Effectiveness and feasibility of intensive versus regular cognitive behaviour therapy in patients with anxiety and obsessive-compulsive disorders: A meta-analysis

Remmerswaal, Karin C.P.; Lans, Luuk; Seldenrijk, Adrie; Hoogendoorn, Adriaan W.; Balkom, A.J.L.M. van; Batelaan, Neeltje M.

doi:10.1016/j.jadr.2021.100267

Cited by 15 publications

(20 citation statements)

References 52 publications

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“…The large reduction in primary outcome and secondary outcome measures is in line with previous research on the B4DT for PD [ 16 , 17 ] and with results from the B4DT for OCD [ 13 – 15 , 33 ]. The large reduction in secondary outcome measures for depression found in the current sample and previous research on the B4DT is in line with meta-analytic findings from Remmerswaal et al [ 9 ].…”

Section: Discussionsupporting

confidence: 92%

“…Research has suggested that intensified exposure has similar treatment outcomes as ordinary exposure treatment, but intensifying treatment could be associated with quicker response, lower drop-out rates as well as reducing disability days and improving quality of life [ 8 ]. Similar findings were reported in a recent meta-analysis, which also added that intensive CBT could be better for reducing comorbid depressive symptoms, but also highlighted that research on intensive CBT formats is understudied [ 9 ]. It is also important to note that intensifying exposure treatment could be associated with slightly higher treatment burden and somewhat stronger side effects [ 10 ].…”

Section: Introductionsupporting

confidence: 81%

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The Bergen 4-day treatment for panic disorder: implementation in a rural clinical setting

et al. 2023

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Introduction The Bergen 4-Day Treatment (B4DT) is a concentrated treatment with individually tailored exposure exercises. The format has shown promising results in the treatment of panic disorder. Aim The aim of the current study was to investigate the effectiveness of the B4DT in a large sample in a rural clinical setting. Method Fifty-eight patients with panic disorder were consecutively included using an open trial design. The primary outcome measure was the Panic Disorder Severity Scale. The Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 were used as secondary outcome measures. Assessments were conducted at pretreatment, posttreatment, and 3-month follow-up. Treatment satisfaction was measured at posttreatment using the Client Satisfaction Questionnaire-8. Results There was a significant reduction in symptoms of panic disorder from pre- to posttreatment (d = 3.36) and from pretreatment to follow-up (d = 3.63). At posttreatment and follow-up, 72.4% and 81.0% of patients, respectively, were classified as in remission. Patients reported high treatment satisfaction, and there were significant reductions in symptoms of generalized anxiety and depression. Conclusion The results from the current study replicated the findings from previous studies using a larger sample size. The findings indicate that the B4DT is a promising treatment format for panic disorder. The study also demonstrated that the treatment format can be successfully implemented in new rural clinics.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionsupporting

confidence: 81%

The Bergen 4-day treatment for panic disorder: implementation in a rural clinical setting

et al. 2023

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“…While evidence supporting massed delivery of disorder-specific CBTs has been an exciting development in the psychotherapy literature (Hansen et al, 2019; Remmerswaal et al, 2021; Sciarrino et al, 2020; Wachen & Held, 2023), the present study adds to preliminary evidence supporting massed delivery of transdiagnostic protocols for depressive, anxious, and trauma- and stressor-related disorders. The preliminary outcomes of UP-IOP were achieved rapidly, making moderate reductions in symptom severity in veterans and service members with varying degrees of diagnostic complexity and various psychiatric disorders.…”

Section: Discussionmentioning

confidence: 64%

“…While the majority of evidence-based CBT protocols were developed for weekly, outpatient settings, there has been a growing interest in adapting these protocols for implementation within cost-effective intensive treatment settings (Wachen & Held, 2023). Recent attempts to implement CBTs for anxiety disorders and trauma- and stressor-related disorders within intensive settings have shown promise in yielding symptom reduction comparable to conventional therapy (Hansen et al, 2019; Remmerswaal et al, 2021; Sciarrino et al, 2020). However, these intensive disorder-specific approaches may have limitations for treating those presenting with multiple comorbid diagnoses.…”

Section: Transdiagnostic Treatmentsmentioning

confidence: 99%

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Sherrill,

Mehta,

Patton

et al. 2024

Psychological Services

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Recent evidence supports the implementation of massed delivery of disorder-specific treatments in the military service member and veteran population. However, many treatment settings serve patients with a wide range of diagnoses, and often patients present with comorbid conditions. Growing evidence suggests transdiagnostic cognitive behavioral treatments are effective for a wide range of emotional disorders and may reduce barriers to access. Little is known about the feasibility and outcomes of the massed delivery of transdiagnostic treatments. The present study examined real-world outcomes of a 2-week intensive outpatient program using the Unified Protocol for emotional disorders (UP-IOP). The sample included military service members and veterans diagnosed with a range of emotional disorders, namely trauma-and stressor-related disorders, unipolar depressive disorders, and anxiety disorders. The present study examined outcomes of UP-IOP (depression, trauma-related symptom severity, and emotion dysregulation). Participants included all patients who sought UP-IOP in its first 15 months of operation (N = 117). A diagnosis of posttraumatic stress disorder (PTSD) was an exclusion criterion because the site had an established PTSD-specific IOP treatment option. Findings indicate UP-IOP was feasible, had 94% patient retention, and was effective in reducing symptom severity (Cohen's d = 0.76 for depression symptom severity, Cohen's d = 0.80 for trauma-related symptom severity). There was no observed reduction in emotion dysregulation over the 2-week course of treatment. The intensive transdiagnostic approach resulted in effective symptom reduction in an accelerated timeframe while minimizing patient attrition. These findings indicate massed delivery of transdiagnostic cognitive behavioral therapy (CBT) treatments should continue to be explored, especially for this population. Impact StatementThis study investigated the Unified Protocol, a transdiagnostic cognitive behavioral therapy delivered every day over 2 weeks with a sample of military service members and veterans diagnosed with anxious, depressive, or trauma-related disorders. Results indicated moderate reductions in symptom severity, and almost all patients completed treatment. Intensive transdiagnostic treatments should be explored further as an approach to retain patients and achieve rapid gains for clinical populations with diverse symptom presentations.

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“…15 Time-intensive treatments deliver the treatment protocol over a shorter period (typically 1-2 weeks) in longer and more frequent sessions, and have been found to be effective in the treatment of OCD, PTSD, social anxiety and panic disorder. 16 This form of delivery has been found to be effective and acceptable for women with postpartum OCD 17 and may be a good fit given the time frame of pregnancy. An effective treatment dose earlier on could alleviate distress in the remainder of the pregnancy and thereby potentially improve a range of outcomes.…”

mentioning

confidence: 99%

Patient and therapist experiences of exposure therapy for anxiety-related disorders in pregnancy: qualitative analysis of a feasibility trial of intensive versus weekly CBT

Challacombe,

Sabin,

Jacobson

et al. 2023

BJPsych open

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Background Approximately 15% of pregnant women experience anxiety disorders. Effective treatments exist but their acceptability during pregnancy, particularly exposure therapy, is not known. Aims To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy. Trial registration: ISRCTN81203286. Method In-depth interviews were conducted with patients and therapists who had taken part in a feasibility trial of predominantly online time-intensive versus weekly cognitive–behavioural therapy in pregnancy in a primary care setting in the UK. Data were analysed using reflexive thematic analysis. Results In total, 45 women participating in the trial and 6 therapists who had delivered the treatments were interviewed. Five themes were developed from the data that showed convergence from therapist and patient perspectives: ‘Acquiring tools to navigate the perinatal period’; ‘Motivated yet constrained by pregnancy’; ‘Having the confidence to face fears and tolerate uncertainty’; ‘Momentum with the need for flexibility’; ‘Being removed from the face-to-face world’. Conclusions Exposure therapy is acceptable and helpful in pregnancy and can lead to lasting gains. Exposure is a key element of treatment and needs to be confidently conducted by therapists with perinatal knowledge and expertise. Treatments need to consider the unfolding context of pregnancy. The momentum of intensive therapy can lead to rapid improvements, but is demanding for both patients and therapists, especially fitting round other commitments. Online treatments can work well and are a good fit for perinatal women, but this needs to be balanced with the need for social connection, suggesting a hybrid model is the ideal.

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Effectiveness and feasibility of intensive versus regular cognitive behaviour therapy in patients with anxiety and obsessive-compulsive disorders: A meta-analysis

Cited by 15 publications

References 52 publications

The Bergen 4-day treatment for panic disorder: implementation in a rural clinical setting

The Bergen 4-day treatment for panic disorder: implementation in a rural clinical setting

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Patient and therapist experiences of exposure therapy for anxiety-related disorders in pregnancy: qualitative analysis of a feasibility trial of intensive versus weekly CBT

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