Brief cognitive-behavioral therapy with fibromyalgia patients in routine care

2009 ◽  
Vol 50 (6) ◽  
pp. 517-525 ◽  
Author(s):  
Susana Vázquez-Rivera ◽  
César González-Blanch ◽  
Laura Rodríguez-Moya ◽  
Dolores Morón ◽  
Sara González-Vives ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Cognitive Behavioral

scholarly journals Effectiveness of Usual-Care Cognitive-Behavioral Therapy for Adolescents with Depressive Disorders Rated by Parents and Patients

2020 ◽  
Author(s):  
Daniel Walter ◽  
Jana Buschsieweke ◽  
Lydia Dachs ◽  
Hildegard Goletz ◽  
Anja Goertz-Dorten ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Depressive Disorders ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Effect Sizes ◽  
Control Group ◽  
Parent Rating ◽  
Wide Range

Abstract BackgroundDepressive disorders are common in adolescence and are associated with a wide range of negative long-term outcomes. Highly controlled randomized controlled trials (RCT) provide considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) as a treatment for depression, but the effectiveness of CBT under routine care conditions remains unproven.MethodsIn the present observational study, the changes achieved through routine CBT in adolescents with depressive disorders treated in a university outpatient clinic were analyzed, and compared to a historical control group of adolescents with depressive disorders who had received treatment as usual. At the start and end of treatment (pre- and post-assessment), parent and self-ratings of the German versions of the Youth Self-Report (YSR), the Child Behavior Checklist (CBCL) and rating scales for depressive symptoms (FBB-DES, SBB-DES) were assessed. A total of 331 adolescents aged 11–18 years with complete data were assessed for the main analysis.ResultsThe analysis yielded small to large pre-post effect sizes (Cohen’s d) for the total sample (d = 0.33 to d = 0.82) and large effect sizes for adolescents who were rated in the clinical range on each (sub)scale at the start of treatment (d = 0.85 to d = 1.30). When comparing patients in the clinical range with historical controls, medium to large net effect sizes (d = 0.53 to d = 2.09) emerged for the total scores in self- and parent rating. However, a substantial proportion of the sample remained in the clinical range at the end of treatment.ConclusionsThese findings suggest that CBT is effective for adolescents with depressive disorders when administered under routine care conditions, but the results must be interpreted with caution due to the lack of a direct control condition.Trial registrationDRKS, DRKS00021518. Registered 27 April 2020 - Retrospectively registered, http://drks.de

scholarly journals Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study (Preprint)

2018 ◽  
Author(s):  
Kim Mathiasen ◽  
Heleen Riper ◽  
Tonny E Andersen ◽  
Kirsten K Roessler
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Secondary Care ◽  
Odds Ratio ◽  
Large Scale ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
High Baseline ◽  
Baseline Severity

BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear. OBJECTIVE This study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care. METHODS n a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment. RESULTS A total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03). CONCLUSIONS iCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and noncompletion. However, all predictor effects were statistically weak.

scholarly journals Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis (Preprint)

2020 ◽  
Author(s):  
Anne Etzelmueller ◽  
Christiaan Vis ◽  
Eirini Karyotaki ◽  
Harald Baumeister ◽  
Nickolai Titov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Effect Sizes ◽  
Depression And Anxiety ◽  
Care Providers ◽  
Treatment Of Depression

BACKGROUND Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. OBJECTIVE This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. METHODS The acceptability (uptake, participants’ characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. RESULTS A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges’ g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants’ characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. CONCLUSIONS This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.

Sudden gains in routine care cognitive behavioral therapy for depression: A replication with extensions

2017 ◽  
Vol 89 ◽  
pp. 24-32 ◽  
Author(s):  
Felix Wucherpfennig ◽  
Julian A. Rubel ◽  
Steven D. Hollon ◽  
Wolfgang Lutz
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Sudden Gains

scholarly journals Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis

10.2196/18100 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e18100 ◽  
Author(s):  
Anne Etzelmueller ◽  
Christiaan Vis ◽  
Eirini Karyotaki ◽  
Harald Baumeister ◽  
Nickolai Titov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Effect Sizes ◽  
Depression And Anxiety ◽  
Care Providers ◽  
Treatment Of Depression

Background Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods The acceptability (uptake, participants’ characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. Results A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges’ g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants’ characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. Conclusions This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.

Internet-delivered Cognitive-Behavioral Therapy for Generalized Anxiety Disorder: Its Effectiveness in Nationwide Routine Care (Preprint)

2021 ◽  
Author(s):  
Ville Ritola ◽  
Jari Lipsanen ◽  
Satu Pihlaja ◽  
Eero-Matti Gummerus ◽  
Jan-Henry Stenberg ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Generalized Anxiety Disorder ◽  
Behavioral Therapy ◽  
Symptomatic Relief ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Computer Assisted ◽  
Generalized Anxiety ◽  
State Worry

BACKGROUND Internet-delivered, therapist-supported Cognitive Behavioral Therapy (iCBT) is efficacious for Generalized Anxiety Disorder (GAD), but few studies have as yet reported its effectiveness in routine care. OBJECTIVE To examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. METHODS The program was free-of-charge for patients and its completion time was unrestricted. A specialized iCBT clinic delivered iCBT to 1,099 physician-referred patients. We measured symptoms with online questionnaires. The primary measure of anxiety was the GAD-7; secondary measures were, for pathological worry, the Penn State Worry Questionnaire (PSWQ) and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS Patients completed a mean 7.8 (65.1%) of 12 sessions, and 44.1% of patients completed all sessions. Effect size in the whole sample for GAD-7 was large (d=0.96; 95%CI: 0.87-1.05). For completers, effect sizes were very large, d=1.34 (95%CI: 1.25-1.53) for GAD-7, d=1.14 (95%CI:1.00-1.27) for PSWQ, and 1.23 (95%CI:1.09-1.37) for OASIS. Patients who dropped out also benefited from the treatment. Greater symptomatic relief (GAD-7) was associated with more completed sessions, older age, and being referred from private or occupational care. Of 894 patients with baseline GAD-7 score ≥10, those achieving a reliable recovery amounted to 421 (47.1%). CONCLUSIONS This nationwide, free-of-charge, therapist-supported HUS-iCBT for GAD was effective in routine care, but further research must establish comparative effectiveness and optimize the design of iCBT for GAD for different patient groups and individual patients. CLINICALTRIAL Nationwide internet-delivered computer-assisted cognitive-behavioral therapy (iCBT) for psychiatric disorders. https://www.isrctn.com/ISRCTN55123131

scholarly journals Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy – results from a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Larissa Schwarzkopf ◽  
Lisa Dorscht ◽  
Ludwig Kraus ◽  
Katharina Luttenberger
Keyword(s):  
Cost Effectiveness ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Productivity Loss ◽  
Cost Effective ◽  
Routine Care ◽  
Cognitive Behavioral ◽  
Distributed Model ◽  
Depression Symptoms

Abstract Background Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care. Methods Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications. Results BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: − 1.35) at higher costs (AMD: +€ 754). No AMD was significant. ICERs amounted to €288 per MADRS-point and €550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of €241 (MADRS) and €615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective. Conclusion BPT is a promising alternate treatment strategy which – in absence of established WTP thresholds for improving symptoms of depression – cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.

Sign in / Sign up

Export Citation Format

Share Document