Esben Hougaard

The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis

BACKGROUND Mindfulness-based cognitive therapy (MBCT) is a group-based clinical intervention program designed to reduce relapse or recurrence of major depressive disorder (MDD) by means of systematic training in mindfulness meditation combined with cognitive-behavioral methods. OBJECTIVE By means of a meta-analysis to evaluate the effect of MBCT for prevention of relapse or recurrence among patients with recurrent MDD in remission. METHOD Electronic databases were searched and researchers were contacted for further relevant studies. Studies were coded for quality. Meta-analyses were performed by means of the Cochrane Collaboration Review Manager 5.1. RESULTS Six randomized controlled trials with a total of 593 participants were included in the meta-analysis. MBCT significantly reduced the risk of relapse/recurrence with a risk ratio of 0.66 for MBCT compared to treatment as usual or placebo controls, corresponding to a relative risk reduction of 34%. In a pre-planned subgroup analysis the relative risk reduction was 43% for participants with three or more previous episodes, while no risk reduction was found for participants with only two episodes. In two studies, MBCT was at least as effective as maintenance antidepressant medication. CONCLUSION Results of this meta-analysis indicate that MBCT is an effective intervention for relapse prevention in patients with recurrent MDD in remission, at least in case of three or more previous MDD episodes.

A randomized pilot study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for young adults with social phobia.

Twenty-six young participants, 18-25 years, with social phobia (SP) were randomly assigned to eight 2-hour sessions of group mindfulness-based cognitive therapy (MBCT) and twelve 2-hour sessions of group cognitive-behavioral therapy (CBT) in a crossover design with participants receiving treatments in reversed order. Outcome was assessed after treatments, and at 6- and 12-month follow-ups. MBCT achieved moderate-high pre-post effect sizes (d=0.78 on a composite SP measure), not significantly different from, although numerical lower than those of CBT (d=1.15). Participants in both groups further improved in the periods following their first and second treatment until 6-months follow-up (pre-follow-up ds = 1.42 and 1.62). Thus, MBCT might be a useful, low cost treatment for SP, although, probably, less efficacious than CBT.

Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social phobia: A systematic review

Background: Although cognitive behavioural therapy (CBT) has been shown to be an efficacious treatment for social phobia (SP), many patients drop out or achieve little or no benefit from treatment. This fact is generally considered an argument for the importance of studies of predictor variables. Aims: This paper systematically reviews pre-treatment patient variables as predictors of drop-out from and outcome of CBT for SP. Method: A structured literature search was conducted in PsycINFO, Embase and PubMed. Results: 28 published studies with n≥60 were located. No pre-treatment patient variables were found to predict drop-out. Consistently across studies, higher levels of pre-treatment symptomatic severity predicted higher levels of end-state symptomatic severity, but not degree of improvement. There was some evidence that comorbid depression and avoidant personality disorder before treatment negatively influenced post-treatment end-state functioning, but not consistently improvement. No other patient variables consistently predicted outcome across studies. Conclusions: Generally, the results are in line with the conclusion that more disturbed patients with SP both begin and end treatment at a higher symptomatic level but with a similar degree of improvement. There is, however, little clinically or theoretically relevant knowledge to be gained from existing studies of pre-treatment patient variables as predictors of drop-out and treatment outcome in CBT for patients with SP. The field is in need of conceptual and methodological improvements if more solid findings should be hoped for.

Group cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis

Objective:  Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive–compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta‐analysis of the effectiveness of group CBT/ERP for OCD.

Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder.

Jónsson H, Hougaard E, Bennedsen BE. Randomized comparative study of group versus individual cognitive behavioural therapy for Obsessive Compulsive Disorder.

Social anxiety and emotion knowledge: A meta-analysis

It has been proposed that social anxiety is associated with poor emotion knowledge (EK), although studies have revealed mixed results. The aim of the present paper was to systematically investigate the association between EK and both non-clinical and clinical social anxiety by means of meta-analyses. Systematic, electronic database literature searches were performed, and meta-analyses were conducted on 43 included studies. Results showed that social anxiety was negatively associated with EK. The strongest association was found between clinical levels of social anxiety and the ability to understand ones own emotions (intrapersonal EK). Regarding interpersonal EK, a subgroup analysis showed that social anxiety was more strongly associated with a decreased ability to understand complex emotions than to recognize basic emotions. No differences were found between patients with social anxiety disorder (SAD) and patients with other anxiety disorders. Although a large between study heterogeneity and differing methodologies may prevent any firm conclusions from being reached, the results indicate that poor EK may play an important role in SAD, and that it could be beneficial to target EK in the treatment of SAD.

A randomized study of massed three-week cognitive behavioural therapy schedule for panic disorder.

Objective:  To compare the efficacy of massed vs. spaced group cognitive behavioural therapy (CBT) for patients with panic disorder with or without agoraphobia (PD).

Mechanisms of change in cognitive behaviour therapy for panic disorder: The role of panic self-efficacy and catastrophic misinterpretations

The efficacy of cognitive behavioural therapy (CBT) for panic disorder with or without agoraphobia (PD) is well-established; however, little is known about the underlying change processes of clinical improvement during therapy. According to cognitive theories, CBT for PD primarily works by changing catastrophic misinterpretations of bodily symptoms and panic attacks. However, panic self-efficacy, i.e. the perceived ability to cope with panic attacks, has also been suggested as an important change mechanism in CBT for PD. The aim of the study was to investigate if change in catastrophic misinterpretations and panic self-efficacy mediated change in the level of anxiety during the course of thirteen sessions of group CBT for PD. Forty-five participants completed weekly self-report measures of the possible cognitive mediators and the level of anxiety throughout therapy. The results indicated that within-person change in panic self-efficacy in one session, but not in catastrophic misinterpretations, predicted within-person level of anxiety symptoms the following week. However, in a reversed analysis, prior change in level of anxiety symptoms also predicted change in panic self-efficacy the following session. These results support panic self-efficacy as a mediator of change in CBT for PD, although a reciprocal causal relationship between panic self-efficacy and level of anxiety seems to be implied.

Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders

Abstract Background: Cognitive behavioural therapy (CBT) has been found to be effective for children and adolescents (6–18 years) with anxiety disorders, but the non-response rate is high—a fact that may argue for the importance of studies on pre-treatment characteristics of children and their families that predict treatment outcome. Aims: To provide a systematic review of clinical and demographic pre-treatment child and family predictors of treatment outcome in CBT for anxiety disorders in youth. Method: A systematic literature search was conducted based on electronic databases (PsycINFO, Embase and PubMed), and retrieved studies were analysed according to the box-score method of counting significant findings. Results: 24 studies with a sample size ≥ 60 were located. Most studies dealt with the following predictors: child age, gender, comorbidity, symptom severity and parental psychopathology. There was some evidence that a higher degree of pre-treatment symptomatic severity and non-anxiety comorbidity predicted higher end-state severity, but not a lesser degree of improvement. There was some but inconsistent support for a negative influence of parental psychopathology. Conclusion: Studies on pre-treatment child and family predictors of outcome in CBT for youth anxiety disorders have until now resulted in few findings of clinical or theoretical significance.

Emotion Differentiation and Emotion Regulation in High and Low Socially Anxious Individuals: An Experience-Sampling Study

AbstractThe present study explored when and how emotional difficulties and poor quality of life arise in the everyday lives of socially anxious individuals. 264 freshmen-year college students completed an online survey for 11 consecutive days. Comparing individuals high (HSA) and low in social anxiety, results revealed that irrespective of daily positive emotion differentiation ability, HSAs engaged daily emotion suppression strategies, pointing to inflexible emotion regulation. Furthermore, HSAs with poor daily negative emotion differentiation used the least daily cognitive reappraisal. Finally, both expressive suppression and cognitive reappraisal showed group-specific effects on daily positive affect. Daily expressive suppression was more strongly associated with diminished daily positive affect in HSAs, and HSAs benefited less in terms of daily positive affect from daily use of cognitive reappraisal. Based on these findings, emotion differentiation ability and emotion regulation appear relevant clinical targets for individuals with social anxiety disorder.