psychotherapy

This systematic review/meta-analysis confirms the benefits of cognitive behavioral therapy for patients with insomnia in the face of chronic health challenges. James W. Mold, MD, MPH

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Importance: Insomnia is highly prevalent among individuals with chronic disease (eg, chronic pain, cardiovascular disease, and cancer) and results in poorer disease outcomes and quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment for insomnia. However, concerns remain about its applicability and efficacy in people with chronic disease.

Objective: To evaluate the nature, efficacy, and acceptability of CBT-I in adults with chronic disease, and to identify moderators of treatment outcomes.

Data sources: Systematic searches were conducted in PsycINFO, Medline, Embase, and CENTRAL from database inception to June 5, 2025. Additional records were identified from reference lists of relevant reviews and studies.

Study selection: Eligible studies were randomized clinical trials (RCTs) involving adults (aged ≥18 years) with chronic disease and insomnia. Studies using CBT-I with measured sleep outcomes were included.

Data extraction and synthesis: Two assessors extracted data from RCTs. Hedges g was used to calculate effect sizes, and random effects meta-analyses were conducted. Heterogeneity was assessed via I2. Subgroup analyses examined whether outcomes varied by delivery format, chronic condition type, or control group.

Main outcomes and measures: Primary outcomes included insomnia severity, sleep efficiency, and sleep onset latency. Secondary outcomes included treatment acceptability and adverse effects.

Results: Sixty-seven RCTs (5232 participants) met inclusion criteria, including chronic diseases such as cancer, chronic pain, irritable bowel syndrome, and stroke. CBT-I was associated with significantly improved outcomes for insomnia severity (g = 0.98; 95% CI, 0.81-1.16) and moderate effect sizes regarding sleep efficiency (g = 0.77; 95% CI, 0.63-0.91) and sleep onset latency (g = 0.64; 95% CI, 0.50-0.78). Subgroup analyses revealed some sample, treatment, and methodological moderators (eg, longer treatment yielded better outcomes for sleep efficiency and sleep onset latency). Satisfaction with CBT-I was high, with a mean dropout rate of 13.3%. Treatment-related adverse effects were rare.

Conclusions and relevance: This systematic review and meta-analysis showed that CBT-I demonstrated strong efficacy and acceptability in chronic disease populations, with moderate to large effect sizes that appear comparable to those in non-chronic disease populations. Efficacy of CBT-I was similar across a range of disease subgroups. Future research should explore the role and nature of treatment adaptations for specific populations and increase access to CBT-I in medical settings.

Author/s:

Amelia J. Scott, Ashleigh B. Correa, Madelyne A. Bisby

Depression - Screening and Treating Depression in Adolescents

Alex Haga — Thu, 20 Jun 2024 21:10:05 +0000

Date Added:

June 20, 2024

Journal/Publication:

New England Journal of Medicine

Publication Date:

June 12, 2024

Issue:

Volume:

390

URL:

Depression - Screening and Treating Depression in Adolescents

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Video

DOI (1):

10.1056/NEJMp2400711

Keywords

adolescent

psychotherapy

depression

PMID (1):

38865659

MeSH

adolescent

Antidepressive Agents* / therapeutic use

Depression* / diagnosis

Depression* / therapy

Depressive Disorder / diagnosis

Depressive Disorder / therapy

Psychotherapy

A 14-minute audio-video discussion of screening and treatment of depression in adolescents. James W. Mold, MD, MPH

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Drs. Crawford, Fallucco, and Scott-Vernaglia take a closer look at the prevalence of depression among teenagers. Recognizing the existing gaps in pediatricians’ training and resources to address this issue, the doctors describe signs and symptoms of depression and how to screen for the diagnosis in this patient population. They review available treatments and associated adverse effects, while also underscoring the importance of follow-up after antidepressants are started.

Author/s:

Christine M Crawford, Elise Fallucco, Maurizio Fava, Julie Ingelfinger, Shannon Scott-Vernaglia

Management of Posttraumatic Stress Disorder

Tracy Ashby — Thu, 20 Dec 2018 06:00:00 +0000

Date Added:

December 21, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

December 17, 2018

URL:

Management of Posttraumatic Stress Disorder

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.19290

Keywords

post-traumatic stress disorder

veterans

psychotherapy

PMID (1):

30556838

MeSH

Stress Disorders

stress disorders, post-traumatic

diagnostic and statistical manual of mental disorders

United States Department of Veterans Affairs

veterans health

This Veterans Affairs/Dept. of Defense Guideline recommends referral for individual, manualized trauma-focused psychotherapy (TFP) as the first line treatment for PTSD. Patients unwilling to undergo that treatment may benefit from SSRIs.

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Summary of the Clinical Problem

Individuals who have been personally or indirectly exposed to actual or threatened death, serious injury, or sexual violence have a wide range of psychological responses, from transient, nondebilitating reactions to symptoms that meet the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for acute stress disorder or PTSD. Between 6% and 7% of adults in the US general population are estimated to experience PTSD during their lifetime. The prevalence is higher in women than in men. In 2016, 10.6% of veterans receiving care in the Veterans Health Administration had a diagnosis of PTSD. Among veterans who served in Iraq and/or Afghanistan, 26.7% of those seeking care in the Veterans Health Administration receive a PTSD diagnosis.

Author/s:

Ostacher, Michael J., Cifu, Adam S.