VirtualPain. Preliminary findings from a group-based digital therapeutics intervention for fibromyalgia.

Introduction: Fibromyalgia (FM) is a disorder characterized by chronic pain, with significant medical, psychological, and socio-economic implications. Although there is limited evidence, cognitive-behavioral therapy (CBT) has shown to be effective in improving FM symptoms. An alternative to enhance CBT effectiveness is to incorporate digital therapeutics (DTx). Aim: We conducted a pilot study to investigate whether the addition of a DTx intervention (VirtualPain) to cognitive-behavioral group therapy (CBGT) can reduce pain perception and associated symptoms in patients with FM. Method: Ten patients with FM were initially recruited from a public hospital in Barcelona. The treatment consisted of 6 weeks of VirtualPain group sessions and 16 weeks of CBGT. Measures of catastrophizing, self-efficacy, and coping were recorded before, during, and after the protocol. In the DTx sessions, pain intensity was recorded before and after each session. Results: The program (DTx and CBGT) showed a significant improvement in pain-related self-efficacy and relaxation measures. Improvement in pain perception was observed only after the DTx intervention. Conclusions: This study provides preliminary results regarding the added value of DTx (VirtualPain) as part of a CBGT for FM. The use of the program has facilitated a significant reduction in pain perception in each of the VirtualPain sessions, which provides further evidence of how this technology can be beneficial for improving FM treatments.

Effect of cognitive behavioral group therapy on rehabilitation of community patients with schizophrenia: A short-term randomized control trial.

BACKGROUND: The efficacy of cognitive behavioral group therapy (CBGT) for cognitive dys-function and negative symptoms of schizophrenia is established, but more evidence is required. AIM: To assess the effectiveness of CBGT combined with mental health education as a treatment for schizophrenia compared with mental health education alone. METHODS: In all, 120 schizophrenia out-patients were randomized into CBGT combined with mental health education or single mental health education. The primary outcomes were positive and negative symptoms, cognitive function, excitatory factor, anxiety and depression symptom improvements on the positive and negative syndrome scale score. Secondary outcome measures included social function and drug compliance. RESULTS: There were significant differences between CBGT combined with mental health education and single mental health education on measures of positive and negative symptoms, cognitive functions, excitatory factor, anxiety and depression symptoms, and social functions. No other significant difference in outcomes was observed. CONCLUSION: CBGT combined with mental health education may be relevant beneficial treatment method in reducing symptoms, cognitive and social functions of patients with schizophrenia.

Women with mood disorders and couples conflict: menopause symptom improvement, after group therapy.

OBJECTIVE: Although a public health crisis, intimate partner violence (IPV) has been understudied for middle-aged women with mood disorders during their perimenopausal and postmenopausal years. The aims of this study were to examine the relationship between IPV and hot flashes/night sweats (HF/NS) frequency and severity among women with mood disorders and to test whether the effect of cognitive behavioral group therapy on menopausal symptoms differs between those with and without IPV at baseline and post-test. METHODS: Of 59 participants from a mood disorders outpatient clinic enrolled in the parent study, 24 experienced IPV. This study analyzed pretreatment and post-treatment data from the Revised Conflict Tactic Scale - Short Form-2, and HF/NS frequency and severity ratings on the Hot Flash Daily Diary using the McNemar chi-square test. RESULTS: The presence of any type of violence at pretreatment was significantly (p < 0.01) linked to improvements in HF/NS frequency and severity. Women who showed improvements in negotiation skills had better outcomes in menopausal symptoms. Sexual coercion increased from one to three women. CONCLUSIONS: Negotiation skills may help women with mood disorders to reduce HF/NS frequency and severity. More studies need to be conducted with a special focus on helping women in this population.

Terapia Cognitivo-Comportamental em Grupo: Estratégia de Psicoeducação com Estudantes de Enfermagem / Group Cognitive Behavioral Therapy: Strategy for Psychoeducation with Nursing Students / Terapia Cognitivo-Conductual en Grupo: Estrategia para la Psicoeducación con Estudiantes de Enfermeira

Este estudo teve por objetivo apresentar os resultados de um grupo psicoterápico psicoeducativo desenvolvido junto a estudantes de Enfermagem. Foram realizados seis encontros com cinco estudantes de uma universidade pública do Estado de São Paulo. Os encontros foram audiogravados, transcritos e submetidos à análise temático-reflexiva. Os resultados encontrados permitiram a construção de cinco categorias temáticas: (1) Desafios da adaptação ao ensino superior; (2) Concepções sobre saúde mental na universidade; (3) Autocuidado e equilíbrio entre a vida universitária e pessoal; (4) Relações interpessoais e vida universitária; (5) Perspectivas e expectativas sobre a formação. O processo de integração à universidade requer mobilização cognitiva, afetiva e social, sendo que as relações com os pares, professores e familiares foram destacadas como importantes para essa adaptação. As participantes destacaram conhecer a importância do cuidado em saúde mental, mas admitiram dificuldades de promoverem o autocuidado. O espaço grupal foi utilizado como ambiente de escuta, estabelecimento de vínculo e autocuidado. Os grupos psicoeducativos demonstraram ser importantes para a construção de estratégias de enfrentamento e um espaço para o acolhimento de demandas que emergem nessa etapa do desenvolvimento.

This study aimed to present the results of a psychoeducational psychotherapy group developed with Nursing students. Six meetings were held with five students from a public university in the state of São Paulo. The meetings were audio-recorded, transcribed and submitted to a reflexive-thematic analysis. The results found allowed the construction of five thematic categories: (1) Challenges of adapting to higher education; (2) Conceptions about mental health at the university; (3) Self-care and balance between university and personal life; (4) Interpersonal relationships and university life; (5) Perspectives and expectations about training. The process of integration into the university requires cognitive, affective and social mobilization, and relationships with peers, teachers and family members were highlighted as important for this adaptation. The participants highlighted knowing the importance of mental health care, but also admitted difficulties in promoting self-care. The group space was used as a listening environment, bonding and self-care. Psychoeducational groups proved to be important for the construction of coping strategies and a space for the reception of emerging demands.

Este estudio tiene como objetivo presentar los resultados de un grupo de psicoterapia psicoeducativa desarrollado con estudiantes de Enfermería. Se realizaron seis reuniones con cinco estudiantes de una universidad pública del Estado de São Paulo. Las reuniones fueron grabadas en audio, transcritas y sometidas a un análisis temático-reflexivo. Los resultados encontrados permitieron la construcción de cinco categorías temáticas: (1) Desafíos de la adaptación a la educación superior; (2) Concepciones sobre la salud mental en la universidad; (3) Auto cuidado y conciliación de la vida universitaria y personal; (4) Relaciones interpersonales y vida universitaria; (5) Perspectivas y expectativas sobre la formación. El proceso de integración universitaria requiere de una movilización cognitiva, afectiva y social, y las relaciones con pares, docentes y familiares son importantes para la adaptación. Los participantes destacan conocer la importancia del cuidado de la salud mental, pero admiten que tienen dificultad para promover el auto cuidado. El espacio grupal fue utilizado como ambiente de escucha, vinculación y auto cuidado. Los grupos psicoeducativos demostraron ser importantes para la construcción de estrategias de afrontamiento y un espacio de recepción de demandas emergentes.

Cognitive Behavioral Group Therapy for Anger Management in Juvenile Delinquents: Effectiveness Study in a Turkey Child Prison.

The purpose of this study was to evaluate the effectiveness of cognitive-behavioral group therapy (CBGT) for anger management in Juvenile Delinquents. The therapy program consisted of eight sessions including relaxation, self-instruction, cognitive restructuring, and assertiveness training techniques. The therapy program has been conducted for juvenile delinquents in one of the juvenile prisons in Turkey. Sixty juvenile delinquents, aged between 14 and 18, who met the inclusion criteria (treatment = 30, control = 30), were included at the beginning of the study. To evaluate the effectiveness of the program, State Trait Anger and Expression Inventory (STAXI), and Brief Symptom Inventory (BSI) were administered as pre-test. At the end of the therapy program, final analysis was conducted on 35 participants (20 therapy group, 15 control group) due to participants dropout. Mixed ANOVA was conducted to examine the time (pre-test and post-test) and group effects (therapy and control group). Results showed that the participants in the therapy group showed a significant decrease in trait anger and anger expression scores, both subscales of STAXI and in the hostility subscale of BSI; a statistically significant increase in the anger control scores of the subscale of STAXI when compared to the control group. In conclusion, this culturally attuned CBGT for anger management may be applicable for Juvenile Delinquents in Turkey.

Brief Cognitive Behavioral Group Therapy and Verbal-Exposure-Augmented Cognitive Behavioral Therapy for Social Anxiety Disorder in University Students: A Randomized Controlled Feasibility Trial.

Background: Considering the need for developing and examining evidenced-based programs using a brief group format for management of social anxiety disorder (SAD) at the community level, we studied the efficacy of two brief versions of cognitive-behavioral therapy (CBT) programs, brief cognitive-behavioral group therapy (bCBGT), and verbal exposure augmented cognitive behavioral therapy (VE-CBT), on social anxiety among university students. Methods: A single-center, randomized, parallel-group design was adopted. We delivered six weekly two-hour group sessions, bCBGT and VE-CBT, to 41 university students diagnosed with SAD. An independent rater assessed participants using the Liebowitz Social Anxiety Scale (LSAS) and Clinical Global Impression scale-Severity (CGI-S) at baseline, postintervention, and two-month follow-up. A patient-rated measure, Social Phobia Inventory (SPIN), was assessed at the same time-points. Results: There was a significant improvement in severity of social anxiety from baseline to posttreatment and baseline to two-month follow-up in both groups. However, the treatment effects in bCBGT were statistically superior to VE-CBT at postintervention (SPIN, P = 0.038; LSAS, P = 0.028; CGI-S, P = 0.036) and follow-up (SPIN, P = 0.006; LSAS, P = 0.01; CGI-S, P = 0.04). Conclusions: Brief CBT treatments, both bCBGT and VE-CBT, are efficacious for SAD among university students. They have the potential to address barriers associated with SAD management. However, we recommend a longer follow-up and replications in diverse settings.Clinical trial registration number: CTRI/2019/11/021954.

The Effects of Cognitive Behavioral Group Therapy on Anxiety and Emotion Regulation in Thai Middle School Students.

This quasi-experimental study examined the effects of Cognitive Behavioral Group Therapy (CBGT) in alleviating anxiety and enhancing emotion regulation in community-sample Thai middle school students. Forty-seven community-sample students in Grades 7-9 with elevated SCARED scores participated in this pre-post treatment-control study. Twenty-three in the treatment group attended the eight-session 2-hour semi-weekly CBGT. The remaining were the control group. Before and after the intervention, the participants completed the measures of anxiety and emotion regulation. Data obtained were subsequently analyzed using repeated-measures and between-groups MANOVAs. At post-intervention, the treatment group reported a significant decrease in anxiety but a significant increase in emotion regulation. Furthermore, when compared with the control group, their anxiety score was significantly lower but their emotion regulation score was significantly higher, respectively. Findings supported the benefits of CBGT in reducing anxiety in Thai middle school students and in enhancing their emotion regulation skills. Therapeutic implications for anxiety reduction were discussed.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial.

INTRODUCTION: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. OBJECTIVE: This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. METHODS: In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. RESULTS: At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference -2.94; 95% CI -8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. CONCLUSIONS: This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

The Effect of Cognitive Behavioral Group Therapy on Children's Self-Esteem.

(1) Background: Self-esteem plays an important role in developing emotional resilience and wellbeing in children. Yet, there has been little related research on Cognitive Behavioral Group Therapy on this topic. Our aims were to assess the effect of the Child Self-Esteem CBT (CSE-CBT) protocol on children's self-esteem in grades five and six; to assess the effect of the CSE-CBT protocol on the therapeutic process; and to explore the feasibility of delivering the CSE-CBT protocol in a school setting. (2) Methods: Eighty elementary school children in grades five and six, divided into four intervention and four control groups, attended 12 structured sessions using the CSE-CBT protocol, led by specially trained teachers. The children completed questionnaires to assess their self-esteem at the beginning and at the end of the study, and answered weekly questionnaires that assessed therapeutic process. Hierarchical linear modeling was used to analyze the data. (3) Results: The CSE-CBT protocol had a significant effect on improving children's self-esteem over the course of the study, regardless of the children's working alliance with the teacher leading the group. (4) Conclusions: The findings suggest that the CSE-CBT protocol has the potential to benefit children's self-esteem and indicate that school teachers can be trained to administer the CBT-protocol.

Narrative Analyses: Cognitive Behavior Group Therapy for Women with Menopause and Bipolar or Major Depressive Disorders.

Background: Bipolar and depressive disorders (bipolar disorder [BD], major depressive disorder [MDD]), as well as menopause affect millions of women. Although there are three known cognitive behavioral group treatment (CBGT) protocols to help women with problematic menopause symptoms, they do not target women on the BD or MDD spectrum. The purpose of this qualitative study was to learn more about the treatment needs and group experiences of women with problematic menopause symptoms and diagnosed on the BD and MDD spectrum, who participated in a CBGT intervention for menopausal symptoms. Methods: Narrative data recorded by clinicians (Interventionists' notes) and participants (Evaluation of Groups Survey) were analyzed using content analyses. Results: Several themes emerged from (n = 11 BD; n = 48 MDD) what women wanted help with (specific symptoms and general aspects of menopause), what women liked about CBGT (specific and general aspects of the program), and changes needed in the CBGT intervention (things wished for and barriers that interfered with the program). The two diagnostic groups differed in their responses, although both groups identified content and delivery gaps they wished would be addressed. Specifically related to their diagnosis, women most commonly talked about problems with worsening mood and mood instability and multiple stressors interfering with their ability to follow through with the intervention. Conclusions: These findings can help refine existing CBGT protocols for women diagnosed on the BD and MDD spectrum seeking help for menopause symptoms. Trial Registry: Parent study ClinicalTrials.gov [identifier: NCT02860910].

Brief cognitive behavior group therapy for social anxiety among medical students: A randomized placebo-controlled trial.

OBJECTIVE: To compare brief cognitive behavior group therapy (bCBGT) for social anxiety disorder (SAD) to a credible placebo, psychoeducational-supportive therapy (PST), in a sample of medical students. METHOD: This was a single-center, rater-blind, randomized, attention placebo-controlled, parallel-group study. Participants were 50 consenting undergraduate medical students of a state government medical college in Cuttack, India having a primary diagnosis of SAD, who recieved 6 weekly 2-h group sessions. Assessments were carried out at baseline, post intervention and at two-month follow. Independent raters assessed the participants on the Liebowitz Social Anxiety Scale and Clinical Global Impression- Improvement scale (CGI-I). Social Phobia Inventory (SPIN), a self-rated measure, was administered in the same periods. RESULTS: bCBGT group improved significantly across periods from pre-treatment to post-treatment and from pre-treatment to two-month follow-up. bCBGT was statistically superior to PST at the post-treatment and follow-up assessments and showed large effect sizes at both post-treatment and follow-up. CONCLUSIONS: A 6-session bCBGT is an efficacious treatment for SAD among medical students. A longer follow-up and replication in other groups, and clinical settings are necessary for generalization to a broader SAD population.

[Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study]. / Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie.

Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study Abstract. Objective: Internet Gaming and Internet Use Disorder (IGD and IUD) have gained increasing attention in the scientific community over the last few years. The inclusion of "Gaming Disorder" in the ICD-11 (International Statistical Classification of Diseases and Related Health Problems) promoted the need for evidence-based and effective treatments. PROTECT+ is such a cognitive-behavioral group therapy program for adolescents with IGD and IUD. The present study evaluates the medium-term effects after 4 months. Method: N = 54 patients, aged 9 to 19 years (M = 13.48, SD = 1.72), participated in the early intervention study between April 2016 and December 2017 in Heidelberg, Germany. Symptom severity was assessed at baseline, at the end of the treatment, and at 4-month follow-up using standardized diagnostic tools. Results: Multilevel analyses showed a significant reduction in symptom severity using the Video Game Dependency Scale (CSAS) at 4-month follow-up. We found a small effect size in self-reported reduction of symptom severity (d = 0.35) and a moderate effect size in parental ratings (d = 0.77). The Reliable Change Index measured by the Compulsive Internet Use Scale (CIUS) indicated a high heterogeneity in individual symptom changes over time. Patients showed high satisfaction regarding the treatment program at 1- und 4-month follow-up. Conclusions: This study is internationally one of the few to show a significant reduction of IGD and IUD symptoms after 4 months.

Changes in Empathy Mediate the Effects of Cognitive-Behavioral Group Therapy but Not Mindfulness-Based Stress Reduction for Social Anxiety Disorder.

Social anxiety disorder (SAD) has been shown to be associated with difficulty in the ability to vicariously share others' positive emotions (positive affective empathy). Mixed evidence also suggests potentially impaired recognition of the positive and negative emotions of others (cognitive empathy) and impaired or enhanced sharing of the negative emotions of others (negative affective empathy). Therefore, we examined whether two efficacious treatments for SAD, cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR), improve empathy in SAD relative to a wait-list condition and whether improvements in empathy mediate improvements in social anxiety. In the context of a randomized controlled trial, participants with SAD completed an empathy task at baseline, posttreatment/wait-list (N = 81), and 1-year follow-up (N = 37). Relative to both MBSR and wait-list, CBGT resulted in significant improvements in positive affective empathy. CBGT-related changes in positive affective empathy also mediated improvements in social anxiety at both posttreatment/wait-list and at 1-year follow-up. Other indices of empathy did not change differentially across the three conditions. Therefore, one way in which CBGT may specifically confer benefits to individuals with SAD is through increasing their ability or willingness to share in the positive emotions of others.

Efficacy and cost-effectiveness of internet-based cognitive behavioral therapy for obsessive-compulsive disorder / 上海交通大学学报（医学版）

Objective • To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods • Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n=16) and CBGT group (n=12) according to the patients' willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results • There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)] between the two groups at baseline (P=0.291, P=0.114, P=0.478, P=0.799). After treatment, the YBOCS scores decreased compared to pre-treatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P=0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P=0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement. Conclusion • ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT.

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder.

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism-cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d's from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.

Brief report: sudden gains in cognitive-behavioral group therapy and group psychotherapy for social anxiety disorder among college students.

The present study examined sudden gains (SGs; large symptom improvements between adjacent treatment sessions) and its association with treatment outcome in a randomized-controlled trial comparing cognitive-behavioral group therapy (CBGT) versus group psychotherapy (GPT; designed to incorporate only non-specific factors) for social anxiety disorder (SAD). SAD symptoms were assessed after each treatment session in a sample of 45 college students. Independent assessors evaluated symptom severity at baseline, post-treatment and follow-up. A total of 10 (22.2%) participants experienced SGs during treatment. No differences were found in symptom improvement at post-treatment or follow-up between individuals with and without SGs. SGs appeared at similar rates across both treatments but were associated with greater improvements at post-treatment and follow-up in GPT compared to CBGT. Majority of SGs in CBGT occurred early in treatment before the provision of specific treatment techniques. These results suggest that non-specific treatment factors may be important in promoting SGs.

Cognitive behavioral group therapy versus psychoeducational intervention in Parkinson's disease.

OBJECTIVE: The aim of the current study was to evaluate whether cognitive behavioral group therapy has a positive impact on psychiatric, and motor and non-motor symptoms in Parkinson's disease (PD). METHODS: We assigned 20 PD patients with a diagnosis of psychiatric disorder to either a 12-week cognitive behavioral therapy (CBT) group or a psychoeducational protocol. For the neurological examination, we administered the Unified Parkinson's Disease Rating Scale and the non-motor symptoms scale. The severity of psychiatric symptoms was assessed by means of the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Brief Psychiatric Rating Scale, and the Clinical Global Impressions. RESULTS: Cognitive behavioral group therapy was effective in treating depression and anxiety symptoms as well as reducing the severity of non-motor symptoms in PD patients; whereas, no changes were observed in PD patients treated with the psychoeducational protocol. CONCLUSION: CBT offered in a group format should be considered in addition to standard drug therapy in PD patients.

Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial.

BACKGROUND: Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. METHODS: Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. RESULTS: Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. CONCLUSIONS: This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

Sensibilidade à ansiedade e transtorno de pânico: avaliação do impacto da terapia cognitivo-comportamental em grupo / Anxiety sensitivity and panic disorder: assessment of the impact of group cognitive behavioral therapy

O transtorno de pânico (TP) é caracterizado pela presença de ataques súbitos de ansiedade e sensação de medo intenso. Embora haja tratamento efetivo com medicações e terapia cognitivo-comportamental (TCC), muitos pacientes tratados apresentam resposta parcial e tendem à cronicidade. A sensibilidade à ansiedade (SA) é um constructo multidimensional que expressa preocupações físicas, sociais e cognitivas da ansiedade, considerada uma tendência específica a reagir com medo aos sintomas de ansiedade. A SA tem sido associada à gênese e à manutenção dos sintomas do TP, porém ainda são escassos estudos que avaliam se a TCC em grupo (TCCG) modifica tal condição. Os objetivos deste estudo foram: 1) avaliar o impacto da TCCG na SA em pacientes com TP; 2) verificar a associação entre as características sociodemográficas e clínicas (comorbidades, uso de medicação, gravidade do TP) relacionadas à SA; 3) verificar as variáveis clínicas relacionadas à mudança da SA após a TCCG; 4) analisar a SA e suas dimensões como preditor de resposta à TCCG. Trata-se de um ensaio clínico controlado para avaliação da SA em pacientes com TP que realizaram 12 sessões de TCCG comparados ao grupo controle sem a intervenção. A gravidade dos sintomas foi avaliada antes e depois da TCCG no grupo intervenção e uma vez no grupo controle. Utilizou-se a Escala de gravidade do TP (PDSS), a Impressão Clínica Global (CGI), a Hamilton Ansiedade (HAM-A), o Inventário de Ansiedade de Beck (BAI) e o Inventário de Depressão de Beck (BDI). Para avaliar a SA, foi utilizada a Escala de Sensibilidade à Ansiedade-Revisada (ESA-R) com quatro fatores: fator 1 − medo de sintomas respiratórios e cardiovasculares; fator 2 − medo de descontrole cognitivo; fator 3 − medo de que as reações à ansiedade sejam observadas publicamente; fator 4 − medo de sintomas gastrintestinais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 14-0379). Os pacientes assinaram o termo de consentimento livre e esclarecido (TCLE). A amostra foi composta por 89 sujeitos, com média de idade de 37,9 (DP=10,6) anos. Observou-se associação significativa entre a SA mais elevada em pacientes com comorbidade com agorafobia e sintomas mais elevados de ansiedade e de depressão. Um total de 37 (42%) pacientes participou do grupo intervenção e 52 (58%) pacientes do grupo controle. Houve melhora significativa em todos os sintomas específicos do TP, da ansiedade geral e dos sintomas depressivos. A SA também sofreu redução significativa em todos os fatores após a intervenção quando comparada aos escores iniciais, com tamanho de efeito (TE) de moderado a grande. Quando comparada a SA do grupo controle e do grupo intervenção após a TCCG, os escores da ESA-R diminuíram significativamente em todos os fatores e no total. Ou seja, a SA modifica-se com a TCCG tanto em termos de intragrupo intervenção quanto em termos de escores do grupo controle. Os resultados deste estudo confirmaram que a relação entre a SA é maior em pacientes com TP mais graves. Também foi evidenciada a eficácia da TCCG na redução das dimensões física, cognitiva e social da SA, confirmando a hipótese do impacto positivo da TCCG para a modificação desse quadro.

Panic disorder (PD) is characterized by the presence of sudden attacks of anxiety and intense fear sensation. Although there are effective treatments with medications and cognitivebehavioral therapy (CBT), many treated patients present partial response and tend to chronicity. Anxiety sensitivity (AS) is a multidimensional construct that expresses physical, social and cognitive anxiety concerns, considered a specific tendency to react with fear to the symptoms of anxiety. AS has been associated with the genesis and maintenance of PD symptoms, but there are still few studies evaluating whether CBT in group (CBT-G) modifies such condition. The objectives of this study were: 1) to evaluate the impact of CBT-G on AS in patients with PD; 2) to verify the association between sociodemographic and clinical characteristics (comorbidities, medication use, severity of PD) related to AS; 3) to verify the clinical variables related to the change in AS after CBT-G; 4) to analyze AS and its dimensions as a predictor of response to CBT-G. This is a controlled clinical trial for the evaluation of AS in patients with PD who performed 12 sessions of CBT-G compared to the control group without the intervention. The severity of the symptoms was evaluated before and after the CBT-G in the intervention group and once in the control group. We used the PD Severity Scale (PDSS), Clinical Global Impression (CGI), Hamilton Anxiety (HAM-A), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). In order to evaluate the AS, the Anxiety Sensitivity Index-Revised (ASI-R) was used with four factors: factor 1 - fear of respiratory and cardiovascular symptoms; factor 2 - fear of cognitive uncontrol; factor 3 - fear that reactions to anxiety could be publicly observed; factor 4 - fear of gastrointestinal symptoms. The study was approved by the Research Ethics Committee of the Hospital de Clínicas of Porto Alegre (nº 14-0379). Patients signed the informed consent form (TCLE). The sample consisted of 89 subjects, with a mean age of 37.9 (SD = 10.6) years. A significant association was observed between the highest AS in patients with comorbidity with agoraphobia and higher anxiety and depression symptoms. A total of 37 (42%) patients participated in the intervention group and 52 (58%) patients in the control group. There was a significant improvement in all the specific symptoms of PD, general anxiety and depressive symptoms. AS also had a significant reduction in all factors after the intervention when compared to the initial scores, with moderate to large effect size (ES). When compared to AS of the control group and the intervention group after the CBT-G, ASI-R scores decreased significantly in all factors and in the total. That is to say, AS is modified with CBT-G both in terms of intragroup intervention and in terms of scores of the control group. The results of this study confirmed that the relationship between AS is higher in patients with more severe PD. The effectiveness of CBT-G in reducing the physical, cognitive and social dimensions of AS was also evidenced, confirming the hypothesis of the positive impact of CBT-G for the modification of this condition.

Cognitive behavioral group therapy for patients with physical diseases and comorbid depressive or adjustment disorders on a waiting list for individual therapy: results from a randomized controlled trial.

BACKGROUND: Depressive and adjustment disorders are highly prevalent in patients with physical diseases and are associated with poorer quality of life, increased morbidity and mortality, as well as higher healthcare costs. Access to mental health care holds strong importance for these patients, although waiting times for outpatient individual psychotherapy in Germany are often long. Attending an intervention while waiting for individual therapy could improve this problem. For this purpose, we developed an eight-session cognitive behavioral group therapy (STEpS) and tested its efficacy in a randomized controlled trial. METHODS: Seventy-six patients with chronic physical diseases and comorbid depressive or adjustment disorders were randomized to either STEpS or a waiting list control group. The primary outcome was self-reported depression measured by the Hospital Anxiety and Depression Scale (HADS-D), while the secondary outcomes included global psychological distress and health-related quality of life. Data was assessed at baseline, post-treatment and 2-month follow-up and was analyzed based on intention-to-treat. RESULTS: Compared to the control group, the STEpS group showed significantly less depression (d = 0.37; p = .009) and significantly higher quality of life (mental: d = 0.47; p = .030; physical: d = 0.70; p = .001) at post-treatment. The groups did not differ in global psychological distress. At 2-month follow-up, the STEpS group indicated significantly higher subjective physical health (d = 0.43; p = .046), but did not differ from the control group in the remaining outcomes. CONCLUSIONS: STEpS proved effective in improving depression and health-related quality of life in the short term but did not reveal effects on mental outcomes at 2-month follow-up. Nonetheless, the implementation of STEpS as a waiting list intervention prior to individual therapy could help patients to handle long waiting periods in outpatient care. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005140 (27 August 2013).