A Randomized Controlled Neuroimaging Trial of Cognitive Behavioral Therapy for Fibromyalgia Pain

Lee, J., Lazaridou, A., Paschali, M., Loggia, M. L., Berry, M. P., Ellingsen, D., Isenburg, K., Anzolin, A., Grahl, A., Wasan, A. D., Napadow, V., & Edwards, R. R. (2023). A randomized controlled neuroimaging trial of cognitive behavioral therapy for fibromyalgia pain. Arthritis & Rheumatology, 76(1), 130–140. https://doi.org/10.1002/art.42672

Summary by: Hagai Berenson

This study addresses the pervasive and debilitating nature of fibromyalgia (FM), a condition marked by widespread pain and significant negative emotional impact.

High levels of pain catastrophizing - a maladaptive cognitive-emotional response characterized by an exaggerated negative orientation toward actual or anticipated pain, Which also associates with increased pain severity, emotional distress, and functional impairment is often correlated to the condition of FM.

The authors discuss the role of cognitive behavioral therapy (CBT) as a mind-body intervention aimed at reducing pain catastrophizing and improving overall functioning in FM patients. While previous research has demonstrated the clinical benefits of CBT in managing chronic pain conditions, the specific neural mechanisms through which CBT exerts its effects on pain catastrophizing remain unclear.

To investigate these mechanisms, the study was designed as a randomized controlled trial with a neuroimaging component.

The study enrolled 114 adult women diagnosed with fibromyalgia, aged between 18 and 75 years and were randomized into two groups:

CBT Group: 64 participants received an 8-week individual CBT program. This intervention focused on identifying and modifying maladaptive thoughts and behaviors related to pain.

Education Control (EDU) Group: 34 participants received an 8-week fibromyalgia education program, matched in duration and structure to the CBT intervention. The control group received education about fibromyalgia and chronic pain without the active cognitive restructuring components inherent in CBT.

98 of the 114 participants in this study also completed a neuroimaging assessment on a baseline level and post intervention.

These Participants engaged in a task designed to elicit pain catastrophizing thoughts while undergoing fMRI scanning. This involved reflecting on personalized pain-related statements to activate relevant brain regions associated with catastrophizing.

The primary objective was to assess the impact of an eight-week individual CBT program on pain catastrophizing and to explore the associated changes in brain functional connectivity, particularly focusing on the default mode network (DMN) and its interaction with somatomotor and salience network regions.

The assessment was made in two parts:

Questioners filled by all participants at baseline and post-CBT intervention:

Pain Catastrophizing Scale (PCS): Assessed the degree of catastrophic thinking related to pain.

Brief Pain Inventory (BPI): Evaluated pain severity and the extent to which pain interfered with daily activities.

Fibromyalgia Impact Questionnaire Revised (FIQR): Measured the overall impact of fibromyalgia on the individual's functioning and well-being.

For the neuroimaging assessment, the focus was on examining functional connectivity patterns, particularly involving the ventral posterior cingulate cortex (vPCC), a key node in the default mode network (DMN). The analysis aimed to identify changes in connectivity between the vPCC and other brain regions implicated in pain processing and emotional regulation, such as the somatomotor and salience networks.

The results showed that participants in the CBT group experienced significantly greater reductions in pain catastrophizing, pain interference, and overall fibromyalgia symptom impact compared to the education control group. Mediation analysis further revealed that reductions in pain catastrophizing partially explained the improvements in functional outcomes, suggesting that changes in maladaptive thinking patterns were a key mechanism through which CBT exerted its effects. Neuroimaging findings supported these behavioral outcomes, showing decreased functional connectivity after CBT between the ventral posterior cingulate cortex (vPCC)—a central hub of the default mode network—and regions in the somatomotor and salience networks. These neural changes were not observed in the control group, indicating that CBT may help recalibrate brain activity associated with excessive self-referential and pain-focused processing.

Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behavior therapy

Carter, J. D., McIntosh, V. V., Jordan, J., Porter, R. J., Frampton, C. M., & Joyce, P. R. (2013). Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of Affective Disorders, 151(2), 500–505. https://doi.org/10.1016/j.jad.2013.06.034

Summary by: Serra Bıtrak

The article I presented is called “Psychotherapy for Depression: A Randomized Clinical Trial Comparing Schema Therapy and Cognitive Behavior Therapy.” by Carter and colleagues (2013). Since the article focuses on Schema Therapy and Cognitive Behavior Therapy, it is important to mention the differences between CBT and ST. We can say that ST mostly concentrates specifically on the schema and what prevents individuals from getting their core needs met. The literature proposes that to make a lasting change, the schema must be modified, especially for people dealing with more persistent problems such as chronic depression. Therefore, based on the literature, the study aimed to compare the efficacy of ST with the traditional CBT for individuals with a major depressive episode. 

The study design was a randomized clinical trial study with 100 adult participants. The participants were recruited from either referrals from General Practitioner’s (GP’s) and mental health services or they could also self-refer. The recruitment took place between the years 2004 to 2008. Sixty nine percent of the participants were women. They were assessed and treated in an outpatient clinical research unit in the Department of Psychological Medicine, University of Otago, New Zealand. The exclusion criteria were moderate or severe alcohol or drug dependence, a history of mania, schizophrenia, major physical illness which would interfere with treatment, and failure to respond to a recent (past year) trial of CBT or ST.

As for the procedure, they did an initial screening by phone, followed by a baseline assessment which used Structured Clinical Interview for DSM-IV Axis I disorders (SCID-PQ), and after that, participants were randomly assigned to weekly therapy sessions for either CBT or ST for 6 months, followed by monthly sessions which were 6 more months. To assess the therapists’ competency, Cognitive therapy rating scale for CBT and its modified form for ST was used by choosing random sessions. Then, to measure participants' depression levels, Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory was used. The first is a clinician-rated scale while the other is self-rated.

The results showed that there were no significant differences between the two therapies at the end of weekly therapy sessions or at the end of the whole therapy (i.e. end of monthly sessions). In terms of participants who reached remission or recovery, again, there was no significant difference. And also, they checked if having a comorbid personality disorder would affect the outcome, but there was no difference for that either.

Therefore, in conclusion, it can be said that this was the first randomized clinical trial comparing the two therapy modalities, and this is of course a limitation, because the results may not be very generalizable, so a replication is needed. And even though there wasn’t a significant difference, these results mean that CBT and ST are comparable when it comes to their effectiveness. Since their approaches are different, depending on the individual’s needs, they now have an option and can prefer one or the other.

Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting

Vrabel, K. R., Waller, G., Goss, K., Wampold, B., Kopland, M., & Hoffart, A. (2024). Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting. Behaviour Research and Therapy, 174, 104480. https://doi.org/10.1016/j.brat.2024.104480

Summary by: Gizem Sönmez

Can Compassion Focused Therapy Help Heal Eating Disorders?

A new study shows that treating eating disorders with compassion focused therapy might be just as powerful as using traditional cognitive behavioral therapy. And this method was even better for people who’ve experienced childhood trauma.

Many people struggle with eating disorders, such as anorexia or bulimia. These are serious mental health conditions that affect how people eat, think about food, and view their bodies.

The most common therapy used is called Cognitive Behavioral Therapy (CBT). It helps people change negative thoughts and behaviors. CBT works well for many, but not for everyone, especially those who’ve had trauma in childhood, such as abuse or neglect. These people often feel shame, are very self-critical, and have trouble accepting kindness from others or even from themselves. So researchers started with this question: “Can therapy that focuses on compassion work better for people with trauma?”

Compassion Focused Therapy (CFT) is particularly suitable for individuals who struggle with intense feelings of shame and self-criticism, and who find it challenging to experience or express kindness and warmth toward themselves or others. This approach supports them in developing a greater sense of safety and emotional warmth in both their self-relationship and their interactions with others.

 What Did the Researchers Do?

They studied 130 adults with eating disorders who had not improved with past treatments. Half of them had a history of childhood trauma.

Participants were randomly assigned to two types of therapy:

1. CBT – Focuses on changing thoughts and behaviors linked to the eating disorder.
2. Compassion-Focused Therapy for Eating Disorders (CFT-E) – A newer therapy that helps people develop self-compassion, manage shame, and feel safe with emotions.

Both therapies were given in an intensive 13-week inpatient program in Norway. People had individual and group therapy, meals, and support. Researchers followed up for one year after treatment.

 What Did They Find?

• Both therapies were effective.
  Eating disorder symptoms dropped significantly during treatment in both groups.
• But there was a key difference:
  People with childhood trauma who got CFT-E were more likely to keep improving one year later.
• CBT worked better for improving some social skills.
  But CFT-E was better at reducing PTSD symptoms linked to ch,idhood trauma.

 Why Compassion Matters?

This study highlights the importance of self-kindness and compassion, especially for individuals who have experienced significant emotional pain due to childhood trauma. Compassion-Focused Therapy for Eating Disorders (CFT-E) supports individuals in several important ways:

• It helps them understand their feelings of shame.
• It teaches them how to treat themselves with care and gentleness.
• It supports them in reducing harsh self-criticism.
• It encourages the development of healthier strategies for managing difficult emotions.

Overall, CFT-E promotes emotional healing by fostering a more compassionate relationship with oneself.

 What Makes This Study Strong?

• It’s the first randomized controlled trial comparing CBT and CFT-E for eating disorders.
• The researchers used a real-world setting with very distressed patients.
• The therapy lasted long enough (13 weeks) to see real effects.

Conclusion

This study happened at one clinic in Norway, so results might not apply everywhere. There was no control group, so we can’t say how much change came just from being in treatment. More research is needed, especially in younger people and with different types of eating disorders

Yet, it’s a promising study. Compassion-focused therapy might be helpful for someone who has an eating disorder, especially with a history of trauma. CBT is still effective, but for people struggling with shame and self-hatred, learning to be kinder to themselves might make a lasting difference.

Positive Cognitive Behavior Therapy in the Treatment of Depression: A Randomized Order Within-subject Comparison With Traditional Cognitive Behavior Therapy

Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive Cognitive Behavior Therapy in the Treatment of Depression: A Randomized Order Within-subject Comparison With Traditional Cognitive Behavior Therapy. Behaviour Research and Therapy, 116, 119–130. https://doi.org/10.1016/j.brat.2019.03.005

Summary by: Wies van der Leest

Positive Cognitive Behavioral Therapy: A Comparative Experimental Evaluation

Recently, interest has arisen in placing elements of positive psychology into traditional cognitive behavioral therapy (CBT) for depression treatment. The study by Geschwind, Arntz, Bannink, and Peeters (2019) shows an empirical investigation into the effectiveness of Positive Cognitive Behavioral Therapy (P-CBT). P-CBT is a variant of CBT that emphasizes well being, positive emotions, and solution-focused strategies. The main objective of the study was to determine whether P-CBT results in bigger improvements of depressive symptoms and positive mental health indices compared to Traditional CBT (T-CBT).

The Experimental Design

The study was conducted using a within-subjects crossover design. It involved 49 patients diagnosed with Major Depressive Disorder (MDD). Each participant received both treatment modalities. The treatment consisted of eight sessions of P-CBT and eight sessions of T-CBT, administered in a randomized order. The design was chosen to improve statistical power and control for individual differences, mostly because of the complications in recruiting participants from a clinical population, that suffer from a moderate to severe depression.

The T-CBT followed the usual protocols that include identifying and restructuring dysfunctional thoughts and behaviors. P-CBT included solution-focused brief therapy and positive psychology exercises, for example, gratitude practices and visualizing the best possible self.

 

The Measures and Methodology

The Quick Inventory of Depressive Symptoms (QIDS-SR-16) was used as the primary outcome measure. It was completed by the participants on a weekly basis. The secondary outcomes, subjective happiness (SHS), including positive and negative affect (PANAS), optimism (LOT-R), and overall mental health (MHC-SF), were assessed every four sessions. For intention-to-treat analysis, mixed regression modeling was used accounting for time, treatment order, and phase.

 

The Key Findings

The most remarkable result was that the participants experienced a significantly greater decrease in symptoms during the P-CBT phase, particularly when following T-CBT first. The results indicate that P-CBT may be a helpful follow-up or extension to T-CBT. Participants who began with T-CBT and afterwards followed the P-CBT showed the largest pre-post effect size (Cohen’s d = 2.71), in comparison to the participants starting with P-CBT (d = 1.85).

Moreover, P-CBT was associated with increased rates of clinically significant and reliable changes in depression, negative affect, and happiness. Furthermore, more participants accomplished normative levels of optimism and positive affect after the P-CBT phase. Additionally, the perceived dropout rates were lower for those who started with P-CBT, demonstrating greater acceptability.

 

Implications and Considerations

The findings imply that emphasizing strengths and positive emotions may decrease depressive symptoms with a larger effectivity than problem-focused methods, specifically in later treatment stages. Remarkably, participants transitioned more effortlessly from T-CBT to P-CBT, possibly due to P-CBT’s future-oriented, uplifting nature. Nevertheless, limitations include potential carry-over effects from the crossover design, lack of treatment fidelity checks, infrequent outcome measures and limited experience with P-CBT of the therapists.

 

Conclusion

Geschwind et al.’s (2019) study offers strong preliminary evidence supporting the effectiveness of Positive Cognitive Behavioral Therapy as standalone treatment and as an addition to traditional CBT. Even though further research is necessary, predominantly randomized controlled trials, this study shows significant improvement in validating approaches that highlight well-being and resilience combined with symptom reduction in treating depression.

Patient's Perceptions of Post-Treatment Factors that Influenced Skill Use After Cognitive-Behavioral Therapy for Bulimia Nervosa Spectrum Disorders

Liu, J., Wang, H., Wetherall, L., Giannone, A., & Juarascio, A. (2024). Patients' perceptions of post‐treatment factors that influenced skill use after cognitive‐behavioral therapy for bulimia nervosa spectrum disorders. International Journal of Eating Disorders, 57(7), 1589–1598. https://doi.org/10.1002/eat.24123

Summary by: Lina Kovač

Introduction

The main evidence-based treatment for patients with bulimia nervosa spectrum eating disorders (BN-EDs) is enhanced Cognitive-behavioral therapy, focused version (CBT-E) (Fairburn et al. 2009). While 30% of patients achieve remission at the end of this treatment (Linardon & Wade, 2018), 30% of them relapse (return to meet diagnostic criteria after remission) within one year after completing CBT-E (Södersten et al., 2017). Knowing predictors of deterioration (worsening of symptoms after a period of symptom improvement) could help us design effective deterioration prevention strategies (Liu et al., 2024). Previous studies have detected some prevailing predictors for deterioration among patients with BN-EDs (see Liu et al., 2024), but mainly focused on patients in higher levels of care, overlooking those receiving CBT-E in outpatient settings. Only two studies explored post-treatment predictors (Cockell et al., 2004; Keel et al., 2005) with one of them identifying (Cockell et al., 2004) a lack of structures and support, low self-efficacy, unrealistic expectations and lack of coping strategies for real-life challenges. One of the post-treatment factors crucial for preventing symptom deterioration in BN-EDs is the continued use of therapeutic skills after treatment, which can be difficult due to the loss of guidance and support from therapy (Cockell et al., 2004). While studies focusing on skill practice as relapse prevention after CBT for depression and substance use disorders have shown effectiveness (Eilert et al., 2023; Powers et al., 2008; Rose et al., 2012; Simons et al., 2005), no studies were done about obstacles and motivators in the context of skill use after CBT for BN-EDs. Due to the lack of research exploring post-treatment factors of deterioration, it is necessary to develop targeted deterioration prevention. This study aimed to qualitatively research post-treatment factors that contributed to deterioration and what are the motivators and barriers to post-treatment skill use (Liu et al. 2024).

Methods

The study included 12 participants (M(age) = 40.08, SD = 13.52) with BN-EDs who received 16 sessions of CBT-E and experienced symptom improvement that met the inclusion criteria at the end of treatment (EOT) compared to baseline (for more details see Liu et al., 2024). The majority of participants self-identified as female (75%), white (59.33%), and non-Hispanic (91.67%). The average follow-up time was 39.85 months (SD = 3.95). Eleven participants experienced deterioration at some point since EOT. The participants completed the study in two Zoom sessions – during the first one they provided consent and demographic data, completed the Eating Disorder Examination (EDE; Fairburn & Cooper, 1993) and a self-report survey on post-treatment experience and skill use; during the second session, they completed a qualitative interview about post-treatment factors within different domains. Inductive, data-driven thematic analysis was used to analyse the core themes that emerged during the qualitative interviews.

Results and Discussion

Researchers identified four themes that summarize post-treatment contributors to deterioration and barriers to/motivators of post-treatment skill use of outpatients with BN-EDs. Firstly, participants reported a sudden loss of accountability following treatment, which resulted in a drop in practising essential skills, especially those related to managing mood and urges. Without therapists' guidance, many struggled to self-motivate. The patients abandoned these skills because of the lack of external monitoring, structured check-ins and therapist's encouragement, particularly during times of negative emotions or stress when they would be more needed.

Secondly, continued body dissatisfaction and fear of gaining weight were perceived as a major driver of decreased eating-related skills and deterioration. Even though participants received a weight-neutral ED treatment (Salvia et al., 2023), many returned to restrictive eating behaviors after treatment because they were worried about gaining weight and their body shape. The continuous use of eating-related skills reduced weight concerns during treatment, but the abandonment of these practices after treatment increased the patients' dissatisfaction and disordered eating.

Thirdly, the discontinued practice of binge analysis resulted in decreased awareness of how poor skill application contributed to ED behaviors. Many believed they were already aware of their triggers and therefore ceased this practice. However, they overlooked how lapses in their skill practices—like inconsistent eating habits—could lead to binge episodes. This highlighted the necessity for ongoing binge analysis after treatment.

Finally, financial and time limitations restricted access to post-treatment therapy, making it difficult for participants to seek help when needed. Without the presence of professional support, participants struggled to stay accountable and continue using their skills, which contributed to symptom relapse.

These findings indicate that deterioration prevention in outpatient CBT-E relapse prevention should focus on enhancing self-accountability, intrinsic motivation, reinforcement of continuous use of skills (like binge analysis) post-treatment, and addressing body image issues (Liu et al., 2024). 

Schema Therapy and the treatment of personality disorders

Arntz, A. (2018). Schematherapie en de behandeling van persoonlijkheidsstoornissen. Bloom.

Summary by: Gijs Hoentjen

Introduction

Schema Therapy (ST) is developed by Jeffrey Young from the perspectives of cognitive (behavior)therapy (C(G)T). He integrated techniques from the gestalt therapy and other experiential therapies with the CT, with the focus on improving personality disorders. Besides Young, also David Edwards en David M. Clark were involved with the integration of experiential therapies in CT. The terminology schema focused therapy clarifies the therapy’s focus on the underlying level of schemas, and not on the surface phenomena (e.g. automatic thoughts and reasoning errors). Because the name was involved with other models, the name changed to schema therapy. Young claims that (personality)psychopathology arises from the activation of maladaptive (or dysfunctional) schema’s, and that they have their origins in the early development. Young expanded the model with: Emotional needs; The nature of the schema; Core beliefs for each DSM-disorder versus. Early maladaptive schemas; Coping; Modi; Experienced as a mechanism of change; the therapeutical alliance and the terminology limited reparenting; attention for experiences in childhood.

 

Research

ST is specifically used in the treatment of personality disorders, chronic depression and (other) treatment-resistant syndrome disorders (eating disorders, OCD and complex PTSD).  Research found different insights towards the ST. For instance, differences between research seemed to have a high correlation with the length of the treatment. Another insight gave information about the superiority of ST when you compare it with the transference focused psychotherapy (TFP) when recovering from BPS. Also, the drop-out was significant lower in ST. Lastly, ST was superior when compared to TFP in costs effectivity, as the ST was cheaper on society level and more effective.

When looking at the recovery of personality disorders, ST seemed to be superior compared to the normally used treatments. Moreover, the treatment drop-out seemed to be lower in ST than in the usual treatments (but not lower than in COP). Lastly, ST seemed to be superior when looking at costs effectivity: less costs on society level, while the clinical effects were bigger.

If you’re looking at chronical depression, there is no evidence yet found to prefer ST over existing treatments like CBT. This result is comparable to the results found in studies comparing ST and CBT when focused on eating disorders. There’s no significant difference found.

In contrast, good effects have been reported when using ST in OCD treatment. A possible explanation can be the admissibility of participants for exposure.

 

Ongoing research

As good results were found by previous studies, but most of them were leaded by the ST developers, questions are asked regarding the replication of those results. Different current studies look at the replication of previous found results.

Currently the effect of group-ST for the comorbid diagnose of social anxiety disorder and avoidant personality disorder.

Forms of ST focused on children and minors are currently being developed, and the first pilot studies are on their way. Most of them focus on personality problematic in the development of children and minors.

Lastly, current pilot studies focus on extreme problematic disorders, such as dissociative identity disorder (DIS), and comorbid diagnose of personality disorders and for instance autism, addiction, psychose.

 

Conclusion

While ST got developed from CGT, there are significant differences: like the focus on the developing history of the client, the therapeutical alliance and the expanded use of experiential techniques. With those changes, ST became an integrative treatment, while still being based on the cognitive model. In a short period of time, ST became popular in the Netherlands and provides the needs of clients and therapeutics regarding the treatment for complex personality disorders. While empirical reasoning provides insight in the (costs)effectiveness and acceptation of ST, the development of ST and research into it has a long way to go. Replication research is needed to expand the evidence-based evidence.

Besides the popularity of ST, also concerns regarding the treatment are rising. Sometimes ST is used for complex clients in forms or doses that have not been tested before, and sometimes this treatment is given by barely schooled therapeutics. There is no mandatory registry for therapists and there is no juristic protection from ST. Another problematic point is the number of schooled therapists (thousands) compared to the limited offered ST treatments for persons with complex personality disorders. This can possibly be explained due to the way therapists get hired, and therapists avoiding the ST even if they are schooled in this domain. 

Cognitive behavioral therapy for insomnia: A meta-analysis of long-term eff ects in controlled studies

Van Der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & Van Straten, A. (2019). Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 48, 101208. https://doi.org/10.1016/j.smrv.2019.08.002

Summary by: Isabel Nemeth

According to the DSM-IV, insomnia can be defined as, “a persistent difficulty initiating or maintaining sleep, for three months or longer and for at least three nights a week, resulting in impaired daytime functioning and signifi cant distress” (van der Zweerde et al., 2019). Only 6% of the general population suff ers from insomnia, but around 30% experience the symptoms of insomnia without meeting the criteria for diagnosis in the DSM-IV (Morin et al., 2006; Ohayon, 2002). If untreated, insomnia may persist for years and have an eff ect on daily life in aspects such as, mood, fatigue, cognitive ability, physical well-being, and social relationships. (Kyle et al., 2010; Morin et al., 2009).

Cognitive behavioral therapy (CBT) has already proven to be an effective treatment for insomnia in the short term. In fact, oftentimes it is the preferred treatment method over pharmacotherapy according to the American and European guidelines (Qaseem et al., 2016; Riemann et al., 2017). This is because of the potential risks that sleep medication constitutes for the patient long-term for instance, dizziness, drowsiness, addiction, and relapse when the medication is discontinued (Buscemi et al., 2007; Riemann et al., 2017). Furthermore, the lack of suffi cient evidence on the long-term eff ects of pharmacotherapy poses additional problems when it comes to prescribing. Following this information, cognitive behavioral therapy for insomnia (CBT-I) is assumed to be the better treatment option for long-term (Riemann et al., 2017).

With that being said, the researchers of the present meta-analysis don’t know of any meta-analyses published that included controlled studies on the long-term eff ects of CBT-I on patients. van der Zweerde and her colleagues aim to address this gap in the literature and include all available randomized control trials (RCT) reporting on the controlled long-term eff ects of CBT-I at 3, 6, and 12 months and quantifying these eff ects (van der Zweerde et al., 2019).

The focus of the present meta-analysis was on subjective sleep outcomes according to accounts of sleep diaries and self-reported symptoms. The researchers used their previous meta-analysis as a starting point and checked whether any of those studies had published follow-up measurements or data since then. Subsequently, they performed a new search that covered the period of time from the end of the previous search (December 2015) to May 2018 (van der Zweerde et al., 2019). The inclusion criteria were the following: RCT design, investigation of CBT-I or its components, adult participants, self-reported or formally diagnosed insomnia, the comparison to a non-active control group, inclusion of sleep diary outcomes,

reporting of follow-up data for 12 or more weeks post test, and the provision of suitable data for eff ect size calculation (van der Zweerde et al., 2019). The CBT-I components were defi ned as relaxation therapy (RE), sleep restriction therapy (SRT), stimulus control therapy (SC), paradoxical intention (PI), and cognitive therapy (CT) (van der Zweerde et al., 2019).

This study was focused primarily on insomnia severity which was measured through questionnaires (ISI), and secondarily on sleep onset latency (SOL) and sleep effi ciency (SE) measured through sleep diaries. The data extraction process involved coding characteristics such as publication year, recruitment setting, insomnia defi nition, comorbidity, age group, treatment format, number of sessions, control group type, and intervention type. Lastly, the statistical analysis involved computing Hedges’ g for eff ect sizes, using a random eff ects model to account for heterogeneity, and checking for outliers and publication bias (van der Zweerde et al., 2019).

The fi nal meta-analysis included 29 studies after excluding one outlier. The results showed that CBT-I had signifi cant eff ects on insomnia severity at 3, 6, and 12 months with eff ect sizes declining over time (large at 3 months, moderate at 6 months, small at 12 months). The researchers found that three months after treatment, the severity of insomnia complaints (primary outcome) was better for patients treated with CBT-I than for patients without the active treatment. Additionally, signifi cant eff ects were observed for SE and SOL at 3, 6, and 12 months (van der Zweerde et al., 2019).

In general, there was a steady decline overtime of the long-term eff ects of CBT-I. This indicates that the long-term eff ects of CBT-I are smaller than the eff ects seen in the short-term. There are several factors we have to consider when analyzing these results. The analyses at the diff erent time points include diff erent studies which could lead to biased eff ect size estimates. Furthermore, patients in the control conditions could start sleeping better over time either because they have sought treatment elsewhere or purely as a result of time passing. As the time of follow-up increases, so does the time frame of opportunity to seek treatment elsewhere. Finally, when looking at the data for the individual studies included in the present meta-analysis, participants reported a return of symptoms over time. This could be because the interventions are relatively short and focus on behavioral changes such as lifestyle, bedtimes, and sleep hygiene (van der Zweerde et al., 2019).

A randomized controlled trial comparing EMDR and CBT for OCD

 

Marsden, Z., Lovell, K., Blore, D., Ali, S., & Delgadillo, J. (2017). A randomized controlled trial comparing EMDR and CBT for obsessive–compulsive disorder. Clinical Psychology & Psychotherapy, 25(1). https://doi.org/10.1002/cpp.2120

Summary by: Swastika Dutta Gupta

The study by Marsden et al. (2018) investigates and compares the effectiveness of Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) in treating Obsessive-Compulsive Disorder (OCD). CBT, especially when using Exposure and Response Prevention (ERP), is widely recognized as the most evidence-based and effective treatment for OCD.

However, the study raises an important question: could EMDR, a therapy primarily used for trauma, offer comparable or complementary benefits for people with OCD—especially those with underlying trauma?

The researchers worked with 55 participants diagnosed with OCD, randomly assigning them to either a CBT group or an EMDR group. Each group received 16 sessions of therapy. For the CBT group, sessions followed the traditional ERP approach, gradually exposing individuals to feared situations while preventing the compulsive responses. The EMDR group followed a standard protocol aimed at processing distressing or traumatic memories that may have contributed to the OCD symptoms.

Results from the study showed that both CBT and EMDR led to improvements in OCD symptoms, as well as reductions in anxiety and depression. However, the CBT group showed significantly greater reductions in OCD symptom severity, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), both immediately post-treatment and at follow-up. This reinforced CBT’s position as the most effective standalone therapy for OCD. However, EMDR still showed promise—particularly for individuals whose obsessions and compulsions seemed to be linked to past emotionally charged experiences.

One of the most interesting aspects of the study is the way it challenges a rigid distinction between “trauma therapy” and “OCD therapy.” By suggesting that certain OCD cases may have trauma-related origins, the authors open up a space for more nuanced, individualized treatment planning. They propose that EMDR might be a useful supplementary or alternative method for people who struggle with or don’t fully respond to CBT.

The study also raises questions for future research. For example, how can clinicians best identify whether a person’s OCD has trauma-based origins? Could a combined approach of CBT and EMDR improve outcomes even further? While the sample size was relatively small, the randomized controlled design gives the findings weight and encourages clinicians to consider flexibility in treatment rather than rigid adherence to one approach.

Overall, the study confirms CBT’s superior efficacy for OCD while inviting us to explore EMDR’s role more deeply in complex or comorbid cases.

Effectiveness and Acceptability of Third-Wave eHealth Treatments: A Meta-Analysis

O’Connor, M., Munnelly, A., Whelan, R., & McHugh, L. (2018). The efficacy and acceptability of third-wave behavioral and cognitive eHealth treatments: A systematic review and meta-analysis of randomized controlled trials. Behavior Therapy, 49(3), 459–475. https://doi.org/10.1016/j.beth.2017.07.007

Summary by: Benedikt Luther

According to a report by the European Parliamentary Research Service, an estimated 84 million people in the European Union (EU) currently suffer from mental health problems (Amand-Eeckhout, 2023). This corresponds to almost one in five EU citizens and is equivalent to the entire population of Germany. Additionally, mental health problems carry negative social and economic consequences, such as job loss, family issues, and decreased social participation, all of which may worsen mental health crises—a vicious cycle. Access to professional mental healthcare is not equally guaranteed for everyone. eHealth applications represent one way for improving access to mental health services, particularly when traditional face-to-face therapy is limited by geographic, economic, or social barriers. However, questions remain regarding how these digital interventions are accepted and how effective they are.

O’Connor et al. (2018) examined in a systematic review and meta-analysis the efficacy and acceptability of digital interventions based on so-called "third-wave" therapies, including for example Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT). The authors define eHealth broadly as “an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural [sic!] and cognitive therapies” (O’Connor et al., 2018, p. 459). The meta-analysis included 21 studies using randomized controlled trials with a total of N = 3,176 participants. The interventions primarily targeted to improve anxiety, depression, and quality of life. The meta-analysis found small to medium positive effects for the reduction of anxiety (g = 0.32, 95 % CI [0.09, 0.56], p = .01) and depression (g = 0.52, 95 % CI [0.26, 0.77], p < .001), compared to inactive control groups. Additionally, quality of life significantly improved under these conditions (g = 0.46, 95 % CI [0.00, 0.92], p = .05) However, compared to active control conditions, the significant effects were smaller in magnitude (O’Connor et al., 2018). The differences in the outcomes anxiety (g = 0.31, 95 % CI [0.07, 0.54], p = .01); depression (g = 0.29, 95 % CI [0.14, 0.44], p < .001); quality-of-life differences were nonsignificant (g = 0.31, 95 % CI [- 0.31, 0.93], p = .33) Furthermore, digital third-wave interventions showed no significant differences in efficacy compared to other established psychotherapeutic treatments, anxiety (g = 0.00, 95 % CI [-0.16, 0.17], p = .97), depression (g = -0.02, 95 % CI [-0.18, 0.15], p = .83), and quality of life (g = 0.22, 95 % CI [-0.21, 0.65], p = .31). This suggests that eHealth programs could serve as viable alternatives. Importantly, there were no significant differences in attrition rate between inactive controls (OR = 1.24, 95 % CI [0.82, 1.86], p = .30), active controls (OR = 1.03, 95 % CI [0.63, 1.66], p = .92), or comparison interventions (OR = 1.03, 95 % CI [0.79, 1.33], p = .84) That indicates good acceptance of digital formats (O’Connor et al., 2018).

Nevertheless, several limitations remain noteworthy. The authors note that access to eHealth may depend on the digital divide (O’Connor et al., 2018). That means that digital offers are not equally accessible to everyone, particularly for vulnerable populations facing socioeconomic disadvantages such as children or individuals dealing with homelessness. Thus, eHealth interventions alone may not fully break the vicious cycle described earlier. That highlights the importance of considering these vulnerable groups explicitly during program design. Additionally, because the meta-analysis drew studies exclusively from peer-reviewed, English-language journals, results are potentially subject to publication bias. It should also be mentioned that the results should not be generalized to children and adolescents, as they were not part of the meta-analysis (O’Connor et al., 2018). Furthermore, it is critical to mention that the study data are relatively old, covering studies published between 2007 and 2015. Given the technological advancements since then, eHealth programs likely have evolved substantially.

To conclude, eHealth interventions are effective and widely accepted by users. Patients do not tend to discontinue these interventions more frequently than face-to-face therapies. However, under certain conditions, eHealth alternatives are not as effective as traditional face-to-face interventions. Nonetheless, eHealth programs offer scalable, costeffective opportunities for broad dissemination (O’Connor et al., 2018). Future initiatives must particularly consider vulnerable groups with lower socioeconomic status and provide targeted support to ensure equity in mental healthcare access.

Tanulók szorongásának csökkentése iskolai védőnők beavatkozásával

Ginsburg, G. S., Drake, K. L., Muggeo, M. A., Stewart, C. E., Pikulski, P. J., Zheng, D. & Harel, O. (2019). A pilot RCT of a school nurse delivered intervention to reduce student anxiety. Journal of Clinical Child & Adolescent Psychology. DOI: 10.1080/15374416.2019.1630833

Készítette: Kollár Dorka

Nagy a szakadék a szorongásos zavaroktól szenvedő fiatalok és a kezelésben részesülők száma között (Merikangas és mtsai., 2010), az iskolai klinikusok által nyújtott iskolai mentálhigiénés szolgáltatások az egyik fontos és potenciálisan hatékony megközelítés e szakadék csökkentésére. (Weist és mtsai., 2017). Az iskolai klinikusok (például szociális munkások, tanácsadók, pszichológusok) azonban nagy esetszámmal rendelkeznek, ami gyakran kizárja őket abban, hogy minden mentális egészségügyi problémával küzdő fiatalt kezeljenek, és a pszichoterápia ellátására szánt idejük korlátozott az egymással versengő felelősségek miatt. (Splett, Fowler, Weist, & McDaniel, 2013). Ezen okok miatt megoldásként javasolták a mentálhigiénés beavatkozások nem mentális egészségügyi szakemberekre való áthelyezését, amely sikeres volt a mentálhigiénés és általános egészségügyi beavatkozások megvalósításában országos és globális szinten is (például Kakuma és mtsai., 2011). Az iskolai személyzet körében az iskolai védőnő létfontosságú szerepet játszhat a tanulók mentális egészségügyi szükségleteinek kielégítésében. Ez különösen igaz a szorongó fiatalokra, mivel a szorongás fő megnyilvánulásai közé tartoznak a szomatikus tünetek és az elkerülő magatartás, ami gyakran az iskolai nővér meglátogatására készteti a fiatalokat (Ollendick & March, 2004). Bár korlátozott számban, a tanulmányok azt sugallják, hogy az iskolai védőnők hatékonyan képesek viselkedési és mentális egészségügyi beavatkozásokat végrehajtani (Pbert és mtsai., 2013; Wilson és mtsai, 2008). Figyelembe véve a mentálhigiénés szolgáltatásokhoz való hozzáférés növelésének szükségességét és előnyeit, valamint a mentálhigiénés szolgáltatások iskolai személyzet körében történő áthelyezését, a szerzők kutatócsoportja iteratív folyamatot alkalmazott egy rövid, iskolai nővér által irányított beavatkozás kidolgozására és finomítására a szorongó fiatalok számára. Az így létrejött CBT stratégiákon alapuló beavatkozást (a továbbiakban: Child Anxiety Learning Modules [CALM]) védőnők általi megvalósításra dolgozták ki és módosítottak. A CALM beavatkozás a szorongásra összpontosít, mivel az adatok azt mutatják, hogy a fiatalok szorongásos zavarai a leggyakoribb pszichiátriai állapotok közé tartoznak, és mélyreható rövid- és hosszú távú funkcionális károsodást okoznak (Swan & Kendall, 2016; Swan és mtsai, 2018). A jelenlegi tanulmány egy kísérleti randomizált kontrollált vizsgálat (RCT) adatait mutatja be, amely a CALM megvalósíthatóságát és előzetes hatását értékeli. A kutató szakemberek kidolgoztak egy összehasonlító feltételt, a CALM-R-t, amely csak relaxációs stratégiákat alkalmazott. A projekt elsődleges célja a teljesen kifejlesztett CALM beavatkozás kísérleti tesztelése és megvalósíthatóságának és elfogadhatóságának felmérése volt. Másodsorban a beavatkozás tanulói eredményekre gyakorolt ​​hatását vizsgálták. Feltételezték, hogy a CALM a szorongásos tünetek és a kapcsolódó károsodások nagyobb csökkenését eredményezi a CALM-R-hez képest.

Harminc főállású vagy részmunkaidős iskolai alkalmazottat randomizáltak, és CALM-ra (n = 14) vagy CALM-R-re (n = 16) képezték ki, minden nővér nő volt. Ötvennégy 5–12 éves, fokozott szorongásos tünetekkel küzdő gyermeket vontak be (CALM=20, CALM-R=34). A gyermekeket kizárták, ha olyan egészségügyi vagy pszichiátriai állapotuk volt, amely ellenjavallta a részvételt (klinikai interjú, valamint a nővérrel és a vizsgálati csoporttal folytatott konzultáció alapján), egyéni kezelésben részesültek szorongás miatt, azonnali kezelésre szorultak egy másik pszichiátriai zavar miatt, és nevelőszülői gondozásban éltek, vagy nem éltek együtt törvényes gyámjukkal. A stabil dózisú gyógyszeres kezelésben részesülő gyermekek akkor voltak jogosultak a részvételre, ha a családok beleegyeztek abba, hogy ezt az adagot a beavatkozási fázis (8 hét) időtartamára fenntartják, kivéve, ha ez klinikailag ellenjavallt.

Mindkét beavatkozás hat modulból állt, amelyeket az iskolai védőnőnek az adott gyermekkel 8 héten át tartó rövid megbeszélések során kellett bemutatnia. A CALM magában foglalta a gyermekkori szorongás kezelésére szolgáló CBT alapvető összetevőit: pszichoedukáció, relaxációs stratégiák, expozíció, kognitív átstrukturálás, problémamegoldás és a visszaesések megelőzése. A CALM-R csak relaxációs készségekből állt, kulcsfontosságú összetevői közé tartozik a pszichoedukáció, a mélylégzés, a progresszív izomrelaxáció, az irányított imagináció és a visszaesés megelőzése. Az ápolónők egy 1 napos képzést végeztek a számukra kijelölt intervencióban. Minden ápolónőnek konzultáció ajánlottak fel (klinikai szakpszichológus által), és ellátták intervenciós anyagokkal. A függő változók közé tartoztak a tanulók szorongásának mértékét felmérő és kiegészítő skálák, amelyekkel feltárásra kerül a szorongás súlyossága (Clinical Global Impression–Severity (CGI-S) and Improvement (CGI-I) Scales; Guy, 1976), a szorongás által érintett funkciókárosodások (Child Anxiety Impact Scale; Langley és mtsai., 2014), szomatizációs tünetek (Children’s Somatization Inventory; Walker, Beck, Garber, & Lambert, 2009), a szorongással kapcsolatos maladaptív gondolatok gyakorisága (Children’s Automatic Thoughts Scale; Schniering & Rapee, 2002) és az elkerülő viselkedés mértéke (Behavioral Avoidance Scale).

A fiatalok mindkét csoportban klinikailag jelentős javulást mutattak a beavatkozás után és az utánkövetés során, de nem találtak csoportbeli különbségeket. A longitudinális adatelemzések eredményei azt mutatták, hogy a gyerekek mindkét csoportban hasonló, statisztikailag szignifikáns és pozitív változásokat mutattak az idő múlásával minden mérőszámon. Mindkét beavatkozás során szignifikánsan csökkentek a szorongásos tünetek és a kapcsolódó károsodások a gyerekeknél, valamint a szorongás súlyosságának, a szomatikus tüneteknek, a maladaptív gondolatok előfordulásának és az elkerülő magatartás javulását figyelték meg. A beavatkozás előtti és utáni javulás általában megmaradt a 3 hónapos követés során. A csoporton belüli hatásméretek általában nagyok voltak, míg a csoportok közötti hatásméretek általában kicsik.

Összességében ezek az ígéretes eredmények azt sugallják, hogy az ápolónők fontos erőforrást jelenthetnek az iskolákban a szorongó fiatalok segítésében, és rávilágítanak egy másik lehetőségre a mentálhigiénés beavatkozások nem mentális egészségügyi szakemberekre való átruházására, hatással vannak a szorongás károsító következményeinek csökkentésére. Ennek a kísérleti RCT-nek az eredményei arra utalnak, hogy az iskolai ápolónők számos CBT-orientált stratégiát képesek hatékonyan megvalósítani, pozitív és terápiásan jelentős hatást gyakorolnak a fokozott szorongással élő gyermekekre. Bár ennek a tanulmánynak az eredményei biztatóak, számos korlátja van, a minta túlnyomórészt fehér és fiatal volt, így az eredmények általánosíthatóságát korlátozza. A minta mérete túl kicsi volt a csoportok közötti különbségek kimutatásához. Bár a jelenlegi eredmények azt sugallják, hogy az ápoló által vezetett beavatkozások megvalósíthatók, nem minden nővér (vagy iskolarendszer) tekinti a mentális egészségügyi beavatkozásokat munkája részének. Különösen az iskolarendszereknek lehet szükségük olyan adatokra, amelyek alátámasztják e beavatkozások költséghaszonságát, mielőtt befektetnének ezekbe a beavatkozásokba.

Az online és személyes kognitív viselkedésterápia összehasonlítása a kényszerbetegség kezelésében: egy hatékonyságvizsgálat

Lisi, D. M., Hawley, L. L., McCabe, R. E., Rowa, K., Cameron, D. H., Richter, M. A., & Rector, N. A. (2023). Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.2908

Készítette: Pongrácz Fanni

A kényszerbetegség (obszesszív-kompulzív zavar, továbbiakban: OCD) az egyik leggyakoribb és az életminőséget leginkább rontó mentális betegség, amelyben kényszeres gondolatok és ismétlődő viselkedések okoznak tartós distresszt. Az OCD kezelése során a kognitív viselkedésterápia (CBT) vált a legszélesebb körben alkalmazott pszichológiai módszerré, amelynek kulcseleme az expozíció-válaszgátlás (ERP). Ez a megközelítés segít a betegeknek megküzdeni a kényszeres gondolatokkal és szokásokkal, valamint csökkenti a tünetek intenzitását. A COVID-19 járvány jelentős hatással volt a mentális egészségügyi ellátás elérhetőségére és felgyorsította az online terápiás lehetőségek térnyerését. Jelen tanulmány célja az volt, hogy összehasonlítsa az online és személyes CBT hatékonyságát az OCD kezelésében.

A vizsgálat két kanadai OCD-specialista központban zajlott, ahol összesen 144 közepes vagy súlyos OCD tüneteket mutató felnőtt vett részt csoportos CBT-n. A program heti kétszer kétórás foglalkozásokat tartalmazott, és 12–15 hétig tartott (az egyik ellátóhelyen több pszichoedukációs alkalom volt). A személyes terápiás foglalkozások 2018 és 2020 között zajlottak, míg az online formát 2020 és 2021 alatt alkalmazták, a COVID-19 világjárvány alatt bevezetett biztonsági intézkedések részeként. Mindkét terápiás formátum ugyanazt a validált CBT protokollt követte, amely magában foglalta a pszichoedukációt, a tünetek monitorozását, az ERP-t, valamint a kognitív átkeretezést és a relapszusprevenciót célzó technikákat.

Az eredmények azt mutatták, hogy mind az online, mind a személyes terápia szignifikáns csökkenést ért el az OCD tünetekben, amit a Yale-Brown Obsessive-Compulsive Scale (YBOCS) és az Obsessive-Compulsive Inventory-Revised (OCI-R) skálák segítségével mértek. Közepes és nagy hatásméret volt megfigyelhető. Az online és a személyes terápia hatékonyságában nem volt statisztikailag szignifikáns különbség. Ez arra enged következtetni, hogy az online CBT ugyanolyan hatékony lehet, mint a hagyományos, személyesen zajló terápia, még a súlyosabb tünetekkel küzdő betegek esetében is.

Az online terápia számos előnnyel jár, különösen azok számára, akik földrajzi távolság, időhiány vagy más akadályok miatt nem tudnak személyesen részt venni a terápián. Az online formátum megőrizte a személyes foglalkozások alapvető elemeit, például a terapeuta aktív részvételét, az ERP gyakorlatok beépítését és a rendszeres visszacsatolást. Az ilyen terápiák jelentős szerepet játszhatnak a mentális egészségügyi ellátásban tapasztalható akadályok enyhítésében, különösen olyan populációk számára, amelyek számára a hagyományos ellátás elérhetősége korlátozott.

Azonban a tanulmánynak akadtak limitációi, például a nem randomizált minta, valamint a kontrollcsoport hiánya, ami korlátozza az eredmények általánosíthatóságát. Továbbá nem történt hosszú távú utánkövetés, így nem ismert, hogy a tünetcsökkenés mennyire fenntartható idővel. A kutatás a járvány által okozott körülmények között zajlott, ami befolyásolhatta a résztvevők online terápiához való hozzáállását, hiszen személyes terápiára nem is volt lehetőség.

Összességében az eredmények megerősítik, hogy az online, valós idejű, terapeuta által vezetett CBT hatékony alternatívája lehet a hagyományos személyes terápiának az OCD kezelésében. Ez különösen fontos lehet a modern pszichiátriai és általános egészségügyi ellátás digitális átalakulása idején, mivel lehetővé teszi a kezelés szélesebb körű hozzáférhetőségét. Az online terápiás formátum a jövőben hivatalos kezelési irányelvek részévé válhat, ezzel bővítve az OCD-ben szenvedők számára elérhető kezelési lehetőségeket és hozzájárulhat a pszichiátriai ellátás minőségének és elérhetőségének javításához.

Az integratív kognitív viselkedésterápia hatékonysága az elhúzódó gyász zavar kezelésében

Rosner, R., Bartl, H., Pfoh, G., Kotoučová, M., & Hagl, M. (2015). Efficacy of an integrative CBT for prolonged grief disorder: A long-term follow-up. Journal of Affective Disorders, 183, 106–112. https://doi.org/10.1016/j.jad.2015.04.051

Készítette: Mihály Adrienn

Az elhúzódó gyász zavar (prolonged grief disorder, PGD) az elmúlt két évtizedben önálló mentális zavarként vált ismertté, amelyet tartós és intenzív gyászreakció jellemez egy jelentős személy halála után. A PGD különbözik a depressziótól és a poszttraumás stressz zavartól, bár gyakran komorbid ezekkel, és hasonló tüneteket mutathat. A PGD esetében a gyászreakció meghaladja a normatív időtartamot (6 hónap), súlyos érzelmi és funkcionális zavarokat okozva. Tünetei közé tartozik a fokozott vágyakozás az elhunyt után, a veszteségre való túlzott fókuszálás, az érzelmi eltompultság és a társas kapcsolatok zavara. Emellett a PGD-t az egészségügyi állapot romlásával, depresszióval és öngyilkossági hajlammal hozzák összefüggésbe. Valamint magasabb kockázattal társul szívbetegségek, magas vérnyomás és egyéb egészségügyi problémákhoz. A PGD kezelésére egyre nagyobb figyelem irányul, mivel az állapot spontán ritkán javul. Az integratív kognitív viselkedésterápia (PG-CBT), mely ötvözi a kognitív viselkedésterápiát a Gestalt-terápia technikáival, valamint a család-rendszer-terápiával és a pszichodrámával ígéretes megközelítés, amely a gyász érzelmi feldolgozására, maladaptív kognitív mintázatok átdolgozására és a jövőorientált gondolkodás elősegítésére épít.

Egy 51 fős mintán végzett kutatás célja az integrált kognitív viselkedésterápia hosszú távú hatékonyságának vizsgálata volt, a gyász tünetei, illetve a mentális egészség tekintetében. A kutatásban résztvevő személyeket először a veszteségtípusa, valamint a gyász időtartama szerint csoportosítottak. Később pedig véletlenszerűen két csoportba osztották: az egyik csoport azonnal megkezdhette a terápiát, míg a másik csoport négy hónapos várakozási idő után csatlakozott. A terápiás folyamat hatékonyságát különböző mérőeszközökkel értékelték, beleértve a gyásztünetek súlyosságát mérő PG-13 interjút és a pszichológiai distresszt vizsgáló SCL-90-R kérdőívet.

A 20 alkalmas terápia három fő szakaszból állt. Az első szakasz az érzelmi stabilizálásra és a motiváció megerősítésére fókuszált, miközben a páciens gyászhelyzetének feltárása is megtörtént. A második szakaszban a relaxációs technikák elsajátítása és a gondolatok, érzések átkeretezése zajlott, amely magában foglalta az önmagával, az elhunyttal és a haláleset körülményeivel kapcsolatos gondolatokat és érzéseket. Végül, a harmadik szakaszban a jövőbeli célok megfogalmazása és az elhunyttal való egészséges kötődés kialakítása és fenntartása történt. Ezen kívül a terápia opcionális üléseket is (5 ülés) kínált, amelyek a különleges, kritikus helyzetek kezelésére szolgáltak, például születésnapok vagy évfordulók idején.

Az eredeti 51 résztvevő közül 37-en fejezték be a terápiát, és közülük 33-an vettek részt a másfél évvel későbbi utánkövetésen. Az azonnali és a késleltetett kezelés csoportjainak eredményei között nem találtak szignifikáns különbséget, így az adatokat összevonták. Az eredmények alapján a gyász tüneteiben klinikailag jelentős javulás mutatkozott mind a terápia befejezése után (49%), mind az utánkövetés során (64%). Az általános mentális egészség szintén jelentős javulást mutatott, amelyek javulása a terápia után is stabil maradt. A résztvevők többsége a terápiát pozitívnak vagy nagyon pozitívnak értékelte, kiemelve a terapeutával való kapcsolatot és a kezelés általános minőségét, mint a legnagyobb elégedettséget kiváltó tényezőket.

Fontos azonban megjegyezni, hogy a kutatás során néhány korlát is felmerült. Az egyik legfőbb limitáció a kis elemszám volt, valamint az, hogy a résztvevők túlnyomó többsége nő volt, mely szűkíti az eredmények általánosíthatóságát. További korlátozó tényező, hogy a várólistás kontrollcsoport tagjai is részt vettek a terápián, így a kezelés hosszú távú hatásait nem lehetett kontrollált környezetben vizsgálni. Limitáció még, hogy csak két terapeuta vezette az üléseket, mely csökkenti az eredmények objektivitását. Mindezek ellenére a kutatás eredményei egyértelműen igazolják, hogy az integrált kognitív viselkedésterápia hatékonyan segíti az elhúzódó gyász zavarral küzdőket, és javítja mentális egészségüket.

Az integrált kognitív viselkedésterápia egy kiemelkedően hatékony és átfogó módszer, amely tartós és jelentős javulást hozhat a kliensek életében. Ez a megközelítés különösen ajánlott azok számára, akik egy szeretett személy elvesztése miatt mély érzelmi megpróbáltatásokkal küzdenek, és életminőségük súlyosan sérült. A kutatási eredmények egyértelműen alátámasztják, hogy az integrált CBT alkalmazása szélesebb körben is helyet érdemel a pszichológiai gyakorlatban.