scholarly journals Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support

2007 ◽  
Vol 190 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Per Carlbring ◽  
Magdalena Gunnarsdóttir ◽  
Linda Hedensjö ◽  
Gerhard Andersson ◽  
Lisa Ekselius ◽  
...  

BackgroundAlthough effective therapies for social phobia exist, many individuals refrain from seeking treatment owing to the embarrassment associated with help-seeking. Internet-based cognitive-behavioural self-help can be an alternative, but adherence is a problem.AimsTo evaluate a 9-week programme of internet-based therapy designed to increase treatment adherence by the addition of short weekly telephone calls, nine in all, with a total duration of 95 min.MethodIn a randomised controlled trial the effects of internet-based cognitive– behavioural therapy in the treatment group (n=29) were compared with a waiting-list control group (n=28).ResultsCompared with the control group the treated participants experienced greater reductions on measures of general and social anxiety avoidance and depression. Adherence to treatment was high, with 93% finishing the complete treatment package. One year later all improvements were maintained.ConclusionsThis study provides evidence to support the use of internet-based treatment supplemented by short, weekly telephone calls.

2011 ◽  
Vol 199 (4) ◽  
pp. 317-322 ◽  
Author(s):  
Edward R. Watkins ◽  
Eugene Mullan ◽  
Janet Wingrove ◽  
Katharine Rimes ◽  
Herbert Steiner ◽  
...  

BackgroundAbout 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive–behavioural therapy (CBT).AimsTo test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression.MethodForty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150).ResultsAdding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination.ConclusionsThis is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.


1997 ◽  
Vol 171 (4) ◽  
pp. 319-327 ◽  
Author(s):  
Elizabeth Kuipers ◽  
Philippa Garety ◽  
David Fowler ◽  
Graham Dunn ◽  
Paul Bebbington ◽  
...  

BackgroundA series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive–behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published.MethodSixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n=28) and a standard care only control condition (n=32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used.ResultsOver nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide)ConclusionsCBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.


Author(s):  
Yuko Urao ◽  
Ikuyo Ohira ◽  
Takako Koshiba ◽  
Shin-ichi Ishikawa ◽  
Yasunori Sato ◽  
...  

Abstract Background In Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers. Methods Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children’s Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up). Results Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were − 4.91 (95% CI − 5.91, − 3.90) in the intervention group and − 2.53 (95% CI − 3.52, − 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group. Conclusions The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme’s effectiveness. Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018—Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083


2021 ◽  
Vol 12 ◽  
Author(s):  
Sharon H. X. Lu ◽  
Hanita A. Assudani ◽  
Tammie R. R. Kwek ◽  
Shaun W. H. Ng ◽  
Trisha E. L. Teoh ◽  
...  

This study examined the efficacy and acceptability of a hybrid, clinician-guided internet-based Cognitive Behavioural Therapy (iCBT) programme for outpatients with depression in a psychiatric hospital in Singapore. Fifty three participants were randomly assigned to a treatment or wait-list control group before they underwent a cross-over of conditions. Treatment consisted of a 4-week iCBT with three face-to-face sessions. 60.9% of participants who received treatment completed all six modules. Intention-to-treat analysis showed treatment was associated with significant reductions in symptoms of depression, anxiety and psychological distress but not in functional impairment, while the control condition was not associated with changes in any measures. These reductions had moderate to large effect sizes (ESs) for symptoms of depression and anxiety, and moderate ES for psychological distress. The between-group difference in depression score had a moderate ES. There was a significant between-group treatment effect in depressive symptoms, but not in the other measures. Treatment gains were maintained at 3-month follow-up. Most of the participants were highly satisfied with the programme, with 90 percent stating they would recommend it. This is the first RCT to provide preliminary evidence for the efficacy and acceptability of iCBT for depression in Singapore.


BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e032649
Author(s):  
Jenny Ingram ◽  
Debbie Johnson ◽  
Sarah Johnson ◽  
Heather A O'Mahen ◽  
David Kessler ◽  
...  

IntroductionOne in eight women suffer from depression during pregnancy. Currently, low-intensity brief treatment based on cognitive behavioural therapy (CBT) is the only talking treatment widely available in the National Health Service (NHS) for mild and moderate depression. CBT involves identifying and changing unhelpful negative thoughts and behaviours to improve mood. Mothers in our patient advisory groups requested greater treatment choice. Interpersonal counselling (IPC) is a low-intensity version of interpersonal therapy. It may have important advantages during pregnancy over CBT because it targets relationship problems, changes in role and previous losses (eg, miscarriage). We aim to compare CBT and IPC for pregnant women with depression in a feasibility study.Methods and analysisA two-arm non-blinded randomised feasibility study of 60 women will be conducted in two UK localities. Women with depression will be identified through midwife clinics and ultrasound scanning appointments and randomised to receive six sessions of IPC or CBT. In every other way, these women will receive usual care. Women thought to have severe depression will be referred for more intensive treatment. After 12 weeks, we will measure women’s mood, well-being, relationship satisfaction and use of healthcare. Women, their partners and staff providing treatments will be interviewed to understand whether IPC is an acceptable approach and whether changes should be introduced before applying to run a larger trial.Several groups of patients with depression during pregnancy have contributed to our study design. A patient advisory group will meet and advise us during the study.Ethics and disseminationStudy results will inform the design of a larger multicentre randomised controlled trial (RCT). Our findings will be shared through public engagement events, papers and reports to organisations within the NHS. National Research Ethics Service Committee approved the study protocol.Trial registration numberISRCTN11513120.


2008 ◽  
Vol 192 (3) ◽  
pp. 202-211 ◽  
Author(s):  
Nadja Slee ◽  
Nadia Garnefski ◽  
Rien van der Leeden ◽  
Ella Arensman ◽  
Philip Spinhoven

BackgroundSelf-harm by young people is occurring with increasing frequency. Conventional in-patient and out-patient treatment has yet to be proved efficacious.AimsTo investigate the efficacy of a short cognitive-behavioural therapy intervention with 90 adolescents and adults who had recently engaged in self-harm.MethodParticipants (aged 15–35 years) were randomly assigned to treatment as usual plus the intervention, or treatment as usual only. Assessments were completed at baseline and at 3 months, 6 months and 9 months follow-up.ResultsPatients who received cognitive-behavioural therapy in addition to treatment as usual were found to have significantly greater reductions in self-harm, suicidal cognitions and symptoms of depression and anxiety, and significantly greater improvements in self-esteem and problem-solving ability, compared with the control group.ConclusionsThese findings extend the evidence that a time-limited cognitive-behavioural intervention is effective for patients with recurrent and chronic self-harm.


1998 ◽  
Vol 173 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Elizabeth Kuipers ◽  
David Fowler ◽  
Phiuppa Garety ◽  
Daniel Chisholm ◽  
Daniel Freeman ◽  
...  

BackgroundA randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.MethodForty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.ResultsThose in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.ConclusionsImprovement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.


2017 ◽  
Vol 210 (5) ◽  
pp. 362-367 ◽  
Author(s):  
Simon Gilbody ◽  
Sally Brabyn ◽  
Karina Lovell ◽  
David Kessler ◽  
Thomas Devlin ◽  
...  

BackgroundComputerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.AimsWe tested the benefits of adding telephone support to cCBT.MethodWe compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.ResultsUse of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.ConclusionsTelephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.


2008 ◽  
Vol 193 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Helen Seivewright ◽  
John Green ◽  
Paul Salkovskis ◽  
Barbara Barrett ◽  
Ula Nur ◽  
...  

BackgroundLittle is known about the management of health anxiety and hypochondriasis in secondary care settings.AimsTo determine whether cognitive–behavioural therapy (CBT) along with a supplementary manual was effective in reducing symptoms and health consultations in patients with high health anxiety in a genitourinary medicine clinic.MethodPatients with high health anxiety were randomly assigned to brief CBT and compared with a control group.ResultsGreater improvement was seen in Health Anxiety Inventory (HAI) scores (primary outcome) in patients treated with CBT (n=23) than in the control group (n=26) (P=0.001). Similar but less marked differences were found for secondary outcomes of generalised anxiety, depression and social function, and there were fewer health service consultations. The CBT intervention resulted in improvements in outcomes alongside higher costs, with an incremental cost of £33 per unit reduction in HAI score.ConclusionsCognitive–behavioural therapy for health anxiety within a genitourinary medicine clinic is effective and suggests wider use of this intervention in medical settings.


2002 ◽  
Vol 180 (06) ◽  
pp. 523-527 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Trevor Turner

BackgroundLittle evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive–behavioural therapists in patients with schizophrenia.AimsTo assess the effectiveness and safety of a brief cognitive- behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings.MethodA pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual.ResultsPatients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]= 13), insight (P&lt;0.001; NNT=10) and depression (P=0.003;NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio =1.15,95% C1 1.01-1.31).There was no increase in suicidal ideation.ConclusionsCommunity psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.


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