Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon.

AIM: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS: Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.

The effectiveness of transdiagnostic cognitive behavioural therapy for anxiety disorders: the role of and impact of comorbid depression.

Transdiagnostic Cognitive Behaviour Therapy (tCBT), an intervention designed to be applicable across multiple diagnoses, was introduced to improve limitations in traditional therapy such as cost and access to trained therapists. It has been established as an effective and efficacious treatment for anxiety disorders, though there has been little research focussed on the role of depression. The current study investigated the role of comorbid depression during tCBT for anxiety disorders in primary care settings as an outcome and a moderator of anxiety outcomes. Results of multi-level ANOVAs indicated no significant difference in anxiety outcomes regardless of whether there was a comorbid depression diagnosis in the tCBT condition, and that individuals with a comorbid depression diagnosis experienced significantly greater reduction in anxiety severity than those without. Depression symptom severity decreased to a significantly greater extent in the tCBT condition than in TAU when the outcome measure of Patient Health Questionnaire was utilised as the outcome measure, but this was not mirrored when the Clinician Severity Rating was utilised as the outcome measure. This study provides preliminary support for the effectiveness of Transdiagnostic Cognitive Behaviour therapy for those with both a principal anxiety disorder and comorbid depression in symptom reduction.

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data.

BACKGROUND: This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. METHODS: This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. RESULTS: Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness. CONCLUSIONS: From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework.

BACKGROUND: Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). METHODS: This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. RESULTS: Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. CONCLUSIONS: The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02811458, 23/06/2016.

An analysis of differential improvement by diagnosis in group transdiagnostic cognitive behaviour therapy for anxiety disorders.

INTRODUCTION: Anxiety disorders are the most prevalent among the mental health disorders and have a negative impact on an individual's life. Cognitive behaviour therapy (CBT) is documented as the most effective treatment for anxiety disorders. However, challenges associated with implementing diagnosis-specific CBT have led to transdiagnostic approaches of CBT (tCBT). tCBT uses a single protocol with core elements of CBT for treatment of anxiety disorders broadly. The aim of the current study is to examine whether participants with different principal anxiety diagnoses demonstrate similar anxiety reduction. METHODS: The current study involved a secondary analysis of 117 participants randomly allocated to receive tCBT for anxiety disorders in a pragmatic randomised effectiveness trial. Beck Anxiety Inventory (BAI) and Clinician Severity Ratings (CSR) scales were administered at pre- and post-treatment and one-year follow-up, while the Anxiety Disorder Diagnostic Questionnaire - Weekly (ADDQ-W) was administered each session. RESULTS: Mixed-factorial analyses of variance (ANOVAs) indicated that participants with GAD, SAD and PD/A improved to post-treatment and maintained to follow-up, with no differential improvement across principal diagnoses. Mixed effect regression modelling of session by session measures indicated non-differential negative slopes across principal diagnoses of GAD, SAD and PD/A. CONCLUSION: Overall, results indicate that group tCBT for anxiety disorders shows equal effectiveness for GAD, PD/A, and SAD in real-world conditions.

French adaptation and validation of the Panic Disorder Severity Scale-self-report.

BACKGROUND: The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale - Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version. METHODS: A sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial. RESULTS: The French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach's alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change. CONCLUSIONS: The French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.

A pragmatic randomized controlled trial of a group self-management support program versus treatment-as-usual for anxiety disorders: study protocol.

BACKGROUND: The integration of a personal recovery-oriented practice in mental health services is an emerging principle in policy planning. Self-management support (SMS) is an intervention promoting recovery that aims at educating patients on the nature of their mental disorder, improving their strategies to manage their day-to-day symptoms, fostering self-efficacy and empowerment, preventing relapse, and promoting well-being. While SMS is well established for chronic physical conditions, there is a lack of evidence to support the implementation of structured SMS programs for common mental disorders, and particularly for anxiety disorders. This study aims to examine the effectiveness of a group-based self-management support program for anxiety disorders as an add-on to treatment-as-usual in community-based care settings. METHODS/DESIGN: We will conduct a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months. TREATMENT AND CONTROL GROUPS: a) group self-management support (10 weekly 2.5-h group web-based sessions with 10-15 patients with two trained facilitators); b) treatment-as-usual. Participants will include adults meeting DSM-5 criteria for Panic Disorder, Agoraphobia, Social Anxiety Disorder, and/or Generalized Anxiety Disorder. The primary outcome measure will be the Beck Anxiety Inventory; secondary outcome measures will comprise self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation. STATISTICAL ANALYSIS: Data will be analysed based on intention-to-treat with a mixed effects regression model accounting for between and within-subject variations in the effects of the intervention. DISCUSSION: This study will contribute to the limited knowledge base regarding the effectiveness of structured group self-management support for anxiety disorders. It is expected that changes in patients' self-management behaviour will lead to better anxiety management and, consequently, to improved patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05124639 . Prospectively registered 18 November 2021.

Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders.

The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.

Impact of group transdiagnostic cognitive-behavior therapy for anxiety disorders on comorbid diagnoses: Results from a pragmatic randomized clinical trial in primary care.

BACKGROUND: Anxiety and depressive disorders are the most common mental illnesses worldwide, with most individuals meeting criteria for more than one diagnosis. Most cognitive-behavioral therapy (CBT) approaches target only one disorder at a time, resulting in the need to treat comorbid diagnoses sequentially. Transdiagnostic CBT protocols have been developed that simultaneously treat principal and comorbid disorders. METHOD: The current study reports on a secondary analysis of data from a pragmatic effectiveness randomized trial of group tCBT in comparison to treatment-as-usual (TAU) in primary care. Of the trial sample of 231 patients, 191 had at least one comorbid diagnosis of clinical severity at T0. RESULTS: Overall rates of comorbidity decreased over time (82.0% at T0, 45.0% at T1, 45.7% at T3) and those receiving tCBT showed a significantly lower rate of comorbidity at T1 (33.7%) than TAU (55.7%) and at T3 (tCBT: 27.9%, TAU: 60.2%). Comorbid diagnosis severity ratings reduced to a significantly greater extent in tCBT than in TAU. CONCLUSIONS: tCBT is effective in promoting remission of and reducing the severity of comorbid diagnoses. Implications for the treatment of whole persons as opposed to specific diagnoses is discussed.

The Quality of Life in Bipolar Disorder (QoL.BD) Scale: Validation of a French Cross-Cultural Adaptation.

OBJECTIVE: The goal of this study was to validate the French version of the Quality of Life in Bipolar Disorder (QoL.BD) scale, a condition-specific measure for bipolar disorder (BD). METHOD: The QoL.BD scale was translated into French in accordance with the recommendations for transcultural adaptation. It was administered to 125 participants with BD living in Quebec, Canada. Construct validity was evaluated through correlations with other measures of self-reported quality of life (QoL), functioning, and symptoms. Factorial structure was examined through an exploratory factor analysis. RESULTS: Internal reliability and test-retest reliability standards were met. Correlations in expected directions with other QoL, functioning, and depressive symptom scales supported convergent validity. The item loadings structure of the French QoL.BD largely replicated the original English version, with some modifications. CONCLUSION: The French version of the QoL.BD (full and brief) is comparable in its psychometric properties to the English version. It is a valid and sound measure for the evaluation of the QoL of French-speaking patients with BD.

Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial.

BACKGROUND: Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care. METHODS: In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis. RESULTS: A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79]. CONCLUSIONS: Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.

Secondary outcomes of the guided self-help behavioral activation and physical activity for depression trial.

Background: This article presents secondary outcome variables from a randomized controlled trial evaluating the efficacy of two guided self-help interventions for the treatment of depression: behavioral activation (BA) and physical activity (PA). Both interventions resulted in significant reductions in depressive symptoms compared to the wait-list control group, however the mechanisms by which these interventions influenced depression were not presented. Purpose: The purpose of this paper was to compare changes in secondary outcome variables to gain insight into the mechanisms by which reactivation interventions reduce depressive symptoms. Results: Mixed-model analysis of variances (ANOVAs) revealed significant increases in life satisfaction (Main effect: F(3, 91.71) = 4.63, p < 0.01) and self-efficacy (Main effect: F(3, 91.32) = 4.05, p < 0.01) as well as significant decreases in negative affect (Main effect: F(2, 75.88) = 5.24, p < 0.01) and loneliness (Main effect: F(2, 71.78) = 7.49, p < 0.01) in both interventions at pre-, mid-, post-intervention and follow-up. The group x time interactions were not significant, suggesting that the PA and BA interventions had comparable effects over time. Conclusion: These findings provide insight into the potential mechanisms underlying the effectiveness of guided self-help PA and BA interventions on depressive symptoms.

A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol.

BACKGROUND: Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. METHODS/DESIGN: The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. STATISTICAL ANALYSIS: Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. DISCUSSION: This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02811458 .

Virtual Reality Exposure Training for Musicians: Its Effect on Performance Anxiety and Quality.

Music performance anxiety affects numerous musicians, with many of them reporting impairment of performance due to this problem. This exploratory study investigated the effects of virtual reality exposure training on students with music performance anxiety. Seventeen music students were randomly assigned to a control group (n=8) or a virtual training group (n=9). Participants were asked to play a musical piece by memory in two separate recitals within a 3-week interval. Anxiety was then measured with the Personal Report of Confidence as a Performer Scale and the S-Anxiety scale from the State-Trait Anxiety Inventory (STAI-Y). Between pre- and post-tests, the virtual training group took part in virtual reality exposure training consisting of six 1-hour long sessions of virtual exposure. The results indicate a significant decrease in performance anxiety for musicians in the treatment group for those with a high level of state anxiety, for those with a high level of trait anxiety, for women, and for musicians with high immersive tendencies. Finally, between the pre- and post-tests, we observed a significant increase in performance quality for the experimental group, but not for the control group.

[Professionals' Perceptions Regarding the Implementation of Guided Self-help in the context of the Programme québécois pour les troubles mentaux]. / Perceptions des professionnels face à l'implantation d'autosoins dirigés dans le cadre du Programme québécois pour les troubles mentaux.

Objective Common mental disorders, such as anxiety and depression, have many individual and societal consequences. Various treatments are available for people with these diagnoses, including medication and cognitive behavioral therapy. When these disorders are mild or moderate, psychotherapy is the recommended first-line treatment, given its greater long-term efficacy than pharmacotherapy. However, this is not what is observed in practice: medication is much more widely used than psychotherapy, the latter's accessibility being greatly reduced by long waiting lists. An alternative to these accessibility difficulties is the stepped-care model, which includes guided self-help. These are low-intensity interventions that enable more people to be treated with fewer resources (e.g., fewer meetings with a professional). The Programme québécois pour les troubles mentaux (PQPTM; Quebec Program for Mental Disorders) is a stepped-care model recently implemented in some settings in Quebec. The aim of this study is to gather the perceptions of social workers (SWs) in a Centre intégré (universitaire) de santé et de services sociaux (CI[U]SSS; Community mental health center) on the implementation of the PQPTM guided self-help. Methods To this end, three focus groups of approximately 1h30 were conducted with 13 SWs. The data were coded and analyzed using a thematic qualitative inductive-deductive approach, based on the Consolidated Framework for Implementing Research (CFIR) and the participants' responses obtained during the focus groups. Results The barriers and facilitators to PQPTM guided self-help implementation identified relate to different CFIR constructs: intervention characteristics (e.g., monitoring, type of self-help), internal implementation parameters (e.g., training, organizational pressures), caregiver characteristics (e.g., experience, appropriation time), user characteristics (e.g., age, personality) and process (e.g., treatment integrity, supervision). The results of this qualitative study show that SWs have varied perceptions and opinions of the PQPTM guided self-help: 64% of the themes discussed were nuanced, while 25% were considered exclusively as barriers and 11% exclusively as facilitators. Conclusion These results shed light on the factors that can contribute to the successful implementation of the PQPTM guided self-help in Quebec, with a view to improving it at the heart of the specific CI(U)SSS of the current study and in other mental health centers in Quebec. Several recommendations are made in this respect: for example, to increase upstream planning for future implementations, to maintain access to training and supervision, and to guarantee the availability and printing of self-help guides.

[Behavioral activation and depression: a contextual treatment approach]. / Activation comportementale et dépression : une approche de traitement contextuelle.

Depression is a widespread psychological disorder that affects approximately one in five North American. Typical reactions to depression include inactivity, isolation, and rumination. Several treatments and psychological interventions have emerged to address this problematic. Cognitive behavioural therapies have received increasingly large amounts of empirical support. A sub-component of cognitive behavioural therapy, behavioural activation, has been shown to in itself effectively treat symptoms of depression. This intervention involves efforts to re-activate the depressed client by having them engage in pleasant, gratifying, leisure, social, or physical activities, thereby counteracting the tendency to be inactive and to isolate oneself. Clients are guided through the process of establishing a list of potentially rewarding social, leisure, mastery-oriented or physical activities, to then establish a gradual hierarchy of objectives to be accomplished over the span of several weeks. Concrete action plans are devised, and solutions to potential obstacles are elaborated. The client is the asked to execute the targeted objective and to record their mood prior to and following the activity. Behavioural activation effectively reverses the downward spiral to depression. Interestingly, studies show that behavioural activation has a positive effect on cognitive activities. It has been shown to reduce rumination and favour cognitive restructuring, without requiring cognitively-based interventions. The advantage of this treatment is therefore that it is simpler to administer in comparison to full-packaged cognitive behavioural therapies, it requires a lesser number of sessions and can be disseminated in a low-intensity format. This article begins by summarizing the origins of the behavioural model of depression, which serves as a basis to the understanding of behavioural activation. This is followed by a detailed explanation of the different phases involved in a behavioural activation intervention. Empirical support for behavioural activation is then presented in regards to depression as well as comorbid physical and psychological health problems. The results of meta-analyses and randomized controlled trials are presented. Behavioural activation is then discussed within the framework of third-wave therapies, discussing the potential role of mindfulness in behavioural activation objectives. Specifically, it is suggested that mindfulness, although not necessarily directly addressed in behavioural activation interventions, is an integral part of this intervention as clients are asked to record their mood and activities and to become cognizant of the relationship between their symptoms of depression and the participation in activities that provide positive reinforcement. This favours self-awareness and allows clients to realize the impact of their actions on their physical and psychological states. In engaging in self-observation and self-recording, and in participating in a variety of tasks and activities, clients are indirectly encouraged to focus on the here and now rather that to succumb to the depressive tendency that is to ruminate. Suggestions are made as to how therapists can include mindfulness-based activities in the behavioural activation hierarchy. It is hypothesized that, due to the calming effect of mindfulness practices on the nervous system, incorporating mindfulness-based activities-such as yoga, tai chi, Qi Gong, or meditation-could for some people enhance the efficacy of behavioural activation interventions and foster a greater sense of well-being. The article concludes by discussing issues that should be addressed in future research. It is suggested that future studies on behavioural activation explore the impacts of incorporating mindfulness-based activities in the behavioural activation hierarchy in comparison to a traditional hierarchy limited to the accomplishment of gratifying or mastery-oriented tasks, social outings, leisure activities and physical activity.

[Efficacy of behavioural lifestyle interventions for weight management of psychiatric patients]. / Efficacité des programmes de modifications des habitudes de vie pour la gestion de poids des personnes avec des troubles psychiatriques.

Significant weight gain is common in patients with psychiatric disorders taking antipsychotics, mood stabilisers and/or antidepressants. Psychiatric patients are at a higher risk of suffering from obesity and from the metabolic syndrome than the general population. One promising alternative to limiting weight gain involves modifying lifestyle behaviors. We reviewed the literature on behavioral weight management programs for this clientele. Of the 17 identified studies, 12 reported a significant impact of the program on weight gain compared to usual care. The importance of offering weight management programs to psychiatric patients in outpatient settings is stressed.

An examination of sudden gain prevalence across cognitive-behavioural therapy for anxiety and depressive disorders: A quantitative analysis and meta-analytic review.

Sudden gains, incidences of unexpectedly large and stable session to session symptom reductions during psychotherapy, have been shown in samples of individuals receiving treatment for both anxiety and depressive disorders, although seemingly more frequently in sample receiving treatment for depressive disorders. This may suggest that sudden gains are a function of depression, but the high comorbidity between anxiety and depressive disorders makes this difficult to assess. Study One utilised a sample of 117 adults undergoing CBT for a principal anxiety disorder to explore the effect of comorbid depression on sudden gain prevalence. Results indicated that sudden gains were not more prevalent in the comorbid depression group; however, the frequency of sudden gains was significantly related to comorbid depressive disorder severity. Study Two involved a meta-analysis of 48 studies to compare sudden gain prevalence between trials of CBT for depressive disorders versus anxiety-related disorders. The results of the meta-analysis indicated significantly higher rates of sudden gains in samples with a principal depressive disorder diagnosis, compared to a principal anxiety disorder diagnosis. Sudden gains may therefore be driven by depression, but only at the more severe level.

Anxiety in bipolar disorder: A review of publication trends.

BACKGROUND: Although anxiety is highly prevalent in people with bipolar disorders and has deleterious impact on the course of the illness, past reviews have shown that many aspects of the topic remain under-researched. This scoping review aims to provide a comprehensive overview of the literature addressing anxiety in bipolar disorder (A-BD) between 2011 and 2020, assess if the interest in the topic has increased over the period and map the publication trends. METHODS: Three databases were systematically searched, and all articles were screened at the title/abstract and full text level based on inclusion and exclusion criteria. Of these, 1099 articles were included in the study. The annual number of articles on A-BD published between 2011 and 2020 was calculated and articles addressing it as a primary topic (n = 310) were classified into 4 categories and 11 subcategories to identify gaps in the knowledge. RESULTS: The results show no clear increase in the number of annual publications during the period and much of the available literature is of a descriptive nature. Less is known about the processes underlying the comorbidity and about treatment approaches. LIMITATIONS: Given the large scope of the research question, no quality assessment of the evidence was made. Only articles in English or French were considered. CONCLUSIONS: These results highlight the need to change the focus of research efforts to better understand and address this unique set of conditions in clinical settings.

[Not Available]. / La psychoéducation pour les troubles bipolaires : recension des écrits et recommandations pour le système de santé québécois.

Bipolar disorder is a chronic mental illness characterized by recurrent affective episodes, as well as marked residual symptoms that interfere with functioning. Pharmacotherapy remains the cornerstone of treatment. Unfortunately, medication has limited effects on some aspects of the disorder, while many patients have difficulty complying with pharmacological treatment. This literature review examines the role of psychoeducation as a complementary treatment for patients with bipolar disorder. Different formats of structured psychoeducation are presented, including two evidence-based, manualized treatments. With a view to dissemination, recommendations are proposed for the implantation of psychoeducation in Quebec's healthcare system.