scholarly journals Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction: U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up (Preprint)

2020 ◽  
Author(s):  
Sophia Monica Humphries ◽  
John Wallert ◽  
Fredrika Norlund ◽  
Emma Wallin ◽  
Gunilla Burell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Group Differences ◽  
Anxiety And Depression ◽  
Treatment As Usual ◽  
Related Mortality

BACKGROUND The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment. OBJECTIVE The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events. METHODS Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post–myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes. RESULTS Both groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (<i>β</i>=–1.14, 95% CI –2.73 to 0.45, <i>P</i>=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual (<i>β</i>=–2.58, 95% CI –4.75 to –0.42, <i>P</i>=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, <i>P</i>=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, <i>P</i>=.25). CONCLUSIONS Internet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results. CLINICALTRIAL ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-015-0689-y

Group cognitive-behavioral therapy for insomnia (CBT-I): long-term follow-up evaluation

2017 ◽  
Vol 40 ◽  
pp. e302
Author(s):  
M. Sforza ◽  
M. Poletti ◽  
L. Giarolli ◽  
A. Galbiati ◽  
S. Marelli ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Long Term Follow Up

Long Term Effect of Cognitive Behavioral Therapy in Patients with Health Anxiety

2017 ◽  
Vol 41 (S1) ◽  
pp. S111-S112
Author(s):  
K.E. Veddegjaerde
Keyword(s):  
Quality Of Life ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Health Anxiety ◽  
Term Effect ◽  
Cognitive Behavioral ◽  
Long Term Effect

IntroductionCognitive-behavioral therapy (CBT) has been found to be an effective treatment of excessive health anxiety (HA), but the long-term effect over 18months has not been examined.ObjectivesSeveral studies have shown effect of CBT for HA-patients. However, these effects have been short or immediate after therapy. To our knowledge no studies have examined long-term effect of CBT for HA over 18 months.AimsTo investigate the long-term effect of CBT on HA, focusing on level of HA, quality of life, subjective health complaints and general anxiety. Follow-up time was at least 10 years. Our hypothesis was that the effect was sustained.MethodsPatients with HA received 16 sessions of CBT over a period of 12–18 months, and were followed up over at least 10 years. All patients fulfilled criteria for F45.2, hypochondriacal disorder according to ICD-10.The patients answered several questionnaires, exploring areas such as HA, Quality of life, somatization, and mental health problems. Questionnaires were answered before CBT, after CBT and at follow up. Mixed model analysis was performed in SPSS 23.0 for all questionnaires.ResultsAll scores were found to be significant in the Pre-CBT–Post-CBT and Pre-CBT–FU (0.034– < 0.001), and none were found to be significant in the Post-CBT–FU.ConclusionsOur findings suggest that for the majority of patients with HA, CBT has a significant and lasting long-term effect. This effect lasts up to ten years post therapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study

2019 ◽  
Vol 88 (4) ◽  
pp. 225-235 ◽  
Author(s):  
Ruth von Brachel ◽  
Gerrit Hirschfeld ◽  
Arleta Berner ◽  
Ulrike Willutzki ◽  
Tobias Teismann ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Outpatient Care ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Follow Up Study

Long-Term Follow-up of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: Symptom Severity and the Role of Exposure 8–10 Years After Inpatient Treatment

2020 ◽  
Vol 34 (3) ◽  
pp. 261-271 ◽  
Author(s):  
Anne Katrin Külz ◽  
Sarah Landmann ◽  
Magdalena Schmidt-Ott ◽  
Bartosz Zurowski ◽  
Andreas Wahl-Kordon ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Healthcare Services ◽  
Cognitive Behavioral ◽  
Long Term Effects ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Obsessive-compulsive disorder (OCD) can be effectively treated by cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Yet, little is known about the long-term effects of inpatient CBT up to one decade after treatment. Thirty patients who had been treated with 12 weeks of intensive inpatient CBT with ERP were examined 8–10 years after their stay in hospital with regard to obsessive-compulsive symptoms, secondary outcomes, and use of healthcare services. Significant (p < .001) improvements in OC symptoms with medium and large effects compared to baseline on the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) and on the Obsessive-Compulsive Inventory (OCI-R) could still be observed, with 20% of the patients reaching remission status. Continuation of exposure exercises after the inpatient stay was the sole significant factor for improved scores at follow-up. The results suggest that OCD does not necessarily take a chronic course. However, maintenance of exposure training seems to be crucial for sustained improvement.

Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

2010 ◽  
Vol 41 (5) ◽  
pp. 1061-1071 ◽  
Author(s):  
V. V. W. McIntosh ◽  
F. A. Carter ◽  
C. M. Bulik ◽  
C. M. A. Frampton ◽  
P. R. Joyce
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Bulimia Nervosa ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Response Prevention ◽  
Cognitive Behavioral ◽  
Term Outcome ◽  
Definition Of

BackgroundFew data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP).MethodOne hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded.ResultsEighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year.ConclusionsThis study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.

Enhanced treatment for depression in primary care: long-term outcomes of a psycho-educational prevention program alone and enriched with psychiatric consultation or cognitive behavioral therapy

2007 ◽  
Vol 37 (6) ◽  
pp. 849-862 ◽  
Author(s):  
HENK JAN CONRADI ◽  
PETER de JONGE ◽  
HERMAN KLUITER ◽  
ANNET SMIT ◽  
KLAAS van der MEER ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Psychiatric Consultation ◽  
Term Outcome ◽  
Long Term Outcome

Background. The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions.Method. A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up.Results. Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9·6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2·07 (95% confidence interval (CI) 1·13–3·00) and 1·62 (95% CI 0·70–2·55) respectively] and PEP patients [2·37 (95% CI 1·35–3·39) and 1·93 (95% CI 0·92–2·94) respectively].Conclusions. The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.

scholarly journals Effects of an Internet-Based Cognitive Behavioral Therapy for Insomnia Program on Work Productivity: A Secondary Analysis

2020 ◽  
Author(s):  
Kelly M Shaffer ◽  
Eric A Finkelstein ◽  
Fabian Camacho ◽  
Karen S Ingersoll ◽  
Frances Thorndike ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Secondary Analysis ◽  
Work Productivity ◽  
Cognitive Behavioral ◽  
Activity Impairment ◽  
Work Related ◽  
Post Assessment

Abstract Background Cognitive-behavioral therapy for insomnia (CBT-I) may improve productivity along with insomnia symptoms, but the long-term duration of productivity gains is unknown. Purpose In this secondary analysis, effects of Internet-delivered CBT-I on work-related and daily activity productivity were examined through 1 year post-treatment. Methods Adults with chronic insomnia (N = 303) were randomized to Internet-delivered CBT-I (Sleep Healthy Using the Internet [SHUTi]) or to patient education (PE). Participants reported interference with attendance (absenteeism) and productivity (presenteeism) at paid employment and in daily activities outside work on the Work Productivity Activity Impairment scale at baseline, 9 weeks later for postintervention assessment (post-assessment), and 6- and 12-month follow-ups. Results Participants randomized to SHUTi were about 50% less likely than those in the PE condition to report any absenteeism (logistic regression odds ratio [OR] = 0.48 [95% confidence intervals {CI} = 0.24,0.96]), total impairment (OR = 0.52 [95% CI = 0.29,0.93]), or activity impairment (OR = 0.50 [95% CI = 0.30,0.85]) at post-assessment; however, differences were not detected at 6- or 12-month follow-ups. SHUTi participants also reported lower overall levels of presenteeism (constrained longitudinal data analysis MDiff = −6.84 [95% CI = −11.53, −2.15]), total impairment (MDiff = −7.62 [95% CI = −12.50, −2.73]), and activity impairment (MDiff = −7.47 [95% CI = −12.68, −2.26]) at post-assessment relative to PE participants. Differences were sustained at 6-month follow-up for presenteeism (MDiff = −5.02 [95% CI = −9.94, −0.10]) and total impairment (MDiff = −5.78 [95% CI = −10.91, −0.65]). No differences were detected by 12-month follow-up. Conclusions Findings suggest that Internet-based CBT-I may help accelerate improvement in work-related and daily activity impairment corroborating prior research, but did not find that CBT-I has persistent, long-term benefits in productivity relative to basic insomnia education. Trial Registration NCT00328250 “Effectiveness of Internet Cognitive Behavioral Therapy Intervention for Treating Insomnia” (https://clinicaltrials.gov/ct2/show/NCT00328250).

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