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1.
Ann Palliat Med ; 10(10): 10684-10696, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763429

RESUMO

BACKGROUND: The treatment of insomnia mainly includes drug therapy and non-drug therapy (cognitive behavioral therapy [CBT]). Traditional face-to-face CBT is affected by factors such as location, time, and treatment cost, making the treatment impossible to implement effectively. With the continuous development of network technology, internet-based CBT (ICBT) has been widely used due to the advantages of time and location. METHODS: It searched the China National Knowledge Internet (CNKI) database (1979-Apr 2021), China Biomedical Literature Database (1994-Apr 2021), Cochrane Library (2005-Apr 2021), Medline (1948-Apr 2021), and Embase (Jan 1966-Apr 2021). Chinese and English databases were searched using the following terms: internet-based cognitive behavioral therapy, cognitive behavioral therapy, sleep problems, and sleep disorders. Meta-analysis was performed using RevMan 5.3 and Stata SE 12.0 software provided by the Cochrane collaboration. RESULTS: A total of 14 randomized controlled trials were included in this study. Of these, 10 described the correct random allocation method, 6 described the allocation scheme in detail, and 1 article used the blind method. Sleep onset latency after ICBT was much shorter than that of the control group [mean difference (MD): -12.27, 95% confidence interval (CI): -16.43 to -9.90, P<0.01]. Total sleep time after ICBT was much longer than that of the control group (MD: 38.67, 95% CI: 34.70-42.65, P<0.01). Sleep efficacy after ICBT was significantly higher in contrast with the control group (MD: 13.28, 95% CI: 10.49-16.06, P<0.01). Anxiety and depression levels after the ICBT were significantly lower than those in the control group (P<0.01). DISCUSSION: Meta-analysis was adopted to confirm that ICBT can greatly improve the sleep parameters of patients with insomnia, and it was found to have a relieving effect on patients with anxiety and depression.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Ansiedade , Transtornos de Ansiedade , Humanos , Internet , Ensaios Clínicos Controlados Aleatórios como Assunto , Distúrbios do Início e da Manutenção do Sono/terapia
2.
Ann Palliat Med ; 10(10): 10744-10755, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763436

RESUMO

BACKGROUND: There are not many drugs for teen depression, and many antidepressants are not recommended for people under the age of 14 years. Thus, cognitive behavioral therapy, such as art therapy, is widely used in the treatment of adolescent depression. Group painting therapy (GPT) is a psycho-art treatment that allows the artist to engage in the creative process of painting. METHODS: Chinese and English databases were searched with a combination of words, including "Adolescent depression", "Group painting therapy", "Art therapy", and "Depression". A meta-analysis of the literature was carried out using the Cochrane system (RevMan 5.3). RESULTS: Six randomized controlled trials (RCTs) were included in this study, of which 4 (66.66%) adopted the correct random assignment method, and 1 (16.67%) adopted a hidden detailed assignment scheme. One (16.67%) article adopted a blind method to evaluate the results. After GPT, depressed adolescent patients' positive emotion scores improved significantly [mean deviation (MD) =4.62, 95% confidence interval (CI) (3.79, 5.45), P<0.01] as did patients' negative emotion scores [MD =-1.88, 95% CI (-2.29, -1.46), P<0.01]. Patients' cognitive function and executive ability were also significantly improved by GPT. DISCUSSION: The results of our systematic evaluation and meta-analysis confirmed that GPT significantly improves adolescent depression and relieves patients' negative emotions.


Assuntos
Antidepressivos , Terapia Cognitivo-Comportamental , Adolescente , Depressão , Emoções , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Neuropsychopharmacol Hung ; 23(3): 296-307, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34751022

RESUMO

Bipolar affective disorder is a chronic illness that usually causes significant psychosocial deficits and functional impairment and is also associated with excess mortality. It is underlied by an endogenous pathology with pharmacotherapy as primary treatment. However, in many cases, medication treatment alone is associated with limited adherence, low remission rates, increased potential for relapse and residual symptoms, which is why bipolarity-specific psychotherapeutic interventions are increasingly gaining ground as an integral part of the management of the disease. An increasing amount of research and evidence suggest that complementary psychotherapeutic interventions improve patients' long-term functioning, and argue for the involvement of psychologists and other helping professionals in the long-term care of patients with bipolar disorder. In this article we overview the major therapeutic methods specifically targeted at this group of patients, including individual and group psychoeducation, cognitive behavioural therapy, family therapy, Interpersonal and Social Rhythm Therapy (IPSRT), Integrated Care Management, Think Effectively About Mood Swings (TEAMS), Imagery Based Emotion Regulation (IBER), and other individual and group techniques and psychotherapeutic interventions, also mentioning efficacy studies and effects experienced by patients.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Transtorno Bipolar/tratamento farmacológico , Terapia Familiar , Humanos , Psicoterapia , Psicotrópicos/uso terapêutico
4.
J Anxiety Disord ; 84: 102494, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34763219

RESUMO

BACKGROUND: Internet cognitive behavioural therapy (iCBT) for health anxiety has demonstrated efficacy but has not been evaluated during the COVID-19 pandemic. This study presents the first evaluation of the uptake and outcomes of iCBT for health anxiety during the COVID-19 pandemic. METHODS: THIS WAY UP is an Australian digital mental health service which delivers iCBT interventions to community members. We compared the uptake of THIS WAY UP's iCBT course for health anxiety in an Australian adult sample who started the course before the pandemic (12th September 2019-11 th March 2020) to during the pandemic (12th March to 11th June 2020). The course was accessible to Australian adults over 18 years old, with no inclusion criteria. Outcomes included course registrations and commencements, lesson and course completion, and self-reported health anxiety (Short Health Anxiety Inventory), depression (Patient Health Questionnaire 9-item) and distress (Kessler-10). RESULTS: From March to June 2020, we observed significant increases in course registrations (N = 238 vs N = 1057); and course commencements (N = 126 vs. N = 778). Large, significant improvements in health anxiety (g = 0.89), and distress (K10: g = 0.91), and medium improvements in depression (g = 0.55) were found. Course completion during COVID was 30.5%. CONCLUSIONS: iCBT improved health anxiety during the COVID-19 pandemic, and provides scalable intervention that can address increased demands for mental health services in the community.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Adolescente , Adulto , Ansiedade/terapia , Austrália , Humanos , Internet , Pandemias , SARS-CoV-2 , Resultado do Tratamento
5.
Eur J Psychotraumatol ; 12(1): 1984049, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745446

RESUMO

Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies. Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies. Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined. Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising. Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.


Assuntos
Ansiedade/terapia , COVID-19/psicologia , Terapia Cognitivo-Comportamental , Depressão/terapia , Pessoal de Saúde/psicologia , Intervenção Baseada em Internet , Transtornos de Estresse Pós-Traumáticos/terapia , Ansiedade/psicologia , COVID-19/epidemiologia , Depressão/psicologia , Humanos , Saúde Mental , Pandemias , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/psicologia
6.
J Med Internet Res ; 23(11): e28999, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34726612

RESUMO

BACKGROUND: There is huge variability in the way that individuals with tinnitus respond to interventions. These experiential variations, together with a range of associated etiologies, contribute to tinnitus being a highly heterogeneous condition. Despite this heterogeneity, a "one size fits all" approach is taken when making management recommendations. Although there are various management approaches, not all are equally effective. Psychological approaches such as cognitive behavioral therapy have the most evidence base. Managing tinnitus is challenging due to the significant variations in tinnitus experiences and treatment successes. Tailored interventions based on individual tinnitus profiles may improve outcomes. Predictive models of treatment success are, however, lacking. OBJECTIVE: This study aimed to use exploratory data mining techniques (ie, decision tree models) to identify the variables associated with the treatment success of internet-based cognitive behavioral therapy (ICBT) for tinnitus. METHODS: Individuals (N=228) who underwent ICBT in 3 separate clinical trials were included in this analysis. The primary outcome variable was a reduction of 13 points in tinnitus severity, which was measured by using the Tinnitus Functional Index following the intervention. The predictor variables included demographic characteristics, tinnitus and hearing-related variables, and clinical factors (ie, anxiety, depression, insomnia, hyperacusis, hearing disability, cognitive function, and life satisfaction). Analyses were undertaken by using various exploratory machine learning algorithms to identify the most influencing variables. In total, 6 decision tree models were implemented, namely the classification and regression tree (CART), C5.0, GB, XGBoost, AdaBoost algorithm and random forest models. The Shapley additive explanations framework was applied to the two optimal decision tree models to determine relative predictor importance. RESULTS: Among the six decision tree models, the CART (accuracy: mean 70.7%, SD 2.4%; sensitivity: mean 74%, SD 5.5%; specificity: mean 64%, SD 3.7%; area under the receiver operating characteristic curve [AUC]: mean 0.69, SD 0.001) and gradient boosting (accuracy: mean 71.8%, SD 1.5%; sensitivity: mean 78.3%, SD 2.8%; specificity: 58.7%, SD 4.2%; AUC: mean 0.68, SD 0.02) models were found to be the best predictive models. Although the other models had acceptable accuracy (range 56.3%-66.7%) and sensitivity (range 68.6%-77.9%), they all had relatively weak specificity (range 31.1%-50%) and AUCs (range 0.52-0.62). A higher education level was the most influencing factor for ICBT outcomes. The CART decision tree model identified 3 participant groups who had at least an 85% success probability following the undertaking of ICBT. CONCLUSIONS: Decision tree models, especially the CART and gradient boosting models, appeared to be promising in predicting ICBT outcomes. Their predictive power may be improved by using larger sample sizes and including a wider range of predictive factors in future studies.


Assuntos
Terapia Cognitivo-Comportamental , Zumbido , Mineração de Dados , Árvores de Decisões , Humanos , Internet , Aprendizado de Máquina , Zumbido/terapia
7.
Artigo em Inglês | MEDLINE | ID: mdl-34770156

RESUMO

(1) Background: The efficacy of the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy, with trauma-focused exposure has not been sufficiently demonstrated for post-traumatic stress disorder (PTSD) with multiple comorbidities. This study examined the effects of UP treatment with trauma-focused exposure on symptoms of PTSD and comorbidities in a client who was hesitant about exposure. (2) Methods: The client, who had comorbid dysthymia, social anxiety disorder, agoraphobia, and bulimia nervosa, participated in the UP for 20 sessions over 6 months. The principal diagnosis and symptoms of the comorbid disorders were assessed at baseline, post-intervention, and at the 3-month follow-up. This treatment was conducted as part of a clinical study (UMIN000008322). (3) Results: The client showed improvement in the principal diagnosis and symptoms of the comorbid disorders post-intervention compared with baseline and no longer met the diagnostic criteria for any of the disorders. Considerable symptom improvement was observed with imaginal exposure to trauma memories. (4) Conclusions: The UP was an effective alternative treatment for PTSD and symptoms of comorbidities in this client who was hesitant about exposure to traumatic memories, and that the inclusion of trauma-focused exposure provided sufficient therapeutic effects. Further research is needed to examine the generalizability of our findings.


Assuntos
Terapia Cognitivo-Comportamental , Fobia Social , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Humanos , Japão/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia
8.
J Med Syst ; 45(12): 110, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34767084

RESUMO

A mobile app could be a powerful medium for providing individual support for cognitive behavioral therapy (CBT), as well as facilitating therapy adherence. Little is known about factors that may explain the acceptance and uptake of such applications. This study, therefore, examines factors from an extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT2) model to explain variation between people's behavioral intention to use a CBT for insomnia (CBT-I) app and their use-behavior. The model includes eight aspects of behavioral intention: performance expectancy, effort expectancy, social influence, self-efficacy, trust, hedonic motivation, anxiety, and facilitating conditions, and investigates further the influence of the behavioral intention and facilitating conditions on app-usage behavior. Data were gathered from a field trial involving people (n = 89) with relatively mild insomnia using a CBT-I app. The analysis applied the Partial Least Squares-Structural Equation Modeling method. The results found that performance expectancy, effort expectancy, social influence, self-efficacy, trust, and facilitating conditions all explained part of the variation in behavioral intention, but not beyond the explanation provided by hedonic motivation, which accounted for R2 = 0.61. Both behavioral intention and facilitating conditions could explain the use-behavior (R2 = 0.32). We anticipate that the findings will help researchers and developers to focus on: (1) users' positive feelings about the app as this was an indicator of their acceptance of the mobile app and usage; and (2) the availability of resources and support as this also correlated with the technology use.


Assuntos
Terapia Cognitivo-Comportamental , Aplicativos Móveis , Distúrbios do Início e da Manutenção do Sono , Humanos , Intenção , Distúrbios do Início e da Manutenção do Sono/terapia , Inquéritos e Questionários
9.
J Int Med Res ; 49(11): 3000605211050798, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34772315

RESUMO

OBJECTIVE: The study aim was to examine the effects of cognitive behavioural therapy (CBT) on the pregnancy outcomes of women receiving in vitro fertilization-embryo transfer (IVF-ET) treatment. METHODS: A literature review was performed using the databases MEDLINE, the Cochrane Database, Embase, Chinese National Knowledge Infrastructure (CNKI) and WANFANG. Eligible studies were selected according to inclusion and exclusion criteria. Relevant data were extracted and the quality of studies assessed. Odds ratios with 95% confidence intervals were pooled to statistically analyse the difference between intervention and control groups. RESULTS: Ten studies were selected for the systematic review and meta-analysis. The findings showed that CBT and cognitive-related therapy significantly improved the pregnancy rate of women undergoing IVF-ET treatment. Subgroup analysis showed that patients who received CBT, rather than complex psychological interventions, and those who received interventions delivered by professional psychologists, were more likely to become pregnant during IVF-ET treatment. CONCLUSION: CBT and cognitive-related interventions had significant effects on the pregnancy outcomes of women receiving IVF-ET treatment. CBT treatment (rather than complex psychological interventions) provided by professional psychologists is strongly recommended.


Assuntos
Terapia Cognitivo-Comportamental , Resultado da Gravidez , Transferência Embrionária , Feminino , Fertilização In Vitro , Humanos , Gravidez , Taxa de Gravidez
10.
J Telemed Telecare ; 27(10): 638-666, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34726992

RESUMO

OBJECTIVES: This systematic review aims to examine the effectiveness of online mental health interventions for youth. METHODS: We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. RESULTS: Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. CONCLUSIONS: Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.


Assuntos
Terapia Cognitivo-Comportamental , Internet , Saúde Mental , Autocuidado , Adolescente , Inteligência Artificial , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Trials ; 22(1): 723, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674732

RESUMO

BACKGROUND: Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS: This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION: This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION: ClinicalTrials.gov NCT04072666 . Registered on 28 August 2019.


Assuntos
Terapia Cognitivo-Comportamental , Tentativa de Suicídio , Terapia Comportamental , Intervenção na Crise , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ideação Suicida
12.
BMC Psychiatry ; 21(1): 496, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635063

RESUMO

BACKGROUND: Seventy per cent of patients with psychotic disorders has paranoid delusions. Paranoid delusions are associated with significant distress, hospital admission and social isolation. Cognitive-behavioural therapy for psychosis (CBTp) is the primary psychological treatment, but the median effect size is only small to medium. Virtual reality (VR) has a great potential to improve the effectiveness of CBTp. In a previous study, we found that VR based CBT (VRcbt) for paranoid delusions is superior to waiting list. As a next step, a direct comparison with CBTp is needed. The present study aims to investigate whether VRcbt is more effective and cost-effective than regular CBTp in treating paranoid delusions and improving daily life social functioning of patients with psychotic disorders. METHODS: A total of 106 patients with DSM-5 diagnosis of psychotic disorder and at least moderate level of paranoid ideations will be recruited for this multicentre randomized controlled trial (RCT). Patients will be randomized to either VRcbt or standard CBTp for paranoid delusions. VRcbt consists of maximum 16 sessions in virtual social situations that trigger paranoid ideations and distress, delivered in an 8-12 week time frame. Standard CBTp also consists of maximum 16 sessions including exposure and behavioural experiments, delivered in an 8-12 week time frame. The two groups will be compared at baseline, post-treatment and six months follow-up. Primary outcome is the level of paranoid ideations in daily life social situations, measured with ecological momentary assessments (EMA) at semi-random moments ten times a day during seven days, before and after treatment. Every session, participants and therapists will rate the level of paranoid ideation and global clinical impression. DISCUSSION: Comparison of VRcbt and CBTp will provide information about the relative (cost-) effectiveness of VRcbt for this population. VRcbt may become a preferred psychological treatment for paranoid delusions and social anxiety in patients with psychotic disorder. TRIAL REGISTRATION: Netherlands Trial Register, NL7758. Registered on 23 May 2019.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Psicóticos , Terapia de Exposição à Realidade Virtual , Realidade Virtual , Delusões/terapia , Humanos , Estudos Multicêntricos como Assunto , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Artigo em Inglês | MEDLINE | ID: mdl-34639523

RESUMO

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.


Assuntos
Terapia de Aceitação e Compromisso , Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Síndrome de Abstinência a Substâncias , Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Humanos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Síndrome de Abstinência a Substâncias/tratamento farmacológico
14.
BMC Health Serv Res ; 21(1): 1162, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702280

RESUMO

BACKGROUND: Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care. METHODS: Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications. RESULTS: BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: - 1.35) at higher costs (AMD: +€ 754). No AMD was significant. ICERs amounted to €288 per MADRS-point and €550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of €241 (MADRS) and €615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective. CONCLUSION: BPT is a promising alternate treatment strategy which - in absence of established WTP thresholds for improving symptoms of depression - cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.


Assuntos
Terapia Cognitivo-Comportamental , Depressão , Análise Custo-Benefício , Depressão/terapia , Humanos , Estudos Prospectivos , Psicoterapia , Anos de Vida Ajustados por Qualidade de Vida
15.
BMC Health Serv Res ; 21(1): 1151, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34696785

RESUMO

BACKGROUND: Approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA). Due to the growing number of TKA procedures, this will affect an increasing number of people worldwide. Catastrophic thinking, dysfunctional illness perception, poor mental health, anxiety and depression characterize these non-improvers, and indicate that these patients may need individualized treatment using a treatment approach based on the bio-psycho-social health model. The present study developed an internet-delivered cognitive behavioral therapy (iCBT) program to be combined with exercise therapy and education for patients with knee osteoarthritis (OA) at increased risk of chronic pain after TKA. METHODS: The development process followed the first two phases of the UK Medical Research Council framework for complex interventions. In the development phase, the first prototype of the iCBT program was developed based on literature review, established iCBT programs and multidisciplinary workshops. The feasibility phase consisted of testing the program, interviewing users, condensing the program, and tailoring it to the patient group. A physiotherapist manual was developed and adapted to physiotherapists who will serve as mentors. RESULTS: The development process resulted in an iCBT program consisting of 10 modules with educational texts, videos and exercises related to relevant topics such as goalsetting, stress and pain, lifestyle, automatic thoughts, mindfulness, selective attention, worry and rumination. A physiotherapist manual was developed to guide the physiotherapists in supporting the patients through the program and to optimize adherence to the program. CONCLUSIONS: The iCBT program is tailored to patients at risk of chronic pain following TKA, and may be useful as a supplement to surgery and/or exercise therapy. A multicentre RCT will evaluate the iCBT program in combination with an exercise therapy and education program. This novel intervention may be a valuable contribution to the treatment of OA patients at risk of chronic pain after TKA. TRIAL REGISTRATION: The RCT is pre-registered at ClinicalTrials.gov: NCT03771430 11/12/2018.


Assuntos
Artroplastia do Joelho , Dor Crônica , Terapia Cognitivo-Comportamental , Artroplastia do Joelho/efeitos adversos , Dor Crônica/etiologia , Dor Crônica/terapia , Terapia por Exercício , Humanos , Internet
16.
BMJ Open ; 11(10): e045607, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635511

RESUMO

INTRODUCTION: Transdiagnostic cognitive-behavioural therapy (CBT) targets common psychological factors that underlie multiple disorders. While transdiagnostic interventions are a promising new approach, limited research has evaluated these treatments within the alcohol and other drug (AOD) sector for young people with comorbid mental health symptoms. This project will examine the feasibility and preliminary efficacy of FullFix-a new risk-targeted transdiagnostic CBT telehealth programme for comorbid AOD and depression/anxiety disorders in young people. Secondary aims are to identify moderators and mediators of treatment outcomes, to determine how and why treatment is effective and who is most likely to benefit. METHODS/DESIGN: Participants will be 130 young people (aged 16-35) accessing AOD services in Queensland, Australia, with comorbid mental health symptoms. They will be randomised to receive either the FullFix intervention plus standard AOD care or standard AOD care alone. Primary outcomes on AOD use and mental health symptoms will be reassessed at 6 weeks, 3 months, 6 months and 12 months, along with secondary outcomes of emotion regulation, social connectedness, perceived self-efficacy, coping skills and quality of life. The trial commenced on October 2018 and expected completion date is September 2021. ETHICS AND DISSEMINATION: Ethical approval for this trial was provided by the University of Queensland (#2018001185). The results of the trial will be disseminated through publication in a peer-reviewed scientific journal, scientific presentations at conferences and distributed via a report and presentations to the partner organisation. TRIAL REGISTRATION NUMBER: ACTRN12618001563257.


Assuntos
Terapia Cognitivo-Comportamental , Saúde Mental , Adolescente , Análise Custo-Benefício , Humanos , Qualidade de Vida , Telefone
17.
BMJ Open ; 11(10): e053971, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-34697123

RESUMO

INTRODUCTION: Approximately 30% of people with long-term physical health conditions (LTCs) experience mental health problems, with negative consequences and costs for individuals and healthcare services. Access to psychological treatment is scarce and, when available, often focuses on treating primary mental health problems rather than illness-related anxiety/depression. The aim of this study is to evaluate the clinical efficacy of a newly developed, therapist-supported, digital cognitive-behavioural treatment (COMPASS) for reducing LTC-related psychological distress (anxiety/depression), compared with standard charity support (SCS). METHODS AND ANALYSIS: A two-arm, parallel-group randomised controlled trial (1:1 ratio) with nested qualitative study will be conducted. Two-hundred adults with LTC-related anxiety and depression will be recruited through national LTC charities. They will be randomly allocated to receive COMPASS or SCS only. An independent administrator will use Qualtrics randomiser for treatment allocation, to ensure allocation concealment. Participants will access treatment from home over 10 weeks. The COMPASS group will have access to the digital programme and six therapist contacts: one welcome message and five fortnightly phone calls. Data will be collected online at baseline, 6 weeks and 12 weeks post-randomisation for primary outcome (Patient Health Questionnaire Anxiety and Depression Scale) and secondary outcomes (anxiety, depression, daily functioning, COVID-19-related distress, illness-related distress, quality of life, knowledge and confidence for illness self-management, symptom severity and improvement). Analyses will be conducted following the intention-to-treat principle by a data analyst blinded to treatment allocation. A purposively sampled group of COMPASS participants and therapists will be interviewed. Interviews will be thematically analysed. ETHICS AND DISSEMINATION: The study is approved by King's College London's Psychiatry, Nursing and Midwifery Research Ethics Subcommittee (reference: LRS-19/20-20347). All participants will provide informed consent to take part if eligible. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT04535778.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Adulto , Ansiedade/terapia , Depressão/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
18.
Trials ; 22(1): 696, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641961

RESUMO

BACKGROUND: Fear of cancer recurrence, depressive symptoms, and cancer-related fatigue are prevalent symptoms among cancer survivors, adversely affecting patients' quality of life and daily functioning. Effect sizes of interventions targeting these symptoms are mostly small to medium. Personalizing treatment is assumed to improve efficacy. However, thus far the empirical support for this approach is lacking. The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue. METHODS: The study is designed as a non-blinded, multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy. In the standard treatment arm, patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence, depressive symptoms, or cancer-related fatigue. In the second arm, treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments, (b) treatment delivery, (c) patients' needs regarding the symptom for which they want to receive treatment, and (d) treatment duration. In total, 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included. Primary outcome is limitations in daily functioning. Secondary outcomes are level of fear of cancer recurrence, depressive symptoms, fatigue severity, quality of life, goal attainment, therapist time, and drop-out rates. Participants are assessed at baseline (T0), and after 6 months (T1) and 12 months (T2). DISCUSSION: To our knowledge, this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors. The study has several innovative characteristics, among which is the personalization of interventions on several dimensions. If proven effective, the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way. TRIAL REGISTRATION: The Dutch Trial Register (NTR) NL7481 (NTR7723). Registered on 24 January 2019.


Assuntos
Sobreviventes de Câncer , Terapia Cognitivo-Comportamental , Neoplasias , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/terapia , Medo , Humanos , Estudos Multicêntricos como Assunto , Neoplasias/complicações , Neoplasias/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
19.
J Neurodev Disord ; 13(1): 46, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635048

RESUMO

BACKGROUND: Anxiety disorders are highly prevalent in children and adolescents with autism spectrum disorder and often emerge before the age of 6 years. Yet, only a few studies have examined anxiety treatment for this group. Preliminary evidence from these studies suggests that utilizing cognitive behavioral therapy (CBT) as well as strategies to target intolerance of uncertainty (IU) and parental accommodation, known mechanistic and maintaining factors of anxiety may improve anxiety and optimize outcomes in this age group. MAIN BODY: To meet this need, we developed an integrated treatment called DINO Strategies for Anxiety and intolerance of Uncertainty Reduction (DINOSAUR), a 12-week group telehealth treatment for 4- to 6-year-old children with ASD. DINOSAUR works with young children and their parents to deliver CBT along with interventions targeting IU and parental accommodation. In this paper, we first discuss the rationale for developing this treatment and then describe a pilot study of its feasibility and preliminary efficacy. CONCLUSIONS: There is a great need to develop anxiety treatments for young children with ASD. We proposed a novel integrated treatment approach that aims to alter the way young children and parents respond to fear, which could potentially improve short- and long-term mental health outcomes for this age group. TRIAL REGISTRATION: ClinicalTrials.gov NCT04432077 on June 03, 2020.


Assuntos
Transtorno do Espectro Autista , Terapia Cognitivo-Comportamental , Dinossauros , Animais , Ansiedade/complicações , Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/terapia , Cognição , Projetos Piloto , Incerteza
20.
Sante Ment Que ; 46(1): 203-227, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34597495

RESUMO

Objectives Despite the existence of several online treatments for people with posttraumatic stress disorder (PTSD), few studies have examined usage data for such interventions. Given the potential of the online modality to alleviate barriers limiting access to psychological help, it is important to document users' interactions with these tools in relation to the improvement of targeted symptoms. The objective of this study is to document usage data of the online treatment platform RESILIENT by people evacuated from the Fort McMurray, Alberta (Canada) fires, and to examine their association with the effectiveness of treatment on symptoms of posttraumatic stress disorder (PTSD), insomnia and depression, and adherence to treatment, as measured by the number of modules accessed by participants. Methods Ninety-seven people evacuated from the Fort McMurray fires with symptoms of PTSD, insomnia and depression were included in this study. Participants were invited to use the RESILIENT platform, an online therapist-assisted self-help treatment program that targets PTSD symptoms, sleep and mood, and includes 12 modules offering evidence-based cognitive-behavioural therapy (CBT) strategies. Both objective (e.g., number of modules accessed) and subjective (e.g., level of effort invested) usage data were collected. Results In order to predict the reduction in PTSD, depression and insomnia symptoms, as well as the number of modules accessed by participants, sequential regression models were conducted, with statistical control for pretreatment symptoms, age and gender. The final models revealed that a reduction in PTSD, depression and insomnia symptoms was significantly predicted by the number of modules accessed (ß = -.41; -.53; -.49 respectively, all p <.001) as well as the mean self-reported level of effort at module 7 (midway) (ß = -.43; p <.001; ß = -.38; p = .005 and ß = -.36; p = .007 respectively). The number of modules accessed, on the other hand, was significantly predicted by the number of words in the 4th module (ß = .34; p <.001) and 7th module (ß = .44; p <.001) and the number of sleep diary entries (ß = .28; p <.001). Conclusion These results confirmed that increased interaction with the platform positively influences treatment effectiveness and that increased use at the beginning of treatment appears to be a good predictor of treatment completion. This study confirms the importance of sustaining participants' commitment to online treatment in order to optimize its effectiveness.


Assuntos
Terapia Cognitivo-Comportamental , Desastres , Distúrbios do Início e da Manutenção do Sono , Transtornos de Estresse Pós-Traumáticos , Alberta , Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos de Estresse Pós-Traumáticos/terapia
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