Browsing by Subject "CBT"
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Item Health-related Quality of Life and its Associated Variables among Individuals with Idiopathic Pulmonary Fibrosis(2019-09) Bors, MelindaIdiopathic pulmonary fibrosis (IPF) is a debilitating lung disease with a median survival of only three to five years from the time of diagnosis, with no known cure, or treatment to extend survival. Due to a lack of clinical studies, large gaps remain in understanding how IPF affects health-related quality of life (HRQOL). Because of the terminal nature of IPF, an improved understanding of how this disease affects patients' lives is needed. The works presented in this dissertation revealed that individuals with IPF are at greater risk for cognitive abnormalities, and confirmed that they are more likely to have depressive symptoms, and worsened HRQOL. The pathways among the variables cannot be easily elucidated, especially the co-existence of depressive symptoms and cognitive impairment. Nonetheless, the presence of depressive symptoms should not be overlooked in research or in clinical management, as depression may be associated with dyspnea, the symptom most commonly found to be responsible for the compromised HRQOL seen in IPF, and could be of increased interest if treating the depression could result in the alleviation of dyspnea and amelioration of HRQOL. The significance of the cognitive impairment observed among individuals with IPF remains unclear, both for selecting therapies and anticipating expected treatment outcomes. Further research is needed to understand if exertional hypoxia is related to the cognitive abnormalities noted in cases of severe IPF, or if there are long term benefits to correcting exertional hypoxia. Patient reported outcomes and HROQL data assist clinicians by providing insight from the patient’s perspective about the level of illness burden and the effectiveness of a given intervention. Understanding which measures of health are most valued by patients is critical when establishing a plan of care, especially if asking patients to comply with a burdensome therapy such as ambulatory oxygen (AO). The role of AO in treating exertional hypoxia in IPF is obscure and more data are needed about its impact on disease progression, and HRQOL. Determining which variables are associated with HRQOL may facilitate clinician and patient interpretation of disease progression and the effects of therapy.Item Insomnia: A Treatment Guide for Patients(2010-07-21) Noel, AndreaCognitive Behavioral Therapy (CBT) has been shown in many studies to be superior to medications in the treatment of a variety of types of insomnia. CBT is administered over several sessions and utilizes techniques of psychotherapy, sleep restriction, stimulus control, sleep hygiene, passive wakefulness, and relaxation training. An abbreviated form of Cognitive Behavioral Therapy designed for use in Primary Care settings has shown similar results to standard length CBT, and superior results compared to sleep hygiene advice typical of a Primary Care setting. For the Primary Care Physician who has the time and resources to learn and implement CBT, CBT holds promise as an effective treatment for insomnia in a Primary Care setting. This PET was designed to teach patients about CBT for the treatment of insomnia.Item Randomized Controlled Trial of Pacifica, a CBT and Mindfulness-based App for Stress, Depression, and Anxiety Management with Health Monitoring(2018-08) Vu, AnnaMariemHealth smartphone apps have inundated the market. The promise of mHealth apps is that they increase access to psychotherapeutic content while also expanding options beyond face-to-face care. However, information on the quality and efficacy of commercial mHealth apps is sparse. Pacifica, a Cognitive Behavioral Therapy and Mindfulness-based mHealth app, is one of the most popular and publicly endorsed apps on the market. An initial week long pilot study was performed to assess feasibility and acceptability of the Pacifica app and Pacifica Lite, an active control version of the app, in a group of college students (N = 41). Participants generally used the app as intended and rated the aesthetics and functionality positively. The subsequent efficacy study extended the intervention period, added a waitlist control group, and enrolled a greater number of participants. To the best of our knowledge, this study was the first randomized controlled trial designed to examine the feasibility and efficacy of a commercial mHealth app using a smartphone active control app as a comparison. Participants (N=420) were randomly assigned to one of three groups: 1) The Pacifica app that includes the psychotherapy-based components, 2) the active control app “Pacifica Lite” without psychotherapy-based components, and 3) waitlist control. The intervention period was 14 days over the final weeks of a college semester. Participants completed pretest and posttest measures of mental health symptoms and general well-being, state-based affect, perceived stress, and mindfulness prior to and following the intervention period. Regression models with baseline scores as moderators indicated there was an effect of the Pacifica intervention compared to the Waitlist control on negative affect and global mental health. The effect of intervention group on negative affect, global mental health, and perceived stress were all moderated by baseline scores, whereby participants who had higher baseline distress levels reported greater responses to the Pacifica intervention compared to being on the Waitlist. A measure of trait mindfulness showed significant between-group differences, with significantly higher scores in the Pacifica group compared to the waitlist control. There were no effects related to group at posttest for total or subscale scores for symptoms of depression, anxiety, positive state-affect, and mindfulness practice. Overall, the Pacifica app appeared feasible and usable over a high demand final exam period, was significantly more effective than Waitlist on some measures, but it was not significantly more effective than the active control on any measures. Pacifica and the majority of mHealth apps available are not designed as alternatives to face-to-face care but college counseling centers and healthcare systems may choose to include apps like Pacifica as additional resources.