Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.     

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.     

认知灵活性和顿悟表征转换：练习类型的影响

以停车场问题为实验材料,以42名大学生为被试,探讨认知灵活性高和低的被试在不同练习类型下顿悟问题表征转换的差异。结果表明：1）不同的练习类型对顿悟表征转换有影响,被试在难度逐渐增加的练习类型下比在简单的练习类型下顿悟产生得更快;2）顿悟表征转换的速度因认知灵活性的不同有差异,在简单的练习类型下,认知灵活性高的被试比认知灵活性低的被试顿悟产生得更早,在难度逐渐增加的练习类型下两者无差异;3）认知灵活性高的被试比认知灵活性低的被试顿悟问题解决更快。     

A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus

This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.     

Training Aboriginal Practitioners in Cognitive Behavioural Therapy

Comments on an article by Bennett‐Levy and colleagues. This commentary reviews a dissemination of cognitive behavioral therapy (CBT) for Aboriginal Australians, with regard to the strengths of the dissemination effort and areas for future efforts. As an initial step in bringing CBT to a population that has been severely limited in access to evidence based practice, despite a notable need, this study was an important step forward. Feedback from the participatory action research group (n = 5 Aboriginal Australian counsellors) identified CBT elements and adaptations perceived to be particularly effective with Aboriginal Australian clients. Case conceptualization was identified as a potential avenue for further tailoring CBT to the individual needs of clients. Several factor including the success of the dissemination effort, reports that clients shared CBT techniques with their communities, and the skill‐building nature of CBT raised the possibility of future community‐based dissemination.     

Dissemination of Therapist-Assisted Internet Cognitive Behaviour Therapy: Development and Open Pilot Study of a Workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.     

Changes in Cognitions, Emotions, and Behaviors in Depressed Patients and Their Spouses Following Marital Cognitive Therapy, Traditional Cognitive Therapy, Pharmacotherapy, and No Intervention

This study evaluated specific influences of a cognitive marital treatment (CMT) for depression based on an integration of cognitive theory of depression and systems theory. The effects of CMT on variables representing cognitions, emotions, and behaviors were compared with the effects of traditional cognitive therapy (CT), pharmacotherapy (PT), and no treatment (NT). Subjects were Major Depression Disorder and Dysthymic outpatients and their spouses. The changes considered were for pre–post treatment and pre-treatment–follow-up. CMT affected a wider range of variables than other treatments. In most instances it was also superior to the NT condition. Most of the gains were manifested at termination and lasted through follow-up. The variables affected by CMT were patients' and spouses' cognitions and emotions. PT had best effects on patients' emotions. CT affected patients' cognitions, but did not achieve superiority on any of the compared variables. None of the treatments produced significant changes in behaviors.     

Absence of Ankle Stiffening While Standing in Focus and Cognitive Task Conditions in Older Adults

Abstract

Research suggests that an external focus or cognitive task may improve postural control. Removing attention from movement production may promote automaticity, or the tasks may promote ankle stiffening. To investigate these two theories, twenty older adults stood while performing baseline standing, internal focus, external focus, and two cognitive tasks. Changes in postural control occurred in external focus and cognitive task conditions compared to baseline and internal focus, while no change occurred in cocontraction indices. This suggests that an external focus and cognitive task can improve postural control in older adults. Since no change occurred in cocontraction indices across conditions, this suggests that stiffening cannot explain these changes. Instead, changes could be due to automaticity of sway.     

Introducing Assertiveness Training in Hungary

Abstract

The preliminary results of an evaluation of a systematic assertiveness training programme (based on a cognitive-behavioural approach) in psychiatric care in Hungary are presented. The method adopted was specific to the Hungarian/Middle-European circumstances since people had difficulty in exercising their personal rights in the past. In groups of “neurotic” patients and comparison subjects three questionnaires (the Rathus-scale (R), the Assertiveness Inventory (AI) and the Uncertainty Questionnaire (UQ)) were administered at the beginning and at the end of the treatment. The training programme consisted of eight sessions with an emphasis on education about assertiveness and on the practice of skills such as saying “no” or standing up for oneself. A statistical analysis indicated significant improvement in the social skills of the participants, while an item analysis showed high internal consistency in all three questionnaires, and a concurrent validity analysis revealed a strong correlation between the Rathus-scale and the Assertiveness Inventory. The results indicate that assertiveness training can be used effectively in mental health care in Hungary.     

An Internet-Based Cognitive-Behavioural Training for Acute Tinnitus: Secondary Analysis of Acceptance in Terms of Satisfaction,Trial Attrition and Non-Usage Attrition

Objectives: Recent studies on tinnitus have focused on the efficacy of Internet-based interventions. Other core features of the quality of service, e.g. acceptance and attrition, have often been overlooked. This study analyses Internet-based training regarding acceptance and attrition in a trial on minimal-contact interventions for acute tinnitus. Whenever possible, we give information on other forms of training for comparison. Methods: In a randomised controlled trial with 337 participants, 87 persons took part in the Internet training. Results: The participants were as satisfied with the Internet-based training as with a face-to-face group training. There was a 34.48% dropout from the Internet-based training (dropout attrition). The training attrition from the Internet-based training was even higher at 64.4%. Conclusions: Two out of three indicators for acceptance—satisfaction and dropout attrition—provide comparable results between the Internet-based training and a face-to-face group training. The third indicator, training attrition, shows a better result for the group training. Future research should focus on attrition in order to enhance the overall effectiveness of training.     

Computerised Cognitive Behavioural Therapy in an Adult Mental Health Service: A Pilot Study of Outcomes and Alliance

This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Reflections on the Theory-Practice Gap in Cognitive Behavior Therapy

The papers in this special series, edited by Pilecki and McKay (2013--this issue), are devoted to examining the theory-practice gap in cognitive-behavior therapy (CBT). A gap between theory and practice can occur at more than one level. First, there exists a substantial and concerning gap between the theories and interventions supported by research and those being offered to patients in the community (i.e., research-practice gap). There is also a growing concern in the field that the techniques and procedures that characterize cognitive-behavioral therapies are becoming increasingly divorced from underlying theories (i.e., theory-procedure gap). In the present commentary we hope to summarize and comment on some of the themes, issues, and future directions raised by our contributors.     

A First Step Toward Cognitive Remediation of Voices: a Case Study

Several studies have shown that source‐monitoring errors are related to verbal hallucinations in schizophrenia. An exploratory pilot study has been carried out to investigate the possibility of training patients in how to avoid errors in source‐monitoring. One patient with paranoid schizophrenia and persistent thought insertions was trained for 6?hours to use mnemonic techniques to compensate specific deficits in source‐monitoring. Results show that the patient was able to improve his performance and maintain the acquired progress at a 1‐month follow‐up assessment. These preliminary results are interesting for developing a larger controlled study of cognitive remediation of source‐monitoring deficits.     

知识点认知规律的实验研究

知识点是人的认知单位,人学习知识,必须以知识点为单位、逐个知识点地学习。本实验以概念学习为例,研究了人一次学习一个知识点与同时学习两个知识点时的成绩差异。研究结果表明,1. 在概念中的信息组块数不超过短时记忆容量的前提下,一次学习一个概念,构成概念的信息组块数对概念掌握影响不显著。2.在同样条件下,一次学习一个知识点的成绩好于同时学习两个知识点的成绩,从而验证了知识点认知规律。     

An Open Trial of Web-Based Mindfulness-Based Cognitive Therapy for Perinatal Women at Risk for Depressive Relapse

Depression occurring during pregnancy and postpartum (i.e., the perinatal period) is common and associated with adverse outcomes for women and their offspring. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk for depressive relapse among at-risk individuals generally, and recent adaptations document the efficacy of MBCT among perinatal women specifically. In addition, MBCT, when delivered using a web-based format (Mindful Mood Balance [MMB] program), has demonstrated acceptability and feasibility for at-risk individuals generally. The aim of the present open trial study was to examine the feasibility, acceptability, and preliminary outcomes of MMB for use with pregnant women at risk for depressive relapse (N = 37). We predicted that MMB would be feasible and acceptable as assessed by session completion and participation in phone coaching calls, home practice completion, and self-reported satisfaction via questionnaire and interview. We also predicted that women would not demonstrate significant worsening of depression symptom severity during MMB, consistent with our focus on prevention. A brief case example based on a composite of participants is presented to illustrate the MMB structure and content and the phone coaching protocol. Participants demonstrated engagement with the program, reported perceiving benefits in the intended depression prevention targets of MMB, and sustained minimal to mild depressive symptom severity over the course of the program. Given these promising results and the potential benefits of averting depression for women and their families, further development and rigorous testing of MMB among at-risk pregnant women is warranted.     

试论伊壁鸠鲁的精神疾患的认知疗法

伊壁鸠鲁创立的哲学在晚期希腊时期的影响甚至超过了斯多亚派,伊壁鸠鲁及其传人卢克莱修的唯物主义哲学其实是面对人类的肉体和精神疾病而进行的治疗活动,其基本原则在两千后演化为精神治疗术中应用广泛、声名著卓的认识疗法。依据伊壁鸠鲁残篇分析了这种古代精神治疗术的基本原理、实施方法及其在思想史上的重要意义。     

Be a Mom: Formative Evaluation of a Web-Based Psychological Intervention to Prevent Postpartum Depression

A formative evaluation (consisting of two phases: a scoping literature review and a focus group with mental health professionals) was conducted to inform the design of a web-based intervention to prevent postpartum depression, in terms of its characteristics and content: the Be a Mom program. The results showed that the web-based intervention should be short-term, delivered postnatally, and grounded in cognitive-behavior therapy principles. Moreover, the intervention should include weekly sessions targeting basic contents: motherhood changes, reorganizations and emotional experience; cognitions, self-criticism, and self-compassion; parenting values, social support, and assertive communication skills; couple relationship, negotiation and conflict resolution skills; and postpartum depression signs and professional help-seeking. These results may improve the Be a Mom’s adequacy, implementation success, and effectiveness.     

Cognitive habilitation in schizophrenia: A theoretical review and model of treatment

Evidence has accumulated for information processing deficits in schizophrenia. The functional significance of these deficits is only beginning to be understood. There are indications that these deficits may respond to intervention. Training on deficient functions has been demonstrated to relate to improvements in performance. A treatment program of cognitive rehabilitation is deduced from the literature and induced from clinical experience. The treatment is designed to impact directly on the information processing deficits of schizophrenic patients and indirectly to ameliorate functional deficits.     

The Development and Initial Validation of the Cognitive Fusion Questionnaire

Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, “defusion” interventions aim to “unhook” thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories, and self-stories. A number of similar concepts have been described in the psychology literature (e.g., decentering, metacognition, mentalization, and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. While there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed-upon measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1,800 people across diverse samples show good preliminary evidence of the CFQ’s factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.