Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial

Background The efficacy of the unified protocol of the transdiagnostic treatment for emotional disorders (UP) has been poorly studied in patients with depressive disorders. This study aimed to examine the efficacy of UP for improving depressive symptoms in patients with depressive and/or anxiety-related disorders. Methods This assessor-blinded, randomized, 20-week, parallel-group, superiority study compared the efficacy of the UP with treatment-as-usual (UP-TAU) v. wait-list with treatment-as-usual (WL-TAU). Patients diagnosed with depressive and/or anxiety disorders and with depressive symptoms participated. The primary outcome was depressive symptoms assessed by GRID-Hamilton depression rating scale (GRID-HAMD) at 21 weeks. The secondary outcomes included assessor-rated anxiety symptoms, severity and improvement of clinical global impression, responder and remission status, and loss of principal diagnosis. Results In total, 104 patients participated and were subjected to intention-to-treat analysis [mean age = 37.4, s.d. = 11.5, 63 female (61%), 54 (51.9%) with a principal diagnosis of depressive disorders]. The mean GRID-HAMD scores in the UP-TAU and WL-TAU groups were 16.15 (s.d. = 4.90) and 17.06 (s.d. = 6.46) at baseline and 12.14 (s.d. = 5.47) and 17.34 (s.d. = 5.78) at 21 weeks, with a significant adjusted mean change difference of −3.99 (95% CI −6.10 to −1.87). Patients in the UP-TAU group showed significant superiority in anxiety and clinical global impressions. The improvement in the UP-TAU group was maintained in all outcomes at 43 weeks. No serious adverse events were observed in the UP-TAU group. Conclusions The UP is an effective approach for patients with depressive and/or anxiety disorders.

Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.

ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders

Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.

Longitudinal Effects of Supported Exercise on Elevated Anxiety and Depression Scores in Formerly Sedentary Adults With Severe Obesity

Persistent anxiety and depression may be particularly high in individuals with obesity. Increasing exercise reliably improves mood in the general population; however, it has rarely been tested specifically in adults with severe obesity. Volunteer participants (60% women) of a theory-based cognitive-behavioral weight-management treatment with severe obesity and elevated (highest 10% based on normative values) depression ( N = 89) or anxiety ( N = 60) were assessed at baseline and Month 6 on measures of exercise output (overall, and whether the equivalent of three moderate sessions/week [i.e., ≥ 15 METs/week] were completed), corresponding mood, and exercise barriers self-efficacy. There were significant improvements (large effect sizes) in exercise outputs and mood. Increase in exercise outputs was significantly associated with reduced depression (β = −.52) and anxiety (β = −.67) scores. At least 15 METs/week of exercise was reached by 61% and 60% of participants, respectively. Participants demonstrated significantly greater reductions in depression and anxiety scores over 6 months than those completing lower amounts. Change in exercise barriers self-efficacy significantly mediated the following: (a) the prediction of depression change by change in exercise output and (b) the prediction of change in anxiety by completion/non-completion of ≥ 15 METs/week of exercise. Findings suggest substantial benefits for depression and anxiety in adults with severe obesity under conditions of moderate exercise supported by a community-based cognitive-behavioral treatment. Because of its identified mediation properties, future behavioral treatments should seek to increase barriers self-efficacy to maximize effects on elevated depression and anxiety and possibly weight.

A Pilot Study of the Swedish Sexual Offender Treatment Program

Purpose: The aim was to test whether dynamic criminogenic risk factors change after participation in a new cognitive-behavioral treatment program adhering to the Risk-Need-Responsivity (RNR) model, within a group of adult men convicted of a sexual offense in Sweden. Methods: Three psychometric tests from approximately 26 participants were completed. Therapists rated 46 participants using the Therapist Rating Scale-2 (TRS-2). Results: Participants reported a significant decrease in hypersexuality, small to medium effect size, a non-significant, increased, internal locus of control, but no change regarding attachment styles, posttreatment. Therapists rated significant decrease in all treatment needs posttreatment, medium to large effect size. Conclusions: The significant reduction of several criminogenic risk factors posttreatment indicates the treatment program may reduce problems related to increased risk of recidivism, especially hypersexuality. Moreover, treatment did not appear to have negative effects, motivating further implementation. However, to evaluate the effectiveness, more research is necessary.

Psychosocial Interventions for People With Dementia and Their Caregivers in Primary Care

Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing. However, psychosocial interventions do not seem to have found their way into routine care yet. We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy. In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies. In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions. Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation. It became obvious that psychosocial interventions are not conveyed sufficiently within medical school. A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions. Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group. General retentions to invest in people with dementia were expressed. These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.

Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial

Background Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. Methods The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14–24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists’ rating of patients’ condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. Discussion The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). Trial registration: German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706