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 Helps Patients with Rheumatoid Arthritis Cope with Pain

OBJECTIVE: Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing.

METHOD: We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups.

RESULTS: Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months.

CONCLUSIONS: The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.

Lumley, M. A., Keefe, F. J., Mosley-Williams, A., Rice, J. R., McKee, D., Waters, S. J., Partridge, R. T., … Kalaj, A. (2014). The Effects of Written Emotional Disclosure and Coping Skills Training in Rheumatoid Arthritis: A Randomized Clinical Trial. Journal of Consulting and Clinical Psychology, 82, 4, 644-658.

Concreteness Training Improves Depressive Symptoms of Dysphoric Individuals

NewStudy-Graphic-72x72_edited-3 A recent randomized control study in the Journal of Abnormal Psychology was performed to determine if increasing concreteness in the thinking of dysphoric individuals would affect depressive symptoms.

Previous research had shown that a cognitive bias to process self-relevant information in an abstract and overgeneralized manner is related to the onset and maintenance of depression and depressive symptoms. Individuals with this cognitive bias have been labeled as dysphoric individuals.

The current study examined dysphoric individuals to determine whether concreteness training (CNT) would help decrease their cognitive biases and therefore decrease depressive symptoms. The study controlled for the level of depression and all subjects scored at least in the category of mild depressive symptoms at the beginning of treatment. Twenty-one men and 39 women were randomly assigned to one of three groups. The first group received CNT, the second group received bogus concreteness training (BGT), and the third group was a waitlist (WL) control condition that received no treatment. Participants received the specific treatment every day for seven days. At the end of the week, participants were again assessed for depression level and symptoms. Results indicated that CNT showed a trend toward a greater decrease in depressive symptoms than BGT or WL.

Study Authors: E. R. Watkins, C. B. Baeyens, R. Read

Repeat Suicide Attempts Reduced by CBT

NewStudy-Graphic-72x72_edited-3A randomized control study in the Journal of the American Medical Association found cognitive behavioral therapy (CBT) to be effective in reducing the number of repeat suicide attempts in adults.

Past research had focused on intensive follow-up treatment or intensive case management, interpersonal psychotherapy, or cognitive behavioral therapy for the preventative treatment of suicide attempts, but empirical evidence for the efficacy of these therapies has been limited. The current study aimed to examine the efficacy of cognitive behavioral therapy as a preventative therapy for suicide, by performing a randomized control study adequate in power to detect treatment differences.

Participants consisted of patients who had attempted suicide and received a medical or psychological evaluation within 48 hours of the attempt. Participants were randomly assigned to follow-up care of either CBT or usual care (UC). Those placed in the CBT group received outpatient CBT sessions that were specifically designed for preventing future suicide attempts. The CBT aimed to address and identify the thoughts, images, and core beliefs that activated the previous suicide attempt, and to teach cognitive and behavioral strategies as better ways of coping with these thoughts and stressors.

The authors found that participants in the CBT group were 50% less likely to reattempt suicide than the participants in the UC group. In addition, the CBT group measured significantly lower for depression as well as hopelessness than the UC group. The authors concluded that “the short-term feature of cognitive therapy would make it particularly applicable for the treatment of suicide attempters at community mental health centers, which typically provide relatively short-term therapy.”

Reference: Brown, G. K, Have, T. T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563-570