CBT Improves Sleep Outcomes in Acquired Brain Injury

 What is your competent? doctor's EXACT SLEEP PROTOCOL?

CBT Improves Sleep Outcomes in Acquired Brain Injury

Cognitive behavioral therapy significantly improves sleep disturbances in adults with acquired brain injury, with benefits observed in sleep quality, insomnia severity, and sleep efficiency. Cognitive behavioral therapy (CBT) may improve sleep disturbances among individuals with acquired brain injury, according to study findings published in Sleep Medicine Sleep disturbances are common among individuals with acquired brain injury — including those recovering from traumatic brain injury or stroke — and may negatively affect recovery and quality of life. Researchers conducted a systematic review and meta-analysis assessing the effect of CBT-based interventions on sleep disturbances following acquired brain injury. Overall, CBT offers multidimensional therapeutic benefits for sleep disturbances, enhancing both subjective sleep perception and the efficiency of sleep architecture. Eligible studies enrolled adults aged 18 years and older with a diagnosis of acquired brain injury who experienced sleep disturbances. Participants in the intervention groups received CBT-based therapies, incorporating components such as sleep hygiene education, stimulus control, sleep restriction, cognitive restructuring, and relaxation techniques. Participants in the control groups received usual care or health education. Sleep-related outcomes included measures such as sleep quality, insomnia severity, and objective sleep parameters. A total of 8 randomized controlled trials were included in the meta-analysis, representing a combined sample of 387 participants. The included studies were published between 2017 and 2025. Across the included trials, intervention durations ranged from 6 to 9 weeks. According to pooled analyses, CBT was associated with significant improvements in overall sleep outcomes among individuals with acquired brain injury (standardized mean difference [SMD], −0.95; 95% CI, −1.47 to −0.43;P=.0003). Further analyses examining specific sleep domains demonstrated that CBT significantly improved subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI; mean difference [MD], −2.34; 95% CI, −3.23 to −1.45;P<.00001). In addition, CBT significantly reduced insomnia severity scores on the Insomnia Severity Index (ISI; MD, −3.46; 95% CI, −4.27 to −2.64; P <.00001), suggesting a meaningful reduction in insomnia symptoms among individuals receiving CBT-based interventions. CBT was also associated with a statistically significant improvement in sleep efficiency (SMD, −0.38; 95% CI, −0.67 to −0.09;P=.01). Subgroup analyses demonstrated that traditional face-to-face CBT and electronically delivered CBT were associated with significant improvements in sleep outcomes. No statistically significant differences in treatment efficacy were observed between these modalities. Study limitations include the relatively small number of randomized trials, limited sample sizes, and reliance on self-reported sleep outcomes. In addition, variability in intervention intensity and control conditions across studies may have contributed to heterogeneity in the pooled results. “Overall, CBT offers multidimensional therapeutic benefits for sleep disturbances, enhancing both subjective sleep perception and the efficiency of sleep architecture,” the researchers concluded. Disclosures: This research was supported by the National Natural Science Foundation of China and Guizhou Province Traditional Chinese Medicine Project. Please see the original reference for a full list of disclosures. References:Zhu H, Wen Q, Zhang F, Li S, Wang X, Li J. The efficacy of cognitive behavioral therapy for sleep disorders following acquired brain injury: a systematic review and meta-analysis. Sleep Med. 2026;138:108678. doi:10.1016/j.sleep.2025.108678

Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression

 If your doctor is not preventing your depression by having 100% recovery protocols, then you don't have a functioning stroke doctor. Your doctor has known since medical school that stroke needed to be solved to 100% recovery and has done nothing in the ensuing years. In my opinion, that is complete incompetence!

Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression

A Randomized Optimization Trial

Edward Watkins, PhD¹; Alexandra Newbold, PhD¹; Michelle Tester-Jones, PhD¹; et al Linda M. Collins, PhD²; Mohammod Mostazir, MSc¹

Author Affiliations

JAMA Psychiatry. 2023;80(9):942-951. doi:10.1001/jamapsychiatry.2023.1937

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Key Points

Question  Which specific components within internet-delivered cognitive behavioral therapy (CBT) for depression are active ingredients that reduce symptoms?

Findings  In this randomized optimization trial that included 767 adults with depression, 6 treatment components (activity scheduling, thought challenging, relaxation, concreteness training, functional analysis, and self-compassion training) did not show a significant main effect on depression. However, the presence of the absorption component outperformed its absence in reducing depression at 6-month follow-up.

Meaning  The findings suggest that the majority of treatment benefit from internet-delivered CBT is likely to accrue from factors common to all CBT components and/or from generic factors common to all therapies, with the possible exception of absorption.

Abstract

Importance  There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable.

Objective  To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients.

Design, Setting, and Participants  This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire−9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023.

Interventions  Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training).

Main Outcomes and Measures  The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning.

Results  Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, −7.79 [90% CI, −8.21 to −7.37]; 6-month follow-up difference in PHQ-9 score, −8.63 [90% CI, −9.04 to −8.22]). A baseline score–adjusted analysis of covariance model using effect-coded intervention variables (−1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], −0.09 [90% CI, −0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], −0.18 [90% CI, −0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, −0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, −0.54, [90% CI, −0.97 to −0.11]).

Conclusions and Relevance  In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers.

Trial Registration  isrctn.org Identifier: ISRCTN24117387

Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

Someplace in here is something but you'll have to decipher it yourself.

Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

Cornelia Exner, Bettina K. Doering, Nico Conrad, Anna Künemund, Sarah Zwick, Kerstin Kühl, show all

Received 16 Oct 2020, Accepted 22 Mar 2021, Published online: 05 Apr 2021

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• https://doi.org/10.1080/09602011.2021.1908902

 

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ABSTRACT

After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre–post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research

 

EXPRESS: Methodology of the Fatigue After STroke Educational Recovery (FASTER) group randomised controlled trial

My jaw dropped to the floor on this one. SUBJECTIVE FATIGUE? You're just trying to make patients 'think' they are better by doing nothing concrete. What fucking objective bullshit.

EXPRESS: Methodology of the Fatigue After STroke Educational Recovery (FASTER) group randomised controlled trial

 

 

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Suzanne Lyn Barker-Collo, Rita Krishnamurthi, Takayoshi Ikeda, ...

First Published March 16, 2021 Research Article 

https://doi.org/10.1177/17474930211006295

Article information

Abstract

Rationale: 

Post-stroke fatigue (PSF) affects up to 92% of stroke survivors, causing significant burden. Educational Cognitive Behavioural Therapy (CBT) fatigue groups show positive results in other health conditions.

Aims: 

FASTER will determine if educational CBT Fatigue Management Group (FMG) reduces subjective fatigue in adults post-stroke.

Design: 

Prospective, multi-centre, two-arm, single-blind, phase III RCT (parallel, superiority design), with blinded assessments at baseline, 6-weeks, and 3-months post-programme commencement. With n=200 (100 per group, 20% drop-out) the trial will have 85% power (2-sided, p= 0.05) to detect minimally clinically important differences of 0.60 (SD=1.27) in Fatigue severity scale and 1.70 points (SD=3.6) in Multidimensional Fatigue Inventory-20 at 3-months.

Outcomes: 

Primary outcomes are self-reported fatigue severity and dimensionality (i.e., types of fatigue experienced - physical, psychological and/or cognitive) post-intervention (6-weeks). Secondary outcomes include subjective fatigue at 3-months, and health-related quality of life, disability, sleep, pain, mood, service use/costs, and caregiver burden at each follow-up.

Discussion: 

FASTER will determine whether FMG reduces fatigue post-stroke.(It does nothing of the sort.)

Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000626167).

Keywords Cognitive Behavioural, Group, Intervention, Protocol, Stroke, fatigue

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Telemedicine Cognitive Behavioral Therapy for Anxiety After Stroke

Are you that FUCKING CLUELESS that you don't understand why the anxiety exists? Treat the primary problem. NOTHING EXISTS TO GET YOU 100% RECOVERED. Provide protocols and survivors will happily do millions of reps to get results and get recovered. Anxiety won't exist because proven methodologies will be used. We need some decent stroke leadership because we aren't even researching the correct problems.

Telemedicine Cognitive Behavioral Therapy for Anxiety After Stroke

Ho-Yan Yvonne Chun

,

Alan J. Carson

,

Athanasios Tsanas

,

Martin S. Dennis

,

Gillian E. Mead

,

Clementina Calabria

,

William N. Whiteley

Originally published24 Jun 2020https://doi.org/10.1161/STROKEAHA.120.029042Stroke. ;0

Abstract

Background and Purpose:

Disabling anxiety affects a quarter of stroke survivors but access to treatment is poor. We developed a telemedicine model for delivering guided self-help cognitive behavioral therapy (CBT) for anxiety after stroke (TASK-CBT). We aimed to evaluate the feasibility of TASK-CBT in a randomized controlled trial workflow that enabled all trial procedures to be carried out remotely. In addition, we explored the feasibility of wrist-worn actigraphy sensor as a way of measuring objective outcomes in this clinical trial.

Methods:

We recruited adult community-based stroke patients (n=27) and randomly allocated them to TASK-CBT (n=14) or relaxation therapy (TASK-Relax), an active comparator (n=13).

Results:

In our sample (mean age 65 [±10]; 56% men; 63% stroke, 37% transient ischemic attacks), remote self-enrolment, electronic signature, intervention delivery, and automated follow-up were feasible. All participants completed all TASK-CBT sessions (14/14). Lower levels of anxiety were observed in TASK-CBT when compared with TASK-Relax at both weeks 6 and 20. Mean actigraphy sensor wearing-time was 33 days (±15).

Conclusions:

Our preliminary feasibility data from the current study support a larger definitive clinical trial and the use of wrist-worn actigraphy sensor in anxious stroke survivors.

REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT03439813.

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training

I would think that perturbation training would be much better because you would be able to recover from balance problems and thus prevent the fall.  But I know nothing, I'm not medically trained. This falls under the same category that you learn faster from your mistakes than from practicing perfection. 

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training

Tai-Wa Liu

,

Gabriel Y.F. Ng

,

Raymond C.K. Chung

,

Shamay S.M. Ng

Originally published7 Dec 2018Stroke. 2018;0:STROKEAHA.118.022406

Abstract

Background and Purpose—

Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes.

Methods—

Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention.

Results—

Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants.

Conclusions—

Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals(So you cherry picked participants?, I expect recovery for all. Yes that will be more difficult but leaders tackle difficult problems. Are you a mouse or a leader?)  with a history of stroke.

Clinical Trial Registration—

URL: http://clinicaltrials.gov. Unique identifier: NCT02937532

Group cognitive behavioural therapy for stroke survivors with depression and their carers

This secondary intervention is only needed because your doctor has completely failed at getting you 100% recovered. Put the blame where it belongs.
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J77369&phrase=no&rec=135307&article_source=Rehab&international=0&international_language=&international_location=
Topics in Stroke Rehabilitation , Volume 23(5) , Pgs. 358-365.

NARIC Accession Number: J77369.  What's this?
ISSN: 1074-9357.
Author(s): Ward, Susan K.; Turner, Alyna; Hambridge, John A.; Halpin, Sean A.; Valentine, Megan E.; Sweetaplle, Anne L.; White, Jennifer H.; Hackett, Maree L..
Publication Year: 2016.
Number of Pages: 8.
Abstract: Study evaluated the implementation and acceptability of Brainstorm, a group cognitive behavioral therapy program for stroke survivors with depression and their caregivers. Brainstorm is a closed group intervention consisting of up to 10 sessions of education, activity planning, problem solving, and thought monitoring and challenging. Participating stroke survivors and their caregivers complete assessment measures at baseline, posttreatment, and 1-month and 6-month follow-ups. A mixed-models for repeated measures data analysis was conducted with depression and anxiety scores for stroke survivors (Beck Depression Inventory-II and Hospital Anxiety and Depression Scale) and the assessment of depression, anxiety and caregiver burden for caregivers. Acceptability was assessed by session attendance and written and open participant feedback upon completion of the program. Forty-eight community dwelling stroke survivors and 34 caregivers attended Brainstorm, with a median attendance of 88 percent of sessions. Follow-up assessments were completed by 77 percent (post-treatment), 46 percent (1-month), and 38 percent (6-month) of stroke survivors. Stroke survivors’ depression scores decreased from baseline to posttreatment; maintained at 1 month but not at 6 months. Anxiety scores decreased between baseline and 1-month follow-up. Caregiver burden, depression, and anxiety scores at 1-month and 6-month follow-ups were all reduced when compared with baseline. The Brainstorm group intervention for depression in stroke survivors appears to have been effectively implemented and is acceptable to stroke survivors and caregivers.
Descriptor Terms: ANXIETY DISORDERS, CAREGIVERS, COGNITIVE DISABILITIES, DEPRESSION, GROUP COUNSELING, PSYCHOTHERAPY, STROKE.


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Citation: Ward, Susan K., Turner, Alyna, Hambridge, John A., Halpin, Sean A., Valentine, Megan E., Sweetaplle, Anne L., White, Jennifer H., Hackett, Maree L.. (2016). Group cognitive behavioural therapy for stroke survivors with depression and their carers.  Topics in Stroke Rehabilitation , 23(5), Pgs. 358-365. Retrieved 1/14/2018, from REHABDATA database.

The Simpler Talk Therapy That Treats Depression Effectively

What is your doctor doing about treating your depression after you realize s/he doesn't have a clue to get you 100% recovered? But maybe you would rather actually be treated with SSRIs since they provide better recoveries? But your doctor can decide which is best for you after you ask about pros and cons to each approach.

Antidepressants may help people recover from stroke even if they are not depressed

The Simpler Talk Therapy That Treats Depression Effectively

The talk therapy that is quicker (and cheaper) than cognitive-behavioural therapy.

Depression can be more simply treated by behavioural activation therapy, a new study concludes.
Behavioural activation therapy is a more straightforward alternative to cognitive-behavioural therapy — the gold standard of depression treatment.
Clinical depression affects around 350 million people around the world, but only a fraction receive the best care.
Behavioural activation therapy could be a good alternative that provides access to therapy for more people.
The therapy itself focuses on encouraging people to take part in meaningful activities that are linked to their core values.
It helps people find out which activities make them feel better.
Unfortunately, many people with depression engage in activities that ultimately make them feel worse.
Chief among these is rumination: letting depressing thoughts roll around in the mind.
The therapy helps people to make the connection between what they do and their mood.
It is also aimed at fighting avoidance and moving towards personally rewarding experiences.
The focus for policy-makers, though, is on cost and the potential to reduce it.
Professor David Richards, the study’s first author, said:

“Effectively treating depression at low cost is a global priority.
Our finding is the most robust evidence yet that Behavioural Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality.
This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”

The study itself recruited 440 people who were split into two groups, one of which received behavioural activation therapy, the other getting cognitive-behavioural therapy.
The results showed that behavioural activation therapy provided similar outcomes to CBT.
Around two-thirds of people in both groups felt better one year later.
The study was published in the journal The Lancet (Richards et al., 2016).

Augmented cognitive behavioral therapy for poststroke depressive symptoms: A randomized controlled trial

Why would you want to do this for depression rather than SSRIs which also gives you better recovery? The comparison should have also been against SSRIs. Now more followup research still needs to be done. All because there is NO stroke strategy and NO stroke leadership.

Common antidepressant can help stroke patients improve movement and coordination Sept. 2015 

Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013

Augmented cognitive behavioral therapy for poststroke depressive symptoms: A randomized controlled trial

Archives of Physical Medicine and Rehabilitation , Volume 98(4) , Pgs. 687-694.

NARIC Accession Number: J75822.  What's this?
ISSN: 0003-9993.
Author(s): Kootker, Joyce A.; Rasquin, Sascha M. C.; Lem, Frederick C.; van Heugten, Caroline M.; Fasotti, Luciano; Geurts, Alexander C. H..
Publication Year: 2017.
Number of Pages: 8.
Abstract: Study evaluated the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety after stroke. Sixty-one patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist. The HADS-D score was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT versus CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor. Mixed-model analyses showed a significant and persistent time effect for HADS-D and for participation and quality of life in both groups. There was no significant group-by-time effect for any of the outcome measures. Findings indicated that the augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
Descriptor Terms: ANXIETY DISORDERS, DEPRESSION, INTERVENTION, OUTCOMES, PSYCHOTHERAPY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Kootker, Joyce A., Rasquin, Sascha M. C., Lem, Frederick C., van Heugten, Caroline M., Fasotti, Luciano, Geurts, Alexander C. H.. (2017). Augmented cognitive behavioral therapy for poststroke depressive symptoms: A randomized controlled trial.  Archives of Physical Medicine and Rehabilitation , 98(4), Pgs. 687-694. Retrieved 5/13/2017, from REHABDATA database.


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More information about this publication:
Archives of Physical Medicine and Rehabilitation.

Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients

We need the exact same research on stroke but it won't occur with the current stroke leadership.  Don't you want to know how to get a better quality of life post stroke? And shouldn't your doctor know how to do that?

Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients

Kenneth E. Freedland, PhD¹; Robert M. Carney, PhD¹; Michael W. Rich, MD²; Brian C. Steinmeyer, MS¹; Eugene H. Rubin, MD, PhD¹

[+] Author Affiliations

JAMA Intern Med. Published online September 28, 2015. doi:10.1001/jamainternmed.2015.5220

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ABSTRACT

ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF).
Objective  To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care.
Design, Setting, and Participants  Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St Louis between January 4, 2010, and June 28, 2013. The primary data analyses were conducted in February 2015. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression.
Interventions  Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or UC alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse.
Main Outcomes and Measures  The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were coprimary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes.
Results  One hundred fifty-eight patients were randomized to UC (n = 79) or CBT (n = 79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P = .88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P = .008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; P < .001) and the Hamilton Depression Scale (51% vs 20%; NNT = 3.29; 95% CI, 3.15-3.43; P  < .001). The groups did not differ on the Self-Care Maintenance or Confidence subscales. The mean (SD) Beck Depression Inventory scores 6 months after randomization were lower in the CBT (12.8 [10.6]) than the UC arm (17.3 [10.7]), P = .008. There were no statistically significant differences between the groups on the Self-Care Maintenance or Confidence subscale scores or on physical functioning measures. Anxiety and fatigue scores were lower and mental- and HF-related quality of life and social functioning scores were higher at 6 months in the CBT than the UC arm, and there were fewer hospitalizations in the intervention than the UC arm.
Conclusions and Relevance  A CBT intervention that targets both depression and heart failure self-care is effective for depression but not for HF self-care or physical functioning relative to enhanced UC. Additional benefits include reduced anxiety and fatigue, improved social functioning, and better health-related quality of life.
Trial Registration  clinicaltrials.gov Identifier: NCT01028625