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.

scholarly journals Patient Uptake, Experiences, and Process Evaluation of a Randomized Controlled Trial of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

2021 ◽  
Vol 8 ◽  
Author(s):  
Eldre W. Beukes ◽  
Gerhard Andersson ◽  
Vinaya Manchaiah
Keyword(s):  
United States ◽  
Clinical Trial ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
The United States ◽  
Cognitive Behavioral ◽  
English Speakers ◽  
Control Group ◽  
Wide Range

Introduction: An internet-based cognitive behavioral therapy (ICBT) offers a way to increase access to evidence-based tinnitus care. To increase the accessibility of this intervention, the materials were translated into Spanish to reach Spanish as well as English speakers. A clinical trial indicated favorable outcomes of ICBT for tinnitus for the population of the United States. In view of later dissemination, a way to increase the applicability of this intervention is required. Such understanding is best obtained by considering the perspectives and experiences of participants of an intervention. This study aimed to identify the processes that could facilitate or hinder the clinical implementation of ICBT in the United States.Methods: This study evaluated the processes regarding enrolment, allocation, intervention delivery, the outcomes obtained, and the trial implementation. The study sample consisted of 158 participants who were randomly assigned to the experimental and control group.Results: Although the recruitment was sufficient for English speakers, recruiting the Spanish participants and participants belonging to ethnic minority groups was difficult despite using a wide range of recruitment strategies. The allocation processes were effective in successfully randomizing the groups. The intervention was delivered as planned, but not all the participants chose to engage with the materials provided. Compliance for completing the outcome measures was low. The personal and intervention factors were identified as barriers for the implementation whereas the facilitators included the support received, being empowering, the accessibility of the intervention, and its structure.Conclusion: An understanding regarding the factors contributing to the outcomes obtained, the barriers and facilitators of the results, engagement, and compliance were obtained. These insights will be helpful in preparing for the future dissemination of such interventions.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04004260. Registered on 2 July 2019.

Cognitive Behavioral Therapy for Insomnia for Caregivers

2019 ◽  
pp. 201-218
Author(s):  
Kelly M. Shaffer ◽  
Patricia Carter ◽  
Sheila N. Garland ◽  
Allison J. Applebaum
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Future Research ◽  
Contributing Factors ◽  
Compensatory Behaviors ◽  
Wide Range ◽  
Cancer Caregivers ◽  
Clinically Significant ◽  
Mental And Physical Health

Between 40% and 76% of cancer caregivers report clinically significant symptoms of insomnia, likely due in part to the unique responsibilities, stressors, and compensatory behaviors endemic to the role. Insomnia negatively affects one’s mental and physical health, is frequently chronic, and may impair the normal grieving process among bereaved caregivers. Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment for insomnia and is well suited to address the multifaceted contributing factors unique to caregivers’ sleep disturbance. This chapter addresses the distinct presentation of insomnia among cancer caregivers and describes key modifications to standard CBT-I that address these specific needs to enhance sensitivity and feasibility. A case example demonstrates the implementation of CBT-I tailored to one caregiver’s presentation. Future research must demonstrate effectiveness and acceptability of CBT-I among active caregivers, as well as develop a wide range of effective CBT-I delivery modalities to best serve this vulnerable population.

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.

scholarly journals Developing a data-driven algorithm for guiding selection between cognitive behavioral therapy, fluoxetine, and combination treatment for adolescent depression

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Meredith Gunlicks-Stoessel ◽  
Bonnie Klimes-Dougan ◽  
Adrienne VanZomeren ◽  
Sisi Ma
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Combination Treatment ◽  
Adolescent Depression ◽  
Behavioral Therapy ◽  
Individual Characteristics ◽  
Cognitive Behavioral ◽  
Treatment Type ◽  
Children’S Depression ◽  
Starting Point ◽  
Wide Range

Abstract Treating adolescent depression effectively requires providing interventions that are optimally suited to patients’ individual characteristics and needs. Therefore, we aim to develop an algorithm that matches patients with optimal treatment among cognitive-behavioral therapy (CBT), fluoxetine (FLX), and combination treatment (COMB). We leveraged data from a completed clinical trial, the Treatment for adolescents with depression study, where a wide range of demographic, clinical, and psychosocial measures were collected from adolescents diagnosed with major depressive disorder prior to treatment. Machine-learning techniques were employed to derive a model that predicts treatment response (week 12 children’s depression rating scale-revised [CDRS-R]) to CBT, FLX, and COMB. The resulting model successfully identified subgroups of patients that respond preferentially to specific types of treatment. Specifically, our model identified a subgroup of patients (25%) that achieved on average a 16.9 point benefit on the CDRS-R from FLX compared to CBT. The model also identified a subgroup of patients (50%) that achieved an average benefit up to 19.0 points from COMB compared to CBT. Physical illness and disability were identified as overall predictors of response to treatment, regardless of treatment type, whereas baseline CDRS-R, psychosomatic symptoms, school missed, view of self, treatment expectations, and attention problems determined the patients’ response to specific treatments. The model developed in this study provides a critical starting point for personalized treatment planning for adolescent depression.

Suitability for Short-Term Cognitive-Behavioral Therapy

2007 ◽  
Vol 21 (4) ◽  
pp. 334-345 ◽  
Author(s):  
Gail Myhr ◽  
Jeanne Talbot ◽  
Lawrence Annable ◽  
Gilbert Pinard
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Linear Regression Analysis ◽  
Cognitive Behavioral ◽  
Reliable Change Index ◽  
Short Term ◽  
Variable Model ◽  
Wide Range

The Suitability for Short-Term Cognitive Therapy Rating Scale (SRS) defines 10 criteria to assess suitability for short-term cognitive-behavioral therapy (CBT). This study examines the relationships between pretreatment SRS scores and outcome of 113 patients treated with short-term CBT for a wide range of disorders. Using the reliable change index (RCI) as a measure of outcome, 65 individuals (57.5%) of the sample experienced statistically reliable improvement. Married status, employed status, female gender, and anxiety disorder as a primary diagnosis were positively correlated with posttreatment RCI. Awareness of emotion and security operations were the SRS items most strongly correlated with outcome. Also correlated were the two alliance potential items (in-session and out-of-session evidence) and the acceptance of personal responsibility for change. Hierarchical multiple linear regression analysis resulted in a three-variable model where married status, primary anxiety disorder, and mean SRS score accounted for 20% of the variance in RCI scores. We conclude that the SRS adds predictive value to the assessment of potential to succeed in CBT.

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 Effectiveness of Usual-Care Cognitive-Behavioral Therapy for Adolescents with Depressive Disorders Rated by Parents and Patients

2020 ◽  
Author(s):  
Daniel Walter ◽  
Jana Buschsieweke ◽  
Lydia Dachs ◽  
Hildegard Goletz ◽  
Anja Goertz-Dorten ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Effect Sizes ◽  
Control Group ◽  
Parent Rating ◽  
Wide Range

Abstract BackgroundDepressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes. Highly controlled randomized controlled trials (RCT) provide considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) as a treatment for depression, but the effectiveness of CBT under routine care conditions remains unproven.MethodsIn the present observational study, the changes achieved through routine CBT in adolescents with depressive disorders treated in a university outpatient clinic were analyzed, and compared to a historical control group of adolescents with depressive disorders who had received treatment as usual. At the start and end of treatment (pre- and post-assessment), parent and self-ratings of the German versions of the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and rating scales for depressive symptoms (FBB-DES, SBB-DES) were assessed. A total of 331 adolescents aged 11–18 years with complete data were assessed for the main analysis.ResultsThe analysis yielded small to large pre-post effect sizes (Cohen’s d) for the total sample (d = 0.33 to d = 0.82) and large effect sizes for adolescents who were rated in the clinical range on each (sub)scale at the start of treatment (d = 0.85 to d = 1.30). When comparing patients in the clinical range with historical controls, medium to large net effect sizes (d = 0.53 to d = 2.09) emerged for the total scores in self- and parent rating. However, a substantial proportion of the sample remained in the clinical range at the end of treatment.ConclusionsThese findings suggest that CBT is effective for adolescents with depressive disorders when administered under routine care conditions, but the results must be interpreted with caution due to the lack of a direct control condition.Trial registrationDRKS, DRKS00021518. Registered 27 April 2020 - Retrospectively registered, http://drks.de

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 Positive Effects of Laser Acupuncture in Methamphetamine Users Undergoing Group Cognitive Behavioral Therapy: A Pilot Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yi-Hsien Shiao ◽  
Yi-Chih Chen ◽  
Yuan-Chieh Yeh ◽  
Tse-Hung Huang
Keyword(s):  
Liver Function ◽  
Cognitive Behavioral Therapy ◽  
Sleep Quality ◽  
Addiction Treatment ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Health Concern ◽  
Laser Acupuncture ◽  
Positive Effects ◽  
Significant Difference

Background. Methamphetamine (MA) addiction has become a crucial public health concern because of its adverse consequences to individuals and the society. Objective. To investigate the clinical efficacy of laser acupuncture combined with group cognitive behavioral therapy for MA addiction treatment. Materials and Methods. MA users who participated in group cognitive behavioral therapy and met the inclusion criteria were referred from psychiatrists to participate. The participants received laser acupuncture treatment once a week for 2 months (total eight treatments) on selected acupoints (PC6, HT7, LI4, ST36, SP6, and LR3). Laboratory assessment included urinalysis for MA and liver function tests aspartate aminotransferase, alanine aminotransferase, and γ-glutamyltransferase (AST, ALT, and γ-GT), whereas the objective assessment included visual analog scale (VAS) for MA craving and refusal and Pittsburgh sleep quality index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) questionnaires. All data were collected before and at 1 and 2 months after treatment. Cognitive behavioral therapy completion rate and rate of relapse to MA use were also determined. Result. Fifteen participants were enrolled, of whom seven completed the trial. Urinalysis for MA revealed a decrease in drug use from 57.1% to 28.6%. Compared with those before treatment, PSQI scores were significantly lower at 1 and 2 months after treatment (−3.73 and −4.10, respectively; both p < 0.001 ), and so were BDI scores (−5.64 and −8.17, respectively; p = 0.01 and 0.001, respectively). However, no significant difference was observed in the liver function test, VAS of craving and refusal, and BAI results. A slight improvement in the motivation for drug abstinence and anxiety was observed during the treatment course. Participants reported no adverse events. Conclusion. Laser acupuncture combined with group cognitive behavioral therapy may improve sleep quality, alleviate depression, and reduce MA use. Additional large-scale studies confirming the effectiveness of this modality are warranted.

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.

Sign in / Sign up

Export Citation Format

Share Document