Curran, G. M., Woo, S. M., Hepner, K. A., Lai, W. P., Kramer, T. L., Drummond, K. L., & Weingardt, K. (2015). Training Substance Use Disorder Counselors in Cognitive Behavioral Therapy for Depression: Development and Initial Exploration of an Online Training Program. Journal of Substance Abuse Treatment, 58(1), 33-42.
The authors of this paper state that evidence-based psychotherapies (EBP) are underutilised and that to combat this models for training in EBP are necessary. These need to be cost-effective, minimally disruptive and flexible, which led them to consider internet technology as a potential platform for delivery. They developed an online training package for the Building Recovery by Improving Goals, Habits and Thoughts (BRIGHT) program, which is based on cognitive behaviour therapy (CBT). This was a sixteen session group depression treatment for people with substance use disorders (SUD). They explored the possibility of delivering the BRIGHT training to counsellors online rather than in a face-to-face program. Eight volunteer counsellors across seven Veterans’ Affairs SUD programs completed the training. A lack of protected time for the counsellors to do the training was the largest barrier. Many had to do it in their own time or in breaks between clients and found it frustrating and fragmented. Those who completed the training found it a positive and useful experience. A limitation in this study is the small and specific sample size.

Delgadillo, J., Gore, S., Ali, S., Ekers, D., Gilbody, S., Gilchrist, G., & … Hughes, E. (2015). Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment. Journal of Substance Abuse Treatment, 55(1), 6-14.

Depression and frequent alcohol and drug use often co-exist prompting this study, which conducted a trial to examine the practicality of screening, recruitment, randomisation and engagement of drug and alcohol users for psychological interventions to treat depressive symptoms The participants (n=50) were all involved in community drugs and alcohol treatment (CDAT). They were then randomly assigned to behavioural intervention delivered by psychologists (n=23) or CBT based self-help introduced by CDAT workers (n=27). Recruitment and retention rates, along with changes in depressive symptoms and changes in days abstinent were measured at the 24 week follow up. The fifty participants were recruited from a pool of approximately 200 individuals and the randomisation produced comparable groups. Seventy-eight percent of the participants were present at the 24 week follow up point. The engagement rate for the participants who received psychological interventions was low with only 42% attending at least one session and there was no significant difference in engagement between the two groups. However, those from both groups who engaged with treatment did have moderate improvements in depressive symptoms. Co-existence of alcohol and drug services and mental health services does appear to improve engagement with treatment. A limitation was the high attrition rate, which was more likely in those with polysubstance use.

Epstein, E. E., McCrady, B. S., Hallgren, K. A., Gaba, A., Cook, S., Jensen, N., & … Litt, M. D. (2018). Individual versus group female-specific cognitive behavior therapy for alcohol use disorder. Journal of Substance Abuse Treatment, 88(1), 27-43.

This study aimed to test group-based female-specific CBT (G-FS-CBT) for women with alcohol use disorder (AUD) against an individual female-specific CBT (I-FS-CBT). The authors wanted to describe the development of G-FS-CBT. They also aimed to examine its content, feasibility, acceptability, group process, participant engagement and treatment outcomes. The study was a randomised controlled trial in which 155 women with AUD were randomly assigned to twelve manual guided sessions of G-FS-CBT or I-FS-CBT. Of the participants, 138 women attended at least one session. Women who were assigned into the G-FS-CBT group attended less sessions than those assigned the I-FS-CBT group. Engagement rate was rated as high in both groups by independent assessors and women in both groups reported high satisfaction with their treatment. During the first six weeks of treatment, participants in both groups significantly reduced their percent drinking days and percent heavy drinking days by equivalent amounts, which they maintained during treatment and at the twelve month follow up. They all also reported significant improvement in treatment outcomes including depression, self-efficacy, anxiety and abstinence. They concluded that the study offered support for G-FS-CBT as a treatment for women with AUD, offering single gender community support, programmed specifically for women. A limitation in the study was the limited demographics in the group being studied, although it was felt that as the program was a tailored one, it could be adapted for different age groups and different socio-economic groups.

Haller, M., Norman, S. B., Cummins, K., Trim, R. S., Xu, X., Cui, R., & … Tate, S. R. (2016). Integrated Cognitive Behavioral Therapy Versus Cognitive Processing Therapy for Adults With Depression, Substance Use Disorder, and Trauma. Journal of Substance Abuse Treatment, 62(1), 38-48.

Posttraumatic stress disorder (PTSD), depression and SUD are often comorbid conditions suffered by veterans. Research has previously indicated that veterans who had comorbidity of these three conditions did not maintain treatment gains from CBT as well as those with depression and SUD but not PTSD. The aim of this study was to investigate if adding trauma-focused treatment after an initial group-based integrated CBT for SUD and depression resulted in improved treatment outcomes. They recruited 123 veterans (89% male) from a single healthcare system to participate in the study. They all received integrated CBT sessions twice a week for 12 weeks (Phase 1). They were then randomly allocated to receive 12 individual follow-up sessions (Phase 2) using either integrated CBT or cognitive processing therapy modified to include SUD treatment (CPT-M). PTSD and depressive symptoms improved slightly at the end of Phase 1 and improved further during Phase 2, except for those without PTSD who received CPT-M. These improvements were maintained one year later. Substance use significantly improved by the end of Phase 1 and was maintained throughout Phase 2 and at one year follow-up. Similar levels of symptom improvement were seen in participants in the trauma-focused Phase 2 treatment (CPT-M) as those in the non-trauma focused treatment (integrated CBT), but there was a slight advantage of CPT-M over integrated CBT in heavy drinking outcomes for participants with PTSD. They concluded that generally group integrated CBT followed by either individual integrated CBT or CPT-M seemed to be effective for veterans with depression, SUD and PTSD. An important limitation of the study was that the participants were mainly male and that the results may not apply to female veterans.

Kiluk, B. D., DeVito, E. E., Buck, M. B., Hunkele, K., Nich, C., & Carroll, K. M. (2017). Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance. Journal of Substance Abuse Treatment, 82(1), 87-92.

The development of coping skills has generally been considered to be a result of CBT for SUD but there is little statistical evidence to support this. The aim of this study was to reproduce and expand previous research on the quality of coping skills as a predictor of abstinence in substance users who had participated in a computerised CBT program. The participants were cocaine-dependent individuals enrolled in a methadone maintenance program. They were randomly assigned to treatment as usual (TAU) (n=54) or computerised CBT and TAU (n=47), which consisted of seven modules accessed on a special computer in a private room. They were interviewed by a research assistant at the beginning and end of treatment, twice weekly during treatments and 1, 3 and 6 months after treatment. Coping skills were measured using the Drug Risk Response Test (DRRT). At the 6 month post treatment point, 89 participants remained. They were unable to replicate the results of the previous studies, which may have been due to differences in the study participants. Their analysis did not support the acquisition of coping skills as a predictor of treatment outcome. However those assigned to computerised CBT and TAU, showed greater improvement in coping skills than those assigned to TAU only. A limitation in the study was the small sample size.

Morris, L., Stander, J., Ebrahim, W., Eksteen, S., Meaden, O., Ras, A., & Wessels, A. (2018). Effect of exercise versus cognitive behavioural therapy or no intervention on anxiety, depression, fitness and quality of life in adults with previous methamphetamine dependency: a systematic review. Addiction Science & Clinical Practice, 13(1), 1-12.

Methamphetamine is a psychostimulant used by approximately 52 million people globally and is extremely addictive. When used chronically it can cause adverse psychological, physical and neurological changes, including increases in depression and anxiety and decreases in fitness and quality of life. It has been suggested that exercise has the possibility of reversing these changes. This systematic review aimed to examine the available evidence on the effectiveness of exercise as opposed to CBT, standard care or no intervention on reducing anxiety and depression and improving fitness and quality of life in previous users of methamphetamine. The initial search identified 251 articles, which was first reduced to 14 potentially relevant studies, whose abstracts were reviewed. The final selection was three articles comprising two randomised control trials and one quasi-experimental pilot. The review concluded that depression and anxiety scores were significantly reduced with exercise as opposed to CBT. There were also significant improvements in quality of life scores in those exercising. It recommended that exercise be included in therapy for methamphetamine use. A limitation in this study was the small number of studies reviewed.

Zhang Z, Zhang L, Zhang G, Jin J, Zheng Z. The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry [serial online]. December 1, 2018; 18(1):1-14. Available from: E-Journals, Ipswich, MA. Accessed March 25, 2018

CBT and its variations could be effective in preventing relapse in individuals with major depressive disorder (MDD). This review therefore aimed to evaluate the efficacy of CBT in preventing relapse in MDD. The researchers searched several databases to find relevant studies. They found sixteen studies investigating a total of 1945 participants, which met the criteria of the review. CBT was found to be more efficacious than control in reducing relapse in MDD individuals who were in remission. In those with three or more previous depressive episodes, mindfulness-based cognitive (MBCT) was more effective than control in reducing relapse. They concluded that using CBT in individuals with MDD may decrease the risk of relapse and that MBCT may only work for those MDD individuals with three or more previous episodes. The limitations in the study include the trial sizes in some of the studies evaluated and that the research was limited to MDD, rather than all depressive disorders.

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