Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2811-2822
Author(s):  
Brandon C Yarns ◽  
Mark A Lumley ◽  
Justina T Cassidy ◽  
W Neil Steers ◽  
Sheryl Osato ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Musculoskeletal Pain ◽  
Behavioral Therapy ◽  
Emotional Awareness ◽  
Pain Reduction ◽  
Post Treatment ◽  
Chronic Musculoskeletal Pain ◽  
Comparison Trial ◽  
Secondary Outcomes

Abstract Objective Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. Design Randomized comparison trial. Setting Outpatient clinics at the West Los Angeles VA Medical Center. Subjects Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. Methods Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. Results EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. Conclusions This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A139-A140
Author(s):  
Janannii Selvanathan ◽  
Chi Pham ◽  
Mahesh Nagappa ◽  
Philip Peng ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioral Therapy ◽  
Cancer Pain ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Comorbid Insomnia ◽  
Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

scholarly journals Long-term stability of benefits of cognitive behavioral therapy for obsessive compulsive disorder depends on symptom remission during treatment

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Björn Elsner ◽  
Frieder Wolfsberger ◽  
Jessica Srp ◽  
Antonia Windsheimer ◽  
Laura Becker ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Roc Curves ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Background Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and may afford stable long-term improvements. It is not clear, however, how stability or symptom recurrence can be predicted at the time of termination of CBT. Method In a 1-year follow-up intention-to-treat study with 120 OCD patients receiving individual CBT at a university outpatient unit, we investigated the predictive value of international consensus criteria for response only (Y-BOCS score reduction by at least 35%) and remission status (Y-BOCS score ≤ 12). Secondly, we applied receiver-operating characteristic (ROC) curves in order to find an optimal cut-off score to classify for deterioration and for sustained gains. Results Response only at post-treatment increased the likelihood of deterioration at follow-up compared to remission at an odds ratio of 8.8. Moreover, ROC curves indicated that a post-treatment score of ≥ 13 differentiated optimally between patients with and without symptom deterioration at follow-up assessment. The optimal cut-off score to classify for any sustained gains (response, remission, or both) at follow-up relative to baseline was 12. Importantly, previous findings of generally high long-term symptom stability after treatment in OCD could be replicated. Conclusion The findings highlight the clinical importance of reaching remission during CBT, and suggest that a recently published expert consensus for defining remission has high utility.

scholarly journals Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy on Symptomatic Generalized Anxiety Disorder: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Si-si Jiang ◽  
Xue-hua Liu ◽  
Nan Han ◽  
Hai-jing Zhang ◽  
Wu-xiang Xie ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Cognitive Therapy ◽  
Generalized Anxiety Disorder ◽  
Behavioral Therapy ◽  
Generalized Anxiety ◽  
Remission Rates ◽  
Anxiety Response ◽  
Secondary Outcomes

Abstract Background: Mindfulness-based cognitive therapy (MBCT) is a promising treatment for generalized anxiety disorder (GAD). Cognitive behavioral therapy (CBT) is currently considered a first-line treatment for GAD. The objective of this study was to examine the efficacy of MBCT in symptomatic GAD patients compared with CBT for a variety of outcomes of anxiety symptoms, as well as depressive symptoms, overall illness severity, quality of life and mindfulness. Methods: Adult patients with GAD (n = 138) were randomized to a MBCT or CBT group. Both groups received either MBCT or CBT in addition to treatment-as-usual (TAU). The primary outcomes were the anxiety response and remission rates, as measured using the Hamilton Anxiety Scale (HAMA). Secondary outcomes included scores on the HAMA, the state-trait anxiety inventory (STAI), the Hamilton Depression Scale (HAMD), the Severity Subscale of the Clinical Global Impression Scale (CGI-S), and the 12-item Short-Form Health Survey (SF-12) , as well as mindfulness measured by the Five Facet Mindfulness Questionnaire (FFMQ). Assessments were performed at baseline, 8 weeks after treatment, and at a 3-month follow-up. For primary analyses, response and remission rates were analyzed by the χ2 test in the two groups at each assessment time. For the secondary analyses, separate two-way mixed ANOVAs were performed to compare the mean differences in all secondary outcomes. Results: The anxiety remission rate of the two groups significantly differed (63.8% in the MBCT group vs. 44.6% in the CBT group, p = 0.040, Cohen’s d = 0.39) but not in anxiety response rate (86.2% vs. 80.4%, p = 0.402; Cohen’s d = 0.16) at 8 weeks. Overall illness severity and mindfulness were significantly different between the groups at 8 weeks. There were no significant differences between the two groups at the 3-month follow-up. Conclusions: Our data indicate that MBCT was effective in reducing anxiety symptoms in GAD patients. While MBCT appeared to have better short-term benefits, the long-term benefits of CBT may be superior.Trial registration: registered at chic.org.cn (registration number: ChiCTR1800019150, registration date: 27/10/2018).

scholarly journals Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia

2021 ◽  
Vol 10 (16) ◽  
pp. 3505
Author(s):  
Yolanda Álvarez-Pérez ◽  
Francisco Rivero ◽  
Manuel Herrero ◽  
Conrado Viña ◽  
Ascensión Fumero ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Brain Activity ◽  
Brain Activation ◽  
Specific Phobia ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Specific Phobias

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. Method: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants’ scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. Results: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. Conclusions: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.

Randomized Study on the Efficacy of Cognitive-Behavioral Therapy for Insomnia Secondary to Breast Cancer, Part II: Immunologic Effects

2005 ◽  
Vol 23 (25) ◽  
pp. 6097-6106 ◽  
Author(s):  
Josée Savard ◽  
Sébastien Simard ◽  
Hans Ivers ◽  
Charles M. Morin
Keyword(s):  
Breast Cancer ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Controlled Study ◽  
Immune Functioning ◽  
Ifn Γ

Purpose Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation. However, there is a definite need for experimental studies on this question. The goal of this randomized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy (CBT) for chronic insomnia on immune functioning of breast cancer survivors. Previous analyses of this study showed that CBT was associated with improved sleep and quality of life, and reduced psychological distress. Patients and Methods Fifty-seven women with chronic insomnia secondary to breast cancer were randomly assigned to CBT (n = 27) or to a waiting-list control condition (WLC; n = 30). Peripheral-blood samples were taken at baseline and post-treatment (and postwaiting for WLC patients), as well as at 3-, 6-, and 12-month follow-up for immune measures, including enumeration of blood cell counts (ie, WBCs, monocytes, lymphocytes, CD3+, CD4+, CD8+, and CD16+/CD56+) and cytokine production (ie, interleukin-1-beta [IL-1β] and interferon gamma [IFN-γ]). Results Patients treated with CBT had higher secretion of IFN-γ and lower increase of lymphocytes at post-treatment compared with control patients. Pooled data from both treated groups indicated significantly increased levels of IFN-γ and IL-1β from pre- to post-treatment. In addition, significant changes in WBCs, lymphocytes, and IFN-γ were found at follow-up compared with post-treatment. Conclusion This study provides some support to the hypothesis of a causal relationship between clinical insomnia and immune functioning. Future studies are needed to investigate the clinical impact of such immune alterations.

scholarly journals Cognitive-Behavioral Therapy for Anxiety in Parkinson’s Disease

2019 ◽  
Vol 44 (4) ◽  
pp. 552-579 ◽  
Author(s):  
Gretchen O. Reynolds ◽  
Marie Saint-Hilaire ◽  
Cathi A. Thomas ◽  
David H. Barlow ◽  
Alice Cronin-Golomb
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Single Case ◽  
Preliminary Evidence ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Baseline Phase

Parkinson’s disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder ( n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person ( n = 5) or via secure videoconferencing ( n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.

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