Evaluating the efficacy of an internet-based cognitive behavioural therapy intervention for fertility stress in women: a feasibility study.

BACKGROUND: Women who are trying to conceive may be at risk of experiencing psychological distress. However, only a small proportion receive appropriate care, although interventions such as cognitive behavioural therapy (CBT) can effectively reduce levels of distress. AIMS: Our aim was to determine the efficacy and feasibility of an internet-based CBT intervention, called Overcome Fertility Stress (OFS). METHOD: Fifty-five women who were struggling with conception were offered 3-month access to OFS, which is a fully automated yet individualized program via pre-programmed text, video and audio files. The program tailors its intervention around the symptoms the users report to the program. RESULTS: Significant improvements were demonstrated on infertility-related stress, with small-to-large effect sizes (d = 0.49 to 0.75). Furthermore, there was a significant decline in symptoms of depression and stress from pre- to post-treatment (d = 0.41 to 0.42, respectively). Finally, participants expressed overall satisfaction with the intervention. CONCLUSIONS: These preliminary results suggest it is feasible and effective for women who experience fertility stress to receive an internet-based CBT intervention. Finally, these results add to the literature on the effectiveness of psychological treatments for those who struggle with fertility issues.

How effective psychological treatments work: mechanisms of change in cognitive behavioural therapy and beyond.

BACKGROUND: Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. AIMS: In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. METHOD: The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. CONCLUSION: Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.

Improving adherence to a web-based cognitive-behavioural therapy program for social anxiety with group sessions: A randomised control trial.

Individuals with social anxiety disorder (SAD) commonly receive non-evidence based, ineffective treatments. Cognitive behaviour therapy (CBT) has been demonstrated to be the gold standard treatment for treating SAD. Scalable web-based CBT programs ensure evidence-based treatment procedures, but low treatment adherence remains problematic. This study aimed to test whether adding group sessions to a fully automated web-based CBT program, Overcome Social Anxiety (OSA), would increase treatment adherence. A total of 69 participants were provided access to a web-based program, and randomly allocated to three conditions: 1) An experimental condition involving an addition of three online group psychoeducation sessions; 2) a placebo condition involving an addition of three online progressive muscle relaxation (PMR) group sessions, or 3) a control condition where participants did not receive group sessions. Adherence was operationalised as number of OSA modules completed. Treatment adherence significantly differed between the conditions. On average, participants assigned to the placebo condition completed significantly more of the program compared to those in the control condition. Further, all conditions produced a significant improvement in BFNE and QOLS. No significant difference in treatment efficacy was found between groups on the SIAS, BFNE or QOLS. The current results indicate PMR can improve treatment adherence for scalable social anxiety interventions.

Evaluation of mechanism of change in transdiagnostic cognitive behaviour therapy using single case experimental design.

BACKGROUND AND OBJECTIVES: Transdiagnostic mechanisms of change (txMOC) specific to cognitive behaviour therapy are poorly understood. Salkovskis (1996) proposed one such mechanism in terms of the shift towards an alternative, less negative view of their problems or cognitive flexibility. This hypothesis has been described as involving a shift in beliefs, from "theory A″ to "theory B". The objective of this research was to evaluate this hypothesis. METHODS: Effectiveness of a novel txCBT and temporal changes in process and symptom measures were evaluated using a non-concurrent multiple baseline design and Tau-U calculations with thirteen participants (five with obsessive-compulsive disorder, two with panic disorder with agoraphobia and six with major depressive disorder). As a secondary analysis authors calculated Kendall's - Tau correlation between process and symptom measures, performed the Wilcoxon signed-rank test to assess treatment modules effect on negative thought and calculated Reliable change index (RCI). RESULTS: The txCBT was clearly effective for eight participants. The results varied dependent on the stimuli evaluated as negative or threatening. Level and trend of the ratings of belief in theory A followed the level and trend of symptom measures to a greater extent than the (inverse) level and trend of belief in theory B. LIMITATIONS: Only thirteen participants were recruited and evaluated. CONCLUSIONS: The results are consistent with the view that effective treatment may involve a txMOC characterized by the ability to shift from a relatively fixed negative view of their experience to a less negative psychologically focused alternative.

'You should always look at the washing machine without actually being in it!' Thematic framework analysis of patients' understanding of transdiagnostic cognitive behaviour therapy and its mechanisms.

OBJECTIVE: Transdiagnostic cognitive behaviour therapy (TCBT) is an efficacious treatment for anxiety and depression, but its mechanisms of change remain poorly understood. The current study used thematic framework analysis to analyse how patients, recruited in a recent trial on transdiagnostic group CBT (TGCBT), understood the treatment and its mechanisms. DESIGN: Cross-sectional thematic framework analysis. METHOD: The sample included 24 participants suffering from anxiety and/or depression, divided into two groups by treatment efficacy (i.e., group doing well and group doing not so well) in order to evaluate whether different understandings of the treatment affected its efficacy. The participants were interviewed and completed self-report measures. They were encouraged to discuss what they believed to be helpful and unhelpful in the TGCBT and what they believed to be the mechanisms of change in the treatment. Each interview was recorded, transcribed verbatim and themes were identified. RESULTS: The analysis revealed four overarching themes and 18 subthemes. The overarching themes were as follows: Cognitive and behavioural flexibility, Awareness/understanding of symptoms and triggers, Therapeutic alliance and engagement, and finally Attitudes towards treatment. Four of the 18 subthemes corresponded to a differentiation between the groups: Cognitive flexibility and Comparison with others in the group on the one hand and Cognitive inflexibility and Negative attitudes towards treatment on the other. CONCLUSION: The most important difference between the groups appeared to be CBT-specific, that is, cognitive flexibility that characterized the group doing well where thematic analysis did not indicate that other themes were important. PRACTITIONER POINTS: Findings The analysis revealed four overarching themes and 18 subthemes, four of which corresponded to the difference between the two groups of participants based on treatment efficacy. The four differentiating subthemes were cognitive flexibility and comparison with others, which characterized the group doing well, and cognitive inflexibility and negative attitude towards treatment, which characterized the group doing less well. The theme evaluated as the most important for the efficacy of the transdiagnostic cognitive behaviour therapy and patients' understanding of the treatment was cognitive flexibility, which characterized the group doing well. Limitations Use of qualitative methodology restricts the generalizability of our results. Data are built on answers from only 24 participants.

Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms.

BACKGROUND: In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT. AIMS: The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment. METHOD: The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores. RESULTS: Pre-post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large. CONCLUSION: The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.

[Efficacy of cognitive behavioral therapy in the treatment of mood and anxiety disorders in adults]. / Gagnsemi hugrænnar atferlismedferdar vid lyndis-og kvídaröskunum hjá fullordnum.

Cognitive behavioral therapy (CBT) represents that form of psychotherapy which has most research data to build on in the treatment of mood and anxiety disorders for adults. In this review we will introduce CBT and present the results of pertinent outcome research. Efficacy at the end of treatment is discussed, as well as long term effectiveness and the efficacy of combined treatment with medication and CBT. In addition, we discuss the pros and cons of group CBT compared to CBT in individual format, and comorbidity of mental disorders. According to this review CBT is efficacious for major depressive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder, social phobia and specific phobia. Efficacy of CBT is equal to or better than efficacy of drugs in the treatment of the above disorders, but there is less access to CBT. Longterm effectiveness of CBT appears to be good, but research on combined treatment is yet in its infancy and conclusions are premature on its place in treatment. Key words: Cognitive behavioral therapy, psychotropic treatment, efficacy, long-term effects, combined treatment, mental disorders, adults.

Psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) among Icelandic schoolchildren.

A psychometric assessment of the Icelandic version of the Multidimensional Anxiety Scale for Children (MASC) was undertaken among Icelandic schoolchildren, between 10 and 15 years of age. In a first study 625 children between 10 and 15 years of age filled in the MASC. A confirmatory factor analysis indicated that the four-factor structure of the instrument was justified. Further, means and standard deviations of the total scale and the subscales were similar to the original normative data reported by March (1997). In a second study the MASC, the Children Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS) were administered to a sample of 249 schoolchildren between 10 and 15 years of age. The results supported the convergent and divergent validity of the MASC. Together the two studies show satisfactory psychometric properties of the Icelandic version of the MASC in a normal population.