Cognitive Behavioral Therapy for Chronic Illness and Disability

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Although they found that the level of depression, belief, disability, and pain were predictors of treatment outcomes, the treatment used in this review was not specific for CBT. The purpose of this paper is to review the predictors of outcomes of CBT intervention among the people with chronic diseases. To investigate the use of CBT in chronic physical illnesses, these studies were then screened by title to remove those that focused on psychological disorders and weight control.

The refined search yielded articles. Abstracts from these articles were reviewed to determine if they met the final inclusion criterion of including the predictors of the cognitive behavioral intervention.

Cognitive Behavioral Therapy for Chronic Illness and Disability by Renee R. Taylor

Ninety-eight articles remained after the abstract review. Finally, the full text of the 98 articles was reviewed for inclusion of the predictors of CBT effectiveness. Eleven articles met the criteria and were included in this review Figure 1. This is a validated instrument used to evaluate the quality of randomized clinical trials.

Early Treatment of TMD May Prevent Chronic Pain and Disability

It emphasizes specific parts of a study, including randomization, blinding, withdrawal, and dropouts. It is an item assessment the reviewer uses to evaluate the quality of a study based on the description of the study and its methodology. Two extra points can be added if the methods of randomization and a double-blind are described. Therefore, the total Jadad quality score ranges from 0 to 13 with the higher score indicating better quality.

Of the 11 articles reviewed, 6 reported the details of their intervention and methodology in the original studies. Therefore, the reviewers evaluated the quality of these six articles based on the descriptions in the original studies [33,34]. The reviewers discussed the item scores among themselves until they came to a consensus Table 1. Table 1 summarizes the characteristics of studies used in this review paper. The quality of the 11 articles based on the Jadad score ranged from 3 to Cognitive behavioral interventions used in the 11 articles Table 2 varied in terms of the CBT features of treatment modality, delivery methods, and format.


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Several reviewed articles indicated that detailed information of their CBT intervention was published elsewhere. Therefore, the original articles were reviewed except for one study Kempke et al. The cognitive restructuring was the key CBT feature used in eight of the studies. Two studies used either the telephone or internet Table 3.

The length of an intervention varied from 1 to 5 hours per session and the number of sessions ranged from 6 to Table 4 describes the study design, outcome variables, clinically significant outcomes identification methods, predictors, and results. Four studies only investigated the immediate effectiveness of CBT by measuring pre- and post-treatment outcomes [38,39].

Seven studies evaluated both short- and longterm outcomes by evaluating participants for up to one year following the intervention [40]. Methods used to identify the success or responsiveness to the intervention were varied. Gersh et al. Five studies classified participants into clinical improvement and nonclinical improvement groups using the cut-off score of outcome variables such as fatigue, function, and depression. Ten other studies investigated the predictability of the predictors on either the outcome variables post-treatment.

Most of the predictors in these 11 articles were psychosocial.

The predictors included: states of change Gersh et al. Only one study investigated the functional brain circuit in association with the response to the CBT intervention Falconer et al. All 11 studies determined that patients with physical illnesses benefit from CBT in both the short and long term. However, these results also found that not all participants receive the same level of benefit. Several factors may influence the effectiveness of a CBT intervention. First, although the 11 articles used the term CBT intervention, they differed in their intervention components, treatment modalities, and delivery methods.

The recommended intervention features for CBT as an adjunctive treatment in chronic physical illnesses include cognitive intervention e.

To ensure that patients use these techniques, homework or workbook assignments are needed. However, the CBT studies described in these articles do not include all of these features Table 3. Second, social support may have had a major influence on the effectiveness of studies that compared group sessions to individual sessions. Third, the number of sessions and time spent for each session varied widely among the reviewed articles.

Finally, 7 of the 11 studies used CBT as an adjunct treatment with other interventions. These differences of treatment modality and methods may have led to differences in outcomes. Methods used to identify the success of CBT were inconsistent among the articles. These Two main methods were used by the reviewed articles include the use of criteria to classify the participants into treatment responders and non-responders and the use outcome variables at the treatment complication or the level of outcome change at completion from baseline.

These inconsistencies can have a major impact on the identification of predictors and make it difficult to determine who will benefit from CBT intervention. The standard criteria or expected outcomes for the CBT intervention should be developed to identify the effectiveness. These outcomes included a shortterm effectiveness of the CBT intervention on pain, fatigue, and physical activity.

Interestingly, these predictors often overlapped or were associated with each other. The association among states of readiness to change, acceptance, and rational-problem solving with depression were reported in three of the studies []. These associations and overlapping outcome predictors could influence the results of a study. Each of these predictors was studied separately and no study investigated all of the predictors in one disease phenomenon. To investigate the predictors that help identify responders to CBT intervention, seven studies identified predictors of both immediate and long-term effectiveness [51].

However, results among the studies were inconsistent, with different significant predictors for immediate and long-term outcomes. In patients with chronic fatigue syndrome, for example, physical activity and a feeling of control over symptoms predicted an immediate outcome improvement, but disability benefit was a predictor for outcomes at 6 months Schreurs et al.

CBT for Chronic Pain

For patients with unexplained physical symptoms, the mental component was a significant outcome predictor of CBT at 3 months, but not significant for the immediate and long-term 1 year after the intervention outcomes. Two studies found consistent significant predictors of immediate and long-term outcomes.

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Dopkin et al. Applebaum et al. In one study there was no significant outcome predictor for CBT in people with irritable bowel syndrome. A number of studies reported the biological predictors of the CBT outcomes in the psychological disorder []. This information will not only help identify the biological mechanism associated with the CBT effectiveness but also identity person potentially will benefit from the intervention.

Based on the articles reviewed, only one study investigated the association of physiological outcome predictors of CBT outcomes posttraumatic stress disorder in civilian trauma. The study result suggested the neural activation pattern of the left-lateralized front striatal inhibitory control associated with the response to CBT.

This finding suggested future research should examine the biological pathways or mechanisms associated with CBT outcomes. This rigorous, targeted review of 11 randomized control trials adds to the field of knowledge on CBT outcome predictors for physical illnesses.

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The results can be used as a guide for future researchers in investigating CBT intervention outcomes predictors in people with chronic physical illnesses, especially physiological and biological predictors. Furthermore, psychological predictors such as acceptance, therapeutic alliance, self-efficacy, physical ability, and depression should be tested for their predictability among people with different physical illnesses. Finally, a standardized guideline of CBT intervention with common components applicable to physical illnesses should be developed and tested.

The sample size was small because our search was limited to randomized control trials that included an investigation of the outcome predictors. Therefore, several comparable but nonrandomized trials were not reviewed. Additionally, the review only included physiological illnesses, so numbers of studies investigating biological predictors associated with CBT outcomes on depression and most other psychological disorders were not included.

Contact us at: nursing irispublishers. Abstract Background: Cognitive behavioral therapy CBT is a self-management strategy used by patients with chronic diseases. Introduction Chronic illnesses are rapidly becoming a major health concern in the United States.