Feasibility and preliminary effectiveness of a novel cognitive-behavioral couple therapy for provoked vestibulodynia: a pilot study.

Introduction Provoked vestibulodynia (PVD), a recurrent, localized vulvovaginal pain problem, carries a significant psychosexual burden for afflicted women, who report impoverished sexual function and decreased frequency of sexual activity and pleasure. Interpersonal factors such as partner responses to pain, partner distress, and attachment style are associated with pain outcomes for women and with sexuality outcomes for both women and partners. Despite these findings, no treatment for PVD has systematically included the partner. Aims This study pilot‐tested the feasibility and potential efficacy of a novel cognitive–behavioral couple therapy (CBCT) for couples coping with PVD. Methods Couples (women and their partners) in which the woman was diagnosed with PVD (N = 9) took part in a 12‐session manualized CBCT intervention and completed outcome measures pre‐ and post‐treatment. Main Outcome Measures The primary outcome measure was women's pain intensity during intercourse as measured on a numerical rating scale. Secondary outcomes included sexual functioning and satisfaction for both partners. Exploratory outcomes included pain‐related cognitions; psychological outcomes; and treatment satisfaction, feasibility, and reliability. Results One couple separated before the end of therapy. Paired t‐test comparisons involving the remaining eight couples demonstrated significant improvements in women's pain and sexuality outcomes for both women and partners. Exploratory analyses indicated improvements in pain‐related cognitions, as well as anxiety and depression symptoms, for both members of the couple. Therapists' reported high treatment reliability and participating couples' high participation rates and reported treatment satisfaction indicate adequate feasibility. Conclusions Treatment outcomes, along with treatment satisfaction ratings, confirm the preliminary success of CBCT in reducing pain and psychosexual burden for women with PVD and their partners. Further large‐scale randomized controlled trials are necessary to examine the efficacy of CBCT compared with and in conjunction with first‐line biomedical interventions for PVD.

Does interpersonal behavior of psychotherapy trainees differ in private and professional relationships?

• Aim: The present study aimed to evaluate the effect of trainees’ interpersonal behavior on work involvement (WI) and compared their social behavior within professional and private relationships as well as between different psychotherapeutic orientations. • Methods: The interpersonal scales of the Intrex short-form questionnaire and the Work Involvement Scale (WIS) were used to evaluate two samples of German psychotherapy trainees in psychoanalytic, psychodynamic, and cognitive behavioral therapy training. Trainees from Sample 1 (N = 184) were asked to describe their interpersonal behavior in relation to their patients when filling out the Intrex, whereas trainees from Sample 2 (N = 135) were asked to describe the private relationship with a significant other. • Results: Interpersonal affiliation in professional relationships significantly predicted the level of healing involvement, while stress involvement was predicted by interpersonal affiliation and interdependence in trainees’ relationships with their patients. Social behavior within professional relationships provided higher correlations with WI than private interpersonal behavior. Significant differences were found between private and professional relation settings in trainees’ interpersonal behavior with higher levels of affiliation and interdependence with significant others. Differences between therapeutic orientation and social behavior could only be found when comparing trainees’ level of interdependence with the particular relationship setting. • Conclusion: Trainees’ interpersonal level of affiliation in professional relationships is a predictor for a successful psychotherapeutic development. Vice versa, controlling behavior in professional settings can be understood as a risk factor against psychotherapeutic growth. Both results strengthen an evidence-based approach for competence development during psychotherapy training.

Cognitive therapy for anxiety disorders: current status and future directions.

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Young Children's Ability to Engage in Cognitive Therapy Tasks: Associations With Age and Educational Experience

Abstract. In two linked studies we examined children’s performance on tasks required for participation in cognitive therapy. In Study 1 we piloted some new tasks with children aged 5 to 11 years. In study 2 the effects of IQ, age and educational experience were examined in children aged 5 to 7 years. In study 1, 14 children aged 5 to 11 completed three tasks related to cognitive therapy; generating post-event attributions, naming emotions, and linking thoughts and feelings. Study 2 used a between-subjects design in which 72 children aged 5, 6, or 7 years from two primary schools completed the three tasks and the Block Design and Vocabulary sub-tests from the WISC III or WPPSI-R. Children were tested individually during the school day. All measures were administered on the same occasion. In study 2 administration order of the cognitive therapy task and the WISC III/WPPSI-R were randomized. The majority of children demonstrated some ability on each of the three tasks. In study 2, performance was associated with school and with IQ but not with age. There were no gender differences. Children attending a school with an integrated thinking skills programme and those with a higher 1Q were more successful on the cognitive therapy tasks. These results suggest that many young children could engage in cognitive therapy given age-appropriate materials. The effects of training in relevant meta-cognitive skills on children’s ability to use concepts in CBT may warrant further research. Keywords: Cognitive behaviour therapy, young children, cognitive development

State of the art of integrated therapy approaches in the treatment of schizophrenia: empirical evidence and clinical relevance

Objective: Integrated behavior therapy approaches are defined by the combination of behavioral and or cognitive interventions targeting neurocognition combined with other goal-oriented treatment targets such as social cognition, social skills, or educational issues. The Integrated Psychological Therapy Program (IPT) represents one of the very first behavior therapy approaches combining interventions of neurocognition, social cognition, and social competence. This comprehensive group-based bottom-up and top-down approach consists of five subprograms, each with incremental steps. IPT has been successfully implemented in several countries in Europe, America, Australia and in Asia. IPT worked as a model for some other approaches designed in the USA. IPT was undergone two further developments: based on the social competence part of IPT, the three specific therapy programs focusing residential, occupational or recreational topics were developed. Recently, the cognitive part of INT was rigorously expanded into the Integrated Neurocognitive Therapy (INT) designed exclusively for outpatient treatment: INT includes interventions targeting all neurocognitive and social cognitive domains defined by the NIMH-MATRICS initiative. These group and partially PC-based exercises are structured into four therapy modules, each starting with exercises on neurocognitive domains followed by social cognitive targets. Efficacy: The evidence of integrated therapy approaches and its advantage compared to of one-track interventions was becoming a discussion tool in therapy research as well as in mental health systems. Results of meta-analyses support superiority of integrated approaches compared to one-track interventions in more distal outcome areas such as social functioning. These results are in line with the large body of 37 independent IPT studies in 12 countries. Moreover, IPT research indicates the maintenance of therapy effects after the end of therapy and some evidence generalization effects. Additionally, the international randomized multi-center study on INT with 169 outpatients strongly supports the successful therapy of integrated therapy in proximal and distal outcome such as significant effects in cognition, functioning and negative symptoms. Clinical implication: therapy research as well as expert’s clinical experience recommends integrated therapy approaches such as IPT to be successful agents within multimodal psychiatric treatment concepts. Finally, integrated group therapy based on cognitive remediation seems to motivate and stimulate schizophrenia inpatients and outpatients to more successful and independent life also demanded by the recovery movement.

Temporomandibular Disorder in Brazilian Patients: A Preliminary Study

The objective of the current study was to evaluate disease-related beliefs, adherence to treatment, quality of life, coping strategies and cognitive status in a group of Brazilian patients with Temporomandibular Disorder (TMD). Thirty patients were evaluated with a semi-directed interview, the Coping Strategies Inventory, and a Mini-Mental State Examination. Although half (50%) of the patients had known their diagnosis long term, 40% of the sample were not correctly following proposed treatment. All patients had a similar pattern of pain behavior related to TMD, while disease-related beliefs, quality of life and coping strategies were variable. Expectations about treatment also had significant association with treatment adherence. The findings of this study suggest that a more thorough understanding of individual differences in TMD is warranted.

Five-day plan for smoking cessation using group behaviour therapy.

The "Five-Day Plan to Stop Smoking" (FDP) is an educational group technique for smoking cessation. We studied a cohort of 123 smokers (55 men, 68 women, mean age 42 years) who participated in 11 successive FDP sessions held in Switzerland between 1995 and 1998 and who were followed up for at least 12 months by telephone or direct interview. Overall, 102 of the 123 subjects (83%) had stopped smoking by the end of the FDP, and self-declared smoking cessation rate was 25% after one year. The following factors potentially associated with outcome were studied: age, sex, smoking habit duration, cigarettes per day, Fagerström Test for Nicotine Dependence (FTND), group size, and medical presence among the group leaders. Smoking habit duration was the only variable which showed a statistically significant association with success: the rate of smoking cessation was higher among patients who had smoked for less than 20 years (34.7% vs. 18.9%, p = 0.049). Stress was the most common cause of relapse. The FDP appears to be an effective smoking cessation therapy. Propositions are made in order to improve the success rate of future sessions.

Programme de remédiation cognitive pour patients présentant une schizophrénie ou un trouble associé (Recos) : résultats préliminaires [Cognitive remediation program for individuals living with schizophrenia (Recos): preliminary results].

BACKGROUND: Nowadays, cognitive remediation is widely accepted as an effective treatment for patients with schizophrenia. In French-speaking countries, techniques used in cognitive remediation for patients with schizophrenia have been applied from those used for patients with cerebral injury. As cognitive impairment is a core feature of schizophrenia, the Département de psychiatrie du CHUV in Lausanne (DP-CHUV) intended to develop a cognitive remediation program for patients with a schizophrenia spectrum disease (Recos-Vianin, 2007). Numerous studies show that the specific cognitive deficits greatly differ from one patient to another. Consequently, Recos aims at providing individualized cognitive remediation therapy. In this feasibility trial, we measured the benefits of this individualized therapy for patients with schizophrenia. Before treatment, the patients were evaluated with a large battery of cognitive tests in order to determine which of the five specific training modules - Verbal memory, visuospatial memory and attention, working memory, selective attention, reasoning - could provide the best benefit depending on their deficit. OBJECTIVES: The study was designed to evaluate the benefits of the Recos program by comparing cognitive functioning before and after treatment. METHOD: Twenty-eight patients with schizophrenia spectrum disorders (schizophrenia [n=18], schizoaffective disorder [n=5], schizotypal disorder [n=4], schizophreniform disorder [n=1], DSM-IV-TR) participated in between one and three of the cognitive modules. The choice of the training module was based on the results of the cognitive tests obtained during the first evaluation. The patients participated in 20 training sessions per module (one session per week). At the end of the training period, the cognitive functioning of each patient was reevaluated by using the same neuropsychological battery. RESULTS: The results showed a greater improvement in the cognitive functions, which were specifically trained, compared to the cognitive functions, which were not trained. However, an improvement was also observed in both types of cognitive functions, suggesting an indirect cognitive gain. CONCLUSION: In our view, the great heterogeneity of the observed cognitive deficits in schizophrenia necessitates a detailed neuropsychological investigation as well as an individualized cognitive remediation therapy. These preliminary results need to be confirmed with a more extended sample of patients.

Cognitive behavioural skills for practice a model for delivery in the Irish mental health service.

This publication outlines a model of delivery for introductory level Cognitive Behavioural Therapy (CBT) training in the Mental Health Service, HSE South (Carlow, Kilkenny, South Tipperary, Waterford, Wexford). This model has proved useful in guiding the development of four introductory programmes during 2009 and 2010. As a result of this experience, we have amended and updated our programme delivery strategies. We see this process as organic and ever changing, thus these reflections are a snap shot of our current thinking which we have no doubt will evolve as we proceed with future programmes. This booklet will act as a guide for our upcoming programmes in 2010 and 2011 and we believe it may also offer guidance to others who will be involved in the delivery of CBT training within the Irish Mental Health Service.This resource was contributed by The National Documentation Centre on Drug Use.

Psychoped, un programme d'entraînement des compétences sociales pour patients psychiatriques chroniques

Dans le domaine de la réhabilitation psycho-sociale de patients psychiatriques chroniques, l'utilité de l'entraînement des compétences sociales est bien connue. Elaboré et expérimenté dans le cadre de l'Unité de réhabilitation du Département universitaire de psychiatrie adulte de Lausanne, le programme de thérapie cognitive et comportementale intitulé Psychoped est une tentative d'intégration face à un champ qui tend à se diversifier. Psychoped comprend six modules thérapeutiques indépendants, pratiqués en groupe, sélectionnés dans l'offre actuelle des modules de réhabilitation, en particulier ceux développés par Libermann et Brenner. Sa modularité permet de le coordonner à l'éventail des soins déjà existants et d'en individualiser les contenus selon les caractéristiques des patients. La structure et le contenu de ce programme sont présentés de manière synthétique. <Auteurs>

Proyecto para la identificación de necesidades formativas y posterior implementación de acción docente en el ERIE Psicosocial de C.R.N.

La responsabilidad del ERIE Psicosocial a la hora de realizar su labor en el marco de la intervención en emergencias debe ir necesariamente acompañada de una correcta identificación de las necesidades que el equipo tiene en lo que respecta a su formación e instrucción, de cara a mantener el nivel de respuesta en su labor. El desarrollo de herramientas y métodos capaces de definir estas variables es, pues el primer paso de este proceso. El formato de desarrollo posterior de esas acciones formativas, teniendo en cuenta el carácter grupal y cooperativo del grupo, debe ser estudiado y validado para obtener la máxima eficacia durante su materialización.

Assessing the link between coping patterns and interpersonal behaviors in depressed women

Aim. Stressful life events are an important contributor to the onset and course of depression. Coping strategies and interpersonal patterns have been found to mediate the effects of stress [1]. Methods. This study examined the relationship between coping patterns and interpersonal interactions in early psychotherapy sessions of 25 female patients with major depression. Transcripts were rated for coping patterns using the Coping Patterns Rating Scale (CPRS; [2]). Interpersonal patterns were assessed using the Structural Analysis of Social Behavior (SASB; [3]). Results. Significant correlations were found between coping patterns and markers of interpersonal functioning in selected contexts. Discussion. The implications of these findings in understanding an important aspect of vulnerability to depression and enhancing treatment outcome are discussed.

Efectividad de la terapia cognitivo-conductual en la pérdida de peso tras dos años de cirugía bariátrica en pacientes con obesidad mórbida.

To evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) in the success of postoperative weight loss after 2 years of CB. METHODS: A prospective observational study was conducted in consecutive patients with morbid obesity aged between 18 and 59 yrs and enrolled in the bariatric surgery program of the Obesity Surgery Unit of our hospital from June 2007 through June 2010, with two years postoperative follow-up. Participants were divided into two groups according to their participation in Cognitive Behavioral Therapy or not. Over a 3-month period, CBT was applied in 12 2-h sessions. The main dependent variables studied were body weight and height, from which we calculated BMI and percentage of excess weight lost (weight lost x 100)/(initial weight-ideal weight), classifying patients as successful (E ) those with EPP > 50%, and unsuccessful (NE) those with EPP <50%. Participants were also, assessed for general (stress, anxiety, depression and self-esteem) and specific (binge eating and food craving) psychopathology. RESULTS: Of the 35 patients with bariatric surgery, 30 responded postoperative evaluations, 16 underwent CBT before CB and 14 underwent surgery without receiving psycho-nutritional therapy, (76% female) with a mean age of 41 ± 9.5 years. The mean baseline BMI was 42 ± 10 and 45% of patients were classified as super obese (BMI: 56 ± 6). Mean excess weight loss (EPP) was 77%. According to the EPP were classified as "successful" (S) (59%) and "unsuccessful" (U) (41%). Of the patients assigned to S, 94% received CBT (15 individuals of 17 total), compared with only 12% who did not receive (2 individuals of the 17 total) with statistically significant differences (p < 0.05). Also, the S patients appeared to be significantly less anxious and stressed and have higher self-esteem (P < 0.05). Regarding specific psychopathology, the food craving guided by hunger, loss of control over food intake and guilt was lower in patients who achieved > 50% of EPP (p < 0.04, p < 0.001, p < 0.001, respectively). It was also noted that these patients were plans to eat less and ate less for positive reinforcement (p < 0.03 and p < 0.000, respectively) than the patient group NE

Low intensity vs. self-guided internet-delivered psychotherapy for major depression: a multicenter, controlled, randomized study.

BACKGROUND Major depression will become the second most important cause of disability in 2020. Computerized cognitive-behaviour therapy could be an efficacious and cost-effective option for its treatment. No studies on cost-effectiveness of low intensity vs self-guided psychotherapy has been carried out. The aim of this study is to assess the efficacy of low intensity vs self-guided psychotherapy for major depression in the Spanish health system. METHODS The study is made up of 3 phases: 1.- Development of a computerized cognitive-behaviour therapy for depression tailored to Spanish health system. 2.- Multicenter controlled, randomized study: A sample (N=450 patients) with mild/moderate depression recruited in primary care. They should have internet availability at home, not receive any previous psychological treatment, and not suffer from any other severe somatic or psychological disorder. They will be allocated to one of 3 treatments: a) Low intensity Internet-delivered psychotherapy + improved treatment as usual (ITAU) by GP, b) Self-guided Internet-delivered psychotherapy + ITAU or c) ITAU. Patients will be diagnosed with MINI psychiatric interview. Main outcome variable will be Beck Depression Inventory. It will be also administered EuroQol 5D (quality of life) and Client Service Receipt Inventory (consume of health and social services). Patients will be assessed at baseline, 3 and 12 months. An intention to treat and a per protocol analysis will be performed. DISCUSSION The comparisons between low intensity and self-guided are infrequent, and also a comparative economic evaluation between them and compared with usual treatment in primary. The strength of the study is that it is a multicenter, randomized, controlled trial of low intensity and self-guided Internet-delivered psychotherapy for depression in primary care, being the treatment completely integrated in primary care setting. TRIAL REGISTRATION Clinical Trials NCT01611818.