What Happens in Treatment

2020 ◽  
pp. 111-130
Author(s):  
Pamela K. Keel

Effective treatment requires a team of health professionals working together. Team members should include, at minimum, a physician, a dietitian, and a therapist. Many treatments begin with psychoeducation to explain what maintains purging disorder, the consequences of the illness, and why a chosen therapy facilitates recovery. This chapter describes therapies that have been used to treat patients with purging disorder, including family-based treatment in adolescents, cognitive-behavioral therapy in adolescents and adults, and integrated cognitive affective therapy in adults. Most treatments require adaptation to effectively address purging as a primary symptom rather than as a response to binge eating. At this time, there are no randomized controlled trials focused on treatment for purging disorder. This means clinicians bear the responsibility of identifying a first line of treatment for their patients with purging disorder and evaluating the treatment’s effectiveness.

2007 ◽  
Vol 21 (2) ◽  
pp. 140-147 ◽  
Author(s):  
Tracey V. Barnfield ◽  
Fiona M. Mathieson ◽  
Graeme R. Beaumont

This article investigates the development of competency in cognitive-behavioral therapy (CBT) as a result of a postgraduate training course in CBT in Wellington, New Zealand. Thirteen experienced mental health professionals attended the half-time 30-week-long course. Preliminary data are presented on the development of knowledge as assessed at the beginning and end of the course by a modified version of the Behaviour Therapy Scale (Freiheit & Overholser, 1997), other-rated competence as measured by the Cognitive Therapy Scale—Revised (Blackburn, Milne, & James, 1997), and supervisor and student evaluations of competence in particular skill areas. All students improved in specific CBT skills as a result of training. The extent that students improved and variations around the other outcome measures, together with the limitations of this pilot study and suggestions for improvements for future investigations, are discussed.


Author(s):  
Quincy J. J. Wong ◽  
Alison L. Calear ◽  
Helen Christensen

Internet-based cognitive behavioral therapy (ICBT) is the provision of cognitive behavioral therapy (CBT) using the Internet as a platform for delivery. The advantage of ICBT is its ability to overcome barriers to treatment associated with traditional face-to-face CBT, such as poor access, remote locations, stigmas around help-seeking, the wish to handle the problem alone, the preference for anonymity, and costs (time and financial). A large number of randomized controlled trials (RCTs) have tested the acceptability, efficacy, and cost-effectiveness of ICBT for anxiety disorders, mood disorders, and associated suicidality. A meta-review was conducted by searching PsycINFO and PubMed for previous systematic reviews and meta-analyses of ICBT programs for anxiety, depression, and suicidality in children, adolescents, and adults. The results of the meta-review indicated that ICBT is effective in the treatment and prevention of mental health problems in adults and the treatment of these problems in youth. Issues of adherence and privacy have been raised. However, the major challenge for ICBT is implementation and uptake in the “real world.” The challenge is to find the best methods to embed, deliver, and implement ICBT routinely in complex health and education environments.


2018 ◽  
Author(s):  
Alexander Rozental ◽  
Roz Shafran ◽  
Tracey D Wade ◽  
Radha Kothari ◽  
Sarah J Egan ◽  
...  

BACKGROUND Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data. OBJECTIVE The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom. METHODS In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial. RESULTS Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85). CONCLUSIONS The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.


2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Elham Razmpoosh ◽  
Maryam Mazloom ◽  
Maryam Bassiri ◽  
Ali Montazeri ◽  
Akram Sajadian ◽  
...  

Context: Lifestyle modifications consist of three components including diet, exercise, and cognitive-behavioral therapy which can reduce side effects of breast cancer. Cognitive-behavioral therapy is a complementary strategy that promotes new skills for any treatment. Published trials have investigated the co-efficacies of the two or three components of lifestyle modifications, especially dietary and cognitive-behavioral interventions in breast cancer survivors. Evidence Acquisition: This protocol is about a meta-analysis which will systematically report the simultaneous effects of dietary intervention or physical activity with cognitive-behavioral therapy, or three of them on quality of life, the recurrence levels and anthropometric measurements among patients with breast cancer and survivors. It was prepared in accordance with the PRISMA-P checklist and will be performed in accordance with the Cochrane Handbook for Systematic reviews of intervention. Cochrane Central Register of Controlled trials, PubMed, EMBASE and ISI web of science will be searched for peer-reviewed literature using defined MeSH terms. Included randomized controlled trials on the combination effects of cognitive-behavioral therapy with either dietary or physical interventions will be assessed. Continuous data will be meta-analyzed using the STATA and will be gathered using random-effects models. The effect size will be reported as standardized mean difference with 95%CIs. Heterogeneity assessment, publication bias, and sensitivity analysis will be performed. The heterogeneity between some trials may be a limitation of this study. Conclusions: This meta-analysis will provide beneficial guidance for healthcare providers and family members to improve the current understanding of the role of lifestyle modification on alleviating the important problems of patients with breast cancer.


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