CBT for Health Anxiety: A Meta-Analysis of Treatment Outcome and Moderators

The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges’s g = 0.95) and at follow-up (Hedges’s g = 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges’s g = 0.64) and at follow-up (Hedges’s g = 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.

Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, J. A. J., & Powers, M. B. (July 01, 2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: A meta-analysis of treatment outcome and moderators. Behaviour Research and Therapy, 58, 10, 65-74.

The Future of CBT

At a recent Beck Institute Workshop, Dr. Aaron Beck discusses the future status of CBT. Dr. Beck proposes that there will be one overarching theory based on the cognitive model with information from other disciplines, and empirically supported treatment methods for each disorder. Using the example of Chronic Fatigue Syndrome, he provides his vision of a triage model that would be used to determine level of care to treat patients with various disorders.

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Group CBT for Insomnia: A Meta-Analysis

Insomnia is the most common sleep disorder among the general population. Although cognitive behavioral therapy for insomnia (CBT-I) is the psychological treatment of choice, the availability of individual therapy is often not sufficient to meet the demand for treatment. Group treatment can increase the efficiency of delivery, but its efficacy has not been well-established. Randomized controlled trials (RCTs) comparing group CBT-I to a control group in patients with insomnia were identified. A review of 670 unique citations resulted in eight studies that met criteria for analysis. Outcome variables included both qualitative (e.g., sleep quality) and quantitative (e.g., sleep diary) outcomes, as well as depression and pain severity, at both pre- to post-treatment and follow-up (3-12 mo post-treatment). Overall, we found medium to large effect sizes for sleep onset latency, sleep efficiency, and wake after sleep onset and small effect sizes for pain outcomes. Effect sizes remained significant at follow-up, suggesting that treatment gains persist over time. Other variables, including total sleep time, sleep quality, and depression, showed significant improvements, but these findings were limited to the within treatment group analyses. It is clear that group CBT-I is an efficacious treatment. Implications for stepped care models for insomnia are discussed.

Koffel, E., Koffel, J., & Gehrman, P. (May 01, 2014). A Meta-analysis of Group Cognitive Behavioral Therapy for Insomnia. Sleep Medicine Reviews.

Individual Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavior Therapy (CBT) Improve Depressive Symptoms in Patients with Diabetes

Depression is a common comorbidity of diabetes, undesirably affecting patients’ physical and mental functioning. Psychological interventions are effective treatments for depression in the general population as well as in patients with a chronic disease. The aim of this study was to assess the efficacy of individual mindfulness-based cognitive therapy (MBCT) and individual cognitive behavior therapy (CBT) in comparison with a waiting-list control condition for treating depressive symptoms in adults with type 1 or type 2 diabetes. In this randomized controlled trial, 94 outpatients with diabetes and comorbid depressive symptoms (i.e., Beck Depression Inventory-II [BDI-II] ?14) were randomized to MBCT (n = 31), CBT (n = 32), or waiting list (n = 31). All participants completed written questionnaires and interviews at pre- and postmeasurement (3 months later). Primary outcome measure was severity of depressive symptoms (BDI-II and Toronto Hamilton Depression Rating Scale). Anxiety (Generalized Anxiety Disorder 7), well-being (Well-Being Index), diabetes-related distress (Problem Areas In Diabetes), and HbA1clevels were assessed as secondary outcomes. Results showed that participants receiving MBCT and CBT reported significantly greater reductions in depressive symptoms compared with patients in the waiting-list control condition (respectively, P = 0.004 and P < 0.001; d = 0.80 and 1.00; clinically relevant improvement 26% and 29% vs. 4%). Both interventions also had significant positive effects on anxiety, well-being, and diabetes-related distress. No significant effect was found on HbA1c values.
CONCLUSIONS: Both individual MBCT and CBT are effective in improving a range of psychological symptoms in individuals with type 1 and type 2 diabetes.

Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C. T. M., Emmelkamp, P. M. G., Sanderman, R., … Schroevers, M. J. (2014). Individual Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavior Therapy (CBT) for Treating Depressive Symptoms in Patients with Diabetes: Results of a Randomized Controlled Trial. Diabetes Care, doi: 10.2337/dc13-2918 1935-5548.

CBT and Medication for Severe Mental Illness

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck and Dr. Judith Beck discuss the effects of combining CBT and medication in the treatment of depression and schizophrenia. They also compare research findings on CBT treatment alone, medication alone, and a combination of CBT and medication among clients with severe depression and schizophrenia.

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Internet-based CBT Skills for Parents or Partners of Individuals with Anorexia Nervosa

Anorexia nervosa (AN) poses a major burden on families. Carers (e.g. parents or partners) of people with AN are often highly distressed and may inadvertently respond in ways that can contribute to the maintenance of the disorder, e.g. through high levels of over-involvement and criticism [also known as expressed emotion (EE)]. This study aimed to evaluate the efficacy of a novel web-based systemic cognitive-behavioral (CBT) intervention for carers of people with AN, designed to reduce carer distress and teach skills in how to offer effective support. Carers of people with AN (n=64) were randomly allocated to either the web-intervention, overcoming anorexia online, with limited clinician supportive guidance (by email or phone), or to ad-hoc usual support from the UK patient and carer organization Beat. Carer outcomes were assessed at post-treatment (4 months) and follow-up (6 months). Compared with the control intervention, web-based treatment significantly reduced carers’ anxiety and depression (primary outcome) at post-treatment, with a similar trend in carers’ EE. Other secondary outcomes did not favor the online intervention. Gains were maintained at follow-up. This is the first ever study to use an online CBT program to successfully reduce carer distress and improve carers’ ability to support the person with AN.

Grover, M., Naumann, U., Mohammad-Dar, L., Glennon, D., Ringwood, S., Eisler, I., Williams, C., … Schmidt, U. (December 01, 2011). A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa. Psychological Medicine, 41(12), 2581-2591.


Cognitive Restructuring in Schizophrenia

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck describes how to modify and utilize cognitive restructuring with a schizophrenic client. Using an example, Dr. Beck explains that he will initially focus on the client’s interests to build engagement and self-efficacy. As self-efficacy increases, the client’s problematic and unhelpful behaviors begin to decrease. Dr. Beck emphasizes the use of cognitive conceptualization to target the variables that drive the client’s behavior, which can be used to structure treatment.

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