Exploring the role of CBT in the self-management of type 2 diabetes: A rapid review

Background: Type 2 diabetes has been recognised as a global health concern: one that requires intervention to lessen the incumbrance caused by the chronic illness. This rapid review was conducted to determine the scientific evidence available on how Cognitive Behaviour Therapy (CBT) interventions improved the self-management of individuals with type 2 diabetes. Aim: The aim of the review was to synthesise current scientific evidence regarding CBT-based interventions and self-management practices. Method: The rapid review served as a framework to appraise current national and international literature. The researchers used Google Scholar, Journal Storage (JSTOR), PsycINFO, APA PsycArticles, SAGE journals and EBSCO Discovery Services to search for relevant studies. This was performed by employing keywords. Nine relevant studies were identified. The studies were heterogenous in methodology. Seven of the nine studies were conducted in developing countries. Results: The study found that the context of developmental countries plays a significant role in the development of type 2 diabetes and requires tailored intervention because of socio-economic variabilities. The main themes identified in relation to improving self-management included: the characteristics of the CBT-based interventions, namely the format, duration, and outcomes, and identifying the techniques and components used in the CBT-based interventions. Conclusion: The review emphasised the need to further investigate the role of CBT in improving self-management of type 2 diabetes, especially in a South African context.

Effectiveness Of Cognitive Behaviour Therapy in managing Rumination And Insomnia among adolescent girls

Background: The present study attempts to study the effectiveness of cognitive behaviour therapy in managing rumination and insomnia among adolescent girls from the Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore. Methodology: 200 students from undergraduates were screened for their level of Rumination and Insomnia using Ruminative Response Scale and Insomnia Inventory. Out of 200, 120 students with high and average level of Rumination and Insomnia were selected using random sampling technique. Cognitive Behaviour Therapy was given to manage Rumination and reduce Insomnia for the adolescent girls. Results: The age range is 17 to 18 years. Pearson correlation, mean and standard deviation and ‘t’ test was computed to analyse the data. The results indicate that there was a positive correlation between rumination and insomnia and significant difference in managing rumination and insomnia among the adolescent girls proving the effectiveness of Cognitive Behaviour Therapy. Conclusion: Cognitive Behaviour Therapy is an effective therapy for the management of insomnia and rumination in adolescent girls and further studies in this area are needed.

Effect of socio-cultural factors in therapeutic intervention

Comorbidity and presence of family dysfunction in personality disorders, namely borderline personality disorder have been found commonly with bipolar affective disorder clients. Dialectic behaviour therapy (DBT) though has shown efficacy in treatment of such conditions, at times due to the socio-cultural differences of the models adopted from the western concept, there is a felt difficulty in the formulation of the therapeutic model making it necessary to collaborate with other models for smoother formulation and improvement in the overall functioning in the clients. A 21-year-old female of bipolar affective disorder with emotionally unstable personality disorder traits was referred to a psychiatric social worker for assessment and plan of intervention inclusive of DBT and family-focused therapy (FFT). Twenty sessions, each lasting for one hour were conducted with the client and family, each on an inpatient basis to (1) Assess and grade the problems in hierarchy, (2) Understand the socio-cultural constructs in sessions, (3) Teach DBT concepts and relaxation techniques to ameliorate stress and help her to improve the relationship and dynamics with her family through FFT. At the time of discharge, the client had improved nearly 30%, and the client and family were more confident in facing social situations, emotional dysregulation, interpersonal issues, distress tolerance goals which has been explained in the context of the socio-cultural factors focusing on alliance, institutions, expectations, and cultural adaptation involved in therapy and the involvement it had in the therapeutic process.

Effectiveness of Cognitive behavior therapy of panic disorder in adults: A naturalistic study from a Medical College Hospital

Background: Panic disorder is the most prevalent among anxiety disorders in psychiatry clinics. Randomized controlled trials and open studies in research settings and studies from naturalistic settings have proved the efficacy and effectiveness of cognitive behavior therapy (CBT) for panic disorder (PD). Panic disorder responds in only a few CBT sessions. In India studies in this regard are practically non-existent. Materials and methods: This study was a part of study titled “The utilization pattern and effectiveness of Cognitive Behavior Therapy for anxiety disorders in adults: A naturalistic study from a medical college hospital”. Out of 80 anxiety disorder patients taken for study, 26 PD patients attended at least one CBT session. In these 26 patients‟ pre and post CBT scores on Panic Disorder Severity Scale (PDSS) were assessed and analyzed for clinically significant change (CSC) and response rate. Effect size, refusal and dropout rates were assessed. Results: Pre and post PDSS score reduction was statistically significant at P<0.5. Large effect size of 1.78 was noted. Though 30% of patients were on medication, they were stably on same medication throughout the evaluation. CSC, as defined by twin criteria proposed by Jacobson and Truax, was noted in 57% of patients. In the intent to treat analysis number needed to treat to achieve CSC/recovery was about four. Response (defined as 40% reduction in PDSS rating) rate was 88%. There was about 50% CBT refusal rate. Conclusions: This open prospective naturalistic study shows that CBT of panic disorder can be effective, when it is conducted by a psychiatrist who has not received rigorous training from certified Sylvester Satish Romero, Sudhir Hebbar. Effectiveness of Cognitive behavior therapy of panic disorder in adults: A naturalistic study from a Medical College Hospital. IAIM, 2018; 5(10): 44-49. Page 45 training centers. Effect size is comparable to that observed in other settings. CBT can be integrated along with medications for PD in general hospital psychiatry setting. Response and recovery can be obtained in as few as 5 sessions. More than half of treatment seeking panic disorder patients refused to take cognitive behavior therapy reducing its effectiveness.

O papel da supervisão em terapia comportamental quanto à promoção de habilidades sociais em estagiários de psicologia / The role of supervision in behaviour therapy in promoting social skills in psychology trainees

O psicólogo necessita de habilidades acadúmicas e interpessoais e a universidade pode ser um ambiente para a aquisição dessas habilidades. A atuação do estudante de psicologia junto à clientela pode ser um fator de risco para problemas de saúde mental. O objetivo deste trabalho é o de comparar trús momentos (início, meio e término) de um estágio supervisionado em psicologia clínica comportamental quanto a indicadores de saúde mental (ansiedade e depressão), habilidades sociais, consequências e sentimentos. Participaram do estudo 14 mulheres e um homem, graduandos do 5Âs ano do curso de Psicologia que responderam a dois instrumentos de habilidades sociais (IHS-Del Prette e QHC-Universitários), sendo que o QHC-Universitários também mensura indicadores de saúde mental. Os resultados apontam para redução de indicadores de saúde mental, aumento de habilidades sociais e redução de comportamentos não habilidosos na interação com diferentes interlocutores, gerando consequências positivas, reduzindo consequências negativas e sentimentos negativos

Psychologist needs academical and interpersonal skills and the university can be an environment to the acquisition of these abilities. Acting of Psychology students in their clientele can be a risk factor to mental health problems. The objective of this paper is to compare three moments (, early middle and late) of a supervised internship at Behavioural Clinical Psychology in relation to mental health indicators (anxiety and depression), social skills, consequences and feelings. 14 women and one man participated in this study. They, who are 5th-year Psychology undergraduate students, answered to two social skill instruments (IHS-Del Prette and QHC-Universitários) “in which the QHC-Universitários also measures mental health indicators. Results point to a decreasing of mental health indicators, an increasing of social skills and a reducing of non-skilled behaviours in the interaction with different interlocutors “ what generates positive consequences and reduces negative consequences and feeling

Aaron Temkin Beck

Background: Aaron Beck is one of the pioneers in the field of psychiatry and a contemporary psychiatrist who played a seminal role in the development of ‘cognitive behaviour therapy’ for depression. He is regarded as ‘father of cognitive therapy’ and contributed his research on psychotherapy, psychopathology, study of suicide and various rating scales.

Dialectical behaviour therapy for women with boderline personality disorder: a case report

Borderline personality disorder (BPD) is often manifested by maladaptive behaviours such as self-injury. The interpersonal style characteristic of BPD makes it difficult to maintain stable therapeutic relationships, with the patient often discontinuing treatment. Although dialectical behavior therapy (DBT) has been reported to benefit patients with BPD, reports in Asian countries have been few. We herein describe a 22-year-old female with BPD and a history of attempted suicide and self-injury who underwent DBT at our hospital. Methods: Our 6-month DBT consists of 4 parts: weekly psychotherapy by a psychiatrist, weekly skills training by a clinical psychologist and nurse, emergency consultations, and supervision/consultation meetings. Individual psychotherapy and skills training sessions, respectively, were conducted for this patient 24 times. Results: After completing DBT, the number of self-injuries and frequency of suicidal ideation in our patient decreased. Conclusion: Although more costly than standard treatment for BPD, a trial of DBT might be worthwhile in Japanese patients.

Childhood

Childhood obesity is increasing in prevalence world-wide, and is an important predictor of adult obesity. As a consequence, many chronic diseases are now appearing in childhood and adolescence, and will contribute to future morbidity and mortality in adulthood. Over the past 5 decades, while the heights of pre-schoolers and school age children appear to have optimised, their weights and body mass indices (BMI) are still increasing. Childhood obesity is defined as a BMI ≳ 95th percentile for age and sex. The family doctor's approach to childhood obesity is to exclude pathological causes and detect complications of obesity for further treatment. However, the main management principles of childhood obesity encompass adopting healthy lifestyle interventions of age-appropriate diet and exercise recommendations which allow normal height growth to continue. The nutritional goal for obese children is to reduce energy-dense foods and increase nutrient density. Regular exercise encourages long term continuation. Equally important is decreasing time spent in sedentary pursuits and substituting with alternative forms of physical activity. For children, behaviour modification involving the family is essential and implementation requires a multi-disciplinary team. There is no data on long term efficacy and safety of medication for treatment of childhood obesity. There is also no role for bariatric surgery in childhood obesity.

Terapia comportamental no controle da incontinência urinária da mulher idosa: uma ação de enfermagem na promoção do autocuidado / Behavioral therapy intne control of urinary incontinence in elderly women: a nursing action in promoting self-care

A incontinência urinária gera implicações negativas nos âmbitos emocional, social e econômico tanto para o indivíduo incontinente, como para seus cuidadores. A terapia comportamental é uma das abordagens não-invasivas para a incontinência urinária. A terapia comportamental é realizada durante as consultas de enfermagem e a atuação do enfermeiro consiste na aplicação de um protocolo de orientações sobre hábitos de vida, medidas de controle da micção, treinamento para realização do diário miccional, treinamento de exercícios perineais e avaliação da resposta da paciente à terapia. O estudo tem como base teórica a Teoria do autocuidado de Dorothea Elisabeth Orem, pois a terapia comportamental visa instrumentalizar o indivíduo a realizar práticas de autocuidado a partir do protocolo de atendimento do ambulatório. O objetivo da pesquisa é avaliar a efetividade da terapia comportamental aplicada pelo enfermeiro para o controle miccional e melhora da qualidade de vida da mulher idosa. Trata-se de um ensaio clínico não-controlado.40 Foram incluídas no estudo mulheres acima de 60 anos que participam do Ambulatório do Núcleo de Atenção ao Idoso com a queixa clínica de perda involuntária de urina encaminhadas para o ambulatório de urogeriatria. A população estudada foi composta por 13 participantes. Os dados da pesquisa foram coletados a partir dos instrumentos de avaliação do ambulatório de urogeriatria que foram arquivados nos prontuários das pacientes: o diário miccional, avaliação de enfermagem na terapia comportamental e o questionário sobre qualidade de vida em mulheres com incontinência urinária chamado de King’s Health Questionnaire. Estes instrumentos foram aplicados antes e depois da terapia comportamental. Foram colhidos dados das pacientes acompanhadas no ambulatório durante o período de abril de 2011 a junho de 2012...

Urinary incontinence generates negative implications in the fields emotional, social and economic incontinent for both the individual and for their caregivers. Behavioral therapy is a noninvasive therapyss for urinary incontinence. Behavioral therapy is performed during the visits by nurses and nursing work involves the application of a protocol for guidance on lifestyle habits, measures to control urination, training for performing voiding diary, training exercises and perineal assessment of patient response therapy. The theoretical study is based on the theory of self-care of Elisabeth Dorothea Orem, because behavioral therapy aims to equip the individual to perform self-care practices from the ambulatory care protocol. The objective of the research is to evaluate the effectiveness of behavioral therapy applied by nurses to control urination and improves the quality of life of women elderly. It is a non-controlled clinical trial. The study included women over 60 who participate in the Clinic's Center for Elderly Care clinic with the complaint of involuntary leakage of urine sent for geriatric clinic. The study population was composed of 13 individuals. The data were collected from records that have been filed in the records of patients: the voiding diary, nursing assessment and behavioral therapy on quality of life questionnaire in women with urinary incontinence called the King's Health Questionnaire. These instruments were administered before and after the behavioral therapy. Data were collected from medical records at the clinic during the period from April 2011 to June 2012...

Psychiatric Intervention Improved Pregnancy Rates in Infertile Couples

Background: Infertility has mental, social, and reproductive consequences. The aim of this study is to evaluate the effect of psychiatric intervention on the pregnancy rate of infertile couples. Methods: In an experimental and intervention-control study, 638 infertile patients who were referred to a university infertility clinic were evaluated; 140 couples (280 patients) with depression (from mild to severe) in at least one of the spouses were followed. All couples provided informed consent and were randomly numbered from 1 to 140. Those with even numbers were assigned to the psychological intervention before infertility treatment, and those with odd numbers were assigned to the psychological intervention during infertility treatment. Patients in the experimental group received 6–8 sessions of psychotherapy (individually) before beginning infertility treatment and were given Fluoxetine (antidepressant) at 20–60 mg per day during the psychotherapy period. The control group did not receive any intervention. Three questionnaires, the Beck Depression Inventory (BDI), the Stress Scale (Holmes-Rahe), and a sociodemographic questionnaire, were administered to all patients before and after treatment. The clinical pregnancy rate was compared between the two groups based on sonographic detection of gestational sac 6 weeks after the last menstrual period. The data were analysed by t test, X2 and logistic regression methods. Results: Pregnancy occurred in 33 (47.1%) couples in the treatment group and in only 5 (7.1%) couples in the control group. There was a significant difference in pregnancy rate between the treatment and control groups (X2= 28.318, P < 0.001). To determine the effectiveness of psychiatric interventions on pregnancy, a logistic regression analysis was used. In this analysis, all demographic and infertility variables were entered in a stepwise manner. The results showed that in the treatment group, Pregnancy in the treatment group was 14 times higher than the control group (95% CI 4.8 to 41.7). Furthermore, cause of infertility was an effective factor of pregnancy. The adjusted odds ratio in male factor infertility was 0.115 (95% CI 0.02 to 0.55) and in both factors (male and female) infertility was 0.142 (95% CI 0.03 to 0.76) compared with the unexplained group. In this study, no other variables had any significant effect on pregnancy. Conclusion: Based on the effectiveness of psychiatric interventions in increasing pregnancy rate, it is crucial to mandate psychiatric counselling in all fertility centres in order to diagnose and treat infertile patients with psychiatric disorders.

Effectiveness of Group Cognitive Behaviour Therapy Augmentation In Reducing Negative Cognitions In The Treatment Of Depression In Malaysia

Objective: Cognitive Behaviour Therapy (CBT) for depression is popular in Western countries. In the context of Malaysia, CBT has been applied as an individual session in a clinical setting. However, there is limited research in the area of group CBT for depression among Malays. The aim of this study is to investigate the effectiveness of Group Cognitive Behavioural Therapy (GCBT) in reducing the negative cognitions that are related to depression in a group of Malay patients. Methods: One hundred and thirteen patients, diagnosed with depression, were randomly allocated to either a Treatment As Usual (TAU) group (n = 55), or a TAU plus GCBT group (n = 58). All participants completed two questionnaires that measured maladaptive cognitions at pre-treatment, midway through treatment, post-treatment (week 4), and at follow-ups after three (week 16) and six months (week 28). Results: The TAU+GCBT patients improved significantly more, and at a faster rate, than the TAU group; which showed minimal improvement. The effect size (Cohen’s d) of the treatment group was 0.93 and 96.55% of the treatment group achieved a clinically significant change. Conclusions: The findings suggest that GCBT, when used in addition to the TAU, is effective in reducing negative thoughts and maladaptive attitudes of Malaysian patients suffering from depression.

Terapia comportamental para incontinência urinária da mulher idosa: uma ação do enfermeiro / Behavioral therapy for urinary incontinence of elderly woman: a nursing action / La terapia comportamental para la incontinencia urinaria de mujeres ancianas: una acción del enfermero

O objetivo deste trabalho foi relatar uma experiência de implementação da Terapia Comportamental para incontinência urinária como uma estratégia para melhorar o controle urinário e qualidade de vida da mulher idosa. Os dados foram coletados em 12 prontuários de mulheres que apresentavam diagnóstico de incontinência urinária mista ou de esforço e são apresentados descritivamente. Três pacientes obtiveram diminuição da frequência e seis pacientes zeraram as perdas. Oito pacientes referiram que os exercícios perineais foram o elemento da terapia que mais ajudou. Seis pacientes referiram que a terapia comportamental melhorou a auto-estima e o autocuidado. Seis pacientes relataram que a Terapia Comportamental ajudou a lidar com o problema. Conclui-se que este procedimento deve ser valorizado como uma ação de enfermagem para a prática clínica em decorrência de sua efetividade observa.

The aim of this study was presente to assess the experience of implementation of behavioral therapy for urinary incontinence as a strategy to improve bladder control and quality of life in elderly women. Data were collected from medical records of 12 women who were diagnosed with mixed or stress incontinence. Data are presented descriptively. Three patients had decreased frequency and six patients zeroed losses. Eight patients reported that perineal exercises were the part of therapy that helped most. Six patients reported that behavioral therapy improved self-esteem and self-care. Six patients reported that behavioral therapy helped them to cope with the problem. It is concluded that this procedure should be valued as a nursing action for clinical practice because of its effectiveness notes.

El objetivo de este estudio fue evaluar la experiencia de la aplicación de la terapia comportamiental para la incontinencia urinaria como una estrategia para mejorar el control de la vejiga y la calidad de vida de las mujeres de edad avanzada. Los datos fueron recogidos de las historias clínicas de 12 mujeres que fueron diagnosticados con incontinencia mixta o de estrés y se presentan de manera descriptiva. Tres pacientes presentaron disminución de la frecuencia y seis pacientes a cero pérdidas. Ocho pacientes informaron de que los ejercicios perineales formaban la parte de la terapia que más las ha ayudado. Seis pacientes reportaron que la terapia comportamental mejora de la autoestima y el autocuidado. Seis pacientes reportaron que la terapia le ayudó a hacer frente al problema. Se concluye que este procedimiento debe ser valorado como una acción de enfermería para la práctica clínica debido a su eficacia observada.

Yoga and Cognitive Behaviour Techniques for Academic Stress and Mental Wellbeing among School Students.

There are many stressors acting upon school children. Today in the era of increasing competitiveness,a child is overloaded with daily living stresses, and he lives a tight rope existence trying to cope up with the tremendous pressures from all institutions, whether it is school, family or society. These are resulting in various stress related ailments and psychological problems, which poses threat and challenges for the physical as well as mental wellbeing of the school going children. The present work was an attempt to measure one of the major source of stress,i.e. academic stress and mental wellbeing of a sample of school children and then to provide an intervention plan for a selected group of students who are having high academic stress and poor mental wellbeing. Certain specific Asanas, Mudras and Pranayams of Yoga were combined with some specific techniques of Cognitive Behaviour therapy (C.B.T.) to reduce the academic stress and to enhance the mental wellbeing of the selected group of school children. The results have shown a significant relief from academic stress and significant improvement in the mental wellbeing of these children. Detailed methodology and results are discussed in this paper. This paper highlights the efficacy of Yoga in combination with certain techniques of C.B.T. in enhancing overall wellbeing of school children.

Psychotherapeutic Approaches in the Management of Elderlies with Dementia An Overview.

The population of the world in 1995 was 5.7 billion and it is expected to reach 10.8 billion by 2050. The percentage of older people in the world population is expected to increase rapidly from 9.5 in 1995 to 20.7 in 2050 and to 30.5 in 2150. In absolute numbers, India’s elderly population is expected to increase from 76 million in 2000 to 327 million in 2050. The prevalence of psychiatric disorders in old age and burden of care will further increase as the proportion of elderly persons in the India population increases over the next 50 years. Now, attention of mental health professionals should be focused on to plan and provide better care in the management of old age psychiatric disorders. From the management point of view cognitive disorders are more challenging psychiatric disorders of the old age. Dementia is one of them. Successful management of patients with dementia requires a broad range of tasks. These tasks help to maximize the patient’s level of functioning and to assure the safety and comfort of patients and their families in the context of living with a difficult disease. The topic provides an overview of psychotherapeutic approaches and its effectiveness in the management of elderly dementia patients.

Effectiveness of Different SSRI Antidepressants in Combination with CBT for Short-term Management of Panic Disorder

Objective: This paper reports the result of an analysis of data of brief therapy for out-patients with panic disorder reffered by physicians in a busy specialist hospital in Kuala Lumpur. Methods: The patients were randomly assigned into different groups of SSRI (Specific Serotonin Reuptake Inhibitor) antidepressants i.e. escitalopram, setraline, or fluoxetine. All patients received cognitive behaviour therapy (CBT). The therapy was aimed for a maximum of twelve sessions. There were 33 patients in the escitalopram group, 31 patients in the setraline group, and 31 patients in the fluoxetine group. Results: the result shows that all the groups were similar in the severity and scores for pre-treatment but for post-treatment, there were significant differences among them. Conclusion: All groups showed significant improvements in all modalities of measurements. However, the escitalopram and setraline groups showed faster overall improvement compared to the fluoxetine group.