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.     

An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status

Objective

To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA_1c and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.

Methods

We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.

Results

35 trials were reviewed and meta-analysis of 19 trials (n = 1431), reporting HbA_1c found a reduction in HbA_1c by 0.54% (−0.32; 95% CI: −0.47 to −0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA_1c by 0.51% (−0.27; 95% CI: −0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists reducing HbA_1c by 0.57% (−0.36; 95% CI: −0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups −0.56 (95% CI: 1.00 to −0.13). Trial quality for the majority of studies remained poor.

Conclusion

Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.

Practice implications

Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care.     

The current status and future direction of self-help treatments for problem gamblers

The self-help treatment (SHT) studies for other psychological problems significantly outweigh those for problem gambling. Currently, very little is published about the application and efficacy of various forms of SHTs for problem gambling. Thus, this paper reviews the self-help literature (using the PsycINFO database--all years up to April 2008) to stimulate further research in this area for problem gambling. The findings show that SHTs in problem gambling are still in their infancy. Although the problem gambling literature has mainly reported on two forms of SHTs with problem gamblers (i.e. use of self-help manuals and audiotapes), the review discuss utilizing a wide range of SHTs with problem gamblers. These include written materials (e.g. self-help books and treatment manuals), audiotapes, videotapes, computer-based SHTs implemented on palmtop computers, desktop computers, via telephone (Interactive Voice Response systems--IVR) or via the Internet and virtual reality applications. These SHTs would suit those problem gamblers who are not accessing professional treatment due to shame, guilt, fear of stigma, privacy concerns or financial difficulties, as well as those living in rural areas or with less severe gambling problems. The review also suggest future protocols for conducting further research in this area with problem gamblers, highlighting a need for a cohesive theory to guide research.     

A review of hearing voices groups: evidence and mechanisms of change

As a heavily stigmatized group, voice hearers often value the chance to meet others with similar experiences. As a result, Hearing Voices Groups (HVGs) are becoming increasingly common in both inpatient and outpatient settings. Where resources are constrained, HVGs are frequently viewed as a desirable alternative to individual therapy and are often preferred by service users themselves. HVGs often vary in their content and structure, with four common approaches: CBT, skills-training, mindfulness and unstructured support groups. This review evaluates the evidence for HVGs and the mechanisms of change for successful interventions. CBT was the only approach with evidence from well-controlled studies. However, several evidence-based treatments share ‘key ingredients’ which evidence suggests help reduce distress. Successful groups supply a safe context for participants to share experiences, and enable dissemination of strategies for coping with voices as well as considering alternative beliefs about voices. Future research should focus on isolating mechanisms of change and predictors of outcome in order to refine HVG approaches, rather than polarizing them and setting them against one another in efficacy trials.     

Normalization of the auditory startle reflex after symptom reduction in children with anxiety disorders

Background

In an earlier study the Auditory Startle Response (ASR) of anxiety disordered (AD) children proved to be enlarged. This study examines in a controlled design to what extent this increase is responsive to symptom reduction during Cognitive Behavioral Therapy (CBT)

Methods

The activity of 6 muscles following 104 dB tones in 20 patients (M = 12,7 years; SD = 2.5) and 25 matched controls was measured with an electromyogram (EMG). In addition, the sympathetic skin response was investigated. Response to treatment was investigated with the Anxiety Disorder Interview Schedule for Children (ADIS-C) and the Spence Children’s Anxiety Scale (SCAS).

Results

Treatment responders (n = 12) showed a significant ASR decrease over time, whereas non-responders (n = 8) showed a significant ASR increase or no significant ASR difference. In controls, the ASR was not significantly different at follow up compared to baseline. The sympathetic skin response was stable in controls and treatment responders but significantly increased over time in treatment non-responders. Linear regression suggested that one of the ASR pre-treatment parameters (multiple muscle EMG magnitude) predicts treatment response.

Conclusions

The ASR decreases in AD children when anxiety symptoms diminish. In addition, the ASR may be useful in predicting response to CBT in AD children.     

Child psychiatry

This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.     

Relational treatment strategies increase social approach behaviors in patients with Generalized Social Anxiety Disorder

We incorporated strategies based on relational and interpersonal circumplex research within a standard cognitive-behavioral regimen for Generalized Social Anxiety Disorder (GSAD, Generalized Social Phobia) to determine whether these techniques increased the social approach behaviors that facilitate relationship development. Individuals seeking treatment for GSAD were randomly assigned to either the integrated interpersonal cognitive-behavioral group treatment (ICBT) or a wait list condition (WL). Results revealed that the interpersonal techniques were readily implemented by the majority of patients. ICBT produced significant increases in frequency of social approach behaviors and relationship satisfaction, in addition to GSAD symptom reductions comparable to other group CBT regimens. The current research highlights the feasibility and potential benefit of incorporating strategies based on relational and circumplex theories into cognitive-behavioral regimens for GSAD.     

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression,and CBT somewhat better for anxiety?

Background: Little is known about whether cognitive behavioral therapy (CBT) or pharmacotherapy is relatively more advantageous for depressive versus anxiety disorders. Methods: We conducted a meta‐analysis wherein we searched electronic databases and references to select randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders. The primary effect size was calculated from disorder‐specific outcome measures as the difference between CBT and pharmacotherapy outcomes (i.e., positive effect size favors CBT; negative effect size favors pharmacotherapy). Results: Twenty‐one anxiety ( N = 1,266) and twenty‐one depression ( N = 2,027) studies comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was.25 (95% CI: ?0.02, 0.55, P =.07). Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive–compulsive disorder showed similar effects‐sizes, though not statistically significant (.49, 95% CI: ?0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (?.22, 95% CI: ?0.50, 0.06). The overall effect size for depression studies was.05 (95% CI: ?0.09, 0.19), with no advantage for medications or CBT. Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety versus depression ( B =.14, 95% CI: ?0.14, 0.43). Conclusions: On balance, the evidence presented here indicates that there are at most very modest differences in effects of CBT versus pharmacotherapy in the treatment of anxiety versus depressive disorders. There seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Treatment of post‐traumatic stress disorder in children using cognitive behavioural writing therapy

Objectives: This study evaluated the effectiveness of Cognitive Behavioral Writing Therapy (CBWT) in 23 children (age 8–18 years) in the Netherlands, who experienced a range of single and recurrent traumatic experiences. CBWT uses exposure, cognitive restructuring and social sharing. Methods: At pre‐test, post‐test and follow‐up, post‐traumatic stress disorder (PTSD) symptoms, depressive symptoms, trauma‐related cognitions and general behavioural problems were assessed. Results: At post‐test there was a significant reduction of all symptoms, and this effect was maintained at 6 months follow‐up. The mean amount of treatment sessions needed was 5.5. Conclusions: This study shows that short‐term CBWT is a potentially effective intervention for clinically referred traumatized children. There is now a clear need of establishing the effectiveness of CBWT in a randomized, controlled trial. Practice implication: This first study indicates CBWT is a promising treatment, which can easily be used in clinical practice. Copyright © 2009 John Wiley & Sons, Ltd. Key practitioner massage:

• CWBT can easily be implemented in clinical practice.
• CWBT is suitable for a clinically representative group of children and adolescents with PTSD, who have experienced a wide range of single and recurrent traumatic experiences.
• CWBT is a short‐term potentially effective treatment.