Brief online-delivered cognitive-behavioural therapy for dysfunctional worry related to the covid-19 pandemic: A randomised trial

2020 ◽  
Author(s):  
Tove Wahlund ◽  
David Mataix-Cols ◽  
Klara Lauri ◽  
Elles de Schipper ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Psychological Intervention ◽  
Randomised Trial ◽  
Intervention Group ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Waiting List ◽  
Medium Effect ◽  
Behavioural Intervention ◽  
Serious Adverse Events ◽  
Cognitive Behavioural

Introduction: Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life. Objective: The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms.Methods: 670 adults from the general Swedish general population reporting daily uncontrollable worry about COVID-19 and its possible consequences (e.g. illness, death, the economy, one’s family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale assessed at baseline and weeks 1-3 (primary endpoint). Follow-up assessments were conducted one month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant.Results: The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to waiting list (=1.14, Z=9.27, p<.001), corresponding to a medium effect size (bootstrapped d=0.74 [95% CI; 0.58 to 0.90]). Improvements were also seen on all secondary measures, including mood, daily functioning, insomnia and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded.Conclusions: A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the COVID-19 pandemic.

scholarly journals Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial

2020 ◽  
pp. 1-9
Author(s):  
Tove Wahlund ◽  
David Mataix-Cols ◽  
Klara Olofsdotter Lauri ◽  
Elles de Schipper ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Psychological Intervention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Waiting List ◽  
Medium Effect ◽  
Behavioural Intervention ◽  
Serious Adverse Events ◽  
Cognitive Behavioural ◽  
Associated Symptoms ◽  
Cognitive Behavioural Intervention

<b><i>Introduction:</i></b> Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life. <b><i>Objective:</i></b> The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms. <b><i>Methods:</i></b> 670 adults from the Swedish general population reporting daily uncontrollable worry about CO­VID-19 and its possible consequences (e.g., illness, death, the economy, one’s family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale administered at baseline and weeks 1–3 (primary endpoint). Follow-up assessments were conducted 1 month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant. <b><i>Results:</i></b> The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to the waiting list (β = 1.14, <i>Z</i> = 9.27, <i>p</i> &#x3c; 0.001), corresponding to a medium effect size (bootstrapped <i>d</i> = 0.74 [95% CI: 0.58–0.90]). Improvements were also seen on all secondary measures, including mood, daily functioning, insomnia, and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded. <b><i>Conclusions:</i></b> A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the COVID-19 pandemic.

Brief online cognitive behavioural intervention for dysfunctional worry related to the covid-19 pandemic: Pre-specified interim results from a randomised trial

2020 ◽  
Author(s):  
Tove Wahlund ◽  
David Mataix-Cols ◽  
Klara Lauri ◽  
Elles de Schipper ◽  
Brjánn Ljótsson ◽  
...  
Keyword(s):  
Psychological Intervention ◽  
Randomised Trial ◽  
Waiting List ◽  
Medium Effect ◽  
Behavioural Intervention ◽  
Serious Adverse Events ◽  
Participant Satisfaction ◽  
Intention To Treat ◽  
Cognitive Behavioural ◽  
Cognitive Behavioural Intervention

Objective: To investigate if a brief self-guided, online cognitive behavioural intervention can reduce the degree of dysfunctional worry related to the covid-19 pandemic.Design: Randomised waiting list controlled trial.Setting: Swedish general population. Participants: Self-referred adults reporting daily uncontrollable worry about covid-19 and its possible consequences. The trial aims to include 670 participants in total. Here we present the results of a pre-specified interim analysis on data from the first 300 randomised participants. Intervention: A brief (3-week) self-guided, online cognitive behavioural intervention targeting dysfunctional worry related to the covid-19 pandemic. Main outcome measure: A covid-19 adapted version of the self-rated Generalised Anxiety Disorder 7-item scale assessed at baseline, week 1, week 2 and week 3 (primary endpoint). Results: The main pre-specified intention-to-treat analysis indicated significant reductions in covid-19-related worry for the intervention compared to waiting list (=2.64, Z=4.02, p&lt;.001), corresponding to a medium effect size (bootstrapped d=0.69 [95% CI; 0.43 to 0.95]). Improvements were also seen on several secondary measures, including mood, daily functioning and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded.Conclusions: A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the covid-19 pandemic. The full trial will provide more precise estimates of the magnitude of the effects, their long-term durability, and potential adverse effects. Trial registration: ClinicalTrials.gov registration ID: NCT04341922, registered on April 10 2020 before inclusion of the first participant.

scholarly journals The People with Asperger syndrome and anxiety disorders (PAsSA) trial: a pilot multicentre, single-blind randomised trial of group cognitive–behavioural therapy

BJPsych Open ◽  
2016 ◽  
Vol 2 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Peter E. Langdon ◽  
Glynis H. Murphy ◽  
Lee Shepstone ◽  
Edward C.F. Wilson ◽  
David Fowler ◽  
...  
Keyword(s):  
Asperger Syndrome ◽  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Mental Health Problems ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Waiting List ◽  
Cognitive Behavioural ◽  
Significant Difference

BackgroundThere is a growing interest in using cognitive–behavioural therapy (CBT) with people who have Asperger syndrome and comorbid mental health problems.AimsTo examine whether modified group CBT for clinically significant anxiety in an Asperger syndrome population is feasible and likely to be efficacious.MethodUsing a randomised assessor-blind trial, 52 individuals with Asperger syndrome were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed up for 24 weeks.ResultsThe conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared with those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety.ConclusionsTrials of psychological therapies with this population are feasible. Larger definitive trials are now needed.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

scholarly journals Randomised controlled trial of CD–ROM-based cognitive–behavioural self-care for bulimia nervosa

2008 ◽  
Vol 193 (6) ◽  
pp. 493-500 ◽  
Author(s):  
U. Schmidt ◽  
M. Andiappan ◽  
M. Grover ◽  
S. Robinson ◽  
S. Perkins ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
Self Care ◽  
Waiting List ◽  
Behavioural Intervention ◽  
Significant Group ◽  
Cd Rom ◽  
Cognitive Behavioural

BackgroundCognitive–behavioural self-care is advocated as a first step in the treatment of bulimia nervosa.AimsTo examine the effectiveness of a CD–ROM-based cognitive–behavioural intervention in bulimia nervosa and eating disorder not otherwise specified (NOS) (bulimic type) in a routine setting.MethodNinety-seven people with bulimia nervosa or eating disorder NOS were randomised to either CD–ROM without support for 3 months followed by a flexible number of therapist sessions or to a 3-month waiting list followed by 15 sessions of therapist cognitive–behavioural therapy (CBT) (ISRCTN51564819). Clinical symptoms were assessed at pre-treatment 3 months and 7 months.ResultsOnly two-thirds of participants started treatment. Although there were significant group × time interactions for bingeing and vomiting, favouring the CD–ROM group at 3 months and the waiting-list group at 7 months, post hoc group comparisons at 3 and 7 months found no significant differences for bingeing or vomiting. CD–ROM-based delivery of this intervention, without support from a clinician, may not be the best way of exploiting its benefits.

scholarly journals Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study

2020 ◽  
Vol 4 (1) ◽  
pp. e000620 ◽  
Author(s):  
Sadaf Malik ◽  
Tarjei Tørre Asprusten ◽  
Maria Pedersen ◽  
Julie Mangersnes ◽  
Gro Trondalen ◽  
...  
Keyword(s):  
Music Therapy ◽  
Intervention Group ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Control Group ◽  
Barr Virus ◽  
Cognitive Behavioural ◽  
Epstein Barr ◽  
Harmful Effects

​BackgroundCognitive–behavioural therapy (CBT) is effective in chronic fatigue syndrome. However, CBT has not been investigated in postinfectious chronic fatigue (CF), nor is it known whether addition of therapeutic elements from other disciplines might be feasible. We studied the feasibility of a combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents.​MethodsAdolescents (12–20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present feasibility study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months.​ResultsA total of 43 individuals with postinfectious CF were included (21 intervention group, 22 control group). Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months’ follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, number of steps/day tended to decrease (difference=−1158, 95% CI −2642 to 325), whereas postexertional malaise tended to improve (difference=−0.4, 95% CI −0.9 to 0.1) in the intervention group at 3 months. At 15 months’ follow-up, there was a trend towards higher recovery rate in the intervention group (62% vs 37%).​ConclusionAn intervention study of combined CBT and music therapy in postinfectious CF is feasible, and appears acceptable to the participants. The tendencies towards positive effects on patients’ symptoms and recovery might justify a full-scale clinical trial.​Trial registration numberNCT02499302.

scholarly journals Computerised cognitive–behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study

BJPsych Open ◽  
2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Barry Wright ◽  
Lucy Tindall ◽  
Rebecca Hargate ◽  
Victoria Allgar ◽  
Dominic Trépel ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Pilot Study ◽  
Cognitive Behavioural Therapy ◽  
Care Pathway ◽  
Intervention Group ◽  
Behavioural Therapy ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Randomised Controlled

Background Computerised cognitive–behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. Aims This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). Method The trial ran within community and clinical settings. Adolescents (aged 12–18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. Results There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. Conclusions CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.

scholarly journals Cognitive Behavioural Therapy for Nightmares for Patients with Persecutory Delusions (Nites): An Assessor-Blind, Pilot Randomized Controlled Trial

2019 ◽  
pp. 070674371984742 ◽  
Author(s):  
Bryony Sheaves ◽  
Emily A. Holmes ◽  
Stephanie Rek ◽  
Kathryn M. Taylor ◽  
Alecia Nickless ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Behavioural Therapy ◽  
Serious Adverse Events ◽  
Persecutory Delusions ◽  
Treatment As Usual ◽  
Cognitive Behavioural

Objective:Nightmares are relatively common in patients experiencing psychosis but rarely assessed or treated. Nightmares may maintain persecutory delusions by portraying fears in sensory-rich detail. We tested the potential benefits of imagery-focused cognitive behavioural therapy (CBT) for nightmares on nightmare severity and persecutory delusions.Method:This assessor-blind parallel-group pilot trial randomized 24 participants with nightmares and persecutory delusions to receive CBT for nightmares delivered over 4 weeks in addition to treatment as usual (TAU) or TAU alone. Assessments were at 0, 4 (end of treatment), and 8 weeks (follow-up). Feasibility outcomes assessed therapy uptake, techniques used, satisfaction, and attrition. The primary efficacy outcome assessed nightmare severity at week 4. Analyses were intention to treat, estimating treatment effect with 95% confidence intervals (CIs).Results:All participants offered CBT completed therapy (mean [SD], 4.8 [0.6] sessions) with high satisfaction, and 20 (83%) participants completed all assessments. Compared with TAU, CBT led to large improvements in nightmares (adjusted mean difference = −7.0; 95% CI, –12.6 to –1.3; d = –1.1) and insomnia (6.3; 95% CI, 2.6 to 10.0; d = 1.4) at week 4. Gains were maintained at follow-up. Suicidal ideation was not exacerbated by CBT but remained stable to follow-up, compared with TAU, which reduced at follow-up (6.8; 95% CI, 0.3 to 3.3; d = 0.7). CBT led to reductions in paranoia (–20.8; 95% CI, –43.2 to 1.7; d = –0.6), although CIs were wide. Three serious adverse events were deemed unrelated to participation (CBT = 2, TAU = 1).Conclusions:CBT for nightmares is feasible and may be efficacious for treating nightmares and comorbid insomnia for patients with persecutory delusions. It shows promise on paranoia but potentially not on suicidal ideation.

scholarly journals Stepped care and cognitive–behavioural therapy for bulimia nervosa: randomised trial

2011 ◽  
Vol 198 (5) ◽  
pp. 391-397 ◽  
Author(s):  
James E. Mitchell ◽  
Stewart Agras ◽  
Scott Crow ◽  
Katherine Halmi ◽  
Christopher G. Fairburn ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Cognitive Behavioural Therapy ◽  
Relative Effectiveness ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Individual Therapy ◽  
Stepped Care ◽  
Self Help ◽  
Treatment Conditions ◽  
Cognitive Behavioural

BackgroundThis study compared the best available treatment for bulimia nervosa, cognitive–behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness.AimsTo establish the relative effectiveness of these two approaches.MethodThis was a randomised trial conducted at four clinical centres (Clinicaltrials.gov registration number: NCT00733525). A total of 293 participants with bulimia nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management.ResultsBoth in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM–IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT.ConclusionsTherapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach.

scholarly journals Cognitive Behavioural Therapy for Unusual Experiences in Children: A Case Series

2012 ◽  
Vol 41 (3) ◽  
pp. 344-358 ◽  
Author(s):  
Lucy Maddox ◽  
Suzanne Jolley ◽  
Kristin R. Laurens ◽  
Colette Hirsch ◽  
Sheilagh Hodgins ◽  
...  
Keyword(s):  
Mental Health Problems ◽  
Case Series ◽  
Emotional Problems ◽  
Behavioural Therapy ◽  
Behavioural Intervention ◽  
Cognitive Behavioural ◽  
Psychosis Risk ◽  
Cognitive Behavioural Intervention ◽  
Controlled Evaluation ◽  
At Risk Mental State

Background: Over half of children in the general population report unusual or “psychotic-like” experiences (PLEs). The development of a later at-risk mental state is associated with persistent, distressing, PLEs, which are appraised negatively and hard to cope with. We have designed a novel, manualized, cognitive behavioural intervention for children aged 9 to 14 years, which aims to reduce emotional problems, improve coping and resilience, and help children manage PLEs, before an identifiable psychosis risk develops. We report on the feasibility, acceptability and clinical impact of the intervention. Method: Four children who reported PLEs and emotional problems in a community survey completed the intervention, and gave detailed feedback. Clinical outcomes were assessed before, during, and after therapy. Results: Emotional problems, PLE frequency, and PLE impact all decreased during the intervention. Child and therapist satisfaction with the treatment was high. Conclusions: It is feasible, acceptable and helpful to offer psychological interventions to children who report emotional distress and PLEs, prior to the emergence of clear risk factors. Our intervention has the potential to increase resilience to the development of future mental health problems. A larger, randomized controlled evaluation is underway.

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