Effects of cognitive-behavioural therapy on anxiety,depression and condom use in people with HIV in Mexico City: a pilot study

Anxiety and depression in people living with HIV (PLWH) are negatively associated with healthy sexual behaviours. We pilot-tested a Cognitive-Behavioural Therapy (CBT)-based intervention to reduce anxiety and depression, aimed to increase serostatus disclosure to sexual partners, quality of sexual life (QoSL) and condom use. The study had a single-case experimental design (AB) with follow-up measures. Eleven PLWH with moderate/severe anxiety/depression received six-module CBT intervention delivered in ten one-hour individual weekly sessions. Anxiety, depression, consistent/correct condom use and QoSL were measured. Depression and anxiety decreased after the intervention (depression baseline [BL] Mdn = 21, final [F] Mdn = 3, z = -2.934, p = .003; anxiety BL Mdn = 30, F Mdn = 4, z = -2.941, p = .003). QoSL improved (BL Mdn = 28, F Mdn = 13, z = -2.625, p = .009), along with participants’ ability to use condoms (57.14 vs.100, z = -2.937, p = .003). Effect size was large, changes were maintained at follow-up measurements. The CBT intervention had positive effects in reducing anxiety and depression, which could facilitate the acquisition of healthy sexual behaviours. Further studies are important to clarify the benefits of targeting emotional variables to improve wellbeing and prevention behaviours in PLWH.     

Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

Psychology in the Service of the School by M. F. Cleugh

Abstract

Forgiveness intervention has been shown to be effective in dealing with problems caused by interpersonal hurt. Problems caused by courtship hurt could also be resolved by this approach. This paper describes the theoretical foundations and application of a group forgiveness treatment program which reflected some elements of collectivist Chinese culture positivity for individuals hurt in romantic relationships. Thirty-one female students from a Chinese university were randomly assigned to three groups (forgiveness group, general group, and control group). They completed a Scale of Courtship Forgiveness, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Index of Well-Being &; Index of General Affect at entry (baseline), at the end of treatment, and at a four-week follow-up. Compared with the control group, clients both from forgiveness and general groups showed significant improvement in anxiety, depression, and well-being at the end of treatment, but only the forgiveness group showed significant improvement in courtship forgiveness. Further, the effectiveness of treatment for the forgiveness group lasted longer than for the general group. The findings suggest that the forgiveness treatment can be beneficial for college students hurt in romantic relationship.     

Cognitive Behaviour Therapy to Improve Mood in People with Epilepsy: A Randomised Controlled Trial

This study compared a 9-week individualised Cognitive Behaviour Therapy (CBT) programme for people with epilepsy (PWE), with a wait-list control. Fifty-nine PWE were randomised and 45 (75%) completed post-treatment outcomes. People with lower quality of life (QoL), particularly for cognitive functioning, were more likely to drop out. Analyses based on treatment completers demonstrated significant improvements on the Neurological Depressive Disorders Inventory for Epilepsy (p = .045) and Hospital Anxiety Depression Scale-Depression subscale (p = .048). Importantly, CBT significantly reduced the likelihood of clinical depressive symptoms (p = .014) and suicidal ideation (p = .005). Improvements were not observed for anxiety, QoL or maintained overtime for depression. Results suggest that CBT was effective, however, and could be improved to increase patient retention and long-term outcomes.     

Evaluating the impact of a worksite stress management programme for distressed student nurses: A randomised controlled trial

Abstract

The effectiveness of a stress management intervention designed to reduce affective distress in 79 student nurses who previously reported significant distress, was evaluated by comparing stress management with wait-list control. The intervention had reliable, positive effects on affective outcomes including General Health Questionnaire-30, State and Trait Anxiety Inventory, Beck Depression Inventory, and a measure of domestic satisfaction. The intervention also led to an increase in Direct Coping use.

State Anxiety immediately preceding two important examinations, i.e. at 3 and 18 month follow-up, was lower for students receiving stress management. However, no effect was detected on sickness, absence and examination performance following this intervention. Stress management delivered in groups reduces affective distress and increases adaptive coping use in both clinical and academic settings.     

Increasing Middle School Students’ Life Satisfaction: Efficacy of a Positive Psychology Group Intervention

This study identified middle school students who were less than delighted with their lives (reported life satisfaction scores between 1 and 6 on a 7-point scale), and attempted to improve these students’ mental health via a 10-week group wellness-promotion intervention developed from prior applications of positive psychology research. Complete data at baseline, post-intervention, and 6-month follow-up was gathered from 55 sixth grade students who were randomly assigned to the intervention condition (n = 28) or wait-list control (n = 27). Repeated measures analyses of a propensity score matched sample of 40 participants indicated a significant group by time interaction for global life satisfaction from baseline to post-intervention. Specifically, life satisfaction of students in the intervention group increased significantly, while the control group declined during the same period (although this change was not statistically significant). The intervention group’s gains were maintained at follow-up, but were matched by similar gains for students in the control group. No effects of intervention group were identified in the indicators of affect or psychopathology. The improvements in life satisfaction evidenced by students in the intervention group during the first semester of middle school are important given the adjustment difficulties that often appear during this sensitive developmental period marked by biological and educational changes.     

Spiritual Well-Being Among HIV-Infected Adolescents and Their Families

Congruence in spirituality between HIV+ adolescent (n = 40)/family (n = 40) dyads and psychological adjustment and quality of life were assessed, using the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy, Beck Depression Inventory-II, Beck Anxiety Inventory and Pediatric Quality of Life Inventory at baseline and 3-month post-intervention. Adolescents were 60 % female and 92 % African American. Congruence in spirituality between adolescent/surrogate dyads remained unchanged at 3 months. High congruence existed for “having a reason for living”; rejection of “life lacks meaning/purpose” and “HIV is a punishment from God.” Adolescents were less likely to forgive the harm others caused them than their families.     

Effectiveness of Acceptance–Commitment Therapy on Craving Beliefs in Patients on Methadone Maintenance Therapy: A Pilot Study

The present study is designed to evaluate the efficacy of acceptance–commitment therapy (ACT) on craving beliefs in opioid dependent patients on methadone maintenance treatment (MMT). Twenty-eight opioid dependent participants, aged 18–50 years, who were on MMT based on Iran’s Ministry of Health and Medical Education published protocol, were evaluated in Mashhad during 2011–2012. The treatment group comprised fourteen participants, who received eight sessions of individual ACT alongside MMT while fourteen participants of the control group received just MMT. The effectiveness of the intervention was assessed by the craving beliefs questionnaire (CBQ), the action and acceptance questionnaire (AAQ-I) and the mean dosage of methadone the participants consumed in the last 3 days. Assessment was performed three times; the first was before the initiation of ACT (as pretest), the second was 2 weeks after ACT was terminated (as posttest), and the third one was 12 weeks after the termination of ACT (as follow-up). The extracted data were analyzed by two way ANOVA and ANCOVA using SPSS-20. While there was no significant difference in the mean methadone dosage between the treatment and the control group at pretest (p = 0.067), patients in the treatment group had a significantly lower methadone dosage at posttest (p < 0.001) and follow-up (p < 0.001) compared to the control group. There was a significant reduction in the CBQ scores between treatment and control groups at posttest (p = 0.047) and follow-up (p = 0.014). There was also a significant difference in AAQ-I score between treatment and control at posttest (p < 0.001) and follow-up (p < 0.001). It seems that short-term individual ACT is associated with a significant decline in craving beliefs in substance-dependent patients, which lasts for at least 12 weeks after the termination of ACT.     

Relationship between sleep disturbance,depression and anxiety in the 12 months following a cardiac event

We aimed to assess the prevalence of sleep disturbance in a cardiac patient population over a 12-month period and assess its relationship with treatment adherence, self-efficacy, anxiety and depression. A total of 134 patients consecutively admitted to two Australian hospitals after acute myocardial infarction (31%), or to undergo bypass surgery (29%) or percutaneous coronary intervention (40%) were interviewed at six weeks and four and 12 months. Sleep disturbance was measured using a recode of the Beck Depression Inventory (v.2) item 16. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Sleep disturbance was highly prevalent (69%) at 6 weeks but was not associated with 12-month psychological outcomes. Path analysis revealed that sleep disturbance at 4 months was, however, associated with reduced treatment adherence and self-efficacy, and higher anxiety and depression scores at 12 months. The high prevalence of sleep disturbance in this study and its association with psychological outcomes may have adverse prognostic implications and possibly impede cardiac rehabilitation efforts.     

Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT

This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9 % male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n = 48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov.:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = 0.022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = 0.008, d = 0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = 0.012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.     

Indigenous Adoption of Novaco’s Model of Anger Management Among Individuals with Psychiatric Problems in Pakistan

The present study was designed to indigenously adopt Novaco’s model of anger management and examine its efficacy among individuals with psychiatric problems in Pakistan. For the assessment of anger and psychiatric problems, Urdu-translated versions of Novaco Anger Inventory (NAI), Anger Self-Report Questionnaire (ASR) and Depression Anxiety Stress Scale were used. A sample of 100 individuals was divided into two groups: a treatment group (received the indigenously adopted model of anger management) and a control group (received general counseling). Results of mixed repeated-measures ANOVA revealed that individuals in the treatment group significantly (p < .01) scored lower on the NAI and ASR (at post-assessment) as compared to the control group. Therefore, the indigenous model of anger management was shown to be more effective than general counseling for anger management.     

Evaluation of executive functions in children and adolescents with familial Mediterranean fever

The aim of the present study was to investigate neuropsychological test performance in children and adolescents with familial Mediterranean fever (FMF). A total of 88 children and adolescents aged 8 to 17 years were included, 52 with FMF and 36 healthy controls. After the participants were administered the Children Depression Inventory (CDI) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor Speed, Processing Speed, Reaction Time, Complex Attention, Executive Function, and Cognitive Flexibility) and a summary score (Neurocognition Index [NCI]). A statistically significant difference between the FMF and control groups was found in six out of seven domains, where the scores of the participants with FMF were found to be significantly lower than those of the control participants (p < .05). Although the mean Reaction Time score of the participants with FMF was found to be lower than that of the control participants, the finding was not statistically significant (p > .05). The mean CDI and SCARED scores of the participants with FMF were found to be significantly higher than those of the control participants (p < .05). Low scores in the Processing Speed and Psychomotor Speed domains of the CNSVS were significantly correlated with higher SCARED scores (r = ?.37, p = .01). Impaired cognitive functions should be taken into consideration in children and adolescents with FMF when assessing and managing this population.     

Efficacy of booster sessions after training in assertiveness

28 subjects participated in a 6-wk. assertion training program. Of these, 22 remained in the study for a 6-mo. follow-up period, during which half received monthly booster sessions and half did not. Assignment to the booster and no-booster groups was random, with the qualification that subjects were equated on trait anxiety before training in assertiveness. Subjects filled out the Gambrill-Richey Assertion Inventory, the Spielberger State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale before the 6-wk. assertion training, after this program, at a 3-mo. follow-up, and at a 6-mo. follow-up. It was hypothesized that the booster group would exhibit significant superiority on these measures at the 3-mo. and 6-mo. follow-ups. On all measures both groups significantly improved from before to after the training program with good maintenance throughout the follow-ups. There were no differences between the booster and no-booster groups on the measures of assertiveness and anxiety. However, there was a significant interaction for the depression scores when the booster and no-booster groups were compared from posttreatment to 6-mo. follow-up. The depression scores of subjects in the booster group were lower than the depression scores of subjects in the no-booster group at the 6-mo. follow-up. These results were discussed with suggestions for further research.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

Rational-Emotive Behavior Therapy in the Treatment of Adult Victims of Childhood Sexual Abuse

This study investigated the effectiveness of Rational-emotive behavior therapy in the treatment of adult victims of childhood sexual abuse. A sample of 42 women, seeking help for their psychological distress associated with childhood sexual abuse, was selected by means of an assessment interview and the Trauma Sympton Checklist, and randomly assigned to a treatment (n=28) and a delayed treatment control group (n=14). The treatment group participated in 10 weekly sessions of group Rational-emotive behavior therapy and was followed up 8 weeks after termination of treatment. Repeated measurements were obtained by means of the Beck Depression Inventory, State-Trait Anxiety Scale, State-Trait Anger Scale, Guilt Inventory, Coopersmith Self-Esteem Inventory and Golombok-Rust Inventory of Sexual Satisfaction. Results indicated significant reductions in depression, State anxiety, State anger, State guilt and low self-esteem. These improvements were maintained at follow-up.     

Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial

Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n = 31) or wait-list control (n = 30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly – S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohen’s d = 0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohen’s d = 0.61, 95% CI [0.04, 1.19], and quality of life, Cohen’s d = 0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.     

E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

The aim of this study was to assess the effects of a 7‐week standardized cognitive behavioural treatment of work‐related stress conducted via e‐mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow‐up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS‐42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI‐GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention‐to‐treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p?0.025). In the treatment group, the effects were large to moderate (0.9 (stress)?d?0.5 (anxiety)). The between‐group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow‐up, the effects were more pronounced, but this result requires replication in view of high attrition at follow‐up. The results warrant further research on Internet‐driven standardized cognitive behavioural therapy for work‐related stress. Such research should include the direct comparison of this treatment with face‐to‐face treatment, and should address the optimal level of therapist contact in Internet‐driven treatment.     

Timed performance weaknesses on computerized tasks in pediatric brain tumor survivors: A comparison with sibling controls

With more children surviving a brain tumor, insight into the late effects of the disease and treatment is of high importance. This study focused on profiling the neurocognitive functions that might be affected after treatment for a pediatric brain tumor, using a broad battery of computerized tests. Predictors that may influence neurocognitive functioning were also investigated. A total of 82 pediatric brain tumor survivors (PBTSs) aged 8–18 years (M = 13.85, SD = 3.15, 49% males) with parent-reported neurocognitive complaints were compared to a control group of 43 siblings (age M = 14.27, SD = 2.44, 40% males) using linear mixed models. Neurocognitive performance was assessed using measures of attention, processing speed, memory, executive functioning, visuomotor integration (VMI), and intelligence. Tumor type, treatment, tumor location, hydrocephalus, gender, age at diagnosis, and time since diagnosis were entered into regression analyzes as predictors for neurocognitive functioning. The PBTSs showed slower processing speeds and lower intelligence (range effect sizes .71–.82, p < .001), as well as deficits in executive attention, short-term memory, executive functioning, and VMI (range effect sizes .40–.57, p < .05). Older age at assessment was associated with better neurocognitive functioning (B = .450, p < .001) and younger age at diagnosis was associated with lower intelligence (B = .328, p < .05). Medical risk factors, e.g., hydrocephalus, did not show an association with neurocognitive functioning. Late effects in PBTSs include a broad range of neurocognitive deficits. The results suggest that even PBTSs that were traditionally viewed as low risk for neurocognitive problems (e.g., surgery only, no hydrocephalus) may suffer from decreased neurocognitive functioning.     

A brief intervention to increase physical activity behavior among adolescents using mental simulations and action planning

This study evaluated the effectiveness of a brief integrated theory-based intervention to increase physical activity (PA) among adolescents over a three-month follow-up period. A 2 (mental simulation: present vs. absent) × 2 (action planning: present vs. absent) × 4 (time: baseline vs. one-month vs. two-month vs. three-month follow-up) mixed-model randomized controlled design was adopted. Adolescents aged 14–15 years (N = 267) completed baseline psychological measures and self-reported PA followed by the relevant intervention manipulation, if appropriate, with follow-up measures collected one, two, and three months later. Results revealed no significant effects for the mental simulation and action planning strategies nor the interaction of the two strategies. However, among participants with low levels of baseline PA, participants in both mental simulation alone and action planning alone groups reported significantly higher levels of PA at one-month follow up than other groups, suggesting that individual intervention components may be effective in low-active adolescents.