Apa summary

1Arnfred B, et al. BMJ Open 2022;12:e051147. doi:10.1136/bmjopen-2021-051147

Open access

Group cognitive behavioural therapy
with virtual reality exposure versus
group cognitive behavioural therapy
with in vivo exposure for social anxiety
disorder and agoraphobia: a protocol for
a randomised clinical trial

Benjamin Arnfred ,1 Peter Bang,1,2 Carsten Hjorthøj ,1,3
Clas Winding Christensen,1 Kirsten Stengaard Moeller,1 Morten Hvenegaard,1
Lone Agerskov,1 Ulrik Krog Gausboel,1 Ditte Soe,1 Peter Wiborg,1
Christopher Ian Schøler Smith,1 Nicole Rosenberg,1 Merete Nordentoft1,4

To cite: Arnfred B, Bang P,
Hjorthøj C, et al. Group
cognitive behavioural therapy
with virtual reality exposure
versus group cognitive
behavioural therapy with in
vivo exposure for social anxiety
disorder and agoraphobia:
a protocol for a randomised
clinical trial. BMJ Open
2022;12:e051147. doi:10.1136/
bmjopen-2021-051147

► Prepublication history and
additional supplemental material
for this paper are available
online. To view these files,
please visit the journal online
(http://dx.doi.org/10.1136/
bmjopen-2021-051147).

Received 26 May 2021
Accepted 24 November 2021

For numbered affiliations see
end of article.

Correspondence to
Dr Benjamin Arnfred;
barn0006@ regionh. dk

Protocol

© Author(s) (or their
employer(s)) 2022. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.

ABSTRACT
Introduction Anxiety disorders have a high lifetime
prevalence, early- onset and long duration or chronicity.
Exposure therapy is considered one of the most effective
elements in cognitive behavioural therapy (CBT) for
anxiety, but in vivo exposure can be challenging to access
and control, and is sometimes rejected by patients
because they consider it too aversive. Virtual reality allows
flexible and controlled exposure to challenging situations
in an immersive and protected environment.
Aim The SoREAL- trial aims to investigate the effect of
group cognitive behavioural therapy (CBT- in vivo) versus
group CBT with virtual reality exposure (CBT- in virtuo) for
patients diagnosed with social anxiety disorder and/or
agoraphobia, in mixed groups.
Methods and analysis The design is an investigator-
initiated randomised, assessor- blinded, parallel- group
and superiority- designed clinical trial. Three hundred
two patients diagnosed with social anxiety disorder and/
or agoraphobia will be included from the regional mental
health centres of Copenhagen and North Sealand and
the Northern Region of Denmark. All patients will be
offered a manual- based 14- week cognitive behavioural
group treatment programme, including eight sessions
with exposure therapy. Therapy groups will be centrally
randomised with concealed allocation sequence to either
CBT- in virtuo or CBT- in vi

Treatment Retention Among Patients
Participating in Coordinated Specialty Care
for First-Episode Psychosis: a Mixed-Methods
Analysis

Jane E. Hamilton, PhD, MPH
Devika Srivastava, PhD
Danica Womack, BS
Ashlie Brown, MEd
Brian Schulz, MEd
April Macakanja, MEd
April Walker, BA
Mon-Ju Wu, PhD
Mark Williamson, MD
Raymond Y. Cho, MD, MSc

Abstract

Young adults experiencing first-episode psychosis have historically been difficult to retain in
mental health treatment. Communities across the United States are implementing Coordinated

Address correspondence to Jane E. Hamilton, PhD, MPH, Department of Psychiatry and Behavioral Sciences, McGovern
Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX 77054,
USA. E-mail: [email protected].

Mon-Ju Wu, PhD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas
Health Science Center Houston, Houston, TX, USA.

Devika Srivastava, PhD, Harris Center for Mental Health and IDD, Houston, TX, USA.
Ashlie Brown, MEd, Harris Center for Mental Health and IDD, Houston, TX, USA.
Brian Schulz, MEd, Harris Center for Mental Health and IDD, Houston, TX, USA.
April Macakanja, MEd, Harris Center for Mental Health and IDD, Houston, TX, USA.
Mark Williamson, MD, Harris Center for Mental Health and IDD, Houston, TX, USA.
Danica Womack, BS, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,

USA.
April Walker, BA, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Raymond Y. Cho, MD, MSc, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston,

TX, USA.

Journal of Behavioral Health Services & Research, 2018. 415–433. c) 2018 National Council for Behavioral Health. DOI
10.1007/s11414-018-9619-6

Retention in First Episode Psychosis Treatment HAMILTON ET AL. 415

Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This
mixed-methods research study examined the relationship between program services and treatment
retention, operationalized as the likelihood of remaining in the program for 9 months or more. In
the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy
were associated with an increased likelihood of remaining in treatment. The key informant
interview findings suggest the shared decision-making process and the breadth, flexibility, and
focus on functional recovery of the home-based cognitive behavioral therapy intervention may
have positively influenced treatment retention. These findings suggest the use of shared decision-
making and improved access to hom

An Investigation into the Feasibility of Intensive Cognitive

Behavioural Therapy

A thesis submitted to The University of Manchester for the
degree of Doctor of Clinical Psychology

in the Faculty of Biology, Medicine and Health

2019

Lauren Hampson

School of Health Sciences
Division of Psychology and Mental Health

ProQuest Number:

All rights reserved

INFORMATION TO ALL USERS
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In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,

a note will indicate the deletion.

Published by ProQuest LLC (

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All Rights Reserved.
This work is protected against unauthorized copying under Title 17, United States Code

Microform Edition © ProQuest LLC.

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28301585

28301585

2020

2

Table of Contents

Figures and Tables ………………………………………………………………………………………. 5

Table of Appendices ……………………………………………………………………………………. 6

Word Counts ………………………………………………………………………………………………. 8

Overall Abstract …………………………………………………………………………………………. 9

Declaration ………………………………………………………………………………………………. 10

Copyright Statement ………………………………………………………………………………….. 10

Acknowledgments …………………………………………………………………………………….. 11

Dedication ……………………………………………………………………………………………….. 12

Introduction to Paper I ……………………………………………………………………………. 13

Paper I Systematic Review ………………………………………………………………………. 14

1. Abstract ……………………………………………………………………………………………….. 15

2. Introduction ………………………………………………………………………………………….. 16

2.1 Mental H

An Engagement Intervention for Young
Adults with Serious Mental Health Conditions

Michelle R. Munson, PhD
Andrea Cole, MSW
James Jaccard, PhD
Derrick Kranke, PhD
Kathleen Farkas, PhD
Fred J. Frese III PhD

Abstract

Young adults with serious mental health conditions (SMHCs) often do not engage continuously
with mental health services, and there are few engagement interventions designed for them. This
qualitative study presents a blueprint for conceptualizing and developing an engagement
intervention designed for young adults with SMHCs. The blueprint includes the following
activities: (1) establishing a strong theoretical basis, (2) designing an initial manual based on
previous research and practice, (3) systematically examining feedback on the manual from
stakeholders, and (4) examining the feasibility, acceptability, and implementation demands of the
intervention. Interviews, group discussions, and journaling were utilized to collect information
from young adult participant-researchers, intervention facilitators (i.e., recovery role models and
clinicians), and additional stakeholders (e.g., clinic staff and administrators) (N=43). Analyses
were performed with multiple coders using constant comparative methods. Results revealed critical
information to improve the intervention, while also suggesting that the engagement intervention for
young adults with SMHCs has promise.

Address correspondence to Michelle R. Munson, PhD, New York University Silver School of Social Work, 1 Washington
Square North, New York, NY 10003, USA. Email: [email protected].
Andrea Cole, MSW, New York University Silver School of Social Work, New York, NY, USA.
James Jaccard, PhD, New York University Silver School of Social Work, New York, NY, USA.
Derrick Kranke, PhD, Veterans Administration, Veterans Emergency Management Evaluation Center (VEMEC), North

Hills, CA, USA.
Kathleen Farkas, PhD, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH,

USA.
Fred J. Frese III PhD, Department of Psychiatry, Northeast Ohio Universities College of Medicine, Rootstown, OH, USA.

Journal of Behavioral Health Services & Research, 2014. 542–563. c) 2014 National Council for Behavioral Health. DOI
10.1007/s11414-014-9424-9

542 The Journal of Behavioral Health Services & Research 43:4 October 2016

Introduction

Unmet mental health needs among children and young adults (YAs) with serious mental health
conditions (SMHCs), defined as either serious emotional disturbances or serious mental illness, is
an urgent matter; one that experts have deemed a crisis.1 Many young adults, those ages 18 to 30,
with SMHCs drop-out, or at best experience fragmentation, of mental health care during

Mechanisms of functional improvement in a 2-year
trial of cognitive enhancement therapy for early
schizophrenia

S. M. Eack1,2*, M. F. Pogue-Geile3, D. P. Greenwald2, S. S. Hogarty2 and M. S. Keshavan2,4

1 School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
2 Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
3 Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
4 Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

Background. Cognitive rehabilitation has emerged as an effective treatment for addressing cognitive impairments

and functional disability in schizophrenia; however, the degree to which changes in various social and non-social

cognitive processes translate into improved functioning during treatment remains unclear. This research sought to

identify the neurocognitive and social-cognitive mechanisms of functional improvement during a 2-year trial of

cognitive enhancement therapy (CET) for early-course schizophrenia.

Method. Patients in the early course of schizophrenia were randomly assigned to CET (n=31) or an enriched
supportive therapy control (n=27) and treated for up to 2 years. A comprehensive neurocognitive assessment battery
and the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) were completed annually, along with measures

of functioning. Mediator analyses using mixed-effects growth models were conducted to examine the effects of

neurocognitive and social-cognitive improvement on functional change.

Results. Improvements over 2 years in neurocognition and the emotion management branch of the MSCEIT were

found to be significantly related to improved functional outcome in early-course schizophrenia patients. Neuro-

cognitive improvement, primarily in executive functioning, and social-cognitive change in emotion management also

mediated the robust effects of CET on functioning.

Conclusions. Improvements in neurocognition and social cognition that result from cognitive rehabilitation are both

significant mediators of functional improvement in early-course schizophrenia. Cognitive rehabilitation programs for

schizophrenia may need to target deficits in both social and non-social cognition to achieve an optimal functional

response.

Received 1 April 2010; Revised 29 June 2010; Accepted 29 July 2010; First published online 22 September 2010

Key words : Cognitive rehabilitation, cognitive remediation, psychosocial treatment, social cognition.

Introduction

Schizophrenia is a chronic mental disorder that is

characterized by significant impairments in cognition

and functioning. Marked deficits have been observed

in social and non-social cognitive domains (Penn

et al.

Arnfred, B., Bang, P., Hjorthøj, C., Clas, W. C., Moeller, K. S., Hvenegaard, M., . . . Nordentoft, M. (2022). Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia: A protocol for a randomised clinical trial. BMJ Open, 12(2) doi:http://dx.doi.org/10.1136/bmjopen-2021-051147

Hamilton, J. E., Srivastava, D., Womack, D., Brown, A., Schulz, B., Macakanja, A., . . . Cho, R. Y. (2019). Treatment retention among patients participating in coordinated specialty care for first-episode psychosis: A mixed-methods analysis. The Journal of Behavioral Health Services & Research, 46(3), 415-433. doi:http://dx.doi.org/10.1007/s11414-018-9619-6

Hampson, L. (2019). An investigation into the feasibility of intensive cognitive behavioural therapy (Order No. 28301585). Available from Nursing & Allied Health Database. (2498498430). Retrieved from https://www.proquest.com/dissertations-theses/investigation-into-feasibility-intensive/docview/2498498430/se-2?accountid=160851

Munson, M. R., PhD., Cole, A., M.S.W., Jaccard, J., PhD., Kranke, D., PhD., Farkas, K., PhD., & Frese, Fred J,I.I.I., PhD. (2016). An engagement intervention for young adults with serious mental health conditions. The Journal of Behavioral Health Services & Research, 43(4), 542-563. doi:http://dx.doi.org/10.1007/s11414-014-9424-9

Eack, S. M., Pogue-Geile, M., Greenwald, D. P., Hogarty, S. S., & Keshavan, M. S. (2011). Mechanisms of functional improvement in a 2-year trial of cognitive enhancement therapy for early schizophrenia. Psychological Medicine, 41(6), 1253-61. doi:http://dx.doi.org/10.1017/S0033291710001765

APA Literature Review Table Rubric

Literature Review Table Rubric
	Unsatisfactory 0	Partially Proficient 10	Proficient 15	Exemplary 25	Score
Articles	0-1 primary research articles are identified	2-3 primary research articles are identified.	4 primary research articles are identified.	5 primary research articles are identified.
Articles appropriate to PICOT	0-1 primary research articles appropriate to PICOT	2-3 primary research articles appropriate to PICOT	4 primary research articles appropriate to PICOT	5 primary research articles appropriate to PICOT
Articles uploaded to Moodle	0-1 primary research articles are included with table	2-3 primary research articles are included with table	4 primary research articles are included with table	5 primary research articles are included with table
Table	There are major errors in the table	There are several errors and/or incomplete data	There is some missing data and/or errors	The table is completed appropriately
Total					/100

APA Summary Table

List all Five references/ citations at bottom of the summary table. Each category will expand down.

PICOT statement: young adults 18 and older receiving treatments for schizophrenia at the Sentara Northern Virginia medical center. Is cognitive behavioral therapy more effective in managing/controlling schizophrenia than psychoeducation in a two-year period in this population?

Citation	Research question	Study design	Sample size and method	Independent variables and measures	Dependent variables and measures	Results	General strengths	General weakness	Overall quality of study	Summary statement practice
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5.

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