scholarly journals Pilot Cohorts for Development of Concurrent Mobile Treatment for Alcohol and Tobacco Use Disorders

2021 ◽  
Vol 15 ◽  
pp. 117822182110305
Author(s):  
Alyssa M Medenblik ◽  
Patrick S Calhoun ◽  
Stephen A Maisto ◽  
Daniel R Kivlahan ◽  
Scott D Moore ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Heavy Drinking ◽  
The United States ◽  
Telephone Counseling ◽  
Low Risk ◽  
Cognitive Behavioral ◽  
Total N ◽  
Polysubstance Use

Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Two cohorts (n = 13 total, n = 5 women) of participants were enrolled, with 10/13 completing treatment and 7/13 completing the 6-month follow-up. At enrollment, participants were drinking a mean of 28.9 drinks per week (SD = 14.1), with a mean of 14.7 heavy drinking days in the past month (SD = 9.9), and a mean of 18.1 cigarettes per day (SD = 11.7). Treatment included a mobile application that participants used to record carbon monoxide and breath alcohol content readings to bioverify abstinence. Participants received up to 4 sessions of phone cognitive-behavioral therapy and monetary reinforcement contingent on abstinence. In cohort 1, 4/6 participants reported abstinent or low-risk drinking post-monitoring. Six weeks post quit-date, 2/6 participants were CO-bioverified abstinent from tobacco use, with 2/6 in dual remission. These results were maintained at 6-months. In cohort 2, 6/7 reported abstinent or low-risk drinking post-monitoring, 5 weeks post quit-date. At the post-monitoring visit, 5/7 were CO-bioverified abstinent from smoking, with 5/7 in dual remission. At 6-months, 3/7 reporting abstinent or low-risk drinking, 1/7 had bioverified abstinence from smoking, with 1/7 in dual remission. Observations suggest that it is possible to develop a concurrent mobile treatment for alcohol and tobacco use disorders.

scholarly journals Trauma informed interventions: A systematic review

PLoS ONE ◽  
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.

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

SLEEP ◽  
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.

Psychosocial Depression Interventions for Dialysis Patients, With Attention to Latinos: A Scoping Review

2019 ◽  
Vol 29 (8) ◽  
pp. 910-923 ◽  
Author(s):  
John E. Sullivan ◽  
Namkee G. Choi ◽  
Christian E. Vazquez ◽  
Margaret A. Neaves
Keyword(s):  
Scoping Review ◽  
Expressive Writing ◽  
Behavioral Therapy ◽  
Grey Literature ◽  
Behavioral Problem ◽  
Experimental Studies ◽  
The United States ◽  
Cognitive Behavioral ◽  
Dialysis Patients ◽  
Quasi Experimental

Purpose: Depression is a common and debilitating condition that often goes undetected and untreated among people with end-stage renal disease (ESRD). We conducted a scoping review to identify psychosocial depression interventions for adult dialysis patients and gaps in depression care, with particular attention to Latinos, a group disproportionately affected by ESRD in the United States. Methods: We searched electronic databases and grey literature sources for studies in English and Spanish. Results: We found 36 studies including cognitive behavioral, problem-solving, hope, psychoeducation, expressive writing, and physical activity interventions. Twelve studies (33%) were U.S.-based, while the rest were conducted elsewhere. U.S.-based studies involved mostly individual-format cognitive behavioral therapy (CBT) interventions carried out during dialysis. CBTs showed the most promising effect on depression in both randomized clinical and quasi-experimental studies. Among 22 randomized trials reviewed, 1 reported participants with Latino/Hispanic ethnicity. Conclusions: More intervention research is needed for depression treatment with ESRD patients, especially Latinos.

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

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.

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

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.  

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

SAGE Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 215824402091439 ◽  
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.

Feasibility and Acceptability of reSET-O®: Patient and Provider Reported Experiences in a Pilot Study of a Novel Digital Therapeutic in People with Opioid Use Disorder (Preprint)

2021 ◽  
Author(s):  
Sarah Kawasaki ◽  
Sara Mills-Huffnagle ◽  
Nicole Aydinoglo ◽  
Halley Maxin ◽  
Edward Nunes
Keyword(s):  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Treatment ◽  
Behavioral Therapy ◽  
Contingency Management ◽  
Opioid Use Disorder ◽  
Cognitive Behavioral ◽  
Opioid Use ◽  
Hub And Spoke ◽  
Buprenorphine Treatment

BACKGROUND Medications for treatment of opioid use disorder (OUD), such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management plus cognitive behavioral counseling has shown promise for improving outcomes of buprenorphine treatment, but is complicated to deliver. Delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. OBJECTIVE reSET-O® is a Prescription Digital Therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based, interactive program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. A pilot study was performed to assess feasibility and acceptability of reSET-O® in a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O®, were obtained from fifteen individuals. METHODS English-speaking individuals over the age of 18 with a diagnosis of current OUD were recruited after being on buprenorphine for at least one week of treatment. Two 12-week prescriptions for reSET-O® were written for a 24-week study. Patient report of drug use and likeability scales of reSET-O® were conducted at weeks 4,8, 12 and 24 of the study. Qualitative interviews were also conducted. Four providers were recruited and gave feedback on the acceptability and feasibility of reSET-O®. RESULTS Of 15 participants who entered this pilot study, 7 completed 24 weeks and 8 were unable to complete due to drop out after enrollment, attrition in treatment, or incarceration. An average of $96 in contingency management rewards were earned by the participants for completion of modules for the duration of the pilot study. Participants’ subjective feedback found that reSET-O® was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. CONCLUSIONS ReSET-O® was well accepted based on patient and provider feedback in this pilot study, but adherence and retention in treatment remain areas for improvement, as with traditional MOUD and CBT approaches. A randomized control trial in a Hub and Spoke model will be needed to assess if retention on buprenorphine treatment is enhanced through the use of technology based behavioral interventions such as reSET-O®. CLINICALTRIAL NCT03826966

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

2017 ◽  
Vol 11 ◽  
pp. 117822341774556 ◽  
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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