scholarly journals Trajectories of Change in an Open-Access Internet-Based Cognitive Behaviour Program for Childhood and Adolescent Anxiety: Open Trial (Preprint)

2021 ◽  
Author(s):  
Sonja March ◽  
Philip J Batterham ◽  
Arlen Rowe ◽  
Caroline Donovan ◽  
Alison Calear ◽  
...  
Keyword(s):  
Childhood Anxiety ◽  
Anxiety Symptoms ◽  
Stepped Care ◽  
Behaviour Therapy ◽  
Symptom Trajectories ◽  
Self Help ◽  
Cognitive Behaviour ◽  
Care Approach ◽  
Additional Support ◽  
Symptom Group

BACKGROUND Although evidence for the efficacy of internet-based cognitive behaviour therapy (iCBT) in the treatment of childhood anxiety has continued to grow, there is scant empirical research investigating the timing of benefits made in iCBT programs (e.g. early or delayed). OBJECTIVE The objective of our study was to examine patterns of symptom trajectories (changes in anxiety) across an iCBT program for anxiety (BRAVE Self-Help). METHODS Participants were 10,366 Australian youth with elevated anxiety aged 7-17 years (4,140 children aged 7-12 years; 6,226 adolescents aged 12-17 years) who registered for the BRAVE Self-Help program. Participants self-reported on their anxiety symptoms at baseline/Session 1 and then at the commencement of each subsequent session. RESULTS Results found that young people completing the BRAVE Self-Help program tend to fall into two trajectory classes that can be reliably identified in terms of high versus medium baseline levels of anxiety and subsequent reduction in symptoms. Both high and medium anxiety severity trajectory classes show significant reductions in anxiety, with the greatest level of change being achieved within the first six sessions for both classes. However, those in the moderate anxiety severity class tend to show reductions in anxiety symptoms to levels below the elevated range, whereas those in the high symptom group tend to remain in the elevated range despite improvements. CONCLUSIONS These findings suggest that those in the high severity group who are not responding well to iCBT on a self-help basis, may benefit from additional support provided alongside the program or a stepped-care approach where progress is monitored and support can be provided as necessary. CLINICALTRIAL n/a

Increasing Access to CBT: Stepped Care and CBT Self-Help Models in Practice

2008 ◽  
Vol 36 (6) ◽  
pp. 675-683 ◽  
Author(s):  
Chris Williams ◽  
Rebeca Martinez
Keyword(s):  
High Intensity ◽  
Phase 1 ◽  
Stepped Care ◽  
Service Development ◽  
Second Phase ◽  
Behaviour Therapy ◽  
New Ways Of Working ◽  
Low Intensity ◽  
Self Help ◽  
Cognitive Behaviour

AbstractThe delivery of cognitive behaviour therapy (CBT) in the UK has moved through two phases. In the first phase specialist practitioners delivered bespoke CBT to individuals often experiencing complex and longer-lasting problems. This phase has been characterized by waiting lists and a high quality service delivered to a few. In the second phase of service delivery CBT has begun to be delivered in all sorts of different formats, including CBT self-help/guided CBT, behavioural activation, computerized CBT and group based CBT that aim to increase access to CBT delivered in these ways. It remains unclear how these varying models – “high intensity” (phase 1) and “low intensity” (phase 2) should relate – and even who does best with each. There are implicit assumptions by practitioners reflected in language such as “stepping up/down” that assumes high intensity working is superior in some way to low intensity. Few studies have however examined this in depth and what studies there are suggest these beliefs may be incorrect for many. How these new ways of working will be introduced, evaluated and integrated into existing services currently remains a challenge. A helpful way of resolving some of these issues is to view CBT using a learning/teaching paradigm. In this the focus is primarily on how the client wishes to learn to tackle their problems. This provides a helpful way for both introducing different and new ways of working, and also maintaining a focus on the client's needs at the centre of service development. Crucially, phase two CBT working does not replace phase one. How the two approaches complement each other and compare will be two of the interesting questions to be addressed over the next few years.

scholarly journals Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

2020 ◽  
Vol 13 ◽  
Author(s):  
Cassie M. Hazell ◽  
Orla Kelly ◽  
Sorcha O’Brien ◽  
Clara Strauss ◽  
Kate Cavanagh ◽  
...  
Keyword(s):  
Patient Experience ◽  
Controlled Trial ◽  
Pilot Trial ◽  
List Type ◽  
Behaviour Therapy ◽  
Hearing Voices ◽  
Self Help ◽  
Cognitive Behaviour ◽  
Therapy Sessions ◽  
Trial Participants

Abstract Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE. Key learning aims (1) To explore participants’ experience of accessing GiVE as part of a trial. (2) To identify what (if any) changes participants noticed over the course of the GiVE trial. (3) To identify what participants attribute these changes to.

The Treatment of Bulimia Nervosa

1987 ◽  
Vol 21 (1) ◽  
pp. 5-15 ◽  
Author(s):  
Rosalyn A. Griffiths ◽  
Stephen W. Touyz ◽  
Philip B. Mitchell ◽  
Wendy Bacon
Keyword(s):  
Family Therapy ◽  
Treatment Group ◽  
Bulimia Nervosa ◽  
Support Groups ◽  
Cognitive Behaviour Therapy ◽  
Psychoanalytic Psychotherapy ◽  
Future Research ◽  
Behaviour Therapy ◽  
Self Help ◽  
Cognitive Behaviour

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

scholarly journals Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools

Autism ◽  
2020 ◽  
Vol 24 (4) ◽  
pp. 867-883 ◽  
Author(s):  
Sebastian B Gaigg ◽  
Paul E Flaxman ◽  
Gracie McLaven ◽  
Ritika Shah ◽  
Dermot M Bowler ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Cost Effective ◽  
Well Being ◽  
Behaviour Therapy ◽  
Self Help ◽  
Online Tools ◽  
Cognitive Behaviour ◽  
Autistic Adults

Anxiety in autism is an important treatment target because of its consequences for quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomised controlled trial examined whether online cognitive behaviour therapy and mindfulness-based therapy self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme or a waitlist control group (n = 19). Primary outcome measures of anxiety, secondary outcome measures of broader well-being and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 mindfulness-based therapies, 9 cognitive behaviour therapies) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools. Lay abstract Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.

scholarly journals Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence

2020 ◽  
Vol 264 ◽  
pp. 474-482 ◽  
Author(s):  
Alejandro de la Torre-Luque ◽  
Aina Fiol-Veny ◽  
Cecilia A. Essau ◽  
Maria Balle ◽  
Xavier Bornas
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Anxiety Symptoms ◽  
Natural Course ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Cognitive Behaviour Therapy for Menopausal Hot Flushes and Night Sweats: A Qualitative Analysis of Women's Experiences of Group and Self-Help CBT

2012 ◽  
Vol 41 (4) ◽  
pp. 441-457 ◽  
Author(s):  
Janet Balabanovic ◽  
Beverley Ayers ◽  
Myra S. Hunter
Keyword(s):  
Interpretative Phenomenological Analysis ◽  
Hot Flushes ◽  
Behaviour Therapy ◽  
Main Trial ◽  
Making Sense ◽  
Self Help ◽  
Cognitive Behaviour ◽  
Night Sweats ◽  
The Impact ◽  
Group Cbt

Background: There is a growing need for non-medical treatments for women experiencing problematic menopausal symptoms such as hot flushes and night sweats (HF/NS). A recent randomized control trial (RCT) (MENOS2) provides evidence of the effectiveness of Group CBT and Self-Help CBT for HF/NS. Aims: This study examines MENOS 2 participants’ experience of the CBT treatments. Method: Twenty women who had experienced CBT for HF/NS (10 Group CBT and 10 Self-Help CBT) were interviewed at the end of the trial to explore how they experienced the treatment and its effects. The interviews were analysed using interpretative phenomenological analysis. Results: Women experienced both treatment formats as positive and helpful, increasing their ability to cope and their sense of control over HF/NS. Four super-ordinate themes were identified: making sense of symptom change, new ways of coping and regaining control, acknowledging and challenging the menopause taboo, and social interaction and support versus individual learning. Conclusions: These qualitative results are consistent with those of the main trial in that women found both CBT formats helpful in reducing the impact of HF/NS. However, the results also suggest possible mechanisms of change and provide useful information on women's responses to the different treatment components and formats.

Randomised Controlled Trial on the Use of Acupuncture in Adults with Chronic, Non-Responding Anxiety Symptoms

2015 ◽  
Vol 33 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Nick Errington-Evans
Keyword(s):  
Trait Anxiety ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Waiting List ◽  
Control Group ◽  
Acupuncture Points ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
The Difference ◽  
Randomised Controlled

Background A group of adults can be identified with chronic non-responding anxiety symptoms who have repeatedly accessed treatments through their GP, such as cognitive behaviour therapy, bibliotherapy and medication, but with no effect. These patients make heavy use of health service resources with no beneficial outcome. This study aims to test the effect of an acupuncture formula of three specific acupuncture points, suggested in a previous pilot study. Method 40 participants from a psychiatry waiting list were randomised into one of two groups: group 1 (n=25) received 10 weeks of acupuncture at PC6, HT7 and LR3, and group 2 was a waiting list control group. The waiting list group (n=15) then received acupuncture. Both groups were followed up for 10 weeks after treatment. The outcome measure was the State and Trait Anxiety Inventory. Results 36 patients completed the study, with two dropouts in each group. State anxiety scores in the acupuncture group decreased from 57.7 (SD 13.1) to 38.8 (12.0); scores in the waiting list control group decreased from 61.5 (11.6) to 60.6 (11.7). The difference was highly significant (p<0.0001). Similar changes were seen for trait anxiety scores. The control group showed similar statistically significant improvements when they received acupuncture. The improvements were maintained after 10 weeks of follow-up in each group. Conclusions Acupuncture is a promising intervention for patients with chronic anxiety symptoms that have proven resistant to other forms of treatment.

scholarly journals Stepped Care Cognitive Behavioural Therapy for Children with Anxiety Disorders: A New Treatment Approach

2010 ◽  
Vol 39 (1) ◽  
pp. 55-75 ◽  
Author(s):  
Adelinde J. M. van der Leeden ◽  
Brigit M. van Widenfelt ◽  
Rien van der Leeden ◽  
Juliette M. Liber ◽  
Elisabeth M. W. J. Utens ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Treatment Approach ◽  
Treatment Phase ◽  
Behavioural Therapy ◽  
Additional Treatment ◽  
Stepped Care ◽  
Depression Symptoms ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Background: The current nonrandomized clinical trial explored changes over time in children with an anxiety disorder during stepped care, manual-based cognitive behaviour therapy (CBT). Methods: Clinically anxious children (8–12 years, n = 133) and their parents participated in child focused CBT (10 sessions). If assessments indicated additional treatment was necessary, participants could step up to a second and possibly third treatment phase (each 5 sessions) including more parental involvement. Results: After the first treatment phase 45% of the Intention-To-Treat sample was free of any anxiety disorder; after the second and third phase an additional 17% and 11% respectively. In total, 74% of the children no longer met criteria for any anxiety disorder following treatment. Child and parent reported anxiety and depression symptoms of children improved significantly during all treatment phases, as well as child reported anxiety sensitivity and negative affect. Children participating in more treatment showed significant improvements during additional treatment phases, indicating that late change occurred for the subgroup that had not changed during the first phase. Conclusions: Stepped care offers a standardized, assessment based, yet tailored treatment approach for children with anxiety disorders. A more intensive treatment is offered when initial CBT is insufficient, providing children additional opportunities to reach the desired outcome.

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