<p>Kognitiv beteendeterapi (KBT) avser att hjälpa personer med problembeteenden så att fokus ligger på nuet och framtiden, vilka mål som bör sättas upp så att en positiv förändring kan ske. KBT syftar till att människor ska kunna leva i samhället utan begränsning och med bättre livskvalitet. Denna kvalitativa studie visar hur KBT kan användas för social fobi och depressionsproblematik. Fem deltagare intervjuades, två psykiatrisjuksköterskor och tre psykologer. Alla arbetar utifrån KBT och studien visar deras upplevelser av metoden samt hur behandlingarna kan se ut. De evidensbaserade metoderna inom KBT, beteendeaktivering för deprimerade patienter och exponering för patienter med social fobi, är en del av det som behandlarna arbetar med och som de uttrycker ger en positiv effekt hos patienter.</p>

This qualitative study aimed to identify how personnel working in a residential home in Sweden work withCognitive Behavioral Therapy (CBT) orientation within the organization. Semi-structured interviews were conducted with five personnel. The research questions were; How do the personnel describe the CBT orientation? How do the personnel describe the CBT tools and methods? How do the personnel describe and measure the implementation of CBT? The results were analyzed an Interpretive Phenomenological Analysis (IPA) tool in order to gain a greater understanding of the data. The theories used to analyze the results were the learning theory, attachment theory and New Public Management (NPM). The results of this study indicate that CBT was incorporated in the daily lives of the residents throughout the course of the day and the personnel described common methods such as Aggression Replacement Therapy (ART), Dialectal Behavioral Therapy (DBT), and Motivational Interviewing (MI).

Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

Clinical research on insomnia has observed that many individuals with this sleep disorder exhibit a significant discrepancy between their subjective reports of symptom severity and objective measures of the same parameters. This study sought to more closely examine this discrepancy by comparing sleep diary estimates with polysomnography data in a population of 60 older adults with comorbid insomnia. Consistent with previous research, results show that participants significantly underestimated sleep efficiency and total sleep time and significantly overestimated sleep onset latency. Participants receiving CBT-I exhibited significantly reduced discrepancy at post-treatment, particularly with regard to sleep latency, compared to those in a Stress Management and Wellness treatment control group. This suggests that the treatment effects observed as a result of CBT can be partly explained by improvements in the accuracy of sleep estimation. Additionally, high discrepancy at baseline was found to be a significant predictor of positive treatment outcome, indicating that sleep misperception is a potential factor in a favorable treatment response to CBT.

Previous research supports the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with comorbid psychiatric diagnoses; however, questions remain about the effectiveness of CBT-I due to the fact that previous studies excluded patients with significant psychiatric symptoms and comorbid diagnoses. This study begins to address this gap in the insomnia literature by testing a five-session CBT-I intervention in a diverse sample of patients receiving mental health treatment in an outpatient psychiatry clinic (N=23) who continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. Participants were randomized to CBT-I (n=13) or a treatment as usual control group (n=10). Following one week of baseline sleep diary assessment, those in the CBT-I group completed five sessions of individual treatment; three in-person and two by phone. Those in the treatment as usual group continued with medication treatment as prescribed by their psychiatrist for a five-week period and were then given the opportunity to cross over to receive CBT-I. Study results show that adding a brief CBT-I intervention to usual care led to significant improvements in sleep compared to treatment as usual. Effect sizes were generally large, illustrating the potency of CBT-I in a psychiatric sample. Sleep gains were largely maintained at two-month follow-up. No significant changes in depression or anxiety severity were seen in the CBT-I group, suggesting that sleep interventions alone may not have the same impact in a psychiatric population with more severe and chronic mental health symptoms. Quality of life in the area of social functioning was improved following CBT-I compared to treatment as usual; however, this gain was not maintained at two-month follow-up. Finally, CBT-I was not associated with a reduction in use of sleep medication. This may reflect this sample's high level of chronicity of insomnia or a propensity towards medication dependency. In sum, the findings of this study suggest that selected patients with complex and chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone. Future research should focus on identifying factors that predict which “real-world” psychiatric patients are most likely to undergo and benefit from CBT-I.

Although evidence-based treatments (EBTs) often perform well in research settings, when EBTs are delivered in practice settings they sometimes fail to outperform usual care (UC). One reason for this could be that therapists in practice settings may not follow the EBT protocol as closely or may deliver more therapeutic interventions that align with other treatment domains. I tested this possibility in the context of cognitive-behavioral treatment (CBT) for youth anxiety by comparing how CBT was delivered in practice (i.e., community-based clinics) and research (i.e., lab) settings. A diverse sample of youth (aged 7-15) received one of two treatments to address primary presenting problems of anxiety: CBT in a lab (N = 51), CBT in clinics (N = 18), or UC in clinics (N = 22). The extensiveness of therapeutic interventions delivered was measured using the Therapy Process Observational Coding System for Child Psychotherapy – Strategies Scale (McLeod & Weisz, 2010). Two coders independently coded the same available sessions. Analyses investigated mean-level differences in interventions session-by-session, over time between the three groups. Results indicated that CBT delivery differed across groups, over time. Future researchers should use this characterization to further implementation and process-outcome research, and eventually either enhance quality control efforts or alter aspects of EBT protocols (Garland, Hulbert, & Hawley, 2006).

Background: One-in-three carers of stroke survivors experience depression with no psychological treatments tailored to meet their needs, such as barriers to attending traditional face-to-face psychological services. A cognitive behavioural therapy (CBT) self-help approach may represent an effective, acceptable solution. Methods: Informed by the MRC framework (2008) for complex interventions, six studies informed development, feasibility and piloting of a CBT self-help intervention for depressed carers of stroke survivors: Study One: Systematic review and meta-analysis of psychological interventions targeting depression and anxiety in carers of people with chronic health conditions; Study Two: Interviews to understand difficulties experienced by depressed and anxious carers; Study Three: Interviews to understand positive coping strategies used by non-depressed and non-anxious carers; Study Four: Drawing on results of Studies One to Three, iterative modelling to develop the CBT self-help intervention; Study Five: Feasibility randomised controlled trial to examine methodological and procedural uncertainties for a Phase III definitive trial; Study Six: Updated systematic review and meta-analysis. Results: Study One: 16 studies identified for inclusion yielding small and medium effect sizes for depression and anxiety respectively, with trends for individually delivered treatments over shorter session durations to be more effective for depression. Six additional studies were included in Study Six, replicating Study One results; Study Two: Depressed and anxious carers experience difficulties adapting to the caring role, managing uncertainty, lack of support and social isolation; Study Three: Non-depressed and non-anxious carers utilise problem-focused coping strategies to gain balance and adapt to caring role, use assertiveness, seek social support and positive reinterpretation; Study Four: Developed a theory-driven CBT self-help intervention; Study Five: Recruited 20 informal carers in 10-months, representing 0.08% of invited carers randomised with high attrition in the intervention arm. Lack of GP recognition, gatekeeping and barriers to accessing psychological support identified as reasons for poor recruitment. Conclusions: A greater appreciation is required concerning barriers experienced by informal carers of stroke survivors to accessing support for depression and type of acceptable psychological support.

Hundreds of thousands of people are affected by natural disasters every year. Many of these people face mental and emotional consequences from the traumatic experience. Research indicates that the aftereffects of such experiences can result in social, familial, and educational impairments in children. The current study tested the efficacy of a brief cognitive behavioral intervention on elementary school aged children intended to alleviate the mental and emotional consequences following a natural disaster. The study applied quantitative methods through pre and post intervention assessments measuring stress and hope. The participants assessed included 18 Filipino children between the ages of 10-12 years, who had recently been exposed to one of the strongest typhoons in the country’s history. Incorporating a quasi-experimental design, 12 of these participants were given a brief cognitive behavioral intervention based on their parent / caregiver involvement in a supplemental workshop and 6 participants were engaged in facilitated play acting as a comparison group. Results indicated that the cognitive behavioral intervention was effective in reducing stress in children, but had little to no effect on hope. However, facilitated play proved to be effective in raising hope levels, but also raised stress levels in children. An inference may be made that future interventions embodying both cognitive behavioral therapy and facilitated play could increase hope and decrease stress in children who have experienced a natural disaster. Furthermore, these initial findings contribute to seeking advocacy for inclusion of brief and low cost mental health interventions as part of relief efforts.

Depression, anxiety, and stress are responsible for an overwhelming number of mental health care visits, and cognitive behavior therapy (CBT) is the most common empirically supported treatment for these conditions. Yet little is known about the effectiveness of CBT with African Americans, Latinos, Asian Americans, and Native Americans — ethnic and racial groups conprising nearly half of the U.S. population. In this volume, Chang, Downey, Hirsch, and Yu show therapists how to adapt cognitive behavioral treatments for use with racial and ethnic minority clients. Contributors demonstrate how a client's particular sociocultural background contextualizes his or her experience and understanding of mental health issues. They examine the influence of sociocultural context on experiences of social anxiety among Asian-Americans, the role of racial identity in the way stress and anxiety are experienced by African American clients, and much more. / https://dc.etsu.edu/etsu_books/1214/thumbnail.jpg

<p>Ett nytt sätt att behandla panikångest i form av gruppterapi med KBT redovisas ur ett patientperspektiv. Gruppterapeutisk historia och beståndsdelar i KBT tas upp liksom skamkänslor, ”compliance” och ”holding”. Fem kvinnor och tre män ur olika terapigrupper och med olika bakgrund intervjuades om sina upplevelser. Deltagarnas förväntningar, erfarenheter av gruppsammansättning och gruppdynamik samt gruppens bidrag till personliga förändringar och insikter studerades. Materialet bearbetades genom begreppskategorisering. Farhågor och förväntningar på andra deltagare dominerade hos deltagarna inför terapin. Under terapins gång hade andra deltagare motiverat och uppvärderat varandras behandlingsarbete samt visat på att individen inte var ensam om sitt tillstånd. Ingen var helt fri från panikångest efter behandling men har kunnat återerövra delar av sitt liv. Alla planerade någon form av behandlingsfortsättning.</p>