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Module 3 Discussion: Selecting Inclusion/Exclusion Criteria for PICO Research

Emmanuel Rodriguez

ST. Thomas University

NUR 670 Psych Management Integration

Dr. Mays

07/17/2025

Abstract

This discussion explores the systematic identification of inclusion and exclusion criteria for the PICO question: In adult patients diagnosed with Schizotypal Personality Disorder (STPD) treated as outpatients in psychiatric units, does Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) affect symptoms of social anxiety? The literature search used a broad search of five major U.S.-based databases in a strict filter that only searched Level 1 and 2 evidence published in the last five years. Boolean terms and keyword phrases were used to limit the search. The selection was reduced to study samples of adult outpatients, comparisons of CBT and DBT, and quantifiable outcomes of social anxiety, to be most relevant and clinically feasible.

PICO Question: In adults with Schizotypal Personality Disorder (STPD) receiving outpatient psychiatric care, how does Cognitive Behavioral Therapy (CBT) compared to Dialectical Behavior Therapy (DBT) affect social anxiety symptoms?

Inclusion/Exclusion Criteria Table:

Database Searched	Search Terms / Keywords	Boolean Operators Used	Limits / Filters Applied	Number of Results Found
PubMed	"Schizotypal Personality Disorder" AND "Cognitive Behavioral Therapy" AND "Dialectical Behavior Therapy" AND "social anxiety"	AND	English; Humans; Adults; Last 5 years; U.S.-based studies	67
CINAHL	"STPD" OR "Schizotypal Personality Disorder" AND "CBT" OR "DBT" AND "outpatient psychiatric care"	OR, AND	Peer-reviewed; English; Published 2019–2024; United States	52
PsycINFO	"CBT" AND "DBT" AND "social anxiety" AND "Schizotypal Personality Disorder"	AND	Adults; English; Empirical studies; U.S. only; Last 5 years	89
Cochrane Library	"Cognitive Behavioral Therapy" AND "Dialectical Behavior Therapy" AND "STPD"	AND	Adults; English; Published in last 5 years; U.S.-based research only	24
Medline (via EBSCO)	"STPD" AND "CBT" AND "DBT" AND "social functioning"	AND	English; Academic journals; U.S. authors; Adults 18+; Published after 2020	41

Database Search and Evidence Gathering Process:

To find high-quality and evidence-based research that would support the PICO question, I made a systematic search of several respected databases, including PubMed, CINAHL, PsycINFO, Cochrane Library, and Medline. I have deliberately chosen these databases, as they have the reputation of including peer-reviewed and scholarly information concerning psychiatric nursing and psychological therapies (Goossen et al., 2020). Combinations of words and MeSH terms that I employed were: distinctions between CBT/DBT and schizotypal personality disorder, as well as social anxiety. The refinement of search results was possible with the help of Boolean operators, such as the word AND and OR, and the search finally found results that compared the two therapy modalities and focused on the specific symptom of social anxiety in STPD adults (Jha et al., 2022).

The limits and filters played a paramount role in the refinement of the search to include only Level 1 and Level 2 evidence and those conducted in the US. The reason why such restrictions were implemented was to make sure that the research is not obsolete and relevant to outpatient psychiatric practice in the United States. I chose to retrieve research published not earlier than five years, with only English-language articles being included, and studies on human adults only being accepted. Also, only peer-reviewed and empirical research studies were incorporated to fulfill the requirements of high-levels of evidence (Vatkar et al., 2025). Relevance to the adult outpatient population, direct comparison between CBT and DBT and the evaluation of the results in terms of social anxiety symptoms became the major inclusion criteria. Articles with inpatient populations, adolescents or children, non-peer-reviewed articles, non-U.S. who wrote the article, and failure to directly compare CBT and DBT were all an exclusion criterion.

Through the five databases, I found out about 273 total articles. I also narrowed down these findings to abstract reading and using other criteria, like the study design (RCTs, systematic reviews, and meta-analyses) so that the studies would provide Level 1 or 2 evidence. Those articles containing mixed personality disorders without emphasis on STPD or those articles that contained either CBT or DBT but neither were an exclusion criteria. I focused on randomized controlled trials and meta-analysis of the relevance of CBT and DBT approaches to treating social anxiety symptoms in this specific population such as Bhattacharya et al. (2022) and Sadat et al. (2025).

References

Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2022). Efficacy of Cognitive Behavioral Therapy for anxiety-related disorders: A meta-analysis of recent literature. Current Psychiatry Reports, 25(1), 19–30. https://doi.org/10.1007/s11920-022-01402-8

Goossen, K., Hess, S., Lunny, C., & Pieper, D. (2020). Database Combinations to Retrieve Systematic Reviews in Overviews of reviews: a Methodological Study. BMC Medical Research Methodology, 20(1). https://doi.org/10.1186/s12874-020-00983-3

Jha, R., Sondhi, V., & Vasudevan, B. (2022). Literature search: Simple Rules for Confronting the Unknown. Medical Journal Armed Forces India, 78(1), S14–S23. https://doi.org/10.1016/j.mjafi.2022.07.009

Sadat, P., Khakpour, M. S., Kazemi, M., Mousavi, S. E., Nitsche, M. A., Salehinejad, M. A., & Mohsen Dadashi. (2025). Efficacy of CBT, intensified tDCS and their combination for reducing clinical symptoms and improving quality of life in social anxiety disorder with comorbid depression: a randomized controlled trial. BMC Psychiatry, 25(1). https://doi.org/10.1186/s12888-025-06866-5

Vatkar, A., Kale, S., Shyam, A., & Srivastava, S. (2025). Understanding the Levels of Evidence in Medical Research. Journal of Orthopaedic Case Reports, 15(5), 6–9. https://doi.org/10.13107/jocr.2025.v15.i05.5534

PICO QUESTION

. In adults with Schizotypal Personality Disorder (STPD) receiving outpatient psychiatric care, how does Cognitive Behavioral Therapy (CBT) compared to Dialectical Behavior Therapy (DBT) affect social anxiety symptoms?

Module 4 Discussion

   https://www.prisma-statement.org/prisma-2020-flow-diagram

How to create a PRISMA flow diagram

Dear Students,

To assist you in creating your literature diagram, please utilize the following resource:  PRISMA Flow Diagram GuideLinks to an external site. . This guide provides step-by-step instructions and templates to help you accurately structure and document your literature review process.

A PRISMA diagram visually maps the flow of information through the different phases of a systematic or literature review. To ensure credibility and academic integrity, your diagram must reflect  real numbers based on your database searches, screening, and selection, not estimates or placeholders.

Quick Guide: Creating a PRISMA Diagram with Actual Numbers

A PRISMA diagram maps how studies are identified, screened, and selected for your literature review. Use  real, not estimated numbers. Follow these key steps:

1. Search and Record

· Use multiple databases (e.g., PubMed, CINAHL, PsycINFO).

· Document: search date, keywords, Boolean operators, filters.

· Total records retrieved (e.g., PubMed: 320, CINAHL: 290).

2. Remove Duplicates

· Use citation managers (e.g., Zotero, EndNote) to de-duplicate.

· Record how many were removed.

3. Screening (Title/Abstract)

· Note how many records were screened and excluded at this level.

4. Full-Text Review

· Report how many full-text articles were assessed.

· Exclude with reasons (e.g., wrong population, not peer-reviewed).

5. Final Inclusion

· Report number of studies included in:

· Qualitative synthesis

· Quantitative synthesis (if applicable)

Tips

· Avoid placeholders—use exact numbers.

· Keep detailed records in case you’re asked to verify.

· All the PRISMA components and the  official PRISMA templateLinks to an external site.  must be used to receive the full points in the main issues category for this assignment.

Let me know if you'd like a template filled out or help listing exclusion reasons.

     Creating a Search Strategy

After studying  Module 4: Lecture Materials & Resources , discuss the following:

·

1. Create and upload a  literature flow diagram using the  PRISMA templateLinks to an external site.

2. Describe the process used to narrow down the search results to the final number of articles selected for your PICO question.

3. Full points for the main issues section of the rubric will be given for including the reasons for the exclusions in your initial post 

4. Inclusion of all the final articles  is required in the reference section 

Submission Instructions:

. Your initial post, question 2, should be at least 250 words, formatted and cited in the current APA style.

. Provide support for your work from at least five academic sources, less than 5 years old. Visit  Purdue OwlLinks to an external site.  for specific examples on how to create in-text citations and cite references using the current APA format.

. Students will use this PICO question when creating the abstract and academic poster.

. Students may not duplicate the PICO question of another student at St. Thomas University.

. Your initial post is worth 8 points.

. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points. (1 point per response)

. All replies must be constructive and use literature where possible

· our assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria	Ratings	Points
Identification of Main Issues, Problems, and Concepts	Distinguished - 4 points Post is substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic.	Excellent - 3 points Post is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be.	Fair - 1-2 points Demonstrates limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given.	Poor - 0 points Post is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear.	4 points
APA Formatting Guidelines	Distinguished - 2 points The reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations.	Excellent - 1 point The reference page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations.	Fair - 0.5 points The reference page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations.	Poor - 0 points The reference page contains no current scholarly academic resources, only internet web pages, or no reference page. Lack of APA guidelines for references provided or in-text citations.	2 points
Writing Mechanics	Distinguished - 2 points Rules of grammar, usage, and punctuation are followed; spelling is correct.	Excellent - 1 point Few grammatical errors, but sentences could be clearer and more precise.	Fair - 0.5 points The paper contains a few grammatical, punctuation, and spelling errors.	Poor - 0 points The paper contains numerous grammatical, punctuation, and spelling errors.	2 points
Response to Posts of Peers	Distinguished - 2 points Constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.	Fair - 1 point Constructively responded to one other post and either extended, expanded, or provided a rebuttal.	Poor - 0 points Provided no response to a peer's post.	2 points
Total Points	10