To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
In the introductory chapter, we introduce transdiagnostic Multiplex CBT for Muslim Cultural Groups. We explain why there is currently a need for culturally sensitive treatments for Muslim populations and how Multiplex CBT fills this need. The chapter provides an overview of Multiplex CBT (e.g., specific treatment elements and key component of each session) and how it is culturally framed for a Muslim population. That is, it goes over the rationale for adapting particular treatment elements for this cultural group such as when teaching mindfulness and attentional control, addressing sleep-related issues, addressing worry, teaching anger management, and providing culturally indicated transitional rituals.
The Covid-19 pandemic created an unprecedented situation whereby essential services within child and adolescent mental health services (CAMHS) were suspended. This created a need to modify regular methods of treatment at a rapid pace, to avoid cessation of clinical intervention and prevent potential regression in mental health. Eighteen children with moderate-severe mental health disorders and their parents were attending weekly group cognitive behaviour therapy (CBT) based sessions (‘The Secret Agent Society’ (SAS) programme) when the Irish Department of Health suspended face-to-face intervention. This report describes how the group sessions were adapted to individualized, online therapeutic triads between each child, his/her parent and their clinician. Whilst internet technology has emerged as a promising solution to shortfalls in therapy services, in-depth exploration is needed to confirm the efficacy of telehealth for children attending CAMHS.
Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures.
To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Competence Scale (CTCP) for panic disorder.
CBT trainees (n = 60) submitted audio recordings of CBT for panic disorder that were scored on a generic competence measure, the Cognitive Therapy Scale – Revised (CTS-R), and the CTCP by markers with experience in CBT practice and evaluation. Trainees also provided pre- to post-treatment clinical outcomes on disorder-specific patient report measures for cases corresponding to their therapy recordings.
The CTCP exhibited strong internal consistency (α = .79–.91) and inter-rater reliability (ICC = .70–.88). The measure demonstrated convergent validity with the CTS-R (r = .40–.54), although investigation into competence classification indicated that the CTCP may be more sensitive at detecting competence for panic disorder-specific CBT skills. Notably, the CTCP demonstrated the first indication of a relationship between therapist competence and clinical outcome for panic disorder (r = .29–.35); no relationship was found for the CTS-R.
These findings provide initial support for the reliability and validity of the CTCP for assessing therapist competence in CBT for panic disorder and support the use of anxiety disorder-specific competence measures. Further investigation into the psychometric properties of the measure in other therapist cohorts and its relationship with clinical outcomes is recommended.
High rates of post-traumatic stress disorder (PTSD) are documented within refugee populations. Although research supports effectiveness of trauma-focused cognitive behaviour therapy (TF-CBT) among Western populations, little research exists for its efficacy among refugees living in camps and settlements in developing nations.
To investigate whether a culturally sensitive, group-based TF-CBT programme (EMPOWER) delivered in a Ugandan refugee settlement effectively reduced refugees’ post-traumatic stress symptoms (PTSS), and whether sociodemographic factors, trauma characteristics, or PTSS severity related to programme completion or treatment outcomes.
Method and Results:
Data linkages were conducted on information provided by 174 Congolese refugees living in a Ugandan settlement (mean age = 33.4 years, SD = 11.7; 49% male). Using a quasi-experimental design, participants who initially completed the intervention (n = 43) delivered across nine 90-minute sessions, reported significant reductions in self-reported PTSS with a large effect size. The delayed treatment group (n = 55) also reported significant treatment gains once they received the intervention. Participants who completed the programme reported significantly greater initial PTSS severity than those who dropped out, while no sociodemographic factors, trauma characteristics or PTSS were associated with better treatment outcomes.
A culturally sensitive, group-based TF-CBT programme delivered in a refugee settlement meaningfully reduces refugees’ PTSS severity and is equally effective for all participants, with the highest retention rates found among those in greatest need of treatment. Programmes such as this, with capacity to treat hundreds of people simultaneously, represent highly cost-effective, accessible, disseminable and effective treatment for PTSS among refugees living in humanitarian settings in developing nations.
Dieticians play an important role in managing eating disorders – not just looking at nutrition but providing psychoeducation around nutrition, helping patients begin to normalise eating and making sure nutrition is adequate for growth, development and life-style. The reader is introduced to the depth and range of work that a dietician is able to provide.
Delusional infestation is a condition at the interface of tactile and visual hallucinations and delusions. Individuals with this condition hold the fixed and false belief that their body or their environment is infested with parasites, insects or other organisms.
There are no guidelines or publications detailing the psychological assessment, formulation, intervention and evaluation of this presentation. This paper aims to address this gap.
Single case experimental design methodology was employed to evaluate the use of cognitive behavioural therapy (CBT) for delusional infestation in a 70-year-old male who was intolerant of anti-psychotic medication. ‘Tom’ had a large, mature infarct in the middle cerebral artery territory as well as a left posterior parietal infarct post-stroke, which may have precipitated his symptoms. After a baseline period of 3 weeks, Tom received eight sessions of CBT based on the model by Collerton and Dudley (2004).
Post-intervention, there was a reliable improvement on clinical measures as well as a large reduction in distress levels, which was maintained at 3-month follow-up. The conviction in the belief that the infestation was real did not shift.
This case demonstrated the potential for the use of CBT to address distress related to delusional infestation. This work is discussed in relation to post-stroke psychosis, psychological therapies with older adults, and suggestions are made for future research.
Children and adolescents display different symptoms of post-traumatic stress disorder (PTSD) than adults. Whilst evidence for the effectiveness of psychological interventions has been synthesised for adults, this is not directly applicable to younger people. Therefore, this systematic review and meta-analysis synthesised studies investigating the effectiveness of psychological interventions for PTSD in children, adolescents and young adults. It provides an update to previous reviews investigating interventions in children and adolescents, whilst investigating young adults for the first time.
We searched published and grey literature to obtain randomised control trials assessing psychological interventions for PTSD in young people published between 2011 and 2019. Quality of studies was assessed using the Cochrane Risk of Bias tool. Data were analysed using univariate random-effects meta-analysis.
From 15 373 records, 27 met criteria for inclusion, and 16 were eligible for meta-analysis. There was a medium pooled effect size for all psychological interventions (d = −0.44, 95% CI −0.68 to −0.20), as well as for Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) (d = −0.30, 95% CI −0.58 to −0.02); d = −0.46, 95% CI −0.81 to −0.12).
Some, but not all, psychological interventions commonly used to treat PTSD in adults were effective in children, adolescents and young adults. Interventions specifically adapted for younger people were also effective. Our results support the National Institute for Health and Care Excellence guidelines which suggest children and adolescents be offered TF-CBT as a first-line treatment because of a larger evidence base, despite EMDR being more effective.
Social anxiety is common among adolescents in Pakistan and is associated with low self-esteem. Among the recommended treatments, cognitive behavioural therapy (CBT) is effective, and self-help approaches are encouraged.
To determine the effectiveness of culturally adapted CBT-based guided self-help (CACBT-GSH) intervention, using a manual ‘Khushi aur Khatoon’, for treating social anxiety when added to treatment as usual (TAU) compared with TAU only.
A total of 76 adolescents with social anxiety aged 13–16 years from six schools in Multan, Pakistan were recruited into this randomized controlled trial. Participants were divided into intervention and control groups in a 1:1 ratio. Social anxiety, self-esteem and fear of negative evaluation were assessed through the Liebowtiz Social Anxiety Scale for children and adolescents, the Rosenberg Self-Esteem Scale and the Brief Fear of Negative Evaluation, respectively, at baseline and at the end of the study. Guided self-help using culturally adapted CBT (CACBT)-based self-help manual (eight sessions, one session per week) was provided to the intervention group. The effect of the CACBT-GSH intervention was analysed with ANCOVA.
There was a statistically significant difference between the intervention and the control groups in favour of intervention. Participants in the intervention group showed reduced symptoms of social anxiety (p < .001), fear of negative evaluation (p < .001) and enhanced self-esteem (p < .001).
The study demonstrated the effectiveness of CACBT-based guided self-help intervention in treating social anxiety and addressing the symptoms associated with it.
This commentary begins by briefly reviewing and expanding upon some relevant factors of personality disorders that present challenges for clinicians. These factors include: lack of routine screening and assessment of personality disorders in routine clinical care; the vast heterogeneity both between and within personality disorder diagnoses; the high rates of comorbid psychological disorders; and the ego-syntonic nature of many personality disorders, which leads many clients to seek treatment for problems other than their personality disorders. The remainder of the commentary then outlines recommendations for clinicians to follow in their treatment of clients with personality disorders. It provides recommendations for the assessment, case conceptualization, treatment goal and target formation, target hierarchy creation, intervention selection, implementation and evaluation, and the creation and maintenance of rapport and therapeutic alliance when working with personality-disordered clients.
In recent years, several cognitive behavioral therapies have been developed to meet the specific challenges involved in treating personality disorders. Cognitive and behavioral treatment (CBT) is best represented as a family of therapies, including manualized treatment packages (or “branded” CBTs) and principle-driven interventions. This chapter reviews cognitive and behavioral intervention options for patients suffering from personality dysfunction. First, the authors provide an overview of the “branded” CBTs tested with personality disorder populations, including dialectical behavior therapy, schema focused therapy, and cognitive therapy for personality disorders. For clinicians who wish to use a cognitive behavioral approach, they then discuss how CBT case conceptualization can be used to inform a flexible and responsive treatment based on the empirically-supported treatments for personality disorders. In this approach, clinicians would formulate a treatment plan that applies cognitive and behavioral strategies, interventions, and principles of change from these empirically-supported “branded” CBTs. For example, the authors discuss ways in which the CBT principle of exposure may be considered for application across different personality disorders. Finally, they discuss the potential value in application of mindfulness and acceptance strategies with personality disorders.
The commentaries from Gold, Yen, Hughes and Rizvi highlight the challenges associated with using cognitive behavioral therapies to treat individuals with personality disorders (PDs). In this rejoinder, the authors extend upon these observations by arguing the importance of a modular, principle-driven approach to assessment and treatment of PDs. First, they discuss how there is a greater demand for treatments beyond the current “branded” CBTs and their empirical basis. In light of this limitation, clinicians need to flexibly use empirically-supported principles of change to treat processes underlying personality dysfunction. This approach requires careful case formulation and identification of behaviorally-specific targets of treatment using validated screening tools. This approach to treatment may be a useful way of meeting the demands for both patient care and current trends in national health care payor reform.
A four- to seven-fold increase in the prevalence of current mood, anxiety, substance use and any mental disorders in Indigenous adults compared with non-Indigenous Australians has been reported. A lifetime prevalence of major depressive disorder was 23.9%. High rates of comorbid mental disorders indicated a transdiagnostic approach to treatment might be most appropriate. The effectiveness of psychological treatment for Indigenous Australians and adjunct Indigenous spiritual and cultural healing has not previously been evaluated in controlled clinical trials.
This project aims to develop, deliver and evaluate the effectiveness of an Indigenous model of mental healthcare (IMMHC). Trial registration: ANZCTR Registration Number: ACTRN12618001746224 and World Health Organization Universal Trial Number: U1111-1222-5849.
The IMMHC will be based on transdiagnostic cognitive–behaviour therapy co-designed with the Indigenous community to ensure it is socially and culturally appropriate for Indigenous Australians. The IMMHC will be evaluated in a randomised controlled trial with 110 Indigenous adults diagnosed with a current diagnosis of depression. The primary outcome will be the severity of depression symptoms as determined by changes in Beck Depression Inventory-II score at 6 months post-intervention. Secondary outcomes include anxiety, substance use disorder and quality of life. Outcomes will be assessed at baseline, 6 months post-intervention and 12 months post-intervention.
The study design adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations and CONSORT extensions for pilot trials. We followed the Standard Protocol Items for Randomised Trials statement recommendations in writing the trial protocol.
This study will likely benefit participants, as well as collaborating Aboriginal Medical Services and health organisations. The transdiagnostic IMMHC has the potential to have a substantial impact on health services delivery in the Indigenous health sector.
Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples.
To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n = 97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome.
The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45 minutes each. Data on patients’ personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis.
The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence.
Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients’ sex, comorbid symptom levels and the personality-trait profiles play a central role.
The general efficacy of cognitive behavior therapy for psychosis (CBTp) is well established. Although guidelines recommend that CBTp should be offered over a minimum of 16 sessions, the minimal number of sessions required to achieve significant changes in psychopathology has not been systematically investigated. Empirically informed knowledge of the minimal and optimal dose of CBTp is relevant in terms of dissemination and cost-effectiveness.
We approached the question of what constitutes an appropriate dose by investigating the dose (duration of CBTp) × response (symptomatic improvement) relationship for positive symptoms, negative symptoms and depression. Patients with psychotic disorders (n = 58) were assessed over the course of 45 sessions of CBTp in a clinical practice setting. At baseline and after session 5, 15, 25, and 45, general psychopathology, psychotic symptoms, symptom distress and coping were assessed with self-report questionnaires. Additionally, individually defined target symptoms and coping were assessed after each session.
Significant symptom improvement and reduction of symptom distress took place by session 15, and stayed fairly stable thereafter. The frequency of positive and negative symptoms reached a minimum by session 25.
Our findings support recommendations to provide CBTp over a minimum of 16 sessions and indicate that these recommendations are generalizable to clinical practice settings. However, the findings also imply that 25 sessions are the more appropriate dose. This study contributes to an empirically informed discussion on the minimal and optimal dose of CBTp. It also provides a basis for planning randomized trials comparing briefer and longer versions of CBTp.
The present study aims to evaluate the effectiveness of cognitive behavioral therapy (CBT) and spiritual-religious intervention in improvement coping responses and quality of life among women surviving from breast cancer.
This was a semi-experimental study. Forty-five breast cancer survivor referred to cancer research center at Shahid Beheshti university of medical Sciences in Tehran, assigned in 3 groups randomly (CBT group, spiritual-religious group and control group). The interventions were eight sessions cognitive-behavioral therapy and spiritual-religious intervention. The participants were evaluated through quality of life questionnaire published by european organization for research and treatment of cancer (QLQ-30C-ver3) and coping responses inventory (CRI). The data were analyzed using covariance.
Although both intervention groups improved in coping and quality of life, it was not statistically significant(P < 0.08).
Although both intervention groups improved in coping and quality of life but there is no differences between two groups.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The need for psychotherapy in primary health care is on the increase but individual-based treatment is costly. The main aim of this randomised controlled trial (RCT) was to compare the effect of mindfulness-based group therapy (MGT) with treatment as usual (TAU), mainly individual-based cognitive behavioural therapy (CBT), on a broad range of psychiatric symptoms in primary care patients diagnosed with depressive, anxiety and/or stress and adjustment disorders. An additional aim was to compare the effect of MGT with TAU on mindful attention awareness.
This 8-week RCT took place in 2012 at 16 primary care centres in southern Sweden. The study population included both men and women, aged 20–64 years (n = 215). A broad range of psychiatric symptoms were evaluated at baseline and at the 8-week follow-up using the Symptom Checklist-90 (SCL-90). Mindful attention awareness was also evaluated using the Mindful Attention Awareness Scale (MAAS).
In both groups, the scores decreased significantly for all subscales and indexes in SCL-90, while the MAAS scores increased significantly. There were no significant differences in the change in psychiatric symptoms between the two groups. The mindfulness group had a somewhat larger change in scores than the control group on the MAAS (P = 0.06, non-significant).
No significant differences between MGT and TAU, mainly individual-based CBT, were found in treatment effect. Both types of therapies could be used in primary care patients with depressive, anxiety and/or stress and adjustment disorders, where MGT has a potential to save limited resources.
A better training in psychotherapy is needed for psychiatry trainees. Online Cognitive Behavioural Therapies (CBT) could be a good solution. Free and wide audience course like Massive Open Online course (MOOCs) increase dissemination and accessibility of the training. However, the engagement needs to be improved. A hybrid approach seems relevant with the MOOC as an incentive. Beyond the promotion of the topic, a MOOC can be a promotion tool for the provider. The economic model of the MOOC needed to be taken into account to allow sustainability. To explore these elements, we take into account a survey taken during the 1st European Psychiatric Association MOOC about CBT.
Older adults have low rates of psychotherapy use despite the effectiveness of multiple psychotherapeutic modalities in late life. Frequent themes in late-life psychotherapy include coping with losses in the setting of physical and cognitive decline, dependence and debility. Choice of treatment modality is based on the abilities and needs of the individual patient rather than age alone. Therapists decide between more structured therapies like cognitive behavioral therapy (CBT) and problem-solving therapy (PST), and more exploratory, affect-focused modalities like interpersonal therapy (IPT) and brief dynamic psychotherapy (BDP). Cognitive therapies have the strongest evidence base for the treatment of depression and anxiety, especially in the setting of medical illness. Problem-solving therapies offer a behavioral approach to patients with depression and executive dysfunction. Interpersonal therapies are readily applicable for older adults struggling with complicated grief, retirement, or family conflict. Brief psychodynamic treatment can be particularly useful for patients with mild to moderate depression struggling with self-esteem or acceptance of mortality. Clinically relevant differences between treatment modalities are difficult to detect due to limited and underpowered trials. Factors common to all psychotherapies, including empathy, alliance, positive regard, and expectations may account for much of the variability in psychotherapy outcomes. Research focused on understanding the mechanism of change associated with psychotherapy is needed to clarify the role of common versus specific factors.
Cognitive behavioural therapy (CBT) is an evidence-based psychotherapy and one of the most widely used treatments for mental health problems. It is generally acknowledged that supervision improves the quality of treatment although systematic descriptions and empirical evaluation of supervision have been sparse. Moreover, there are relatively few valid and reliable instruments to evaluate supervision. Based on a comprehensive review of the supervision literature, six competency domains were identified to cover the scope of CBT supervision: Theory, Focus, Learning strategy, Techniques, Structure, and Interpersonal style. The Moeller, Moerch, Rosenberg Supervision Scale (MMRSS) was developed to evaluate supervisor performance within each of these domains after observation of supervision. The present study examined the psychometric properties of the MMRSS (inter-rater reliability and construct validity), the clinical utility, and satisfaction when using MMRSS to evaluate CBT supervision. CBT supervisors (n = 8) were recruited for the study and provided videos of group supervision. A total of 21 videos were rated using the MMRSS and the Supervisory Competency Scale (SCS) by two independent raters. Supervisees and supervisors completed a satisfaction questionnaire to capture their experience of using the MMRSS during supervision of supervision. The MMRSS showed acceptable internal consistency and validity. Several domains in MMRSS (Structure, Learning strategy, and Interpersonal style) correlated significantly with the corresponding domains in the SCS for cognitive supervision. Preliminary results indicate that the MMRSS may be a valid and clinically useful tool to evaluate CBT supervision, although further systematic evaluation is needed.
Key learning aims
(1) To understand that empirically founded evaluation of cognitive behavioural supervision is essential for good training.
(2) To argue that a modern view of supervision places an emphasis on learning principles.
(3) To describe the Moeller, Moerch, Rosenberg Supervision Scale (MMRSS) and the scale’s preliminary psychometric properties.
(4) To describe the supervisors’ and supervisees’ reported satisfaction using the MMRSS.