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Journal of Clinical Psychology in Medical Settings

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01-06-2020 | Mood Disorders

The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans

Authors: Charles P. Brandt, Frances Deavers, Natalie E. Hundt, Terri L. Fletcher, Jeffrey A. Cully

Published in: Journal of Clinical Psychology in Medical Settings | Issue 2/2020

Abstract

The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the “physical health” and “thoughts” modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.

Andersen, P., Toner, P., Bland, M., & McMillan, D. (2016). Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: A systematic review and meta-analysis. Behavioural And Cognitive Psychotherapy,44, 673–690. https://doi.org/10.1017/S1352465816000229.CrossRefPubMed

Aquin, J. P., El-Gabalawy, R., Sala, T., & Sareen, J. (2017). Anxiety disorders and general medical conditions: Current research and future directions. Focus,15, 173–181. https://doi.org/10.1176/appi.focus.20160044.CrossRefPubMedPubMedCentral

Bartels, S. J., Coakley, E. H., Zubritsky, C., Ware, J. H., Miles, K.M., Areán, P. A., … & Levkoff, S. E. (2004). PRISM-E Investigators: Improving access to geriatric mental health services: A randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry, 161, 1455–1462. https://doi.org/10.1176/appi.ajp.161.8.1455.

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology,56, 893–897. https://doi.org/10.1037/0022-006X.56.6.893.CrossRefPubMed

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Beck, A. T., & Steer, R. A. (1990). Beck anxiety inventory manual. San Antonio, TX: The Psychological Corporation.

Beck, A. T., & Steer, R. A. (1991). Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients. Journal of Anxiety Disorders, 5(3), 213–223.CrossRef

Bell, E. C., Marcus, D. K., & Goodlad, J. K. (2013). Are the parts as good as the whole? A meta-analysis of component treatment studies. Journal of Consulting and Clinical Psychology,81, 722. https://doi.org/10.1037/a0033004.CrossRefPubMed

Bennett, J. A., Riegel, B., Bittner, V., & Nichols, J. (2002). Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart & Lung: The Journal of Acute and Critical Care,31, 262–270. https://doi.org/10.1067/mhl.2002.124554.CrossRefPubMed

Bestall, J. C., Paul, E. A., Garrod, R., Garnham, R., Jones, P. W., & Wedzicha, J. A. (1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax,54, 581–586. https://doi.org/10.1136/thx.54.7.581.CrossRefPubMedPubMedCentral

Callahan, C. M., Unverzagt, F. W., Hui, S. L., Perkins, A. J., & Hendrie, H. C. (2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care,40, 771–781. https://doi.org/10.1097/00005650-200209000-00007.CrossRefPubMed

Cully, J. A., Armento, M. E., Mott, J., Nadorff, M. R., Naik, A. D., Stanley, M. A., … & Kauth, M. R. (2012). Brief cognitive behavioral therapy in primary care: A hybrid type 2 patient-randomized effectiveness-implementation design. Implementation Science, 7, 64.

Cully, J. A., Paukert, A., Falco, J., & Stanley, M. (2009). Cognitive-behavioral therapy: Innovations for cardiopulmonary patients with depression and anxiety. Cognitive and Behavioral Practice,16, 394–407. https://doi.org/10.1016/j.cbpra.2009.04.004.CrossRef

Cully, J. A., Stanley, M. A., Deswal, A., Hanania, N., Phillips, L. L., & Kunik, M. E. (2010). Cognitive-behavioral therapy for chronic cardiopulmonary conditions: Preliminary outcomes from an open trial. Primary Care Companion to the Journal of Clinical Psychiatry,12(4), e1–e6.

Cully, J. A., Stanley, M. A., Petersen, N. J., Hundt, N. E., Kauth, M. E., Naik, A. D. … & Kunik, M. E. (2017). Delivery of brief cognitive behavioral therapy for medically ill patients in primary care: A pragmatic randomized clinical trial. Journal of General Internal Medicine, 32, 1014–1024. https://doi.org/10.1186/1748-5908-7-64.

Dickinson, L. M., Rost, K., Nutting, P. A., Elliott, C. E., Keeley, R. D., & Pincus, H. (2005). RCT of a care manager intervention for major depression in primary care: 2-year costs for patients with physical vs psychological complaints. Annals of Family Medicine,3, 15–22. https://doi.org/10.1370/afm.216.CrossRefPubMedPubMedCentral

Fortney, J. C., Pyne, J. M., Turner, E. E., Farris, K. M., Normoyle, T. M., Avery, M. D., … & Unützer, J. (2015). Telepsychiatry integration of mental health services into rural primary care settings. International Review of Psychiatry, 27, 525–539. https://doi.org/10.3109/09540261.2015.1085838.

Funderburk, J. S., Shepardson, R. L., Wray, J., Acker, J., Beehler, G. P., Possemato, K., … Maisto, S. A. (2018). Behavioral medicine interventions for adult primary care settings: A review. Families, Systems and Health,36(3), 368–399.CrossRefPubMed

Gates, K., Petterson, S., Wingrove, P., Miller, B., & Klink, K. (2016). You can’t treat what you don’t diagnose: An analysis of the recognition of somatic presentations of depression and anxiety in primary care. Families, Systems, & Health,34, 317. https://doi.org/10.1037/fsh0000229.CrossRef

Gelhorn, H. L., Sexton, C. C., & Classi, P. M. (2011). Patient preferences for treatment of major depressive disorder and the impact on health outcomes: Asystematic review. Primary Care Companion to CNS Disorders. https://doi.org/10.4088/pcc.11r01161.CrossRefPubMedPubMedCentral

Green, C. P., Porter, C. B., Bresnahan, D. R., & Spertus, J. A. (2000). Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for heart failure. Journal of the American College of Cardiology,35, 1245–1255. https://doi.org/10.1016/S0735-1097(00)00531-3.CrossRefPubMed

Guyatt, G. H., Berman, L. B., Townsend, M., Pugsley, S. O., & Chambers, L. W. (1987). A measure of quality of life for clinical trials in chronic lung disease. Thorax,42, 773–778. https://doi.org/10.1136/thx.42.10.773.CrossRefPubMedPubMedCentral

Harper, R., Brazier, J. E., Waterhouse, J. C., Walters, S. J., Jones, N. M., & Howard, P. (1997). Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax,52, 879–887. https://doi.org/10.1136/thx.52.10.879.CrossRefPubMedPubMedCentral

Hughes, G., Martinez, C., Myon, E., Taïeb, C., & Wessely, S. (2006). The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: An observational study based on clinical practice. Arthritis and Rheumatism,54, 177–183. https://doi.org/10.1002/art.21545.CrossRefPubMed

Kearney, L. K., Post, E. P., Pomerantz, A. S., & Zeiss, A. M. (2014). Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care. American Psychologist,69, 399–408. https://doi.org/10.1037/a0035909.CrossRefPubMed

Keeley, R. D., Smith, J. L., Nutting, P. A., Miriam Dickinson, L., Perry Dickinson, W., & Rost, K. M. (2004). Does a depression intervention result in improved outcomes for patients presenting with physical symptoms? Journal of General Internal Medicine,19, 615–623. https://doi.org/10.1111/j.1525-1497.2004.30611.x.CrossRefPubMedPubMedCentral

Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric co-morbidity and management. International Journal of Methods in Psychiatric Research,12, 34–43. https://doi.org/10.1002/mpr.140.CrossRefPubMed

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). ThePHQ-9. Journal of General Internal Medicine,16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentral

Kwan, B. M., Dimidjian, S., & Rizvi, S. L. (2010). Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression. Behaviour Research and Therapy,48, 799–804. https://doi.org/10.1016/j.brat.2010.04.003.CrossRefPubMedPubMedCentral

Larson, J. L., Covey, M. K., Berry, J. K., Wirtz, S., & Kim, M. J. (1993). Reliability and validity of the Chronic Respiratory Disease Questionnaire. American Journal of Critical Care Medicine,147, A350.

Linde, K., Sigterman, K., Kriston, L., Rucker, G., Jamil, S., Meissner, K., & Schneider, A. (2015). Effectiveness of psychological treatments for depressive disorders in primary care: Systematic review and meta-analysis. Annals of Family Medicine,13, 56–68. https://doi.org/10.1370/afm.1719.CrossRefPubMedPubMedCentral

McMillan, S. S., Kendall, E., Sav, A., King, M. A., Whitty, J. A., Kelly, F., & Wheeler, A. J. (2013). Patient-centered approaches to health care: A systematic review of randomized controlled trials. Medical Cere Research and Review,70(6), 567–596.CrossRef

Messer, S. B., & Wampold, B. E. (2002). Let’s face facts: Common factors are more potent than specific therapy ingredients. Clinical Psychology: Science and Practice,9(1), 21–25.

Mignogna, J., Hundt, N. E., Kauth, M. R., Kunik, M. E., Sorocco, K. H., Naik, A. D., … & Cully, J. A. (2014). Implementing brief cognitive behavioral therapy in primary care: A pilot study. Translational Behavioral Medicine, 4, 175–183. https://doi.org/10.1007/s13142-013-0248-6.

Nieuwsma, J. A., Trivedi, R. B., McDuffie, J., Kronish, I., Benjamin, D., & Williams, J. W. (2012). Brief psychotherapy for depression in primary care: A systematic review of the evidence. International Journal of Psychiatry in Medicine,43, 129–151. https://doi.org/10.2190/PM.43.2.c.CrossRefPubMedPubMedCentral

Olfson, M., Kroenke, K., Wang, S., & Blanco, C. (2014). Trends in office-based mental health care provided by psychiatrists and primary care physicians. Journal of Cinical Psychiatry,75, 247–253. https://doi.org/10.4088/JCP.13m08834.CrossRef

Patten, S. B., Williams, J. V. A., Lavorato, D. H., Wang, J. L., Jetté, N., Sajobi, T. T., … & Bulloch, A. G. M. (2016). Patterns of association of chronic medical conditions and major depression. Epidemiology and Psychiatric Sciences, 27, 42–50. https://doi.org/10.1017/s204579601600072x.

Pomerantz, A. S., Kearney, L. K., Wray, L. O., Post, E. P., & McCarthy, J. F. (2014). Mental health services in the medical home in the Department of Veterans Affairs: Factors for successful integration. Psychological Services,11, 243–253. https://doi.org/10.1037/a0036638.CrossRefPubMed

Rubenstein L. V. (2017). Integrating physical and mental health care in the Veterans Health Administration: A path to the future. In Integrating behavioral health and primary care. New York: Oxford Press.

Sarkisian, C. A., Lee-Henderson, M. H., & Mangione, C. M. (2003). Do depressed older adults who attribute depression to “old age” believe it is important to seek care? Journal of General Internal Medicine,18, 1001–1005. https://doi.org/10.1111/j.1525-1497.2003.30215.x.CrossRefPubMedPubMedCentral

Schurr, P. P., Friedman, M. J., Engel, C. C., et al. (2006). Issues in the design of multisite clinical trials of psychotherapy: VA Cooperative Study No. 494 as an example. Contemporary Clinical Trials,26, 626–636.CrossRef

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janays, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59 (suppl 20), 22–23.

Strupp, H. H., & Hadley, S. W. (1979). Specific vs nonspecific factors in psychotherapy: A controlled study. Archives of General Psychiatry, 36(10), 1125–1136.CrossRefPubMed

Tylee, A., & Walters, P. (2007). Underrecognition of anxiety and mood disorders in primary care: Why does the problem exist and what can be done? Journal of Clinical Psychiatry,68(suppl 2), 27–30.PubMed

Vogel, M. E., Kanzler, K. E., Aikens, J. E., & Goodie, J. L. (2017). Integration of behavioral health and primary care: Current knowledge and future directions. Journal of Behavioral Medicine,40, 69–84. https://doi.org/10.1007/s10865-016-9798-7.CrossRefPubMed

Yates, W. R., Mitchell, J., Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Warden, D., … & Bryan, C. (2004). Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR* D. General Hospital Psychiatry, 26, 421–429. https://doi.org/10.1016/j.genhosppsych.2004.06.008.

Title: The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans
Authors: Charles P. Brandt
Frances Deavers
Natalie E. Hundt
Terri L. Fletcher
Jeffrey A. Cully
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Mood Disorders
Care
Heart Failure
Affective Disorder
Chronic Obstructive Lung Disease
Anxiety
Published in: Journal of Clinical Psychology in Medical Settings / Issue 2/2020
Print ISSN: 1068-9583
Electronic ISSN: 1573-3572
DOI: https://doi.org/10.1007/s10880-019-09634-2

At a glance: The STEP trials

Springer Medicine

The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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