Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement

Psychological treatment is recommended for depression and anxiety in those with epilepsy. This review used standardised criteria to evaluate, for the first time, the clinical relevance of any symptom change these treatments afford patients. Databases were searched until March 2017 for relevant trials in adults. Trial quality was assessed and trial authors asked for individual participants’ pre-treatment and post-treatment distress data. Jacobson’s methodology determined the proportion in the different trial arms demonstrating reliable symptom change on primary and secondary outcome measures and its direction. Search yielded 580 unique articles; only eight eligible trials were identified. Individual participant data for five trials—which included 398 (85%) of the 470 participants randomised by the trials—were received. The treatments evaluated lasted ~7 hours and all incorporated cognitive-behavioural therapy (CBT). Depression was the primary outcome in all; anxiety a secondary outcome in one. On average, post-treatment assessments occurred 12 weeks following randomisation; 2 weeks after treatment had finished. There were some limitations in how trials were conducted, but overall trial quality was ‘good’. Pooled risk difference indicated likelihood of reliable improvement in depression symptoms was significantly higher for those randomised to CBT. The extent of gain was though low—the depressive symptoms of most participants (66.9%) receiving CBT were ‘unchanged’ and 2.7% ‘reliably deteriorated’. Only 30.4% made a ‘reliable improvement. This compares with 10.2% of participants in the control arms who ‘reliably improved’ without intervention. The effect of the treatments on secondary outcome measures, including anxiety, was also low. Existing CBT treatments appear to have limited benefit for depression symptoms in epilepsy. Almost 70% of people with epilepsy do not reliably improve following CBT. Only a limited number of trials have though been conducted in this area and there remains a need for large, well-conducted trials.

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Cognitive change in cognitive-behavioural therapy v. pharmacotherapy for adult depression: a longitudinal mediation analysis

Psychological Medicine ◽

10.1017/s0033291718003653 ◽

2018 ◽

Vol 49 (15) ◽

pp. 2626-2634

Author(s):

Leanne Quigley ◽

David J. A. Dozois ◽

R. Michael Bagby ◽

Daniela S. S. Lobo ◽

Lakshmi Ravindran ◽

...

Keyword(s):

Cognitive Behavioural Therapy ◽

Cognitive Change ◽

Behavioural Therapy ◽

Automatic Thoughts ◽

Depression Symptoms ◽

Symptom Change ◽

Mediation Model ◽

Cognitive Mediation ◽

Adult Depression ◽

Cognitive Behavioural

AbstractBackgroundAlthough cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model.MethodsThe present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models.ResultsBoth CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant.ConclusionsThe results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.

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Group cognitive-behavioural therapy for schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.bp.106.021386 ◽

2006 ◽

Vol 189 (6) ◽

pp. 527-532 ◽

Cited By ~ 83

Author(s):

Christine Barrowclough ◽

Gillian Haddock ◽

Fiona Lobban ◽

Steve Jones ◽

Ron Siddle ◽

...

Keyword(s):

Cognitive Behavioural Therapy ◽

Treatment Method ◽

Self Esteem ◽

Behavioural Therapy ◽

Positive Symptom ◽

Secondary Outcome ◽

Symptom Improvement ◽

Treatment As Usual ◽

Group Cognitive Behavioural Therapy ◽

Cognitive Behavioural

BackgroundThe efficacy of cognitive–behavioural therapy for schizophrenia is established, but there is less evidence for a group format.AimsTo evaluate the effectiveness of group cognitive – behavioural therapy for schizophrenia.MethodIn all, 113 people with persistent positive symptoms of schizophrenia were assigned to receive group cognitive – behavioural therapy or treatment as usual. The primary outcome was positive symptom improvement on the Positive and Negative Syndrome Scales. Secondary outcome measures included symptoms, functioning, relapses, hopelessness and self-esteem.ResultsThere were no significant differences between the cognitive-behavioural therapy and treatment as usual on measures of symptoms or functioning or relapse, but group cognitive – behavioural therapy treatment resulted in reductions in feelings of hopelessness and in low self-esteem.ConclusionsAlthough group cognitive – behavioural therapy may not be the optimum treatment method for reducing hallucinations and delusions, it may have important benefits, including feeling less negative about oneself and less hopeless for the future.

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Cost-effectiveness and cost-utility evaluation of the individual vs. group transdiagnostic psychological treatment for emotional disorders in Primary Care (PsicAP-Costs) v2

10.17504/protocols.io.bx2npqde ◽

2021 ◽

Author(s):

Angel Aguilera-Martin ◽

Mario Gálvez-Lara ◽

Fátima Cuadrado ◽

Eliana Moreno ◽

Francisco García-Torres ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Emotional Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Cost Utility ◽

Cognitive Behavioural ◽

Utility Evaluation ◽

The Individual

The aim of this study is to compare, in cost-effectiveness and cost-utility terms, a brief transdiagnostic cognitive-behavioural therapy in two different modes, individual and group, with the treatment usually administered in primary care (TAU). Participants between 18 and 65 years old and with, according to the pretreatment evaluation, mild to moderate emotional disorders will be randomly allocated to the three clusters. They will be assessed again immediately after treatment and 6 and 12 months later. ClinicalTrials.gov: NCT04847310

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Cognitive–behavioural therapy for personal recovery of patients with schizophrenia: A systematic review and meta-analysis

General Psychiatry ◽

10.1136/gpsych-2018-100040 ◽

2019 ◽

Vol 32 (4) ◽

pp. e100040

Author(s):

Weiliang Wang ◽

Yuqiu Zhou ◽

Nannan Chai ◽

Dongwei Liu

Keyword(s):

Cognitive Behavioural Therapy ◽

Effect Size ◽

Behavioural Therapy ◽

Post Treatment ◽

Effect Sizes ◽

Fundamental Aspect ◽

Long Term Effects ◽

Personal Recovery ◽

Cognitive Behavioural

BackgroundTo date, cognitive–behavioural therapy (CBT) trials have primarily focused on clinical recovery; however, personal recovery is actually the fundamental aspect of the recovery process. The aim of this study was to summarise and synthesise the existing evidence regarding the effectiveness of CBT for personal recovery in patients with schizophrenia.AimThis study aimed to determine the effectiveness of CBT for personal recovery in patients with schizophrenia.MethodsA systematic search of the literature in PsycINFO, PubMed, Cochrane (CENTRAL), Embase and Web of Science (SCI) was conducted to identify randomised controlled trials reporting the impact of CBT interventions on personal recovery in patients with schizophrenia. The estimated effect sizes of the main study outcomes were calculated to estimate the magnitude of the treatment effects of CBT on personal recovery. We also evaluated the CBT’s effect size at the end-of-treatment and long-term (follow-up) changes in some aspects of personal recovery.ResultsTwenty-five studies were included in the analysis. The effect of CBT on personal recovery was 2.27 (95% CI 0.10 to 4.45; I2=0%; p=0.04) at post-treatment and the long-term effect size was 2.62 (95% CI 0.51 to 4.47; I2=0%; p=0.02). During the post-treatment period, the pooled effect size of CBT was 0.01 (95% CI −0.12 to 0.15; I2=33.0%; p>0.05) for quality of life (QoL), 0.643 (95% CI 0.056 to 1.130; I2=30.8%; p<0.01) for psychological health-related QoL, −1.77 (95% CI −3.29 to −0.25; I2=40%; p=0.02) for hopelessness and 1.85 (95% CI 0.69 to 3.01; I2=41%; p<0.01) for self-esteem. We also summarised the effects of CBT on QoL (subscale scores not included in the evaluation of the pooled effect size), self-confidence and connectedness, and all results corresponded to positive effects. However, there was insufficient evidence regarding the long-term effects of CBT on personal recovery.ConclusionsCBT is an effective therapy with meaningful clinical effect sizes on personal recovery and some aspects of personal recovery of schizophrenia after treatment. However, the effect is relatively immediate and rapidly decreases as time progresses. Therefore, in the future, more studies should focus on the mechanism of CBT for personal recovery and the factors that influence the long-term effects of CBT.Trial registration numberCRD42018085643.

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Therapist-guided internet-delivered cognitive–behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial

BMJ Open ◽

10.1136/bmjopen-2017-018345 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018345 ◽

Cited By ~ 13

Author(s):

Martina Nordh ◽

Sarah Vigerland ◽

Lars-Göran Öst ◽

Brjánn Ljótsson ◽

David Mataix-Cols ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Behavioural Therapy ◽

Post Treatment ◽

Feasibility Trial ◽

Cognitive Behavioural ◽

Exposure Sessions

ObjectivesSocial anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT).DesignA proof-of-concept, open clinical trial with 6-month follow-up.ParticipantsThe trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD.Intervention12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents.ResultsAdolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Post-treatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at post-treatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD.ConclusionTherapist-guided and parent-guided internet-delivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising intervention for adolescents with SAD.Trial registration numberNCT02576171; Results.

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Effectiveness of cognitive behavioural therapy augmentation in major depression treatment (ECAM study): study protocol for a randomised clinical trial

BMJ Open ◽

10.1136/bmjopen-2014-006359 ◽

2014 ◽

Vol 4 (10) ◽

pp. e006359 ◽

Cited By ~ 4

Author(s):

Atsuo Nakagawa ◽

Mitsuhiro Sado ◽

Dai Mitsuda ◽

Daisuke Fujisawa ◽

Toshiaki Kikuchi ◽

...

Keyword(s):

Major Depression ◽

Cognitive Behavioural Therapy ◽

Study Protocol ◽

Rating Scale ◽

Behavioural Therapy ◽

Depression Symptoms ◽

Routine Practice ◽

Depression Care ◽

Treatment As Usual ◽

Cognitive Behavioural

IntroductionMajor depression is a serious mental disorder that causes substantial distress and impairment in individuals and places an enormous burden on society. Although antidepressant treatment is the most common therapy provided in routine practice, there is little evidence to guide second-line therapy for patients who have failed to respond to antidepressants. The aim of this paper is to describe the study protocol for a randomised controlled trial that measures the clinical effectiveness of cognitive behavioural therapy (CBT) as an augmentation strategy to treat patients with non-psychotic major depression identified as suboptimal responders to usual depression care.Methods and analysisThe current study is a 16-week assessor-blinded randomised, parallel-groups superiority trial with 12-month follow-up at an outpatient clinic as part of usual depression care. Patients aged 20–65 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Major Depressive Disorder who have experienced at least one failed trial of antidepressants as part of usual depression care, will be randomly assigned to receive CBT plus treatment as usual, or treatment as usual alone. The primary outcome is the change in clinician-rated 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD) score at 16 weeks, and secondary outcomes include severity and change in scores of subjective depression symptoms, proportion of responders and remitters, safety and quality of life. The primary population will be the intention-to-treat patients.Ethics and disseminationAll protocols and the informed consent form comply with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethics review committees at the Keio University School of Medicine and the Sakuragaoka Memorial Hospital approved the study protocol. The results of the study will be disseminated at several research conferences and as published articles in peer-reviewed journals. The study will be implemented and reported in line with the CONSORT statement.Trial registration numberUMIN Clinical Trials Registry: UMIN000001218.

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Physical Activity of Patients With Chronic Pain Receiving Acceptance and Commitment Therapy or Cognitive Behavioural Therapy

Behaviour Change ◽

10.1017/bec.2014.6 ◽

2014 ◽

Vol 31 (2) ◽

pp. 131-143 ◽

Cited By ~ 6

Author(s):

Katherine VanBuskirk ◽

Scott Roesch ◽

Niloofar Afari ◽

Julie Loebach Wetherell

Keyword(s):

Physical Activity ◽

Chronic Pain ◽

Cognitive Behavioural Therapy ◽

Acceptance And Commitment Therapy ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Tailored Interventions ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

Cognitive Behavioural

Physical activity is positively related to various indices of quality of life and is found to reduce symptoms in individuals with chronic pain. This manuscript presents findings from a post hoc analysis investigating whether treatment-related improvements from psychological treatment for chronic pain are mediated by changes in physical activity (PA). Secondary analyses sought to determine predictor variables of PA in patients with chronic pain and to determine the relationship between objective and self-report measurements of PA. The effect of psychological treatment on physical activity was assessed using accelerometers in a sample of participants with chronic pain in a randomised controlled trial comparing 8 weeks of acceptance and commitment therapy (ACT) to cognitive behavioural therapy (CBT). Participants wore actigraph accelerometers for 7 consecutive days at baseline, post-treatment, and at 6-month follow-up. Hierarchical linear modelling analyses found that the variance in physical activity was not significantly predicted by time (b = 104.67, p = .92) or treatment modality (b = −1659.34, p = .57). Women had greater increases in physical activity than did men (b = 6804.08, p = .02). Current ‘gold standard’ psychological treatments for chronic pain were not found to significantly increase physical activity, an important outcome to target in the treatment of physical and mental health. These results suggest that tailored interventions with greater emphasis on exercise may complement psychological treatment for chronic pain. In particular, gender-tailored interventions may capitalise on physical activity differences found between men and women.

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Effectiveness of group-based cognitive–behavioural therapy in patients with obsessive–compulsive disorder

The Psychiatrist ◽

10.1192/pb.bp.106.011510 ◽

2010 ◽

Vol 34 (1) ◽

pp. 6-9 ◽

Cited By ~ 1

Author(s):

Colette Kearns ◽

Yvonne Tone ◽

Gavin Rush ◽

James V. Lucey

Keyword(s):

Obsessive Compulsive Disorder ◽

Cognitive Behavioural Therapy ◽

Rating Scales ◽

Behavioural Therapy ◽

Post Treatment ◽

Group Setting ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Cognitive Behavioural ◽

The Mean

Aims and methodTo establish whether cognitive-behavioural therapy (CBT) with response and exposure prevention (ERP) is effective in individuals with obsessive–compulsive disorder (OCD). Twenty-four patients with OCD, divided into four groups, participated in ten sessions of group CBT. All patients completed the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Maudsley Obsessive–Compulsive Inventory (MOCI), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) pre- and post-treatment.ResultsThe mean (s.d.) YBOC score post-treatment was 17.1 (5.8). This was significantly lower than the mean (s.d.) YBOC pre-treatment (24.7 (6.1); t = 8.4, d.f. = 23, P < 0.005). A significant reduction was also observed in relation to all other rating scales.Clinical implicationsCognitive–behavioural therapy for OCD delivered in a group setting is a clinically effective and acceptable treatment for patients. The use of group-based CBT is an effective means to improve access to psychotherapy.

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Cognitive behavioural therapy on improving the depression symptoms in patients with diabetes: a meta-analysis of randomized control trials

Bioscience Reports ◽

10.1042/bsr20160557 ◽

2017 ◽

Vol 37 (2) ◽

Cited By ~ 3

Author(s):

Zhi-da Wang ◽

Yu-fei Xia ◽

Yue Zhao ◽

Li-ming Chen

Keyword(s):

Cognitive Behavioural Therapy ◽

Meta Analysis ◽

Behavioural Therapy ◽

Control Group ◽

Depression Symptoms ◽

Randomized Control Trials ◽

Cognitive Behavioural ◽

Subgroup Analyses ◽

Patients With Diabetes ◽

Randomized Control

This meta-analysis was performed to evaluate the effect of cognitive behavioural therapy (CBT) in improving the depression symptoms of patients with diabetes. Literature search was conducted in PubMed and Embase up to October 2016 without the initial date. The pooled SMD (standard mean difference) and its 95% confidence interval (CI) were calculated by Revman 5.3. Subgroup analyses were performed by type of diabetes and evaluation criteria of depression. A total of five randomized control trials involving 834 patients with diabetes mellitus (including 417 patients in CBT group and 417 patients in control group) were included in this meta-analysis. The pooled estimates indicated significant improvement of depression by CBT compared with routine approaches in overall outcomes (SMD =–0.33, 95% CI =–0.46 to –0.21, P<0.00001), post-intervention outcomes (SMD =–0.43, 95% CI =–0.73 to –0.12, P=0.006) and outcomes after 12 months intervention (SMD =–0.38, 95% CI = –0.54 to –0.23, P<0.0001). Subgroup analyses showed that the results were not influenced by the type of diabetes. However, the effect of CBT on improving the depression symptoms disappeared when only using CES-D (Centre for Epidemiological Studies scale for Depression) to evaluate depression.

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Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Health Technology Assessment ◽

10.3310/hta20560 ◽

2016 ◽

Vol 20 (56) ◽

pp. 1-206 ◽

Cited By ~ 24

Author(s):

Steve W Parry ◽

Claire Bamford ◽

Vincent Deary ◽

Tracy L Finch ◽

Jo Gray ◽

...

Keyword(s):

Older Adults ◽

Usual Care ◽

Outcome Measures ◽

Fear Of Falling ◽

Controlled Trial ◽

Behavioural Therapy ◽

Secondary Outcome ◽

Cognitive Behavioural ◽

Randomised Controlled ◽

Anxiety Depression

BackgroundFalls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is ‘fear of falling’, seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive–behavioural therapy (CBT) approach.ObjectivesPrimary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling.Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention.DesignPhase I CBTi development.Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone.SettingMultidisciplinary falls services.ParticipantsConsecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale–International (FES-I) score of > 23.InterventionsPhase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting.Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care.Main outcome measuresThese were assessed at baseline, 8 weeks, 6 months and 12 months.Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months.Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial.ResultsFour hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [–4.02; 95% confidence interval (CI) –5.95 to –2.1], single-item numerical fear of falling scale (–1.42; 95% CI –1.87 to 1.07) and HADS (–1; 95% CI –1.6 to –0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective.ConclusionsOur new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures.Further workFurther work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists.Trial registrationCurrent Controlled Trials ISRCTN78396615.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.

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