Using Cognitive-Behavioral Therapy with Exposure for Anxious Students with Classroom Accommodations

Gross total resection (GTR) of contrast-enhancing tumor is associated with significantly increased overall survival in primary glioblastoma (GBM). Even when achieved, recurrence is likely, in part due to malignant cells infiltrating outside enhanced regions. Subsequently, there has been increasing interest in performing supratotal resections (SpTRs) for GBM. Published results have varied in part due to a lack of consensus on the definition of SpTR in GBM and its appropriate use. A crowdsourcing approach was used to survey 21 academic neurosurgical oncologists representing 13 health systems nationwide. Participants’ demographics including fellowship training status, years of experience, and operative volume with various techniques was collected. Participants were presented with 11 definitions of SpTR from published, peer-reviewed studies and asked to rate the appropriateness of each definition. Subsequently, participants reviewed T1-weighed post-contrast and FLAIR MR imaging videos in the axial, coronal, and sagittal planes for 22 GBMs. Participants were asked to assess eloquence of the tumor’s location, perceived equipoise of enrolling patients in a randomized clinical trial comparing GTR to SpTR, and their own personal surgical treatment plans. Most neurosurgeons surveyed (n=18, 85.7%) agree or strongly agree that GTR plus resection of some non-contrast enhancement is an appropriate definition for SpTR. Overall, there was only moderate inter-rater agreement, measured using sample variance and the index of qualitative variation, regarding eloquence, equipoise, and personal treatment plans. Neurosurgeons who performed more than 10 SpTRs for GBMs in the past year were more likely than counterparts to recommend it as their personal treatment plan (p< 0.005). Anterior temporal and right frontal GBMs were considered the best randomization candidates. We established a consensus definition for SpTR of GBM and identified anatomically distinct locations deemed most amenable to SpTR. These results will be used to plan prospective trials further investigating the potential clinical utility of SpTR for GBMs.

Copyright © 2004 BMJ Publishing Group Ltd., Royal College of Psychiatrists, & British Psychological Society

The effect of cognitive behavioral interventions applied to children with anxiety disorders on their anxiety level: A meta-analysis study.

We examined if manualized cognitive behavioral therapy (CBT) was more effective than Treatment As Usual (TAU) for clinically depressed adolescents within routine care. This multisite Randomized controlled trail included 88 clinically depressed adolescents (aged 12–21 years) randomly assigned to CBT or TAU. Multiple assessments (pre-, post treatment and six-month follow-up) were done using semi-structured interviews, questionnaires and ratings and multiple informants. The primary outcome was depressive or dysthymic disorder based on the KSADS. Completers, CBT (n = 19) and TAU (n = 26), showed a significant reduction of affective diagnoses at post treatment (76% versus 76%) and after six months (90% versus 79%). Intention-to-treat analyses on depressive symptoms showed that 41.6% within CBT and 31.8% within the TAU condition was below clinical cut-off at post treatment and after six-months, respectively 61.4% and 47.7%. No significant differences in self-reported depressive symptoms between CBT and TAU were found. No prediction or moderation effects were found for age, gender, child/parent educational level, suicidal criteria, comorbidity, and severity of depression. We conclude that CBT did not outperform TAU in clinical practice in the Netherlands. Both treatments were found to be suitable to treat clinically referred depressed adolescents. CBT needs further improvement to decrease symptom levels below the clinical cut-off at post treatment.

The objective of this study was to evaluate the efficacy of cognitive behavioral therapy intervention for patients who experienced pain during orthodontic treatment. The baseline characteristics were assessed via questionnaires and oral examinations. Four hundred and fifty eligible individuals were recruited and randomized by computer-generated block randomization into three groups: cognitive behavioral therapy intervention (n = 150), ibuprofen intervention (n = 150), and no intervention (control; n = 150). Primary outcomes were the change from baseline in pain intensity measured with 100-mm Visual Analog Scale (VAS) scores at 1, 2, 3, 7, 14, and 30 days after initial archwire placement. Outcomes assessment was blinded and followed the intention-to-treat principle. One hundred forty-three (95.30%), 145 (96.70%), and 141 (94.00%) individuals in the cognitive behavioral therapy, the ibuprofen, and the control groups, respectively, completed the one-month follow-up evaluations. Those in the cognitive behavioral therapy group showed a greater decrease in mean VAS scores than did those in the control group over the previous five time-points (p < 0.001). Cognitive behavioral therapy was shown to be effective in pain control during the initial stage of orthodontic treatment. The study registration number was ChiCTR-TRC-00000556.

Antipsychotic medications, while effective, often leave patients with ongoing positive and negative symptoms of schizophrenia. Guidelines recommend using cognitive behavior therapy (CBT) with this group. Clearly, mental health professionals require training and supervision to deliver CBT-based interventions. This study tested which antipsychotic-resistant patients were most likely to respond to brief CBT delivered by psychiatric nurses. Staff were trained over 10 consecutive days with ongoing weekly supervision. Training for carers in the basic principles of CBT was also provided. This article represents the secondary analyses of completer data from a previously published randomized controlled trial (Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180:523-527) (n = 354) to determine whether a number of a priori variables were predictive of a good outcome with CBT and treatment as usual. Logistic regression was employed to determine whether any of these variables were able to predict a 25% or greater improvement in overall symptoms and insight. In the CBT group only, female gender was found to strongly predict a reduction in overall symptoms (P = .004, odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33, 4.30) and increase in insight (P = .04, OR = 1.84, 95% CI = 1.03, 3.29). In addition, for individuals with delusions, a lower level of conviction in these beliefs was associated with a good response to brief CBT (P = .02, OR = 0.70, 95% CI = 0.51, 0.95). Women with schizophrenia and patients with a low level of conviction in their delusions are most likely to respond to brief CBT and should be offered this routinely alongside antipsychotic medications and other psychosocial interventions.

Background: Generalized anxiety disorder (GAD) is a prevalent psychiatric condition characterized by persistent and excessive worry, significantly impairing quality of life and daily functioning. Both cognitive behavioral therapy (CBT) and pharmacological interventions are recognized as first-line treatments; however, uncertainty remains regarding their relative long-term effectiveness and relapse prevention potential. Existing studies have yielded variable outcomes, warranting a comprehensive synthesis to guide evidence-based clinical decision-making. Objective: This systematic review aims to evaluate and compare the effectiveness of cognitive behavioral therapy versus pharmacologic treatments in reducing symptoms and preventing relapse in adult patients with generalized anxiety disorder. Methods: A systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library up to 2024. Randomized controlled trials and high-quality meta-analyses comparing CBT with pharmacologic treatments in adults diagnosed with GAD were included. Studies were screened using predefined inclusion and exclusion criteria, with data independently extracted and assessed for risk of bias using the Cochrane RoB 2.0 tool. A narrative synthesis was performed due to heterogeneity in outcome measures and interventions. Results: Eight studies encompassing a total of 2,643 participants were included. Both CBT and pharmacological treatments significantly reduced anxiety symptoms. While pharmacologic treatments provided faster initial symptom relief, CBT demonstrated superior long-term outcomes, including lower relapse rates and sustained symptom reduction. CBT was also associated with fewer adverse effects and better treatment adherence. Methodological quality was generally high, although heterogeneity and potential publication bias were noted. Conclusion: CBT appears to be as effective as pharmacologic treatment for GAD in the short term and offers distinct advantages in long-term management and relapse prevention. Despite the strength of current evidence, further large-scale, standardized trials are needed to validate these findings and refine treatment guidelines.

Objective: This study examines the effectiveness of character strength-based cognitive (SCBC) and cognitive behavioral therapy (CBT) in improving college freshmen's mental health and positive traits. Methods: Freshmen were randomly assigned to SCBC, CBT or a PC group. Interventions included a 90-min session and a 7-day self-guided task. Assessments occurred at five time points: Preintervention (T1), postclass (T2), postintervention (T3), and at one-month (T4) and three-month (T5) follow-ups. Results: Both SCBC and CBT improved mental health. SCBC showed significantly greater self-efficacy gains at T4, while CBT demonstrated greater adjustability improvement at T2. Other differences were nonsignificant. Conclusion: SCBC and CBT positively impacted freshmen's mental health. The observed differences may stem from the distinct characteristics of SCBC and CBT. These findings can inform social workers in designing targeted mental health programs for college students.

BackgroundAdolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.Methods/designThe current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.DiscussionThis is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.Trial registrationCurrent controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017.

Background: Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature.Aim: To test whether there is evidence on treatment based on CBT, medication or a combination of these.Methods: Systematic and critical review of the literature on CBT and/or pharmacological treatments of SM. Literature was sought on PubMed, Embase and Psycinfo in March 2017.Results: Of the included studies, six examined CBT, seven pharmacologic treatment and two a combination of these. Using CBT 53/60 children improved symptomatically whilst respectively 55/67 and 6/7 improved using pharmacologic- and combination-treatment.Conclusion: Pharmacologic treatment and especially CBT showed promising results supported by some degree of evidence, which combination treatment lacks. Yet small numbers, few RCTs, heterogeneous study designs, lack of consistent measures, short treatment and follow-up periods, generally limits the evidence. This needs focus in future research.

Assessing treatment efficacy by examining relationships between age groups of children with autism spectrum disorder and clinical anxiety symptoms: Prediction by correspondence analysis

This paper critically reviews research studies examining the long-term effects of cognitive-behavioral therapy interventions for managing pain in rheumatoid arthritis patients. The first section of the paper evaluates long-term results obtained in studies of cognitive-behavioral therapy, arthritis education interventions, and combined cognitive-behavioral therapy-arthritis education interventions. These studies show that although some rheumatoid arthritis patients are able to maintain initial improvements in pain and disability, other rheumatoid arthritis patients do not. In the second section of this review, a cognitive-behavioral model of maintenance of pain coping skills is presented. This model may be useful in increasing our understanding of the relapse process and in planning interventions to enhance and prolong cognitive-behavioral therapy treatment gains. The final section of this paper addresses important future directions for research. The need for empirical studies of relapse and maintenance processes is underscored. Controlled studies are needed to test the utility of new cognitive-behavioral interventions designed to enhance the long-term maintenance of treatment gains in RA patients. We suggest that a focus on issues of relapse and maintenance may be just as important for medical and surgical interventions for rheumatoid arthritis pain, as it is for cognitive-behavioral therapy interventions.

BackgroundA previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted.ObjectiveThis study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms.MethodsThe economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings.ResultsDifferences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT.ConclusionsThe results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations.Trial registrationNetherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.

There has been a growing interest in the use of cognitive behavioural therapy (CBT) in school settings by educational psychologists in England. This small-scale study set out to explore the effectiveness of a school-based, eight-session CBT intervention for 12–13-year-old children with externalizing behavioural difficulties. Twelve pupils were referred by a school's pastoral manager as having externalizing behavioural difficulties. Pupils were matched in pairs and then randomly assigned to two groups. One group received cognitive-behavioural intervention, while the other continued with normal school support (control group). Participants in both groups and their teachers completed a pre- and post-intervention assessment taken from the Behaviour Assessment System for Children (BASC-2). Pupil self-ratings showed a large differential effect size (Cohen's d = 0.818) between the CBT group and the control group (F (1,8) = 7.080, p = 0.029). This indicates a positive change for pupils' self-perceptions of their behaviour. However, an unexpected result was found for teacher ratings, which positively changed for all pupils in the study and no differential effect was noted with all pupils reported to be better behaved at the end of the study. Our hypothesis is thus that there is a systemic effect of a targeted intervention by reducing the cumulative effect of low-level challenges that teachers experience.

Objective: To explore the effect of cognitive behavioral intervention therapy on the cellular immune function of patients undergoing radical mastectomy for the first time, and to provide a scientific basis for improving the treatment of breast cancer patients. Methods: 100 patients with breast cancer who were eligible for admission to the Department of Breast Surgery, Hainan Provincial People’s Hospital from January 2016 to December 2017 were selected as subjects. It is the first time to improve the radical mastectomy. They were randomly divided into control group and intervention group, 50 cases each. The control group used conventional treatment and routine care. On the basis of this, the intervention group conducted cognitive behavioral interventions including cognitive reconstruction and behavioral therapy. The patients were measured for serum IL-2, IL-4, IL-6, IL-8 and TNF-α levels on the second day after admission and three months after discharge. The changes of serum IL-2, IL-4, IL-6, IL-8 and TNF-α levels in the two groups were compared before and after cognitive intervention. Results: The concentrations of IL-2, IL-4, IL-6, IL-8 and TNF-α in the serum of the intervention group and the control group before intervention were compared. The difference was not statistically significant (P > 0.05). After the intervention, the serum levels of IL-2, IL-4 and IL-8 in the intervention group were lower than before the intervention. The concentration of TNF-α was higher than before the intervention. The difference was statistically significant (P < 0.05). Conclusion: Cognitive behavioral intervention therapy can change the levels of IL-2, IL-4, IL-6, IL-8 and TNF-α in serum of breast cancer patients. It has a positive effect on the regulation of immune function in breast cancer patients.