scholarly journals The use of brief cognitive behavioral therapy interventions in the treatment of chronic non-cancer pain in the primary care setting

2019 ◽  
Author(s):  
Megan Ann Newton
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Cancer Pain ◽  
Care Setting ◽  
Primary Care Setting ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Therapy Interventions

Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting?

2005 ◽  
Vol 35 (11) ◽  
pp. 1645-1654 ◽  
Author(s):  
MICHELLE G. CRASKE ◽  
DANIELA GOLINELLI ◽  
MURRAY B. STEIN ◽  
PETER ROY-BYRNE ◽  
ALEXANDER BYSTRITSKY ◽  
...  
Keyword(s):  
Primary Care ◽  
Panic Disorder ◽  
Cognitive Behavioral Therapy ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Randomized Clinical Trials ◽  
Primary Care Setting ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Propensity Score Model

Background.Randomized clinical trials indicate a benefit from combining medications with cognitive behavioral therapy (CBT) relative to medication alone for panic disorder. Using an as-treated analysis, we evaluated whether the addition of CBT enhanced outcomes for panic disorder relative to medications alone in the primary-care setting.Method.Primary-care patients with panic disorder reported on their receipt of CBT and medications over the 3 months following baseline assessment. The degree to which outcomes for those who used anti-panic medications were enhanced by the receipt of at least one component of CBT was analyzed using a propensity score model that took into account observable baseline patient characteristics influencing both treatment selection and outcomes.Results.The addition of CBT resulted in statistically and clinically significant improvements at 3 months on anxiety sensitivity, social avoidance, and disability. Also, patients receiving CBT in the first 3 months of the study were more improved at 12 months than patients who took medications only during the first 3 months of the study.Conclusions.The clinical utility of the findings are discussed in terms of the importance of primary-care physicians encouraging their panic disorder patients to receive CBT as well as medications.

scholarly journals Assessing the feasibility and acceptability of a cluster-randomized study of cognitive behavioral therapy for chronic insomnia in a primary care setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Isabel Torrens ◽  
Magdalena Esteva ◽  
Caterina Vicens ◽  
María Rosa Pizá-Portell ◽  
María Clara Vidal-Thomàs ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Sleep Quality ◽  
Care Setting ◽  
Primary Care Setting ◽  
Behavioral Therapy ◽  
Randomized Study ◽  
Chronic Insomnia ◽  
Cluster Randomized

Abstract Background Cognitive behavioral therapy for chronic insomnia (CBT-i) is the treatment of choice for this condition but is underutilized in patients who attend primary care. The purpose of the present feasibility-pilot study was to assess the feasibility and acceptability of a cluster-randomized study of CBT-i in a primary care setting. Methods This study, performed at two primary health care centers in Majorca, Spain, was a mixed methods feasibility-pilot study of a parallel cluster-randomized design comparing CBT-i and usual care (UC). Patients were included if they were 18 to 65 years-old; had diagnoses of chronic insomnia according to the Insomnia Severity Index (ISI ≥ 8); had insomnia for more than 3 months. Twenty-five GPs and nurses and 32 patients were randomly allocated to two groups. The main outcome of the intervention was improvement of dimensions of sleep quality, measured using the Spanish version of the Pittsburgh Sleep Quality Index, at baseline and at 3 months after the intervention. Other primary outcomes of the study were the feasibility and applicability of the intervention, collected through nominal groups. A thematic analysis was performed to classify primary care provider (PCP) proposals. Additionally, we assessed the recruitment process, compliance with the intervention sessions, and patient retention. Results We adapted the CBT-i approach of Morin to a primary care context. After intervention training, PCPs expressed the need for more extensive training in the different aspects of the therapy and the discussion of more cases. PCPs considered the intervention as adequate but wanted fewer but longer sessions as well as to discard the cognitive restructuring component. PCPs considered it crucial to prepare each session in advance and to establish a specific agenda for the CBT-i. Regular reminders given to PCPs and patients were suggested to improve study participation. Compared to the UC group, higher proportions of patients in the intervention group had short sleep latency, slept for longer than 5 h, and had fewer sleep disruptions. Conclusions This feasibility-pilot study identified several key issues that must be addressed before performing a CBT-i intervention in future clinical trial in a primary care setting. Trial registration NCT04565223. (Clinical trials.gov) Registered 1 September 2020—Retrospectively registered.

scholarly journals Assessing The Feasibility and Acceptability of A Cluster-Randomized Study of Cognitive Behavioral Therapy For Chronic Insomnia In A Primary Care Setting

2020 ◽  
Author(s):  
Isabel Torrens ◽  
Magdalena Esteva ◽  
Caterina Vicens ◽  
Maria Clara Vidal-Thomas ◽  
Maria Rosa Pizà-Portell ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Feasibility Study ◽  
Care Setting ◽  
Primary Care Setting ◽  
Behavioral Therapy ◽  
Randomized Study ◽  
Chronic Insomnia ◽  
Cluster Randomized ◽  
Pilot Feasibility Study

Abstract Background: Cognitive behavioral therapy (CBT) is the treatment of choice for chronic insomnia but is underutilized in patients in primary care. The purpose of this study was to assess the feasibility and acceptability of a pilot cluster-randomized study of CBT for chronic insomnia (CBT-i) in a primary care setting. Methods: This pilot-feasibility study with a parallel cluster-randomized design comparing CBT-i-intervention group (IG) and usual care (UC) was performed at two primary health care centers in Majorca, Spain. Patients were included if they were 18 to 65 years-old; had diagnoses of chronic insomnia according to the Insomnia Severity Index (ISI ³ 8) and had insomnia longer than 3 months; and did or did not use a hypnotic medication. A total of 25 GPs and nurses and 32 patients were randomly allocated to two groups. The outcome of the intervention was improvement in quality of sleep. Other primary outcomes were the feasibility and applicability of the intervention, which were defined using nominal groups. UC was defined based on previous studies. The recruitment process, compliance with intervention sessions, and patient retention were also assessed.Results: We adapted the CBT-i approach of Morin to a primary care context. After intervention training, primary care providers (PCPs) expressed the need for more extensive training in the different aspects of the therapy and the discussion of more cases. PCPs considered the intervention as adequate but wanted fewer and shorter sessions as well as to discard the cognitive restructuring component. PCPs considered it crucial to prepare each session in advance and to establish a specific agenda for the CBT-i. Regular reminders given to PCPs and patients were suggested to improve study participation. Compared to the UC group, significantly higher proportions of patients in the IG had short sleep latency, slept for longer than 5 h, and had fewer sleep disruptions. Conclusions: This pilot-feasibility study identified several key issues that must be addressed before performing CBT-i intervention in future clinical trials in a primary care setting. Trial registration: NCT04565223. (Clinical trials.gov) Registered 1 September 2020 - Retrospectively registered.

349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A139-A140
Author(s):  
Janannii Selvanathan ◽  
Chi Pham ◽  
Mahesh Nagappa ◽  
Philip Peng ◽  
Marina Englesakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioral Therapy ◽  
Cancer Pain ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Comorbid Insomnia ◽  
Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice

2021 ◽  
Vol 78 ◽  
pp. 102345
Author(s):  
Olivia E. Bogucki ◽  
Julia R. Craner ◽  
Summer L. Berg ◽  
Megan K. Wolsey ◽  
Stephanie J. Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Anxiety Disorders ◽  
Primary Care Practice ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Care Practice
Sign in / Sign up

Export Citation Format

Share Document