Group-based Cognitive Behavioural Therapy for Anxiety Disorder in Children with Autism Spectrum Disorder: a feasibility study

Abstract

Purpose: Autism spectrum disorder (ASD) includes core symptoms that affect general and social development. High risk of developing comorbid disorders such as anxiety is prominent. Up to 60% of children with ASD suffer from anxiety disorders which can negatively influence educational, social and general development together with quality of life. This study is the first to investigate the feasibility of the manualised cognitive behavioural therapy (CBT) group programme 'Cool Kids ASD' for anxiety adapted for children with ASD in a general hospital setting.

Methods: Nine children, aged 9–13 years, with ASD and anxiety recruited from a public child psychiatric health clinic were enrolled in the study. Outcome measures were collected from both child and parent pre- and post-treatment and at 3-month follow-up and included scores from a semi-structured anxiety interview, together with questionnaires on anxiety symptoms, life interference, children's automatic thoughts and satisfaction with the programme.

Results: Eight out of nine families found the programme useful and would recommend it to other families in a similar situation. Six families attended all 12 sessions in the programme, two missed one session and one family only managed to attend eight sessions. At follow-up, five children were free of all anxiety diagnoses and a further two out of the nine children no longer met the criteria for their primary anxiety diagnosis.

Conclusions: This study suggests that the transition of the group programme 'Cool Kids ASD' from University Clinics to standard child psychiatric clinical settings is feasible. Further randomised studies are needed to confirm the efficacy of the programme in a larger sample.     

Insight as a Predictor of Treatment Outcome in Behavioral Group Treatment for Obsessive–Compulsive Disorder

The presence of poor insight into the senselessness of symptoms of obsessive–compulsive disorder (OCD) has been theoretically linked to poor treatment response, yet few studies have examined this question. This study examined the role of poor insight in 69 OCD patients, who completed 7 weeks of cognitive behavioral group therapy. Participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of psychopathology. Insight was measured using interviewer ratings on an item of the Y-BOCS and participants were grouped as having “poor” or “adequate” insight. The analyses revealed that, after pre-treatment levels of OCD severity, depression, and medication status, were controlled, patients with adequate insight experienced better post-treatment outcomes than those with poor insight. These results suggest that patients with poorer insight can still benefit from treatment, but may experience a less favorable outcome than patients with better insight. Implications for the treatment of OCD are discussed.     

Web-based cognitive behavior therapy for depression with and without telephone tracking in a national helpline: secondary outcomes from a randomized controlled trial

Background

An earlier report indicated that callers to a telephone counseling service benefited from the addition of an evidence-based Web intervention for depression. It is not known whether the Web intervention would also lower alcohol use and stigma, or improve quality of life and knowledge of depression and its treatments.

Objective

To report the secondary outcomes of a trial of a Web-based cognitive behavior therapy (CBT) intervention for depression, including hazardous alcohol use, quality of life, stigma, depression literacy, and CBT literacy.

Methods

We recruited a sample of 155 callers to Lifeline, a national telephone counseling service in Australia, who met the criteria for moderate to high psychological distress. Participants were randomly assigned to 1 of 4 conditions: (1) Web CBT plus weekly telephone tracking, (2) Web CBT only, (3) weekly telephone tracking only, and (4) neither Web CBT nor telephone tracking. Participants were assessed at preintervention, postintervention, and 6 and 12 months postintervention.

Results

At postintervention, participants who completed the Web intervention either with or without telephone support had lower levels of hazardous alcohol use (without tracking: P = .008, effect size = 0.23; with tracking: P = .003, effect size = 0.26), improved quality of life (without tracking: P = .001, effect size = 0.81; with tracking: P = .009, effect size = 0.63), and improved CBT literacy (without tracking: P = .01, effect size = 0.71; with tracking: P < .001, effect size = 0.80) compared with those who did not receive the Web intervention or telephone support. Results for quality of life and CBT literacy were maintained at 6- and 12-month’s follow-up, but differences in hazardous alcohol use were not significantly different between conditions at 6 and 12 months. Although omnibus tests for depression literacy and stigma were nonsignificant, contrasts revealed that those in the Web-only condition showed significantly lower levels of stigma than participants in the control condition at postintervention. This was true for participants in the Web-only and Web plus tracking conditions at 6 months. Similarly, those in the Web-only and Web plus tracking conditions had significantly higher depression literacy at postintervention, and this was maintained in the Web-only condition at 6-months’ follow-up. No significant differences were found in depression literacy and stigma between conditions at 12 months.

Conclusions

Evidence-based Web interventions for depression can be effective not only in reducing depression symptoms but also in improving other health outcomes, including quality of life, hazardous alcohol use, and knowledge about effective strategies for depression self-management.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 93903959; http://www.controlled-trials.com/ISRCTN93903959/ (Archived by WebCite at http://www.webcitation.org/65y61nSsH)     

Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use

In the development of consumer-centered care for mental health consumers with schizophrenia, one key ingredient is consumer participation in health care decisions together with their healthcare providers, termed "shared decision making" (SDM). SDM requires consumers to form a number of complex ideas about themselves and their providers then use that knowledge to make sense of the illness and reach medical and psychosocial decisions. However, metacognitive deficits widely observed in schizophrenia might lead to poor insight and pragmatic language deficits in some consumers, disrupting the whole process by which a personal and consensually valid narrative account of psychiatric challenges is synthesized and flexibly evolved. Given the current understanding that it is possible to improve metacognition, in this article we summarize how Metacognitive Training (MCT) and individual psychotherapy could potentially be tailored, or modified, to help consumers to develop metacognitive capacities with an end goal of facilitating the SDM process. Consistent with the principles of consumer-defined recovery, we also suggest a strategy for engaging consumers in SDM dialogue based on "where the consumers are at". Providers are advised to be cognizant of their medically driven perspective and attempt to work with the consumers in the perspective of the consumers' own recovery goals.     

An analysis of matching cognitive-behavior therapy techniques to learning styles

Background and objectives

To optimize the effectiveness of cognitive-behavior therapy (CBT) for each individual patient, it is important to discern whether different intervention techniques may be differentially effective. One factor influencing the differential effectiveness of CBT intervention techniques may be the patient's preferred learning style, and whether this is ‘matched’ to the intervention.

Method

The current study uses a retrospective analysis to examine whether the impact of two common CBT interventions (thought records and behavioral experiments) is greater when the intervention is either matched or mismatched to the individual's learning style.

Results

Results from this study give some indication that greater belief change is achieved when the intervention technique is matched to participants' learning style, than when intervention techniques are mismatched to learning style.

Limitations

Conclusions are limited by the retrospective nature of the analysis and the limited dose of the intervention in non-clinical participants.

Conclusions

Results suggest that further investigation of the impact of matching the patient's learning style to CBT intervention techniques is warranted, using clinical samples with higher dose interventions.     

Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review

The most prevalent mental disorders, anxiety and mood disorders, are associated with both functional and morphological brain changes that commonly involve the ‘fear network’ including the (medial) prefrontal cortex, hippocampus and amygdala. Patients suffering from anxiety disorders and major depressive disorder often show excessive amygdala and reduced prefrontal cortex functioning. It is, however, still unclear whether these brain abnormalities disappear or diminish following effective treatment. This review aims to compare the effects of psychotherapy and pharmacotherapy on functional and morphological brain measures in these disorders. Sixty-three studies were included, 30 investigating psychotherapy effects and 33 investigating pharmacotherapy effects. Despite methodological differences, results suggest a functional normalization of the ‘fear network’. Pharmacotherapy particularly decreases over-activity of limbic structures (bottom-up effect) while psychotherapy tends to increase activity and recruitment of frontal areas (top-down effect), especially the anterior cingulate cortex. Additionally, pharmacotherapy, but not psychotherapy, has been associated with morphological changes, depending on the disorder. These findings suggest that both types of treatments normalize (functional) brain abnormalities each in specific ways.     

护士引导的认知行为治疗对乳腺癌患者疲乏程度和生活质量的影响

目的:探讨护士引导的认知行为治疗(CBT)对放射治疗中乳腺癌患者疲乏程度和生活质量(QOL)的影响。方法:选择2007年6～9月在韩国釜山国立大学医院行放射治疗乳腺癌患者36例为对照组,接受由医疗机构提供的标准治疗;选择2007年10月～2008年3月在韩国釜山国立大学医院行放射治疗乳腺癌患者35例为实验组,接受护士引导的CBT 6个周期,包括认知重建、疾病教育、医学治疗、放松疗法及康复锻炼。观察、比较治疗前后两组患者疲乏程度和QOL情况。结果:两组患者疲乏程度均有增加,但实验组患者疲乏程度的增加低于对照组(P<0.01),且生活质量高于对照组(P<0.01)。结论:护士引导的CBT可控制患者的疲乏程度,提高生活质量,有必要提倡护士引导的CBT在接受放射治疗中乳腺癌患者的应用。     

A pilot study of intensive 7-day internet-based cognitive behavioral therapy for social anxiety disorder

Accessible, affordable cognitive behavioral therapy (CBT) options for Social Anxiety Disorder (SAD) that allow for rapid symptom improvement are needed. The present study investigated the first intensive, 7-day internet-based CBT for SAD. An open pilot trial was conducted to test the acceptability, feasibility and preliminary outcomes of the program in a sample of 16 participants (9 females, M age = 40.34, SD = 10.55) with a DSM-5 diagnosis of SAD. Participants were enrolled into the 6-lesson online program, and completed the Social Phobia Scale [SPS], Social Interaction Anxiety Scale [SIAS], Patient Health Questionnaire-9 (PHQ-9), and Work and Social Adjustment Scale (WSAS) at baseline, post and one month follow-up. We found support for the feasibility and acceptability of the program; 15 participants (93.8%) completed the program, and all participants reported the program was satisfactory. Large, significant reductions in social anxiety severity on both the SPS and SIAS (Hedges’ g_s = 1.26–1.9) and functional impairment (WSAS; g_s = 0.88–0.98) were found at post-treatment and follow-up. Medium, significant reductions in depressive symptom severity were also found (g_s = 0.88–0.98 at post and follow-up, respectively). A third of participants scored below the clinical cut-off on both the SPS and SIAS at post-treatment and follow-up. A randomized controlled trial with longer follow-up is needed to evaluate the efficacy of this intensive internet-based treatment for SAD. Implications and future research directions are discussed.     

Determinants of Pain Treatment Response and Nonresponse: Identification of TMD Patient Subgroups

The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to 1 of 2 treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral therapy condition (STD + CBT) in which patients received all elements of STD but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or nonresponders to treatment based on reported pain over a 1-year follow-up period. Results indicated that treatment nonresponders accounted for 16% of the sample and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the nonresponder group included the addition of CBT to STD, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care.