Cognitive and Behavioral Practice最新文献

Cognitive Behavioral Therapy (CBT) is used widely throughout the world in diverse populations for successful treatment of a wide range of psychiatric and comorbid conditions. Over the years clinicians have been making efforts to culturally adapt CBT to various groups. This paper discusses the assessment and treatment of a young female from Pakistan with depression and anxiety with comorbid headache. After ruling out all organic causes, the treatment continued over 20 sessions with the initial phase consisting of introduction to CBT, risk assessment, and identification of treatment goals. Following this, the patient was helped in identifying automatic thoughts, feelings, and behaviors. Finally, tools such as thought substitutions, reappraisals, and positive diversions were used effectively to decrease automatic negative thoughts. A focus on the patient’s religio-cultural identity was maintained throughout. Understanding of contextual factors like religio-cultural values and family dynamics helped to bring about favorable therapy outcomes. A case conceptualization that cohesively addressed factors relating to ethnicity, class, and gender yielded a positive result in our case. Involvement of the family and psychoeducation regarding neurobiological causes also proved to be helpful. Such an approach can facilitate a culturally responsive application of CBT in Pakistani youth experiencing comorbid medical and psychiatric disorders.

While many youths recover from concussions within several weeks, a subset of patients experience persistent postconcussive symptoms (PPCS), lasting 4 weeks or longer. PPCS have a significant negative impact on children’s social and academic functioning, often leading to extended absences from school, disruption of normal activities, and increased mental health burden. Cognitive-behavioral therapy (CBT) has demonstrated promise as a treatment for PPCS but requires tailoring to specifically address concussion-related targets. This paper describes the clinical adaptation of CBT for pediatric patients with PPCS, including core intervention modifications and recommendations for the implementation and delivery of CBT in medical settings. A model of an integrated concussion clinic with pediatric neurology and psychology is discussed.

Integrated behavioral health (IBH) in primary care is growing as an approach to decrease barriers and provide earlier intervention for youth experiencing behavioral and mental health symptoms. However, increasing access to mental health providers alone without ensuring evidence-based treatment (EBT) is provided will not sufficiently address the current mental health crisis. To spread to scale, IBH needs to be implemented and tested in community-based practices with integrity to EBT. This paper provides a model for implementing cognitive behavioral therapy (CBT) in community pediatric primary care via master’s prepared therapists through an academic-community partnership. This paper describes the hiring practices, training in CBT, ongoing supervision and consultation, and use of data to inform the evolution of the model. Using a retrospective review of the rate of emergency department (ED) admissions per 1,000 patients with a diagnosis of depression, we compared practices enrolled in our academic-community partnership IBH model to practices who implemented their own IBH and practices with no IBH. Across a four-year period, we found that practices enrolled in the academic-community partnership IBH model had a lower number of patients per 1,000 patients with a diagnosis of depression admitted to the ED with behavioral health concerns compared to practices that did not incorporate an IBH therapist. There was no difference in ED admission rates per 1,000 between practices that hired their own IBH and those without IBH. Analysis of costs of the program against generated revenue from billed services demonstrated that the academic-community partnership model shows promise of sustainability.

The current pilot study evaluates a cognitive behavioral (CBT) sleep intervention specifically developed for adolescents with ADHD – Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA). Based on a qualitative and quantitative evaluation, the final aim is to fine-tune SIESTA and the assessment protocol to the target population. Eight adolescents (13–17 years old) with ADHD and sleep problems completed SIESTA. Separate focus groups with adolescents and parents were conducted to evaluate their experience with SIESTA and the assessment protocol. These were analyzed using thematic analysis. Additionally, individual reliable change indices were computed from pretest to posttest for sleep hygiene practices. Thematic analysis showed that adolescents and parents reported both positive aspects and points of improvement of SIESTA and the assessment protocol during the focus groups. Reliable change indices showed that all adolescents significantly improved on at least one of the subscales of the revised Adolescent Sleep Hygiene Scale. Preliminary qualitative findings indicate satisfaction with SIESTA and the assessment protocol, with some suggestions for further improvements, and quantitative findings indicate significant improvement in sleep hygiene. The next step is to test the effectiveness of SIESTA in a randomized controlled trial, based on the adaptations after this pilot study.