scholarly journals Cognitive-behavioural therapy for schizophrenia: Filling the therapeutic vacuum

2003 ◽  
Vol 183 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Paul Chadwick
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Convincing Evidence ◽  
Family Work ◽  
Standard Clinical Practice ◽  
Cognitive Behavioural ◽  
Accepted Part ◽  
The Cost

When does a therapeutic intervention become an accepted part of standard clinical practice? Is it when there is sufficient research evidence? But what constitutes ‘sufficient’? What about available resources and acceptability to patients? Do we have to wait until the National Institute for Clinical Excellence pronounces? A convincing evidence base for family work in schizophrenia (Kuipers, 2000) has existed for many years but has been poorly implemented (Anderson & Adams, 1996). Will cognitive-behavioural therapy (CBT) for psychosis suffer the same fate? Which professional group will champion such an implementation? The evidence for other psychological treatments is less robust. Psychoeducation may prolong time to relapse and improve insight but at the cost of increasing suicidal ideation (Carroll et al, 1998). Personal therapy (Hogarty et al, 1997) may be of value but is contra-indicated for patients who are living alone in the community. Psychodynamic approaches are advocated (Mace & Margison, 1997) but most psychiatrists do not support their use in practice, owing to lack of evidence of efficacy.

Supporting low intensity interventions using the telephone

2010 ◽  
pp. 275-280 ◽  
Author(s):  
Karina Lovell
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Practical Application ◽  
Low Intensity ◽  
Cognitive Behavioural ◽  
Therapy Interventions

Chapter 27 discusses LI interventions using the telephone, and aims to provide the rationale, evidence base, challenges, solutions and practical application of delivering low intensity psychological (mainly cognitive behavioural therapy) interventions by telephone.

scholarly journals Use of cognitive–behavioural therapy skills among trained psychiatrists

2006 ◽  
Vol 30 (2) ◽  
pp. 58-60 ◽  
Author(s):  
Graeme Whitfield ◽  
Moira Connolly ◽  
Alan Davidson ◽  
Chris Williams
Keyword(s):  
Professional Development ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Postal Survey ◽  
Clinical Implications ◽  
Therapeutic Activity ◽  
Protected Time ◽  
Training And Supervision ◽  
Cognitive Behavioural ◽  
The Cost

Aims and MethodPrevious studies have suggested that despite the cost of attendance at postgraduate cognitive–behavioural therapy (CBT) courses, psychiatrists are unable to engage in CBT after qualification. A postal survey of psychiatrists with postgraduate CBT training currently practising in Scotland was performed to assess the levels of training and supervision that they provide, therapeutic CBT activity, and supervision and continued professional development that they receive.ResultsOf the 58 psychiatrists, 51 replied to the survey (88%). Less than half of the respondents supervised other staff. Although 43 (84%) engaged in some therapeutic CBT activity, only 25 (49%) received supervision for their own practice. The main reasons given for not engaging in CBT therapeutic activity were that there was inadequate ‘protected time’ and that CBT had not been included in ‘job plans'.Clinical ImplicationsPsychiatrists can help to disseminate CBT skills. To do this, they require personal supervision, and time for the development and maintenance of therapeutic skills as well as for the training and supervision of others. This survey builds on the results of others and indicates that these requirements are currently being inadequately met.

scholarly journals Cost-effectiveness of computerized cognitive–behavioural therapy for the treatment of depression in primary care: findings from the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial

2017 ◽  
Vol 47 (10) ◽  
pp. 1825-1835 ◽  
Author(s):  
A. Duarte ◽  
S. Walker ◽  
E. Littlewood ◽  
S. Brabyn ◽  
C. Hewitt ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Scenario Analyses ◽  
Cognitive Behavioural ◽  
Life Years ◽  
Gp Care ◽  
The Cost

BackgroundComputerized cognitive–behavioural therapy (cCBT) forms a core component of stepped psychological care for depression. Existing evidence for cCBT has been informed by developer-led trials. This is the first study based on a large independent pragmatic trial to assess the cost-effectiveness of cCBT as an adjunct to usual general practitioner (GP) care compared with usual GP care alone and to establish the differential cost-effectiveness of a free-to-use cCBT programme (MoodGYM) in comparison with a commercial programme (Beating the Blues) in primary care.MethodCosts were estimated from a healthcare perspective and outcomes measured using quality-adjusted life years (QALYs) over 2 years. The incremental cost-effectiveness of each cCBT programme was compared with usual GP care. Uncertainty was estimated using probabilistic sensitivity analysis and scenario analyses were performed to assess the robustness of results.ResultsNeither cCBT programme was found to be cost-effective compared with usual GP care alone. At a £20 000 per QALY threshold, usual GP care alone had the highest probability of being cost-effective (0.55) followed by MoodGYM (0.42) and Beating the Blues (0.04). Usual GP care alone was also the cost-effective intervention in the majority of scenario analyses. However, the magnitude of the differences in costs and QALYs between all groups appeared minor (and non-significant).ConclusionsTechnically supported cCBT programmes do not appear any more cost-effective than usual GP care alone. No cost-effective advantage of the commercially developed cCBT programme was evident compared with the free-to-use cCBT programme. Current UK practice recommendations for cCBT may need to be reconsidered in the light of the results.

scholarly journals Economic evaluation of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

2010 ◽  
Vol 196 (4) ◽  
pp. 310-318 ◽  
Author(s):  
S. A. H. Gerhards ◽  
L. E. de Graaf ◽  
L. E. Jacobs ◽  
J. L. Severens ◽  
M. J. H. Huibers ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cost Utility ◽  
Significant Group ◽  
Efficient Treatment ◽  
Cognitive Behavioural ◽  
The Cost

BackgroundEvidence about the cost-effectiveness and cost utility of computerised cognitive–behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).AimsTo assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU.MethodCosts, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses.ResultsCosts were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT.ConclusionsOn balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

scholarly journals The clinical effectiveness of a cognitive behavioural therapy intervention in a work setting: a 5-year retrospective analysis of outcomes

2018 ◽  
Vol 23 (4) ◽  
pp. 360-372
Author(s):  
David Hitt ◽  
Tayyeb Tahir ◽  
Lyndon Davies ◽  
Jo Delahay ◽  
Mark Kelson
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Clinical Excellence ◽  
Clinical Effectiveness ◽  
Positive Outcome ◽  
Behavioural Therapy ◽  
Funding Agency ◽  
Cognitive Behavioural ◽  
Significant Difference

Background The National Institute for Health and Clinical Excellence (NICE) guidance recommends Cognitive Behavioural Therapy (CBT) as part of multidisciplinary occupational mental health interventions for people with long-term or recurrent short-term sickness absence from work (NICE, 2009). Despite this, there is a paucity of data for both randomised trials for CBT and literature that supports the transferability of CBT into occupational environments. Aims This service evaluation aimed to evaluate the clinical effectiveness of CBT by analysing data from a partnership scheme between a local authority and a local heath board using a routine employee population. Methods A clinical cohort of 81 employees referred through the partnership scheme completed CBT over a 5-year period via a CBT nurse therapist. A sample of 76 employees was included in the evaluation who completed pre-/post-measures to establish outcome. Of these, 30 were followed up at a 3-year point, completing the same measures. Results Each of the clinical measures yielded significant outcomes at 95% confidence intervals, and large effect sizes using Cohen’s d both at post-test and follow-up. No significant difference was shown between post-treatment and follow-up outcomes. CBT was demonstrated to be clinically effective within an occupational mental health setting. Conclusions In conclusion, partnership schemes with a focus on mental health between public sector agencies can have a positive outcome for the funding agency as well as individual employees.

scholarly journals The evidence base for cognitive—behavioural therapy in depression: delivery in busy clinical settings

2003 ◽  
Vol 9 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Graeme Whitfield ◽  
Chris Williams
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Clinical Settings ◽  
Face To Face ◽  
Psychological Therapies ◽  
Department Of Health ◽  
Self Help ◽  
Cognitive Behavioural

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review documentTreatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

Evaluation of an adapted cognitive behavioural therapy (CBT) group programme for people with obsessive compulsive disorder: a case study

2012 ◽  
Vol 5 (4) ◽  
pp. 112-123
Author(s):  
Abigail L. Wroe ◽  
Caroline Wise
Keyword(s):  
Group Therapy ◽  
Cognitive Behavioural Therapy ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Individual Therapy ◽  
Standard Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Group Cbt

AbstractDespite a strong evidence base for cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD), there is limited evidence regarding the effectiveness of group therapy compared to individual therapy. As services struggle to manage high demands, CBT for OCD is often offered in group format. This paper examines the current evidence base for group CBT for OCD considering both clinical outcomes and cost, and describes a group CBT intervention for people with OCD. A CBT group was set up, consistent with NICE guidelines, but slightly adapted from standard group protocols, in line with recommendations from experts in the field. It was evaluated as part of an audit of the service. Statistical analyses demonstrated significant improvements in both measures of depression and the impact of difficulties, and on specific measures of OCD, in clients who attended group CBT (n = 17). The analyses also demonstrated improved effectiveness of therapist hours for group therapy compared to individual therapy. It is concluded that group therapy for OCD should be considered as an alternative to individual therapy when there are significant demands on the service. Recommendations regarding specific adaptations to the standard group CBT format are made.

scholarly journals The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis

2021 ◽  
Vol 51 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Beth Fordham ◽  
Thavapriya Sugavanam ◽  
Katherine Edwards ◽  
Paul Stallard ◽  
Robert Howard ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Prediction Interval ◽  
Psychological Treatment ◽  
Meta Analysis ◽  
Random Effect ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
World Health ◽  
Cognitive Behavioural ◽  
Treatment Research

AbstractThe majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic review evidence and evaluate the consistency of CBT's effect across different conditions. We included reviews of CBT randomised controlled trials in any: population, condition, format, context, with any type of comparator and published in English. We searched DARE, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, CDAS, and OpenGrey between 1992 and January 2019. Reviews were quality assessed, their data extracted and summarised. The effects upon health-related quality of life (HRQoL) were pooled, within-condition groups. If the across-condition heterogeneity was I2 < 75%, we pooled effects using a random-effect panoramic meta-analysis. We summarised 494 reviews (221 128 participants), representing 14/20 physical and 13/20 mental conditions (World Health Organisation's International Classification of Diseases). Most reviews were lower-quality (351/494), investigated face-to-face CBT (397/494), and in adults (378/494). Few reviews included trials conducted in Asia, South America or Africa (45/494). CBT produced a modest benefit across-conditions on HRQoL (standardised mean difference 0.23; 95% confidence intervals 0.14–0.33, I2 = 32%). The effect's associated prediction interval −0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers.

Cognitive behavioural therapy for psychogenic non-epileptic seizures in the context of mild intellectual disability: a case study

2020 ◽  
Vol 14 (6) ◽  
pp. 287-297
Author(s):  
Peter Robert Diamond ◽  
Claire Delaney
Keyword(s):  
Intellectual Disability ◽  
Cognitive Behavioural Therapy ◽  
Epileptic Seizures ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Care Giver ◽  
Mild Intellectual Disability ◽  
Content Type ◽  
Cognitive Behavioural ◽  
Primary Care Giver

Purpose There is a growing evidence base for cognitive behavioural therapy (CBT) as a treatment for psychogenic non-epileptic seizures (PNES) in the general population. Despite the relatively high proportion of individuals with PNES who have an intellectual disability (ID) there is a paucity of literature on the use of CBT for PNES in this population. The purpose of this paper is to describe the use of an adapted CBT approach to treat PNES in a woman with mild ID. Design/methodology/approach The intervention used a CBT approach that included both the client and her mother, her primary care giver, throughout the therapy sessions. It involved 13 1-hour sessions over 20 weeks. Findings Over the course of the intervention the client experienced a reduction in seizure activity. Both the client and her mother reported increases in her perceived ability to cope with the seizures. Originality/value This report describes an adapted CBT-based intervention for individuals with PNES in the context of ID. It is the first report to include the involvement of a care-giver in adapting this approach for individuals with ID.

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