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 for Treatment of Intolerance of Uncertainty

Intolerance of uncertainty usually involves negative emotional, cognitive, and behavioral reactions to uncertain situations, and it has often been associated with generalized anxiety disorder (GAD) and obsessive compulsive disorder (OCD). Studies show that intolerance of uncertainty may be the common feature within these various anxiety disorders.

The current study published in the Journal of Clinical Psychology aims to investigate the relationship between intolerance of uncertainty and emotional disorders such as GAD, OCD, panic disorder, and social phobia, and/or depressive disorders. Thirty-seven participants were randomly assigned to receive eighteen weeks of transdiagnostic cognitive-behavioral therapy intervention (Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders; UP) or were waitlisted for treatment.

Results indicated that intolerance of uncertainty was positively correlated with symptoms of depression and anxiety, and that intolerance of uncertainty decreased during CBT treatment. Additionally, reduced post treatment intolerance of uncertainty was associated with reduced post treatment symptoms of depression and anxiety. These results suggest that transdiagnostic treatment to target intolerance of uncertainty can help improve treatment outcomes across emotional disorders.

Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: a common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69, 6, 630-45.

Group CBT is Effective for Generalized Social Anxiety Disorder in Japan

According to a recent study published in Neuropsychiatric Disease and Treatment, cognitive behavior therapy (CBT) effectively reduces symptoms of generalized social anxiety disorder (SAD) and improves quality of life among Japanese patients for up to a year post-treatment. The present study aimed to identify the long-term efficacy and predictors of group CBT among patients diagnosed with SAD in a naturalistic setting in Japan. From July 2003 to August 2010, outpatient participants (n=113) received 12-20 group-based CBT sessions and were assessed at 1-year follow up points. The researchers then compared treatment completers to those who had dropped out. According to results, group-based CBT significantly reduced symptoms of SAD among patients, and these improvements were maintained for up to one year post-treatment.

Kawaguchi, A, Watanabe, N, Nakano, Y, et al. (2013). Group cognitive behavioral therapy for patients with generalized social anxiety disorder in japan: Outcomes at 1-year follow up and outcome predictors. Neuropsychiatric Disease and Treatment, 9, 267-275.

Symptom Change in CBT for Generalized Anxiety Disorder

According to a recent study published in the Journal of Consulting and Clinical Psychology, cognitive behavior therapy (CBT) may have a greater effect on symptom change in generalized anxiety disorder (GAD) than applied relaxation (AR). The current study sought to determine if change in worry accounts for change over time in somatic anxiety to the same degree in CBT and AR. Participants (treatment-seeking adults with GAD) were assigned to receive 12 weeks of either CBT (n=31) or AR (n=26).

At post-treatment, participants in both treatment groups experienced significant reductions in somatic anxiety and time spent worrying. On average, worrying was reduced from 5-6 hours per day to 3 hours per day. However, change in worry accounted for subsequent change in somatic anxiety to a much greater extent in the CBT group than the AR group. When treatment focused on reducing worry, 49.95% of somatic anxiety was also reduced among participants in the CBT Group, and just 25.87% among participants in the AR group. These results suggest that although two treatments may have similar efficacies at post treatment, the mechanisms of change may differ. Further, these results demonstrate that CBT produces symptom change in a manner that is consistent with the theoretical underpinnings on which treatment is based.

Donegan, E., and Dugas, M. (2012) Generalized anxiety disorder: A comparison of adults receiving cognitive behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology, 80(3), 490-496.

CBT is Effective for Trait Anxiety and Worry

According to a study published in the Canadian Journal of Psychiatry, both cognitive behavior therapy (CBT) and short term psychodynamic psychotherapy (STPP), help reduce symptoms of anxiety and depression in patients with generalized anxiety disorder (GAD).  In the long-term however, CBT has demonstrated superiority in measures of trait anxiety and worry.

Participants (n=57) in the current study were treated with either CBT (n=29) or STPP (n=28) for up to 30 sessions. Both groups yielded large improvements concerning symptoms of depression and anxiety which remained stable at a 6 month follow-up.  At the 12 month follow-up, CBT treatment was shown to provide greater reductions in anxiety symptoms, as measured by the State-Trait Anxiety Inventory (STAI) and the Penn State Worry Questionnaire (PSWQ).  These results are consistent with several other previous trials demonstrating the long-term benefits of CBT for GAD.

Salzer, S., Winkelbach, C., Leibing, E., Leweke, F., & Leichsenring, F. (2011). Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-Month follow-up. Canadian Journal of Psychiatry, 56, 8, 503-508.

Generalized Anxiety Disorder Benefited More by CBT than by Short-term Psychodynamic Psychotherapy

NewStudy-Graphic-72x72_edited-3 A recent randomized controlled study published in the American Journal of Psychiatry compared the efficacy of cognitive behavioral therapy (CBT) to short-term psychodynamic psychotherapy. Participants were randomly assigned to either a CBT treatment group or a short-term psychodynamic psychotherapy treatment group that was based on supportive-expressive therapy. Participants in the CBT group focused on “changing and controlling worrying and catastrophizing anticipations” using CBT strategies such as planning recreational activities, worry exposure, relaxation training, and homework.  Participants in the short-term psychodynamic psychotherapy received treatment that focused “on the core conflictual relationship theme associated with the symptoms of generalized anxiety disorder. Emphasis is put on a positive therapeutic alliance.”

The authors found that both CBT and short-term psychodynamic psychotherapy were beneficial in improving the symptoms of anxiety and depression. Additionally, they found that CBT was superior in reducing trait anxiety, worry, and depression

Study authors: F. Leichsenring, S. Salzer, U. Jaeger, H. Kachele, R. Kreische, F. Leweke, U. Ruger, C. Winkelbach, E. Leibing

Generalized Anxiety Disorder — CBT Benefits Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3 The results of a randomized clinical trial published in JAMA indicate that cognitive behavior therapy (CBT) can be effective for older adults with symptoms of worry and depression.

The 3-month CBT protocol was conducted in primary care clinics and included education, cognitive therapy, and problem-solving skills. Measures included the Beck Anxiety Inventory and Beck Depression Inventory II. Post-treatment assessments were conducted every three months over fifteen months.

Compared with the control group, patients who received treatment showed improvement in worry severity, depressive symptoms, and general mental health. A measure of GAD severity, however, did not indicate greater improvement with CBT.

The authors concluded that CBT is useful for this population especially in primary care settings, “where older adults most often seek treatment.”

Study authors: M. A. Stanley, N. L. Wilson, D. M. Novy, H. M. Rhoades, et al.