The Value of Fidelity to The Scientist Practitioner Model in the Delivery of Cognitive Behavior Therapy in Substance Misuse

Objective: The benefits of adherence to an evidence-based model of intervention in the delivery of Cognitive Behavior Therapy in substance misuse is debated. The advantages to both patient and therapist of taking a structured and systematic approach is explored in depth. Fidelity to The Scientist Practitioner Model is an evidence-based way of yielding good clinical outcomes. Along the way, on their journey through treatment, patients are facilitated toward a reduction in the intensity and frequency of anxiety-based symptoms, thus improving their functionality and overall quality of life. The use of Validated Rating Scales is an independent method of measurement. Cognitive Behavior Therapy has an over-whelming evidence-base to support its use, with reference to anxiety-based disorders. Conclusion(s): This discussion supports the importance of the role of Validated Rating Scales and how they can benefit evidence-based clinical interventions such as Cognitive Behavior Therapy, as they represent an impartial method of measurement of functionality and symptom severity. The importance of their integration into routine interventions is highlighted. Adapting to new ways of working such as remote delivery of psychological interventions has now become the new 'normal' as a consequence of the COVID-19 pandemic. Copyright © 2021 Taylor & Francis Group, LLC.

Multisite randomised controlled trial of trauma-focused cognitive behaviour therapy for psychosis to reduce post-traumatic stress symptoms in people with co-morbid post-traumatic stress disorder and psychosis, compared to treatment as usual: study protocol for the STAR (Study of Trauma And Recovery) trial.

BACKGROUND: People with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial, the largest to date, will evaluate the clinical effectiveness of a TF therapy integrated with cognitive behaviour therapy for psychosis (TF-CBTp) on post-traumatic stress symptoms in people with psychosis. The secondary aims are to compare groups on cost-effectiveness; ascertain whether TF-CBTp impacts on a range of other meaningful outcomes; determine whether therapy effects endure; and determine acceptability of the therapy in participants and therapists. METHODS: Rater-blind, parallel arm, pragmatic randomised controlled trial comparing TF-CBTp + treatment as usual (TAU) to TAU only. Adults (N = 300) with distressing post-traumatic stress and psychosis symptoms from five mental health Trusts (60 per site) will be randomised to the two groups. Therapy will be manualised, lasting 9 months (m) with trained therapists. We will assess PTSD symptom severity (primary outcome); percentage who show loss of PTSD diagnosis and clinically significant change; psychosis symptoms; emotional well-being; substance use; suicidal ideation; psychological recovery; social functioning; health-related quality of life; service use, a total of four times: before randomisation; 4 m (mid-therapy); 9 m (end of therapy; primary end point); 24 m (15 m after end of therapy) post-randomisation. Four 3-monthly phone calls will be made between 9 m and 24 m assessment points, to collect service use over the previous 3 months. Therapy acceptability will be assessed through qualitative interviews with participants (N = 35) and therapists (N = 5-10). An internal pilot will ensure integrity of trial recruitment and outcome data, as well as therapy protocol safety and adherence. Data will be analysed following intention-to-treat principles using generalised linear mixed models and reported according to Consolidated Standards of Reporting Trials-Social and Psychological Interventions Statement. DISCUSSION: The proposed intervention has the potential to provide significant patient benefit in terms of reductions in distressing symptoms of post-traumatic stress, psychosis, and emotional problems; enable clinicians to implement trauma-focused therapy confidently in this population; and be cost-effective compared to TAU through reduced service use. TRIAL REGISTRATION: ISRCTN93382525 (03/08/20).

A mixed-methods pilot study of a psychoeducational group programme for nurse managers during the COVID-19 pandemic.

AIM: This mixed-methods pilot study aimed to measure the feasibility and acceptability of a psychoeducational group programme and determine its impact on mental well-being. BACKGROUND: The programme was developed to promote self-care, growth and adaptive coping for nurse managers. The programme themes were resilience, insight, self-compassion and empowerment. METHODS: The sample included 19 hospital-based nurse managers. Outcomes included post-traumatic growth, resilience, insight, self-compassion, empowerment, perceived stress, burnout and job satisfaction. Paired samples t tests were conducted to compare outcomes at baseline to follow-up. Qualitative interviews were conducted. Thematic analysis was used to code the qualitative responses by keyword, which were then aggregated into themes. RESULTS: Participants reported higher post-traumatic growth and psychological empowerment after the intervention. The following six themes emerged most consistently from the qualitative interviews: feasibility of the programme, benefits of peer support, sources of stress, barriers to self-care, sources of strength and sustainability of effects. CONCLUSIONS: The results support the acceptability and feasibility of the psychoeducational group programme. IMPLICATIONS FOR NURSING MANAGEMENT: Health care organizations can support and promote the implementation of programmes to alleviate burnout and improve mental well-being amid the complex demands of nursing management (ClinicalTrials.gov: NCT04987697).

Meta-analysis of cognitive behaviour therapy and selective serotonin reuptake inhibitors for the treatment of hypochondriasis: Implications for trial design.

BACKGROUND: Classification of hypochondriasis as an obsessive-compulsive and related disorder in the International Classification of Diseases 11th Revision (ICD-11) has generated new heuristics for treatment of this common, chronic and disabling disorder. Standard treatment involves cognitive behaviour therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs), but no meta-analysis has so far considered hypochondriasis as a structured diagnosis or assessed the role of medication. A clearer understanding of the relative effectiveness of these interventions and identification of clinically relevant factors moderating the treatment response is needed for clinical guideline development. METHODS: The current systematic review and meta-analysis of interventions for hypochondriasis was preregistered on PROSPERO (CRD42020185768) and follows PRISMA guidelines. We searched MEDLINE, PsycINFO, and Cochrane Library databases until July 2021 for randomized controlled trials (RCTs) of interventions for patients diagnosed with hypochondriasis (or historical diagnostic equivalents). We assessed aspects of study quality using: the CONSORT Checklist for evaluation of RCTs, the Cochrane Risk of Bias 2 tool, researcher allegiance and treatment fidelity. The primary outcome was improvement in hypochondriasis symptoms, comparing intervention and control groups at trial endpoint. Moderator variables were assessed using subgroup and meta-regression analyses. RESULTS: Searches identified 13 randomised controlled trials (RCTs) (N = 1405); 12 included CBT (N = 1212) and three included SSRI (N = 193) arms as the experimental intervention. Random effects meta-analysis yielded a moderate-to-large effect size for CBT versus all controls (g = -0.70 [95% CI -0.99 to -0.41], k = 18, I2 = 81.1%). Funnel plot asymmetry indicated possible publication bias and two potentially missing trials, reducing the effect size (g = -0.60 [95% CI -0.88 to -0.32]). Subgroup analysis showed that choice of control significantly moderated effect size, with those in CBT vs. wait-list (g = -1.32 [95% CI -1.75 to -0.90], k = 7, I2 = 0%) being double those of CBT vs. psychological or pharmacological placebo controls (g = -0.58 [95% CI -0.95 to -0.22], k = 7, I2 = 82%). Analysis of studies directly comparing CBT and SSRIs found a numerical, but not statistical advantage for SSRIs (g = 0.21 [95% CI -0.46 to 0.87], k = 2, I2 = 58.34%) and a modest effect size emerged for SSRIs vs. pill placebo (g = -0.29 [95% CI -0.57 to -0.01], k = 3, I2 = 0%). Most studies (11/13) were rated as high on potential researcher allegiance bias in favour of CBT. Meta-regressions revealed that effect sizes were larger in younger participants, and smaller in better quality and more recent RCTs and those with greater CBT fidelity. CONCLUSION: CBT and SSRIs are effective in the acute treatment of hypochondriasis, with some indication that intervention at a younger age produces better outcomes for CBT. In the case of CBT, effect sizes appear to have been significantly inflated by the use of wait list controls, and researcher allegiance bias. We recommend that a definitive, adequately controlled trial, designed with respect to the methodological issues raised in this meta-analysis, is needed to determine the magnitude effects for CBT and SSRIs with confidence and the long-term effect of treatments, to inform mental health service provision for this overlooked patient group.

The effective delivery of digital CBT: A service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020

Despite its impressive evidence base, there is a widening access gap to receiving cognitive behavioural therapy (CBT). Video conferencing therapy (VCT) offers an effective solution for logistical barriers to treatment, which has been salient throughout the Coronavirus pandemic. However, research concerning the delivery of CBT via VCT for children and young people (CYP) is in its infancy, and clinical outcome data are limited. The aim of this service evaluation was to explore the effectiveness of a VCT CBT intervention for CYP referred from Child and Adolescent Mental Health Services (CAMHS) in the UK. A total of 989 records of CYP who had completed CBT via VCT in 2020 with Healios, a digital mental health company commissioned by the National Health Service (NHS), were examined to determine changes in anxiety, depression and progress towards personalised goals. Routine outcome measures (ROMs) were completed at baseline and endpoint, as well as session by session. Feedback was collected from CYP and their families at the end of treatment. There was a significant reduction in symptoms of anxiety and depression and significant progress towards goals, with pre- to post-effect sizes (Cohen's d) demonstrating medium to large effects (d = .45 to d = -1.39). Reliable improvement ranged from 31 to 80%, clinical improvement ranged from 33 to 50%, and 25% clinically and reliably improved on at least one measure;92% reported that they would recommend Healios. This service evaluation demonstrates that Healios' CBT delivered via VCT is effective for CYP receiving it as part of routine mental health care. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Is it as good as being in person? The effectiveness of a modified clinician facilitated buried in treasures group for hoarding disorder using video teleconferencing.

The COVID-19 pandemic has necessitated the use of video-teleconferencing (VTC) for psychological treatments but VTC effectiveness studies are sparse. We examined treatment outcomes for a modified Buried in Treasures (BIT) group program for hoarding disorder (HD) delivered via VTC. Participants were 10 individuals with HD. Hoarding severity was evaluated at pre, mid, post, and six-month follow-up. Results showed significant decrease in hoarding symptoms over time (with an average decrease of 32%). The dropout rate was low (9%) and 30% of participants were fully recovered at follow-up. These results support the adaptation of in-person BIT for HD into a VTC format.

OCD and COVID-19: a new frontier.

People with obsessive compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19. This paper shares the perspectives of expert clinicians working with OCD considering how to identify OCD in the context of COVID-19, changes in the presentation, and importantly what to consider when undertaking cognitive behaviour therapy (CBT) for OCD in the current climate. The expert consensus is that although the presentation of OCD and treatment may have become more difficult, CBT should still continue remotely unless there are specific reasons for it not to, e.g. increase in risk, no access to computer, or exposure tasks or behavioural experiments cannot be undertaken. The authors highlight some of the considerations to take in CBT in light of our current understanding of COVID-19, including therapists and clients taking calculated risks when developing behavioural experiments and exposure tasks, considering viral loading and vulnerability factors. Special considerations for young people and perinatal women are discussed, as well as foreseeing what life may be like for those with OCD after the pandemic is over. KEY LEARNING AIMS: (1)To learn how to identify OCD in the context of COVID-19 and consider the differences between following government guidelines and OCD.(2)To consider the presentation of OCD in context of COVID-19, with regard to cognitive and behavioural processes.(3)Review factors to be considered when embarking on CBT for OCD during the pandemic.(4)Considerations in CBT for OCD, including weighing up costs and benefits of behavioural experiments or exposure tasks in light of our current understanding of the risks associated with COVID-19.

A qualitative examination of low-intensity cognitive behaviour therapy to reduce anxiety and depression during the COVID-19 pandemic

Objective Method Results Conclusions The COVID-19 pandemic has had a severe impact on mental health. There is an urgent need to deliver low-intensity cognitive behaviour therapy (CBT) tailored to mitigate the impacts of the pandemic. The aim was to engage in a qualitative study of participants’ views surrounding anxiety and depression during the pandemic and feedback on the acceptability and usefulness of a low-intensity CBT intervention during the pandemic to inform intervention development and refinement.There were 21 participants (21–80 years, M = 40.90 years, SD = 16.33;71% female) from Australia who participated in qualitative interviews who had completed low-intensity CBT for anxiety and depression during the pandemic.     Themes emerged including the negative impact of the pandemic on mental health, prior experience of psychological therapy, acceptability, and usefulness of the intervention, participants’ ideas for intervention improvement, and preferences for using the guide. The majority of participants reported the intervention was useful, however, suggested several areas including content and format to improve the intervention and feedback on what they would prefer for an intervention.A low-intensity CBT intervention was reported as useful and acceptable by participants for their concerns related to the pandemic and exacerbation of pre-existing anxiety and depression. (English) [ FROM AUTHOR] KEY POINTS What is already known about this topic: The COVID-19 pandemic has increased anxiety and depression worldwide. There is a need to deliver low intensity cognitive behaviour therapy (CBT) to mitigate the impacts of the pandemic. Previous research has demonstrated the efficacy of low intensity CBT in reducing pandemic related anxiety and depression. The COVID-19 pandemic has increased anxiety and depression worldwide. There is a need to deliver low intensity cognitive behaviour therapy (CBT) to mitigate the impacts of the pandemic. Previous research has demonstrated the efficacy of low intensity CBT in reducing pandemic related anxiety and depression. What this topic adds: Participants provided positive feedback in qualitative interviews on a low intensity CBT intervention in reducing anxiety and depression related to the pandemic. Participants had several suggestions to improve the intervention, including increasing content for culturally and linguistic diverse populations and alternative formats. Low intensity CBT may hold promise in reducing the burden of anxiety and depression related to the pandemic. Participants provided positive feedback in qualitative interviews on a low intensity CBT intervention in reducing anxiety and depression related to the pandemic.Participants had several suggestions to improve the intervention, including increasing content for culturally and linguistic diverse populations and alternative formats.Low intensity CBT may hold promise in reducing the burden of anxiety and depression related to the pandemic. (Spanish) [ FROM AUTHOR] Copyright of Clinical Psychologist is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Groups 4 Health protects against unanticipated threats to mental health: Evaluating two interventions during COVID-19 lockdown among young people with a history of depression and loneliness.

BACKGROUND: Decades of research indicate that when social connectedness is threatened, mental health is at risk. However, extant interventions to tackle loneliness have had only modest success, and none have been trialled under conditions of such threat. METHOD: 174 young people with depression and loneliness were randomised to one of two evidence-based treatments: cognitive behaviour therapy (CBT) or Groups 4 Health (G4H), an intervention designed to increase social group belonging. Depression, loneliness, and well-being outcomes were evaluated at one-year follow-up; COVID-19 lockdown restrictions were imposed partway through follow-up assessments. This provided a quasi-experimental test of the utility of each intervention in the presence (lockdown group) and absence (control group) of a threat to social connectedness. RESULTS: At one-year follow-up, participants in lockdown reported significantly poorer wellbeing than controls who completed follow-up before lockdown, t(152)=2.41, p=.017. Although both CBT and G4H led to symptom improvement, the benefits of G4H were more robust following an unanticipated threat to social connectedness for depression (χ2(16)=31.35, p=.001), loneliness (χ2(8)=21.622, p=.006), and wellbeing (χ2(8)=22.938, p=.003). LIMITATIONS: Because the COVID-19 lockdown was unanticipated, this analysis represents an opportunistic use of available data. As a result, we could not measure the specific impact of restrictions on participants, such as reduced income, degree of isolation, or health-related anxieties. CONCLUSIONS: G4H delivered one year prior to COVID-19 lockdown offered greater protection than CBT against relapse of loneliness and depression symptoms. Implications are discussed with a focus on how these benefits might be extended to other life stressors and transitions.

A tale of two countries: Increased uptake of digital mental health services during the COVID-19 pandemic in Australia and New Zealand.

BACKGROUND: Digital mental health services (DMHS) provide highly accessible psychological supports and interventions that can supplement existing mental health services. Concerns about the mental health impact of the COVID-19 pandemic have been widespread and provide a unique impetus to examine the utility and responsivity of DMHS. This study examined the service utilisation and user characteristics of two DMHS (THIS WAY UP and Just a Thought) in Australia and New Zealand before and during the early pandemic period in these countries (March to June 2020). METHODS: Service use indices (website visits, course registrations and prescriptions, clinician registrations) were compared across different time periods before (12, 6 and 3 months) and during the pandemic in Australia and New Zealand. The demographic and clinical characteristics of course registrants (anxiety and depression symptom severity and psychological distress) were also compared across the pre- and during-COVID periods. RESULTS: Comparing pre-COVID to during-COVID time periods, we observed substantial increases across all service use indices in both DMHS (increases of >100% on the majority of service use indices). For example, in the 3 months prior to the pandemic, 2806 people registered for a THIS WAY UP course and 1907 people registered for a Just a Thought course, whereas 21,872 and 5442 registered for a THIS WAY UP and Just a Thought course, respectively, during the first 3 months of the COVID pandemic. Slight differences in the demographic and clinical profiles of course registrants were found between pre- and during-COVID time periods, with limited evidence of elevated anxiety and depression symptom severity in the COVID period. CONCLUSIONS: Following the outbreak of COVID-19 in Australia and New Zealand, the volume of users accessing DMHS increased yet the demographic and clinical characteristics of course registrants remained stable. Results underscore how nimble and scalable DMHS can be during periods of high demand.

Unguided low intensity cognitive behaviour therapy for anxiety and depression during the COVID-19 pandemic: A randomised trial.

The COVID-19 pandemic has had a severe impact on mental health worldwide, with increased rates of anxiety and depression widely documented. The aim of this study was to examine unguided low intensity cognitive behaviour therapy for anxiety and depression during the pandemic. A sample of 225 individuals in Australia and the United Kingdom (M age 37.79, SD = 14.02, range 18-80 years; 85% female) were randomised into intervention or waitlist control. The intervention group demonstrated significant decreases in anxiety (d = 0.36 [0.18, 0.54]) and depression (d = 0.28 [0.11, 0.45]) compared to controls. The majority of participants (96%) rated the intervention as useful, and most (83%) reported they spent 30 min or less reading the guide, with 83% agreeing the intervention was easy to read. The results indicate that low intensity cognitive behaviour therapy has efficacy in reducing anxiety and depression during the COVID-19 pandemic. There is an urgent need to disseminate low intensity psychological therapies to improve mental health in this challenging time.

Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial.

INTRODUCTION: Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life. OBJECTIVE: The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms. METHODS: 670 adults from the Swedish general population reporting daily uncontrollable worry about CO-VID-19 and its possible consequences (e.g., illness, death, the economy, one's family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale administered at baseline and weeks 1-3 (primary endpoint). Follow-up assessments were conducted 1 month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant. RESULTS: The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to the waiting list (ß = 1.14, Z = 9.27, p < 0.001), corresponding to a medium effect size (bootstrapped d = 0.74 [95% CI: 0.58-0.90]). Improvements were also seen on all secondary measures, including mood, daily functioning, insomnia, and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded. CONCLUSIONS: A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the COVID-19 pandemic.

Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual.

The worldwide coronavirus pandemic has forced health services to adapt their delivery to protect the health of all concerned, and avoid service users facing severe disruption. Improving Access to Psychological Therapies (IAPT) services in particular are having to explore remote working methods to continue functioning. Australian IAPT services have utilised remote delivery methods and disruptive technologies at their core from inception. This was to maintain fidelity and clinical governance across vast distances but has allowed training, supervision and service delivery to continue virtually uninterrupted through coronavirus restrictions. On this basis, key recommendations for remote working are outlined. Remote methods are defined as (1) real time delivery, (2) independent delivery and (3) blended delivery. These are applied across three broad areas of remote training, remote clinical supervision and remote service delivery. Recommendations may be of great benefit to IAPT training institutions, clinical supervisors and service providers considering a move towards remote delivery. Challenges, adaptations and examples of applying remote methods are outlined, including case examples of methods applied to low-intensity and high-intensity cognitive behavioural therapy. Remote methods can safeguard service continuity in times of worldwide crisis and can contribute to reducing the impact of increased mental health presentations post-COVID-19. KEY LEARNING AIMS: To understand the core areas of remote training, clinical supervision and service delivery.To review and distinguish between three broad methods of remote working.To understand how to plan remote working via key recommendations and case examples.

Challenges and opportunities for enhanced cognitive behaviour therapy (CBT-E) in light of COVID-19.

In the past few weeks, coronavirus disease 2019 (COVID-19) has dramatically expanded across the world. To limit the spread of COVID-19 and its negative consequences, many countries have applied strict social distancing rules. In this dramatic situation, people with eating disorders are at risk of their disorder becoming more severe or relapsing. The risk comes from multiple sources including fears of infection and the effects of social isolation, as well as the limited availability of adequate psychological and psychiatric treatments. A potential practical solution to address some of these problems is to deliver enhanced cognitive behaviour therapy (CBT-E), an evidence-based treatment for all eating disorders, remotely. In this guidance we address three main topics. First, we suggest that CBT-E is suitable for remote delivery and we consider the challenges and advantages of delivering it in this way. Second, we discuss new problems that patients with eating disorders may face in this period. We also highlight potential opportunities for adapting some aspects of CBT-E to address them. Finally, we provide guidelines about how to adapt the various stages, strategies and procedures of CBT-E for teletherapy use in the particular circumstances of COVID-19. KEY LEARNING AIMS: (1)To appreciate that CBT-E is suitable for remote delivery, and to consider the main challenges and potential advantages of this way of working.(2)To identify and discuss the additional eating disorder-related problems that may arise as a result of COVID-19, as well as potential opportunities for adapting some aspects of CBT-E to address them.(3)To learn how to adapt CBT-E for remote delivery to address the consequences of COVID-19. Specifically, to consider adaptations to the assessment and preparation phase, the four stages of treatment and its use with underweight patients and adolescents.