Cognitive behaviour therapy
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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.
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In the last several years, a number of researchers have developed a transdiagnostic or unified group cognitive behavioral therapy (CBT) that is provided to a diagnostically heterogeneous group consisting of individuals with various anxiety disorders and/or depression. This article provides a review of recent developments within this transdiagnostic perspective to CBT. ⋯ At this time, the unified protocol for emotional disorders offers the most cogent theory-driven transdiagnostic treatment approach, although its efficacy has yet to be demonstrated. The advantages and challenges of transdiagnostic CBT are reviewed, and the article concludes with a proposal that future research on transdiagnostic CBT would be better served if viewed as complementary rather than antagonist to well-established manualized disorder-specific CBT for the anxiety disorders and depression.
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Comparative Study
Measuring mindfulness: pilot studies with the Swedish versions of the Mindful Attention Awareness Scale and the Kentucky Inventory of Mindfulness Skills.
The present article describes data from pilot studies with the Swedish versions of the Mindful Attention Awareness Scale (MAAS) and the Kentucky Inventory of Mindfulness Skills (KIMS). The MAAS and two of the KIMS scales, Act with Awareness and Accept without Judgment, were found to correlate in the predicted direction with measures of well-being and emotional distress. ⋯ The KIMS was also used in an uncontrolled study with participants in an educational programme for close relatives of persons with borderline personality disorder, Family Connections (FC), which includes components of mindfulness training. The FC participants were found to (a) score lower than a comparison group on Act with Awareness and Accept without Judgment before treatment and (b) show significantly increased scores on Accept without Judgment after treatment.
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Chronic pain (CP) and posttraumatic stress disorder (PTSD) are both frequent and often comorbid in refugees. To date, few controlled trials have studied the efficacy of treatments targeting this comorbidity; no treatment guidelines yet exist. The authors examined the feasibility and efficacy of short-term cognitive behavioural biofeedback (BF) addressing CP in traumatised refugees. ⋯ Acceptance of BF was high. Pre-post effects were small to medium for increased pain management and associated heart rate reactivity but large for coping with pain. The results encourage further research to confirm whether BF is indicated as a treatment component, but not a stand-alone treatment, for traumatised refugees with comorbid CP and PTSD.
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Randomized Controlled Trial
Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial.
Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. ⋯ No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7-month follow-up. The authors discuss implications of these findings and offer suggestions for further research in this area.