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Abstract Background: Cognitive Behaviour Therapy, (CBT) is well established as an effective treatment for depression. Its applicability in routine public mental health practice is however unknown, as most published studies excluded participants with suicide risk or if co-morbid with other disorders such as schizophrenia or bipolar affective disorder. Clients of public mental health services are characterised by symptom severity, chronic course of illness, treatment resistance and / or co-morbidity. In order to determine whether CBT has utility in routine public mental health practice, it is important to find out whether symptoms of depression (and anxiety) in this client population will respond to a course of CBT provided as part of standard care. Aims and Hypotheses: This effectiveness study aimed to ascertain if CBT is effective in treating depressed and/or anxious symptoms when such symptoms exist within the clinically more complex population found within Community Mental Health Services / Settings, (CMHSs). It was hypothesised that clients receiving CBT would show reliable and clinically significant improvement in symptoms of depression and anxiety but that the amount of improvement would be less than that reported in efficacy studies with less complex client groups. Method: This was a repeated measures, uncontrolled intervention study with results benchmarked against published data. Forty six adult clients of the Inner North Brisbane Mental Health Service (INBMHS) with diagnoses of Depression and / or Anxiety, in isolation or in conjunction with Schizophrenia, Bipolar affective disorder, or a Personality Disorder were treated with an eight (8) session manualised CBT program as part of routine clinical care. Standardised measures of depression, anxiety and stress were taken at time of referral, time of the commencement of treatment, time of treatment completion and at six-month post completion of treatment. Results: Participants showed reliable and statistically significant improvement in self reported symptoms from commencement to completion of treatment. Gains were retained at follow-up. Effect sizes were in the moderate to large range and improvements were clinically significant for approximately one third of the participants. Conclusions: CBT seems to be an effective treatment for depression and anxiety where such symptoms exist within a mental health population. Further research addressing the limitations of this study would add strength to the argument that the mental health population could benefit from the broad availability of such treatment.

<p>In this study have I examined how treatment of girls with neuropsychological impairments is functioning? I have looked at the theories and methods of treatment on the base of the care program and how it is put into practice. In addition I have interviewed four girls who have undergone the treatment program.</p><p>To gain perspective on institutional care as a social phenomenon, I have tried to give a brief historical retrospect in which particular care for women are described. I am also affecting certain gender aspects of institutional care. I have also tried to make a brief account of current research on the treatment.</p><p>The study is a qualitative study in which I am apart from literature studies used participant observation in depth interviews as a method.</p><p>My results indicate that a well structured treatment with CBT approach can work well to achieve lasting behavioural changes in students.</p>

<p>This study investigated the efficacy of a multicomponent cognitive–behavioral intervention of insomnia, CBT-I, for patients suffering from an anxiety disorder and/or a major depressive episode together with comorbid insomnia. In particular, the aim of the study was to evaluate whether anxiety and depressive symptoms declined as a function of</p><p>treatment for insomnia. After rigorous diagnostic procedures, 8 patients were treated in a multiple baseline design. Patients experienced clinically significant reductions in insomnia-, (57 %) depressive- (75 %) and anxiety symptoms (40 %). A three week follow-up measurement</p><p>demonstrated retained effects. These findings suggest that CBT-I is a feasible treatment for comorbid insomnia. It also provides partial support for insomnia as a possible causal agent of depression and anxiety. Further, a schematic model of transdiagnostic processes common to insomnia, anxiety and depression, is presented. More research is warranted to render better treatment for patients with anxiety</p><p>and/or depression and comorbid insomnia.</p> / <p>Denna studie undersökte effekten av en Kognitiv- Beteende Terapeutisk behandling mot insomni, KBT-I, för patienter som lider av ångeststörning och/eller egentlig depression samt komorbid insomni. Studiens syfte var framförallt att utvärdera om ångestsymtom och depressiva symtom reducerades som en följd av behandlingen mot insomni. En minutiös diagnostisk procedur tillämpades, varefter 8 patienter inkluderades i en multipel-baslinjes design. Deltagarna erhöll kliniskt signifikanta förbättringar på insomni-, (57 %) depressions- (75 %) och ångestsymtom</p><p>(40 %). Resultaten kvarhölls vid uppföljning tre veckor efter avslutad behandling. Resultaten tyder på att KBT-I är en tillämpbar behandling för patienter med komorbid insomni. Resultaten bidrar även med visst stöd för en kausal länk från insomni över till depression och ångest. Vidare</p><p>presenteras en teoretisk modell över transdiagnostiska processer som förekommer vid insomni, ångest och depression. Ytterligare forskning behövs för att åstadkomma effektivare behandling för patienter med ångest och/eller depression och komorbid insomni.</p>

This study investigated the efficacy of a multicomponent cognitive–behavioral intervention of insomnia, CBT-I, for patients suffering from an anxiety disorder and/or a major depressive episode together with comorbid insomnia. In particular, the aim of the study was to evaluate whether anxiety and depressive symptoms declined as a function of treatment for insomnia. After rigorous diagnostic procedures, 8 patients were treated in a multiple baseline design. Patients experienced clinically significant reductions in insomnia-, (57 %) depressive- (75 %) and anxiety symptoms (40 %). A three week follow-up measurement demonstrated retained effects. These findings suggest that CBT-I is a feasible treatment for comorbid insomnia. It also provides partial support for insomnia as a possible causal agent of depression and anxiety. Further, a schematic model of transdiagnostic processes common to insomnia, anxiety and depression, is presented. More research is warranted to render better treatment for patients with anxiety and/or depression and comorbid insomnia. / Denna studie undersökte effekten av en Kognitiv- Beteende Terapeutisk behandling mot insomni, KBT-I, för patienter som lider av ångeststörning och/eller egentlig depression samt komorbid insomni. Studiens syfte var framförallt att utvärdera om ångestsymtom och depressiva symtom reducerades som en följd av behandlingen mot insomni. En minutiös diagnostisk procedur tillämpades, varefter 8 patienter inkluderades i en multipel-baslinjes design. Deltagarna erhöll kliniskt signifikanta förbättringar på insomni-, (57 %) depressions- (75 %) och ångestsymtom (40 %). Resultaten kvarhölls vid uppföljning tre veckor efter avslutad behandling. Resultaten tyder på att KBT-I är en tillämpbar behandling för patienter med komorbid insomni. Resultaten bidrar även med visst stöd för en kausal länk från insomni över till depression och ångest. Vidare presenteras en teoretisk modell över transdiagnostiska processer som förekommer vid insomni, ångest och depression. Ytterligare forskning behövs för att åstadkomma effektivare behandling för patienter med ångest och/eller depression och komorbid insomni.

In this study have I examined how treatment of girls with neuropsychological impairments is functioning? I have looked at the theories and methods of treatment on the base of the care program and how it is put into practice. In addition I have interviewed four girls who have undergone the treatment program. To gain perspective on institutional care as a social phenomenon, I have tried to give a brief historical retrospect in which particular care for women are described. I am also affecting certain gender aspects of institutional care. I have also tried to make a brief account of current research on the treatment. The study is a qualitative study in which I am apart from literature studies used participant observation in depth interviews as a method. My results indicate that a well structured treatment with CBT approach can work well to achieve lasting behavioural changes in students.

The literature review produced for this thesis systematically analysed qualitative studies of cognitive therapy using a methodology checklist and a meta-synthesis technique. Ten papers which used qualitative analysis to look at clients’ experiences of Cognitive Behavioural Therapy (CBT) met the selection criteria. Seven themes emerged. Three were linked to a therapeutic relationships theme; the trusted listener, power and authority and others like me. Four were linked to the impact of cognitive therapy theme; empowering information, analysing the problem, thinking differently and doing things differently. It was concluded that future research should focus on the components of cognitive therapy and that differences in technique between CBT and Rational Emotive Behaviour Therapy (REBT) should be explored via a qualitative study of clients’ experiences of REBT. A qualitative approach was taken to look at clients’ experiences of REBT. Seven participants were interviewed using a semi-structured interview guide and the resulting transcripts were analysed using interpretive phenomenological analysis. Three themes emerged: one which looked at what it was like to have mental health problems; a second, which looked at clients’ expectations and experiences of the more technical aspects of therapy, and a third which examined the therapeutic relationship. All of the participants appeared to value therapy. However, the extent to which they knew about and used the theory and philosophy of REBT varied greatly. These results suggest that further research needs to be carried out which looks at how people benefit from therapy as clients views may differ from those of therapists. A critical appraisal of the research process was written using the REBT model to reflect the experience of producing the thesis.

Cognitive-behavioral therapy (CBT) is used to treat children and adolescents with depression. Researchers determined that many individuals undergoing CBT and other therapies experienced sudden gains, meaning that they experienced a rapid and large improvement in their symptoms between sessions. The studies demonstrated that by the end of treatment, individuals who experienced sudden gains were significantly less depressed and had better long-term outcomes than individuals who did not experience sudden gains. Previous studies investigated sudden gains in individual therapy while the present study examined sudden gains in group treatment. In addition to replicating results of previous studies, the present study sought to examine the effect of sudden gains on depressive symptoms, family environment, cognitive triad, and negative life events at pre-treatment and at a one year follow-up using multivariate analysis of variance. Participants included 136 girls, aged 9 to 13, in two treatment conditions (CBT, CBT+ parent training (CBT+PT), and a Minimal Contact Control (MCC)). At pre-treatment, post-treatment, and at a one year follow-up, participants completed self-report measures of the family environment, cognitive triad, and negative life events. They also completed a semi-structured diagnostic interview designed to symptoms of depression. After beginning the study, participants’ depressive symptoms were monitored with a brief symptom interview and/or a self-report measure of depressive symptoms. Findings from the study provided further evidence that sudden gains occur during group CBT, and that the majority of sudden gains occur early in CBT. The number of sudden gains did not vary significantly by treatment condition, and similar to previous research, the presence of a parent intervention component did not appear to significantly change the relation between sudden gains and treatment outcome. One important finding was participants in the Minimal Contact Control group experienced sudden gains despite not being in treatment. Another important finding was that the participants who experienced sudden gains differed significantly from the participants who did not experience sudden gains on pre-treatment measures of family environment and the cognitive triad but no differences were found at post-treatment or at a one year follow-up. Implications of these results, limitations, and recommendations for future research are provided. / text

Depressive and anxiety disorders are the most commonly encountered mental health problems seen in the primary care setting; they represent a serious public health concern, and are inordinately time consuming for the primary care provider. Cognitive behavioral therapy (CBT) is an effective tool for the treatment of both depression and anxiety, and can be delivered in a variety of abbreviated forms appropriate for use in the primary care setting. Despite its apparent benefits, few primary care providers report using CBT in their practices. The purpose of this project was to develop a better understanding of provider knowledge and perceived barriers regarding the use of CBT for the treatment of depression and anxiety in the primary care setting. A better understanding of practitioners' knowledge of CBT and their perceived barriers to its use will establish a baseline for further exploration of the issue, and will help guide the development of strategies to address the gap in practice. A brief questionnaire was provided to a convenience sample of Nurse Practitioners (NP) during a regular meeting of the Southern Arizona Advanced Practice Nurse/Nurse Practitioner Society. The results of the data analysis showed that 90% of the sampled NPs considered themselves to be skilled in detecting depression and anxiety in their patients, and 80% were confident in their abilities to treat patients with these disorders. However, only 30% of sampled NPs currently use CBT in their practices. The sample indicated a broad lack of knowledge related to multiple aspects of CBT including technique, training, implementation, and reimbursement. Education and training were revealed to be the strongest predictors of willingness to use CBT. Only 30% of NPs were introduced to the use of CBT in their NP programs. The results suggest that increased education in the proper technique, process, and billing methods for CBT may contribute to greater utilization by NPs in the primary care setting.