Internet-Delivered Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: Uncontrolled Pilot Trial (Preprint)

BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. AF is associated with a poor quality of life (QoL) and, in many patients, current medical treatments are inadequate in alleviating AF symptoms (eg, palpitations). Patients often present with symptom preoccupation in terms of symptom fear, avoidance, and control behaviors. Internet-delivered cognitive behavior therapy is effective for treating other somatic disorders but has never been evaluated in patients with AF. OBJECTIVE The aim of this study is to evaluate the efficacy and feasibility of AF-specific internet-delivered cognitive behavior therapy. METHODS We conducted an uncontrolled pilot study in which 19 patients with symptomatic paroxysmal AF underwent internet-delivered cognitive behavior therapy. Participants completed self-assessments at pretreatment, posttreatment, and at a 6-month follow-up along with handheld electrocardiogram measurements with symptom registration. The treatment lasted 10 weeks and included exposure to physical sensations, reduction in avoidance behavior, and behavioral activation. RESULTS We observed large within-group improvements in the primary outcome, AF-specific QoL (Cohen d=0.80; P<.001), and in symptom preoccupation (Cohen d=1.24; P<.001) at posttreatment; the results were maintained at the 6-month follow-up. Treatment satisfaction and adherence rates were also high. We observed an increased AF burden, measured by electrocardiogram, at the 6-month follow-up, but a significant decrease was observed in the overestimation of AF symptoms at posttreatment and 6-month follow-up. Exploratory mediation analysis showed that a reduction in symptom preoccupation mediated the effects of internet-delivered cognitive behavior therapy on AF-specific QoL. CONCLUSIONS This study presents preliminary evidence for the potential efficacy and feasibility of a novel approach in treating patients with symptomatic AF with internet-delivered cognitive behavior therapy. CLINICALTRIAL ClinicalTrials.gov NCT02694276; https://clinicaltrials.gov/ct2/show/NCT02694276

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Internet-Delivered Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: Uncontrolled Pilot Trial

JMIR Cardio ◽

10.2196/24524 ◽

2021 ◽

Vol 5 (1) ◽

pp. e24524

Author(s):

Josefin Särnholm ◽

Helga Skúladóttir ◽

Christian Rück ◽

Sofia Klavebäck ◽

Eva Ólafsdóttir ◽

...

Keyword(s):

Atrial Fibrillation ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Behavioral Activation ◽

Adult Population ◽

Pilot Trial ◽

Preliminary Evidence ◽

Poor Quality ◽

Cognitive Behavior

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. AF is associated with a poor quality of life (QoL) and, in many patients, current medical treatments are inadequate in alleviating AF symptoms (eg, palpitations). Patients often present with symptom preoccupation in terms of symptom fear, avoidance, and control behaviors. Internet-delivered cognitive behavior therapy is effective for treating other somatic disorders but has never been evaluated in patients with AF. Objective The aim of this study is to evaluate the efficacy and feasibility of AF-specific internet-delivered cognitive behavior therapy. Methods We conducted an uncontrolled pilot study in which 19 patients with symptomatic paroxysmal AF underwent internet-delivered cognitive behavior therapy. Participants completed self-assessments at pretreatment, posttreatment, and at a 6-month follow-up along with handheld electrocardiogram measurements with symptom registration. The treatment lasted 10 weeks and included exposure to physical sensations, reduction in avoidance behavior, and behavioral activation. Results We observed large within-group improvements in the primary outcome, AF-specific QoL (Cohen d=0.80; P<.001), and in symptom preoccupation (Cohen d=1.24; P<.001) at posttreatment; the results were maintained at the 6-month follow-up. Treatment satisfaction and adherence rates were also high. We observed an increased AF burden, measured by electrocardiogram, at the 6-month follow-up, but a significant decrease was observed in the overestimation of AF symptoms at posttreatment and 6-month follow-up. Exploratory mediation analysis showed that a reduction in symptom preoccupation mediated the effects of internet-delivered cognitive behavior therapy on AF-specific QoL. Conclusions This study presents preliminary evidence for the potential efficacy and feasibility of a novel approach in treating patients with symptomatic AF with internet-delivered cognitive behavior therapy. Trial Registration ClinicalTrials.gov NCT02694276; https://clinicaltrials.gov/ct2/show/NCT02694276

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455 - Durability of the the Effects of Self-Administered Cognitive Behavior Therapy for Patients with Moderate-to-Severe Irritable Bowel Syndrome: 12-Month Follow-up from the IBSOS Trial

Gastroenterology ◽

10.1016/s0016-5085(18)30789-3 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-105

Author(s):

Jeffrey M. Lackner ◽

James Jaccard ◽

Rebecca S. Firth ◽

Darren M. Brenner ◽

Gregory D. Gudleski ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Cognitive Behavior ◽

Irritable Bowel

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Comparison between the efficiency of pharmacotherapy and cognitive behavioral therapy in reducing captagon (fenethylline) dependence and relapse prevention

BJPsych Open ◽

10.1192/bjo.2021.454 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S164-S164

Author(s):

Mohammed Binnwejim ◽

Atheer Alhumade ◽

Deiaaeldin Hosny ◽

Mohamed Alhabib

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Relapse Prevention ◽

Behavioral Therapy ◽

Automatic Thoughts ◽

Cognitive Behavioral ◽

Cognitive Behavior ◽

Significant Discrepancy

AimsTo examine the therapeutic efficacy and effectiveness of cognitive behavior therapy and pharmacotherapy in the treatment of Major Captagon (Fenethylline) Dependence.MethodA 41 outpatients males selected for the study, diagnosed as they are suffering from Captagon Dependence according to the DSM-5, with mean age 34.58 ± 5.11. The sample was divided into three experimental groups, (A) (N = 14) treated by cognitive behavior therapy (CBT) and pharmacotherapy in combination. (B) (N = 13) treated by CBT alone. (C) (N = 14) treated by pharmacotherapy alone. All groups were assigned to four measurements, one for the baseline before any treatment interventions, one post-treatment evaluation and two for follow-up within a short and long time. Non-parametric statistics were used to analyze the data collected by SPSS.ResultThere is no significant intra-group differences were found in terms of baseline assessment. There was no significant discrepancy between the first and the second group except in the term of reducing Captagon craving, as it was clearer in the first group in comparison with other groups. There was a clear significant discrepancy between the first and third groups, for all the study variables and it is phases of assessment especially follow-up. There was a clear degree of differences among the second and the third group, through the different phases of post-assessment, which refers to the great efficacy and effectiveness of CBT in Treating Captagon Dependence CBT was proved to be more effective than pharmacotherapy in the treatment of Captagon Dependence. The combination of CBT and pharmacotherapy was more effective than each other alone in the treatment of Captagon Dependence and Relapse Prevention.ConclusionAvailable evidence suggests that cognitive–behavioral therapy is an effective intervention method for psychological aspects of automatic thoughts, depression, negative health beliefs, craving, and relapse prevention, although its efficacy in reducing Captagon (Fenethylline) dependence.

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COGNITIVE BEHAVIOR THERAPY FOR HOARDING DISORDER: FOLLOW-UP FINDINGS AND PREDICTORS OF OUTCOME

Depression and Anxiety ◽

10.1002/da.22222 ◽

2013 ◽

Vol 31 (12) ◽

pp. 964-971 ◽

Cited By ~ 29

Author(s):

Jordana Muroff ◽

Gail Steketee ◽

Randy O. Frost ◽

David F. Tolin

Keyword(s):

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Cognitive Behavior ◽

Predictors Of Outcome ◽

Hoarding Disorder

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An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating

Psychological Medicine ◽

10.1017/s0033291716002543 ◽

2016 ◽

Vol 47 (4) ◽

pp. 703-717 ◽

Cited By ~ 26

Author(s):

E. Y. Chen ◽

J. Cacioppo ◽

K. Fettich ◽

R. Gallop ◽

M. S. McCloskey ◽

...

Keyword(s):

Binge Eating ◽

Behavior Therapy ◽

Dialectical Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Initial Response ◽

Early Response ◽

Cognitive Behavior ◽

Additional Group ◽

Dsm Iv

BackgroundEarly weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH).MethodOne hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+).ResultsBaseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = −0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD.ConclusionsEarly weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.

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Sleep misestimation among older adults suffering from insomnia with short and normal objective sleep duration and the effects of cognitive behavior therapy

SLEEP ◽

10.1093/sleep/zsaa250 ◽

2020 ◽

Author(s):

Nicole Lovato ◽

Gorica Micic ◽

Leon Lack

Keyword(s):

Older Adults ◽

Sleep Duration ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Sleep Onset ◽

Sleep Diary ◽

Cognitive Behavior ◽

Sleep Onset Latency ◽

Normal Sleep

Abstract Study Objectives Compare the degree of sleep misestimation in older adults with insomnia presenting with objectively short relative to normal sleep duration, and investigate the differential therapeutic response on sleep misestimation between the proposed sleep duration phenotypes to cognitive-behavior therapy for insomnia (CBTi). Methods Ninety-one adults (male = 43, mean age = 63.34, SD = 6.41) with sleep maintenance insomnia were classified as short sleepers (SS; <6 h total sleep time [TST]) or normal sleepers (NS; ≥6 h TST) based on one night of home-based polysomnography. Participants were randomly allocated to CBTi (N = 30 SS, N = 33 NS) or to a wait-list control condition (N = 9 SS, N = 19 NS). Sleep misestimation was calculated as the difference scores of subjective (sleep diary reported) and objective (derived from actigraphy) sleep onset latency (SOL), wake after sleep onset (WASO), and TST at pre- and post-treatment, and 3-month follow-up. Results Prior to treatment, perception of SOL, WASO, and TST did not differ between patients with objectively short sleep duration relative to those with objectively normal sleep duration. Patients’ perception of WASO and TST, improved immediately following treatment and at 3-month follow-up relative to the waitlist group. These improvements did not differ significantly between those with short or normal objective sleep duration prior to treatment. Conclusions The degree of sleep misestimation is similar for older adults suffering from chronic insomnia with short or normal objective sleep duration. Irrespective of objective sleep duration prior to treatment, CBTi produces significant improvements in sleep perception. Clinical Trial Registration Number ACTRN12620000883910

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Exposure and Ritual Prevention, Clomipramine, or Their Combination for Obsessive-Compulsive Disorder

10.1093/med/9780190625085.003.0029 ◽

2018 ◽

Author(s):

Brandon M. Kitay ◽

Michael H. Bloch

Keyword(s):

Obsessive Compulsive Disorder ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Clinical Management ◽

Clinical Case ◽

Cognitive Behavior ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Landmark Study

This chapter provides a summary of a landmark study on the management of obsessive-compulsive disorder (OCD) in adults. Is the combination of exposure and ritual prevention (a cognitive behavior therapy based intervention) along with clomipramine more efficacious than monotherapy with either treatment for OCD? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study interventions, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications for clinical management, and concludes with an exemplary clinical case applying the evidence.

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Adapted cognitive behavior therapy for obsessive–compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study

Autism ◽

10.1177/1362361319856974 ◽

2019 ◽

Vol 24 (1) ◽

pp. 190-199

Author(s):

Oskar Flygare ◽

Erik Andersson ◽

Helene Ringberg ◽

Anna-Clara Hellstadius ◽

Johan Edbacken ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Obsessive Compulsive Disorder ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Cognitive Behavior ◽

Obsessive Compulsive ◽

Compulsive Disorder

Obsessive–compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive–compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale–Brown Obsessive–Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale–Brown Obsessive–Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive–compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive–compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive–compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.

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