The second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist created a feeling of being seen as an individual. The feeling of being acknowledged as a person also made it easier to continuously work with the changes necessary to improve their health. Conclusions Engaging in an iCBT program tailored for patients with CVD and depression was by the patients perceived as helpful in the treatment of depression. They experienced positive changes in emotions, thoughts, and behaviors which a result of learning to take control of their CVD, being confirmed and getting support. The patients considered working with the iCBT program as demanding and emotionally challenging, but necessary to achieve changes in emotions, thoughts, and behaviors.

scholarly journals Telemedicine-delivered cognitive-behavioral therapy for insomnia in alcohol use disorder (AUD): study protocol for a randomized controlled trial

2021 ◽  
Author(s):  
J.Todd Arnedt ◽  
Libby Hobson ◽  
Deirdre A. Conroy ◽  
Mandilyn Graham ◽  
Sajni Amin ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Alcohol Use ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Post Treatment ◽  
Treatment Seeking ◽  
Randomized Controlled ◽  
Sleep Homeostasis ◽  
Hygiene Education ◽  
The Impact

Abstract Background: Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD and insomnia. The impact of CBT for insomnia on relapse, however, is unclear. This trial will compare telemedicine-delivered CBT for insomnia (CBT-TM) with sleep hygiene education (SHE-TM) on improving insomnia/sleep, daytime symptom, and drinking outcomes in treatment-seeking AUD adults with insomnia. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes. Methods: This is a single-site randomized controlled trial with planned enrollment of 150 adults meeting criteria for both AUD and chronic insomnia. Eligible participants will be randomized 1:1 to 6 weeks of telemedicine-delivered Cognitive Behavioral Therapy for Insomnia (CBT-TM) or Sleep Hygiene Education (SHE-TM) with clinical assessments conducted at pre-treatment, post- treatment, and at 3-, 6-, and 12-months post-treatment. Overnight polysomnography will be conducted before and after treatment. Primary clinical outcomes will include post-treatment scores on the Insomnia Severity Index and the General Fatigue subscale of the Multidisciplinary Fatigue Inventory, and the percent of days abstinent (PDA) on the interview-administered Time Line Follow Back. EEG delta activity, derived from overnight polysomnography, will be the primary endpoint to assess the sleep homeostasis mechanism. Discussion: This adequately powered randomized controlled trial will provide clinically-relevant information about whether targeting insomnia is effective for improving treatment outcomes among treatment-seeking adults with AUD. Additionally, the study will offer new scientific insights on the impact of an evidence-based non-medication treatment for insomnia on a candidate mechanism of sleep dysfunction in this population - sleep homeostasis.Registration: NCT, NCT # 04457674. Registered 07 July 2020, https://clinicaltrials.gov/ct2/show/NCT04457674?cond=alcohol+use&cntry=US&state=US%3AMI&draw=2&rank=1

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

Trials ◽  
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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