Cognitive behaviour therapy
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The current study investigated the role of fear-avoidance-a concept from chronic pain research-in chronic tinnitus. A self-report measure the "Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)" was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. ⋯ Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.
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The purpose of this proof of concept study was to explore the role of attentional bias modification (ABM) in improving clinically relevant outcomes in chronic pain. Eight participants with chronic pain completed eight ABM sessions, which featured a modified version of the visual-probe task implicitly training attention away from pain-related stimuli towards neutral stimuli. Training sessions included a variety of linguistic and pictorial pain-related stimuli, which were presented at two presentation times (500 and 1250 ms). ⋯ Attentional bias scores did not statistically differ across time. These results support the continued exploration of ABM in chronic pain and the modifications we made to the intervention (i.e. the inclusion of pictorial stimuli and a longer presentation time). Future research is needed to explore the optimal form of ABM and whether improvements are maintained over time.
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Randomized Controlled Trial
Guided internet-delivered cognitive behavior therapy for generalized anxiety disorder: a randomized controlled trial.
Generalized anxiety disorder (GAD) has been effectively treated with cognitive behavioural therapy (CBT) in face-to face settings. Internet-delivered CBT could be a way to increase the accessibility and affordability of CBT for people suffering from GAD. The aim of this study was to evaluate the efficacy of guided Internet-delivered CBT for GAD in a controlled trial with a wait-list control group. ⋯ Large effect sizes (Cohen's d > 0.8) were found both within the treatment group and between the groups in favor of the treatment on all outcome measures except on a measure of quality of life. Results at 1- and 3-year follow-up indicated that treatment results improved or were maintained. The authors conclude that Internet-delivered CBT with therapist support can reduce symptoms and problems related to GAD.
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Randomized Controlled Trial
Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help.
Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. ⋯ In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.
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This review covers the current cognitive behavioural treatments available to address fear-avoidance beliefs in patients with chronic musculoskeletal pain (CMP). Four types of treatment protocols were identified for inclusion in the review: (a) graded in vivo exposure (GivE); (b) graded activity (GA); (c) acceptance and commitment therapy (ACT); and (d) mixed cognitive behavioural protocols. ⋯ This relative absence of North American research raises potentially important questions about the role of compensation status and access to care, which differ between countries, on treatment outcome. Implications and directions for future research are discussed.