scholarly journals Treatment of comorbid alcohol use disorders and depression with cognitive‐behavioural therapy and motivational interviewing: a meta‐analysis

Addiction ◽  
2014 ◽  
Vol 109 (3) ◽  
pp. 394-406 ◽  
Author(s):  
Heleen Riper ◽  
Gerhard Andersson ◽  
Sarah B. Hunter ◽  
Jessica Wit ◽  
Matthias Berking ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Motivational Interviewing ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Alcohol Use Disorders ◽  
Behavioural Therapy ◽  
Cognitive Behavioural

scholarly journals Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Munyaradzi Madhombiro ◽  
Alfred Musekiwa ◽  
James January ◽  
Alfred Chingono ◽  
Melanie Abas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Motivational Interviewing ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Psychological Interventions ◽  
People Living With Hiv ◽  
Inclusion Criteria ◽  
Cognitive Behavioural ◽  
Living With Hiv

Abstract Background Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. Methods A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. Results A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. Conclusion This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. Systematic review registration PROSPERO CRD 42017063856.

scholarly journals Overcoming challenges in delivering integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder with co-morbid alcohol use: therapist perspectives

2020 ◽  
Vol 48 (5) ◽  
pp. 615-620
Author(s):  
Katherine Berry ◽  
Christine Barrowclough ◽  
Mike Fitsimmons ◽  
Rosalyn Hartwell ◽  
Claire Hilton ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Alcohol Use ◽  
Focus Group ◽  
Motivational Interviewing ◽  
Cognitive Behavioural Therapy ◽  
Alcohol Misuse ◽  
Mental Health Problems ◽  
Behavioural Therapy ◽  
Client Group ◽  
Cognitive Behavioural

AbstractBackground:Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.Aims:Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.Method:Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.Results:We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.Conclusions:Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.

scholarly journals Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Harry Banyard ◽  
Alex J. Behn ◽  
Jaime Delgadillo
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Cognitive Behavioural ◽  
Primary Focus ◽  
Effect Of Pd ◽  
Evidence Based Care

Abstract Background Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes. Methods This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590). Results Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions). Conclusions The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.

scholarly journals Guided or self-guided internet-based cognitive–behavioural therapy (iCBT) for depression? Study protocol of an individual participant data network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026820 ◽  
Author(s):  
Eirini Karyotaki ◽  
Toshi A Furukawa ◽  
Orestis Efthimiou ◽  
Heleen Riper ◽  
Pim Cuijpers
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Substantial Reduction ◽  
Behavioural Therapy ◽  
Cochrane Library ◽  
Individual Participant Data ◽  
Relative Efficacy ◽  
Patient Level ◽  
Cognitive Behavioural ◽  
Individual Participant

IntroductionAlthough guided forms of internet-based cognitive–behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is unclear which types of patients may benefit more from each of these two forms of iCBT. Network meta-analysis (NMA) using individual participant data (IPD) offers a way to assess the relative efficacy of multiple (>2) interventions. Moreover, it maximises our power to detect patient-level characteristics (covariates) that have an important effect on the efficacy of interventions. This protocol describes the procedures of an IPD-NMA, which aims at examining the relative efficacy of guided compared with self-guided iCBT and at identifying predictors and moderators of treatment outcome.Methods and analysisWe will use an existing database on psychotherapies for adult depression to identify eligible studies. This database has been updated up to 1 January 2018, through literature searches in PubMed, Embase, PsycINFO and Cochrane Library. The outcome of this IPD-NMA is reduction in depressive symptoms severity. We will fit the model in a Bayesian setting. After fitting the model, we will report the relative treatment effects for different types of patients, and we will discuss the clinical implications of our findings. Based on the results from the IPD-NMA model, we will develop and validate a personalised prediction model, aiming to provide patient-level predictions about the effects of the interventions.Ethics and disseminationAn ethical approval is not required for this study. The results will be published in a peer-review journal. These results will guide clinical decisions about the most efficient way to allocate iCBT resources, thereby increasing the scalability of this innovative therapeutic approach.

Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis

2008 ◽  
Vol 117 (6) ◽  
pp. 403-411 ◽  
Author(s):  
G. J. Hendriks ◽  
R. C. Oude Voshaar ◽  
G. P. J. Keijsers ◽  
C. A. L. Hoogduin ◽  
A. J. L. M. van Balkom
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Late Life ◽  
Behavioural Therapy ◽  
Cognitive Behavioural
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