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Internet-based CBT for Depression

A 12-month follow-up of a randomized controlled trial

CBT study

BACKGROUND: In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers.

METHOD: Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section.

RESULTS: The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank ?2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06–0.75), when estimated by the Cox proportional hazard model.

CONCLUSIONS: The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

Imamura, K., Kawakami, N., Furukawa, T. A., Matsuyama, Y., Shimazu, A., Umanodan, R., Kawakami, S., … Kasai, K. (2015). Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial. Psychological Medicine, 1-11.

CBT plus Medication is Effective for Treatment Resistant Depression

According to a new study published online in The Lancet (December 7, 2012) and Contemporary Clinical Trials, cognitive behavior therapy (CBT) as an adjunct to usual care has shown to be an effective treatment for reducing depression and improving quality of life in patients with treatment resistant depression. Although pharmacotherapy is often used as a first-line treatment for depression, only one-third of patients fully respond to anti-depressants and only half receive up to a fifty percent decrease in symptoms. The current study employed a large-scale CoBalT (two parallel-group) randomized controlled trial to investigate the effectiveness of combining CBT and usual care (including pharmacotherapy) versus usual care, alone, for treatment resistant depression. Participants (n=469) ranged from age 18 to 75 and were already taking anti-depressants. They were randomly assigned to receive either CBT plus usual care (n=234) or usual care alone (n=235).

At the 6 month follow up, 46% of  participants (n=95) in the CBT plus usual care group met criteria for response to treatment, as compared to only 22% of participants (n=46)  in the usual care group. Those who received CBT were more likely to experience remission, received lower scores on the Beck Depression Inventory (BDI), and experienced fewer symptoms of anxiety and panic. At the 12-month follow up, these improvements were maintained.

This study is the first large-scale randomized control trial investigating CBT treatment as an adjunct to usual care in patients showing treatment resistance to anti-depressants.  Findings suggest that CBT in combination with usual care can be extremely effective for treating depressive symptoms and improving the quality of life of patients suffering from depression.

Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Garland, A, Hollinghurst, S., Jerrom, B., Kessler, D., Kuyken, W., Morrison, J., Turner, K., Williams, C., Peters, T., & Lewis, G. (2012). Cognitivebehavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. Published online 7th December 2012.

Long-Term Comparison of Traditional CBT and Acceptance and Commitment Therapy

According to a recent study published in Behavior Therapy, traditional cognitive behavior therapy (CT) may be more effective for treating anxiety and depression in the long-term than Acceptance and Commitment Therapy (ACT). The current study is a follow up comparison of the long-term outcomes of CT and ACT. The original study measured symptoms of students seeking treatment, (n=132) age 18-52 (M=26.7) before and after receiving CT and ACT. At post treatment, both groups improved on measures of depression, anxiety, and general functioning, and the results did not yield a significant difference in effectiveness between the two samples receiving treatment.

This long-term follow up study, conducted 18 months later included a majority (n=91) of the original sample who received either CT (n=45) or ACT (n=46). Although participants in both treatment groups benefitted initially from the different therapies, participants from the CT treatment group gained significant and lasting improvement in their symptoms and functioning:

 

  • 81.8% of CT patients versus 60.7% of ACT patients remained reliably recovered on measures of depression (Beck Depression Inventory-II);
  • 72.7% of CT patients versus 56.0% ACT patients remained in the recovered range for anxiety (Beck Anxiety Inventory);
  • 46.4% of CT patients versus 22.6% ACT patients maintained improvements in interpersonal and occupational functioning (Outcome Questionnaire); and
  • 37.8% of CT patients versus 22.9% of ACT patients remained in the normative range on measures of quality of life (Quality of Life Inventory).

This is the first known comparison of the long-term efficiency of CT versus ACT. While research and replication studies are necessary, these preliminary findings suggest that traditional CT has long-term advantages over ACT in treating depression and anxiety, and in increasing general functioning and overall quality of life.

Forman, E.M., Shaw, J.A., Goetter E.M., Herbert, J.D., Park, J.A., & Yuen, E.K, (2012). Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behavior     Therapy, 43(4) 801-811

Group CBT Helps Women with Low Self-Esteem

A recent study published in Behavioural and Cognitive Psychotherapy indicates that cognitive behavioral therapy (CBT) group intervention may be helpful for women with low self-esteem, and co-morbid depression and anxiety. In the current study, researchers used a set of CBT-based self-help workbooks, Overcoming Low Self-Esteem Self-Help Course (Fennell, 2006), to implement group therapy in a recruited sample of 37 women with low self-esteem (as indicated by the Robson Self Concept Questionnaire (RSCQ)). The group met once per week for two hours, for a total of eight sessions. Final results revealed clinically significant improvements in self-esteem and mood, including decreased depression and anxiety scores at post-intervention. While the mechanism for change is not yet clear, the researchers hypothesize that the group experience, combined with their learning adaptive skills and gaining new perspectives via CBT treatment, enhanced participants’ overall feelings of acceptance and increased confidence, both of which contribute to healthy self-esteem.

Morton, L., Roach, L., Reid, H., & Stewart, S. H. (2012). An evaluation of a CBT group for women with low self-esteem. Behavioural and Cognitive Psychotherapy, 40, 2, 221-5.

National Dissemination and Implementation of CBT for Depression in the Department of Veterans Affairs Health Care System Improves Patient Outcomes

According to a recent study published in the Journal of Consulting and Clinical Psychology, the implementation of CBT training for depression (CBT-D) significantly improves patient outcomes in the Veterans Affairs (VA) health care system. In the current study, 211 therapists participated in a VA CBT-D Training Program and delivered therapy to 356 patients. Therapist training included a 3-day CBT workshop followed by a 6-month consultation phase (weekly, 90-minute telephone-based consultation sessions led by an expert CBT-D clinician). Therapist competencies were assessed using the Cognitive Therapy Rating Scale (CTRS) and patient outcomes were assessed using the Beck Depression Inventory-II and World Health Organization Quality of Life-BREF. At the conclusion of the program, all of the therapists who completed training (82%) demonstrated competency in administering CBT-D, as well as higher levels of confidence, self-efficacy, and positive attitudes toward treatment. Furthermore, the implementation of CBT-D resulted in highly significant reductions in depressive symptoms and improvements in quality of life among patients treated. In fact, patient assessments revealed a 40% average decline in mean BDI-II scores recorded during the initial and later phases of treatment. This study has important implications for both therapists and veterans suffering from depression: A comprehensive CBT training program, when implemented in a realistic time-frame with follow-up consultation, significantly increases therapists’ ability to deliver effective treatment to depressed VA patients.

Karlin, B.E., Brown, G.K., Trockel, M., Cunning, D., Zeiss, A.M., & Taylor, C.B. (2012, July23). National dissemination of cognitive behavioral therapy for depression in the department of veteran affairs health care system: therapist and patient-level outcomes. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029328

Beck Institute’s Level I CBT Workshop for Students and Faculty

Click the picture to see all group photos with Dr. Judith Beck

AUGUST 13-15, 2012: 173 post-doctoral fellows, psychiatry residents, other graduate students, and faculty from mental health, medical, and related fields traveled from 27 states and 10 foreign countries, including: Australia, Brazil, Canada, Costa Rica, Dominican Republic, Mexico, Philippines, Slovenia, South Africa and Thailand, to Philadelphia, PA for Beck Institute’s 3rd Annual Cognitive Behavior Therapy Workshop for Graduate Students and Faculty. The diversity of attendees was remarkable. Students and faculty came from all over the world, demonstrating a tremendous commitment to the study and practice of cognitive behavior therapy.

Cognitive Behavior Therapy Training with Dr. Judith BeckOn the first two days of training, Dr. Judith Beck covered the fundamentals of cognitive behavior therapy and CBT for depression. On the third day of training, Dr. Randy Fingerhut , Assistant Professor of Psychology at LaSalle University, covered CBT for anxiety disorders.

In addition to didactic instruction, our attendees participated in case discussions, dyadic role plays, and other experiential exercises to practice newly learned CBT strategies and techniques with their peers and colleagues.

Father of Cognitive TherapyDr. Judith Beck conducted several role plays with workshop participants to demonstrate a variety of CBT techniques for treating depression, and Dr. Aaron Beck participated in a special question and answer and role play session with workshop participants. He answered clinical questions and questions about CBT history, research, and theory, and role played with a workshop participant on how to divert a client’s attention from distress.

Afterward, both Drs. Beck met with the Beck Institute scholarship winners for an intimate discussion about current CBT research.

Cognitive Behavior Therapy Scholarship Winners

Next year’s CBT Workshop for Graduate Students and Faculty will be held on August 12-14, 2013.  Click here for more information.  For more pictures from our Student and Faculty Workshop visit our Facebook page.

Online CBT Course Shows Promise in Treating Depression among Adolescents and Young Adults

According to a recent study published in the Journal of Medical Internet Research, internet-based cognitive behavior therapy (CBT) may help reduce depressive symptoms among adolescents and young adults. The current study aimed to determine the effectiveness of Master Your Mood (MYM), an internet based CBT intervention, for depressive symptoms among young people. Participants (244; ages 16-25) were randomly assigned to the online MYM course or to a wait-list control. The online MYM group focused on cognitive restructuring—participants were taught and encouraged to identify and respond to their own unhelpful and inaccurate thoughts; to engage in pleasant activities every day; and to measure their mood every day to help them understand the connection between pleasant activities and mood level. At a 3-month follow up, the MYM group showed significant improvements in depressive and anxiety symptoms. These promising results suggest that internet-based interventions may help reach adolescents and young adults who might otherwise remain untreated.

Van der Zanden, R., Kramer, J., Gerrits, R., & Cuijpers, P. (2012). Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. Journal of Medical Internet Research 14(3).

Tailored Internet-Based CBT is Effective for Depression

According to a recent study published in Plos One, tailored internet-based cognitive behavior therapy (CBT) may be helpful in the treatment of depression. In the current study, researchers compared individually tailored, internet-based self-help CBT to standardized (non-tailored) internet-based CBT and an active control (a monitored online discussion group). Participants included 121 individuals diagnosed with major depressive disorder and a range of comorbid symptoms. The standardized CBT (non-tailored) group received 8 self-help downloadable chapters with material on behavioral activation, cognitive restructuring, sleep management, general health advice and relapse prevention. The tailored CBT group received 25 self-help downloadable chapters with material on depression, panic, social anxiety, worrying and additional material (e.g., information on stress management and problem solving strategies) and each participant received an individual 10-week treatment plan. Both CBT groups (tailored and non-tailored) received email support from a therapist. At post-treatment and at a 6 month follow-up, both groups improved on measures of depression, anxiety, and quality of life. Subgroup analyses showed that the tailored CBT group had greater recovery rates as well as greater reductions in depressive symptoms among participants who presented with higher levels of depression and comorbidity at baseline. These results suggest that tailoring guided self-help treatments for depression may help make them more effective than standardized approaches.

Johansson, R., Sjoberg, E., Sjogren, M., Johnsson, E., Carlbring, P., Andersson, T., Rousseau, A., Andersson, G.  (2012).   Tailored vs. Standard Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial.  Plos ONE, 7(5) : e36905.  doi:  10.1371/journal.pone.0036905

The Versatility of Cognitive Behavior Therapy

In this video clip from a recent 3-day CBT Workshop at the Beck Institute for Cognitive Behavior Therapy, Dr. Aaron Beck discusses the similarities and differences between CBT for Depression and CBT for Schizophrenia. Dr. Beck explains that both treatments aim to help patients relinquish their feelings of alienation and to elevate their beliefs about themselves and their future. Treatment for Schizophrenia also addresses the specific symptoms of schizophrenia, such as paranoia and hallucinations, which require specialized cognitive and behavioral techniques. For information about training in cognitive behavior therapy, visit our website.

Cognitive Behavior Therapy for Depression

In this clip from a recent 3-day workshop at the Beck Institute for Cognitive Behavior Therapy, Dr. Aaron Beck discusses CBT strategies for suicidal patients facing a number of losses or negative events (e.g., loss of job/family/assets/health/etc.) Dr. Beck explains that depression stems from the meaning one attaches to life events rather than the events themselves. For example, a person who is vulnerable to depression might believe, “Losing my job means I am worthless.” Dr. Beck then uses a patient example to demonstrate cognitive restructuring, a key CBT strategy for treating depression.

To learn more about Cognitive Behavior Therapy, visit our website.