Utilization and Implementation of Trauma-Focused Cognitive–Behavioral Therapy for the Treatment of Maltreated Children

Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) is one of the most researched and widely disseminated interventions for maltreated children. This study describes the findings of a survey of 132 mental health clinicians in children’s advocacy centers (CACs) across the United States to determine the percentage of clinicians who are trained in and utilize TF-CBT and the frequency with which TF-CBT components are implemented. A total of 103 (78%) of the clinicians reported being trained in and utilizing TF-CBT on a regular basis; however, only 66% of these clinicians (58% of the full sample) reported being likely to use each component. The most preferred components were teaching relaxation skills and providing psychoeducation, whereas teaching caregiver child behavior management skills, developing a trauma narrative, and cognitive restructuring were less preferred. Results are discussed in the context of continued dissemination efforts and implications for improving clinical practice.

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Trauma informed interventions: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0252747 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252747

Author(s):

Hae-Ra Han ◽

Hailey N. Miller ◽

Manka Nkimbeng ◽

Chakra Budhathoki ◽

Tanya Mikhael ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Health Inequities ◽

The United States ◽

Psychological Outcomes ◽

Cognitive Behavioral ◽

Health Concern ◽

Ptsd Symptoms ◽

Wide Range ◽

Trauma Informed

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

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Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States

SLEEP ◽

10.1093/sleep/zsaa223 ◽

2020 ◽

Author(s):

Michael Darden ◽

Colin A Espie ◽

Jenna R Carl ◽

Alasdair L Henry ◽

Jennifer C Kanady ◽

...

Keyword(s):

United States ◽

Cost Effectiveness ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cost Effective ◽

The United States ◽

Cognitive Behavioral ◽

Life Years ◽

Insomnia Treatment ◽

Group Cbt

Abstract Study Objectives To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). Methods We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. Results Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (−$3,124.73). Conclusions Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.

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Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

American Journal of Audiology ◽

10.1044/2020_aja-20-00002 ◽

2020 ◽

Vol 29 (3) ◽

pp. 476-490

Author(s):

Vinaya Manchaiah ◽

George Vlaescu ◽

Srinivas Varadaraj ◽

Elizabeth Parks Aronson ◽

Marc A. Fagelson ◽

...

Keyword(s):

United States ◽

Health Care ◽

Cognitive Behavioral Therapy ◽

Health Care Professionals ◽

Behavioral Therapy ◽

The United States ◽

Cognitive Behavioral ◽

Software Safety ◽

Regulatory Aspects ◽

The United Kingdom

Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals ( n = 11) and patients with bothersome tinnitus ( n = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.

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Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation

Journal of Medical Internet Research ◽

10.2196/13432 ◽

2019 ◽

Vol 21 (8) ◽

pp. e13432 ◽

Cited By ~ 4

Author(s):

Renée V H IJzerman ◽

Rosalie van der Vaart ◽

Andrea W M Evers

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Medical Setting ◽

Intention To Use ◽

Management Skills ◽

Use Of Technology ◽

Somatic Illness ◽

Actual Use ◽

Facilitating Conditions

Background Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging. Objective This study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers. Methods A Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Results In total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001). Conclusions In spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs.

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Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia

Proceedings of IMPRS ◽

10.18060/24800 ◽

2020 ◽

Vol 3 ◽

Author(s):

Emily Wilson ◽

Aaron Roberts

Keyword(s):

Cognitive Behavioral Therapy ◽

Clinical Decision Making ◽

Behavioral Therapy ◽

Adult Population ◽

Severity Index ◽

The United States ◽

Cognitive Behavioral ◽

Control Group ◽

Insomnia Severity ◽

Over Time

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time. Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time. Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time. Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.

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Collaborative care clinician perceptions of computerized cognitive behavioral therapy for depression in primary care

Translational Behavioral Medicine ◽

10.1093/tbm/ibz122 ◽

2020 ◽

Vol 10 (3) ◽

pp. 565-572

Author(s):

Lucinda B Leung ◽

Karen E Dyer ◽

Elizabeth M Yano ◽

Alexander S Young ◽

Lisa V Rubenstein ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Cognitive Behavioral Therapy ◽

Collaborative Care ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Mental Health Clinicians ◽

Depression Care ◽

Care Managers ◽

Primary Care Patients

Abstract In Veterans Health Administration’s (VA) Primary Care–Mental Health Integration (PC-MHI) models, primary care providers, care managers, and mental health clinicians collaboratively provide depression care. Primary care patients, however, still lack timely, sufficient access to psychotherapy treatment. Adapting PC-MHI collaborative care to improve uptake of evidence-based computerized cognitive behavioral therapy (cCBT) may be a potential solution. Understanding primary care-based mental health clinician perspectives is crucial for facilitating adoption of cCBT as part of collaborative depression care. We examined PC-MHI mental health clinicians’ perspectives on adapting collaborative care models to support cCBT for VA primary care patients. We conducted 16 semi-structured interviews with PC-MHI nurse care managers, licensed social workers, psychologists, and psychiatrists in one VA health-care system. Interviews were audio-recorded, transcribed, coded using the constant comparative method, and analyzed for overarching themes. Although cCBT awareness and knowledge were not widespread, participants were highly accepting of enhancing PC-MHI models with cCBT for depression treatment. Participants supported cCBT delivery by a PC-MHI care manager or clinician and saw it as an additional tool to engage patients, particularly younger Veterans, in mental health treatment. They commented that current VA PC-MHI models did not facilitate, and had barriers to, use of online and mobile treatments. If effectively implemented, however, respondents thought it had potential to increase the number of patients they could treat. There is widespread interest in modernizing health systems. VA PC-MHI mental health clinicians appear open to adapting collaborative care to increase uptake of cCBT to improve psychotherapy access.

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Internet-Based Cognitive-Behavioral Therapy for Employees With Anxiety, Depression, Social Phobia, or Insomnia: Clinical and Work Outcomes

SAGE Open ◽

10.1177/2158244020914398 ◽

2020 ◽

Vol 10 (1) ◽

pp. 215824402091439 ◽

Cited By ~ 1

Author(s):

Mark Attridge

Keyword(s):

Cognitive Behavioral Therapy ◽

Social Phobia ◽

Clinical Symptoms ◽

Behavioral Therapy ◽

Work Productivity ◽

The United States ◽

Clinical Severity ◽

Cognitive Behavioral ◽

Financial Return ◽

Item Scale

This applied study profiled four self-directed behavioral health support tools from Learn to Live, Inc., when offered as an employee benefit. Each of these automated online programs featured eight structured lessons that emphasized cognitive-behavioral therapy techniques. Archival operational information collected across multiple employers in the United States was analyzed for 1,297 unique participants with longitudinal program use data. Significant reductions were found on validated measures of clinical symptoms specific to each program: Depression ( d = 0.93, n = 268; Patient Health Questionnaire–nine-item scale [PHQ-9]), Insomnia ( d = 0.69, n = 295; Medical Outcomes Study [MOS] Sleep), Social Anxiety ( d = 0.53, n = 170; Social Phobia Inventory [SPIN]), and Stress, Anxiety, & Worry ( d = 0.50, n = 633; Generalized Anxiety Disorders–seven-item scale [GAD-7]). Moderators of improvement included greater initial clinical severity and greater engagement in the programs (more lessons used and use of optional live support from a coach or friend/family). Follow-up survey results ( n = 290) revealed high satisfaction and improved work absenteeism and job performance. Financial return to the employer from improved work productivity was estimated at US$2,431 per employee user.

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Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223417745564 ◽

2017 ◽

Vol 11 ◽

pp. 117822341774556 ◽

Cited By ~ 4

Author(s):

Simon B Zeichner ◽

Rachel L Zeichner ◽

Keerthi Gogineni ◽

Sharon Shatil ◽

Octavian Ioachimescu

Keyword(s):

Breast Cancer ◽

Cognitive Behavioral Therapy ◽

Sleep Disturbance ◽

Treatment Approach ◽

Psychological Treatment ◽

Behavioral Therapy ◽

The United States ◽

Cognitive Behavioral ◽

The Past ◽

Number Of Patients

The number of patients with breast cancer diagnosed with sleep disturbance has grown substantially within the United States over the past 20 years. Meanwhile, there have been significant improvements in the psychological treatment of sleep disturbance in patients with breast cancer. More specifically, cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and yoga have shown to be 3 promising treatments with varying degrees of benefit, supporting data, and inherent limitations. In this article, we will outline the treatment approach for sleep disturbance in patients with breast cancer and conduct a comprehensive review of CBT-I, mindfulness, and yoga as they pertain to this patient population.

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Transgender Affirmative Cognitive–Behavioral Therapy

Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities ◽

10.1093/med-psych/9780190669300.003.0004 ◽

2019 ◽

pp. 74-96

Author(s):

Ashley Austin ◽

Shelley L. Craig

Keyword(s):

Mental Health ◽

Cognitive Behavioral Therapy ◽

Cultural Awareness ◽

Behavioral Therapy ◽

Gender Diversity ◽

Cognitive Behavioral ◽

Mental Health Clinicians ◽

Transgender People ◽

Empirically Supported ◽

Trauma Informed

Although there is growing cultural awareness of transgender identities, transgender people continue to be marginalized and subject to identity-based discrimination and victimization resulting in disproportionate rates of psychological distress and particularly high rates of suicidality. Mental health clinicians can effectively support the mental health needs of transgender clients through the use of empirically supported, trans-affirmative interventions. This chapter focuses on transgender affirmative cognitive–behavioral therapy (TA-CBT), an evidence-informed intervention rooted in the unique needs and experiences of transgender individuals. TA-CBT is a version of CBT that has been adapted to ensure (1) an affirming stance toward gender diversity, (2) recognition of transgender-specific sources of stress and resilience, and (3) the delivery of CBT content within an affirming and trauma-informed framework. Clinical examples are utilized to elucidate affirmative delivery of several important components of TA-CBT: transgender affirmative case conceptualization, psychoeducation, and the development of coping skills to promote identity-affirming changes.

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