Cognitive Behaviour Therapy

Purpose: To investigate how psychotherapists experience using individual, face-to-face cognitive behavioural therapy (CBT) aimed at alleviating depressive symptoms in persons with multiple sclerosis (MS). Method: Semi-structured interviews with three psychotherapists were conducted after CBT with 12 participants with MS, and analysed using qualitative content analysis. Results: Two main themes emerged: Trusting their expertise as psychotherapists whilst lacking MS-specific knowledge, and The process of exploring the participants' readiness for CBT with modifications of content and delivery. The psychotherapists perceived it difficult to know whether a symptom was attributable to depression or to MS, and for some participants the CBT needed to be adapted to a more concrete content. Conclusions: Psychotherapists may need more MS-specific knowledge and an insight into the individual's functioning. The content of CBT in terms of concrete home assignments and behavioural activation needs to be individualised.

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by recurrent intrusive thoughts and repetitive behaviors, causing significant distress and disruption to daily life. Early identification and intervention are crucial for improving outcomes. This research compared the performance of four AI models (ChatGPT-3.5, ChatGPT-4, Claude 3.5 Sonnet, and Gemini 1.5 Pro) to that of human mental health professionals in recognizing OCD, recommending evidence-based therapies, and assessing stigma attributions. Using six vignettes, the study analyzed 480 AI evaluations and 315 assessments by mental health professionals. The AI models demonstrated superior performance in OCD recognition (100 % vs. 87 % accuracy for humans) and in recommending evidence-based interventions (60-100 % vs. 61.9 % for humans). Additionally, the AI models showed lower stigma and danger estimations. These findings indicating that AI demonstrated higher accuracy in vignette-based recognition tasks highlight the potential for AI integration into mental health care, particularly for enhancing OCD diagnosis and treatment.

Background: Internet-based cognitive behavior therapy (ICBT) has shown promising effects in the treatment of irritable bowel syndrome (IBS). However, to date no study has used a design where participants have been sampled solely from a clinical population. We aimed to investigate the acceptability, effectiveness, and costeffectiveness of ICBT for IBS using a consecutively recruited sample from a gastroenterological clinic. Methods: Sixty-one patients were randomized to 10 weeks of ICBT (n = 30) or a waiting list control (n = 31). The ICBT was guided by an online therapist and emphasized acceptance of symptoms through exposure and mindfulness training. Severity of IBS symptoms was measured with the Gastrointestinal symptom rating scale -IBS version (GSRS-IBS). Patients in both groups were assessed at pre-and post-treatment while only the ICBT group was assessed 12 months after treatment completion. Health economic data were also gathered at all assessment points and analyzed using bootstrap sampling. Results: Fifty of 61 patients (82%) completed the post-treatment assessment and 20 of 30 patients (67%) in the ICBT group were assessed at 12-month follow-up. The ICBT group demonstrated significantly (p < .001) larger improvements on the IBS-related outcome scales than the waiting list group. The between group effect size on GSRS-IBS was Cohen's d = 0.77 (95% CI: 0.19-1.34). Similar effects were noted on measures of quality of life and IBSrelated fear and avoidance behaviors. Improvements in the ICBT group were maintained at 12-month follow-up. The ICBT condition was found to be more cost-effective than the waiting list, with an 87% chance of leading to reduced societal costs combined with clinical effectiveness. The cost-effectiveness was sustained over the 12month period. Conclusions: ICBT proved to be a cost-effective treatment when delivered to a sample recruited from a gastroenterological clinic. However, many of the included patients dropped out of the study and the overall treatment effects were smaller than previous studies with referred and self-referred samples. ICBT may therefore be acceptable and effective for only a subset of clinical patients. Study dropout seemed to be associated with severe symptoms and large impairment. Objective and empirically validated criteria to select which patients to offer ICBT should be developed.

The Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV) is a self-report diagnostic measure of generalized anxiety disorder. Previous studies have established the psychometric properties of the GAD-Q-IV revealing excellent diagnostic specificity and sensitivity as well as good test-retest reliability and convergent and discriminant validity . Recent analyses with other measures of anxiety symptoms have revealed differences across racial or national groups. Given that the GAD-Q-IV was tested primarily on Caucasian (78%) participants, the purpose of this study was to demonstrate the psychometric properties of the GAD-Q-IV across four racial groups: African American, Caucasian, Hispanic/Latino, and Asian. A student sample of 585 undergraduate psychology students completed the GAD-Q-IV as well as other measures of anxiety symptoms. A clinical replication sample was obtained from 188 clinical participants who completed the GAD-Q-IV as part of a larger psychotherapy study. Results indicated excellent and very similar factor structures in the student sample, and similar psychometric properties across both samples across the racial groups. Implications for the use of the GAD-Q-IV across racial groups are discussed.

This analysis included 276 participants (207 women [75%] and 69 men [25%]; mean [SD] age, 33 [13] years) (eFigure in Supplement 2). Participants identified as Asian (51 [19%], Black (40 [15%]), Hispanic (25 [9%]), White (166 [60%]), or other race or ethnicity (19 [6%]). 2 No significant betweengroup differences in demographic characteristics or baseline outcome measures were observed, except for BAI scores. Participants in both groups demonstrated reductions in anxiety symptoms

BackgroundHow best to plan and provide psychosocial care following disasters remains keenly debated.AimsTo develop evidence-informed post-disaster psychosocial management guidelines.MethodA three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others&#39; responses in the subsequent rounds.ResultsA total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cogn...

Objective: To evaluate the scientific literature concerning the treatment of child sexual abuse. Method: A critical review of the scientific literature. Results: There are only nine published research studies in which subjects were randomly assigned to an index treatment or treatments and a comparison treatment or no-treatment control group. In seven of the studies, the index treatment exceeded the control or comparison group in regard to treatment outcome; in two studies it did not. The successful treatments involved group therapy, combined individual and group play therapy and cognitive behaviour therapy. Conclusions: Treatment should be based on an explicit conceptual model of the psychopathology of sexual abuse. The University of Queensland Sexual Abuse Treatment Project, which is based on a transactional model, is described.

The present study explored the effectiveness of Mindfulness-Based Cognitive Behavioral Therapy (MCBT) in improving mental health outcomes among patients with neurotraumatic diseases. Utilizing an informal experimental pre-post design, 25 participants received structured MCBT sessions over a defined intervention period. The study aimed to assess changes in depression and anxiety levels, psychological adaptation (BASE), and coping skills (COPE) before and after the intervention. Quantitative analyses, including paired-samples t-tests, revealed statistically significant improvements across all three psychological domains. Depression and anxiety scores showed a substantial decrease from pre-test (M = 55.08, SD = 8.63) to post-test (M = 29.72, SD = 4.67), while adaptation scores (BASE) also significantly declined, indicating better psychological adjustment. In contrast, coping skills demonstrated a marked increase from pre-test (M = 51.98, SD = 6.86) to post-test (M = 112.93, SD = 3.66), suggesting enhanced resilience and stress management. Normality assumptions were met for all variables, confirming the suitability of parametric testing. These findings support the theoretical foundations of MCBT, which emphasize the role of mindfulness and cognitive restructuring in managing psychological distress. The results hold significant practical implications for integrating MCBT into routine mental health services for neurodegenerative patients. Recommendations include the formal adoption of MCBT in healthcare systems, training for practitioners, and the development of culturally adapted interventions. The study concludes that MCBT is a highly effective, non-pharmacological approach for enhancing mental health, coping capacity, and overall psychological well-being in patients facing the chronic challenges of neurodegenerative disease. Future research should expand on these findings through longitudinal and multicenter studies.

BackgroundThe initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.AimsTo test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.MethodThis was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.ResultsThere were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of intro...

Background: Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP). This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral.

Objective:  Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio.Method:  A literature search in PubMed, EMBASE and PsycINFO was performed.Results:  Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow‐up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side‐effects of antipsychotic medication and non‐adherence with medication are essential problems.Conclusion:  At the present time, the data concerning the benefits and risks do not ...

Objective: Recent research suggests that there are aspects of Hashimoto's disease (HD) for which medical treatment may be limited. Medical treatment of HD involves returning thyroid hormone levels to the normal reference range, a condition called euthyroidism. Poor quality of life (QOL), low psychological well-being, depression, anxiety, and stress are among the factors associated with symptoms that persist despite being euthyroid. Method: Considering these findings, the present study investigated the effects of dialectical behaviour therapy skills training (DBT-ST), group cognitive behavioural therapy (CBT) and a waitlist group on QOL, stress, and related variables in euthyroid HD women (N = 62). Data was collected pre-intervention, post-intervention, and at two-month follow-up. Results: Results demonstrated that the DBT-ST intervention provided statistically significant benefits, while no significant changes occurred in the group CBT and waitlist group. Among the outcome variables, DBT-ST was found to significantly increase the general health domain of QOL, the environmental mastery subscale of psychological well-being, the persistence subscale of emotional reactivity, and the tolerance subscale of distress tolerance, and significantly decrease levels of depression, anxiety, stress, and difficulties in emotion regulation. Economic status was identified as a covariate for anxiety and stress, and body mass index for general health. Considering the effects of covariates, DBT-ST explained the decrease in stress by 10.1%, an additional 2.7% compared to economic status, which explained 7.4% (p < 0.05). Discussion: Future research in line with the recommendations of this study may further contribute to the development of HD treatment guidelines.

Avoidant Personality Disorder (APD) is the most prevalent diagnosis amongst the personality disorders. However, it remains under-researched, and few psychotherapeutic approaches have proven effectiveness in treating the disorder. Focusing on specific elements of psychopathology may therefore help in refining treatments for this disorder. Here we present a case where Metacognitive Interpersonal Therapy (MIT) was used to directly address the negative metacognitive schemas held by clients with APD. We also describe the theoretical background of MIT and why it may be effective in the psychotherapeutic treatment of APD.

Obsessive compulsive disorder (OCD) is a common disorder characterised by persistent and unwanted intrusive thoughts, images, and urges and repetitive behaviours or mental acts and can cause pervasive impairments. In Bangladesh, the prevalence of OCD among children is 2% which is higher than in previous reporting. This study was aimed at looking into the type, frequency, and severity of symptoms of OCD and comorbidity among children and adolescents. A consecutive 60 OCD cases from a child mental health service with age range of 5–18 years were recruited and divided into below and above 12 years of age group. The assessment was carried out using standardized Bangla version of Development and Wellbeing Assessment and Children’s Yale-Brown Obsessive Compulsive Scale was administered. Of the obsession, contamination was the highest followed by doubt, and of the compulsion, washing/cleaning was the highest followed by checking, repeating, and ordering rituals. More than half of the subje...

This study investigates the relationship between reported bruxism, recurrent headaches and signs o f TMJ dysfunction. 244 consecutive pa­ tients attending the Examination and Emergency Primary Care Unit for dental treatment, were examined for signs o f TMJ dysfunction. The patients also completed a questionnaire which determined the preva­ lence o f recurrent headaches and habitual bruxism. Results were anal­ ysed using cross-tabulation to obtain chi-square values to investigate associations between reported bruxism, recurrent headaches and TMJ dysfunction. There was a highly significant relationship between: TMJ and masticatory muscle pain and recurrent headaches (p&lt;0.005); Reported bruxism and TMJ and masticatory muscle pain (p&lt;0.001), and a significant relationship between: Reported bruxism and recurrent headaches (p&lt;0.05). The frequency o f the signs and symptoms provides support for clo­ ser liaison between dentists and other disciplines to provide improved education, ...

A recent study identified three distinct OCD treatment-response trajectories during and after treatment in a large pediatric sample, where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study is an extension of this, examining what characterizes limited responders to CBT regarding contamination symptoms from baseline to 3-year follow-up. The study sample comprised 269 patients with OCD, aged 7–17 years. All participants received stepped-care treatment with manualized CBT. Differences in single item-reporting between the three groups was examined using linear mixed-effect modeling. Limited responders were characterized by a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. In the limited responder group, five contamination items showed persistence from baseline to 3-year follow-up. The results indicate that specific contamination symptoms may play an importa...

Balancing plays a crucial role in our day-to-day activities and sports performance. However, the evaluation of this skill lacks standardized approaches, resulting in a wide range of practices. This article presents an introduction and critique to some conventional assessment tests used to evaluate balance skills and examines the principles, advantages, and limitations associated with these conventional tools. The conventional balance assessment reviewed in this paper included 10 conventional tests such as Berg Balance Scale, Tinetti Balance Test, Romberg Test, among others, and 2 slightly newer approach, which are the Balance Evaluation Systems Test (BESTest) and the Limits of Stability (LOS) test. The aim of the article was to introduce the available conventional balance assessment methods and highlights the importance of enhancing the conventional method with more precise, individualized approach through incorporation of sensor-based measurements. Suggestions to reduce dependency ...

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingiva...

Public safety personnel (PSP) and healthcare providers (HCP) are routinely exposed to potentially psychologically traumatic events and are at increased risk of developing mental disorder symptoms and posttraumatic stress injuries (PTSI). The Before Operational Stress program (BOS) is an evidence-informed mental health and resiliency training programme designed to mitigate the effects of PTSI. We conducted 41 in-depth semi-structured interviews with PSP and HCP who had completed the BOS program to investigate whether and how the programme benefits mental health, and how the content can integrate with their personal and professional lives. Data were analysed using team-based template analysis. The four overarching themes that emerged were: (1) health journeys; (2) the ripple effect of helping; (3) the destabilising effect of organizational pressures; and (4) context matters to how the programme was received. Each main theme was developed and supported by multiple subthemes explored herein. The results indicated BOS was well-received and helpful to participants at various career stages while furthering the discourse on mental health in PSP and HCP workplaces; however, difficulties were reported related to persistent stigma around mental health injuries. Organizational policies and systemic strains appear to be key contextual determinants and barriers.

Background: Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making. Methods: Cross-sectional, semi-structured questionnaire-based study. Results: Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose secondgeneration antipsychotics than those without knowledge of these trials (χ 2 = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form of psychotherapy for themselves rather than patients (χ 2 = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0). Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy.

Objective: To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality, mood, life satisfaction, health-related quality of life, sense of coherence and pain for patients with a spinal cord injury and neuropathic pain. Design: A prospective intervention study. Patients: Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme in parallel with 11 patients in a control group. Methods: A comprehensive pain management programme comprising educational, cognitive, and behavioural interventions was created for patients with spinal cord injury and neuropathic pain. The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions, behavioural therapy, relaxation, stretching, light exercise and body awareness training. All patients were followed-up 3, 6 and 12 months after completion of the programme. Results: At the 12-month follow-up, levels of anxiety and depression in the treatment group decreased compared with baseline values, and a tendency towards better quality of sleep was seen. In comparison with the control group, patients in the treatment group improved regarding sense of coherence and depression. This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain.

Background: Fatigue is the most frequent and burdensome symptom of patients with diffuse glioma. It is closely linked to decreased health-related quality of life and symptoms such as depression and sleep disturbances. Currently, there is no evidence-based treatment that targets severe fatigue in patients with brain tumours. Cognitive behavioural therapy is aimed at fatigue-maintaining beliefs and behaviour. This therapy has been proven effective in reducing severe fatigue in cancer survivors and patients with multiple sclerosis. A blended therapy program combines sessions with a therapist with therapist-guided web-based therapy modules. The aim of this randomized controlled trial is to determine the efficacy of blended cognitive behavioural therapy in treating severe fatigue in patients with diffuse glioma. We will include a maximum of 100 patients with diffuse glioma with clinically and radiologically stable disease and severe fatigue (i.e. Checklist Individual Strength, subscale fatigue severity ≥ 35). Patients will be randomized to blended cognitive behavioural therapy or a waiting list condition. The 12-week intervention GRIP on fatigue consists of five patient-therapist sessions and five to eight individualized web-based therapy modules supported by email contact. The primary outcome measure is fatigue severity. Secondary outcome measures include sleep quality, health-related quality of life, depression, anxiety, functional impairment and subjective and objective cognitive functioning. Primary and secondary outcome measures will be assessed at baseline and after 14 and 24 weeks. Magnetoencephalography and MRI will be used to evaluate potential biomarkers for intervention success. This trial has a Bayesian design: we will conduct multiple interim analyses to test for efficacy or futility of the trial. This is the first trial within the GRIP trial platform: a platform developing four to five different interventions for the most common symptoms in patients with diffuse glioma.

Health-related Quality of Life (HRQoL) has become an important construct in contemporary medicine and health care, permitting assessment of disorder burden and evaluation of interventions on various aspects of functioning, in a standardized manner. Here we review literature on the measurement of HRQoL in insomnia populations, and the extent to which insomnia treatment improves domains of HRQoL. It is concluded from the relatively small literature that insomnia impacts on diverse areas of HRQoL, and that both pharmacological and non-pharmacological interventions can produce, to varying degrees, improvements in domains spanning physical, social and emotional functioning. Limitations of the current literature are identified; with particular emphasis on measurement and conceptual shortcomings. Suggestions are made in relation to improving the quality of future research, and how to further shed light on the impact of insomnia -and treatment thereof -on both HRQoL and global quality of life.

Objective: To investigate whether the use of cognitive behavioural therapy in pulmonary rehabilitation addresses the depression and anxiety burden and thereby improves rehabilitation outcomes. Design: Prospective controlled clinical trial. Patients: A total of 70 patients with chronic obstructive pulmonary disease who were referred to a community centre for pulmonary rehabilitation. Methods: Patients were allocated to either the control group, consisting of pulmonary rehabilitation alone, or to the treatment group, receiving pulmonary rehabilitation and an additional 6 sessions of group-based cognitive behavioural therapy. Assessments consisting of questionnaires and walk tests were conducted pre-and post-pulmonary rehabilitation. Results: A total of 28 patients were enrolled. The cognitive behavioural therapy group had significant improvements in exercise capacity following pulmonary rehabilitation (mean change 32.9 m, p = 0.043), which was maintained at 3 months post-pulmonary rehabilitation (mean change 23.4 m, p = 0.045). Patients in the cognitive behavioural therapy group showed significant short-term improvements in fatigue, stress and depression (mean change 2.4, p = 0.016, 3.9, p = 0.024 and 4.3, p = 0.047, respectively) and a 3-month post-pulmonary rehabilitation improvement in anxiety score (mean change 3.1, p = 0.01). No significant changes were seen in the control group. Conclusion: The addition of cognitive behavioural therapy improved patients' physical, psychological and quality of life results. Cognitive behavioural therapy should be considered for inclusion in a pulmonary rehabilitation programme to enhance outcomes.

This paper explores the innovative use of pop cultureparticularly film and television-as a pedagogical tool for teaching Cognitive Behavioural Therapy (CBT). By analyzing familiar narratives through a CBT lens, learners can observe key concepts such as cognitive distortions, automatic thoughts, and behavioral patterns in action. Films like Inside Out, Good Will Hunting, and Groundhog Day vividly depict core CBT principles, enabling students to engage with psychological content in an emotionally resonant and accessible manner. This media-based approach supports experiential learning, enhances empathy, and facilitates the application of theoretical knowledge to real-world contexts. Moreover, it promotes cultural sensitivity and clinical reasoning through reflective and interactive activities such as scene analysis, role-play, and cognitive restructuring exercises. The integration of narrative media into CBT education represents a valuable, inclusive strategy that bridges the gap between abstract theory and therapeutic practice, enriching both academic instruction and clinical training.

Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common "therapist behaviours" and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one-and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework, informed about module content, emphasised the importance of patient responsibility, confronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirming correlated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

Objective: To determine whether the addition of cognitive behaviour therapy and motivational interviewing (CBT/MI) to standard alcohol and other drug (AOD) care improves outcomes for young people with comorbid depression and substance misuse. Participants and setting: Participants were young people with comorbid depression (Kessler Psychological Distress Scale score у 17) and substance misuse (mainly alcohol and/or cannabis) seeking treatment at two youth AOD services in Melbourne, Australia. The study was conducted between September 2006 and September 2008. Sixty young people received CBT/MI in addition to standard care (SC) (the SC+CBT/MI group) and 28 received SC only (the SC group). Main outcome measures: Depressive symptoms and AOD use in the previous 30 days, measured at baseline and at 3-month and 6-month follow-up. Results: Compared with participants in the SC group, those in the SC+CBT/MI group showed significant reductions in depression and cannabis use and increased social contact and motivation to change substance use at 3-month follow-up. However, at 6month follow-up, the SC group had achieved similar improvements to the CBT/MI group on these variables. All young people achieved significant improvements in functioning and quality of life variables over time, regardless of treatment group. No changes in AOD use were found in either group at 6-month follow-up. The delivery of CBT/MI in addition to SC may achieve accelerated MJA 2011; 195: S31-S37 treatment gains in the short term.

The purpose of this study is to compare the impact of cognitive-behavioral therapy and metacognitive therapy on social phobia symptoms of Hamadan city patients. In this experimental design, among the patients with social phobia who referred to psychological and guidance clinics of Hamadan in 2011, 45 subjects were selected through simple random sampling method, and 15 subjects were randomly assigned in the first experimental group (cognitive-behavior therapy), 15 subjects in the second experimental group (meta-cognitive therapy) and 15 subjects in the control group. The first experimental group received eight sessions (two hours) of cognitive-behavior therapy intervention during two months, the second experimental group received eight sessions (two hours) of meta-cognitive therapy intervention during two months while the control group received no intervention. The data collection instrument was Moshaveri&#39;s Social Phobia Assessment Scale. The result of the one-way ANOVA analysis ...

Jan Scott trained in CBT with Aaron T. Beck in Philadelphia. She is one of three convenors of the Newcastle Cognitive Therapy Centre Diploma Course and is a specialist registrar trainer in CBT. Her main research interests are the application of CBT to chronic and severe mental disorders. Stephen Moorhead took up one of the first psychotherapy training posts dedicated to CBT.He is in his second year as a Lecturer in Cognitive Therapy (University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne NEI 4LP) and has recently submitted an MD on bipolar disorders.

Background: Persistent auditory hallucinations are common, disabling and difficult to treat. Cognitive behavioural therapy is recommended in their treatment though there is limited empirical evidence of the role of cognitive factors in the formation and persistence of voices. Low self-esteem is thought to play a causal and maintaining role in a range of clinical disorders, particularly depression, which is prevalent and disabling in schizophrenia. It was hypothesized that low self-esteem is prominent in, and contributes to, depression in voice hearers. Methods: Beliefs about persistent auditory hallucinations were investigated in 82 patients using the Beliefs About Voices Questionnairerevised in a cross-sectional design. Self-esteem and depression were assessed using standardized measures. Results: Depression and low self-esteem were prominent as were beliefs about the omnipotence and malevolence of auditory hallucinations. Beliefs about the uncontrollability and dominance of auditory hallucinations and low self-esteem were significantly correlated with depression. Low self-esteem did not mediate the effect of beliefs about auditory hallucinations-both acted independently to contribute to depression in this sample of patients with schizophrenia and persistent auditory hallucinations. Conclusions: Low self-esteem is of fundamental importance to the understanding of affective disturbance in voice hearers. Therapeutic interventions need to address both the appraisal of self and hallucinations in schizophrenia. Measures which ameliorate low self-esteem can be expected to improve depressed mood in this patient group. Further elucidation of the mechanisms involved can strengthen existing models of positive psychotic symptoms and provide targets for more effective treatments.

A comprehensive meta-analysis was conducted using studies of cognitive-behaviouraltherapy-based interventions (CBT-BIs) for late-life depression. Patient characteristics, CBT modality, and other study variables were analyzed using subgroup and metaregression analysis methods. Results showed the collective treatment effect of CBT-BIs for reducing late-life depression to be moderate (g = -0.63) with significant heterogeneity (I 2 = 66.12%). CBT-BIs were found to be no more effective immediately posttreatment than other psychological treatments, pharmacotherapy, or combination interventions. The data support the notion that CBT is more effective in the long term. résumé On a mené une méta-analyse approfondie d'après des interventions basées sur la thérapie cognitivo-comportementale (IB-TCC) conçues pour le traitement de la dépression à un âge avancé. On analysa les caractéristiques du patient, les modalités de la TCC et d'autres

According to cognitive models of social anxiety, negatively distorted self-images have a central role in the development and maintenance of social anxiety. In the present study, the relationship between social anxiety and the perception of one's own voice was investigated in a sample of 17 undergraduate students. The participants were asked to recount a story aloud in front of a tape recorder, and then to rate their voice characteristics on a Voice Evaluation Questionnaire. Independent observers (speech therapy students) were then asked to listen to the tape recordings and to rate the participants' voice characteristics on an equivalent version of the Voice Evaluation Questionnaire. Two hypotheses were contrasted: a skill deficits hypothesis and a cognitive distortion hypothesis. The results supported the cognitive distortion hypothesis. A high level of social performance anxiety was associated with an underestimation of one's voice qualities, compared with the independent observers. It is suggested that sound-tape feedback with cognitive preparation should be tested as a method for correcting the negatively distorted voice perception that is associated with social anxiety.

Background: The prevalence of mental illness in young people is the highest of any age group, with the onset of depression, anxiety and substance use peaking between 18 and 24 years. Effective treatments that target subthreshold or mild to moderate levels of disorder in young people are required to reduce the risk of persistence and recurrence. The aims of this study are to evaluate whether treatments that are less intensive than cognitivebehaviour therapy, such as problem solving therapy and exercise treatments, are acceptable and effective in managing depression and anxiety symptoms in young people and to identify possible attributes in those who are likely to respond to these treatments. Methods/design: This is a factorial randomised controlled trial conducted at a large, metropolitan youth mental health service. Participants are young help-seekers aged 15-25 years with sub-threshold or mild to moderate levels of depression and anxiety (with or without comorbid substance use). The interventions comprise 4 treatment combinations delivered by psychologists over 6 sessions on a weekly basis: a psychological intervention (problem solving therapy versus supportive counselling) and an exercise intervention (behavioural exercise versus psychoeducation). Structured assessments occur at baseline, mid-point, end-point (6 weeks) and at a 6-and 12month follow-up. The primary outcomes are depression and anxiety symptoms as measured by the Beck Depression and Anxiety Inventories. Secondary outcomes include remission (defined as no longer meeting the diagnostic criteria for a disorder if threshold level was reached at baseline, or no longer scoring in the clinical range on scale scores if sub-threshold at baseline), substance use, and functioning. Discussion: The effectiveness of less complex psychological and exercise interventions in young help-seekers with sub-threshold or mild to moderate presentations of high prevalence disorders is yet to be explored. This study has been designed to examine the effectiveness of these interventions delivered alone, or in combination, in a youthspecific service. If effective, the interventions have the potential to prevent the progression of early symptoms and distress to later and potentially more serious stages of mental disorder and reduce the likelihood of ongoing problems associated with the risk of persistence and recurrence.

Objective To compare the cost effectiveness of general practitioner care and two general practice based psychological therapies for depressed patients. Design Prospective, controlled trial with randomised and patient preference allocation arms. Setting General practices in London and greater Manchester. Participants 464 of 627 patients presenting with depression or mixed anxiety and depression were suitable for inclusion. Interventions Usual general practitioner care or up to 12 sessions of non-directive counselling or cognitive-behaviour therapy provided by therapists. Main outcome measures Beck depression inventory scores, EuroQol measure of health related quality of life, direct treatment and non-treatment costs, and cost of lost production. Results 197 patients were randomly assigned to treatment, 137 chose their treatment, and 130 were randomised only between the two psychological therapies. At four months, both non-directive counselling and cognitive-behaviour therapy reduced depressive symptoms to a significantly greater extent than usual general practitioner care. There was no significant difference in outcome between treatments at 12 months. There were no significant differences in direct costs, production losses, or societal costs between the three treatments at either four or 12 months. Sensitivity analyses did not suggest that the results depended on particular assumptions in the statistical analysis. Conclusions Within the constraints of available power, the data suggest that both brief psychological therapies may be significantly more cost effective than usual care in the short term, as benefit was gained with no significant difference in cost. There are no significant differences between treatments in either outcomes or costs at 12 months.

Existing literature regarding the efficacy of Botulinum toxin A (BoNT-A) therapy in improving the clinical outcomes of temporomandibular disorders (TMDs) is ambiguous and lacks consistency. Thus, this study aimed to evaluate the efficacy of BoNT-A in reducing pain, occlusal force, electromyographic (EMG) changes, and maximum mouth opening compared with placebo and other interventions. An electronic database search was conducted using MEDLINE, PubMed, Google Scholar, the Cochrane Library, and ClinicalTrials.gov from January 2000 to June 2024 to identify randomized controlled trials (RCTs). A manual search complemented the electronic search. The Risk of Bias 2 (RoB 2) assessment was used to evaluate the internal validity of the included studies. A total of 1719 studies were identified, of which 23 fulfilled the inclusion criteria. Nineteen of these studies evaluated pain levels (primary outcome) after BoTN-A therapy, with six of them observing a decrease. In terms of secondary outcomes, seven of 10 studies noted an increase in maximum mouth opening, while all six reported a drop in EMG activity, and all four found a decrease in occlusal force following BoNT-A therapy. Muscle activity and biting force were significantly reduced in the therapeutic groups. Clinicians must consider these adverse events before treating patients with BoNT-A therapy. Additional regulatory guidelines and standardization of injection protocols are essential in improving therapeutic outcomes and patient safety. These findings suggest that BoNT-A may be a feasible option for TMD management but should be used with caution in clinical settings.

In the first article in this series (Williams & Garland, 2002) we encouraged readers to try out elements of the Five Areas model of cognitive–behavioural therapy (CBT) with some patients. Before we further discuss the model it might be of value to reflect on your experiences. If you did try, was it successful? Did it teach you anything about your clinical skills and the patients&#39; problems? Can you build on this experience and use the Five Areas model more widely in your practice? If you did not try this out, why not? Were you prevented by internal factors (too busy, could not see the patient, thought you could not do it) or problems beyond your control (the patient failed to turn up)? How can you overcome these obstacles?

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.

T he author suggests that contemporary enthusiasm for cognitive-behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. T he psychoanalytic and cognitive-behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. T he author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. S he discusses how the analytic stance is always under pressure to 'collapse' into simpler modes, one of which resembles a cognitive one. T his also occurs inevitably, she argues, when attempts are made to 'integrate' the two models. Cognitive and 'integrated' treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on 'dynamic' than 'cognitive' elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.

Abstract
Multiple psychotherapy approaches for schizophrenia spectrum disorders were evaluated as evidence-based and even held as gold-standard treatments by the general psychiatric community. However, none of the treatments were found to produce consistently strong effect sizes in randomized clinical trials, and none were found to be effective as standalone treatments. A major criticism of the existing treatments was that they focused exclusively on direct intervention rather than using the therapeutic relationship as the major vehicle for change. The qualitative study explored the lived experiences of individuals who suffered from schizophrenia and psychotic disorders. The study focused on what the participants felt was helpful or unhelpful in their relationship with their treating psychotherapists. Justification for focusing on relational dynamics and interventions was based on the work of Kingdon et al. (2004) and Norcross (2019), who found that relational dynamics served as a major mechanism for change across all diagnostic boundaries. A group of 16 participants was interviewed to identify common themes regarding what they found to be helpful in achieving remission from their psychotic illness.
Key Words: Psychosis, Schizophrenia, Schizoaffective, Delusions, Auditory Hallucinations, Therapeutic Relationship

This forensic case study examines the rehabilitation of Mr. 12X, a 35-year-old inmate from Rajkot, India, who had a privileged background but struggled with substance dependency and aggression. His involvement in a violent act of revenge following an assault led to multiple charges, including murder. Psychological intervention using Cognitive Behavioral Therapy (CBT), structured counseling, and lifestyle modifications were employed to address his aggression, substance cravings, and emotional dysregulation. The intervention resulted in a significant reduction in irritability, cessation of psychiatric medication, improved sleep, and the adoption of healthier coping mechanisms such as exercise and meditation. The study underscores the potential for rehabilitation in forensic settings, demonstrating how targeted psychological care fosters accountability and long-term behavioral change, enabling reintegration into society. Background: This case study focuses on Mr. 12X, a 35-year-old inmate, whose privileged upbringing and artistic talents were overshadowed by substance dependency and unaddressed psychological trauma. After surviving a brutal assault by gang members, Mr. X retaliated in a violent act of revenge, leading to his imprisonment under multiple charges, including murder. The study explores the psychological, social, and legal dimensions of his actions and subsequent rehabilitation. Methodology: Structured psychological intervention was given initiating rapport building as well as completing MSE, that included tailored application of CBT specific to addressing agitation, craving substances, and emotional regulation. Counselling interventions along with adjustments in the individual's lifestyle as applied with modifications of exercises in addition to conducting meditation for all clients who undergo the treatment programme. There are constant reviews aimed at continuous enhancement of intervention practices based on improvements. Result: The intervention led to remarkable improvements in the psychological and behavioural condition of Mr. X. He quit taking psychiatric and sleeping medications as he no longer required them. His irritability and aggression considerably reduced, while he started enjoying quality sleep with the help of neither medication nor medical intervention. Positive lifestyle patterns such as daily exercise and meditation were adopted by him. Self-awareness led him to reflect on his previous behaviour and action and commit towards long-term selfimprovement. This case illustrates the capacity for rehabilitation, even in a forensic context, through planned psychological treatment. Such intervention allowed for confronting the root cause and bringing positive behavioural change so that the person would learn better for long

This case study examined the assessment, treatment, and outcomes of a 53-year-old man presenting with chronic paranoid schizophrenia. This individual presented with significant anxiety, stress, and depression symptoms resulting from his inability to cope with persistent and persecutory auditory hallucinations and delusions. The treatment approach was drawn from principles of cognitive behavioral therapy, in particular the Coping Strategy Enhancement Approach (CSE; . This approach is used for people suffering from persistent hallucinations and delusions. The CSE aims to assist the individual develop adaptive coping strategies in the physiological, cognitive, and behavioral domains. Findings suggested a reduction in depression, anxiety, and stress reported during the course of the interview despite the persistent and significant positive symptoms. Furthermore, the participant reported increased confidence in managing these symptoms and developed simple and reportedly effective coping skills. As results supported the use of the cognitive behavior therapy (CBT) approach, the findings were moderate. There were several factors contributing to these results, such as lack of consistent carer support and the intellectual impairments associated with the illness. These factors are described in the study, with recommendations for future interventions.

This case study examined the assessment, treatment, and outcomes of a 53-year-old man presenting with chronic paranoid schizophrenia. This individual presented with significant anxiety, stress, and depression symptoms resulting from his inability to cope with persistent and persecutory auditory hallucinations and delusions. The treatment approach was drawn from principles of cognitive behavioral therapy, in particular the Coping Strategy Enhancement Approach (CSE; . This approach is used for people suffering from persistent hallucinations and delusions. The CSE aims to assist the individual develop adaptive coping strategies in the physiological, cognitive, and behavioral domains. Findings suggested a reduction in depression, anxiety, and stress reported during the course of the interview despite the persistent and significant positive symptoms. Furthermore, the participant reported increased confidence in managing these symptoms and developed simple and reportedly effective coping skills. As results supported the use of the cognitive behavior therapy (CBT) approach, the findings were moderate. There were several factors contributing to these results, such as lack of consistent carer support and the intellectual impairments associated with the illness. These factors are described in the study, with recommendations for future interventions.

A growing body of work suggests that obese adults are less likely to adhere to exercise than normal-weight adults because they experience greater levels of discomfort and distress during exercise sessions. The present study introduces and provides a preliminary test of the hypothesis that the distress experienced during exercise among persons with elevated body mass index is particularly high among those who fear somatic arousal (i.e. elevated anxiety sensitivity [AS]). Young adults were randomly assigned to complete 20 min of treadmill exercise (at 70% of their age-adjusted predicted maximum heart rate) or 20 min of rest. Body mass, AS, and negative affect were measured at baseline, and fear was measured at 4-min intervals during the experimental phase. Consistent with the authors' hypothesis, there was a significant Exercise £ BMI £ ASI interaction (sr 2 ¼ .08), suggesting that the greatest fear levels during exercise were observed among participants with high body mass, but only if they also had elevated AS. These findings offer a new approach for identifying specific vulnerable individuals and have clear clinical implications, given that the amplification factor of AS can be modified with clinical intervention.

The present study examined symptom change profiles in patients with generalized anxiety disorder (GAD) receiving either cognitive behavioural therapy (CBT) or applied relaxation (AR). It was hypothesized that (a) changes in worry would uniquely predict changes in somatic anxiety for most participants receiving CBT and (b) changes in somatic anxiety would uniquely predict changes in worry for most participants in the AR condition. Twenty participants (CBT n=10; AR n=10) completed daily ratings of worry and somatic anxiety during therapy, and multivariate time series analysis was used to assess the causal impact of each variable on the other. The hypotheses were not supported because we found no evidence of a match between individual symptom change profiles and treatment condition. Rather, a bidirectional relationship between worry and somatic anxiety was observed in 80% of participants receiving CBT and 70% of participants receiving AR. When only treatment responders were considered, 83% of participants receiving CBT and 86% of those receiving AR had such a bidirectional effect. The findings are discussed in terms of models of psychopathology that posit dynamic interactions between symptom clusters and in terms of the value of examining treatment mechanisms at the individual level.