Treatment feasibility of a digital tool for brief self-help behavioural therapy for insomnia (FastAsleep)

Cognitive behavioural therapy for insomnia is efficacious and recommended for insomnia, but availability is scarce. Cognitive behavioural therapy for insomnia self-help interventions could increase availability, especially if unguided. Optimizing cognitive behavioural therapy for insomnia methods and system user-friendliness, we developed a short, digital, self-help programme—FastAsleep—based on the behavioural components of sleep restriction and stimulus control. This study investigated its feasibility and preliminary effects. Thirty media-recruited participants with moderate to severe insomnia were assessed via telephone before using FastAsleep for 4 weeks, and were interviewed afterwards. Self-ratings with web questionnaires were conducted at screening, pre-, mid- and post-treatment, and at 3-month follow-up. Primary outcomes were feasibility (credibility, adherence, system user-friendliness and adverse effects), and secondary outcomes were changes in symptom severity (insomnia, depression and anxiety). Adherence was generally high, participants' feasibility ratings were favourable, and adverse effects matched previously reported levels for cognitive behavioural therapy for insomnia. Symptoms of insomnia decreased after the treatment period (Hedge's g = 1.79, 95% confidence interval = 1.20–2.39), as did symptoms of depression and anxiety. FastAsleep can be considered feasible and promising for alleviating insomnia symptoms among patients fit for self-care. Future controlled trials are needed to establish the efficacy of FastAsleep and its suitability in a stepped care model.     

Palliative Care in Parkinson's Disease: Role of Cognitive Behavior Therapy

Background:

Parkinson''s disease (PD) is a chronic, progressive, neurodegenerative disorder that leads to the classic features of akinesia (encompassing hypokinesia and bradykinesia), tremor, rigidity and postural instability. Other non-motor complications include depression, fatigue, pain, and sleep disturbances. For the management of these complications, non-pharmacological techniques, such as Cognitive-behavioral therapy (CBT) can be used. This can focus on overt behavior and underlying cognitions and train the patient in coping strategies to obtain better symptom control.

Objectives:

To review studies on CBT as palliative care in PD patients.

Materials and Methods:

A survey was conducted for all available English-language studies by means of a MEDLINE search. Keywords in the searches included Parkinson''s disease, palliative care, and cognitive behavior therapy. All articles that reported the cognitive behavior therapy and palliative care in a group of PD patients regardless of the method used by the researchers were identified and analyzed.

Result and Conclusion:

CBT has a strong evidence base for its use and has proven to be an effective treatment in management of people with chronic pain, fatigue syndrome, depression and sleep disturbances, with efficacy that lasts beyond the duration of treatment. Although PD patients suffer from these complications, there are only a few studies on administration of CBT on them. Considering its effectiveness, CBT can be used as an option for palliative care for PD patients, directed toward improving the patient''s functional status, clinical disability and quality of life. Further studies are required in this area.     

An Italian validation of the Comparative Psychotherapy Process Scale: Reliability and validity

The Comparative Psychotherapy Process Scale (CPPS) is an instrument designed to measure therapist interventions in a psychotherapy session. The scale includes 20 items divided into two subscales: the PI (psychodynamic‐interpersonal) scale, which describes psychodynamic‐interpersonal techniques; and the CB (cognitive‐behavioural) scale, which includes cognitive‐behavioural interventions. The aim of the study was to examine the psychometric properties of the CPPS, comparing the PI and CB subscales with the psychodynamic, cognitive and STTP prototypes, as described by the Psychotherapy Process Q‐set(PQS). The sample comprised 94 sessions (N = 94) of psychodynamic and cognitive‐behavioural orientation. Two groups of independent raters with excellent interrater reliability (ICC = .78) evaluated the sessions. The results suggest that the CPPS is a valid and reliable instrument that provides a clinically sensitive and psychometrically robust evaluation of a therapist's techniques. The clinical and research implications of the results are discussed.     

Cognitive‐Behavioral School‐Based Interventions for Anxious and Depressed Youth: A Meta‐Analysis of Outcomes

A meta‐analysis of school‐based interventions for anxious and depressed youth using QUORUM guidelines was conducted. Studies were located by searching electronic databases, manual effort, and contact with expert researchers. Analyses examined 63 studies with 8,225 participants receiving cognitive‐behavioral therapy (CBT) and 6,986 in comparison conditions. Mean pre–post effect sizes indicate that anxiety‐focused school‐based CBT was moderately effective in reducing anxiety (Hedge's g = 0.501) and depression‐focused school‐based CBT was mildly effective in reducing depression (Hedge's g = 0.298) for youth receiving interventions as compared to those in anxiety intervention control conditions (Hedge's g = 0.193) and depression intervention controls (Hedge's g = 0.091). Predictors of outcome were explored. School‐based CBT interventions for youth anxiety and for youth depression hold considerable promise, although investigation is still needed to identify features that optimize service delivery and outcome.     

Effect of the coronavirus disease 2019 pandemic on people with Parkinson's disease: experience from a Croatian regional center

AimTo assess the effect of social isolation due to the coronavirus disease 2019 (COVID-19) pandemic on physical and mental health of Parkinson’s disease patients treated at the University Hospital Center Rijeka.MethodsThis cross-sectional telephone study involved Parkinson’s disease patients who had at least one control examination at University Hospital Center Rijeka in 2020 and were Croatian citizens. A questionnaire was used to obtain data on the socio-demographic characteristics and the severity of motor, anxiety, depression, and non-motor symptoms.ResultsThe final sample included 87 patients. Most patients reported subjective worsening of motor symptoms. Patients who lived alone had worse motor scores than those not living alone. The majority of patients reported worsening of anxiety symptoms. Significant worsening of anxiety symptoms was found in patients who lived alone, had a longer disease duration, and had avoided check-ups. Fewer patients had depression symptoms than motor and anxiety symptoms. Significantly higher Hamilton Depression Rating Scale scores were observed in patients with a longer disease duration. Significant worsening of non-motor symptoms was identified in patients who lived alone, were less educated, had a longer disease duration, and had a higher Charlson comorbidity index.ConclusionPatients who live alone, have longer disease duration, are less educated, avoid check-ups, and have more comorbidities are more vulnerable to the negative effects of social isolation.

⁴Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

The coronavirus disease 2019 (COVID-19) pandemic has thoroughly changed many aspects of human daily life (1). From December 31, 2019 to February 21, 2021, there were 112 348 223 COVID-19 cases worldwide and 36 607 500 in Europe. In Croatia, 240 017 people were infected and 5449 died (1). Poorer outcomes and higher mortality rates have been reported in older adults and people with comorbidities such as cardiovascular disease, diabetes, hypertension, chronic obstructive pulmonary disorder, and chronic kidney disease (2). Recent studies suggest that people with Parkinson''s disease have an increased death rate (3,4).During the pandemic, people belonging to risk groups were forced to limit their social life and reduce the number of contacts. Any change in behavior that greatly alters a person''s life requires the flexibility to adapt to new circumstances. This cognitive process depends on dopaminergic function (5). A deficient dopamine-dependent adaptation can lead to feelings of helplessness and increased psychological stress (5). Higher levels of psychological stress can worsen motor and non-motor symptoms of Parkinson''s disease, but also trigger psychiatric comorbidities such as depression and anxiety (6). Physical activity can alleviate the progression of Parkinson''s disease symptoms, so a lack of activity often worsens motor symptoms (5,7). A further significant problem during the COVID-19 pandemic is avoidance of follow-up examinations (4,5,8,9). Delaying or avoiding medical care may increase the risk of morbidity and mortality associated with otherwise treatable or preventable diseases (9).The main aim of this study was to assess the effect of social isolation due to the COVID-19 pandemic on physical and mental health in Parkinson’s disease patients treated at the Clinic of Neurology of University Hospital Center Rijeka. The specific aims were to assess the effect of social isolation on 1) non-motor symptoms, 2) the occurrence of depression, 3) the occurrence of anxiety, and 4) avoiding check-ups, in people with Parkinson''s disease.     

Psychological well‐being across 1 year with rheumatoid arthritis: Coping resources as buffers of perceived stress

Objectives. Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well‐being among rheumatoid arthritis (RA) patients. Design. A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year. Methods. Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well‐being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for. Results. Perceived stress had the strongest relationship with psychological well‐being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well‐being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months. Conclusion. Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.     

A cognitive behavioural intervention in the context of methadone tapering treatment for opiate addiction—two single cases

A seven‐session cognitive behavioural programme was designed in an attempt to facilitate the engagement of opiate‐addicted clients in a methadone tapering treatment regime. The programme was based on a functional view of addiction, and cognitive behavioural techniques suggested by Beck's cognitive treatment of depression, motivational interviewing, and relapse prevention adapted to this specific clinical context. Two cases successfully engaged in the programme are presented. The techniques are outlined, short‐term outcome measures reported, and the implications of such an approach discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

An overview of sleep and circadian dysfunction in Parkinson's disease

Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co‐morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.     

Evaluating the effectiveness of a brief group cognitive behavioural therapy intervention for perinatal depression

Archives of Women's Mental Health - Little is known about the effectiveness of group cognitive behavioural therapy (CBT) in women with perinatal depression (PND) and psychiatric comorbidities....     

Social cognition and metacognition in social anxiety: A systematic review

Cognitive–behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross‐sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self‐focused attention, the post‐mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.     

Cognitive vulnerability in the development of concomitant pain and sleep disturbances

Objectives. The present study uses a cognitive behavioural framework to explore the idea that people with pain and sleep disturbances share a common cognitive vulnerability. Design. A longitudinal classification of people (N =592) in a community sample reporting on symptoms of pain and sleep at baseline, 3 and 12 months after the initial survey. Method. Cluster analysis was used to classify people reporting different degrees of symptoms, and their endorsement of cognitive behavioural processes, and consequences at each time point. Groups in similar clusters were linked at adjacent time points to document patterns of stability and change. The clusters are described at baseline on a range of indices not used to form them (problem duration, problem frequency, anxiety, and depression). Reliable change in reports of symptom‐related interference was cross tabulated with reliable change in cognitive behavioural processes and consequences. Results. Cluster analyses resulted in six homogenous and distinct profiles at each time point. Linking the clusters over time showed partial individual stability in cluster membership at adjacent time points. Reliable change in symptom‐related interference was associated with reliable change in endorsement of cognitive behavioural processes and consequences on the short term. Conclusion. The character and partial individual stability of symptom cluster membership suggests that problems with pain and sleep may share mutually maintaining cognitive behavioural processes and consequences. Future research should examine the utility of identifying mutually maintaining factors in the treatment of concomitant pain and sleep disturbances.     

Effectiveness of metacognitive interventions for mental disorders in adults—A systematic review and meta‐analysis (METACOG)

We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random‐effects meta‐analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = ?0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = ?0.31). MCTrain was more effective than standard treatment in patients with obsessive–compulsive disorder (SMD = ?0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = ?2.80), posttraumatic stress disorder (SMD = ?2.36), and psychological treatments (cognitive–behavioural) in patients with anxiety (SMD = ?0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive–behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add‐on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.     

The Epidemiology of Dementia Associated with Parkinson's Disease

Parkinson''s disease (PD) is the second most common neurodegenerative illness after Alzheimer''s disease (AD). Cognitive impairment and dementia are common features in PD and characterized by a wide range of cognitive deficits distinct from those seen in AD. Mild cognitive impairment occurs even early in PD and is associated with shorter time to dementia. The purpose of this review is to present recent findings on clinical aspects of dementia in PD and to elucidate underlying clinical and neurobiological risk factors.     

Effect of animal-assisted therapy on the psychological and functional status of elderly populations and patients with psychiatric disorders: a meta-analysis

Abstract

Animal-assisted therapy (AAT) may affect health via an increase in perceived social support and social interaction. A meta-analysis was conducted to determine its effects on selected populations with poor social functioning. Studies involving elderly participants and those with depression and schizophrenia were searched in Medline, PsycINFO and Cochrane up to January 2009. Matched or controlled trials incorporating pre- and post-test outcome measures and with at least five participants subjected to a multiple-day AAT intervention were selected (n=21). Participants' characteristics, study design, intervention features, outcome variables, reported effects and study quality were retrieved. Design-specific effect sizes were pooled using random-effects models. Heterogeneity of effects by study characteristics, including target population and intervention features, was explored through meta-regression. Pooled effect sizes were calculated for social functioning, depression, anxiety, behavioural disturbances, loneliness, daily living skills and cognitive status. As hypothesised, AAT improved social functioning (pooled effect size = 1.06, n=275). Moderate effects were found for depression (?0.34, n=447), anxiety (?0.29, n=291) and behavioural disturbances (?0.32, n=367). Effects on social functioning and depression were larger in individuals with psychiatric conditions while behavioural disturbances were reduced in patients with dementia. The inconsistent methodological characteristics of the studies meta-analysed suggest a conservative interpretation of these findings.     

Am I (hyper)aroused or anxious? Clinical significance of pre‐sleep somatic arousal in young adults

Self‐reported somatic arousal remains a challenging clinical construct, particularly because only a subset of patients report symptoms such as racing heart, palpitations or increased body temperature interfering with their sleep. It is unclear whether self‐reported somatic arousal is a marker of hyperarousal or co‐morbid clinical anxiety in individuals with insomnia. Participants included 196 young adults aged 20.2 ± 1.0 years old who were predominantly females (75%). About 39% of the sample reported subthreshold insomnia, and about 8% reported clinically significant insomnia, based on their Insomnia Severity Index. Participants completed the Pre‐Sleep Arousal Scale, Beck Anxiety Inventory, Beck Depression Inventory, Arousal Predisposition Scale, and Ford Insomnia Response to Stress Test. Multivariable stepwise regression assessed which factors were independently associated with pre‐sleep cognitive (Pre‐Sleep Arousal Scale‐Cognitive) and somatic (Pre‐Sleep Arousal Scale‐Somatic) arousal. Receiver‐operating characteristic analysis assessed the predictive value to identify clinically significant anxiety (Beck Anxiety Inventory ≥ 20), insomnia (Insomnia Severity Index ≥ 15) and arousability (Arousal Predisposition Scale ≥ 32). Beck Anxiety Inventory (β = 0.42) was the best single correlate of Pre‐Sleep Arousal Scale‐Somatic, while Insomnia Severity Index (β = 0.33) was of Pre‐Sleep Arousal Scale‐Cognitive. A Pre‐Sleep Arousal Scale‐Somatic score of 12 or more identified those with clinically significant anxiety with 65% specificity and 65% sensitivity, while a cut‐off score of 14 increased its sensitivity (86%). Self‐reported pre‐sleep somatic arousal may be an index of co‐morbid clinical anxiety in individuals with insomnia. These findings aid clinicians with assessment and treatment, particularly in the absence of clinical guidelines indicating when somatically focused relaxation techniques should be included as part of multicomponent cognitive behavioural treatment of insomnia.     

Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review

Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non‐Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non‐randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post‐treatment using non‐controlled designs. The remaining eight studies (seven randomized and one non‐randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.     

Telehealth‐delivered CBT‐I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial

Cognitive behavioural therapy for insomnia is the recommended treatment for chronic insomnia. However, up to a quarter of patients dropout from cognitive behavioural therapy for insomnia programmes. Acceptance, mindfulness and values‐based actions may constitute complementary therapeutic tools to cognitive behavioural therapy for insomnia. The current study sought to evaluate the efficacy of a remotely delivered programme combining the main components of cognitive behavioural therapy for insomnia (sleep restriction and stimulus control) with the third‐wave cognitive behavioural therapy acceptance and commitment therapy in adults with chronic insomnia and hypnotic dependence on insomnia symptoms and quality of life. Thirty‐two participants were enrolled in a pilot randomized controlled trial: half of them were assigned to a 3‐month waiting list before receiving the four “acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia” treatment sessions using videoconference. The primary outcome was sleep quality as measured by the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. All participants also filled out questionnaires about quality of life, use of hypnotics, depression and anxiety, acceptance, mindfulness, thought suppression, as well as a sleep diary at baseline, post‐treatment and 6‐month follow‐up. A large effect size was found for Insomnia Severity Index and Pittsburgh Sleep Quality Index, but also daytime improvements, with increased quality of life and acceptance at post‐treatment endpoint in acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia participants. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index was maintained at the 6‐month follow‐up. Wait‐list participants increased their use of hypnotics, whereas acceptance and commitment therapy‐enhanced cognitive behavioural therapy for insomnia participants evidenced reduced use of them. This pilot study suggests that web‐based cognitive behavioural therapy for insomnia incorporating acceptance and commitment therapy processes may be an efficient option to treat chronic insomnia and hypnotic dependence.     

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression

OBJECTIVE:

To compare verbal fluency among Alzheimer''s disease, Parkinson''s disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity.

METHODS:

Patients from an outpatient university center with a clinical diagnosis of Alzheimer''s disease, Parkinson''s disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson''s disease, major depression, and Alzheimer''s disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals).We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model.

RESULTS:

The mean digit span and verbal fluency scores were lower in patients with Alzheimer''s disease (n = 34) than in patients with major depression (n = 52) or Parkinson''s disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer''s disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson''s disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson''s disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer''s disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases.

CONCLUSIONS:

Verbal fluency provides a better characterization of Alzheimer''s disease, major depression, and Parkinson''s disease, even at later stages.     

Improving outcomes for COPD patients with mild‐to‐moderate anxiety and depression: A systematic review of cognitive behavioural therapy

Purpose Anxiety and depression are highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and are associated with lower levels of self‐efficacy, impaired health status, poorer treatment outcomes and reduced survival following emergency admission. Cognitive behavioural therapy (CBT) may be effective for treating anxiety and depression in COPD patients but evidence for this is uncertain. Methods A systematic review of controlled trials that evaluated the effectiveness of CBT for treating mild‐to‐moderate anxiety or depression in adults with clinically stable COPD. Ovid electronic bibliographic databases were searched from inception to May 2006; all content held by the Cochrane Library Issue 3, 2006 was also searched. Results One small randomized controlled trial (RCT) of moderate quality showed that CBT, when given with exercise training and education, was associated with large and significant treatment effects for both anxiety (?1.39 (95% CIs ?2.19, ?0.59)) and depression (?0.86 (95% CIs ?1.61, ?0.11)). Additionally, a larger RCT of higher quality demonstrated that CBT, when given with exercise and education, was associated with large and significant treatment effects for depression (?0.76 (95% CIs ?1.34, ?0.17)), but not for anxiety. No other included study reported significant reductions in either anxiety or depression in COPD patients given CBT. Conclusion There is only limited evidence that CBT, when used with exercise and education, can contribute to significant reductions in anxiety and depression in COPD patients. There is scope for a well‐powered RCT to evaluate the effectiveness and acceptability of CBT among this patient population.     

Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Anxiety is the most prevalent childhood psychopathology. Cognitive behavioural therapy is considered the most effective treatment, but outcomes remain variable. This study investigated children's communication patterns in child–therapist conversations and whether changes in these patterns, from rigid to more flexible, were associated with better treatment outcomes. Fifty‐three children (31% boys), with a mean age in years of M = 9.68 (SD = 1.85), completed a 12‐week cognitive behavioural therapy program. Maternal as well as children's reports of children's anxiety were assessed pretreatment and posttreatment. Additionally, 15‐min segments of two therapy sessions were audiotaped and children's conversational turns were coded for properties of response and initiative. The structure of children's communication patterns was further quantified using recurrence quantification analysis. As expected children entering treatment were characterised by rigid and inhibited conversational behaviour. Children who became less repetitive and deterministic over time had better maternal‐rated treatment outcomes. These findings did not generalize to child reports. Last, the hypothesis that the positive relation between the breaking of rigid communication patterns and treatment outcome would be mediated by increases in proactive conversational behaviours of the child was only partly supported. These study findings contribute to the emergent literature on processes of change in childhood anxiety treatment by providing initial support for the hypothesis that breaking rigid (communication) patterns may be a prerequisite of clinical change.