scholarly journals Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses

2010 ◽  
Vol 14 (44) ◽  
Author(s):  
MD Stevenson ◽  
A Scope ◽  
PA Sutcliffe ◽  
A Booth ◽  
P Slade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Postnatal Depression ◽  
Value Of Information ◽  
Clinical Effectiveness ◽  
Behavioural Therapy ◽  
Group Cognitive Behavioural Therapy ◽  
Cognitive Behavioural

scholarly journals Cognitive–behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT

2019 ◽  
Vol 23 (7) ◽  
pp. 1-144 ◽  
Author(s):  
Anthony P Morrison ◽  
Melissa Pyle ◽  
Andrew Gumley ◽  
Matthias Schwannauer ◽  
Douglas Turkington ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Primary Outcome ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Health Technology ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
End Of Treatment

BackgroundClozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of cognitive–behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome.DesignThe Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU).SettingSecondary care mental health services in five cities in the UK.ParticipantsPeople with CRS aged ≥ 16 years, with anInternational Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms.InterventionsIndividual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services.Main outcome measuresThe primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs.ResultsParticipants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) –3.32 to 1.55 points;p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (–2.40 points, 95% CI –4.79 to –0.02 points;p = 0.049). CBT was associated with a net cost of £5378 (95% CI –£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46;p = 0.58).ConclusionsCognitive–behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained.Trial registrationCurrent Controlled Trials ISRCTN99672552.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.

21st Century Cognitive Behavioural Therapy for Anger: A Systematic Review of Research Design, Methodology and Outcome

2018 ◽  
Vol 46 (4) ◽  
pp. 385-404 ◽  
Author(s):  
Ephrem Fernandez ◽  
Catia Malvaso ◽  
Andrew Day ◽  
Deepan Guharajan
Keyword(s):  
Systematic Review ◽  
Clinical Significance ◽  
Cognitive Behavioural Therapy ◽  
Research Design ◽  
Controlled Trial ◽  
Anger Expression ◽  
Clinical Effectiveness ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Measurement Methodology

Background:Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review.Aims:The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome.Method:After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance.Results:The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB.Conclusions:Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.

scholarly journals Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Harry Banyard ◽  
Alex J. Behn ◽  
Jaime Delgadillo
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Cognitive Behavioural ◽  
Primary Focus ◽  
Effect Of Pd ◽  
Evidence Based Care

Abstract Background Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes. Methods This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590). Results Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions). Conclusions The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.

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