How anxious is too anxious? State and trait physiological arousal predict anxious youth’s treatment response to brief cognitive behavioral therapy

Purpose Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. The authors hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. Design/methodology/approach A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n = 29) to those in DC (n = 34). Findings Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (family, strangers, etc.) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. Research limitations/implications This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples. Practical implications Integrated CBT buffered depressive symptoms’ impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. Originality/value Although integrated CBT’s efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.

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Psychoeducation

Managing Social Anxiety, Therapist Guide ◽

10.1093/med-psych/9780190247591.003.0002 ◽

2019 ◽

pp. 13-24

Author(s):

Debra A. Hope ◽

Richard G. Heimberg ◽

Cynthia L. Turk

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Restructuring ◽

Physiological Arousal ◽

Cognitive Behavioral ◽

Common Language ◽

Tripartite Model ◽

Behavioral Disruption ◽

Downward Spiral ◽

Three Components

This chapter explains the tripartite model of anxiety: physiological arousal, behavioral disruption and avoidance, and distorted cognition. The interaction of these three components underlies the cognitive–behavioral therapy (CBT) model for this treatment. The material begins laying the groundwork for cognition as the precipitating event in a downward spiral and for avoidance as key in maintaining the problem. These concepts are important for helping clients understand the rationale for the primary components of treatment (cognitive restructuring and exposure both in and out of session). One goal of this chapter is to develop a common language to understand anxiety, which is helped by spending some time on each of the three components of anxiety to ensure that the client understands each component before moving on to their interaction.

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Intraindividual variability in sleep schedule: effects of an internet-based cognitive-behavioral therapy for insomnia program and its relation with symptom remission

SLEEP ◽

10.1093/sleep/zsaa115 ◽

2020 ◽

Vol 43 (12) ◽

Cited By ~ 1

Author(s):

Kelly M Shaffer ◽

Donald Hedeker ◽

Charles M Morin ◽

Karen Ingersoll ◽

Frances Thorndike ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Intraindividual Variability ◽

Insomnia Symptom ◽

Symptom Remission ◽

Sleep Schedule ◽

Post Assessment ◽

Rising Time

Abstract Study Objectives Sleep schedule consistency is fundamental to cognitive-behavioral therapy for insomnia (CBT-I), although there is limited evidence suggesting whether it predicts treatment response. This analysis tested whether: (1) an Internet-based CBT-I program affects intraindividual variability (IIV) in sleep schedule and (2) sleep schedule IIV predicts insomnia symptom remission. Methods This secondary analysis compares participants (N = 303) randomized to an Internet-based CBT-I program (SHUTi—Sleep Healthy Using the Internet) or Internet-based patient education (PE). Participants reported daily bedtimes and rising times on 10 online sleep diaries collected over 2 weeks at baseline and 9-week post-intervention assessment. Participants completed the Insomnia Severity Index (ISI) at post-assessment and 6-month follow-up; symptom remission was defined by ISI < 8. Mixed effects location scale modeling was used to examine the effect of SHUTi on bedtime and rising time IIV; a novel two-staged analysis examined the effect of bedtime and rising time IIV on insomnia symptom remission. Results At post-assessment, SHUTi participants reported about 30% less bedtime and 32% less rising time variability compared to PE (ps < 0.03). Bedtime and rising time IIV was not independently associated with likelihood of insomnia symptom remission at the subsequent time point (ps > 0.18), nor did sleep schedule IIV moderate treatment response (ps > 0.12). Conclusions Findings demonstrate that an Internet-delivered CBT-I program can effectively increase users’ sleep schedule consistency relative to an educational control. This consistency, however, was not related to treatment outcome when defined by insomnia symptom remission, suggesting that enforcing rigid sleep schedules for patients may not be necessary for treatment success. Clinical Trial Registration NCT00328250

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Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia

Journal of Child Psychology and Psychiatry ◽

10.1111/jcpp.12623 ◽

2016 ◽

Vol 57 (10) ◽

pp. 1194-1202 ◽

Cited By ~ 8

Author(s):

Jeremy C. Kane ◽

Laura K. Murray ◽

Judith Cohen ◽

Shannon Dorsey ◽

Stephanie Skavenski van Wyk ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Behavioral Therapy ◽

Cognitive Behavioral

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Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

BMC Psychiatry ◽

10.1186/s12888-020-02880-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Johannes Kopf-Beck ◽

Petra Zimmermann ◽

Samy Egli ◽

Martin Rein ◽

Nils Kappelmann ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Treatment Approach ◽

Behavioral Therapy ◽

Antidepressant Medication ◽

Supportive Therapy ◽

Cognitive Behavioral ◽

Schema Therapy ◽

Clinic Setting ◽

Day Clinic

Abstract Background Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. Methods In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. Discussion To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. Trial registration Identifier on clinicaltrials.gov: NCT03287362; September, 12, 2017

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Thought Content and Appraisals in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.29.2.106 ◽

2015 ◽

Vol 29 (2) ◽

pp. 106-115 ◽

Cited By ~ 1

Author(s):

Stian Solem ◽

Kristen Hagen ◽

Bjarne Hansen ◽

Åshild T. Håland ◽

Gunvor Launes ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Obsessive Compulsive Disorder ◽

Cognitive Theory ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Obsessive Compulsive ◽

Compulsive Disorder

A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients with autogenous thoughts who appraised their intrusions as more important than others. OCD is heterogeneous regarding thought content and strength of appraisals but can be quite homogeneous in terms of CBT treatment response. Also, and in line with cognitive theory, recovery from OCD is associated with changes in appraisals.

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Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive–compulsive disorder

European Neuropsychopharmacology ◽

10.1016/j.euroneuro.2012.06.014 ◽

2013 ◽

Vol 23 (7) ◽

pp. 569-580 ◽

Cited By ~ 39

Author(s):

Marcelo Q. Hoexter ◽

Darin D. Dougherty ◽

Roseli G. Shavitt ◽

Carina C. D'Alcante ◽

Fabio L.S. Duran ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Obsessive Compulsive Disorder ◽

Gray Matter ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Polysomnographic Predictors of Treatment Response to Cognitive Behavioral Therapy for Insomnia in Participants With Co-morbid Insomnia and Sleep Apnea: Secondary Analysis of a Randomized Controlled Trial

Frontiers in Psychology ◽

10.3389/fpsyg.2021.676763 ◽

2021 ◽

Vol 12 ◽

Author(s):

Alexander Sweetman ◽

Bastien Lechat ◽

Peter G. Catcheside ◽

Simon Smith ◽

Nick A. Antic ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Sleep Apnea ◽

Cognitive Behavioral Therapy ◽

Sleep Disturbance ◽

Treatment Response ◽

Behavioral Therapy ◽

Controlled Trial ◽

Cognitive Behavioral ◽

Randomized Controlled ◽

Pre Treatment

ObjectiveCo-morbid insomnia and sleep apnea (COMISA) is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia (CBTi) is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia (ICSD-3) and sleep apnea [apnea-hypopnea index (AHI) ≥ 15] were randomized to CBTi (n = 72) or no-treatment control (n = 73). Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional (AASM sleep macrostructure), and novel [quantitative electroencephalography (qEEG)] polysomnographic predictors of between-group changes in Insomnia Severity Index (ISI) scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI (interaction p = 0.011), less wake after sleep onset (interaction p = 0.045), and less N3 sleep (interaction p = 0.005). No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change (all p > 0.09).DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance.

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