Ricard, Richard J.; Lerma, Eunice; Heard, Courtney C. C.
This study explored the impact of a 4-week skills group intervention based on the principles of Dialectical Behavior Therapy (DBT) with a sample of adolescents attending a Disciplinary Alternative Education Program. This article provides a session-by-session overview of activities adapted from DBT-specified training modules of mindfulness,…
Pistorello, Jacqueline; Fruzzetti, Alan E.; MacLane, Chelsea; Gallop, Robert; Iverson, Katherine M.
Objective: College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a…
Pistorello, Jacqueline; Fruzzetti, Alan E.; MacLane, Chelsea; Gallop, Robert; Iverson, Katherine M.
Objective College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students to an optimized control condition, and analyzed baseline global functioning as a moderator. Method The intent-to-treat (ITT) sample included 63 college students between the ages of 18 and 25 who were suicidal at baseline, reported at least one lifetime non-suicidal self-injurious (NSSI) act or suicide attempt, and met three or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or an optimized Treatment as Usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments. Both treatments lasted 7–12 months and included both individual and group components. Assessments were conducted at pretreatment, 3-months, 6-months, 9-months, 12-months, and 18-months (follow-up). Results Mixed effects analyses (ITT sample) revealed that DBT, compared to the control condition, showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and psychotropic medication use, and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up. No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who were lower functioning at pretreatment. Conclusions DBT is an effective treatment for suicidal, multi-problem college students. Future research should examine the implementation of DBT in CCCs in a stepped care approach. PMID:22730955
Shelton, Deborah; Kesten, Karen; Zhang, Wanli; Trestman, Robert
Purpose This article reports the findings of a Dialectical Behavioral Therapy- Corrections Modified (DBT-CM) intervention upon difficult to manage, impulsive and/or aggressive incarcerated male adolescents. Methods A secondary analysis of a sub-sample of 38 male adolescents who participated in the study was conducted. A one-group pretest-posttest design was used; descriptive statistics and t-tests were conducted. Results Significant changes were found in physical aggression, distancing coping methods and number of disciplinary tickets for behavior. Conclusion The study supports the value of DBT-CM for management of incarcerated male adolescents with difficult to manage aggressive behaviors. PMID:21501287
von Auer, Anne Kristin; Kleindienst, Nikolaus; Ludewig, Sonia; Soyka, Oliver; Bohus, Martin; Ludäscher, Petra
In April 2004 the inpatient unit "Wellenreiter" at the Vorwerker Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Lubeck (Germany) opened its doors. Despite reservations by the therapeutic community, we implemented a specialized treatment for female adolescents with symptoms of borderline personality disorder - the I;>ialectical Behavior Therapy for Adolescents (DBT-A). In this article we present the concept, our experiences, and data from the past 10 years of clinical work in this specialized unit. PMID:26373383
Welch, Stacy Shaw; Kim, Junny
Results and a case study for a DBT-enhanced habit reversal treatment (HRT) for adult trichotillomania (TTM) (Keuthen & Sprich, 2012) is adapted for use with adolescents. Trichotillomania in adolescence is a very important but understudied problem. Onset often occurs in adolescence, and yet very little treatment research exists. DBT-enhanced habit…
Panos, Patrick T.; Jackson, John W.; Hasan, Omar; Panos, Angelea
Objective: The objective was to quantitatively and qualitatively examine the efficacy of DBT (e.g., decreasing life-threatening suicidal and parasuicidal acts, attrition, and depression) explicitly with borderline personality disorder (BPD) and using conservative assumptions and criteria, across treatment providers and settings. Method: Five…
Background Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program. Methods/design Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design. Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in December 2014. Discussion Highly suicidal outpatient patients can pose a dilemma for mental health care professionals. Although hospitalization seems inevitable under some circumstances, it has proven to be harmful in its own right. This paper outlines the background and methods of a randomized trial evaluating the possible surplus value of a short-term inpatient DBT program. PMID:24885551
Kerr, Patrick L.; Muehlenkamp, Jennifer J.; Larsen, Margo Adams
University training clinics offer state-of-the-art treatment opportunities for clients, particularly for underserved and underinsured client populations. Little has been published regarding the implementation of Dialectical Behavior Therapy (DBT) in settings such as a university training clinic, which may face challenges in utilizing such a…
Rizvi, Shireen L.
Dialectical behavior therapy (DBT) has become a widely used treatment model for individuals with borderline personality disorder (BPD) and other individuals with significant emotion dysregulation problems. Despite its strong empirical support, DBT obviously does not have positive outcomes for all individuals. It is critical that cases of DBT…
DiGiorgio, Kimberly E.; Glass, Carol R.; Arnkoff, Diane B.
The purpose of this study was to examine how therapists conduct Dialectical Behavior Therapy (DBT) individual psychotherapy with clients, focusing on clinical factors that could account for decisions regarding modifications of DBT (e.g., client diagnosis, therapist theoretical orientation, and intensity of DBT training). Additionally, the study…
Lajoie, Travis; Sonkiss, Joshua; Rich, Anne
Objective: The authors describe the first 6 months of a dialectical behavior therapy (DBT) clinic operated by trainees in a general adult psychiatry residency program. The purpose of this report is to provide a model for the creation and maintenance of a formalized resident DBT clinic. Methods: Residents participated in the DBT clinic, attended a…
Neacsiu, Andrada D.; Ward-Ciesielski, Erin F.; Linehan, Marsha M.
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its…
Sharma, Binali; Dunlop, Boadie W.; Ninan, Philip T.; Bradley, Rebekah
Objective: The authors describe the use of dialectical behavior therapy (DBT) in treating borderline personality disorder during psychiatry residency, and assess the status of DBT education within psychiatry residencies in the United States. Method: The authors present a patient with borderline personality disorder treated by a resident using DBT,…
Lynch, T R; Whalley, B; Hempel, R J; Byford, S; Clarke, P; Clarke, S; Kingdon, D; O'Mahen, H; Russell, I T; Shearer, J; Stanton, M; Swales, M; Watkins, A; Remington, B
Introduction Only 30–40% of depressed patients treated with medication achieve full remission. Studies that change medication or augment it by psychotherapy achieve only limited benefits, in part because current treatments are not designed for chronic and complex patients. Previous trials have excluded high-risk patients and those with comorbid personality disorder. Radically Open Dialectical Behaviour Therapy (RO-DBT) is a novel, transdiagnostic treatment for disorders of emotional over-control. The REFRAMED trial aims to evaluate the effectiveness and cost-effectiveness of RO-DBT for patients with treatment-resistant depression. Methods and analysis REFRAMED is a multicentre randomised controlled trial, comparing 7?months of individual and group RO-DBT treatment with treatment as usual (TAU). Our primary outcome measure is depressive symptoms 12?months after randomisation. We shall estimate the cost-effectiveness of RO-DBT by cost per quality-adjusted life year. Causal analyses will explore the mechanisms by which RO-DBT is effective. Ethics and dissemination The National Research Ethics Service (NRES) Committee South Central – Southampton A first granted ethical approval on 20 June 2011, reference number 11/SC/0146. Trial registration number ISRCTN85784627. PMID:26187121
... Email Print Share Behavior Therapy for Children with ADHD Article Body Behavior Therapy Has 3 Basic Principles: ... using both medication and behavior therapy to treat attention-deficit/hyperactivity disorder (ADHD) . This is known as a multimodal treatment ...
Federici, Anita; Wisniewski, Lucene; Ben-Porath, Denise
The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well…
Miller, Alec L.; Rathus, Jill H.; Linehan, Marsha M.
Filling a tremendous need, this highly practical book adapts the proven techniques of dialectical behavior therapy (DBT) to treatment of multiproblem adolescents at highest risk for suicidal behavior and self-injury. The authors are master clinicians who take the reader step by step through understanding and assessing severe emotional…
Chapman, Alexander L.
Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) are both innovative behavioral treatments that incorporate mindfulness practices and acceptance-based interventions into their treatment packages. Although there are many similarities between these treatments, including the fact that they are part of a newer "wave" in…
MacPherson, Heather A.; Cheavens, Jennifer S.; Fristad, Mary A.
Dialectical behavior therapy (DBT) was originally developed for chronically suicidal adults with borderline personality disorder (BPD) and emotion dysregulation. Randomized controlled trials (RCTs) indicate DBT is associated with improvements in problem behaviors, including suicide ideation and behavior, non-suicidal self-injury (NSSI), attrition,…
Lindenboim, Noam; Comtois, Katherine Anne; Linehan, Marsha M.
Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients' practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according…
Koons, Cedar R.; Chapman, Alexander L.; Betts, Bette B.; O'Rourke, Beth; Morse, Nesha; Robins, Clive J.
Twelve vocational rehabilitation clients with severe mental illness received a comprehensive adaptation of dialectical behavior therapy (DBT) delivered in a group format. Treatment consisted of 2 hours of standard DBT skills training per week and 90 minutes of diary card review, chain analysis, and behavioral rehearsal. Participants were selected…
Neacsiu, Andrada D; Eberle, Jeremy W; Kramer, Rachel; Wiesmann, Taylor; Linehan, Marsha M
Difficulties with emotions are common across mood and anxiety disorders. Dialectical behavior therapy skills training (DBT-ST) reduces emotion dysregulation in borderline personality disorder (BPD). Preliminary evidence suggests that use of DBT skills mediates changes seen in BPD treatments. Therefore, we assessed DBT-ST as a stand-alone, transdiagnostic treatment for emotion dysregulation and DBT skills use as a mediator of outcome. Forty-four anxious and/or depressed, non-BPD adults with high emotion dysregulation were randomized to 16 weeks of either DBT-ST or an activities-based support group (ASG). Participants completed measures of emotion dysregulation, DBT skills use, and psychopathology every 2 months through 2 months posttreatment. Longitudinal analyses indicated that DBT-ST was superior to ASG in decreasing emotion dysregulation (d = 1.86), increasing skills use (d = 1.02), and decreasing anxiety (d = 1.37) but not depression (d = 0.73). Skills use mediated these differential changes. Participants found DBT-ST acceptable. Thirty-two percent of DBT-ST and 59% of ASG participants dropped treatment. Fifty-nine percent of DBT-ST and 50% of ASG participants complied with the research protocol of avoiding ancillary psychotherapy and/or medication changes. In summary, DBT-ST is a promising treatment for emotion dysregulation for depressed and anxious transdiagnostic adults, although more assessment of feasibility is needed. PMID:24974307
Kliem, Soren; Kroger, Christoph; Kosfelder, Joachim
Objective: At present, the most frequently investigated psychosocial intervention for borderline personality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was undertaken to find relevant literature from online…
Chugani, Carla D.
This article examines the topic of Dialectical Behavior Therapy (DBT) applied in college counseling centers. Trends in mental health issues on college campuses are briefly reviewed in support of the increased need for evidence-based treatment of severe mental health issues. The article next presents an overview of the standard DBT model and…
Manning, Sharon Y.
Telephone consultation is an integral mode of the comprehensive treatment in dialectical behavior therapy (DBT). The mode of telephone consultation functions primarily to ensure that the skills learned in skills training group and the solutions created in DBT individual psychotherapy generalize to the client's environment. However, there are many…
Comtois, Katherine Anne; Elwood, Lynn; Holdcraft, Laura C.; Smith, Wayne R.; Simpson, Tracy L.
Dialectical behavior therapy (DBT) has been shown to be effective in randomized controlled trials with women with borderline personality disorder and histories of chronic self-inflicted injury including suicide attempts. The present study is a pre-post replication of a comprehensive DBT program in a community mental health center for individuals…
Woodberry, Kristen A.; Popenoe, Ellen J.
Dialectical behavior therapy (DBT), an empirically supported treatment for adult women diagnosed with borderline personality disorder (BPD), has been increasingly adapted for use with adolescents across a variety of settings. This article describes a community-based application of DBT principles and strategies for adolescents and their families.…
Waltz, Jennifer; Dimeff, Linda A.; Koerner, Kelly; Linehan, Marsha M.; Taylor, Laura; Miller, Christopher
This study tested the feasibility of using a psychoeducational video recording to teach a behavioral skill from the Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b) skills training program to individuals meeting criteria for borderline personality disorder. A video presenting a DBT emotion-regulation skill was developed and the extent to…
Brown, Julie F.; Brown, Milton Z.; Dibiasio, Paige
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities. PMID:23914278
Dimeff, Linda A.; Woodcock, Eric A.; Harned, Melanie S.; Beadnell, Blair
This study evaluated the efficacy of methods of training community mental health providers (N=132) in dialectical behavior therapy (DBT) distress tolerance skills, including (a) Linehan's (1993a) Skills Training Manual for Borderline Personality Disorder (Manual), (b) a multimedia e-Learning course covering the same content (e-DBT), and (c) a…
Ditty, Matthew S; Landes, Sara J; Doyle, Andrea; Beidas, Rinad S
Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative methods (n = 20) to identify relationships between inner setting variables and DBT implementation. Four interpersonal variables-team cohesion, team communication, team climate, and supervision-were correlated with the quantity of DBT elements implemented. Qualitative themes corroborated these findings. Additional variables were connected to implementation by either quantitative or qualitative findings, but not both. PMID:25315183
Brown, Julie F.; Brown, Milton Z.; Dibiasio, Paige
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in…
Steinberg, Jennifer A.; Steinberg, Sara J.; Miller, Alec L.
Preliminary studies evaluating dialectical behavior therapy with adolescents have obtained promising outcomes. This multimodal therapy includes telephone consultation for adolescents and for their family members to help ensure generalization of skills from the therapy office to their natural environments. Telephone contact with the DBT therapist…
Rizvi, Shireen L.; Dimeff, Linda A.; Skutch, Julie; Carroll, David; Linehan, Marsha M.
Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have…
Herschell, Amy D.; Lindhiem, Oliver J.; Kogan, Jane N.; Celedonia, Karen L.; Stein, Bradley D.
We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a two-year period from front-line mental health therapists (N = 64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes towards consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training resulted in positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes towards individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation. PMID:24333657
Bullock, Kim D; Mirza, Nida; Forte, Craig; Trockel, Mickey
Neuroimaging evidence suggests deficits in affective regulation in conversion disorder (CD). Dialectical-behavior therapy skills training (DBT-ST) was developed to target emotion dysregulation. This study was aimed to test the feasibility of stand-alone DBT-ST for CD using Linehan's manual for borderline personality disorder. In a prospective naturalistic design, 19 adult outpatients diagnosed with video EEG-confirmed seizure type CD were recruited and received weekly group DBT. Seventeen out of 19 subjects finished an average of 20.5 weeks of treatment. The mean seizure rate decreased by 66%. Cessation of seizures occurred in 35% of the sample. Completion rates reached 90%. PMID:25959039
Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.
The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…
Treatment Differences in the Therapeutic Relationship and Introject during a 2-Year Randomized Controlled Trial of Dialectical Behavior Therapy versus Nonbehavioral Psychotherapy Experts for Borderline Personality Disorder
Bedics, Jamie D.; Atkins, David C.; Comtois, Katherine A.; Linehan, Marsha M.
Objective: The present study explored the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Method: Women meeting "DSM-IV" criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community…
Keuthen, Nancy J.; Sprich, Susan E.
Traditional cognitive-behavioral interventions for trichotillomania have had modest acute treatment outcomes and poor maintenance of gains over time. Techniques adopted from dialectical behavior therapy (DBT) can potentially enhance treatment outcomes by specifically addressing issues of impulsivity, emotion regulation, and distress tolerance. In…
Teti, Germán Leandro; Boggiano, Juan Pablo; Gagliesi, Pablo
Clinical work with patient suffering complex or multiple problems represents one of the biggest challenges for mental health professionals. The third wave of cognitive behavioral therapies emphasizes the context and function of psychological events more so than their validity, frequency, or form, while incorporating processes of acceptance and mindfulness. The current work aims to provide a description of one type of these therapies, Dialectical Behavioral Therapy (DBT), which was developed by Dr. Marsha M. Linehan. In the 80's DBT's efficacy was investigated among women diagnosed with borderline personality disorder, while later extending the model to be used for other disorders. Specifically, the orientation of DBT, the central dialectic component between acceptance and change, validation procedures, and changes are explained. Moreover, the biosocial theory of the etiology and maintenance of behavioral problems are considered. Lastly, the targeted problems specific to when they occurred and their components for treatment are explained in stages. PMID:26323115
Wisniewski, Lucene; Ben-Porath, Denise D
Several researchers have adapted and/or applied dialectical behavior therapy (DBT) for populations with eating disorders. There is a growing body of research that indicates that DBT is an effective treatment option for this population, including those who have co-occurring Axis II disorders. The goal of the current paper is to summarize the research conducted in the area of DBT with those individuals who present with eating disorders only as well as those who present with both eating disorders and Axis II disorders. We also describe a dialectical dilemma, apparent compliance vs. active defiance, which is commonly observed in the group with comorbidities A DBT change strategy, contingency management, is discussed as an intervention to target apparent compliance and active defiance. PMID:26160619
Koons, Cedar R.
Standard, outpatient Dialectical Behavior Therapy (DBT) includes the provision of intersession telephone contact between the therapist and the client to reduce suicidal crisis behaviors, enhance skills generalization, and reduce alienation and conflict in the therapeutic relationship. Therapists providing telephone consultation need the help of…
Drossel, Claudia; Fisher, Jane E.; Mercer, Victoria
A Dialectical Behavior Therapy Skills training manual (DBT Skills) was adapted for use with caregivers of individuals with dementia. Implementation occurred in a community clinic with a heterogeneous caregiver group at risk for elder abuse. Sixteen caregivers completed the 9-week group. The results point to improved psychosocial adjustment,…
Lynch, Thomas R; Hempel, Roelie J; Dunkley, Christine
Radically Open-Dialectical Behavior Therapy (RO-DBT) is a transdiagnostic treatment designed to address a spectrum of difficult-to-treat disorders sharing similar phenotypic and genotypic features associated with maladaptive over-control-such as anorexia nervosa, chronic depression, and obsessive compulsive personality disorder. Over-control has been linked to social isolation, aloof and distant relationships, cognitive rigidity, high detailedfocused processing, risk aversion, strong needs for structure, inhibited emotional expression, and hyper-perfectionism. While resting on the dialectical underpinnings of standard DBT, the therapeutic strategies, core skills, and theoretical perspectives in RO-DBT often substantially differ. For example, RO-DBT contends that emotional loneliness secondary to low openness and social-signaling deficits represents the core problem of over-control, not emotion dysregulation. RO-DBT also significantly differs from other treatment approaches, most notably by linking the communicative functions of emotional expression to the formation of close social bonds and via skills targeting social-signaling and changing neurophysiological arousal. The aim of this paper is to provide a brief overview of the core theoretical principles and unique treatment strategies underlying RO-DBT. PMID:26160620
Panepinto, Amberly R.; Uschold, Carissa C.; Olandese, Michelle; Linn, Braden K.
The study investigated the efficacy of a dialectical behavior therapy (DBT) program with a general college counseling center population, not limited to students diagnosed with borderline personality disorder. A review of records of 64 students found that obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, paranoia,…
Behavior therapy approaches to the treatment of male sexual impotence, specifically premature ejaculation and erective impotence, are discussed. Included in the behavioral therapies are systematic desensitization, active graded therapy, assertive techniques, sexual responses, operant approaches and others. Often marriage counseling is also…
Andrade, A. Chitra; Kumaraiah, V.; Mishra, H.; Chatterji, S.; Andrade, Chittaranjan
Transsexualism is a rare disorder, and there is little literature available on its treatment. A case is presented of transsexualism with homosexual orientation in a 24 year old male. Since the disorder appeared to have behavioral antecedents, it was treated with a behavior therapy package comprising relaxation, aversion therapy with aversion relief, modelling, hypnosis, orgasmic reconditioning, behavioral counselling and sex education. Therapy resulted in normalization of gender identity, but the homosexual orientation persisted. PMID:21743738
Axelrod, Seth R.; Perepletchikova, Francheska; Holtzman, Kevin; Sinha, Rajita
Background Dialectical Behavior Therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. Objective Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. Method Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. Conclusions This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. Significance and Future Research Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dyregulation such as BPD and substance dependence, and to further explore emotion regulation as a potential mechanism of change for clinical interventions. PMID:21091162
Schulz-Wendtland, R; Dilbat, G; Bani, M; Fasching, P A; Heusinger, K; Lux, M P; Loehberg, C R; Brehm, B; Hammon, M; Saake, M; Dankerl, P; Jud, S M; Rauh, C; Bayer, C M; Beckmann, M W; Uder, M; Meier-Meitinger, M
Aim: This prospective clinical study aimed to evaluate whether it would be possible to reduce the rate of re-excisions using CMOS technology, a specimen radiography system (SRS) or digital breast tomosynthesis (DBT) compared to a conventional full field digital mammography (FFDM) system. Material and Method: Between 12/2012 and 2/2013 50 patients were diagnosed with invasive breast cancer (BI-RADS™ 5). After histological verification, all patients underwent breast-conserving therapy with intraoperative imaging using 4 different systems and differing magnifications: 1. Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1?mm, resolution 85?µm pixel pitch, 8?lp/mm; 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS technology, photodiode array, flat panel, tungsten source, focus 0.05, resolution 50?µm pixel pitch, 12?lp/mm; 3. the Trident™ specimen radiography system (SRS) (Hologic, Bedford, MA, USA), amorphous selenium, tungsten source, focus 0.05, resolution 70?µm pixel pitch, 7.1?lp/mm; 4. tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1?mm, resolution 85?µm pixel pitch, 8?lp/mm, angular range 50 degrees, 25 projections, scan time >?20?s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiographs were prospectively shown to 3 radiologists. Results: Of the 50 patients with histologically proven breast cancer (BI-RADS™ 6), 39 patients required no further surgical therapy (re-excision) after breast-conserving surgery. A retrospective analysis (n?=?11) showed a significant (p?0.05) increase of sensitivity with the BioVision™, the Trident™ and tomosynthesis compared to the Inspiration™ at a magnification of 1.0?:?2.0 or 1.0?:?1.0 (tomosynthesis) (2.6, 3.3 or 3.6?%), i.e. re-excision would not have been necessary in 2, 3 or 4 patients, respectively, compared to findings obtained with a standard magnification of 1.0?:?1.0. Conclusion: The sensitivity of the BioVision™, the Trident™ and tomosynthesis was significantly (p?0.05) higher and the rate of re-excisions was reduced compared to FFDM using a conventional detector at a magnification of 2.0 but without zooming. PMID:24771921
Apsche, J. A.; Ward Bailey, S. R.
This case study presents a theoretical analysis of implementing mode deactivation therapy (MDT) (Apsche & Ward Bailey, 2003) family therapy with a 13 year old Caucasian male. MDT is a form of cognitive behavioral therapy (CBT) that combines the balance of dialectical behavior therapy (DBT) (Linehan, 1993), the importance of perception from…
Goodman, Marianne; Carpenter, David; Tang, Cheuk Y.; Goldstein, Kim E.; Avedon, Jennifer; Fernandez, Nicolas; Mascitelli, Kathryn A.; Blair, Nicholas J.; New, Antonia S.; Triebwasser, Joseph; Siever, Larry J.; Hazlett, Erin A.
Objective Siever and Davis’ (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity—part of the disturbed neural circuitry underlying emotional dysregulation in BPD. Future work includes examining how DBT-induced amygdala changes interact with frontal-lobe regions implicated in emotion regulation. PMID:25038629
Jones, W. Paul
Discusses the theoretical and practical applications of cosmetic behavior therapy in a private practice. Enhancement of physical appearance will frequently result in an enhancement of self-concept, and the client's attainment of physical attractiveness contributes to the probability of success in current culture. (Author/JAC)
Wagner, Elizabeth E.; Miller, Alec L.; Greene, Lori I.; Winiarski, Mark G.
The primary aim of this article is to describe modifications made to Dialectical Behavior Therapy (DBT) for a predominantly ethnic minority population of persons living with HIV/AIDS with substance-use diagnoses and borderline personality disorder (BPD) or three features of BPD plus suicidality (i.e., the triply diagnosed). Despite the myriad…
Background Anorexia Nervosa (AN) is a highly life-threatening disorder that is extremely difficult to treat. There is evidence that family-based therapies are effective for adolescent AN, but no treatment has been proven to be clearly effective for adult AN. The methodological challenges associated with studying the disorder have resulted in recommendations that new treatments undergo preliminary testing prior to being evaluated in a randomized clinical trial. The aim of this study was to provide preliminary evidence on the effectiveness of a treatment program based on a novel adaptation of Dialectical Behavior Therapy (DBT) for adult Anorexia Nervosa (Radically Open-DBT; RO-DBT) that conceptualizes AN as a disorder of overcontrol. Methods Forty-seven individuals diagnosed with Anorexia Nervosa-restrictive type (AN-R; mean admission body mass index?=?14.43) received the adapted DBT inpatient program (mean length of treatment?=?21.7 weeks). Results Seventy-two percent completed the treatment program demonstrating substantial increases in body mass index (BMI; mean change in BMI?=?3.57) corresponding to a large effect size (d?=?1.91). Thirty-five percent of treatment completers were in full remission, and an additional 55% were in partial remission resulting in an overall response rate of 90%. These same individuals demonstrated significant and large improvements in eating-disorder related psychopathology symptoms (d?=?1.17), eating disorder-related quality of life (d?=?1.03), and reductions in psychological distress (d?=?1.34). Conclusions RO-DBT was associated with significant improvements in weight gain, reductions in eating disorder symptoms, decreases in eating-disorder related psychopathology and increases in eating disorder-related quality of life in a severely underweight sample. These findings provide preliminary support for RO-DBT in treating AN-R suggesting the importance of further evaluation examining long-term outcomes using randomized controlled trial methodology. PMID:24199611
Thoma, Nathan; Pilecki, Brian; McKay, Dean
Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed. PMID:26301761
Treating Co-Occurring Axis I Disorders in Recurrently Suicidal Women with Borderline Personality Disorder: A 2-Year Randomized Trial of Dialectical Behavior Therapy versus Community Treatment by Experts
Harned, Melanie S.; Chapman, Alexander, L.; Dexter-Mazza, Elizabeth T.; Murray, Angela; Comtois, Katherine A.; Linehan, Marsha M.
This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were…
Black, J L; Bruce, B K
Through refinements from research and judicious combination with other therapies, behavior therapy has become increasingly relevant in the treatment of psychiatric disorders. After outlining the four models that serve as a framework for behavior therapy (classical conditioning, operant conditioning, social learning theory, and cognitive behavior modification), the authors provide an update for clinicians on developments in the behavioral treatment of anxiety disorders, sexual disorders, depression, and schizophrenia. Most advances have been made in the treatment of anxiety disorders, including definition of variables for successful use of exposure to phobic stimuli in the treatment of phobic disorders and the use of flooding for post-traumatic stress disorder. By becoming better acquainted with cognitive and behavioral therapies, clinicians may be able to offer their patients more effective treatment options. PMID:2680882
Apsche, Jack A.
This article summarizes all of the Mode Deactivation Therapy, (MDT) articles published to date. MDT has shown to be more effective than Cognitive Behavior Therapy, (CBT), Social Skills Training, (SST), and Dialectical Behavior Therapy, (DBT), Apsche, Bass, Jennings, Murphy, Hunter, and Siv, (2005); Apsche & Bass, (2005); Apsche, Bass & Murphy,…
Cognitive behavioral therapy (CBT) can help many people deal with chronic back pain. ... Nonspecific back pain - cognitive behavioral; Backache - chronic - ... - back - chronic - cognitive behavioral; Chronic back pain - low - ...
Rathus, Jill; Campbell, Bevin; Miller, Alec; Smith, Heather
In light of dialectic behavioral therapy's effectiveness in treating suicidal adults, the treatment has been adapted for use in diverse clinical populations, including adolescents who are suicidal and have multiple problem. Walking the Middle Path is a new skill- training module that addresses specific problems and skill deficits of adolescents and their families. The present study evaluated the acceptability of Walking the Middle Path, in order to establish a basis for further assessment of the module's effectiveness. Fifty participants receiving DBT for adolescent were administered a Treatment Acceptability Scale, a skills-rating scale and an open-ended, qualitative assessment. Results indicated high ratings of acceptability. Middle Path skills ranked highly among the DBT skills perceived as most helpful, with validation rated the most beneficial aspect of skills training. The study provides preliminary support for inclusion of Middle Path in the skills training component of DBT with adolescents and their caregivers. Clinical implications of responses and the role of validation in improving family functioning are discussed. PMID:26160621
Rothberg, C V
Behavior therapy is rapidly gaining on importance in the treatment of anxiety disorders. A brief overview of assessment and models of the origins and maintenance of anxiety is presented and demonstrated with a case example of strong avoidance behavior based on feared anxiety attacks in specific situations. The cognitive behavioral intervention comprised 4 sessions of treatment in the office with extensive self-exposure to the feared and previously avoided situation, namely driving the car on the highway and visiting shopping centers, between sessions. The exposure treatment in conjunction with cognitive restructuring and provided problem solving strategies lead to rapid elimination of avoidance behavior as well as the fear of anxiety attacks within one month. Two years later, the patient is free of the previously presented symptoms. PMID:9432748
... who are trying to end their addiction to marijuana can benefit from a treatment program that combines motivational incentives with cognitive-behavioral therapy. "Marijuana remains one of the most widely used drugs ...
Bastien, Celyne H.; Morin, Charles M.; Ouellet, Marie-Christine; Blais, France C.; Bouchard, Sebastien
Forty-five adults with primary insomnia received cognitive-behavioral therapy (CBT) implemented in a group therapy format, in individual face-to-face therapy or through brief individual telephone consultations. The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation, and there was no…
Chalker, Samantha A; Carmel, Adam; Atkins, David C; Landes, Sara J; Kerbrat, Amanda H; Comtois, Katherine Anne
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout. PMID:26496225
Gross, James J.
COMMENTARY United We Stand: Emphasizing Commonalities Across Cognitive-Behavioral Therapies Douglas behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies
Kendrick, Margaret J.; And Others
Compared the efficiency of cognitive-behavioral therapy, emphasizing self-instruction and attention-focusing techniques, with behavior rehearsal and with a waiting-list control in the treatment of debilitating musical-performance anxiety. Multivariate analyses indicated that both the cognitive-behavioral therapy and behavior-rehearsal programs…
Key, D.H.; Fox, R.V.; Kase, R.S.; Willey, M.S.; Stoner, D.L.; Ward, T.E.
We are studying the interactions of isolated bacteria with dibenzothiophene (DBT), a sulfur-containing model compound, and with a solubilized coal product derived from a high-organic-sulfur lignite. The sensitivity of the tetrazolium assay used to identify and study these strains was improved by substituting tetrazolium violet for triphenyltetrazolium. DBT metabolism by thirteen strains was investigated using qualitative and quantitative GC and GC-MS analyses. Growth medium and incubation time affect the extent of DBT degradation and the production of DBT metabolites. Under specific conditions, seven of the strains produce metabolites which elute close to the position of one or another of the biphenyl standards. However, when these samples are spiked with the standard compounds, the bacterial metabolites do not co-elute with the standards. The modification of solubilized high-organic-sulfur coal by six of these strains was also studied. No selective removal of sulfur relative to carbon was observed. 13 refs., 1 fig., 2 tabs.
Constraint-induced (CI) therapy is a term given to a family of efficacious neurorehabilitation treatments including to date: upper extremity CI movement therapy, lower extremity CI movement therapy, pediatric CI therapy, and CI aphasia therapy. The purpose of this article is to outline the behavior analysis origins of CI therapy and the ways in…
Vancamberg, Laurence; Carton, Ann-Katherine; Abderrahmane, Ilyes H.; Palma, Giovanni; Milioni de Carvalho, Pablo; Iordache, R?zvan; Muller, Serge
In breast X-ray images, texture has been characterized by a noise power spectrum (NPS) that has an inverse power-law shape described by its slope ? in the log-log domain. It has been suggested that the magnitude of the power-law spectrum coefficient ? is related to mass lesion detection performance. We assessed ? in reconstructed digital breast tomosynthesis (DBT) images to evaluate its sensitivity to different typical reconstruction algorithms including simple back projection (SBP), filtered back projection (FBP) and a simultaneous iterative reconstruction algorithm (SIRT 30 iterations). Results were further compared to the ? coefficient estimated from 2D central DBT projections. The calculations were performed on 31 unilateral clinical DBT data sets and simulated DBT images from 31 anthropomorphic software breast phantoms. Our results show that ? highly depends on the reconstruction algorithm; the highest ? values were found for SBP, followed by reconstruction with FBP, while the lowest ? values were found for SIRT. In contrast to previous studies, we found that ? is not always lower in reconstructed DBT slices, compared to 2D projections and this depends on the reconstruction algorithm. All ? values estimated in DBT slices reconstructed with SBP were larger than ? values from 2D central projections. Our study also shows that the reconstruction algorithm affects the symmetry of the breast texture NPS; the NPS of clinical cases reconstructed with SBP exhibit the highest symmetry, while the NPS of cases reconstructed with SIRT exhibit the highest asymmetry.
Safren, Steven A.; Hendriksen, Ellen S.; Mayer, Kenneth H.; Mimiaga, Matthew J.; Pickard, Robert; Otto, Michael W.
For patients with HIV, depression is a common, distressing condition that can interfere with a critical self-care behavior--adherence to antiretroviral therapy. The present study describes a cognitive-behavioral treatment designed to integrate cognitive-behavioral therapy for depression with our previously tested approach to improving adherence to…
Forty years ago it was shown that neuroses are persistent unadaptive anxiety response habits that can be systematically overcome by deconditioning procedures collectively known as behavior therapy. Indispensable to behavior therapy is behavior analysis--detailed and accurate specification of the antecedents of the individual's neurotic patterns. In recent years, the behavior therapy movement has been infiltrated by two alien orientations--"exposure therapy" and cognitivism--which repudiate conditioning theory and dispense with the characteristic behavior analysis. By claiming to be more effective, the alien approaches have induced widespread abandonment of the conditioning model. In fact, outcomes have not been improved by the alien methodologies, and in many cases have become worse. Also, no viable theory of change has been proposed in place of conditioning. The result is an amorphous eclecticism to which psychoanalysis and primal scream could readily be added. Some first steps are suggested towards restoring conditioning principles to their central role in the behavior therapy field. PMID:2671049
Xavier, Rodrigo Nunes; Kanter, Jonathan William; Meyer, Sonia Beatriz
This paper aimed to highlight the process of therapist direct contingent responding to shape client behavior in two Child Behavior Analytic Therapy (CBAT) cases using transitional probabilities. The Functional Analytic Psychotherapy Rating Scale (FAPRS) was used to code client behaviors and the Multidimensional System for Coding Behaviors in…
Ryan, Tracey Ellen; Blau, Shawn; Grozeva, Dima
This article describes an experimental undergraduate psychology course that ran for two semesters during the 2009 academic year at a private, urban university in the United States. Students learned the techniques and strategies of cognitive behavioral therapy (CBT) and rational emotive behavior therapy (REBT) with a focus on the practical elements…
Walkup, John T.; Albano, Anne Marie; Piacentini, John; Birmaher, Boris; Compton, Scott N.; Sherrill, Joel T.; Ginsburg, Golda S.; Rynn, Moira A.; McCracken, James; Waslick, Bruce; Iyengar, Satish; March, John S.; Kendall, Philip C.
Background Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. Methods In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. Results The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. Conclusions Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.) PMID:18974308
Job Title Contract Psychotherapist Employer/ Agency DBT CENTER of HOUSTON Job Description Provide@gmail.com Application Method Please email resume and cover letter to email above Opening Date ASAP To post a job opportunity or if your response to this job posting results in successful employment, please email the GCSW
Art therapy in conjunction with cognitive behavioral therapy reduces symptoms and enhances the potential for positive outcomes for sexually abused children in trauma-focused treatment. This article presents a treatment model that utilizes specific art therapy interventions to facilitate treatment, based on research on the effectiveness of combined…
The Motivational Enhancement Therapy and Cognitive Behavioral Therapy Supplement: 7 Sessions of Cognitive Behavioral Therapy for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 2.
Webb, Charles; Scudder, Meleney; Kaminer, Yifrah; Kaden, Ron
This manual, a supplement to "Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5 Sessions, Cannabis Youth Treatment (CYT) Series, Volume 1", presents a seven-session cognitive behavioral treatment (CBT7) approach designed especially for adolescent cannabis users. It addresses the implementation and…
Fresco, David M
For the past half century, behavior therapy has served as the theoretical basis for successful inquiries into the nature and treatment of many emotional disorders. Although there are core principles shared by all behavior therapies, two primary approaches, traditional cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT), have emerged as the most viable treatment approaches, even though they achieve their success through different methods and are predicated in different assumptions, principles, questions, and scientific strategies. In this special series, theorists and therapists with allegiances to one of these two approaches articulate the philosophical and theoretical underpinnings of their approach, summarize the evidence to date, point out current gaps or inconsistencies, and map out future directions with predictions informed by theory. The series concludes with a capstone paper that seeks to find common ground within the family of behavior therapies while also positing ways for behavior therapy to remain relevant in a world that increasingly emphasizes neuroscience and biobehavioral approaches to understand and reduce human suffering. PMID:23611067
Fitzgerald, Monica M.; Cohen, Judith A.
Schools are ideal settings for identifying children and adolescents who have been exposed to traumatic events. They are also ideal for providing evidence-based mental health services, such as trauma-focused cognitive behavioral therapy, to students affected by childhood posttraumatic stress disorder and co-occurring mental health and behavioral…
Wood, Jeffrey J.; Piacentini, John C.; Southam-Gerow, Michael; Chu, Brian C.; Sigman, Marian
Objective: This study compared family-focused cognitive behavioral therapy (CBT: the Building Confidence Program) with traditional child-focused CBT with minimal family involvement for children with anxiety disorders. Method: Forty clinically anxious youth (6-13 years old) were randomly assigned to a family- or child-focused cognitive-behavioral…
Mercer, Anne L.; Schubert, George W.
The purpose of this study was to investigate the frequency and type of nonverbal behaviors which occur in the speech pathology clinical practicum situation. It was hypothesized that undergraduate and graduate student clinicians ranked highest by clinical supervisors would differ in the use of nonverbal behaviors during the therapy session from…
Stewart, Carment D.; Quinn, Andrea; Plever, Sally; Emmerson, Brett
Cognitive behavior therapy (CBT), problem-solving therapy (PST), or treatment as usual (TAU) were compared in the management of suicide attempters. Participants completed the Beck Hopelessness Scale, Beck Scale for Suicidal Ideation, Social Problem-Solving Inventory, and Client Satisfaction Questionnaire at pre- and posttreatment. Both CBT and PST…
Coffman, Sandra J.; Martell, Christopher R.; Dimidjian, Sona; Gallop, Robert; Hollon, Steven D.
In a recent placebo-controlled comparison, behavioral activation was superior to cognitive therapy in the treatment of moderate to severely depressed adults. Moreover, a subset of patients exhibited a pattern of extreme nonresponse to cognitive therapy on self-reports of depression not evident on the clinician ratings. These patients were severely…
O'Hearn, Amanda; Pollard, Robert Q., Jr.
Therapies that rely on written materials, information, or procedures involving familiarity with the dominant culture (e.g., colloquialisms, history) often pose barriers to people who use another language, have low English literacy, or are less familiar with the dominant culture. All this applies deaf individuals. One of the most well-validated…
Cooper, Katy; Martyn-St James, Marrissa; Kaltenthaler, Eva; Dickinson, Kath; Cantrell, Anna; Wylie, Kevan; Frodsham, Leila; Hood, Catherine
Introduction Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or pharmacological approaches. Aim To systematically review the randomized controlled trial (RCT) evidence for behavioral therapies in the management of PE. Methods Nine databases including MEDLINE were searched up to August 2014. Included RCTs compared behavioral therapy against waitlist control or another therapy, or behavioral plus drug therapy against drug treatment alone. [Correction added on 10 September 2015, after first online publication: Search period has been amended from August 2013 to August 2014.] Main Outcome Measure Intravaginal ejaculatory latency time (IELT), sexual satisfaction, ejaculatory control, and anxiety and adverse effects. Results Ten RCTs (521 participants) were included. Overall risk of bias was unclear. All studies assessed physical techniques, including squeeze and stop-start, sensate focus, stimulation device, and pelvic floor rehabilitation. Only one RCT included a psychotherapeutic approach (combined with stop-start and drug treatment). Four trials compared behavioral therapies against waitlist control, of which two (involving squeeze, stop-start, and sensate focus) reported IELT differences of 7–9 minutes, whereas two (web-based sensate focus, stimulation device) reported no difference in ejaculatory latency posttreatment. For other outcomes (sexual satisfaction, desire, and self-confidence), some waitlist comparisons significantly favored behavioral therapy, whereas others were not significant. Three trials favored combined behavioral and drug treatment over drug treatment alone, with small but significant differences in IELT (0.5–1 minute) and significantly better results on other outcomes (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy vs. drug treatment gave mixed results, mostly either favoring drug treatment or showing no significant difference. No adverse effects were reported, though safety data were limited. Conclusions There is limited evidence that physical behavioral techniques for PE improve IELT and other outcomes over waitlist and that behavioral therapies combined with drug treatments give better outcomes than drug treatments alone. Further RCTs are required to assess psychotherapeutic approaches to PE. PMID:26468381
Jennings, Jerry L.; Deming, Adam
Although cognitive-behavioral therapy (CBT) is touted as the predominant approach in sex offender-specific group treatment, a review of the field shows that the "behavioral" part of CBT has become minimal in relation to that which is cognitive. The authors show how a revitalized "behavioral sensibility" may help to enhance…
Devlin, Sarah; Healy, Olive; Leader, Geraldine; Hughes, Brian M.
The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables…
Roecklein, Kathryn A.; Schumacher, Julie A.; Miller, Megan A.; Ernecoff, Natalie C.
Objective Although light therapy is effective in the treatment of seasonal affective disorder (SAD) and other mood disorders, only 53–79% of individuals with SAD meet remission criteria after light therapy. Perhaps more importantly, only 12–41% of individuals with SAD continue to use the treatment even after a previous winter of successful treatment. Method Participants completed surveys regarding (1) social, cognitive, and behavioral variables used to evaluate treatment adherence for other health-related issues, expectations and credibility of light therapy, (2) a depression symptoms scale, and (3) self-reported light therapy use. Results Individuals age 18 or older responded (n?=?40), all reporting having been diagnosed with a mood disorder for which light therapy is indicated. Social support and self-efficacy scores were predictive of light therapy use (p's<.05). Conclusion The findings suggest that testing social support and self-efficacy in a diagnosed patient population may identify factors related to the decision to use light therapy. Treatments that impact social support and self-efficacy may improve treatment response to light therapy in SAD. PMID:22720089
Huppert, Jonathan D
Cognitive behavioral therapy (CBT) is a set of treatments that focus on altering thoughts, sensations, emotions and behaviors by addressing identified maintenance mechanisms such as distorted thinking or avoidance. The current article describes the history of CBT and provides a description of many of the basic techniques used in CBT. These include: psychoeducation, self-monitoring, cognitive restructuring, in vivo exposure, imaginal exposure, and homework assignments. PMID:20635770
Brown, Lily A.; Forman, Evan M.; Herbert, James D.; Hoffman, Kimberly L.; Yuen, Erica K.; Goetter, Elizabeth M.
Many university students suffer from test anxiety that is severe enough to impair performance. Given mixed efficacy results of previous cognitive-behavior therapy (CBT) trials and a theoretically driven rationale, an acceptance-based behavior therapy (ABBT) approach was compared to traditional CBT (i.e., Beckian cognitive therapy; CT) for the…
Reports that expand the understanding of the treatment of childhood obsessive-compulsive disorder by using exposure-based cognitive-behavioral therapy in the age group of 5 to 8-year-olds are presented. A model for collecting the common core elements of evidence-based psychosocial treatments for childhood disorders is also presented.
Wilhelm, Sabine; Phillips, Katharine A.; Fama, Jeanne M.; Greenberg, Jennifer L.; Steketee, Gail
This study pilot tested a newly developed modular cognitive-behavioral therapy (CBT) treatment manual for body dysmorphic disorder (BDD). We tested feasibility, acceptability, and treatment outcome in a sample of 12 adults with primary BDD. Treatment was delivered in weekly individual sessions over 18 or 22 weeks. Standardized clinician ratings…
Fine, Kathi M.; Walther, Michael R.; Joseph, Jessica M.; Robinson, Jordan; Ricketts, Emily J.; Bowe, William E.; Woods, Douglas W.
Although several studies have examined the efficacy of Acceptance Enhanced Behavior Therapy (AEBT) for the treatment of trichotillomania (TTM) in adults, data are limited with respect to the treatment of adolescents. Our case series illustrates the use of AEBT for TTM in the treatment of two adolescents. The AEBT protocol (Woods & Twohig, 2008) is…
Mulick, Patrick S.; Landers, Sara J.; Kanter, Jonathan W.
Empirical evidence supports cognitive-behavioral interventions for the treatment Posttraumatic Stress Disorder (PTSD), with exposure therapy typically being the most frequently utilized. While the success of exposure treatments is well established there are factors which may hinder their use in "real-world" settings (e.g., poor treatment…
Bramham, Jessica; Young, Susan; Bickerdike, Alison; Spain, Deborah; McCartan, Denise; Xenitidis, Kiriakos
Objective: A brief cognitive behavioral therapy (CBT) group intervention was designed to treat comorbid anxiety, depression, and low self-esteem and self-efficacy in adults with ADHD. It was hypothesised that participants would gain knowledge about ADHD, experience a reduction in comorbid symptoms, and benefit from the supportive aspect of group…
Franklin, Martin E.; Edson, Aubrey L.; Ledley, Deborah A.; Cahill, Shawn P.
Objective: To examine the efficacy and durability of a behavioral therapy (BT) protocol for pediatric TTM compared with a minimal attention control (MAC) condition. It was hypothesized that the BT condition would be superior to MAC at the end of acute treatment, and would also demonstrate durability of gains through the maintenance treatment…
Reilly-Harrington, Noreen A.; Knauz, Robert O.
This article describes the application of cognitive-behavioral therapy (CBT) to the treatment of rapid cycling bipolar disorder. Between 10% and 24% of bipolar patients experience a rapid cycling course, with 4 or more mood episodes occurring per year. Characterized by nonresponse to standard mood-stabilizing medications, rapid cyclers are…
Bharwani, Govind; Parikh, Pratik J; Lawhorne, Larry W; VanVlymen, Eric; Bharwani, Meena
Person-centered, nonpharmacological interventions for managing Alzheimer's/dementia-related behavioral disturbances have received significant attention. However, such interventions are quite often of a single type limiting their benefits. We develop a comprehensive nonpharmacological intervention, the Behavior-Based Ergonomic Therapy (BBET), which consists of multiple therapies. This low-cost, 24/7 program uses learning, personality, and behavioral profiles and cognitive function of each resident to develop a set of individualized therapies. These therapies are made available through an accessible resource library of music and video items, games and puzzles, and memory props to provide comfort or stimulation depending on an individual resident's assessment. The quantitative and qualitative benefits of the BBET were evaluated at the dementia care unit in a not-for-profit continuing care retirement community in west central Ohio. The 6-month pilot study reduced falls by 32.5% and markedly reduced agitation through increased resident engagement. PMID:22517891
Mennin, Douglas S; Ellard, Kristen K; Fresco, David M; Gross, James J
Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multicomponent approaches, incorporated alternative therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (a) context engagement to promote adaptive imagining and enacting of new experiences; (b) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (c) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components, including behavioral exposure/activation, attention training, acceptance/tolerance, decentering/defusion, and cognitive reframing, may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relationships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science. PMID:23611074
O'Donohue, William; Fryling, Mitch
Applied behavior analysis and behavior therapy are now nearly a half century old. It is interesting to ask if and how these disciplines have changed over time, particularly regarding some of their key internal controversies (e.g., role of cognitions). We examined the first five years and the 2000-2004 five year period of the "Journal of Applied…
This catalog contains some 250 listings of films, videotapes, and slide programs on the subjects of behavioral modification, behavior therapy, programed instruction, and learning and conditioning. Listings are accompanied by brief descriptions taken directly from distributors' catalogs. Names and addresses of distributors are included, but price…
Anxiety disorders occur frequently, and can have a negative impact on the quality of people's lives. They often begin at an early age and can have some serious consequences. This article is an overview of the recent studies concerning group cognitive-behavioral interventions for anxiety disorders. In the last few years, anxiety disorder prevention for children and adolescents has become an important focus of research work. Group prevention programs are based on standard cognitive behavioral therapy (CBT) strategies and are aimed at preventing anxiety disorders as early as possible. Numerous cognitive behavioral group therapies for children as well as adults have been well studied. There are many CBT protocols that have been developed for treating specific anxiety disorders. Now, specialized CBT programs are available for individuals who suffer from different anxiety disorders, enabling them to be treated together in groups. PMID:26487815
Moreira, Fernanda Pedrotti; Cardoso, Taiane de Azevedo; Mondin, Thaíse Campos; Souza, Luciano Dias de Mattos; Silva, Ricardo; Jansen, Karen; Oses, Jean Pierre; Wiener, Carolina David
Major depressive disorder (MDD) is a debilitating disorder and its pathophysiology is associated with deregulation of the immune system. We investigated the changes in circulating levels of proinflammatory cytokines (specifically IL-6 and TNF-?) measured by the ELISA kit in two psychotherapeutic interventions for MDD: Narrative Cognitive Therapy (NCT) and Cognitive Behavioral Therapy (CBT). This is a randomized clinical trial including 97 individuals (18 to 29years-old) with MDD. In CBT there was a significant difference in serum levels of IL-6 and TNF-?, therefore indicating that CBT was more effective than NCT on serum levels proinflammatory cytokines. PMID:26198931
Hoellen, B; Laux, J
Although cognitive-behavior therapy (CBT) is a relatively new psychotherapeutic approach, the theoretical antecedents actually date back two thousand years, to the period of the hellenistic philosophers. The Stoic Epictetus is often acknowledged as the main philosophical father of CBT and especially of rational-emotive therapy (RET). Beck and Ellis frequently noted that they have drawn upon the writings of the ancient philosophers in developing their psychotherapeutic techniques. This paper reviews some implications of hellenistic philosophy for CBT. We like to show that the teachings of the ancient 'healer of souls' are remarkably consistent with the current theoretical framework and techniques of CBT. PMID:3073604
Drass, Jessica Masino
Art therapy has shown benefits for people with borderline personality disorder and borderline personality traits by alleviating interpersonal difficulties such as affect regulation, an unstable sense of self, self-injurious behaviors, and suicidal ideation. Borderline personality disorder is currently viewed as a trauma spectrum disorder, because…
Volery, M; Bonnemain, A; Latino, A; Ourrad, N; Perroud, A
The psychological assessment of the patient with obesity aims to identify the factors of maintenance of excess weight, such as eating disorders or anxio-depressive disorders. Psychotherapy helps a better weight management. Cognitive-behavioral therapy has shown its effectiveness in the treatment of obesity. New psychotherapeutic approaches are explored. The hypnosis and mindfulness are proposed for the management of emotions and stress. A targeted approach on the body image disorder decreases body dissatisfaction. When post-traumatic stress syndrome is involved, EMDR (Eye Movement Desensitization & Reprocessing) is better than other types of therapies. Family therapy is indicated when the entourage is impacted. Psychological difficulties should be the subject of specific care. PMID:26111421
Wolpe, J; Plaud, J J
The foundation, accomplishments, and proliferation of behavior therapy have been fueled largely by the movement's grounding in behavioral principles and theories. Ivan P. Pavlov's discovery of conditioning principles was essential to the founding of behavior therapy in the 1950s and continues to be central to modern behavior therapy. Pavlov's major legacy to behavior therapy was his discovery of "experimental neuroses", shown by his students M.N. Eroféeva and N.R. Shenger-Krestovnikova to be produced and eliminated through the principles of conditioning and counterconditioning. In this article, the Pavlovian origins of behavior therapy are assessed, and the relevance of conditioning principles to modern behavior therapy are analyzed. It is shown that Pavlovian conditioning represents far more than a systematic basic learning paradigm. It is also an essential theoretical foundation for the theory and practice of behavior therapy. PMID:9382243
Gilbert, Fiona J; Tucker, Lorraine; Young, Ken C
Breast screening with full-field digital mammography (FFDM) fails to detect 15-30% of cancers. This figure is higher for women with dense breasts. A new tomographic technique in mammography has been developed - digital breast tomosynthesis (DBT) - which allows images to be viewed in sections through the breast and has the potential to improve cancer detection rates. Results from retrospective reading studies comparing DBT with FFDM have been largely favourable with improvement in sensitivity and specificity. Increases in diagnostic accuracy have been reported as being independent of breast density; however there are mixed reports regarding the detection of microcalcification. Prospective screening studies using DBT with FFDM have demonstrated increased rates in cancer detection compared with FFDM alone. A reduction in false-positive recall rates has also been shown. Screening with the addition of DBT would approximately double radiation dose; however a simulated FFDM image can be generated from a DBT scan. The combination of simulated FFDM images and DBT is being evaluated within several studies and some positive results have been published. Interval cancer rates for the UK National Health Service Breast Screening Programme (NHSBSP) demonstrate the limited sensitivity of FFDM in cancer detection. DBT has the potential to increase sensitivity and decrease false-positive recall rates. It has approval for screening and diagnostics in several countries; however, there are issues with DBT as a screening tool including additional reading time, IT storage and connectivity, over-diagnosis, and cost effectiveness. Feasibility and cost-effectiveness trials are needed before the implementation of DBT in NHSBSP can be considered. PMID:26707815
Apsche, Jack A.; Bass, Christopher K.; Siv, Alexander M.
This study summarized two treatment research studies and included recidivism data for two years post discharge for group therapy. The study compared Mode deactivation Therapy (MDT), Cognitive Behavior Therapy (CBT), and Social Skills training (SST), results of the MDT series of studies and the two year post-study recidivism data. The data from the…
Swales, Michaela A.
Dialectical Behaviour Therapy (DBT) is a cognitive behavioural treatment initially developed for adult women with a diagnosis of borderline personality disorder (BPD) and a history of chronic suicidal behaviour (Linehan, 1993a; 1993b). DBT was the first treatment for BPD to demonstrate its efficacy in a randomised controlled trial (Linehan ,…
Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: combining an evidence based treatment with cultural, traditional, and spiritual beliefs.
Beckstead, D Joel; Lambert, Michael J; DuBose, Anthony P; Linehan, Marsha
This pilot study examined pre to post-change of patients in a substance use residential treatment center that incorporated Dialectical Behavior Therapy with specific cultural, traditional and spiritual practices for American Indian/Alaska Native adolescents. Specifically, the incorporation of cultural, spiritual and traditional practices was done while still maintaining fidelity to the evidence based treatment (DBT). 229 adolescents participated in the study and were given the Youth Outcome Questionnaire-Self-Report version at pre-treatment and post-treatment and the total scores were compared. The results of the research study showed that 96% of adolescents were either "recovered" or "improved" using clinical significant change criteria. Additionally, differences between the group's pre-test scores and post-test scores were statistically significant using a matched standard T-test comparison. Finally, the effect size that was calculated using Cohen's criteria was found to be large. The results are discussed in terms of the implication for integrating western and traditional based methods of care in addressing substance use disorders and other mental health disorders with American Indian/Alaska Native adolescents. PMID:26240942
Effectiveness of cognitive behavioral therapy integrated with systematic desensitization, cognitive behavioral therapy combined with eye movement desensitization and reprocessing therapy, and cognitive behavioral therapy combined with virtual reality exposure therapy methods in the treatment of flight anxiety: a randomized trial
Triscari, Maria Teresa; Faraci, Palmira; Catalisano, Dario; D’Angelo, Valerio; Urso, Viviana
The purpose of the research was to compare the effectiveness of the following treatment methods for fear of flying: cognitive behavioral therapy (CBT) integrated with systematic desensitization, CBT combined with eye movement desensitization and reprocessing therapy, and CBT combined with virtual reality exposure therapy. Overall, our findings have proven the efficacy of all interventions in reducing fear of flying in a pre- to post-treatment comparison. All groups showed a decrease in flight anxiety, suggesting the efficiency of all three treatments in reducing self-report measures of fear of flying. In particular, our results indicated significant improvements for the treated patients using all the treatment programs, as shown not only by test scores but also by participation in the post-treatment flight. Nevertheless, outcome measures maintained a significant effect at a 1-year follow-up. In conclusion, combining CBT with both the application of eye movement desensitization and reprocessing treatment and the virtual stimuli used to expose patients with aerophobia seemed as efficient as traditional cognitive behavioral treatments integrated with systematic desensitization. PMID:26504391
Lerman, Dorothea C; Sansbury, Tesa; Hovanetz, Alyson; Wolever, Erin; Garcia, Amber; O'Brien, Erin; Adedipe, Hellen
It has become increasingly common for parents of children with autism to supplement behavior analytic interventions with therapies that have not yet been subjected to adequate scientific scrutiny. When caregivers elect to use unproven therapies despite advice to the contrary, practitioners should employ the methods of applied behavior analysis to experimentally evaluate the outcomes. Controlled evaluations of unproven therapies can be challenging, however, particularly when ongoing behavioral services are supplemented with biomedical interventions. This paper describes the methods and results of a behavior analytic evaluation of hyperbaric oxygen therapy, an unproven intervention that has been growing in popularity over the past several years. Three young children with autism participated. No benefits of the therapy were evident beyond those obtained through the behavioral intervention alone. Considerations for conducting this type of research are highlighted, along with suggestions for practitioners. PMID:22477688
Jackson, Jeffrey L; O'Malley, Patrick G; Kroenke, Kurt
Somatic symptoms are common in primary care and clinicians often prescribe antidepressants as adjunctive therapy. There are many possible reasons why this may work, including treating comorbid depression or anxiety, inhibition of ascending pain pathways, inhibition of prefrontal cortical areas that are responsible for "attention" to noxious stimuli, and the direct effects of the medications on the syndrome. There are good theoretical reasons why antidepressants with balanced norepinephrine and serotonin effects may be more effective than those that act predominantly on one pathway, though head-to-head comparisons are lacking. For the 11 painful syndromes review in this article, cognitive-behavioral therapy is most consistently demonstrated to be effective, with various antidepressants having more or less randomized controlled data supporting or refuting effectiveness. This article reviews the randomized controlled trial data for the use of antidepressant and cognitive-behavior therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain, headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic pelvic pain. For some syndromes, the data for or against treatment effectiveness is relatively robust, for many, however, the data, one way or the other is scanty. PMID:16575378
Hayes, Steven C.; Levin, Michael E.; Plumb-Vilardaga, Jennifer; Villatte, Jennifer L.; Pistorello, Jacqueline
A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term “contextual behavioral science.” We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy. PMID:23611068
Goldstein, Tina R.; Axelson, David A.; Birmaher, Boris; Brent, David A.
Objective: To describe an adapted version of dialectical behavior therapy for adolescents with bipolar disorder. Method: The dialectical behavior therapy intervention is delivered over 1 year and consists of two modalities: family skills training (conducted with individual family units) and individual therapy. The acute treatment period (6 months)…
Coffey, Scott F; Banducci, Anne N; Vinci, Christine
Cognitive behavior therapy (CBT) is a time-limited, goal-oriented psychotherapy that has been extensively researched and has benefits in a number of psychiatric disorders, including anxiety, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, autism, obsessive-compulsive and tic disorders, personality disorders, eating disorders, and insomnia. CBT uses targeted strategies to help patients adopt more adaptive patterns of thinking and behaving, which leads to positive changes in emotions and decreased functional impairments. Strategies include identifying and challenging problematic thoughts and beliefs, scheduling pleasant activities to increase environmental reinforcement, and extended exposure to unpleasant thoughts, situations, or physiologic sensations to decrease avoidance and arousal associated with anxiety-eliciting stimuli. CBT can be helpful in the treatment of posttraumatic stress disorder by emphasizing safety, trust, control, esteem, and intimacy. Prolonged exposure therapy is a CBT technique that includes a variety of strategies, such as repeated recounting of the trauma and exposure to feared real-world situations. For attention-deficit/hyperactivity disorder, CBT focuses on establishing structures and routines, and clear rules and expectations within the home and classroom. Early intensive behavioral interventions should be initiated in children with autism before three years of age; therapy consists of 12 to 40 hours of intensive treatment per week, for at least one year. In many disorders, CBT can be used alone or in combination with medications. However, CBT requires a significant commitment from patients. Family physicians are well suited to provide collaborative care for patients with psychiatric disorders, in concert with cognitive behavior therapists. PMID:26554473
Cinciripini, Paul M.; And Others
Process and outcome of a smoking cessation program using behavior therapy along (BT) or behavior therapy plus the nicotine patch (BTP) was studied in 64 participants. Abstinence was significantly higher for the BTP group from the end of behavioral treatment (79% vs. 63%) through the three-month follow-up, with the effects weakening at the six- and…
Arch, Joanna J.; Eifert, Georg H.; Davies, Carolyn; Vilardaga, Jennifer C. Plumb; Rose, Raphael D.; Craske, Michelle G.
Objective: Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method: One hundred twenty-eight individuals (52% female, mean age = 38, 33%…
Rohan, Kelly J.; Roecklein, Kathryn A.; Tierney Lindsey, Kathryn; Johnson, Leigh G.; Lippy, Robert D.; Lacy, Timothy J.; Barton, Franca B.
This first controlled psychotherapy trial for seasonal affective disorder (SAD) compared SAD-tailored cognitive-behavioral therapy (CBT), light therapy (LT), and their combination to a concurrent wait-list control. Adults (N = 61) with major depression, recurrent with seasonal pattern, were randomized to one of four 6-week conditions: CBT (1.5-hr…
Sampl, Susan; Kadden, Ronald
This manual is designed to help train substance abuse treatment counselors to conduct a brief five-session treatment intervention for adolescents with cannabis use disorders presenting for outpatient treatment. It combines two sessions of motivational enhancement therapy provided individually and three sessions of cognitive behavioral therapy…
Goldstein, L.H.; Chalder, T.; Chigwedere, C.; Khondoker, M.R.; Moriarty, J.; Toone, B.K.; Mellers, J.D.C.
Objective: To compare cognitive-behavioral therapy (CBT) and standard medical care (SMC) as treatments for psychogenic nonepileptic seizures (PNES). Methods: Our randomized controlled trial (RCT) compared CBT with SMC in an outpatient neuropsychiatric setting. Sixty-six PNES patients were randomized to either CBT (plus SMC) or SMC alone, scheduled to occur over 4 months. PNES diagnosis was established by video-EEG telemetry for most patients. Exclusion criteria included comorbid history of epilepsy, <2 PNES/month, and IQ <70. The primary outcome was seizure frequency at end of treatment and at 6-month follow-up. Secondary outcomes included 3 months of seizure freedom at 6-month follow-up, measures of psychosocial functioning, health service use, and employment. Results: In an intention-to-treat analysis, seizure reduction following CBT was superior at treatment end (group × time interaction p < 0.0001; large to medium effect sizes). At follow-up, the CBT group tended to be more likely to have experienced 3 months of seizure freedom (odds ratio 3.125, p = 0.086). Both groups improved in some health service use measures and on the Work and Social Adjustment Scale. Mood and employment status showed no change. Conclusions: Our findings suggest that cognitive-behavioral therapy is more effective than standard medical care alone in reducing seizure frequency in PNES patients. Classification of evidence: This study provides Class III evidence that CBT in addition to SMC, as compared to SMC alone, significantly reduces seizure frequency in patients with PNES (change in median monthly seizure frequency: baseline to 6 months follow-up, CBT group, 12 to 1.5; SMC alone group, 8 to 5). GLOSSARY AED = antiepileptic drug; CBT = cognitive-behavioral therapy; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; HADS = Hospital Anxiety and Depression Scale; IQR = interquartile range; ITT = intention-to-treat; OR = odds ratio; PNES = psychogenic nonepileptic seizures; RCT = randomized controlled trial; SMC = standard medical care; WASAS = Work and Social Adjustment Scale. PMID:20548043
Bang, Magnus; Timpka, Toomas; Eriksson, Henrik; Holm, Einar; Nordin, Conny
Cognitive behavioral therapy (CBT) for psychological disorders is becoming increasingly popular on the Internet. However, when using this workstation approach, components such as training and learning relaxation skills, problem solving, exposure exercises, and sleep management guidance must be done in the domestic environment. This paper describes design concepts for providing spatially explicit CBT with mobile phones. We reviewed and analyzed a set of treatment manuals to distinguish elements of CBT that can be improved and supported using mobile phone applications. The key advantage of mobile computing support in CBT is that multimedia can be applied to record, scale, and label anxiety-provoking situations where the need arises, which helps the CBT clients formulate and convey their thoughts and feelings to relatives and friends, as well as to therapists at subsequent treatment sessions. PMID:17911881
Dalle Grave, Riccardo; El Ghoch, Marwan; Sartirana, Massimiliano; Calugi, Simona
Cognitive behavioral therapy (CBT) for anorexia nervosa (AN), based on Beck's cognitive theory, was developed in a "generic" form in the early eighties. In recent years, however, improved knowledge of the mechanisms involved in maintaining eating disorder psychopathology has led to the development of a "specific" form of CBT, termed CBT-E (E?=?enhanced), designed to treat all forms of eating disorders, including AN, from outpatient to inpatient settings. Although more studies are required to assess the relative effectiveness of CBT-E with respect to other available treatments, the data indicate that in outpatient settings it is both viable and promising for adults and adolescents with AN. Encouraging results are also emerging from inpatient CBT-E, particularly in adolescents, and clinical services offering CBT-E at different levels of care are now offered in several countries around the world. However, CBT-E requires dissemination in order to become widely available to patients. PMID:26689208
Purpose: The purpose of this article is to present an exploration of some of the issues surrounding adherence to vocal behavioral change in voice therapy within the context of Motivational Interviewing (MI) and to explore MI's potential for integration into voice therapy (MI-adapted voice therapy). MI is a style of interpersonal communication in…
Homework, or self-help, is an essential and required part of cognitive behavioral treatment. It offers several opportunities for the therapist to extend and increase therapy contact by having the patient "live" the therapy outside of the consulting room. It can also serve as a measure of the patient's motivation for therapy or for change. Homework…
Watson, Jeanne C.; Bedard, Danielle L.
The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 *…
Friedlander, Myrna L.; Bernardi, Shaina; Lee, Hsin-Hua
To be responsive to clients' evaluations of the unfolding therapy process, therapists must first accurately "read" client behavior, a particularly challenging task in conjoint family therapy. In this study, the authors compared client behavior in 28 sessions that one family member and the therapist concurred, on the Session Evaluation…
Sallinen, Bethany J.; Nangle, Douglas W.; O'Grady, April C.
The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and…
Hogue, Aaron; Henderson, Craig E.; Dauber, Sarah; Barajas, Priscilla C.; Fried, Adam; Liddle, Howard A.
This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake,…
Felmingham, Kim L.; Bryant, Richard A.
Objective: To examine potential differential responses in men and women to cognitive behavior therapy for posttraumatic stress disorder (PTSD). Method: Fifty-two men and 56 women diagnosed with PTSD participated in randomized controlled trials of cognitive behavior therapy for PTSD. Participants were randomly allocated to either (a) exposure-only…
Hoppes, Steve; Hellman, Chan M
Community-based practice has always been a central domain of occupational therapy, and evidence supporting its increasing importance is growing. Preparing occupational therapy students for community practice has received considerable attention in professional literature, but students' voices have seldom been heard concerning this issue. This study sought to investigate attitudes, intentions, and behaviors regarding community service among occupational therapy students enrolled in one professional program using the Community Service Attitudes Survey. We present the Theory of Planned Behavior as a conceptual framework linking students' attitudes and intentions with behaviors. Results indicate that these occupational therapy students' attitudes and intentions regarding community service tended to be more strongly positive than those of their counterparts in other allied health disciplines; however, the community service behaviors of occupational therapy students were not significantly different from those of other allied health students, possibly because occupational therapy students perceived high costs to community service. PMID:17944290
Sung, Huei-Chuan; Chang, Anne M; Abbey, Jennifer
Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia. PMID:17004208
Allen, Laura B.; White, Kamila S.; Barlow, David H.; Shear, M. Katherine; Gorman, Jack M.; Woods, Scott W.
Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depressiondepression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (
Van Lankveld, Jacques J. D. M.; ter Kuile, Moniek M.; de Groot, H. Ellen; Melles, Reinhilde; Nefs, Janneke; Zandbergen, Maartje
Women with lifelong vaginismus (N = 117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9…
Apsche, Jack A.; Bass, Christopher K.; Siv, Alexander M.
This treatment research study extended the results of Apsche, Bass, Jennings, Murphy, Hunter, and Siv (2005), from behavioral data to standard measures of psychological distress. In Apsche, et. al. (2005) results suggest that Mode Deactivation Therapy (MDT) was more effective than Cognitive Behavior Therapy (CBT) and Social Skills Therapy (SST) in…
Button, Katherine S; Munafò, Marcus R
A recent network meta-analysis by Zhu and colleagues reported in the Shanghai Archives of Psychiatry compared two different comparators (psychological placebo and waitlist control) in trials assessing the effectiveness of cognitive behavioral therapy (CBT) for the treatment of generalized anxiety disorder (GAD). CBT was superior to both of these control conditions, but psychological placebo was superior to waitlist. However, we argue that the term 'psychological placebo' is a misnomer because the impossibility of effectively blinding participants to treatment allocation in CBT trials makes it impossible to control for placebo effects. This failure to blind participants and therapists - and the resultant high risk of bias - was the main reason Zhu and colleagues found that the overall quality of the evidence supporting the conclusion that CBT is effective for GAD is poor. This is a general problem in all psychotherapy trials, which suffer from well-documented methodological and conceptual problems that prevent adequate placebo control and undermine casual inference. We discuss these problems and suggest potential solutions. We conclude that, while it may be difficult to remove potential bias in randomized controlled trials of psychotherapy, we can improve on the status quo by integrating basic science within applied trials to adjust for these biases and, thus, improve the strength of the causal inferences. PMID:26300596
BUTTON, Katherine S.; MUNAFÒ, Marcus R.
Summary A recent network meta-analysis by Zhu and colleagues reported in the Shanghai Archives of Psychiatry compared two different comparators (psychological placebo and waitlist control) in trials assessing the effectiveness of cognitive behavioral therapy (CBT) for the treatment of generalized anxiety disorder (GAD). CBT was superior to both of these control conditions, but psychological placebo was superior to waitlist. However, we argue that the term ‘psychological placebo’ is a misnomer because the impossibility of effectively blinding participants to treatment allocation in CBT trials makes it impossible to control for placebo effects. This failure to blind participants and therapists – and the resultant high risk of bias – was the main reason Zhu and colleagues found that the overall quality of the evidence supporting the conclusion that CBT is effective for GAD is poor. This is a general problem in all psychotherapy trials, which suffer from well-documented methodological and conceptual problems that prevent adequate placebo control and undermine casual inference. We discuss these problems and suggest potential solutions. We conclude that, while it may be difficult to remove potential bias in randomized controlled trials of psychotherapy, we can improve on the status quo by integrating basic science within applied trials to adjust for these biases and, thus, improve the strength of the causal inferences. PMID:26300596
Smailes, David; Alderson-Day, Ben; Fernyhough, Charles; McCarthy-Jones, Simon; Dodgson, Guy
Cognitive behavioral therapy (CBT) for voice-hearing (i.e., auditory verbal hallucinations; AVH) has, at best, small to moderate effects. One possible reason for this limited efficacy is that current CBT approaches tend to conceptualize voice-hearing as a homogenous experience in terms of the cognitive processes involved in AVH. However, the highly heterogeneous nature of voice-hearing suggests that many different cognitive processes may be involved in the etiology of AVH. These heterogeneous voice-hearing experiences do, however, appear to cluster into a set of subtypes, opening up the possibility of tailoring treatment to the subtype of AVH that a voice-hearer reports. In this paper, we (a) outline our rationale for tailoring CBT to subtypes of voice-hearing, (b) describe CBT for three putative subtypes of AVH (inner speech-based AVH, memory-based AVH, and hypervigilance AVH), and (c) discuss potential limitations and problems with such an approach. We conclude by arguing that tailoring CBT to subtypes of voice-hearing could prove to be a valuable therapeutic development, which may be especially effective when used in early intervention in psychosis services.
Smailes, David; Alderson-Day, Ben; Fernyhough, Charles; McCarthy-Jones, Simon; Dodgson, Guy
Cognitive behavioral therapy (CBT) for voice-hearing (i.e., auditory verbal hallucinations; AVH) has, at best, small to moderate effects. One possible reason for this limited efficacy is that current CBT approaches tend to conceptualize voice-hearing as a homogenous experience in terms of the cognitive processes involved in AVH. However, the highly heterogeneous nature of voice-hearing suggests that many different cognitive processes may be involved in the etiology of AVH. These heterogeneous voice-hearing experiences do, however, appear to cluster into a set of subtypes, opening up the possibility of tailoring treatment to the subtype of AVH that a voice-hearer reports. In this paper, we (a) outline our rationale for tailoring CBT to subtypes of voice-hearing, (b) describe CBT for three putative subtypes of AVH (inner speech-based AVH, memory-based AVH, and hypervigilance AVH), and (c) discuss potential limitations and problems with such an approach. We conclude by arguing that tailoring CBT to subtypes of voice-hearing could prove to be a valuable therapeutic development, which may be especially effective when used in early intervention in psychosis services. PMID:26733919
Deckersbach, Thilo; Chou, Tina; Britton, Jennifer C.; Carlson, Lindsay E.; Reese, Hannah E.; Siev, Jedidiah; Scahill, Lawrence; Piacentini, John C.; Woods, Douglas W.; Walkup, John T.; Peterson, Alan L.; Dougherty, Darin D.; Wilhelm, Sabine
Tourette’s disorder, also called Tourette syndrome (TS), is characterized by motor and vocal tics that can cause significant impairment in daily functioning. Tics are believed to be due to failed inhibition of both associative and motor cortico-striato-thalamo-cortical pathways. Comprehensive Behavioral Intervention for Tics (CBIT), which is an extension of Habit Reversal Therapy (HRT), teaches patients to become more aware of sensations that reliably precede tics (premonitory urges) and to initiate competing movements that inhibit the occurrence of tics. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural changes associated with CBIT treatment in subjects with TS. Eight subjects with TS were matched with eight healthy controls in gender, education, age, and handedness. Subjects completed the Visuospatial Priming (VSP) task, a measure of response inhibition, during fMRI scanning before and after CBIT treatment (or waiting period for controls). For TS subjects, we found a significant decrease in striatal (putamen) activation from pre- to post-treatment. Change in VSP task-related activation from pre- to post-treatment in Brodmann’s area 47 (the inferior frontal gyrus) was negatively correlated with changes in tic severity. CBIT may promote normalization of aberrant cortico-striato-thalamo-cortical associative and motor pathways in individuals with TS. PMID:25444535
Wilfley, Denise E.; Kolko, Rachel P.; Kass, Andrea E.
Synopsis Eating disorders and obesity in children and adolescents involve harmful behavior and attitude patterns that infiltrate daily functioning. Cognitive behavioral therapy (CBT) is well-suited to treat these conditions, given the emphasis on breaking negative behavior cycles. This article reviews the current empirically-supported treatments and the considerations for youth with weight control issues. New therapeutic modalities (i.e., Enhanced CBT and the socio-ecological model) are discussed. Rationale is provided for extending therapy beyond the individual treatment milieu to include the family, peer network, and community domains to promote behavior change, minimize relapse, and support healthy long-term behavior maintenance. PMID:21440855
Gross, James J.
Cognitive Reappraisal Self-Efficacy Mediates the Effects of Individual Cognitive-Behavioral Therapy-SE) mediate the effects of individually administered cognitive-behavioral therapy (I-CBT) for social anxiety anxiety. Keywords: social anxiety, cognitive-behavioral therapy, emotion regulation, cognitive reappraisal
Wadden, Thomas A; Stunkard, Albert J.
Assessed the effectiveness of a combined program of very low calorie diet and behavior therapy in treating obesity. Combined treatment and behavior therapy alone subjects maintained weight losses; none of the diet alone subjects met the criterion used to define maintenance. Only those receiving behavior therapy alone and combined treatment showed…
Schaal, David W.
This article presents an introduction to "The Behavior-Analytic Origins of Constraint-Induced Movement Therapy: An Example of Behavioral Neurorehabilitation," by Edward Taub and his colleagues (Taub, 2012). Based on extensive experimentation with animal models of peripheral nerve injury, Taub and colleagues have created an approach to overcoming…
This study attempted to compare the behavioral effects of active, rhythm-based group music therapy vs. those of passive, listening-based group music therapy on preadolescents with emotional, learning, and behavioral disorders. It was hypothesized that preadolescents who participated in active music therapy would more significantly improve target behaviors than those involved in passive music therapy. Achenbach's Teacher Report Form (TRF) was used to confirm changes among subjects in attention, motivation, and hostility as rated by homeroom teachers. Twelve music therapy sessions were conducted over a 4-month period with three different groups of subjects (n = 16), with two groups participating in active music therapy and the other receiving passive music therapy. Results indicate that subjects improved significantly after receiving both music therapy interventions. The most significant change in subjects was found on the aggression/hostility scale. These results suggest that group music therapy can facilitate the process of serf-expression in emotionally disturbed/learning disabled adolescents and provide a channel for transforming frustration, anger, and aggression into the experience of creativity and self-mastery. Discussion of results also includes recommendations for chousing one music therapy approach over another based on personality types and/or clinical diagnoses of subjects. PMID:10519828
Patton, Susana R.; Dolan, Lawrence M.; Smith, Laura B.; Brown, Morton B.; Powers, Scott W.
This study examined mealtime behaviors in families of young children with type 1 diabetes (T1DM) on intensive insulin therapy. Behaviors were compared to published data for children on conventional therapy and examined for correlations with glycemic control. Thirty-nine families participated and had at least three home meals videotaped while children wore a continuous glucose monitor. Videotaped meals were coded for parent, child, and child eating behaviors using valid coding system. A group difference was found for child request for food only. There were also associations found between children's glycemic control and child play and away. However, no associations were found between parent and child behaviors within meals and children's corresponding post-prandial glycemic control. Results reinforce existing research indicating that mealtime behavior problems exist for families of young children even in the context of intensive therapy and that some child behaviors may relate to glycemic control. PMID:24183137
ABSTRACT The purpose of this study was to examine the effectiveness of individualized music therapy protocols in decreasing the duration of instances of elevated levels of maladaptive emotionally regulative behaviors in adults with developmental...
Women with breast cancer who were suffering from treatment-related menopausal symptoms experienced symptom relief with cognitive behavioral therapy, physical exercise, or both, according to a Dutch study.
Okajima, Isa; Nakajima, Shun; Ochi, Moeko; Inoue, Yuichi
The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals’ scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia. PMID:25025164
Chiu, Angela W.; McLeod, Bryce D.; Har, Kim; Wood, Jeffrey J.
Background: Few studies have examined the link between child-therapist alliance and outcome in manual-guided cognitive behavioral therapy (CBT) for children diagnosed with anxiety disorders. This study sought to clarify the nature and strength of this relation. Methods: The Therapy Process Observational Coding System for Child…
Szigethy, Eva; Kenney, Elyse; Carpenter, Johanna; Hardy, Diana M.; Fairclough, Diane; Bousvaros, Athos; Keljo, David; Weisz, John; Beardslee, William R.; Noll, Robert; DeMaso, David Ray
Objective: To examine the feasibility and efficacy of a manual-based cognitive-behavioral therapy (CBT) in reducing depressive symptomatology in adolescents with inflammatory bowel disease (IBD). Primary and Secondary Control Enhancement Therapy-Physical Illness(PASCET-PI) modified for youths with IBD was compared to treatment as usual (TAU), plus…
Newman, Michelle G.; Fisher, Aaron J.
Objective: This study examined (a) duration of generalized anxiety disorder (GAD) as a moderator of cognitive behavioral therapy (CBT) versus its components (cognitive therapy and self-control desensitization) and (b) increases in dynamic flexibility of anxious symptoms during the course of psychotherapy as a mediator of this moderation. Degree of…
Gosselin, Patrick; Ladouceur, Robert; Morin, Charles M.; Dugas, Michel J.; Baillargeon, Lucie
This study evaluated the specific effectiveness of cognitive-behavior therapy (CBT) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder (GAD) patients by using a nonspecific therapy control group. Sixty-one patients who had used benzodiazepines for more than 12 months were randomly assigned to…
Baer, Susan; Garland, E. Jane
Objective: A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric…
Hjalmarsson, Erik; Kaver, Anna; Perseius, Kent-Inge; Cederberg, Kerstin; Ghaderi, Ata
The aim of this paper was to investigate the feasibility and impact of dialectical behaviour therapy (DBT) for patients with borderline personality disorder (BPD) in a clinical outpatient setting. Eighteen clinicians were trained and supervised in using DBT. Twenty-seven female patients were assessed on a number of variables before the treatment,…
Sakdalan, J. A.; Shaw, J.; Collier, V.
Background: Dialectic behaviour therapy (DBT) has been widely used with individuals diagnosed with borderline personality disorder who exhibit severe emotional and behavioural dysregulation. There is a paucity of research in assessing the effectiveness of DBT with forensic clients with intellectual disability (ID). Methods: This pilot study aims…
Yu, Jun-Sang; Kim, Chun-Bae; Kim, Ki-Kyong; Lee, Ji-Eun; Kim, Min-Young
Objectives: In Korea, cancer is one of the most important causes of death. Cancer patients have sought alternative methods, like complementary and alternative medicine (CAM) together with Western medicine, to treat cancer. Also, there are many kinds of providers of CAM therapy, including providers of Korean oriental medicine therapy. The purpose of this study is to identify the behaviors of Korean oriental medicine therapy and CAM therapy providers who treat cancer patients and to provide background knowledge for establishing a new policy with the management and quality control of CAM. Methods: Structured and well organized questionnaires were made, and 350 persons were surveyed concerning the providers of CAM or Korean oriental medicine. The questionnaires were collected and analyzed. Results: The questionnaires (182) were collected. The questionnaires identified a total of 73 known providers, such as medicinal professionals or other providers of CAM suppliers, 35.6% of whom had had experience with treating cancer patients (52.6% vs. 29.6%). The treatment methods were a little different: alternative therapy and nutritional therapy being preferred by medicinal professionals and mind body modulation therapy and alternative therapy being preferred by other CAM providers. Four patients (7.4%) experienced side effects, and 6 patients (12.5%) experienced legal problems. As the method for managing the therapy, CAM providers, medicinal professionals, and other CAM providers had different viewpoints. For example, some CAM providers stated that both legislation and an official education on CAM or a national examination were needed as a first step to establish the provider’s qualifications and that as a second step, a license test was needed for quality control. To the contrary, medicinal professionals stated that a license test was needed before legislation. Conclusion: Adequate management and quality control of CAM providers is thought to involve both education and legislation. PMID:25830056
Schulz-Wendtland, R.; Dilbat, G.; Bani, M.; Fasching, P. A.; Lux, M. P.; Wenkel, E.; Schwab, S.; Loehberg, C. R.; Jud, S. M.; Rauh, C.; Bayer, C. M.; Beckmann, M. W.; Uder, M.; Meier-Meitinger, M.
Aim: The aim of this prospective clinical study was to assess whether it would be possible to reduce the rate of re-excisions and improve the quality using CMOS technology or digital breast tomosynthesis (DBT) compared to a conventional FFDM system. Material and Methods: An invasive breast cancer (BI-RADS 5) was diagnosed in 200 patients in the period from 5/2011 to 1/2012. After histological verification, a breast-conserving therapy was performed with intraoperative imaging. Three different imaging systems were used: 1) Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1?mm, resolution 85?µm pixel pitch, 8?l/mm as the standard; 2) BioVision™ (Bioptics, Tucson, USA), flat panel photodiode array, tungsten source, focus 0.05, resolution 50?µm pixel pitch, 12?l/mm; 3) Tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1?mm, resolution 85?µm pixel pitch, 8?l/mm, range: 50°, 25 projections, scan time >?20?s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiograms were prospectively shown to 3 radiologists. Results: Out of a total of 200 patients with histologically confirmed breast cancer (BI-RADS 6) 156 patients required no further operative therapy (re-excision) after breast-conserving therapy. A retrospective analysis (n?=?44) showed an increase in sensitivity with tomosynthesis compared to the BioVision™ (CMOS technology) and the Inspiration™ at a magnification of 1.0?:?1.0 of 8?% (p?0.05), i.e. re-excision would not have been necessary in 16 patients with tomosynthesis. Conclusions: The sensitivity of tomosynthesis for intraoperative radiography is significantly (p?0.05) higher compared to both CMOS technology and an FFDM system with a conventional detector. Additional studies using higher magnification, e.g. 2.0?:?1.0, but no zooming will be necessary to evaluate the method further.
Jungbluth, Nathaniel J.; Shirk, Stephen R.
This study examined predictive relations between 9 therapist behaviors and client involvement in manual-guided, cognitive-behavioral therapy for adolescent depression. Analyses included 42 adolescents who met criteria for a depressive disorder (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and who were…
Stanley, Barbara; Brown, Gregory; Brent, David A.; Wells, Karen; Poling, Kim; Curry, John; Kennard, Betsy D.; Wagner, Ann; Cwik, Mary F.; Klomek, Anat Brunstein; Goldstein, Tina; Vitiello, Benedetto; Barnett, Shannon; Daniel, Stephanie; Hughes, Jennifer
Objective: To describe the elements of a manual-based cognitive-behavioral therapy for suicide prevention (CBT-SP) and to report its feasibility in preventing the recurrence of suicidal behavior in adolescents who have recently attempted suicide. Method: The CBT-SP was developed using a risk reduction and relapse prevention approach and…
Martin-Pichora, Andrea L.; Antony, Martin M.
Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social…
Dicker, Stacy L.; Craighead, Linda Wilcoxon
The first-line treatment for bulimia nervosa (BN), cognitive-behavioral therapy (CBT), uses food-based self-monitoring. Six young women presenting with BN or significant purging behavior were treated with a modification, Appetite-Focused CBT (CBT-AF), in which self-monitoring is based on appetite cues and food monitoring is proscribed. This change…
Tremblay, Valerie; Savard, Josee; Ivers, Hans
Prior studies have supported the efficacy of cognitive behavioral therapy (CBT) for insomnia comorbid with cancer. This article reports secondary analyses that were performed on one of these studies to investigate the predictive role of changes in dysfunctional beliefs about sleep, adherence to behavioral strategies, and some nonspecific factors…
McEvoy, Christopher; And Others
The report documents the theoretical basis and application of massage therapy, with six students who exhibited self-injurious behaviors (SIB), in two studies. The first study investigated the relationship between physical and/or emotional stress and self-abusive behavior in five severely mentally impaired students. Subjects received two to three…
Escalona, Angelica; Field, Tiffany; Singer-Strunck, Ruth; Cullen, Christy; Hartshorn, Kristen
Twenty children with autism, ages 3 to 6 years, received either massage therapy or reading attention by their parents for 15 minutes daily for one month. Evaluation suggested that children in the massage group exhibited less stereotypic behavior and showed more on-task and social relatedness behavior during play observations at school, and they…
Delinsky, Sherrie S.; Wilson, G. Terence
Cognitive behavior therapy (CBT) is an effective treatment for bulimia nervosa (BN). However, among patients with BN, symptom improvement is more pronounced for behavioral eating symptoms (i.e., bingeing and purging) than for body image disturbance, and the persistence of body image disturbance is associated with relapse. The need for more…
Binford, Roslyn B.; Mussell, Melissa Pederson; Crosby, Ross D.; Peterson, Carol B.; Crow, Scott J.; Mitchell, James E.
This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1-and 6-month follow-up. Frequency of…
Cooper, Zafra; Fairburn, Christopher G.
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has…
Kanter, Jonathan W.; Baruch, David E.; Gaynor, Scott T.
The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the "common cold" of outpatient populations. Two treatments for depression have emerged:…
Britton, Peter C.; Patrick, Heather; Wenzel, Amy; Williams, Geoffrey C.
Cognitive behavioral therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a…
Park, Yeonok; Park, Chulkyu; Cho, Hyosung; Je, Uikyu; Hong, Daeki; Lee, Minsik; Cho, Heemoon; Choi, Sungil; Koo, Yangseo
Digital breast tomosynthesis (DBT) is considered in clinics as a standard three-dimensional imaging modality, allowing the earlier detection of cancer. It typically acquires only 10-30 projections over a limited angle range of 15-60° with a stationary detector and typically uses a computationally-efficient filtered-backprojection (FBP) algorithm for image reconstruction. However, a common FBP algorithm yields poor image quality resulting from the loss of average image value and the presence of severe image artifacts due to the elimination of the dc component of the image by the ramp filter and to the incomplete data, respectively. As an alternative, iterative reconstruction methods are often used in DBT to overcome these difficulties, even though they are still computationally expensive. In this study, as a compromise, we considered a projection-angle-dependent filtering method in which one-dimensional geometry-adapted filter kernels are computed with the aid of a conjugate-gradient method and are incorporated into the standard FBP framework. We implemented the proposed algorithm and performed systematic simulation works to investigate the imaging characteristics. Our results indicate that the proposed method is superior to a conventional FBP method for DBT imaging and has a comparable computational cost, while preserving good image homogeneity and edge sharpening with no serious image artifacts.
A typical goal of voice therapy is a behavioral change in the patient's everyday speech. The SLP's plan for voice therapy should therefore optimally include strategies for automatization. The aim of the present study was to identify and describe factors that promote behavioral learning and habit change in voice behavior and have the potential to affect patient compliance and thus therapy outcome. Research literature from the areas of motor and behavioral learning, habit formation, and habit change was consulted. Also, specific elements from personal experience of clinical voice therapy are described and discussed from a learning theory perspective. Nine factors that seem to be relevant to facilitate behavioral learning and habit change in voice therapy are presented, together with related practical strategies and theoretical underpinnings. These are: 1) Cue-altering; 2) Attention exercises; 3) Repetition; 4) Cognitive activation; 5) Negative practice; 6) Inhibition through interruption; 7) Decomposing complex behavior; 8) The 'each time-every time' principle; and 9) Successive implementation of automaticity. PMID:25054888
DBT and EMDR as primary treatment methods provide effective treatment for adolescents in the setting of group residential facilities. Regardless of the intensity of the pathology or the length of stay, these compatible treatment methods provide adolescents with significant decreases in the impact of traumatic memories and increased emotional…
Waller, Glenn; Stringer, Hannah; Meyer, Caroline
Objective: Clinicians commonly "drift" away from using proven therapeutic techniques. This study examined the degree to which such drift occurs among cognitive behavioral therapy (CBT) clinicians working with a specific clinical population--adults with eating disorders. Method: The study used a correlational design. The participants were 80…
Storch, Eric A.; McKay, Dean; Reid, Jeannette M.; Geller, Daniel A.; Goodman, Wayne K.; Lewin, Adam B.; Murphy, Tanya K.
This paper discusses a recent translational success in combining behavioral psychotherapy with a novel medication, d-cycloserine (DCS), to augment cognitive-behavioral therapy (CBT) for anxiety disorders. The literature on behavioral theory of exposure-based therapies is provided, followed by a discussion of the role of DCS in enhancing extinction…
Field, Tiffany; And Others
Preschool children received twice-weekly massages for five weeks. Compared to control children, the massaged children had better behavior ratings on mood state, vocalization, activity, and cooperation following massage on day one and throughout the study. Teachers rated their behavior more optimally, and their parents rated them as having less…
Roepke, Stefan; Schröder-Abé, Michela; Schütz, Astrid; Jacob, Gitta; Dams, Andreas; Vater, Aline; Rüter, Anke; Merkl, Angela; Heuser, Isabella; Lammers, Claas-Hinrich
Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self-esteem and low self-concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self-esteem and self-concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self-esteem, self-concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self-concept clarity compared with those on the waiting list. Further, the scales of global self-esteem and, more specifically, the facets of self-esteem self-regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self-esteem in this group. On the other hand, the scale of earning self-esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self-esteem and self-concept clarity, and thus on identity disturbance, in women with BPD. PMID:20187169
Suzuki, Mizue; Kanamori, Masao; Watanabe, Motoko; Nagasawa, Shingo; Kojima, Emi; Ooshiro, Hajime; Nakahara, Daiichirou
The present study investigated the effectiveness of music therapy for dementia patients using endocrinological and behavioral evaluations. The study comprised 10 patients with senile dementia who received music therapy; six had Alzheimer's dementia and four had vascular dementia. Music therapy was performed twice a week for 8 consecutive weeks (16 sessions). As a result, total scores on the Mini-Mental State Examination (MMSE) did not significantly change, but the scores of a subscale, "language", improved significantly. According to the Multidimensional Observation Scale For Elderly Subjects (MOSES), scores for "irritability" decreased significantly. Regarding changes in salivary chromogranin A (CgA) levels, the average was significantly decreased before session 16 compared to after this. These results suggest that the combination of endocrinological measurements, behavioral evaluations and functional assessment methods are useful in evaluating the effects of music therapy in persons with senile dementia. PMID:14764189
Coelho, Luzia Flavia; Barbosa, Deise Lima Fernandes; Rizzutti, Sueli; Muszkat, Mauro; Bueno, Orlando Francisco Amodeo; Miranda, Monica Carolina
Medication has proved highly efficacious as a means of alleviating general symptoms of attention-deficit hyperactivity disorder (ADHD). However, many patients remain functionally impaired by inappropriate behavior. The present study analyzed the use of cognitive behavioral therapy (CBT) with the Token-Economy (TE) technique to alleviate problem behavior for 25 participants with ADHD, all children (19 boys, mean age 10.11) on long-term methylphenidate medication, who were given 20 CBT sessions with 10?weeks of TE introduced as of session 5. Their ten most acute problem behaviors were selected and written records kept. On weekdays, parents recorded each inappropriate behavior and provided a suitable model for their actions. At weekly sessions, problem behaviors were counted and incident-free participants rewarded with a token. To analyze improvement (less frequent problem behavior), a list of 11 behavioral categories was rated: inattention, impulsivity, hyperactivity, disorganization, disobeying rules and routines, poor self-care, verbal/physical aggression, low frustration tolerance, compulsive behavior, antisocial behavior, lacking in initiative and distraction. Two CBT specialists categorized behaviors and an ADHD specialist ruled on discrepancies. Statistical analyses used were Generalized Estimating Equations with Poisson distribution and autoregressive order correlation structure. In the course of the sessions, problematic behaviors decreased significantly in seven categories: impulsiveness, hyperactivity, disorganization, disobeying rules and routine, poor self-care, low frustration tolerance, compulsive behaviors, and antisocial behaviors. Caregiver attitudes to children’s inappropriate behavior were discussed and reshaped. As functional improvement was observed on applying TE for 10?weeks, this type of intervention may be useful as an auxiliary strategy combined with medication. PMID:26635642
Coelho, Luzia Flavia; Barbosa, Deise Lima Fernandes; Rizzutti, Sueli; Muszkat, Mauro; Bueno, Orlando Francisco Amodeo; Miranda, Monica Carolina
Medication has proved highly efficacious as a means of alleviating general symptoms of attention-deficit hyperactivity disorder (ADHD). However, many patients remain functionally impaired by inappropriate behavior. The present study analyzed the use of cognitive behavioral therapy (CBT) with the Token-Economy (TE) technique to alleviate problem behavior for 25 participants with ADHD, all children (19 boys, mean age 10.11) on long-term methylphenidate medication, who were given 20 CBT sessions with 10?weeks of TE introduced as of session 5. Their ten most acute problem behaviors were selected and written records kept. On weekdays, parents recorded each inappropriate behavior and provided a suitable model for their actions. At weekly sessions, problem behaviors were counted and incident-free participants rewarded with a token. To analyze improvement (less frequent problem behavior), a list of 11 behavioral categories was rated: inattention, impulsivity, hyperactivity, disorganization, disobeying rules and routines, poor self-care, verbal/physical aggression, low frustration tolerance, compulsive behavior, antisocial behavior, lacking in initiative and distraction. Two CBT specialists categorized behaviors and an ADHD specialist ruled on discrepancies. Statistical analyses used were Generalized Estimating Equations with Poisson distribution and autoregressive order correlation structure. In the course of the sessions, problematic behaviors decreased significantly in seven categories: impulsiveness, hyperactivity, disorganization, disobeying rules and routine, poor self-care, low frustration tolerance, compulsive behaviors, and antisocial behaviors. Caregiver attitudes to children's inappropriate behavior were discussed and reshaped. As functional improvement was observed on applying TE for 10?weeks, this type of intervention may be useful as an auxiliary strategy combined with medication. PMID:26635642
Khilnani, Sonya; Field, Tiffany; Hernandez-Reif, Maria; Schanberg, Saul
In the present study, 30 students between the ages of 7 and 18 years (M = 13 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) were randomly assigned to a massage group or a wait-list control group. The massage group received massage therapy for 20 minutes twice per week over the course of one month. The results revealed that massage therapy benefited students with ADHD by improving short-term mood state and longer-term classroom behavior. PMID:15053490
Eells, Tracy D; Barrett, Marna S; Wright, Jesse H; Thase, Michael
This article reviews the use of computer technology in treating depression as a substitute or adjunct for standard therapy. It discusses advantages and disadvantages of introducing computer technology as a treatment option, problems and barriers to expanded use, the varieties of computer-assisted psychotherapy for major depression, and relevant research. Three specific Internet-based programs are described, assessed and compared: Good Days Ahead, Beating the Blues, and MoodGYM. The authors conclude that these and similar programs are promising. Preliminary outcome studies suggest that these programs produce outcome similar to standard therapy, although methodological shortcomings limit confidence in these findings. Suggestions are offered for practitioners considering the addition of computer assistance to their treatment of depression. PMID:24059735
Frick, G; Frick, U; Feyerherd, F
In a little prospective study it could be shown that a series of 10-51 low dose heparin injections may be followed by slight or unspecific thrombocyte diminutions without specific heparin antibodies being available. Depending on stress and trauma potential complement activations caused by heparin histon complexes may result in insignificant thrombocyte diminutions by liberating those factors activating platelets from granulocytes. These are not bound to interrupt heparin therapy or heparin prophylaxis. PMID:2448206
Izadi- Mazidi, Maryam; Riahi, Frough; Khajeddin, Niloufar
Background: Due to the various problems of children with autism, their families and especially their mothers become exposed to stress. Objectives: This study aimed to evaluate the effect of cognitive behavior group therapy on parenting stress of mothers of children with autism. Materials and Methods: The sample of this research consisted of sixteen mothers of children with autism. The measurement tools were the Abidin Parenting Stress questionnaire and a demographic questionnaire. The samples participated in seven sessions of cognitive behavior group therapy. The data were analyzed using the repeated measures test. Results: The findings indicated significant differences between scores of pretest and posttest considering parenting stress (P = 0.03) and subscales of parenting distress (P = 0.01), yet there weren’t significant differences in the other subscales (P > 0.05). Conclusions: Cognitive behavior group therapy could be an important part of interventions used to decrease parenting stress of mothers of children with autism. PMID:26576170
Benson, Lisa A.; Sevier, Mia; Christensen, Andrew
Emotion-Focused Therapy (EFT; Greenberg & Johnson, 1988) is anchored in attachment theory (Johnson, 2003) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999). However, there is little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non-attachment focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of Integrative Behavioral Couple Therapy and Traditional Behavioral Couple Therapy (Christensen et al., 2004) indicate that although there is a trend for early change in attachment-related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment-related anxiety through the end of treatment and two-year follow-up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy. PMID:25800417
Muñoz-Martínez, Amanda M; Coletti, Juan Pablo
Abstract Functional Analytic Psychotherapy (FAP) is a therapeutic approach developed in
Lovaas, O. Ivar; Koegel, Robert; Simmons, James Q.; Long, Judith Stevens
We have treated 20 autistic children with behavior therapy. At intake, most of the children were severely disturbed, having symptoms indicating an extremely poor prognosis. The children were treated in separate groups, and some were treated more than once, allowing for within- and between-subject replications of treatment effects. We have employed reliable measures of generalization across situations and behaviors as well as across time (follow-up). The findings can be summarized as follows: (1) Inappropriate behaviors (self-stimulation and echolalia) decreased during treatment, and appropriate behaviors (appropriate speech, appropriate play, and social non-verbal behaviors) increased. (2) Spontaneous social interactions and the spontaneous use of language occurred about eight months into treatment for some of the children. (3) IQs and social quotients reflected improvement during treatment. (4) There were no exceptions to the improvement, however, some of the children improved more than others. (5) Follow-up measures recorded 1 to 4 yr after treatment showed that large differences between groups of children depended upon the post-treatment environment (those groups whose parents were trained to carry out behavior therapy continued to improve, while children who were institutionalized regressed). (6) A brief reinstatement of behavior therapy could temporarily re-establish some of the original therapeutic gains made by the children who were subsequently institutionalized. PMID:16795385
Patton, Susana R.; Dolan, Lawrence M.; Chen, Ming; Powers, Scott W.
Diet is an important component of diabetes treatment and integral to successful management. While intensive insulin therapy can allow patients to eat more freely, it is not known how the rapid uptake of intensive therapy in young children with type 1 diabetes has impacted their diet and if diet and healthful eating in young children correlates with mealtime behaviors and glycemic control. This study examined diet, mealtime behaviors, and glucose control in a sample of 39 young children on intensive therapy. This was a one-sample, cross-sectional study. Children had a mean age of 5.1±1.1 years. Children’s 3-day diet diaries were assessed using a deviation scale (measure of adherence) and a healthy eating index. Mealtime behaviors were assessed using the Behavioral Pediatric Feeding Assessment Scale. Children’s glucose control was measured using continuous glucose monitoring. Children’s mean carbohydrate intake was 72%±24% of the recommended levels based on their age, sex, size, and activity level, and children exceeded national guidelines for percentage of calories from fat and saturated fat. A more healthful diet correlated with fewer child mealtime behavior problems, but better dietary adherence correlated with more parent mealtime behavior problems. Even in the context of intensive management, diet can be problematic for young children with type 1 diabetes. Parent-reported problems with mealtime behaviors seem to correlate with healthy eating and dietary adherence. PMID:23351629
Patton, Susana R; Dolan, Lawrence M; Chen, Ming; Powers, Scott W
Diet is an important component of diabetes treatment and integral to successful management. While intensive insulin therapy can allow patients to eat more freely, it is not known how the rapid uptake of intensive therapy in young children with type 1 diabetes has impacted their diet and if diet and healthful eating in young children correlates with mealtime behaviors and glycemic control. This study examined diet, mealtime behaviors, and glucose control in a sample of 39 young children on intensive therapy. This was a one-sample, cross-sectional study. Children had a mean age of 5.1 ± 1.1 years. Children's 3-day diet diaries were assessed using a deviation scale (measure of adherence) and a healthy eating index. Mealtime behaviors were assessed using the Behavioral Pediatric Feeding Assessment Scale. Children's glucose control was measured using continuous glucose monitoring. Children's mean carbohydrate intake was 72% ± 24% of the recommended levels based on their age, sex, size, and activity level, and children exceeded national guidelines for percentage of calories from fat and saturated fat. A more healthful diet correlated with fewer child mealtime behavior problems, but better dietary adherence correlated with more parent mealtime behavior problems. Even in the context of intensive management, diet can be problematic for young children with type 1 diabetes. Parent-reported problems with mealtime behaviors seem to correlate with healthy eating and dietary adherence. PMID:23351629
Ellis, Deborah A; Naar-King, Sylvie; Cunningham, Phillippe B; Fowler, Sandra L
Objective?To present a case study using multisystemic therapy (MST), an intensive family focused psychotherapy. For the clinical trial from which this case was drawn, MST was adapted to address multiple human immunodeficiency virus (HIV) transmission risk behaviors in HIV-infected youth. Targeted behaviors included medication nonadherence, risky sexual behaviors, and substance use.?Method?One young woman's transmission risk behaviors are described, followed by a description of the MST procedures used to identify and treat the primary drivers of these risk behaviors. Outcome measures were self-report, urine screens, and blood draws.?Results?At discharge, the young woman showed significant improvements in medication adherence and related health status (e.g., reduced HIV viral load), healthier sexual behaviors, and reduced substance use. Importantly, neither her boyfriend nor her newborn tested positive for HIV. Conclusions?Findings from this case study suggest that MST has the potential to reduce transmission risk behaviors among teens with HIV. PMID:19815654
Benjamin, Courtney L.; Puleo, Connor M.; Settipani, Cara A.; Brodman, Douglas M.; Edmunds, Julie M.; Cummings, Colleen M.
Synopsis CBT represents a combination of behavioral and cognitive theories of human behavior and psychopathology, and a melding of emotional, familial, and peer influences. The numerous intervention strategies that comprise CBT reflect its complex and integrative nature and include such topics as extinction, habituation, modeling, cognitive restructuring, problem-solving, and the development of coping strategies, mastery, and a sense of self-control. CBT targets multiple areas of potential vulnerability (e.g., cognitive, behavioral, affective) with developmentally-guided strategies and traverses multiple intervention pathways. Although CBT is often considered the “first line treatment” for many psychological disorders in youth, additional work is necessary to address treatment non-responders and to facilitate the dissemination of efficacious CBT approaches. PMID:21440849
Markle, Allan; And Others
Examined the relationship between outcomes of behaviorally oriented treatment for children (N=366) and eye color. Findings were consistent with theoretical expectations: Dark-eyed children and teenagers responded better to reactive treatment programs than their light-eyed counterparts, while the reverse was true for self-paced treatment programs.…
Kendall, Philip C., Ed.
Widely regarded as the definitive clinical reference and text in the field, this authoritative volume presents effective cognitive-behavioral approaches for treating frequently encountered child and adolescent disorders. The editor and contributors are leading experts who provide hands-on, how-to-do-it descriptions illustrated with clinical…
Morin, Charles M.; And Others
Assigned 24 older adults with persistent psychophysiological insomnia to immediate or delayed cognitive-behavioral intervention in waiting-list control group design. Treatment was effective in reducing sleep latency, wake after sleep onset, and early morning awakening, and in increasing sleep efficiency. Sleep improvements obtained by…
The Effect of Cognitive Behavioral Therapy and Cognitive Behavioral Therapy Plus Media on the Reduction of Bullying and Victimization and the Increase of Empathy and Bystander Response in a Bully Prevention Program for Urban Sixth-Grade Students
McLaughlin, Laura Pierce
The purpose of this study was to investigate the effect of cognitive behavioral therapy and cognitive behavioral therapy plus media on the reduction of bullying and victimization and the increase in empathy and bystander response in a bully prevention program for urban sixth-graders. Sixty-eight students participated. Because one of the…
Brown, Lily A.; Gaudiano, Brandon A.; Miller, Ivan W.
There has been much discussion in the literature recently regarding the conceptual and technical differences between so-called second- (e.g., Beckian cognitive therapy) and third-wave (e.g., acceptance and commitment therapy) behavioral therapies. Previous research has not addressed the potential similarities and differences among the…
Sudak, Donna M.
In January 2001, Accreditation Council of Graduate Medical Education accredited general psychiatry training programs were charged with the requirement to train residents in cognitive-behavioral therapy (CBT) to a level of competence. Programs were given the responsibility to delineate standards for trainees, to determine measures of competence,…
Storch, Eric A.; Merlo, Lisa J.; Larson, Michael J.; Geffken, Gary R.; Lehmkuh, Heather D.; Jacob, Marni L.; Murphy, Tanya K.; Goodman, Wayne K.
A chronic psychiatric condition among children and adolescents of concern is obsessive-compulsive disorder, which involves comorbid conditions. The impact of a range of comorbid illnesses on cognitive-behavioral therapy response and remission rates was conducted, with results revealing a negative impact on treatment response.
Shirk, Stephen R.; Gudmundsen, Gretchen; Kaplinski, Heather Crisp; McMakin, Dana L.
This study examined predictive relations between therapeutic alliance and treatment outcomes in manual-guided, cognitive-behavioral therapy for adolescent depression. Fifty-four adolescents met criteria for a depressive disorder and were treated in school-based clinics. Alliance was measured after the third session from both therapist and…
King, Gillian; Tam, Cynthia; Fay, Linda; Pilkington, Martha; Servais, Michelle; Petrosian, Hasmik
There is growing interest in understanding the usefulness of mentorship programs for children's rehabilitation service providers. This evaluation study examined the effects of an occupational therapy mentorship program on the skills and behaviors of 8 new and 17 experienced occupational therapists practicing at a regional children's rehabilitation…
Budney, Alan J.; Moore, Brent A.; Rocha, Heath L.; Higgins, Stephen T.
Ninety cannabis-dependent adults seeking treatment were randomly assigned to receive cognitive-behavioral therapy, abstinence-based voucher incentives, or their combination. Treatment duration was 14 weeks, and outcomes were assessed for 12 months post treatment. Findings suggest that (a) abstinence-based vouchers were effective for engendering…
Dietrich, Coralie; And Others
This study explored the efficacy of semantic behavior therapy in the management of chronic osteoarthritis pain in elderly patients as well as the relationships among pain, physical health, personality, and social characteristics in this population. The sample consisted of 8 elderly persons who had osteoarthritis of the knee, and 11 healthy elderly…
Crawley, Sarah A.; Kendall, Philip C.; Benjamin, Courtney L.; Brodman, Douglas M.; Wei, Chiaying; Beidas, Rinad S.; Podell, Jennifer L.; Mauro, Christian
We developed and evaluated a brief (8-session) version of cognitive-behavioral therapy (BCBT) for anxiety disorders in youth ages 6 to 13. This report describes the design and development of the BCBT program and intervention materials (therapist treatment manual and child treatment workbook) and an initial evaluation of child treatment outcomes.…
Kaufman, Noah K.; Rohde, Paul; Seeley, John R.; Clarke, Gregory N.; Stice, Eric
Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder…
Hwang, Wei-Chin; Wood, Jeffrey J.; Lin, Keh-Ming; Cheung, Freda
In this article, we discuss how to conduct cognitive-behavioral therapy with Chinese Americans. We present an integration of theory, research, and clinical practice to help mental health practitioners understand how Chinese culture may potentially influence the CBT treatment process for Chinese immigrants. Several recommendations are provided as…
Hopko, Derek R.; Armento, Maria E. A.; Robertson, Sarah M. C.; Ryba, Marlena M.; Carvalho, John P.; Colman, Lindsey K.; Mullane, Christen; Gawrysiak, Michael; Bell, John L.; McNulty, James K.; Lejuez, Carl W.
Objective: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with…
Warren, Jeffrey M.
This literature review explores the potential impact of Rational Emotive Behavior Therapy (REBT) on teacher efficacy and student achievement. Research conducted to date, focusing on increasing teacher efficacy and student achievement, has produced mixed results. Teachers continue to think, emote, and behave in unhelpful ways. REBT appears to…
Forand, Nicholas R.; Evans, Susan; Haglin, Dean; Fishman, Baruch
Cognitive-behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to…
Mohr, David C.; Carmody, Timothy; Erickson, Lauren; Jin, Ling; Leader, Julie
Objective: Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Method: Eighty-five veterans…
Spangler, Diane L.; Baldwin, Scott A.; Agras, W. Stewart
Cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) has received considerable empirical support for its efficacy. However, few investigators have examined the mechanisms proposed to account for the reduction of BN symptoms during CBT. The current study examined the associations between therapist interventions, client mechanisms, and…
Kertes, Angela; Westra, Henny A.; Angus, Lynne; Marcus, Madalyn
Motivational Interviewing (MI) has recently been applied to the treatment of anxiety disorders in an effort to bolster engagement with and response rates to cognitive behavioral therapy (CBT). In a recent randomized control trial, the addition of MI as a pretreatment compared to no pretreatment was found to significantly improve response to CBT…
Weersing, V. Robin; Iyengar, Satish; Kolko, David J.; Birmaher, Boris; Brent, David A.
In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR…
McCloskey, Michael S.; Noblett, Kurtis L.; Deffenbacher, Jerry L.; Gollan, Jackie K.; Coccaro, Emil F.
No randomized clinical trials have evaluated the efficacy of psychotherapy for intermittent explosive disorder (IED). In the present study, the authors tested the efficacy of 12-week group and individual cognitive-behavioral therapies (adapted from J. L. Deffenbacher & M. McKay, 2000) by comparing them with a wait-list control in a randomized…
Bateman, Katy; Hansen, Lars; Turkington, Douglas; Kingdon, David
Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to…
Grilo, Carlos M.; Crosby, Ross D.; Wilson, G. Terence; Masheb, Robin M.
Objective: The longer term efficacy of medication treatments for binge-eating disorder (BED) remains unknown. This study examined the longer term effects of fluoxetine and cognitive behavioral therapy (CBT) either with fluoxetine (CBT + fluoxetine) or with placebo (CBT + placebo) for BED through 12-month follow-up after completing treatments.…
Curry, John F.; Wells, Karen C.
The Treatment for Adolescents With Depression Study (TADS) was designed to compare the relative and combined effectiveness of cognitive behavior therapy (CBT) and fluoxetine, each of which had demonstrated efficacy in carefully controlled single-site studies. Models of CBT from these efficacy studies served as the foundation for the TADS…
Pinkham, Amy E.; Gloege, Andrew T.; Flanagan, Steven; Penn, David L.
In this article, we describe a pilot study that investigated the effectiveness of group cognitive behavioral therapy (CBT) for auditory hallucinations. Eleven inpatients with either chronic schizophrenia or schizoaffective disorder participated in 2 CBT groups of differing treatment duration (i.e., 7 versus 20 sessions). The results showed that…
van Rooij, Antonius J.; Zinn, Mieke F.; Schoenmakers, Tim M.; van de Mheen, Dike
In 2009, one of the major Dutch addiction care organizations initiated a pilot program to explore the possibility of using an existing Cognitive Behavioral Therapy and Motivational Interviewing based treatment program ("Lifestyle Training") to treat internet addiction. The current study evaluates this pilot treatment program by providing a…
Perlman, Lawrence M.; Arnedt, J. Todd; Earnheart, Kristie L.; Gorman, Ashley A.; Shirley, Katherine G.
Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a…
Eckshtain, Dikla; Gaynor, Scott T.
Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…
Hofmann, Stefan G.; Meuret, Alicia E.; Rosenfield, David; Suvak, Michael K.; Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.
Cognitive-behavioral therapy (CBT) and pharmacotherapy are similarly effective for treating panic disorder with mild or no agoraphobia, but little is known about the mechanism through which these treatments work. The present study examined some of the criteria for cognitive mediation of treatment change in CBT alone, imipramine alone, CBT plus…
Sauter, Floor M.; Heyne, David; Westenberg, P. Michiel
Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report…
Chen, Szu-Yu; Jordan, Catheleen; Thompson, Sanna
Objective: Many studies have confirmed the efficacy of cognitive behavioral therapy (CBT) as a treatment for depression. However, the mechanism of CBT for depression reduction is still not well understood. This study explored the mechanism of CBT from the perspective of individuals' problem-solving appraisal. Method: A one-group pretest-posttest…
Hamilton, Kate E.; Wershler, Julie L.; Macrodimitris, Sophie D.; Backs-Dermott, Barb J.; Ching, Laurie E.; Mothersill, Kerry J.
Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the…
Bryant, Richard A.; Moulds, Michelle L.; Guthrie, Rachel M.; Nixon, Reginald D. V.
This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N = 87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure,…
Wallach, Helene S.; Safir, Marilyn P.; Bar-Zvi, Margalit
Public speaking anxiety (PSA) is a common phobia. Although cognitive behavior therapy (CBT) is preferred, difficulties arise with the exposure component (lack of therapist control, patient's inability to imagine, self-flooding, loss of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist…
Herschell, Amy D.; Kolko, David J.; Baumann, Barbara L.; Brown, Elissa J.
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) is an evidence-based treatment for families with children aged 5 to 15 years who have been affected by verbal and physical aggression in the family. AF-CBT was designed to address risks for exposure to emotional and physical aggression as well as common clinical consequences of…
Salloum, Alison; Scheeringa, Michael S.; Cohen, Judith A.; Storch, Eric A.
Background: In order to develop Stepped Care trauma-focused cognitive behavioral therapy (TF-CBT), a definition of early response/non-response is needed to guide decisions about the need for subsequent treatment. Objective: The purpose of this article is to (1) establish criterion for defining an early indicator of response/non-response to the…
Martin, Paul R.; Forsyth, Michael R.; Reece, John
Sixty-four headache sufferers were allocated randomly to cognitive-behavioral therapy (CBT), temporal pulse amplitude (TPA) biofeedback training, or waiting-list control. Fifty-one participants (14M/37F) completed the study, 30 with migraine and 21 with tension-type headache. Treatment consisted of 8, 1-hour sessions. CBT was highly effective,…
Jacob, Karen L.; Christopher, Michael S.; Neuhaus, Edmund C.
Although several theories exist to describe why patients improve in cognitive-behavioral therapy (CBT), in only a limited number of studies has CBT skill acquisition been examined, particularly among patients with complex clinical profiles. Thus, the overarching aim of this research was to develop a tool to measure patients' use of CBT skills,…
Kearny, Regina; Pawlukewicz, Justine; Guardino, Mary
Because anxiety is the most common mental health disorder diagnosed in children, early intervention is crucial for fundamental coping. Although cognitive-behavioral therapy (CBT) is the preferred treatment method for this affective disorder, instruction for children needs to be specific for them to successfully acquire and implement essential CBT…
Kennard, Betsy D.; Emslie, Graham J.; Mayes, Taryn L.; Nightingale-Teresi, Jeanne; Nakonezny, Paul A.; Hughes, Jennifer L.; Jones, Jessica M.; Tao, Rongrong; Stewart, Sunita M.; Jarrett, Robin B.
The outcome of a sequential treatment strategy that included cognitive behavioral therapy (CBT) in the prevention of major depressive disorder relapse among 46 youths is examined. Results show that youths under the antidepressant medication management plus relapse prevention CBT treatment was at lower risk for relapse than those under the…
Wood, Jeffrey J.; Drahota, Amy; Sze, Karen; Har, Kim; Chiu, Angela; Langer, David A.
Background: Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or…
Gonzalez, Vivian M.; Schmitz, Joy M.; DeLaune, Katherine A.
This study examines the effect of homework compliance on treatment outcome in 123 participants receiving cognitive-behavioral therapy (CBT) for cocaine dependence. Regression analyses revealed a significant relationship between homework compliance and cocaine use that was moderated by readiness to change. Homework compliance predicted less cocaine…
Choate, Laura H.
Eating disorder not otherwise specified (EDNOS; American Psychiatric Association, 2000) is, by far, the most common eating disorder that college counseling professionals encounter among their female clients. Empirical evidence and best practice guidelines support use of cognitive behavior therapy (CBT) with women experiencing EDNOS. This article…
Westra, Henny A.; Dozois, David J. A.; Marcus, Madalyn
Belief in one's ability to change is an important cognitive variable related to treatment gains. This study investigated pretreatment expectancy for anxiety change and early homework compliance in relation to initial and total cognitive change in group cognitive-behavioral therapy (CBT) for anxiety. Participants, who met diagnostic criteria for at…
Hayes, Steven C.; Pistorello, Jacqueline; Levin, Michael E.
The present article summarizes the assumptions, model, techniques, evidence, and diversity/social justice commitments of Acceptance and Commitment Therapy (ACT). ACT focused on six processes (acceptance, defusion, self, now, values, and action) that bear on a single overall target (psychological flexibility). The ACT model of behavior change has…
Hodge, David R.
Cognitive-behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients. More specifically, by…
Suveg, Cynthia; Sood, Erica; Comer, Jonathan S.; Kendall, Philip C.
This study examined emotion-related functioning following cognitive-behavioral therapy (CBT) with 37 youth with anxiety disorders (22 boys, 15 girls) ranging in age from 7 to 15 with a principal diagnosis of generalized anxiety disorder (n = 27), separation anxiety disorder (n = 12), and/or social phobia (n = 13). Treated youth exhibited a…
Safir, Marilyn P.; Wallach, Helene S.; Bar-Zvi, Margalit
Public speaking anxiety (PSA) is a common social phobia. Although cognitive-behavior therapy (CBT) is the treatment of choice, difficulties arise with both in vivo and in vitro exposure (lack of therapist control, patient's inability to imagine, self-flooding, and a lack of confidentiality resulting from public exposure). Virtual reality CBT…
Khanna, Muniya S.; Kendall, Philip C.
Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7-13 (M = 10.1 [plus or minus] 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were…
Ahmed, Mariyam; Westra, Henry A.; Stewart, Sherry H.
Although prescription rates may be declining, benzodiazepines (BZs) are still very commonly prescribed for the treatment of anxiety disorders. Because many anxiety patients require assistance in successfully discontinuing BZs, cognitive behavioral therapy (CBT) approaches have been specifically developed to target this issue, and an evidence base…
Radhu, Natasha; Daskalakis, Zafiris J.; Arpin-Cribbie, Chantal A.; Irvine, Jane; Ritvo, Paul
Objective: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress. Participants: Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban…
Safer, Debra L.; Couturier, Jennifer L.; Lock, James
Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge…
Shirk, Stephen R.; Kaplinski, Heather; Gudmundsen, Gretchen
The current study evaluated cognitive-behavioral therapy (CBT) for adolescent depression delivered in health clinics and counseling centers in four high schools. Outcomes were benchmarked to results from prior efficacy trials. Fifty adolescents diagnosed with depressive disorders were treated by eight doctoral-level psychologists who followed a…
Satterfield, Jason M.; Crabb, Rebecca
Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were…
Uebelacker, Lisa A.; Weisberg, Risa B.; Haggarty, Ryan; Miller, Ivan W.
Major depressive disorder is commonly treated in primary care settings. Psychotherapy occurring in primary care should take advantage of the unique aspects of the setting and must adapt to the problems and limitations of the setting. In this open trial, the authors used a treatment development model to adapt behavior therapy for primary care…
Habigzang, Luisa Fernanda; Damasio, Bruno Figueiredo; Koller, Silvia Helena
This study evaluated the impact of a cognitive behavioral group therapy model in Brazilian girls who had experienced sexual abuse. The effect of the waiting period before treatment and the enduring effectiveness of the treatment after six and 12 months were also evaluated. Forty-nine female sexual abuse victims between the ages of 9 and 16…
Dobkin, Roseanne D.; Rubino, Jade Tiu; Allen, Lesley A.; Friedman, Jill; Gara, Michael A.; Mark, Margery H.; Menza, Matthew
Objective: The purpose of this study was to examine predictors of treatment response to cognitive-behavioral therapy (CBT) for depression in Parkinson's disease (PD). Method: The sample comprised 80 depressed ("DSM-IV" criteria) adults with PD (60% male) and their caregivers who participated in an National Institutes of Health-sponsored…
Szigethy, Eva; Whitton, Sarah W.; Levy-Warren, Anna; DeMaso, David Ray; Weisz, John; Beardslee, William R.
Objective: To evaluate the safety and feasibility of cognitive-behavioral therapy (CBT) for depression in physically ill adolescents. Method: In an open trial, 11 adolescents (12-17 years) with inflammatory bowel disease and either major or minor depression underwent 12 sessions of a manual-based CBT enhanced by social skills, physical illness…
de Graaf, L. Esther; Hollon, Steven D.; Huibers, Marcus J. H.
Objective: To explore pretreatment and short-term improvement variables as potential moderators and predictors of 12-month follow-up outcome of unsupported online computerized cognitive behavioral therapy (CCBT), usual care, and CCBT combined with usual care for depression. Method: Three hundred and three depressed patients were randomly allocated…
Cohen, Judith A.; Mannarino, Anthony P.; Staron, Virginia R.
Objective: This pilot study evaluated outcomes for a modified 12-session protocol of cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG) conducted between March 2004 and October 2005. CTG is an emerging condition characterized by a combination of posttraumatic stress and unresolved grief symptoms. This two-module treatment model…
Webb, Monica S.; de Ybarra, Denise Rodriguez; Baker, Elizabeth A.; Reis, Isildinha M.; Carey, Michael P.
Objective: The health consequences of tobacco smoking disproportionately affect African Americans, but research on whether efficacious interventions can be generalized to this population is limited. This study examined the efficacy of group-based cognitive-behavioral therapy (CBT) for smoking cessation among African Americans. Method: Participants…
Valmaggia, Lucia R.; Tabraham, Paul; Morris, Eric; Bouman, Theo K.
Since the early 1990s, cognitive behavioral therapy (CBT) has been increasingly used as an adjunctive treatment for psychotic disorders. This paper describes the CBT of three cases, each at a different stage of psychotic disorder: at-risk mental state, first-episode psychosis, and chronic psychotic disorder. For the at-risk mental state, treatment…
Lincoln, Tania M.; Ziegler, Michael; Mehl, Stephanie; Kesting, Marie-Luise; Lullmann, Eva; Westermann, Stefan; Rief, Winfried
Objective: Randomized controlled trials have attested the efficacy of cognitive behavioral therapy (CBT) in reducing psychotic symptoms. Now, studies are needed to investigate its effectiveness in routine clinical practice settings. Method: Eighty patients with schizophrenia spectrum disorders who were seeking outpatient treatment were randomized…
Menzies, Ross G.; O'Brian, Sue; Onslow, Mark; Packman, Ann; St Clare, Tamsen; Block, Susan
Purpose: The aims of the present study were to (a) examine the rate of social phobia among adults who stutter, (b) study the effects of speech restructuring treatment on social anxiety, and (c) study the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety. Method: Thirty-two adults with chronic…
Harwood, Michelle D.; Eyberg, Sheila M.
We examined the role of specific therapist verbal behaviors in predicting successful completion of Parent?Child Interaction Therapy (PCIT) in 22 families, including 11 families that successfully completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 6 years old and diagnosed with oppositional defiant disorder…
Rybarczyk, Bruce; Stepanski, Edward; Fogg, Louis; Lopez, Martita; Barry, Paulette; Davis, Andrew
The present study tested cognitive-behavioral therapy (CBT) for insomnia in older adults with osteoarthritis, coronary artery disease, or pulmonary disease. Ninety-two participants (mean age = 69 years) were randomly assigned to classroom CBT or stress management and wellness (SMW) training, which served as a placebo condition. Compared with SMW,…
Clarke, Gregory; DeBar, Lynn; Lynch, Frances; Powell, James; Gale, John; O'Connor, Elizabeth; Ludman, Evette; Bush, Terry; Lin, Elizabeth H. B.; Von Korff, Michael; Hertert, Stephanie
Objective: To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. Method: A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the…
Melvin, Glenn A.; Tonge, Bruce J.; King, Neville J.; Heyne, David; Gordon, Michael S.; Klimkeit, Ester
Objective: To evaluate cognitive-behavioral therapy, antidepressant medication alone, and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents. Method: Seventy-three adolescents (ages 12-18 years) with a primary diagnosis of DSM-IV major depressive disorder, dysthymic disorder, or depressive disorder…
Makinson, Ryan A.; Young, J. Scott
There is increasing evidence to support the biological basis of mental disorders. Subsequently, understanding the neurobiological context from which mental distress arises can help counselors appropriately apply cognitive behavioral therapy and other well-researched cognitive interventions. The purpose of this article is to describe the…
Kennard, Betsy D.; Clarke, Greg N.; Weersing, V. Robin; Asarnow, Joan Rosenbaum; Shamseddeen, Wael; Porta, Giovanna; Berk, Michele; Hughes, Jennifer L.; Spirito, Anthony; Emslie, Graham J.; Keller, Martin B.; Wagner, Karen D.; Brent, David A.
In this report, we conducted a secondary analysis of the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study to explore the impact of specific cognitive-behavioral therapy (CBT) treatment components on outcome. In TORDIA, 334 youths (ages 12 to 18 years) with major depressive disorder who had failed to respond to an adequate…
Interian, Alejandro; Diaz-Martinez, Angelica M.
The purpose of this paper is to outline considerations for adapting cognitive-behavioral therapy (CBT) to Hispanic patients who have recently immigrated, particularly those presenting with depressive symptoms. Culturally competent CBT is framed within a model originally proposed by Rogler and his colleagues (1987). The considerations outlined by…
Scheeres, Korine; Wensing, Michel; Knoop, Hans; Bleijenberg, Gijs
Objective: This study evaluated the success of implementing cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) in a representative clinical practice setting and compared the patient outcomes with those of previously published randomized controlled trials (RCTs) of CBT for CFS. Method: The implementation interventions were the…
Bazelmans, Ellen; Prins, Judith; Bleijenberg, Gijs
In chronic fatigue syndrome (CFS), facilitating, initiating, and perpetuating factors are distinguished. Although somatic factors might have initiated symptoms in CFS, they do not explain the persistence of fatigue. Cognitive behavior therapy (CBT) for CFS focuses on factors that perpetuate and prolong symptoms. Recently it has been shown that,…
Youdas, James W.; Krause, David A.; Hellyer, Nathan J.; Rindflesch, Aaron B.; Hollman, John H.
Medical professionals and public consumers expect that new physical therapy graduates possess cognitive, technical, and behavioral skills required to provide safe and high-quality care to patients. The purpose of this study was to determine if a repertoire of ten professional behaviors assessed at the beginning of doctorate of physical therapy…
Gross, James J.
symptom severity post-CBT. The trajectory of weekly changes in emotion regulation strategies may helpTrajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy regulation Reappraisal Suppression CBT Trajectory of change a b s t r a c t Cognitive-behavioral therapy (CBT
Selles, Robert R.; Arnold, Elysse B.; Phares, Vicky; Lewin, Adam B.; Murphy, Tanya K.; Storch, Eric A.
Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder appears efficacious; however, maintenance of treatment gains has not yet been studied. Using a sample of 32 youth who had benefited at least minimally from a past trial of cognitive-behavioral therapy for anxiety in autism spectrum disorder, this study assessed…
McCarthy, B W
This paper examines uses of sexual exercises and their role in effecting changes in attitudes, behaviors, and feelings. In reaction to the charge that exercises are overly mechanistic, clinicians now underutilize exercises and/or give only general suggestions. The common errors of nonspecificity, use as a cookbook, quick abandonment, and setting performance criterion are discussed. The use of semistructured, written exercises which function as in vivo desensitization, facilitate development of verbal and stimulation skills, and provide a positive model of sexuality are most efficacious. A case example illustrating the multiple therapeutic benefits of exercises is presented. PMID:4068046
Zafar, Qayyum; Ahmad, Zubair; Sulaiman, Khaulah
We present a ternary blend-based bulk heterojunction ITO/PEDOT:PSS/PFO-DBT:MEH-PPV:PC71BM/LiF/Al photodetector. Enhanced optical absorption range of the active film has been achieved by blending two donor components viz. poly[2,7-(9,9-di-octyl-fluorene)-alt-4,7-bis(thiophen-2-yl)benzo-2,1,3-thiadiazole] (PFO-DBT) and poly(2-methoxy-5(2?-ethylhexyloxy) phenylenevinylene (MEH-PPV) along with an acceptor component, i.e., (6,6)-phenyl-C71 hexnoic acid methyl ester. The dependency of the generation rate of free charge carriers in the organic photodetector (OPD) on varied incident optical power density was investigated as a function of different reverse biasing voltages. The photocurrent showed significant enhancement as the intensity of light impinging on active area of OPD is increased. The ratio of Ilight to Idark of fabricated device at ?3 V was ?3.5 × 104. The dynamic behaviour of the OPD under on/off switching irradiation revealed that sensor exhibits quick response and recovery time of <800 ms and 500 ms, respectively. Besides reliability and repeatability in the photoresponse characteristics, the cost-effective and eco-friendly fabrication is the added benefit of the fabricated OPD. PMID:25574936
Hunter, Jennifer A; Button, Melissa L; Westra, Henny A
Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy. PMID:24655131
Mander, Helen; Kingdon, David
Cognitive therapy for psychosis has developed over the past 30 years from initial case studies, treatment manuals, pilot randomized controlled studies to fully powered and methodologically rigorous efficacy and, subsequently, effectiveness trials. Reviews and meta-analyses have confirmed the benefits of the interventions. Considered appraisal by government and professional organizations has now led to its inclusion in international treatment guidelines for schizophrenia. Patients consistently ask for access to psychotherapeutic interventions, and it is slowly becoming available in many European countries and other parts of the world, eg, US and the People’s Republic of China. However, it remains unacceptably difficult to access for the vast majority of people with psychosis who could benefit from it. Psychosis affects people in the prime of their lives and leads to major effects on their levels of distress, well-being, and functioning, and also results in major costs to society. Providing effective interventions at an early stage has the potential to reduce the high relapse rates that occur after recovery from first episode and the ensuing morbidity and premature mortality associated with psychosis. PMID:25733937
Hesser, Hugo; Gustafsson, Tore; Lunden, Charlotte; Henrikson, Oskar; Fattahi, Kidjan; Johnsson, Erik; Westin, Vendela Zetterqvist; Carlbring, Per; Maki-Torkko, Elina; Kaldo, Viktor; Andersson, Gerhard
Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were…
Apsche, Jack A.; Bass, Christopher K.; Jennings, Jerry L.; Murphy, Christopher J.; Hunter, Linda A.; Siv, Alexander M.
This research study compared the efficacy of three treatment methodologies for adolescent males in residential treatment with conduct disorders and/or personality dysfunctions and documented problems with physical and sexual aggression. The results showed that Mode Deactivation Therapy, an advanced form of cognitive behavioral therapy based on…
Kanter, Jonathan W; Baruch, David E; Gaynor, Scott T
The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the “common cold” of outpatient populations. Two treatments for depression have emerged: acceptance and commitment therapy (ACT) and behavioral activation (BA). At times ACT and BA may suggest largely redundant intervention strategies. However, at other times the two treatments differ dramatically and may present opposing conceptualizations. This paper will compare and contrast these two important treatment approaches. Then, the relevant data will be presented and discussed. We will end with some thoughts on how and when ACT or BA should be employed clinically in the treatment of depression. PMID:22478462
Andersson, Gerhard; Kaldo, Viktor
Tinnitus is a common otological problem that is often resistant to surgical or medical interventions. In common with chronic pain, cognitive-behavioral treatment has been found to alleviate the distress and improve the functioning of tinnitus patients. Recently, a self-help treatment has been developed for use via the Internet. In this article, we describe the self-help program and apply it to a middle-aged woman with tinnitus. We report the case formulation, which was done in a structured interview, and the treatment interactions, which were conducted via e-mail. The self-help program was presented on Web pages, and weekly diaries were submitted to follow progress and give feedback. The treatment was successful with reductions of tinnitus-related annoyance and anxious and depressive mood. Implications for Internet administration of self-help treatment are discussed. PMID:14724924
Soleimani, Robabeh; Modabbernia, Mohammad Jafar; Habibi, Sharareh; Roudsary, Maryam Habibi; Elahi, Masoumeh
Background: Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT). There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI) on sleep disorders in patients undergoing MMT. Methods: Twenty-two patients with insomnia due to MMT (aged 18-60 years) participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT). The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software version 19. Results: Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses). Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02). The effects of CBTI versus placebo were significantly different (P<0.001). The time course was also significant (P<0.001). Conclusion: This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT. PMID:26379345
Carroll, Kathleen M.
In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community-friendly. For CBT, barriers such as relative complexity, lack of trained providers and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes. PMID:25204847
Cuello, A C
This brief review discusses experimental therapy with neurotrophic factors in a model of central nervous system (CNS) neural atrophy and synaptic loss resulting from unilateral cortical infarctions. It discusses the trophic factor protection of the cholinergic phenotype of neurons belonging to the forebrain-to-neocortex projection, as well as the capacity of trophic therapy to elicit synaptogenesis in the cerebral cortex of adult animals. Finally, it addresses the behavioral consequences of trophic factor-induced synaptic remodeling of the neocortex in this model. Images Figure 3 PMID:9002392
Gross, James J.
Impact of cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional Emotion regulation Cognitive-behavioral therapy Reappraisal Neuroimaging Emotion a b s t r a c t We examined whether Cognitive-Behavioral Therapy (CBT) for social anxiety disorder (SAD) would modify self
Hanscom, David A.; Brox, Jens Ivar; Bunnage, Ray
Study Design?Narrative review of the literature. Objectives?Determine if the term cognitive behavioral therapy (CBT) is useful in clinical care and research. What literature supports these variables being relevant to the experience of chronic pain? What effects of CBT in treating these factors have been documented? What methods and platforms are available to administer CBT? Methods?Chronic low back pain (CLBP) is a complex neurologic disorder with many components. CBT refers to a broad family of therapies that address both maladaptive thoughts and behaviors. There are several ways to deliver it. CLBP was broken into five categories that affect the perception of pain, and the literature was reviewed to see the effects of CBT on these variables. Results?The term cognitive behavioral therapy has little use in future research because it covers such a wide range of therapies. CBT should always be defined by the problem it is intended to solve. The format and method of delivery should be defined because they have implications for outcomes. They are readily available even at the primary care level. The effectiveness of CBT is unquestioned regarding its effectiveness in treating each of the variables that affect CLBP. It is unclear why it is not more widely implemented. Conclusions?CBT represents a family of therapies that are effective for a wide range of problems, many of which coexist with and influence CLBP. Each of the variables can be improved with focused CBT. Early, widespread adoption of CBT in treating and preventing CLBP is recommended. Future research and clinical care should focus on strategies to operationalize these well-documented treatments utilizing a public health approach. PMID:26682100
Hanscom, David A; Brox, Jens Ivar; Bunnage, Ray
Study Design?Narrative review of the literature. Objectives?Determine if the term cognitive behavioral therapy (CBT) is useful in clinical care and research. What literature supports these variables being relevant to the experience of chronic pain? What effects of CBT in treating these factors have been documented? What methods and platforms are available to administer CBT? Methods?Chronic low back pain (CLBP) is a complex neurologic disorder with many components. CBT refers to a broad family of therapies that address both maladaptive thoughts and behaviors. There are several ways to deliver it. CLBP was broken into five categories that affect the perception of pain, and the literature was reviewed to see the effects of CBT on these variables. Results?The term cognitive behavioral therapy has little use in future research because it covers such a wide range of therapies. CBT should always be defined by the problem it is intended to solve. The format and method of delivery should be defined because they have implications for outcomes. They are readily available even at the primary care level. The effectiveness of CBT is unquestioned regarding its effectiveness in treating each of the variables that affect CLBP. It is unclear why it is not more widely implemented. Conclusions?CBT represents a family of therapies that are effective for a wide range of problems, many of which coexist with and influence CLBP. Each of the variables can be improved with focused CBT. Early, widespread adoption of CBT in treating and preventing CLBP is recommended. Future research and clinical care should focus on strategies to operationalize these well-documented treatments utilizing a public health approach. PMID:26682100
Shnaider, Philippe; Pukay-Martin, Nicole D.; Fredman, Steffany J.; Macdonald, Alexandra; Monson, Candice M.
A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in “one” partner are negatively associated with their intimate partner’s psychological functioning. The present study investigated intimate partners’ mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive–behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners’ psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive–behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress. PMID:24706354
Perfect, Michelle M; Elkins, Gary R
Inadequate sleep among adolescents frequently contributes to obesity and reduced academic performance, along with symptoms of anxiety, depression, fatigue, and attention deficits. The etiological bases of sleep quality has been associated with both stress and sleep habits. These problems tend to be especially important for adolescents with diabetes as the effects of poor sleep complicate health outcomes. This case example concerns a 14-year-old adolescent girl with a history of type I diabetes and stress-related sleep difficulties. Treatment included cognitive-behavioral methods and hypnotic relaxation therapy. Results of this case example and other controlled research suggest that hypnotic relaxation therapy is well accepted, results in good compliance, and serves as a useful adjunctive to cognitive-behavioral intervention for sleep problems. PMID:20865769
Khalsa, Manjit K.; Greiner-Ferris, Julie M.; Hofmann, Stefan G.; Khalsa, Sat Bir S.
Cognitive behavioral therapy is an effective treatment for generalized anxiety disorder (GAD), but there is still room for improvement. The aim of the present study was to examine the potential benefit of enriching cognitive behavioral therapy (CBT) with Kundalini Yoga (Y-CBT). Participants consisted of treatment resistant clients at a community mental health clinic. A total of 32 participants enrolled in the study and 22 completed the program. After the Y-CBT intervention, pre-post comparisons showed statistically significant improvements in state and trait anxiety, depression, panic, sleep, and quality of life. Results from this preliminary study suggest that Y-CBT may have potential as a promising treatment for those suffering from GAD. PMID:24804619
Fields, Barry G.; Schutte-Rodin, Sharon; Perlis, Michael L.; Myers, Megin
Despite the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating chronic insomnia, it remains underutilized. Lack of appropriately-trained CBT-I providers is a major reason. Master's-level practitioners (MLPs) may, in addition to doctoral-level psychologists, be uniquely positioned to fill this role, based not only on “goodness of professional fit” but also given a handful of studies showing these individuals' care outcomes meet or exceed standard outcomes. However, the ability of MLPs to provide CBT-I will be significantly restricted until a clear pathway is established that extends from training opportunities to credentialing. Further questions remain about how to attract and incorporate MLPs into established practices. Citation: Fields BG; Schutte-Rodin S; Perlis ML; Myers M. Master's-level practitioners as cognitive behavioral therapy for insomnia providers: an underutilized resource. J Clin Sleep Med 2013;9(10):1093-1096. PMID:24127157
Limbrunner, Heidi M.; Ben-Porath, Denise D.; Wisniewski, Lucene
The goal of this paper is to report on the typology, frequency, and duration of intersession calls placed by outpatient eating disorder clients to their therapists. Participants were 17 women, offered DBT after-hours telephone coaching adapted for individuals with eating disorders. Results indicated that clients used telephone coaching primarily…
Willard, Victoria W.; Conklin, Heather M.; Boop, Frederick A.; Wu, Shengjie; Merchant, Thomas E.
Purpose: The standard of care for pediatric patients with ependymoma involves postoperative radiation therapy. Prior research suggests that conformal radiation therapy (CRT) is associated with relative sparing of cognitive and academic functioning, but little is known about the effect of CRT on emotional and behavioral functioning. Methods and Materials: A total of 113 patients with pediatric ependymoma underwent CRT using photons as part of their enrollment on an institutional trial. Patients completed annual evaluations of neurocognitive functioning during the first 5 years after CRT. Emotional and behavioral functioning was assessed via the Child Behavior Checklist. Results: Before CRT, emotional and behavioral functioning were commensurate with those of the normative population and within normal limits. After 5 years, means remained within normal limits but were significantly below the normative mean. Linear mixed models revealed a significant increase in attention problems over time. These problems were associated with age at diagnosis/CRT, tumor location, and extent of resection. A higher-than-expected incidence of school problems was present at all assessment points after baseline. Conclusions: The use of photon CRT for ependymoma is associated with relatively stable emotional and behavioral functioning during the first 5 years after treatment. The exception is an increase in attention problems. Results suggest that intervening earlier in the survivorship period—during the first year posttreatment—may be beneficial.
Breitstein, Joshua; Penix, Brandon; Roth, Bernard J.; Baxter, Tristin; Mysliwiec, Vincent
The case of a 59-year-old woman psychiatrically hospitalized with comorbid insomnia, suicidal ideation, and generalized anxiety disorder is presented. Pharmacologic therapies were unsuccessful for treating insomnia prior to and during hospitalization. Intensive sleep deprivation was initiated for 40 consecutive hours followed by a recovery sleep period of 8 hours. Traditional components of cognitive behavioral therapy for insomnia (CBTi), sleep restriction, and stimulus control therapies, were initiated on the ward. After two consecutive nights with improved sleep, anxiety, and absence of suicidal ideation, the patient was discharged. She was followed in the sleep clinic for two months engaging in CBTi. Treatment resulted in substantial improvement in her insomnia, daytime sleepiness, and anxiety about sleep. Sleep deprivation regimens followed by a restricted sleep recovery period have shown antidepressant effects in depressed patients. Similar treatment protocols have not been investigated in patients with pharmacotherapy refractory insomnia and generalized anxiety disorder. Citation: Breitstein J, Penix B, Roth BJ, Baxter T, Mysliwiec V. Intensive sleep deprivation and cognitive behavioral therapy for pharmacotherapy refractory insomnia in a hospitalized patient. J Clin Sleep Med 2014;10(6):689-690. PMID:24932151
Glassman, Lisa Hayley
Individuals with public speaking phobia experience fear and avoidance that can cause extreme distress, impaired speaking performance, and associated problems in psychosocial functioning. Most extant interventions for public speaking phobia focus on the reduction of anxiety and avoidance, but neglect performance. Additionally, very little is known about the relationship between verbal working memory and social performance under conditions of high anxiety. The current study compared the efficacy of two cognitive behavioral treatments, traditional Cognitive Behavioral Therapy (tCBT) and acceptance-based behavior therapy (ABBT), in enhancing public speaking performance via coping with anxiety. Verbal working memory performance, as measured by the backwards digit span (BDS), was measured to explore the relationships between treatment type, anxiety, performance, and verbal working memory. We randomized 30 individuals with high public speaking anxiety to a 90-minute ABBT or tCBT intervention. As this pilot study was underpowered, results are examined in terms of effect sizes as well as statistical significance. Assessments took place at pre and post-intervention and included self-rated and objective anxiety measurements, a behavioral assessment, ABBT and tCBT process measures, and backwards digit span verbal working memory tests. In order to examine verbal working memory during different levels of anxiety and performance pressure, we gave each participant a backwards digit span task three times during each assessment: once under calm conditions, then again while experiencing anticipatory anxiety, and finally under conditions of acute social performance anxiety in front of an audience. Participants were asked to give a video-recorded speech in front of the audience at pre- and post-intervention to examine speech performance. Results indicated that all participants experienced a very large and statistically significant decrease in anxiety (both during the speech and BDS), as well as an improvement in speech performance regardless of intervention received. While not statistically significant, participants who received an acceptance-based intervention exhibited larger improvements in observer-rated speech performance at post-treatment in comparison to tCBT (F (1,21) = 1.91, p =.18, etap2 = .08) such that individuals in the ABBT condition exhibited a considerably greater improvement in observer-rated speech performance than those in the tCBT condition. There was no differential impact of treatment condition on subjective speech anxiety or working memory task performance. Potential mediators and moderators of treatment were also examined. Results provide support for a brief 90-minute intervention for public speaking anxiety, but more research is needed in a study with a larger sample to fully understand the relationship between ABBT strategies and improvements in behavioral performance.
Gipson, Tanjala T.; Jennett, Heather; Wachtel, Lee; Gregory, Mary; Poretti, Andrea; Johnston, Michael V.
Background Self-injury and aggression have been reported in individuals with TSC (tuberous sclerosis complex), yet few data exist about treatment. Everolimus, an mTOR inhibitor, has been FDA-approved for subependymal giant cell astrocytomas (SEGAs) and renal angiomyolipomas in TSC. However, clinical use of everolimus with direct, real-time observations of self-injury and aggression in an individual with TSC has not been reported. Methods During an inpatient admission to a neurobehavioral unit, real-time measurements of behaviors and seizures were recorded. An interdisciplinary team used these data to make treatment decisions and applied behavioral and pharmacological treatments, one at a time, in order to evaluate their effects. Results Aggression and self-injury improved with applied behavioral analysis (ABA), lithium, and asenapine. Improvements in SEGA size, facial angiofibromas, seizures, and the most stable low rates of self-injury were observed during the interval of treatment with everolimus. Conclusion Mechanism-based treatments in the setting of an evidence-based behavioral and psychopharmacological intervention program may be a model with utility for characterization and treatment of individuals with severe behavior and TSC. PMID:25667844
Xu, Xiao; Yonkers, Kimberly A.; Ruger, Jennifer P.
Objectives To determine and compare costs of a nurse-administered behavioral intervention for pregnant substance users that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) to brief advice (BA) administered by an obstetrical provider. Both interventions were provided concurrent with prenatal care. Methods We conducted a micro-costing study that prospectively collected detailed resource utilization and unit cost data for each of the two intervention arms (MET-CBT and BA) within the context of a randomized controlled trial. A three-step approach for identifying, measuring and valuing resource utilization was used. All cost estimates were inflation adjusted to 2011 U.S. dollars. Results A total of 82 participants received the MET-CBT intervention and 86 participants received BA. From the societal perspective, the total cost (including participants’ time cost) of the MET-CBT intervention was $120,483 or $1,469 per participant. In contrast, the total cost of the BA intervention was $27,199 or $316 per participant. Personnel costs (nurse therapists and obstetric providers) for delivering the intervention sessions and supervising the program composed the largest share of the MET-CBT intervention costs. Program set up costs, especially intervention material design and training costs, also contributed substantially to the overall cost. Conclusions Implementation of an MET-CBT program to promote drug abstinence in pregnant women is associated with modest costs. Future cost effectiveness and cost benefit analyses integrating costs with outcomes and benefits data will enable a more comprehensive understanding of the intervention in improving the care of substance abusing pregnant women. PMID:24760017
Washington, Karla T.; Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Baldwin, Paula K.; Tappana, Jessica; Wright, Jesse H.; Demiris, George
Hospice family caregivers experience significantly higher rates of psychological distress than demographically similar noncaregivers. Interventions based on cognitive–behavioral therapy have been shown to reduce psychological distress in the general population by providing tools to modify thinking patterns that directly affect emotions and behavior. Such interventions might reasonably be incorporated into hospice social work; however, numerous contextual factors must be taken into account to ensure that any interventions are appropriate to the unique needs of clients. The purpose of the study discussed in this article was to contextualize one aspect of the cognitive–behavioral model based on firsthand accounts of hospice family caregivers. Following a modified grounded theory approach, researchers engaged in a secondary analysis of data from a larger study provided in a subsample of 90 audio-recorded conversations between hospice family caregivers and interventionists. Findings indicated that distressed caregivers engaged in five dominant thinking patterns: (1) “should” statements, (2) catastrophizing or minimizing, (3) personalizing, (4) absolute thinking, and (5) making assumptions. Implementing cognitive–behavioral therapies based on identified caregiver thinking patterns will allow hospice social workers to empower caregivers to cope more effectively with the numerous stressors they encounter while caring for a dying loved one. PMID:25369725
Harned, Melanie S.; Linehan, Marsha M.
Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat…
Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy disorders Affective disorders Cognitive therapy Affect a b s t r a c t Major depressive disorder (MDD in revised form 24 August 2010 Accepted 11 September 2010 Keywords: Event-related fMRI Depression Mood
Kim, Jinah; Wigram, Tony; Gold, Christian
The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized…
Haarhoff, Beverly A.; Kazantzis, Nikolaos
Encouraging and facilitating homework completion is a core cognitive behavior therapy (CBT) skill. Consequently, it represents an important part of training practitioners. Oftentimes the process of integrating homework into therapy is rushed, poorly executed, or forgotten, and trainees are surprised to find that some patients do not complete…
Young, Brittany M.; Nigogosyan, Zack; Walton, Léo M.; Song, Jie; Nair, Veena A.; Grogan, Scott W.; Tyler, Mitchell E.; Edwards, Dorothy F.; Caldera, Kristin; Sattin, Justin A.; Williams, Justin C.; Prabhakaran, Vivek
This study aims to examine the changes in task-related brain activity induced by rehabilitative therapy using brain-computer interface (BCI) technologies and whether these changes are relevant to functional gains achieved through the use of these therapies. Stroke patients with persistent upper-extremity motor deficits received interventional rehabilitation therapy using a closed-loop neurofeedback BCI device (n = 8) or no therapy (n = 6). Behavioral assessments using the Stroke Impact Scale, the Action Research Arm Test (ARAT), and the Nine-Hole Peg Test (9-HPT) as well as task-based fMRI scans were conducted before, during, after, and 1 month after therapy administration or at analogous intervals in the absence of therapy. Laterality Index (LI) values during finger tapping of each hand were calculated for each time point and assessed for correlation with behavioral outcomes. Brain activity during finger tapping of each hand shifted over the course of BCI therapy, but not in the absence of therapy, to greater involvement of the non-lesioned hemisphere (and lesser involvement of the stroke-lesioned hemisphere) as measured by LI. Moreover, changes from baseline LI values during finger tapping of the impaired hand were correlated with gains in both objective and subjective behavioral measures. These findings suggest that the administration of interventional BCI therapy can induce differential changes in brain activity patterns between the lesioned and non-lesioned hemispheres and that these brain changes are associated with changes in specific motor functions. PMID:25076886
Young, Brittany M; Nigogosyan, Zack; Walton, Léo M; Song, Jie; Nair, Veena A; Grogan, Scott W; Tyler, Mitchell E; Edwards, Dorothy F; Caldera, Kristin; Sattin, Justin A; Williams, Justin C; Prabhakaran, Vivek
This study aims to examine the changes in task-related brain activity induced by rehabilitative therapy using brain-computer interface (BCI) technologies and whether these changes are relevant to functional gains achieved through the use of these therapies. Stroke patients with persistent upper-extremity motor deficits received interventional rehabilitation therapy using a closed-loop neurofeedback BCI device (n = 8) or no therapy (n = 6). Behavioral assessments using the Stroke Impact Scale, the Action Research Arm Test (ARAT), and the Nine-Hole Peg Test (9-HPT) as well as task-based fMRI scans were conducted before, during, after, and 1 month after therapy administration or at analogous intervals in the absence of therapy. Laterality Index (LI) values during finger tapping of each hand were calculated for each time point and assessed for correlation with behavioral outcomes. Brain activity during finger tapping of each hand shifted over the course of BCI therapy, but not in the absence of therapy, to greater involvement of the non-lesioned hemisphere (and lesser involvement of the stroke-lesioned hemisphere) as measured by LI. Moreover, changes from baseline LI values during finger tapping of the impaired hand were correlated with gains in both objective and subjective behavioral measures. These findings suggest that the administration of interventional BCI therapy can induce differential changes in brain activity patterns between the lesioned and non-lesioned hemispheres and that these brain changes are associated with changes in specific motor functions. PMID:25076886
Grilo, Carlos M.; Masheb, Robin M.; Wilson, G. Terence; Gueorguieva, Ralitza; White, Marney A.
Objective: Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).…
Miller, Natalie V.; Haas, Sarah M.; Waschbusch, Daniel A.; Willoughby, Michael T.; Helseth, Sarah A.; Crum, Kathleen I.; Coles, Erika K.; Pelham, William E.
The conduct problems of children with callous-unemotional traits (i.e., lack of empathy, guilt/lack of caring behaviors) (CU) are particularly resistant to current behavioral interventions, and it is possible that differential sensitivities to punishment and reward may underlie this resistance. Children with conduct problems and CU (CPCU) are less responsive to behavioral punishment techniques (e.g., time-out), however reward techniques (e.g., earning points for prizes or activities) are effective for reducing conduct problems. This study examined the efficacy of modified behavioral interventions, which de-emphasized punishment (condition B) and emphasized reward techniques (condition C), compared to a standard behavioral intervention (condition A). Interventions were delivered through a Summer Treatment Program over seven weeks with an A-B-A-C-A-BC-A design to a group of eleven children (7–11 years; 91% male). All children were diagnosed with either oppositional defiant disorder or conduct disorder, in addition to attention-deficit/hyperactivity disorder. Results revealed the best treatment response occurred during the low punishment condition, with rates of negative behavior (e.g., aggression, teasing, stealing) increasing over the seven weeks. However, there was substantial individual variability in treatment response, and several children demonstrated improvement during the modified intervention conditions. Future research is necessary to disentangle treatment effects from order effects, and implications of group treatment of CPCU children (i.e., deviancy training) are discussed. PMID:25022772
Rickson, Daphne J; Watkins, William G
This pilot study was undertaken to investigate whether music therapy is effective in promoting prosocial behaviors in aggressive adolescent boys who have social, emotional, and learning difficulties. Fifteen subjects (aged 11-15 years), enrolled at a special residential school in New Zealand, were randomly assigned to music therapy treatment groups (n = 6, n = 5), and a waitlist control group (n = 4). Examination of demographic data identified differences between groups for diagnosis (p =.044), with Group 1 all having Attention Deficit Hyperactivity Disorder (ADHD), and for age (p =.027), with Group 2 having a mean age 1.38 years older. Measures included parent and teacher versions of the Developmental Behaviour Checklist (DBC-P & DBC-T) (Einfeld & Tonge, 1994; Einfeld, Tonge, & Parmenter, 1998). While no definite treatment effects could be detected, results suggest that a music therapy program promoting autonomy and creativity may help adolescents to interact more appropriately with others in a residential villa setting, but might also lead to a temporary mild increase in disruptive behavior in the classroom. A more highly structured program and smaller group numbers may be advantageous for boys who have ADHD. PMID:15015908
Landowska, A.; Karpienko, K.; Wróbel, M.; Jedrzejewska-Szczerska, M.
In this article the procedure of selection of physiological parameters for optoelectronic system supporting behavioral therapy of autistic children is proposed. Authors designed and conducted an experiment in which a group of 30 health volunteers (16 females and 14 males) were examined. Under controlled conditions people were exposed to a stressful situation caused by the picture or sound (1kHz constant sound, which was gradually silenced and finished with a shot sound). For each of volunteers, a set of physiological parameters were recorded, including: skin conductance, heart rate, peripheral temperature, respiration rate and electromyography. The selected characteristics were measured in different locations in order to choose the most suitable one for the designed therapy supporting system. The bio-statistical analysis allowed us to discern the proper physiological parameters that are most associated to changes due to emotional state of a patient, such as: skin conductance, temperatures and respiration rate. This allowed us to design optoelectronic sensors network for supporting behavioral therapy of children with autism.
Lackner, Jeffrey M.; Jaccard, James; Krasner, Susan S.; Katz, Leonard A.; Gudleski, Gregory D.; Holroyd, Kenneth
Background and Aims Given the limitations of conventional therapies and restrictions imposed on newer pharmacological agents, there is an urgent need to develop efficacious and efficient treatments that teach patients behavioral self management skills for relieving irritable bowel syndrome (IBS) symptoms and associated problems. Method 75 Rome II diagnosed IBS patients (86% female) without comorbid GI disease were recruited from local physicians and the community and randomized to either 2 versions of cognitive behavior therapy (10 session, therapist administered CBT vs. 4 session, patient administered CBT) or a wait list comparison (WLC) that controlled for threats to internal validity Final assessment occurred two weeks after the 10 week treatment phase ends. Outcome measures included adequate relief from pain and bowel symptoms; global improvement of IBS symptoms (CGI-Improvement Scale); IBS symptom severity (IBS SSS); quality of life (IBSQOL); psychological distress (Brief Symptom Inventory); patient satisfaction (Client Satisfaction Scale). Results At week 12, both CBT versions were significantly (p < .0001) superior to WLC in the percentage of participants reporting adequate relief (e.g., MC-CBT = 72%, S-CBT = 60.9%, WLC = 7.4%) and improvement of symptoms. CBT treated patients reported significantly improved quality of life and IBS symptom severity but not psychological distress than WL patients (p < .0001) Conclusions Data from this pilot study lend preliminary empirical support to a brief patient administered CBT regimen capable of providing short term relief from IBS symptoms largely unresponsive to conventional therapies. PMID:18524691
Savaskan, Egemen; Bopp-Kistler, Irene; Buerge, Markus; Fischlin, Regina; Georgescu, Dan; Giardini, Umberto; Hatzinger, Martin; Hemmeter, Ulrich; Justiniano, Isabella; Kressig, Reto W; Monsch, Andreas; Mosimann, Urs P; Mueri, Renè; Munk, Anna; Popp, Julius; Schmid, Ruth; Wollmer, Marc A
In patients with dementia, Behavioral and Psychological Symptoms of Dementia (BPSD) are frequent findings that accompany deficits caused by cognitive impairment and thus complicate diagnostics, therapy and care. BPSD are a burden both for affected individuals as well as care-givers, and represent a significant challenge for therapy of a patient population with high degree of multi-morbidity. The goal of this therapy-guideline issued by swiss professional associations is to present guidance regarding therapy of BPSD as attendant symptoms in dementia, based on evidence as well as clinical experience. Here it appears to be of particular importance to take into account professional experience, as at this point for most therapeutic options no sufficiently controlled clinical trials are available. A critical discussion of pharmaco-therapeutic intervention is necessary, as this patient-population is particularly vulnerable for medication side-effects. Finally, a particular emphasis is placed on incorporating and systematically reporting psycho-social and nursing options therapeutic intervention. PMID:24468453
Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Stangier, Ulrich
The evaluation of treatment integrity (therapist adherence and competence) is a necessary condition to ensure the internal and external validity of psychotherapy research. However, the evaluation process is associated with high costs, because therapy sessions must be rated by experienced clinicians. It is debatable whether rating session segments is an adequate alternative to rating entire sessions. Four judges evaluated treatment integrity (i.e., therapist adherence and competence) in 84 randomly selected videotapes of cognitive-behavioral therapy for major depressive disorder, social anxiety disorder, and hypochondriasis (from three different treatment outcome studies). In each case, two judges provided ratings based on entire therapy sessions and two on session segments only (i.e., the middle third of the entire sessions). Interrater reliability of adherence and competence evaluations proved satisfactory for ratings based on segments and the level of reliability did not differ from ratings based on entire sessions. Ratings of treatment integrity that were based on entire sessions and session segments were strongly correlated (r=.62 for adherence and r=.73 for competence). The relationship between treatment integrity and outcome was comparable for ratings based on session segments and those based on entire sessions. However, significant relationships between therapist competence and therapy outcome were only found in the treatment of social anxiety disorder. Ratings based on segments proved to be adequate for the evaluation of treatment integrity. The findings demonstrate that session segments are an adequate and cost-effective alternative to entire sessions for the evaluation of therapist adherence and competence. PMID:24912466
Craske, Michelle G; Niles, Andrea N.; Burklund, Lisa J.; Wolitzky-Taylor, Kate B.; Vilardaga, Jennifer C. Plumb; Arch, Joanna J.; Saxbe, Darby E.; Lieberman, Matthew D.
Objective Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. Method The current study (N=87) was a 3-arm randomized clinical trial comparing CBT, Acceptance and Commitment therapy (ACT), and a waitlist control group (WL) in participants with a DSM-IV diagnosis of social phobia. Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and post-treatment, and participants assigned to CBT and ACT also completed assessments at 6 and 12 months following baseline. Assessments consisted of self-report measures, a public speaking task, and clinician ratings. Results Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-mo follow-up in CBT compared to ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control, and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. Conclusions Implications for clinical practice and future research are discussed. PMID:24999670
Brooks, Alyssa T; Wallen, Gwenyth R
Sleep disturbances are common among alcohol-dependent individuals and are often associated with relapse. The utility of behavioral therapies for sleep disturbances, including cognitive-behavioral therapy for insomnia (CBT-I), among those with alcohol-related disorders is not well understood. This review systematically evaluates the evidence of CBT-I and related behavioral therapies applied to those with alcohol-related disorders and accompanying sleep disturbances. A search of four research databases (PubMed, PsycINFO, Embase, and CINAHL Plus) yielded six studies that met selection criteria. Articles were reviewed using Cochrane’s Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. A majority of the studies demonstrated significant improvements in sleep efficiency among behavioral therapy treatment group(s), including but not limited to CBT-I. While behavioral sleep interventions have been successful in varied populations, they may not be utilized to their full potential among those with alcohol-related disorders as evidenced by the low number of studies found. These findings suggest a need for mixed-methods research on individuals’ sleep experience to inform interventions that are acceptable to the target population. PMID:25288884
Kaczkurkin, Antonia N.; Foa, Edna B.
A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia. The purpose of the current article is to provide an overview of two of the most commonly used CBT methods used to treat anxiety disorders (exposure and cognitive therapy) and to summarize and discuss the current empirical research regarding the usefulness of these techniques for each anxiety disorder. Additionally, we discuss the difficulties that arise when comparing active CBT treatments, and we suggest directions for future research. Overall, CBT appears to be both efficacious and effective in the treatment of anxiety disorders, but dismantling studies are needed to determine which specific treatment components lead to beneficial outcomes and which patients are most likely to benefit from these treatment components. PMID:26487814
Harwood, Michelle D; Eyberg, Sheila M
We examined the role of specific therapist verbal behaviors in predicting successful completion of Parent-Child Interaction Therapy (PCIT) in 22 families, including 11 families that successfully completed treatment and 11 that discontinued treatment prematurely. The children were 3 to 6 years old and diagnosed with oppositional defiant disorder (ODD). Chamberlain et al.'s (1986) Therapy Process Code (TPC) was used to measure therapist verbalizations during therapist-parent interactions during the initial clinical interview and the second treatment session. Results indicated that therapists' use of the categories Question, Facilitate, and Support during these sessions accurately predicted treatment dropout versus completion for 73% of families. Findings suggest that the early therapist-parent relationship in PCIT may be critical to successful treatment completion. PMID:15271617
Baucom, Katherine J. W.; Sevier, Mia; Eldridge, Kathleen A.; Doss, Brian D.; Christensen, Andrew
Objective: To examine changes in observed communication after therapy termination in distressed couples from a randomized clinical trial. Method: A total of 134 distressed couples were randomly assigned to either traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979) or integrative behavioral couple therapy (IBCT; Jacobson &…
Mewton, Louise; Smith, Jessica; Rossouw, Pieter; Andrews, Gavin
The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years), as compared with waiting list or active control. The included studies were identified from Medline searches and from reference lists, and only published data were included. Several trials of iCBT for generalized anxiety disorder, panic disorder, and social phobia were identified. Two trials of iCBT for obsessive-compulsive disorder were identified, whilst one trial each was identified for hypochondriasis, specific phobia (spiders), and post-traumatic stress disorder. Finally, there were five trials that focused on transdiagnostic therapy for either a range of comorbid anxiety disorders or comorbid anxiety and depression. Between-group effect sizes were moderate to large for all disorders, and ranged from 0.30 to 2.53. iCBT was found to be commensurate with face-to-face cognitive behavioral therapy whether delivered individually or in group format. Guidance may not be necessary for iCBT to be effective for immediate gains, but may be more important in longer-term maintenance of symptom improvement and maximizing patient adherence. The clinical experience of the individual providing guidance does not appear to impact treatment outcomes. Future research needs to focus on the optimal level of guidance required to generate maximum patient benefits, whilst balancing the efficient use of clinician time and resources. Evidence-based contraindications to iCBT should also be developed so that the choice of treatment modality accurately reflects patients’ needs. Further research should be conducted into the effective elements of iCBT, as well as the extent to which therapy enhancers and advancing technology can be accommodated into established iCBT frameworks. PMID:24511246
Mewton, Louise; Smith, Jessica; Rossouw, Pieter; Andrews, Gavin
The aim of the current review is to provide a summary of research into Internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. We include 37 randomized controlled trials that examined the efficacy of iCBT programs in adults (aged over 18 years), as compared with waiting list or active control. The included studies were identified from Medline searches and from reference lists, and only published data were included. Several trials of iCBT for generalized anxiety disorder, panic disorder, and social phobia were identified. Two trials of iCBT for obsessive-compulsive disorder were identified, whilst one trial each was identified for hypochondriasis, specific phobia (spiders), and post-traumatic stress disorder. Finally, there were five trials that focused on transdiagnostic therapy for either a range of comorbid anxiety disorders or comorbid anxiety and depression. Between-group effect sizes were moderate to large for all disorders, and ranged from 0.30 to 2.53. iCBT was found to be commensurate with face-to-face cognitive behavioral therapy whether delivered individually or in group format. Guidance may not be necessary for iCBT to be effective for immediate gains, but may be more important in longer-term maintenance of symptom improvement and maximizing patient adherence. The clinical experience of the individual providing guidance does not appear to impact treatment outcomes. Future research needs to focus on the optimal level of guidance required to generate maximum patient benefits, whilst balancing the efficient use of clinician time and resources. Evidence-based contraindications to iCBT should also be developed so that the choice of treatment modality accurately reflects patients' needs. Further research should be conducted into the effective elements of iCBT, as well as the extent to which therapy enhancers and advancing technology can be accommodated into established iCBT frameworks. PMID:24511246
Pelham, W E; Schnedler, R W; Bologna, N C; Contreras, J A
Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observation of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, high-lighting the importance of behavioral parent training in the treatment of hyperactivity. PMID:7380749
O'Callaghan, Paul; McMullen, John; Shannon, Ciaran; Rafferty, Harry; Black, Alastair
Objective: To assess the efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) delivered by nonclinical facilitators in reducing posttraumatic stress, depression, and anxiety and conduct problems and increasing prosocial behavior in a group of war-affected, sexually exploited girls in a single-blind, parallel-design, randomized,…
Taylor, Leslie K.; Weems, Carl F.
Youth traumatized by natural disasters report high levels of posttraumatic stress such as symptoms of posttraumatic stress disorder, other anxiety disorders, and depression. Research suggests that cognitive behavioral therapies are promising interventions for symptom reduction; however, few cognitive behavioral treatments have been systematically…
Ang, Dennis C.; Jensen, Mark P.; Steiner, Jennifer L.; Hilligoss, Janna; Gracely, Richard H.; Saha, Chandan
Objectives To evaluate the feasibility of a randomized-controlled trial (RCT) and to obtain estimates of the effects of combined cognitive behavioral therapy (CBT) and milnacipran for the treatment of fibromyalgia (FM). Methods Fifty eight patients with FM were randomized to one of the 3 treatment arms: (1) combination therapy (n=20), (2) milnacipran + education (n=19), and (3) placebo + CBT (n=19). Subjects received either milnacipran (100 mg/day) or placebo. Subjects also received 8 sessions of phone-delivered CBT or educational instructions, but only from baseline to week 9. Assessments were conducted at baseline, week 9 and 21. The primary endpoints were baseline to week 21 changes in weekly average pain intensity and physical function (SF-36 physical function scale). Results Compared to milnacipran, combination therapy demonstrated a moderate effect on improving SF-36 physical function (mean difference (SE) = 9.42 (5.48), p=0.09, effect size (ES) =0.60) and in reducing weekly average pain intensity (mean difference (SE) = ?1.18 (0.62), p=0.07, ES=0.67). Compared to milnacipran, CBT had a moderate to large effect in improving SF-36 physical function (mean difference (SE) = 11.0 (5.66), p=0.06, ES=0.70). Despite the presence of concomitant centrally-acting therapies, dropout rate was lower than anticipated (15% at week 21). Importantly, at least 6 out of the 8 phone-based therapy sessions were successfully completed by 89% of the subjects; and adherence to the treatment protocols was >95%. Conclusions In this pilot study, a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable. Moreover, the preliminary data supports conducting a fully powered RCT. PMID:23446065
Weersing, V Robin; Iyengar, Satish; Kolko, David J; Birmaher, Boris; Brent, David A
In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples. PMID:16942959
O’Kelly, Julian; James, L.; Palaniappan, R.; Taborin, J.; Fachner, J.; Magee, W. L.
Assessment of awareness for those with disorders of consciousness is a challenging undertaking, due to the complex presentation of the population. Debate surrounds whether behavioral assessments provide greatest accuracy in diagnosis compared to neuro-imaging methods, and despite developments in both, misdiagnosis rates remain high. Music therapy may be effective in the assessment and rehabilitation with this population due to effects of musical stimuli on arousal, attention, and emotion, irrespective of verbal or motor deficits. However, an evidence base is lacking as to which procedures are most effective. To address this, a neurophysiological and behavioral study was undertaken comparing electroencephalogram (EEG), heart rate variability, respiration, and behavioral responses of 20 healthy subjects with 21 individuals in vegetative or minimally conscious states (VS or MCS). Subjects were presented with live preferred music and improvised music entrained to respiration (procedures typically used in music therapy), recordings of disliked music, white noise, and silence. ANOVA tests indicated a range of significant responses (p???0.05) across healthy subjects corresponding to arousal and attention in response to preferred music including concurrent increases in respiration rate with globally enhanced EEG power spectra responses (p?=?0.05–0.0001) across frequency bandwidths. Whilst physiological responses were heterogeneous across patient cohorts, significant post hoc EEG amplitude increases for stimuli associated with preferred music were found for frontal midline theta in six VS and four MCS subjects, and frontal alpha in three VS and four MCS subjects (p?=?0.05–0.0001). Furthermore, behavioral data showed a significantly increased blink rate for preferred music (p?=?0.029) within the VS cohort. Two VS cases are presented with concurrent changes (p???0.05) across measures indicative of discriminatory responses to both music therapy procedures. A third MCS case study is presented highlighting how more sensitive selective attention may distinguish MCS from VS. The findings suggest that further investigation is warranted to explore the use of music therapy for prognostic indicators, and its potential to support neuroplasticity in rehabilitation programs. PMID:24399950
Beidas, Rinad S.; Mychailyszyn, Matthew P.; Podell, Jennifer L.; Kendall, Philip C.
We provide a detailed description of the clinical application of brief cognitive-behavioral therapy (BCBT) for anxious youth. A rationale for the development of BCBT is presented, followed by a description and discussion of the 8 sessions of the treatment. Mike, a 7-year-old youth with anxiety disorders, is used to illustrate the inner workings of implementing BCBT. Case conceptualization, session details, and pre-, post- and follow-up-treatment information are provided. Conclusions regarding clinical advantages and future directions are made. PMID:25083131
Spofford, Christopher M; McLaughlin, Nicole C R; Penzel, Fred; Rasmussen, Steven A; Greenberg, Benjamin D
We report the case of a patient requiring gamma ventral capsulotomy (GVC), a neurosurgical intervention to address severe refractory obsessive-compulsive disorder (OCD). GVC involves stereotactic lesions in the ventral anterior limb of the internal capsule and adjacent ventral striatum. This study details the course of an extinction-based behavioral therapy, namely exposure and response prevention (ERP). The patient experienced significant changes in motivation and ability to tolerate ERP post-surgery. Furthermore, he was better able to absorb and remember exposure sessions. GVC surgery may affect the neural mechanisms involved in the extinction learning process, the same process implicated in ERP treatment. PMID:23057416
In this study, the spin coating of template-assisted method is used to synthesize poly[2,7-(9,9-dioctylfluorene)-alt-4,7-bis(thiophen-2-yl)benzo-2,1,3-thiadiazole] (PFO-DBT) nanorod bundles. The morphological, structural, and optical properties of PFO-DBT nanorod bundles are enhanced by varying the spin coating rate (100, 500, and 1,000 rpm) of the common spin coater. The denser morphological distributions of PFO-DBT nanorod bundles are favorably yielded at the low spin coating rate of 100 rpm, while at high spin coating rate, it is shown otherwise. The auspicious morphologies of highly dense PFO-DBT nanorod bundles are supported by the augmented absorption and photoluminescence. PMID:24872806
Essential Functions/Standards for the Occupational Therapy Assistant Student The following standards pertain to particular cognitive, motor, behavioral and social skills that are associated Standards: A. Practice occupational therapy assistant skills and techniques under the supervision
Konanur, Sheila; Muller, Robert T; Cinamon, Julie S; Thornback, Kristin; Zorzella, Karina P M
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a widely used treatment model for trauma-exposed children and adolescents (Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program (HCP) was a multi-site community based intervention carried out in a diverse Canadian city. A randomized, waitlist-control design was used to evaluate the effectiveness of TF-CBT with trauma-exposed school-aged children (Muller & DiPaolo, 2008). A total of 113 children referred for clinical services and their caregivers completed the Trauma Symptom Checklist for Children (Briere, 1996) and the Trauma Symptom Checklist for Young Children (Briere, 2005). Data were collected pre-waitlist, pre-assessment, pre-therapy, post-therapy, and six months after the completion of TF-CBT. The passage of time alone in the absence of clinical services was ineffective in reducing children's posttraumatic symptoms. In contrast, children and caregivers reported significant reductions in children's posttraumatic stress (PTS) following assessment and treatment. The reduction in PTS was maintained at six month follow-up. Findings of the current study support the use of the TF-CBT model in community-based settings in a diverse metropolis. Clinical implications are discussed. PMID:26318778
Cornelius, Jack R.; Douaihy, Antoine; Bukstein, Oscar G.; Daley, Dennis C.; Wood, D. Scott; Kelly, Thomas M.; Salloum, Ihsan M.
Objective Behavioral therapies developed specifically for co-occurring disorders remain sparse, and such therapies for comorbid adolescents are particularly rare. This was an evaluation of the long-term (2-year) efficacy of an acute phase trial of manualized cognitive behavioral therapy/motivation enhancement therapy (CBT/MET) versus naturalistic treatment among adolescents who had signed consent for a treatment study involving the SSRI antidepressant medication fluoxetine and CBT/MET therapy for comorbid major depressive disorder (MDD) and an alcohol use disorder (AUD). We hypothesized that improvements in depressive symptoms and alcohol-related symptoms noted among the subjects who had received CBT/MET would exceed that of those in the naturalistic comparison group that had not received CBT/MET therapy. Methods We evaluated levels of depressive symptoms and alcohol-related symptoms at a two-year follow-up evaluation among comorbid MDD/AUD adolescents who had received an acute phase trial of manual-based CBT/MET (in addition to the SSRI medication fluoxetine or placebo) compared to those who had received naturalistic care. Results In repeated measures ANOVA, a significant time by enrollment status difference was noted for both depressive symptoms and alcohol-related symptoms across the two-year time period of this study, with those receiving CBT/MET demonstrating superior outcomes compared to those who had not received protocol CBT/MET therapy. No significant difference was noted between those receiving fluoxetine versus those receiving placebo on any outcome at any time point. Conclusions These findings suggest long-term efficacy for an acute phase trial of manualized CBT/MET for treating comorbid MDD/AUD adolescents. Large multi-site studies are warranted to further clarify the efficacy of CBT/MET therapy among various adolescent and young adult comorbid populations. PMID:21530092
Onifer, Stephen M.; Reed, William R.; Sozio, Randall S.; Long, Cynthia R.
Optimizing pain relief resulting from spinal manipulative therapies, including low velocity variable amplitude spinal manipulation (LVVA-SM), requires determining their mechanisms. Pain models that incorporate simulated spinal manipulative therapy treatments are needed for these studies. The antinociceptive effects of a single LVVA-SM treatment on rat nociceptive behavior during the commonly used formalin test were investigated. Dilute formalin was injected subcutaneously into a plantar hindpaw. Licking behavior was video-recorded for 5 minutes. Ten minutes of LVVA-SM at 20° flexion was administered with a custom-made device at the lumbar (L5) vertebra of isoflurane-anesthetized experimental rats (n = 12) beginning 10 minutes after formalin injection. Hindpaw licking was video-recorded for 60 minutes beginning 5 minutes after LVVA-SM. Control rats (n = 12) underwent the same methods except for LVVA-SM. The mean times spent licking the formalin-injected hindpaw of both groups 1–5 minutes after injection were not different. The mean licking time during the first 20 minutes post-LVVA-SM of experimental rats was significantly less than that of control rats (P < 0.001). The mean licking times of both groups during the second and third 20 minutes post-LVVA-SM were not different. Administration of LVVA-SM had a short-term, remote antinociceptive effect similar to clinical findings. Therefore, mechanistic investigations using this experimental approach are warranted. PMID:26693243
Budney, Alan J.; Stanger, Catherine; Tilford, J. Mick; Scherer, Emily; Brown, Pamela C.; Li, Zhongze; Li, Zhigang; Walker, Denise
Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), i.e., motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% African Americans, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials. PMID:25938629
Budney, Alan J; Stanger, Catherine; Tilford, J Mick; Scherer, Emily B; Brown, Pamela C; Li, Zhongze; Li, Zhigang; Walker, Denise D
Computer-assisted behavioral treatments hold promise for enhancing access to and reducing costs of treatments for substance use disorders. This study assessed the efficacy of a computer-assisted version of an efficacious, multicomponent treatment for cannabis use disorders (CUD), that is, motivational enhancement therapy, cognitive-behavioral therapy, and abstinence-based contingency-management (MET/CBT/CM). An initial cost comparison was also performed. Seventy-five adult participants, 59% Black, seeking treatment for CUD received either, MET only (BRIEF), therapist-delivered MET/CBT/CM (THERAPIST), or computer-delivered MET/CBT/CM (COMPUTER). During treatment, the THERAPIST and COMPUTER conditions engendered longer durations of continuous cannabis abstinence than BRIEF (p < .05), but did not differ from each other. Abstinence rates and reduction in days of use over time were maintained in COMPUTER at least as well as in THERAPIST. COMPUTER averaged approximately $130 (p < .05) less per case than THERAPIST in therapist costs, which offset most of the costs of CM. Results add to promising findings that illustrate potential for computer-assisted delivery methods to enhance access to evidence-based care, reduce costs, and possibly improve outcomes. The observed maintenance effects and the cost findings require replication in larger clinical trials. (PsycINFO Database Record PMID:25938629
Lynk, Michelle; McCay, Elizabeth; Carter, Celina; Aiello, Andria; Donald, Faith
Objective: The objective of this secondary analysis was to identify factors associated with engagement of street-involved youth in a Dialectical Behavioural Therapy (DBT) intervention. Methods: This was a cross-sectional correlational study. Youth were recruited from two agencies providing services to street-involved youth in Canada. Mental health indicators were selected for this secondary analysis to gain a better understanding of characteristics that may account for levels of engagement. Results: Three distinct groups of participants were identified in the data, a) youth who expressed intention to engage, but did not start DBT (n=16); b) youth who started DBT but subsequently dropped out (n=39); and c) youth who completed the DBT intervention (n=67). Youth who did engage in the DBT intervention demonstrated increased years of education; increased depressive symptoms and suicidality; and lower levels of resilience and self-esteem compared to youth participants who did not engage in the intervention. Conclusions: These findings indicate that it is possible to engage street-involved youth in a DBT intervention who exhibit a high degree of mental health challenges. Despite the growing literature describing the difficult psychological and interpersonal circumstances of street-involved youth, there remains limited research regarding the process of engaging these youth in service. PMID:26379723
Compton, Scott; Thomsen, Per Hove; Weidle, Bernhard; Dahl, Kitty; Nissen, Judith Becker; Torp, Nor Christian; Hybel, Katja; Melin, Karin Holmgren; Valderhaug, Robert; Wentzel-Larsen, Tore; Ivarsson, Tord
Abstract Objective: The purpose of this study was to investigate whether the presence of tic disorder is negatively associated with sertraline (SRT) outcomes, but not with continued cognitive-behavioral therapy (CBT), in a sample of youth who were unresponsive to an initial full course of CBT. Methods: In the Nordic Long-Term OCD Study, children and adolescents with OCD who were rated as nonresponders to 14 weeks of open-label CBT were randomized to continued CBT (n=28) or SRT treatment (n=22) for an additional 16 weeks of treatment. We investigated whether the presence or absence of comorbid tic disorder moderated treatment outcomes on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Results: Twelve out of 50 (24.0%) participants were diagnosed with comorbid tic disorder, with 7 receiving continued CBT and 5 receiving SRT, respectively. In patients without tic disorder, results showed no significant between-group differences on average CY-BOCS scores. However, in patients with comorbid tic disorder, those who received SRT had significantly lower average CY-BOCS scores than those who received continued CBT. Conclusions: Children and adolescents with OCD and comorbid tic disorder, who are nonresponders to an initial 14 week course of CBT, may benefit more from a serotonin reuptake inhibitor (SRI) than from continued CBT. PMID:26091197
Hogue, Aaron; Dauber, Sarah; Henderson, Craig E; Bobek, Molly; Johnson, Candace; Lichvar, Emily; Morgenstern, Jon
A major focus of implementation science is discovering whether evidence-based approaches can be delivered with fidelity and potency in routine practice. This randomized trial compared usual care family therapy (UC-FT), implemented without a treatment manual or extramural support as the standard-of-care approach in a community clinic, to nonfamily treatment (UC-Other) for adolescent conduct and substance use disorders. The study recruited 205 adolescents (M age = 15.7 years; 52% male; 59% Hispanic American, 21% African American) from a community referral network, enrolling 63% for primary mental health problems and 37% for primary substance use problems. Clients were randomly assigned to either the UC-FT site or one of five UC-Other sites. Implementation data confirmed that UC-FT showed adherence to the family therapy approach and differentiation from UC-Other. Follow-ups were completed at 3, 6, and 12 months postbaseline. There was no between-group difference in treatment attendance. Both conditions demonstrated improvements in externalizing, internalizing, and delinquency symptoms. However, UC-FT produced greater reductions in youth-reported externalizing and internalizing among the whole sample, in delinquency among substance-using youth, and in alcohol and drug use among substance-using youth. The degree to which UC-FT outperformed UC-Other was consistent with effect sizes from controlled trials of manualized family therapy models. Nonmanualized family therapy can be effective for adolescent behavior problems within diverse populations in usual care, and it may be superior to nonfamily alternatives. PMID:25496283
Motzny, Nicole; Abraham, Christine M.; Yaffe, Donna; Seebach, Caryn L.; Devin, Clinton J.; Spengler, Dan M.; McGirt, Matthew J.; Aaronson, Oran S.; Cheng, Joseph S.; Wegener, Stephen T.
Background and Purpose Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral–based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone. Case Description Eight patients who underwent surgery for a lumbar degenerative condition completed the 6-session CBPT intervention. The intervention included empirically supported behavioral self-management, problem solving, and cognitive restructuring and relaxation strategies and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), postintervention (3 months after surgery), and at follow-up (6 months after surgery). Performance-based outcomes were tested at baseline and postintervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, 5-Chair Stand Test, and 10-Meter Walk Test. Outcomes Seven of the patients demonstrated a clinically significant reduction in pain, and all 8 of the patients had a clinically significant reduction in disability at 6-month follow-up. Improvement on the performance-based tests also was noted postintervention, with 5 patients demonstrating clinically meaningful change on the 10-Meter Walk Test. Discussion The findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the telephone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model. PMID:23599351
Hou, Yongmei; Hu, Peicheng; Liang, Yanping; Mo, Zhanyu
The objective of the study was to evaluate the effects of cognitive behavioral therapy [sleep-related behavior modification and progressive muscle relaxation on insomnia of maintenance hemodialysis (MHD) patients] on improving insomnia of MHD patients. 103 MHD patients complicated with insomnia were randomly assigned to treatment (n = 52) and control (n = 51) groups. The control group was treated with conventional hemodialysis, and the treatment group was additionally treated with cognitive behavioral therapy for 3 months (sleep-related behavior modification and progressive muscle relaxation). All cases were assessed by Symptom Checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) before and 2, 4, 6, 8, 10, and 12 weeks after treatment. Fifty-one patients in the treatment group and 47 patients in the control group completed the experiments. After treatment, the total mean scores were (1.94 ± 0.50/2.29 ± 0.31); scores of somatization, depression, anxiety, hostility, and additional items were (1.87 ± 0.58/2.56 ± 0.26), (2.25 ± 0.80/2.79 ± 0.50), (1.79 ± 0.26/2.37 ± 0.34), (1.71 ± 0.46/2.25 ± 0.43), and (1.91 ± 0.67/2.26 ± 0.59) in SCL-90, respectively. The total scores for PSQI were (12.63 ± 2.27/16.40 ± 2.16); scores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, hypnotics, and daytime dysfunction which were (1.98 ± 0.76/2.57 ± 0.58), (1.75 ± 0.59/2.60 ± 0.50), (2.10 ± 0.50/2.62 ± 0.53), (2.06 ± 0.47/2.57 ± 0.54), (2.04 ± 0.69/2.45 ± 0.72), (1.02 ± 0.79/1.51 ± 0.98), and (1.69 ± 0.55/2.09 ± 0.58), respectively, were significantly lower in the treatment group compared with the control group. However, there were no significant differences in the scores of factors of obsessive-compulsive (2.26 ± 0.62/2.32 ± 0.38), interpersonal sensitivity (2.23 ± 0.64/2.43 ± 0.47), phobic anxiety (1.98 ± 0.62/2.01 ± 0.67), paranoid ideation (1.55 ± 0.43/1.69 ± 0.39), and psychoticism (1.57 ± 0.46/1.66 ± 0.49). The conclusion is that sleep-related behavior modification in combination with progressive muscle relaxation effectively improved the mental state and sleep quality of MHD patients with insomnia. PMID:24577747
Garland, Sheila N; Johnson, Jillian A; Savard, Josee; Gehrman, Philip; Perlis, Michael; Carlson, Linda; Campbell, Tavis
Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care. PMID:24971014
Newman, Cory F
The delivery of cognitive-behavioral therapy (CBT) is described in terms of foundational and functional competencies, with additional attention paid to how these skills are applied in clinical supervision. Foundational competencies include such qualities as ethical behavior, good interpersonal relational skills, a healthy capacity for self-awareness and self-correction, cross-cultural sensitivity, and an appreciation for the empirical basis of clinical procedures. Functional competencies include the ability to think like an empiricist and to teach clients to do the same, to conceptualize cases in terms of maladaptive beliefs and behavioral patterns, to structure sessions in an organized and time-effective manner, and to assign and review homework assignments. CBT supervisors have the multiple responsibilities of serving as professional role models for their supervisees, nurturing the latter's professional development (although also being ready to identify and remediate problems in the supervisee's performance), and engaging in ongoing self-improvement and education to function most effectively as clinical mentors. A brief, descriptive supervisory vignette is presented. PMID:22401996
Battagliese, Gemma; Caccetta, Maria; Luppino, Olga Ines; Baglioni, Chiara; Cardi, Valentina; Mancini, Francesco; Buonanno, Carlo
Externalizing disorders are the most common and persistent forms of maladjustment in childhood. The aim of this study was to conduct a meta-analysis evaluating the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce externalizing symptoms in two disorders: Attention Deficit Hyperactivity Disorder (ADHD) and Oppositive Defiant Disorder (ODD). The efficacy of CBT to improve social competence and positive parenting and reduce internalizing behaviors, parent stress and maternal depression was also explored. The database PsycInfo, PsycARTICLES, Medline and PubMed were searched to identify relevant studies. Twenty-one trials met the inclusion criteria. Results showed that the biggest improvement, after CBT, was in ODD symptoms (-0.879) followed by parental stress (-0.607), externalizing symptoms (-0.52), parenting skills (-0.381), social competence (-0.390) and ADHD symptoms (-0.343). CBT was also associated with improved attention (-0.378), aggressive behaviors (-0.284), internalizing symptoms (-0.272) and maternal depressive symptoms (-0.231). Overall, CBT is an effective treatment option for externalizing disorders and is also associated with reduced parental distress and maternal depressive symptoms. Multimodal treatments targeting both children and caregivers' symptoms (e.g. maternal depressive symptoms) appear important to produce sustained and generalized benefits. PMID:26575979
Blocher, Jacquelyn B.; Fujikawa, Mayu; Sung, Connie; Jackson, Daren C.; Jones, Jana E.
Anxiety disorders are prevalent in children with epilepsy. The purpose of this study was to evaluate the efficacy, adaptability, and feasibility of a manual-based, computer-assisted cognitive behavioral therapy (CBT) intervention for anxiety disorders in children with epilepsy. Fifteen anxious youth (aged 8–13 years) with epilepsy completed 12 weeks of manualized computer-assisted CBT. Children and parents completed a semi-structured interview at baseline, and questionnaires assessing symptoms of anxiety, depression, and behavior problems were completed prior to treatment, at treatment midpoint, after treatment completion, and three months post treatment. There were significant reductions in symptoms of anxiety and depression reported by the children at completion of the intervention and at the three-month follow-up. Similarly, parents reported fewer symptoms of anxiety and a reduction in behavior problems. No adverse events were reported. This CBT intervention for children with epilepsy and anxiety disorders is safe, effective, and feasible with a promising future. PMID:23376339
Arnedt, J. Todd; Cuddihy, Leisha; Swanson, Leslie M.; Pickett, Scott; Aikens, James; Chervin, Ronald D.
Study Objectives: To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Design: Randomized controlled parallel trial. Setting: N/A. Participants: Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Interventions: Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Measurements and Results: Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P < 0.001) and were classified as “in remission” from insomnia at follow-up (P < 0.05). Posttreatment effect sizes on most daytime symptoms were large (Cohen d = 0.8–2.5) for CBTI-Phone patients and small to moderate (Cohen d = -0.1–0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. Conclusions: The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Citation: Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362. PMID:23450712
Markowitz, Jessica T.; Alleyn, Cielo A.; Phillips, Roxanne; Muir, Andrew; Young-Hyman, Deborah
Abstract Background There is risk for disordered eating behaviors in type 1 diabetes, especially related to insulin manipulation. Implementation of insulin pump therapy may encourage either normalization of eating behaviors or a greater focus on food intake due to renewed emphasis on carbohydrate counting. There is need for prospective studies to assess disordered eating behaviors upon implementation of pump therapy using diabetes-specific measurement tools. Subjects and Methods In a multicenter pilot study, 43 youth with type 1 diabetes, 10–17 years old, were assessed prior to pump initiation and after 1 and 6 months of pump therapy. Youth completed the Diabetes-specific Eating Problems Survey-Revised (DEPS-R), a validated measure of risk for both diabetes-specific and general disordered eating behaviors. Results Youth (45% female), 13.3 years old with diabetes for 2.1 years, had a mean hemoglobin A1c of 8.3±1.3% (68±14.5?mmol/mol) at baseline. DEPS-R scores decreased over time (P=0.01). Overall rate of high risk for eating disorders was low. Overweight/obese youth endorsed more disordered eating behaviors than normal-weight participants. DEPS-R scores were correlated with z-score for body mass index at all three time points and with hemoglobin A1c after 1 and 6 months. Hemoglobin A1c did not change significantly over the 6 months and was higher in overweight/obese compared with normal-weight participants. Conclusions Initiation of insulin pump therapy was associated with diminished endorsement of disordered eating behaviors in youth with type 1 diabetes. Longer follow-up studies are needed to assess the impact of insulin pump therapy on glycemic control, weight status, and disordered eating behaviors in this vulnerable population. PMID:23550556
Conroy, Deirdre A.; Ebben, Matthew R.
This study examined referring practices for cognitive behavioral therapy for insomnia (CBTI) by physicians at University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. A five-item questionnaire was sent via email that inquired about the physician's patient load, number of patients complaining of insomnia, percent referred for CBTI, and impressions of what is the most effective method for improving sleep quality in their patients with insomnia. The questionnaire was completed by 239 physicians. More physicians believed a treatment other than CBTI and/or medication was most effective (N = 83). “Sleep hygiene” was recommended by a third of the sample. The smallest number of physicians felt that CBTI alone was the most effective treatment (N = 22). Additional physician education is needed. PMID:26265887
Lopez, Molly A; Basco, Monica Ramirez
State mental health systems are actively seeking to disseminate empirically supported treatment approaches to improve the outcomes of adults with serious mental illnesses. However, many of these interventions have not been studied within public mental health settings. Cognitive behavioral therapy (CBT) has been shown to be effective for major depression in well-controlled trials, but its effectiveness in public mental health settings is less known. The present study examines the feasibility of dissemination of CBT in the Texas public mental health system. Seven clinicians were trained by a CBT expert and supervised for 5 months, during which time their skills approached competency levels of therapists in randomized controlled trials. Forty clients were treated during the therapists' training phase, attending an average of ten sessions and experiencing a significant reduction in depressive symptoms. Study results are compared with previously published studies of CBT. PMID:20162373
Winter, Lotta; Kraft, Julia; Boss, Katharina; Kahl, Kai G
Psychiatric disorders, in particular depression and anxiety disorders, are important causes of impaired job performance and increased sick leave. Longer periods of sickness leave lead regularly to difficulties concerning return to work. Furthermore, work is an important factor for psychological health. The central issue of the "return to work" (RTW) module by Lagerveldt and colleagues 5 is remission from psychiatric disorder, and structured support to return to work. The module is based on principles of cognitive-behavioral therapy (CBT), and can be integrated in standard CBT. Existing data from a randomized controlled trial suggest that treatment outcome concerning remission is similar between CBT supplemented with RTW (CBT-W) module and standard CBT. However, time to return to work is reduced in CBT-W. PMID:25919056
Edmunds, Julie; Ditty, Matthew; Watkins, Jessica; Walsh, Lucia; Marcus, Steven; Kendall, Philip
Among the challenges facing the mental health field are the dissemination and implementation of evidence-based practices. The present study investigated the relationships between inner context variables (i.e., adopter characteristics and individual perceptions of intra-organizational factors) and two implementation outcomes – independently rated therapist fidelity on a performance-based role-play (i.e., adherence and skill) and self-reported penetration of cognitive behavioral therapy for youth anxiety following training. A significant relationship was found between inner context variables and fidelity. Specifically, adopter characteristics were associated with adherence and skill; individual perceptions of intra-organizational factors were associated with adherence. Inner context variables were not associated with penetration. Future directions are discussed. PMID:24202067
Ryu, Tae-Kyung; Lee, Gyoung-Ja; Rhee, Chang-Kyu; Choi, Sung-Wook
This paper describes the design and fabrication of doxorubicin (Dox)-conjugated nanodiamond (ND) clusters with controlled sizes and cellular uptake behaviors of free Dox and Dox-conjugated ND clusters. The ND clusters with an average size of 45.84?nm exhibited a higher amount of cellular uptake as compared to the ND clusters with larger sizes. The amount of Dox taken up as free Dox increased initially and then decreased over time. In contrast, the amount of Dox taken up as Dox-ND clusters continuously increased and reached a plateau, resulting in high ablation efficiency. At the same Dox concentration, the cell viabilities after treatment with free Dox and Dox-ND clusters were 26.38 and 5.31%, respectively. The Dox-ND clusters potentially could be employed as efficient drug carriers for efficient cancer therapy. PMID:26097075
Oertel, W H; Depboylu, C; Krenzer, M; Vadasz, D; Ries, V; Sixel-Döring, F; Mayer, G
Rapid eye movement (REM) sleep behavior disorder (RBD) is defined as a parasomnia characterized by loss of REM sleep-associated atonia and the presence of motor activity during dreaming typically presenting with an aggressive dream content. Epidemiological data on the prevalence of RBD are insufficient but it can be idiopathic or symptomatic. A video-audio polysomnography is essential for diagnosis. Clonazepam and melatonin are available as pharmaceutical treatment. Recent studies demonstrated that individuals suffering from idiopathic RBD carry a high specific risk (up to 80?%) for developing a neurodegenerative disorder of the ?-synucleinopathy type (e.g. Parkinson's disease, dementia with Lewy bodies and multiple system atrophy) within 10-20 years. The current article provides a short overview of symptoms, epidemiology, pathophysiology, diagnosis and therapy of RBD. PMID:24399499
Dalle Grave, Riccardo; Calugi, Simona; El Ghoch, Marwan; Conti, Maddalena; Fairburn, Christopher G.
Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12?months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. PMID:24575055
Gonzalez, Jeffrey S.; McCarl, Lauren A.; Wexler D, Deborah D.; Cagliero, Enrico; Delahanty, Linda; Soper, Tiffany D.; Goldman, Valerie; Knauz, Robert; Safren, Steven A.
Depression is one of the most common psychological problems among individuals diabetes, and it is associated with worse treatment adherence and clinical outcomes. As part of a program of treatment research aimed at integrating interventions for depression and treatment nonadherence, five depressed patients with suboptimally controlled type 2 diabetes were treated with 10-12 sessions of individual cognitive behavioral therapy for adherence and depression (CBT-AD) in a case-series design. The intervention was delivered in a hospital setting by a collaborative team consisting of a psychologist, a nurse educator, and a dietitian. Post-treatment, all participants demonstrated a decrease in depression severity and demonstrated improvements in diabetes self-care. Four of the five demonstrated improved glycemic control. These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 2 diabetes and depression. PMID:23667294
Holland, Jason M.; Schatzberg, Alan F.; O'Hara, Ruth; Marquett, Renee M.; Gallagher-Thompson, Dolores
Previous studies suggest that individuals with elevated levels of cortisol (the “stress hormone”) could be particularly resistant to treatment for depression. However, most of these studies have been conducted in the context of antidepressant medications, and no study has examined pretreatment cortisol levels as a predictor of treatment outcomes among older adults with depression in cognitive-behavioral therapy (CBT), despite the relevance of this population for such a research question. The current study includes 54 older adults with depression who provided salivary cortisol samples at baseline and completed measures of depression at pretreatment and posttreatment, following a 12-week course of CBT. Structural equation modeling results suggest that those with higher daily outputs of cortisol and flatter diurnal slopes were less likely to benefit from CBT—a finding which if replicated could have important implications for clinical practice and future research. PMID:23953171
Levis, D J
In recent years, a growing number of behavior therapists have expressed concern over the current state of the behavioral therapy movement. Some of the major problems raised center on current overload and fractionization, the lack of a coherent overall picture, the loss of identity, and the influx of cognitivism. In an attempt to enhance understanding of the factors responsible for the current crises in the behavior therapy field, the author provides a historical overview of the behavioral movement from its original conception to its current state. An argument is made that the solution to the afore-mentioned problems resides in the readoption of the underlying philosophy of science that originally gave birth and purpose to the field. PMID:10363350
Summary Impulse control disorders (ICD) (most commonly pathologic gambling, hypersexuality, and uncontrollable spending) and compulsive behaviors can be triggered by dopaminergic therapies in Parkinson disease (PD). ICD are especially prevalent in patients receiving a dopamine agonist as part of their treatment regimen for PD, and have also been reported when dopamine agonists are used for other indications (e.g., restless legs syndrome). Although these iatrogenic disorders are common, affecting 1 in 7 patients with PD on dopamine agonists, they often elude detection by the treating physician. ICD lead to serious consequences, causing significant financial loss and psychosocial morbidity for many patients and families. ICD can appear at any time during treatment with dopamine agonists, sometimes within the first few months, but most often after years of treatment, particularly when patients receive dopamine agonists and levodopa together. In most cases ICD resolve if the dopamine agonist is withdrawn, and PD motor symptoms are managed with levodopa monotherapy. Familiarity with the clinical aspects, risk factors, pathophysiology, and management of ICD is essential for physicians using dopaminergic therapies to treat PD and other disorders. PMID:23634371
Jones, Emily; Manassis, Katharina; Arnold, Paul; Ickowicz, Abel; Mendlowitz, Sandra; Nowrouzi, Behdin; Wilansky-Traynor, Pamela; Bennett, Kathryn; Schmidt, Fred
This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51% social workers, 49% other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings. PMID:25982829
Li, Fuli; Zhang, Zhengzhi; Feng, Jinhui; Cai, Xiaofeng; Xu, Ping
Mycobacterium goodii X7B, a facultative thermophilic bacterium, cleaving the C-S bond of dibenzothiophene via a sulfur-specific pathway, was investigated for DBT in tetradecane and crude oil desulfurization. The extent of growth was improved by fed-batch culture controlled at a constant pH. The total sulfur level of dibenzothiophene in tetradecane, was reduced by 99%, from 200 to 2 ppm within 24h at 40 degrees C. After 72 h treatment, 59% of the total sulfur content in Liaoning crude oil was removed, from 3600 to 1478 ppm. PMID:16905217
Fernandez-Aranda, Fernando; Jimenez-Murcia, Susana; Santamaría, Juan J; Giner-Bartolomé, Cristina; Mestre-Bach, Gemma; Granero, Roser; Sánchez, Isabel; Agüera, Zaida; Moussa, Maher H; Magnenat-Thalmann, Nadia; Konstantas, Dimitri; Lam, Tony; Lucas, Mikkel; Nielsen, Jeppe; Lems, Peter; Tarrega, Salomé; Menchón, José Manuel
Although cognitive behavioral therapy (CBT) has been demonstrated to be the most effective approach for the treatment of bulimia nervosa (BN), there is lack of studies showing whether a combination with a serious video game (SVG) might be useful to enhance patients' emotional regulation capacities and general outcome. The aims of this study were (a) to analyze whether outpatient CBT?+?SVG, when compared with outpatient CBT?-?SVG, shows better short-term outcome; (b) to examine whether the CBT?+?SVG group is more effective in reducing emotional expression and levels of anxiety than CBT?-?SVG. Thirty-eight patients diagnosed as having BN according to DSM-5 criteria were consecutively assigned to two outpatient group therapy conditions (that lasted for 16 weekly sessions): 20 CBT?+?SVG versus 18 CBT?-?SVG. Patients were assessed before and after treatment using not only a food and binging/purging diary and clinical questionnaires in the field of eating disorders but also additional indexes for measuring anger expression and anxiety. Regarding the post-treatment psychometric measures, most of the mean differences (Eating Disorder Inventory-2, Symptom Checklist-Revised, State-Trait Anxiety Index, and partially State-Trait Anger Expression Inventory) achieved moderate to high effect size (d?>?0.5), in the sense that CBT?+?SVG obtained the best results compared with the CBT?-?SVG group. Regarding therapy outcome (dropout, partial remission, and total remission), CBT?+?SVG showed better results and a moderate effect size emerged for the comparison of the risk of dropout during the treatment, being higher for CBT?-?SVG compared with CBT?+?SVG (44.1 percent versus 20.0 percent, d?=?0.54). Although the sample size in our study was low, and consequently results should be considered with caution, we have obtained promising findings suggesting that in the short-term CBT?+?SVG might be a good option not only for improving emotional dysregulation and approaching the current limitations of CBT?-?SVG in BN but also for enhancing the therapy adherence of patients. PMID:26583754
Hooke, Geoffrey R; Page, Andrew C
An attempt was made to predict outcomes following group Cognitive Behavior Therapy (CBT) for patients with affective and neurotic disorders. A group of 348 patients at a private psychiatric clinic, treated in a group CBT program, completed the Depression, Anxiety, and Stress Scale (DASS) before and after treatment. Prior to treatment, data from the Locus of Control of Behavior (LCB), a Global Assessment of Function (GAF), the Health of the Nation Outcome Scales (HoNOS), and the Rosenberg Self Esteem Scale (RSE) were also collected. Results indicated that posttreatment stress scores of all patients were predicted by pretreatment stress and self-esteem. Among patients with neurotic disorders, posttreatment anxiety was predicted by initial anxiety and self-esteem whereas among patients with affective disorders, posttreatment anxiety scores were predicted by initial anxiety and GAF. For patients with neurotic disorders, self-esteem did not predict variance in posttreatment depression in addition to that explained by pretreatment depression. In contrast, for patients with affective disorders, pretreatment depression and Locus of Control predicted posttreatment depression. PMID:12375379
Hofmann, Stefan G.; Asnaani, Anu; Vonk, Imke J.J.; Sawyer, Alice T.; Fang, Angela
Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples. PMID:23459093
Piacentini, John; Bergman, R. Lindsey; Chang, Susanna; Langley, Audra; Peris, Tara; Wood, Jeffrey J.; McCracken, James
Objective: To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). Method: A total of 71…
Asbahr, Fernando Ramos; Castillo, Ana Regina; Ito, Ligia Montenegro; Latorre, Maria do Rosario Dias de Oliveira; Moreira, Michele Nunes; Lotufo-Neto, Francisco
Objective: To compare the effectiveness of group cognitive-behavioral therapy (GCBT) and of sertraline in treatment-naive children and adolescents with obsessive-compulsive disorder. Method: Between 2000 and 2002, 40 subjects between 9 and 17 years old were randomized to receive GCBT (n = 20) or sertraline (n = 20). GCBT consisted of a…
Iverson, Katherine M.; Gradus, Jaimie L.; Resick, Patricia A.; Suvak, Michael K.; Smith, Kamala F.; Monson, Candice M.
Objective: Women who develop symptoms of posttraumatic stress disorder (PTSD) and depression subsequent to interpersonal trauma are at heightened risk for future intimate partner violence (IPV) victimization. Cognitive-behavioral therapy (CBT) is effective in reducing PTSD and depression symptoms, yet limited research has investigated the…
Jepson, Bryan; Granpeesheh, Doreen; Tarbox, Jonathan; Olive, Melissa L.; Stott, Carol; Braud, Scott; Yoo, J. Helen; Wakefield, Andrew; Allen, Michael S.
Hyperbaric oxygen therapy (HBOT) has been used to treat individuals with autism. However, few studies of its effectiveness have been completed. The current study examined the effects of 40 HBOT sessions at 24% oxygen at 1.3 ATA on 11 topographies of directly observed behavior. Five replications of multiple baselines were completed across a total…
Hirshfeld-Becker, Dina R.; Masek, Bruce; Henin, Aude; Blakely, Lauren Raezer; Pollock-Wurman, Rachel A.; McQuade, Julia; DePetrillo, Lillian; Briesch, Jacquelyn; Ollendick, Thomas H.; Rosenbaum, Jerrold F.; Biederman, Joseph
Objective: To examine the efficacy of a developmentally appropriate parent-child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4-7 years. Method: Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were…
Liber, Juliette M.; McLeod, Bryce D.; Van Widenfelt, Brigit M.; Goedhart, Arnold W.; van der Leeden, Adelinde J. M.; Utens, Elisabeth M. W. J.; Treffers, Philip D. A.
Little is known about the contribution of technical and relational factors to child outcomes in cognitive behavioral therapy (CBT) for children with anxiety disorders. This study investigated the association between treatment adherence, the child-therapist alliance, and child clinical outcomes in manual-guided individual- and group-based CBT for…
Brozovich, Faith A.; Heimberg, Richard G.
Over the past 25 years researchers have made enormous strides in the implementation of cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD), although considerable work remains to be done. The present paper discusses a treatment refractory case seen in our clinic. The young man presented numerous interrelated obstacles, such as low…
Huppert, Jonathan D.; Barlow, David H.; Gorman, Jack M.; Shear, M. Katherine; Woods, Scott W.
This report is a post-hoc, exploratory examination of the relationships among patient motivation, therapist protocol adherence, and panic disorder outcome in patients treated with cognitive behavioral therapy within the context of a randomized clinical trial for the treatment of panic disorder (Barlow, Gorman, Shear, & Woods, 2000). Results…
Morgenstern, Jon; Kuerbis, Alexis N.; Chen, Andrew C.; Kahler, Christopher W.; Bux, Donald A., Jr.; Kranzler, Henry R.
Objective: This study tested the comparative effectiveness of modified behavioral self-control therapy (MBSCT) and naltrexone (NTX), as well as the added benefit of combining the 2, in problem drinking men who have sex with men (MSM) seeking to reduce but not quit drinking. Method: Participants (N = 200) were recruited and urn randomized to 1 of 2…
Ost, Lars-Goran; Karlstedt, Anna; Widen, Sara
Relatively little is known about the efficacy of clinically inexperienced student therapists carrying out cognitive behavior therapy (CBT) under supervision during a professional, psychologist training program. The current study evaluated this by collecting pre- and post-treatment data on 591 consecutive patients receiving treatment at the…
Spence, Susan H.; Holmes, Jane M.; March, Sonja; Lipp, Ottmar V.
Seventy-two clinically anxious children, aged 7 to 14 years, were randomly allocated to clinic-based, cognitive-behavior therapy, the same treatment partially delivered via the Internet, or a wait-list control (WL). Children in the clinic and clinic-plus-Internet conditions showed significantly greater reductions in anxiety from pre-to…
Ward-Ciesielski, Erin F.
This open trial sought to develop and evaluate the preliminary feasibility and effectiveness of a brief, one-time, dialectical behavior therapy skills-based intervention with specific focus on ensuring acceptability to nontreatment-seekers. Treatment-seeking and nontreatment-seeking suicidal individuals were recruited successfully from the…
Stewart, Rebecca E.; Chambless, Dianne L.
The efficacy of cognitive-behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized.…
Flynn, Heather A.
Unipolar depression is one of the most disabling and costly medical illnesses in the world (Lancet Global Mental Health Group et al., 2007; Moussavi et al., 2007). Cognitive behavioral therapy (CBT), a widely studied and taught psychotherapeutic treatment for depression, is among the recommended evidence-based treatments. Although CBT and other…
Diefenbach, Gretchen J.; Tolin, David F.; Gilliam, Christina M.; Meunier, Suzanne A.
Data suggesting that cognitive-behavioral therapy (CBT) is efficacious for late-life anxiety are accumulating; however, effectiveness has not been well established. Incorporating CBT for anxiety into home care is needed to facilitate access to evidenced-based treatment for a growing population of community-dwelling, functionally impaired elderly…
Peak bone mass is achieved in adolescence/early adulthood and is the key determinant of bone mass in adulthood. We evaluated the association of bone mass with HIV infection and antiretroviral therapy (ART) during this critical period among behaviorally HIV infected young men and seronegative control...
Mancil, G. Richmond; Conroy, Maureen A.; Haydon, Todd F.
The purpose of the current study was to evaluate the effectiveness of combining milieu therapy and functional communication training (FCT) to replace aberrant behavior with functional communicative skills in 3 male preschool or elementary aged children with Autism Spectrum Disorders (ASD). Study activities were conducted in the natural…
Hollon, Steven D.; Garber, Judy; Shelton, Richard C.
This article reviews and comments on the recent Treatment for Adolescents With Depression Study (TADS) that found that cognitive behavior therapy (CBT) was less efficacious than fluoxetine alone and no more efficacious than pill placebo in the treatment of depression in adolescents. Adding CBT to fluoxetine, however, improved treatment response in…
Grilo, Carlos M.; Masheb, Robin M.; Crosby, Ross D.
Objective: To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED). Method: 108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors,…
Southam-Gerow, Michael A.; Weisz, John R.; Chu, Brian C.; McLeod, Bryce D.; Gordis, Elana B.; Connor-Smith, Jennifer K.
Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used…
This study was designed to examine the effectiveness of the "Fear and Loathing of Speaking Out in Public" program. The program, a personal initiative, adapts primary features of the treatment offered by Cognitive Behavioral Therapy (CBT) for clients suffering from fears and phobias. CBT strategies include progressive desensitization, identifying…
Wood, Jeffrey J.; Fujii, Cori; Renno, Patricia; Van Dyke, Marilyn
This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7-11 years old) were randomly assigned to 32 sessions of CBT…
Goldin, Philippe R.; Ziv, Michal; Jazaieri, Hooria; Werner, Kelly; Kraemer, Helena; Heimberg, Richard G.; Gross, James J.
Objective: To examine whether changes in cognitive reappraisal self-efficacy (CR-SE) mediate the effects of individually administered cognitive-behavioral therapy (I-CBT) for social anxiety disorder (SAD) on severity of social anxiety symptoms. Method: A randomized controlled trial in which 75 adult patients (21-55 years of age; 53% male; 57%…
Oldershaw, Anna; Simic, Mima; Grima, Emanuela; Jollant, Fabrice; Richards, Clair; Taylor, Lucy; Schmidt, Ulrike
Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also…
Reaven, Judy; Blakeley-Smith, Audrey; Culhane-Shelburne, Kathy; Hepburn, Susan
Background: Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavioral therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions…
Bodden, Denise H. M.; Bogels, Susan M.; Nauta, Maaike H.; De Hann, Else; Ringrose, Jaap; Appelboom, Carla; Brinkman, Andries G.; Appelboom-Geerts, Karen C. M. M. J.
Child-focused and family-focused cognitive-behavioral therapy (CBT) for 128 children with clinical anxiety disorders and their parents were compared in terms of efficacy and partial effectiveness. Results indicate that 53% of the children under the child CBT became free of anxiety disorders at posttreamtent compared to only 28% under family CBT.…
Arch, Joanna J.; Craske, Michelle G.
In this paper, we present a client with panic disorder and agoraphobia who relapses following a full course of cognitive behavioral therapy (CBT). To frame the client's treatment, the major components of CBT for panic disorder with or without agoraphobia (PD/A) are reviewed. Likely reasons for the treatment's failure and strategies for improving…
Miller, Lynn D.; Short, Christina; Garland, E. Jane; Clark, Sandra
This study evaluated a locally developed cognitive behavior therapy (CBT) intervention program in a public elementary school. In the prevention approach, 118 children were randomly assigned either to an 8-week intervention or to a wait-list control. Results of statistical analysis indicated that the manualized CBT intervention did not reduce…
Lickel, Athena; MacLean, William E., Jr.; Blakeley-Smith, Audrey; Hepburn, Susan
The purpose of this study was to assess the cognitive skills of children with autism spectrum disorders (ASD) thought to be necessary for Cognitive Behavioral Therapy (CBT). Forty children with ASD and forty age-matched typically developing children between the ages of 7-12 years participated. Groups were comparable with regard to nonverbal IQ,…
Donohue, Brad; Azrin, Nathan; Allen, Daniel N.; Romero, Valerie; Hill, Heather H.; Tracy, Kendra; Lapota, Holly; Gorney, Suzanne; Abdel-al, Ruweida; Caldas, Diana; Herdzik, Karen; Bradshaw, Kelsey; Valdez, Robby; Van Hasselt, Vincent B.
A comprehensive evidence-based treatment for substance abuse and other associated problems (Family Behavior Therapy) is described, including its application to both adolescents and adults across a wide range of clinical contexts (i.e., criminal justice, child welfare). Relevant to practitioners and applied clinical researchers, topic areas include…
Shea, Munyi; Cachelin, Fary; Uribe, Luz; Striegel, Ruth H.; Thompson, Douglas; Wilson, G. Terence
Data on the compatibility of evidence-based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N = 12) feedback on a cognitive behavior therapy guided self-help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation…
La Roche, Martin; Lustig, Kara
In this article we review a wide range of cultural adaptations of acceptance-based behavior therapies (ABBT) from a cultural perspective. Consistent with the cultural match model, we argue that psychotherapeutic cultural adaptations are more effective as the cultural characteristics of patients are matched to the cultural characteristics of the…
Lewis, Cara C.; Simons, Anne D.; Kim, Hyoun K.
Objective: Research has focused on 2 different approaches to answering the question, "Which clients will respond to cognitive behavioral therapy (CBT) for depression?" One approach focuses on rates of symptom change within the 1st few weeks of treatment, whereas the 2nd approach looks to pretreatment client variables (e.g., hopelessness) to…
DePrince, Anne P.; Shirk, Stephen R.
A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports…
Newman, Cory F.
In spite of the fact that cognitive-behavioral therapy (CBT) for major depressive disorder is an empirically supported treatment, some clients do not respond optimally or readily. The literature has provided a number of hypotheses regarding the factors that may play a role in these clients' difficulties in responding to CBT, with the current paper…
Simons, Anne D.; Padesky, Christine A.; Montemarano, Jeremy; Lewis, Cara C.; Murakami, Jessica; Lamb, Kristen; DeVinney, Sharon; Reid, Mark; Smith, David A.; Beck, Aaron T.
Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated…
Storch, Eric A.; Murphy, Tanya K.; Geffken, Gary R.; Mann, Giselle; Adkins, Jennifer; Merlo, Lisa J.; Duke, Danny; Munson, Melissa; Swaine, Zoe; Goodman, Wayne K.
Objective: To provide preliminary estimates of the effectiveness of cognitive-behavioral therapy (CBT) in treating pediatric obsessive-compulsive disorder (OCD) of the pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) subtype. Method: Seven children with OCD of the PANDAS subtype (range 9-13 years) were treated…
McBride, Carolina; Atkinson, Leslie; Quilty, Lena C.; Bagby, R. Michael
Anxiety and avoidance dimensions of adult attachment insecurity were tested as moderators of treatment outcome for interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT). Fifty-six participants with major depression were randomly assigned to these treatment conditions. Beck Depression Inventory-II, Six-Item Hamilton Rating Scale…
Dobson, Keith S.; Hollon, Steven D.; Dimidjian, Sona; Schmaling, Karen B.; Kohlenberg, Robert J.; Gallop, Robert J.; Rizvi, Shireen L.; Gollan, Jackie K.; Dunner, David L.; Jacobson, Neil S.
This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior…
Wilson, Courtney J.; Cottone, R. Rocco
A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. (Contains 3…
Nofzinger, Eric A.; And Others
Explored relationship between daytime affect and REM (rapid eye movement) sleep in 45 depressed men before and after treatment with cognitive-behavioral therapy and in control group of 43 healthy subjects. For depressed subjects only, intensity of daytime affect correlated significantly and positively with phasic REM sleep measures at pre- and…
Flessner, Christopher A.; Busch, Andrew M.; Heideman, Paul W.; Woods, Douglas W.
This pilot study examined the utility of acceptance-enhanced behavior therapy (AEBT) for trichotillomania (TTM) and chronic skin picking (CSP) and the impact of altering treatment sequence on overall treatment efficacy. Participants referred to a TTM and CSP specialty clinic were assessed by an independent evaluator within separate, nonconcurrent,…
Park, Yeonok; Cho, Hyosung; Je, Uikyu; Hong, Daeki; Lee, Minsik; Park, Chulkyu; Cho, Heemoon; Choi, Sungil; Koo, Yangseo
In practical applications of three-dimensional (3D) tomographic techniques, such as digital breast tomosynthesis (DBT), computed tomography (CT), etc., there are often challenges for accurate image reconstruction from incomplete data. In DBT, in particular, the limited-angle and few-view projection data are theoretically insufficient for exact reconstruction; thus, the use of common filtered-backprojection (FBP) algorithms leads to severe image artifacts, such as the loss of the average image value and edge sharpening. One possible approach to alleviate these artifacts may employ iterative statistical methods because they potentially yield reconstructed images that are in better accordance with the measured projection data. In this work, as another promising approach, we investigated potential applications to low-dose, accurate DBT imaging with a state-of-the-art reconstruction scheme based on compressed-sensing (CS) theory. We implemented an efficient CS-based DBT algorithm and performed systematic simulation works to investigate the imaging characteristics. We successfully obtained DBT images of substantially very high accuracy by using the algorithm and expect it to be applicable to developing the next-generation 3D breast X-ray imaging system.
Donohue, Brad; Azrin, Nathan H.; Bradshaw, Kelsey; Van Hasselt, Vincent B.; Cross, Chad L.; Urgelles, Jessica; Romero, Valerie; Hill, Heather H.; Allen, Daniel N.
Objective Approximately 50% of Child Protective Service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design. Method 72 mothers evidencing drug abuse or dependence and child neglect were randomly assigned to Family Behavior Therapy (FBT) or Treatment as Usual (TAU). Participants were assessed at baseline, 6- month-, and 10-month post-randomization. Results As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month post-randomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6- and 10-month post-randomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug exposed children and FBT mothers of drug exposed children at 6- and 10-month post-randomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6- and 10-month post-randomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6-month post-randomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6-month post-randomization relative to TAU mothers. Conclusion Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed. PMID:24841866
Safren, Steven A.; Sprich, Susan; Mimiaga, Matthew J.; Surman, Craig; Knouse, Laura; Groves, Meghan; Otto, Michael W.
Context Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. Objective To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Design, Setting, and Patients Randomized controlled trial assessing the efficacy of cognitivebehavioraltherapyfor86symptomaticadultswithADHDwhowerealreadybeing treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. Interventions Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). Main Outcome Measures The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. Results Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude ?0.0531; 95% confidence interval [CI], ?1.01 to ?0.05; P=.03) and the ADHD rating scale (magnitude ?4.631; 95% CI, ?8.30 to ?0.963; P=.02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (?=?0.41; 95% CI, ?0.64 to ?0.17; P<001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P=.01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P=.002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. Conclusion Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. PMID:20736471
Morin, Charles M.; Vallières, Annie; Guay, Bernard; Ivers, Hans; Savard, Josée; Mérette, Chantal; Bastien, Célyne; Baillargeon, Lucie
Context Cognitive-behavior therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome. Objectives To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome. Design, Setting, and Patients Prospective, randomized, clinical trial involving two-stage therapy with 160 adults with persistent insomnia treated at a university hospital sleep center between January 2002 and April 2005. Interventions Participants received CBT alone or CBT plus zolpidem for an initial six-week therapy, followed by extended 6-month therapy. Patients treated with CBT initially attended monthly maintenance CBT or no additional treatment and those treated with combined therapy initially continued with CBT plus intermittent medication or CBT without medication (tapering). Main Outcome Measures Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary) and response and remission rates derived from the Insomnia Severity Index (secondary). Results CBT used singly or in combination with medication produced significant improvements of sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (Ps < 0.001); a larger increase of sleep time was obtained with the combined approach (P = 0.04). Both CBT and combined therapies produced similar rates of treatment responders (60% [45/75] vs. 61% [45/74], P = 0.84) and remissions (39% [29/75] vs. 44% [33/74], P = 0.52) with acute treatment, but combined therapy produced a higher remission rate relative to CBT alone over the extended therapy and follow up period (56% [43/74, 32/59] vs. 43% [34/75, 28/68], P = 0.05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up relative to patients who remained on medication during extended therapy (67% [20/30] vs. 41% [12/29], P = 0.04) Conclusions In patients with persistent insomnia, the addition of medication to CBT produces added benefits during acute therapy, but long-term outcome is optimized when medication is discontinued during maintenance CBT. PMID:19454639
Mullenix, P.J.; Kernan, W.J.; Tassinari, M.S.; Schunior, A.; Waber, D.P.; Howes, A.; Tarbell, N.J. )
Central nervous system prophylactic therapy used in the treatment of acute lymphoblastic leukemia can reduce intelligence quotient scores and impair memory and attention in children. Cranial irradiation, intrathecal methotrexate, and steroids are commonly utilized in acute lymphoblastic leukemia therapy. How they induce neurotoxicity is unknown. This study employs an animal model to explore the induction of neurotoxicity. Male and female Sprague-Dawley rats at 17 and 18 days of age were administered 18 mg/kg prednisolone, 2 mg/kg methotrexate, and 1000 cGy cranial irradiation. Another 18-day-old group was administered 1000 cGy cranial irradiation but no drugs. Matching controls received saline and/or a sham exposure to radiation. All animals at 6 weeks and 4 months of age were tested for alterations in spontaneous behavior. A computer pattern recognition system automatically recorded and classified individual behavioral acts displayed during exploration of a novel environment. Measures of behavioral initiations, total time, and time structure were used to compare treated and control animals. A permanent sex-specific change in the time structure of behavior was induced by the prednisolone, methotrexate, and radiation treatment but not by radiation alone. Unlike hyperactivity, the effect consisted of abnormal clustering and dispersion of acts in a pattern indicative of disrupted development of sexually dimorphic behavior. This study demonstrates the feasibility of an animal model delineating the agent/agents responsible for the neurotoxicity of central nervous system prophylactic therapy.
Young, Brittany Mei; Nigogosyan, Zack; Remsik, Alexander; Walton, Léo M.; Song, Jie; Nair, Veena A.; Grogan, Scott W.; Tyler, Mitchell E.; Edwards, Dorothy Farrar; Caldera, Kristin; Sattin, Justin A.; Williams, Justin C.; Prabhakaran, Vivek
Brain-computer interface (BCI) technology is being incorporated into new stroke rehabilitation devices, but little is known about brain changes associated with its use. We collected anatomical and functional MRI of nine stroke patients with persistent upper extremity motor impairment before, during, and after therapy using a BCI system. Subjects were asked to perform finger tapping of the impaired hand during fMRI. Action Research Arm Test (ARAT), 9-Hole Peg Test (9-HPT), and Stroke Impact Scale (SIS) domains of Hand Function (HF) and Activities of Daily Living (ADL) were also assessed. Group-level analyses examined changes in whole-brain task-based functional connectivity (FC) to seed regions in the motor network observed during and after BCI therapy. Whole-brain FC analyses seeded in each thalamus showed FC increases from baseline at mid-therapy and post-therapy (p < 0.05). Changes in FC between seeds at both the network and the connection levels were examined for correlations with changes in behavioral measures. Average motor network FC was increased post-therapy, and changes in average network FC correlated (p < 0.05) with changes in performance on ARAT (R2 = 0.21), 9-HPT (R2 = 0.41), SIS HF (R2 = 0.27), and SIS ADL (R2 = 0.40). Multiple individual connections within the motor network were found to correlate in change from baseline with changes in behavioral measures. Many of these connections involved the thalamus, with change in each of four behavioral measures significantly correlating with change from baseline FC of at least one thalamic connection. These preliminary results show changes in FC that occur with the administration of rehabilitative therapy using a BCI system. The correlations noted between changes in FC measures and changes in behavioral outcomes indicate that both adaptive and maladaptive changes in FC may develop with this therapy and also suggest a brain-behavior relationship that may be stimulated by the neuromodulatory component of BCI therapy. PMID:25071547
Young, Brittany Mei; Nigogosyan, Zack; Remsik, Alexander; Walton, Léo M; Song, Jie; Nair, Veena A; Grogan, Scott W; Tyler, Mitchell E; Edwards, Dorothy Farrar; Caldera, Kristin; Sattin, Justin A; Williams, Justin C; Prabhakaran, Vivek
Brain-computer interface (BCI) technology is being incorporated into new stroke rehabilitation devices, but little is known about brain changes associated with its use. We collected anatomical and functional MRI of nine stroke patients with persistent upper extremity motor impairment before, during, and after therapy using a BCI system. Subjects were asked to perform finger tapping of the impaired hand during fMRI. Action Research Arm Test (ARAT), 9-Hole Peg Test (9-HPT), and Stroke Impact Scale (SIS) domains of Hand Function (HF) and Activities of Daily Living (ADL) were also assessed. Group-level analyses examined changes in whole-brain task-based functional connectivity (FC) to seed regions in the motor network observed during and after BCI therapy. Whole-brain FC analyses seeded in each thalamus showed FC increases from baseline at mid-therapy and post-therapy (p < 0.05). Changes in FC between seeds at both the network and the connection levels were examined for correlations with changes in behavioral measures. Average motor network FC was increased post-therapy, and changes in average network FC correlated (p < 0.05) with changes in performance on ARAT (R (2) = 0.21), 9-HPT (R (2) = 0.41), SIS HF (R (2) = 0.27), and SIS ADL (R (2) = 0.40). Multiple individual connections within the motor network were found to correlate in change from baseline with changes in behavioral measures. Many of these connections involved the thalamus, with change in each of four behavioral measures significantly correlating with change from baseline FC of at least one thalamic connection. These preliminary results show changes in FC that occur with the administration of rehabilitative therapy using a BCI system. The correlations noted between changes in FC measures and changes in behavioral outcomes indicate that both adaptive and maladaptive changes in FC may develop with this therapy and also suggest a brain-behavior relationship that may be stimulated by the neuromodulatory component of BCI therapy. PMID:25071547
SPRINGER, TAMAR; LOHR, NAOMI E.; BUCHTEL, HENRY A.; SILK, KENNETH R.
A randomized, controlled study evaluated the effectiveness of a cognitive-behavioral therapy group, based on Linehan’s dialectical behavior therapy, for inpatients with personality disorders. The treatment, a problem-solving skills group focused on parasuicidality, was compared with a discussion control group. Change was assessed by self-report measures and behavioral observations on the unit. Subjects in both groups improved significantly on most change measures, although no significant between-group differences were found. However, the treatment group patients viewed the intervention as more beneficial to them in their lives outside the hospital. The usefulness of this type of group on a short-term unit is discussed. PMID:22700265
Peters, Emmanuelle; Crombie, Tessa; Agbedjro, Deborah; Johns, Louise C.; Stahl, Daniel; Greenwood, Kathryn; Keen, Nadine; Onwumere, Juliana; Hunter, Elaine; Smith, Laura; Kuipers, Elizabeth
Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service’s routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months’ follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ?5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen’s d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen’s d: 0.44–0.75). All gains were maintained at follow-up (Cohen’s d: 0.29–0.82), with little change between end of therapy and follow-up (Cohen’s d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services. PMID:26579041
Lopes, Alessandra Pereira; Macedo, Tânia Fagundes; Coutinho, Evandro Silva Freire; Figueira, Ivan; Ventura, Paula Rui
Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed. PMID:25296020
Over the past two decades a new model of behavior change--one derived from a functional contextual philosophy, while up holding to basic principles of learning with an eye on practical utility--has emerged tour de force of the psychotherapy scene. This model is based on a modern behavior analytic account of language and cognition known as…
Friedman, A G; Campbell, T A; Evans, I M
This paper provides a practical illustration of a four-component model for conducting child behavior therapy. It describes the treatment of a 7-year-old boy, whose fears and anxieties regarding impending surgery were interfering with his sleep, concentration, and academic performance. Such childhood difficulties are encountered in primary care medical settings and it is likely that mental health practitioners will be increasingly called upon to treat them. The model provides a framework for selecting, organizing, and implementing strategies based on behavioral principles, with the goal of: (a) reducing the probability of the behavior by ecological change; (b) manipulating the immediate consequences of the problem behavior; (c) facilitating acquisition of new, more adaptive behaviors; and (d) long-term prevention by remedying fundamental deficits. The strategies used for each goal and the success of the overall intervention are described. PMID:8188848
Ueda, Tomomi; Suzukamo, Yoshimi; Sato, Mai; Izumi, Shin-Ichi
Behavioral and psychological symptoms of dementia (BPSD) are common problems for patients and caregivers. Although music therapy is considered a non-pharmacological intervention for the management of BPSD, its effectiveness remains unclear. This study aimed to investigate the effects of music therapy on BPSD, cognitive function, and activities of daily living in patients with dementia. A literature search was conducted in the following databases: MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi. We selected 20 studies, including randomized controlled trials, controlled clinical trials, cohort studies, and controlled trials, and conducted a meta-analysis using standardized mean differences (SMD). The results showed that music therapy had moderate effects on anxiety [SMD, -0.64; 95% confidence interval (CI), -1.05 - -0.24; p=0.002] and small effects on behavioral symptoms (SMD, -0.49; 95% CI, -0.82 - -0.17; p=0.003). In studies of duration >3 months, music therapy had large effects on anxiety (SMD, -0.93; 95% CI, -1.72 - -0.13; p=0.02). The present systematic review and meta-analysis suggests that music therapy is effective for the management of BPSD. PMID:23511664
Sil, Soumitri; Arnold, Lesley M.; Lynch-Jordan, Anne; Ting, Tracy V.; Peugh, James; Cunningham, Natoshia; Powers, Scott W.; Lovell, Daniel J.; Hashkes, Philip J.; Passo, Murray; Schikler, Kenneth N.; Kashikar-Zuck, Susmita
The primary objective of this study was to estimate a clinically significant and quantifiable change in functional disability to identify treatment responders in a clinical trial of cognitive-behavioral therapy (CBT) for youth with juvenile fibromyalgia (JFM). The second objective was to examine whether baseline functional disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children’s Depression Inventory), coping self-efficacy (Pain Coping Questionnaire), and parental pain history predicted treatment response in disability at 6-month follow-up. Participants were 100 adolescents (11–18 years old) with JFM enrolled in a recently published clinical trial comparing CBT to a fibromyalgia education intervention (FE). Patients were identified as achieving a clinically significant change in disability (i.e., treatment responders) if they achieved both a reliable magnitude of change (estimated as a ? 7.8 point reduction on the FDI) using the Reliable Change Index (RCI), and a reduction in FDI disability grade based on established clinical reference points. Using this rigorous standard, 40% of patients who received CBT (n=20/50) were identified as treatment responders, compared to 28% in FE (n=14/50). For CBT, patients with greater initial disability and higher coping efficacy were significantly more likely to achieve a clinically significant improvement in functioning. Pain intensity, depressive symptoms, and parent pain history did not significantly predict treatment response. Estimating clinically significant change for outcome measures in behavioral trials sets a high bar but is a potentially valuable approach to improve the quality of clinical trials, enhance interpretability of treatment effects, and challenge researchers to develop more potent and tailored interventions. PMID:24650858
Kronemyer, David; Bystritsky, Alexander
Belief revision is the key change mechanism underlying the psychological intervention known as cognitive behavioral therapy (CBT). It both motivates and reinforces new behavior. In this review we analyze and apply a novel approach to this process based on AGM theory of belief revision, named after its proponents, Carlos Alchourrón, Peter Gärdenfors and David Makinson. AGM is a set-theoretical model. We reconceptualize it as describing a non-linear, dynamical system that occurs within a semantic space, which can be represented as a phase plane comprising all of the brain's attentional, cognitive, affective and physiological resources. Triggering events, such as anxiety-producing or depressing situations in the real world, or their imaginal equivalents, mobilize these assets so they converge on an equilibrium point. A preference function then evaluates and integrates evidentiary data associated with individual beliefs, selecting some of them and comprising them into a belief set, which is a metastable state. Belief sets evolve in time from one metastable state to another. In the phase space, this evolution creates a heteroclinic channel. AGM regulates this process and characterizes the outcome at each equilibrium point. Its objective is to define the necessary and sufficient conditions for belief revision by simultaneously minimizing the set of new beliefs that have to be adopted, and the set of old beliefs that have to be discarded or reformulated. Using AGM, belief revision can be modeled using three (and only three) fundamental syntactical operations performed on belief sets, which are expansion; revision; and contraction. Expansion is like adding a new belief without changing any old ones. Revision is like adding a new belief and changing old, inconsistent ones. Contraction is like changing an old belief without adding any new ones. We provide operationalized examples of this process in action. PMID:24860491
Lertpiriyasuwat, Cheewanan; Pradipasen, Mandhana; Thiangtham, Weena; Kaewduangjai, Punthip
An increasing trend in sexual risk behavior has occurred in the era of antiretroviral therapy (ART) in Thailand. This study was conducted to identify sexual risk behavior and examine relationships between unprotected sex and CD4 levels among HIV-infected patients receiving ART in the National Antiretroviral Program. A cross-sectional survey was conducted in 460 HIV-infected patients age 18-49 years who visited the out-patient clinic of Bamrasnaradura Infectious Diseases Institute in February 2006 by using a standardized self-administered questionnaire. The results show that 60.4% of participants were men. The median most recent CD4 cell count during the prior 6 months was 261 cells/mm3. Twenty-three percent of the participants who had no sexual activity after they knew their HIV positive status started having sex again after receiving ART with a 12-week median duration period from starting ART to having first sex. There was a significant difference between the number of those having sexual activity before and after starting ART (p-value=0.013). Fifty-six percent of participants had sex during the previous 6 months. Of these, 26.5% had sex with commercial partners and 28.4% with non-regular partners. Inconsistent condom use, with commercial partners or non-regular partners, in females (35.3-36.8%) was higher than in males (7.8-11.1%). Participants with a known HIV-negative regular partner were 0.25 times more likely to have unprotected sex than those with a known HIV-positive regular partner (adjusted OR, 0.25; 95%CI, 0.09-0.73). No association between unprotected sex and CD4 levels was found. The findings support the need for reinforcing risk reduction programs among HIV-infected persons, particularly couple counseling, and promoting awareness of risk of acquirring sexually transmitted infections and drug-resistant strains of HIV. PMID:17877219
Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.
Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155
Pearce, Michelle J; Koenig, Harold G; Robins, Clive J; Nelson, Bruce; Shaw, Sally F; Cohen, Harvey J; King, Michael B
Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients' spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive-behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155
Mohlman, Jan; Price, Rebecca B.; Vietri, Jeff
Attentional biases are known to play a contributing, and perhaps even causal role in the etiology of anxiety and other negative affective states. The prevalence of anxiety disorders in the older cohort is growing, and there are both theoretical and empirical reasons to suspect that age-related factors could moderate attentional bias effects in the context of late-life anxiety. The current study included one of the most widely-used measures of attentional bias, the dot-probe task (Mathews & MacLeod, 1985). Participants were older adults who were either nonanxious or diagnosed with generalized anxiety disorder. The patient subsample also completed cognitive behavior therapy (CBT) or an equivalent wait list condition, after which the dot probe was administered a second time. Results showed that clinical anxiety had no particular importance for the deployment of attention, casting doubt on the universality of biased attention in older anxiety patients. Although there were no maladaptive biases detected toward either threat or depression words at pretreatment, there was nevertheless a marginally significant differential reduction in bias towards threat words following CBT. This reduction did not occur among those in the wait list condition. Implications are discussed. PMID:23916715
Windsor, Liliane Cambraia; Jemal, Alexis; Alessi, Edward
Cognitive behavioral therapy (CBT) is an effective intervention for reducing substance use. However, because CBT trials have included predominantly White samples caution must be used when generalizing these effects to Blacks and Hispanics. This meta-analysis compared the impact of CBT in reducing substance use between studies with a predominantly non-Hispanic White sample (hereafter NHW studies) and studies with a predominantly Black and/or Hispanic sample (hereafter BH studies). From 322 manuscripts identified in the literature, 17 met criteria for inclusion. Effect sizes between CBT and comparison group at posttest had similar effects on substance abuse across NHW and BH studies. However, when comparing pre-posttest effect sizes from groups receiving CBT between NHW and BH studies, CBT’s impact was significantly stronger in NHW studies. T-test comparisons indicated reduced retention/engagement in BH studies, albeit failing to reach statistical significance. Results highlight the need for further research testing CBT’s impact on substance use among Blacks and Hispanics. PMID:25285527
Yeung, Wing-Fai; Chung, Ka-Fai; Ho, Fiona Yan-Yee; Ho, Lai-Ming
Dropout from self-help cognitive-behavioral therapy for insomnia (CBT-I) potentially diminishes therapeutic effect and poses clinical concern. We analyzed the characteristics of subjects who did not complete a 6-week internet-based CBT-I program. Receiver operator characteristics (ROC) analysis was used to identify potential variables and cutoff for predicting dropout among 207 participants with self-report insomnia 3 or more nights per week for at least 3 months randomly assigned to self-help CBT-I with telephone support (n = 103) and self-help CBT-I (n = 104). Seventy-two participants (34.4%) did not complete all 6 sessions, while 42 of the 72 (56.9%) dropped out prior to the fourth session. Significant predictors of non-completion are total sleep time (TST) ? 6.82 h, Hospital Anxiety and Depression Scale depression score ? 9 and Insomnia Severity Index score < 13 at baseline in this ranking order. Only TST ? 5.92 h predicts early dropout. Longer TST and less severe insomnia predict dropout in this study of self-help CBT-I, in contrast to shorter TST as a predictor in 2 studies of face-to-face CBT-I, while greater severity of depression predicts dropout in both this study and a study of face-to-face CBT-I. Strategies for minimizing dropout from internet-based CBT-I are discussed. PMID:26226091
Phillips, Katharine A.; Rogers, Jamison
SYNOPSIS Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with nonexistent or slight defect(s) in appearance, usually begins during early adolescence and appears to be common in youth. BDD is characterized by substantial impairment in psychosocial functioning and markedly high rates of suicidality. Cognitive-behavioral therapy (CBT) tailored to BDD’s unique features is the best tested and most promising psychosocial treatment for adults with BDD. CBT has been used for youth with BDD, but it has not been systematically developed for or tested in this age group, and there is a pressing need for this work to be done. This article focuses on CBT for BDD in adults and youth, possible adaptations for youth, and the need for treatment research in youth. We also discuss BDD’s prevalence, clinical features, how to diagnose BDD in youth, recommended pharmacotherapy for BDD (serotonin-reuptake inhibitors), and treatments that are not recommended (surgery and other cosmetic treatments). PMID:21440856
Murray, Laura K; Familiar, Itziar; Skavenski, Stephanie; Jere, Elizabeth; Cohen, Judy; Imasiku, Mwiya; Mayeya, John; Bass, Judith K; Bolton, Paul
Objectives To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). Methods As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5–18 completed the TF-CBT treatment, with pre- and post-assessments. Results The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Conclusions Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the apprenticeship model of training and supervision. PMID:23768939
Kertz, Sarah J; Koran, Jennifer; Stevens, Kimberly T; Björgvinsson, Thröstur
Repetitive negative thinking (RNT) is a common symptom across depression and anxiety disorders and preliminary evidence suggests that decreases in rumination and worry are related to improvement in depression and anxiety symptoms. However, despite its prevalence, relatively little is known about transdiagnostic RNT and its temporal associations with symptom improvement during treatment. The current study was designed to examine the influence of RNT on subsequent depression and anxiety symptoms during treatment. Participants (n = 131; 52% female; 93% White; M = 34.76 years) were patients presenting for treatment in a brief, cognitive behavior therapy based, partial hospitalization program. Participants completed multiple assessments of depression (Center for the Epidemiological Studies of Depression-10 scale), anxiety (the 7-item Generalized Anxiety Disorder Scale), and repetitive negative thinking (Perseverative Thinking Questionnaire) over the course of treatment. Results indicated statistically significant between and within person effects of RNT on depression and anxiety, even after controlling for the effect of time, previous symptom levels, referral source, and treatment length. RNT explained 22% of the unexplained variability in depression scores and 15% of the unexplained variability in anxiety scores beyond that explained by the control variables. RNT may be an important transdiagnostic treatment target for anxiety and depression. PMID:25812825
Greer, Joseph A.; Park, Elyse R.; Prigerson, Holly G.; Safren, Steven A.
Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive behavioral therapy (CBT) is an empirically-validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability and death, as well as management of multiple stressors, changes in functional status and burdensome medical treatments. In this paper, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life. PMID:21234281
Weingarden, Hilary; Marques, Luana; Fang, Angela; LeBlanc, Nicole; Buhlmann, Ulrike; Phillips, Katharine A.; Wilhelm, Sabine
Individuals with Body Dysmorphic Disorder (BDD) have distressing or impairing preoccupations with imagined or slight defects in their appearance (e.g., nose too big). BDD is a severe psychiatric disorder often associated with high rates of suicidality as well as social and occupational impairment (Phillips, Coles et al., 2005). Researchers have only recently begun to investigate psychological treatments for BDD, with available data suggesting that cognitive behavioral therapy (CBT) appears efficacious for BDD (Williams, Hadjistavropoulos, & Sharpe, 2006). To our knowledge, however, there are no reports of whether CBT for BDD can be effectively generalized to ethnic minority and other special populations. The current report suggests specific modifications within the CBT for BDD framework that might improve the effectiveness and retention rates of CBT among ethnic minority patients with BDD. Specifically, the present study describes the cases of Ben*, a 40-year-old, Jewish, married male, and John, a 30-year-old, African American, single male, both with a primary diagnosis of BDD. Various treatment techniques were used to make the course of CBT more culturally responsive. This case report illustrates the challenges and benefits of integrating cultural variables into a CBT framework for BDD, and it highlights the need for more work in this area. PMID:25346783
Bayard, Sophie; Langenier, Muriel Croisier; Dauvilliers, Yves
Study Objectives: To assess whether the frequency of impulse control disorders (ICDs), addictive behaviors, impulsivity, and impairment of decision-making task performance under ambiguous and risky conditions were present in patients with restless legs syndrome (RLS) and whether changes could be related to dopaminergic medications. Design: Case-control prospective study. Setting: Academic Sleep Disorders Center. Participants: Of the 149 participants, there were 39 who were drug free with primary RLS, 50 who were taking dopamine agonists (DA), and 60 control subjects. Participants were assessed with a clinical interview screening for ICDs, augmentation syndrome, impulsivity, depression, and addictive behaviors. All participants completed two decision-making tasks, one under an ambiguous condition (Iowa Gambling Task) and the other under a risky condition (Game of Dice Task). Drug-free patients with RLS underwent 1 night of polysomnography recording. Measurements and Results: Seventy percent of patients were treated with pramipexole (median dose, 0.36 mg), and 30% with ropinirole (median dose, 0.75 mg). Median duration of DA intake was 11 mo (range, 1-72 mo). No differences were found on impulsivity scores, ICDs, and substance addiction between drug-free patients or those taking DA, or control subjects. Patients with RLS reported more depressive symptoms than control subjects, but without differences between patients taking or not taking DA. Drug-free and treated patients demonstrated reduced performances on the Iowa Gambling Task but not on the Game of Dice Task compared to control subjects, with no differences between patients taking medications and those who were not. No association was found between decision-making task performances, or polysomnographic and clinical variables. Conclusion: Impulse control disorders, impulsivity, and substance addiction were infrequent in drug-free patients with restless legs syndrome or those treated with a low dose of dopamine agonists. However, patients with restless legs syndrome, either drug free or taking dopamine agonists, had preferences toward risky choices on the Iowa Gambling Task, which led to negative consequences in the long run, a condition potentially leading to further development of impulse control disorders. Citation: Bayard S; Langenier MC; Dauvilliers Y. Decision-making, reward-seeking behaviors and dopamine agonist therapy in restless legs syndrome. SLEEP 2013;36(10):1501-1507. PMID:24082309
Misurell, Justin R.; Springer, Craig; Tryon, Warren W.
This preliminary investigation examined the efficacy of a game-based cognitive-behavioral therapy group program for elementary school-aged children who have experienced sexual abuse. Treatment aimed to improve: (a) internalizing symptoms, (b) externalizing behaviors, (c) sexually inappropriate behaviors, (d) social skills deficits, (e) self-esteem…
Perepletchikova, Francheska; Axelrod, Seth R.; Kaufman, Joan; Rounsaville, Bruce J.; Douglas-Palumberi, Heather; Miller, Alec L.
Background Dialectical Behaviour Therapy (DBT) has been used to treat adults and adolescents with suicidal and non-suicidal self-injury. This article describes initial progress in modifying DBT for affected pre-adolescent children. Method Eleven children from regular education classes participated in a 6-week pilot DBT skills training program for children. Self-report measures of children’s emotional and behavioural difficulties, social skills and coping strategies were administered at pre- and post-intervention, and indicated that the children had mild to moderate symptoms of depression, anxiety and suicidal ideation at baseline. Results Subjects were able to understand and utilise DBT skills for children and believed that the skills were important and engaging. Parents also regarded skills as important, child friendly, comprehensible and beneficial. At post-treatment, children reported a significant increase in adaptive coping skills and significant decreases in depressive symptoms, suicidal ideation and problematic internalising behaviours. Conclusions These promising preliminary results suggest that continued development of DBT for children with more severe clinical impairment is warranted. Progress on adapting child individual DBT and developing a caregiver training component in behavioural modification and validation techniques is discussed. PMID:21643467
Ruger, Jennifer Prah; Lazar, Christina M.
Economic evaluations are an important tool to improve our understanding of the costs and effects of health care services and to create sustainable health care systems. This article critically assesses empirical evidence from economic evaluations of pharmaco- and behavioral therapies for smoking cessation. A comprehensive literature review of PubMed and the British National Health Service Economic Evaluation Database was conducted. The search identified 15 articles on nicotine-based pharmacotherapies, 12 articles on nonnicotine based pharmacotherapies, no articles on selegiline, and 10 articles on brief counseling for smoking cessation treatment. Results show that both pharmaco- and behavioral therapies for smoking cessation are cost-effective or even cost-saving. The review highlights several shortcomings in methodology and a lack of standardization of current economic evaluations. Efforts to improve methodology will help make future studies more comparable and increase the evidence base so that such evaluations can be more useful to public health practitioners and policy makers. PMID:22224889
Wang, Ying; Chang, Ting; Chen, Yun-Chun; Zhang, Rui-Guo; Wang, Hua-Ning; Wu, Wen-Jun; Peng, Zheng-Wu; Tan, Qing-Rong
Quetiapine, an atypical antipsychotic, may have efficacy as augmentation therapy in treatment resistant depression (TRD), but evidence is limited and the underlying mechanism remains poorly understood. Therefore, this study was aimed to investigate whether and how quetiapine can be served as an augmentation agent in fluoxetine treatment resistant depressive rats induced by chronic unpredictable mild stress (CUMS). In this study, the effects of CUMS regimen and antidepressant treatment were assessed by behavioral tests and hippocampal neurogenesis. Approximately 20-30% of depressive rats respond poorly to fluoxetine treatment. In their hippocampus, a significant decrease of neurogenesis was also observed. However, quetiapine add-on therapy significantly improved the depressive behaviors and increased the number of the newborn neurons in the hippocampus of fluoxetine treatment resistant depressive rats. Thus, our results suggest that quetiapine may be used as an augmentation agent in the treatment resistant depression partly mediated by increasing the number of newborn neurons in the hippocampus. PMID:23876404
Jones, Martin; Oosterbroek, Chloe
Background People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners. Objective To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations. Methods We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants. Results A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns. Conclusions CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities. PMID:26048193
Kendall, Philip C.; Barmish, Andrea J.
Cognitive-behavioral therapy (CBT) has been reviewed and described as an empirically supported treatment for anxious youth. One component of CBT is the use of out-of-session "Show That I Can" tasks (STIC; i.e., homework tasks). STIC tasks vary in content and are to be completed between sessions. We discuss homework in CBT for Robert, a 13-year-old…
Alvares, Gail A.; Balleine, Bernard W.; Guastella, Adam J.
Social anxiety disorder is characterized by excessive fear and habitual avoidance of social situations. Decision-making models suggest that patients with anxiety disorders may fail to exhibit goal-directed control over actions. We therefore investigated whether such biases may also be associated with social anxiety and to examine the relationship between such behavior with outcomes from cognitive-behavioral therapy. Patients diagnosed with social anxiety and controls completed an instrumental learning task in which two actions were performed to earn food outcomes. After outcome devaluation, where one outcome was consumed to satiety, participants were re-tested in extinction. Results indicated that, as expected, controls were goal-directed, selectively reducing responding on the action that previously delivered the devalued outcome. Patients with social anxiety, however, exhibited no difference in responding on either action. This loss of a devaluation effect was associated with greater symptom severity and poorer response to therapy. These findings indicate that variations in goal-directed control in social anxiety may represent both a behavioral endophenotype and may be used to predict individuals who will respond to learning-based therapies. PMID:24728288
Marchiori, Cleber F. N.; Yamamoto, Natasha A. D.; Matos, Carolina F.; Kujala, Jiri; Macedo, Andréia G.; Tuomisto, Filip; Zarbin, Aldo J. G.; Koehler, Marlus; Roman, Lucimara S.
In this work, poly[2,7-(9,9-bis(2-ethylhexyl)-dibenzosilole)-alt-4,7-bis(thiophen-2-yl)benzo-2,1,3-thiadiazole] (PSiF-DBT) was used as active layer in bilayer solar cell with C60 as electron acceptor. As cast devices already show reasonable power conversion efficiency (PCE) that increases to 4% upon annealing at 100 °C. Space charge limited measurements of the hole mobility (?) in PSiF-DBT give ? ˜ 1.0 × 10-4 cm2/(V s) which does not depend on the temperature of the annealing treatment. Moreover, positron annihilation spectroscopy experiments revealed that PSiF-DBT films are well stacked even without the thermal treatment. The variations in the transport of holes upon annealing are then small. As a consequence, the PCE rise was mainly induced by the increase of the polymer surface roughness that leads to a more effective interface for exciton dissociation at the PSiF-DBT/fullerene heterojunction.
Zorzella, Karina P M; Muller, Robert T; Cribbie, Robert A
Therapeutic alliance has been considered an important factor in child psychotherapy and is consistently associated with positive outcomes. Nevertheless, research on alliance in the context of child trauma therapy is very scarce. This study examined the relationships between child therapeutic alliance and psychopathology in an empirically supported child trauma therapy model designed to address issues related to trauma with children and their caregivers. Specifically, we examined the extent to which the child's psychopathology would predict the establishment of a positive alliance early in treatment, as well as the association between alliance and outcome. Participants were 95 children between the ages of 7 and 12 and their caregivers, who went through a community-based Trauma-Focused Cognitive Behavioral Therapy program in Canada. Caregivers filled out the CBCL prior to assessment and following treatment. Children and therapists completed an alliance measure (TASC) at three time points throughout treatment. Symptomatology and child gender emerged as important factors predicting alliance at the beginning of treatment. Girls and internalizing children developed stronger alliances early in treatment. In addition, a strong early alliance emerged as a significant predictor of improvement in internalizing symptoms at the end of treatment. Our findings indicate that symptomatology and gender influence the development of a strong alliance in trauma therapy. We suggest that clinicians should adjust therapeutic style to better engage boys and highly externalizing children in the early stages of therapy. PMID:26338348
Background Procrastination, to voluntarily delay an intended course of action despite expecting to be worse-off for the delay, is a persistent behavior pattern that can cause major psychological suffering. Approximately half of the student population and 15%-20% of the adult population are presumed having substantial difficulties due to chronic and recurrent procrastination in their everyday life. However, preconceptions and a lack of knowledge restrict the availability of adequate care. Cognitive behavior therapy (CBT) is often considered treatment of choice, although no clinical trials have previously been carried out. Objective The aim of this study will be to test the effects of CBT for procrastination, and to investigate whether it can be delivered via the Internet. Methods Participants will be recruited through advertisements in newspapers, other media, and the Internet. Only people residing in Sweden with access to the Internet and suffering from procrastination will be included in the study. A randomized controlled trial with a sample size of 150 participants divided into three groups will be utilized. The treatment group will consist of 50 participants receiving a 10-week CBT intervention with weekly therapist contact. A second treatment group with 50 participants receiving the same treatment, but without therapist contact, will also be employed. The intervention being used for the current study is derived from a self-help book for procrastination written by one of the authors (AR). It includes several CBT techniques commonly used for the treatment of procrastination (eg, behavioral activation, behavioral experiments, stimulus control, and psychoeducation on motivation and different work methods). A control group consisting of 50 participants on a wait-list control will be used to evaluate the effects of the CBT intervention. For ethical reasons, the participants in the control group will gain access to the same intervention following the 10-week treatment period, albeit without therapist contact. Results The current study is believed to result in three important findings. First, a CBT intervention is assumed to be beneficial for people suffering from problems caused by procrastination. Second, the degree of therapist contact will have a positive effect on treatment outcome as procrastination can be partially explained as a self-regulatory failure. Third, an Internet based CBT intervention is presumed to be an effective way to administer treatment for procrastination, which is considered highly important, as the availability of adequate care is limited. The current study is therefore believed to render significant knowledge on the treatment of procrastination, as well as providing support for the use of Internet based CBT for difficulties due to delayed tasks and commitments. Conclusions To our knowledge, the current study is the first clinical trial to examine the effects of CBT for procrastination, and is assumed to render significant knowledge on the treatment of procrastination, as well as investigating whether it can be delivered via the Internet. Trial Registration ClinicalTrials.gov: NCT01842945; http://clinicaltrials.gov/show/NCT01842945 (Archived by WebCite at http://www.webcitation.org/6KSmaXewC). PMID:24220277
Bowler, Jennifer O.; Mackintosh, Bundy; Dunn, Barnaby D.; Mathews, Andrew; Dalgleish, Tim; Hoppitt, Laura
Objective: Computerized cognitive behavioral therapy (cCBT) and cognitive bias modification for interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other has not been investigated. The present study tested the prediction that both interventions would reduce anxiety relative to a no-intervention comparison condition, but CBM-I would be particularly effective at modifying threat-related cognitive bias under high mental load. Method: Sixty-three primarily Caucasian adults (mean age = 22.7, SD = 5.87; 68.3% female) with high social anxiety, randomly allocated to 3 groups: CBM-I (n = 21), cCBT (n = 21), and a no-intervention control group (n = 21) provided complete data for analysis. Pre- and postintervention (4 sessions lasting 2 weeks, control participants only attended the pre–post sessions) self-report measures of anxiety, depression, attentional control, and threat-related interpretive bias were completed. In addition, interpretive bias under high versus low cognitive load was measured using the Scrambled Sentences Test. Results: Both CBM-I and cCBT groups reported significantly reduced levels of social anxiety, trait anxiety, and depression and improved attentional control, relative to the control group, with no clear superiority of either active intervention. Although both active conditions reduced negative bias on the Scrambled Sentences Test completed under mental load, CBM-I was significantly more effective at doing so. Conclusions: The results suggest that although not differing in therapeutic efficacy, CBM-I and cCBT might differ in the resilience of their effects when under mental load. PMID:22963595
Chu, Brian C; Skriner, Laura C; Zandberg, Laurie J
Multilevel growth analysis was used to establish the shape of change (mean growth trajectory) for youth- and therapist-rated alliance in cognitive behavioral therapy (CBT) for anxious youth and to identify between-youth predictors of alliance trajectory. Youth (N = 69; ages 7-17; 52.2% female) and their parents participated in an empirically supported CBT protocol. Therapists rated alliance each session and youth every four sessions. Data were fit to four growth models: linear, quadratic, a dual slope, and a novel "alliance rupture" model. Two-level models were estimated to examine the effect of youth age, sex, pretreatment symptom severity, diagnostic comorbidity, early treatment factors (use of Selective Serotonin Reuptake Inhibitors), and coping styles (engagement, disengagement, and involuntary coping). A dual slope model fit therapist data best, whereas youth data did not evidence systematic growth. Two-level growth models identified that pretreatment anxiety severity predicted higher initial alliance levels. Depressive symptoms predicted less linear growth and engagement coping predicted greater growth during exposure sessions. No variables predicted preexposure growth. In the therapist model, 22% of initial alliance, 50% of preexposure growth, and 75% of postexposure growth were accounted for by between youth variables (mood disorder, anxiety and depression symptoms, engagement and involuntary coping). Therapist-reported alliance ratings may grow over the course of manual-based CBT, even during exposure-focused sessions. Pretreatment youth factors and coping style may influence the absolute value and linear trajectory of alliance during CBT. Findings about alliance-influencing factors can help set expectations for, and enhance training in, empirically supported treatments. PMID:23581531
Salam, K P Abdul; Sharma, Mahendra P; Prakash, Om
Dhat syndrome is a culture-bound syndrome prevalent in the natives of the Indian subcontinent characterized by excessive concern about harmful consequences of loss of semen (ICD-10). Treatment offered to the patients suffering from it continues to be esoteric, unstructured and without standardization. The present study aimed to develop and examine the feasibility of Cognitive - Behavior Therapy module for patients with Dhat syndrome. A draft module was developed based on existing theoretical knowledge and suggestions from five mental health professionals. This module was then applied on five patients with Dhat syndrome to assess and judge the suitability of the module. The pre and post-assessments were carried out using Sexual Knowledge and Attitude Questionnaire - II, Hamilton Depression Rating Scale, The Cognitive-Somatic Anxiety Scale, Screener for Somatoform Disorder, International Index for Erectile Function, Clinical Global Impressions, The World Health Organization Quality of Life Assessment - BREF. Experiences and insights gained from each patient were used to refine the module before applying on the next patient. The final module consisted of the following components was developed: Basic sex education, cognitive restructuring, relaxation training, imaginal desensitization, masturbatory training as homework and Kegel's exercises and 'start-stop technique' and 'squeeze technique' for sexual dysfunctions. Results of the study reveal that it is feasible to carry out the CBT module in clinical settings. Number of sessions ranged from 11 to 16 sessions. The duration of the session was 45 minutes on the average. Findings of the present study revealed improvement in sexual knowledge, anxiety, depressive and somatic symptoms. Implications and limitations of the study are highlighted and suggestions for future research offered. PMID:23372242
Andersson, Evelyn; Rück, Christian; Lavebratt, Catharina; Hedman, Erik; Schalling, Martin; Lindefors, Nils; Eriksson, Elias; Carlbring, Per; Andersson, Gerhard; Furmark, Tomas
Objective The role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients. Method Participants were recruited from two separate randomized controlled CBT trials (trial 1: n?=?112, trial 2: n?=?202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report. Results At long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials. Conclusions None of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD. Trial Registration ClinicalTrials.gov (ID-NCT0056496) PMID:24260145
Hedman, Erik; Andersson, Gerhard; Lindefors, Nils; Gustavsson, Petter; Lekander, Mats; Rück, Christian; Andersson, Erik; Ljótsson, Brjánn
Personality traits have traditionally been viewed as stable, but recent studies suggest that they could be affected through psychological treatment. Internet-based cognitive behavior therapy (ICBT) for severe health anxiety (DSM-IV hypochondriasis) has been shown to be effective in reducing health anxiety, but its effect on measures of personality traits has not been investigated. The main aim of this study was to investigate the impact of ICBT on personality traits in the three broad dimensions - neuroticism, extraversion and aggression. We hypothesized that participants in ICBT would reduce their level of neuroticism compared to controls that did not receive the active treatment. No specific predictions were made regarding extraversion and aggression. Data from a randomized controlled trial were used in which participants were allocated to 12 weeks of ICBT (n?=?40) or to a basic attention control condition (n?=?41). Personality traits were assessed with the Swedish Universities Scales of Personality and the primary outcome of health anxiety was the Health Anxiety Inventory. There was a significant interaction effect of group and time on neuroticism-related scales, indicating larger pre- to post-treatment reductions in the Internet-based CBT group compared to the control condition. Analyses at 6-month follow-up showed that changes were stable. Traits relating to extraversion and aggression were largely unchanged. This study is the first to demonstrate that a brief ICBT intervention for severe health anxiety causes long-term changes in measures of personality traits related to neuroticism. The treatment thus has a broader impact than just reducing health anxiety. Trial Registration Clinicaltrials.gov (ID NCT00828152) PMID:25437150
Background: Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action. PMID:21552319
Hwang, Wei-Chin; Myers, Hector; Chiu, Eddie; Mak, Elsie; Butner, Jonathan; Fujimoto, Ken; Wood, Jeff; Miranda, Jeanne
Objective No randomized controlled trials (RCTs) for adults have tested the effectiveness of a well-specified psychotherapy compared with a culturally adapted version of the same treatment. This study evaluates the effectiveness of cognitive behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese American adults. Methods This was a RCT that treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Participants were screened beginning September 2008, with the last assessment conducted in March 2011. Participants were randomly assigned to 12 sessions of CBT or CA-CBT. Stratified randomization was used for patients who were on and not on antidepressants when they first came to the clinic, and the study did not influence regular prescription practices. The primary outcomes were dropout rates and the Hamilton Depression Rating Scale measured at baseline, session 4, session 8, and session 12. Results Participants in CA-CBT evidenced a greater overall decrease in depressive symptoms than those in CBT, but depression rates remained similarly high at week 12. Differences in dropout rates approached, but did not meet statistical significance (7% CA-CBT and 26% CBT). Conclusions Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT evidenced significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits. PMID:26129996
Gary, Rebecca A.; Dunbar, Sandra B.; Higgins, Melinda K.; Musselman, Dominique L.; Smith, Andrew L.
Objective The purpose of this study is to compare the effectiveness of a combined 12-week home-based exercise (EX)/cognitive behavioral therapy (CBT) program (n=18) with CBT alone (n=19), EX alone (n=20), and with usual care (UC, n=17) in stable New York Heart Association Class II to III heart failure (HF) patients diagnosed with depression. Methods Depressive symptom severity [Hamilton Rating Scale for Depression (HAM-D)], physical function [6-min walk test (6MWT)], and health-related quality of life (HRQOL) (Minnesota Living with Heart Failure Questionnaire) were evaluated at baseline (T1), after the 12-week intervention/control (T2), and following a 3-month telephone follow-up (T3). A repeated measures analysis of variance was used to determine group differences. Depression severity was dichotomized as minor (HAM-D, 11–14) and moderate-to-major depression (HAM-D, ?15), and group intervention and control responses were also evaluated on that basis. Results The greatest reduction in HAM-D scores over time occurred in the EX/CBT group (?10.4) followed by CBT (?9.6), EX (?7.3), and UC (?6.2), but none were statistically significant. The combined group showed a significant increase in 6-min walk distance at 24 weeks (F=13.5, P<.001). Among all groups with moderate-to-major depression, only those in CBT/EX had sustained lower HAM-D scores at 12 and 24 weeks, 6MWT distances were significantly greater at 12 (P=.018) and 24 (P=.013) weeks, and the greatest improvement in HRQOL also occurred. Conclusions Interventions designed to improve both physical and psychological symptoms may provide the best method for optimizing functioning and enhancing HRQOL in patients with HF. PMID:20624510
Rasu, Rafia S.; Malewski, David F.; Banderas, Julie W.; Thomson, Domonique Malomo; Goggin, Kathy
Objective To provide data on the actual costs associated with behavioral ART adherence interventions and electronic drug monitoring used in a clinical trial to inform their implementation in future studies and real-world practice. Methods Direct and time costs were calculated from a multi-site three-arm randomized controlled ART adherence trial. HIV positive participants (n = 204) were randomized to standard care (SC), enhanced counseling (EC), or EC and modified directly observed therapy (mDOT) interventions. Electronic drug monitoring (EDM) was used. Costs were calculated for various components of the 24-week adherence intervention. This economic evaluation was conducted from the perspective of an agency that may wish to implement these strategies. Sensitivity analyses were conducted to examine costs and savings associated with different scenarios. Results Total direct costs were $126,068 ($618/patient). Initial time costs were $53,590 ($262/patient). Base cost of labor was $0.36/minute. EC costs for 134 patients were $18,427 ($137/patient) and mDOT for 64 patients cost $18,638 ($291/patient). Total per patient costs were: SC=$880, EC=$1,018, EC/mDOT=$1,309. Removing driving costs evidenced the most variable impact on savings between the three study arms. The tornado diagram (sensitivity analysis) showed a graphical representation of how each sensitivity assumption reduced costs compared to each other and the resulting comparative costs for each group. Conclusion This novel economic analysis provides valuable cost information to guide treatment implementation and research design decisions. PMID:23337364
Brambilla, F; Dalle Grave, R; Calugi, S; Marchesini, G; Baroni, S; Marazziti, D
The effects of cognitive-behavioral therapy (CBT) on central dopamine (DA), noradrenaline (NE) and serotonin (5-HT) secretion were studied in a group of 50 female inpatients, of which 14 suffered from anorexia nervosa restricted type (AN-R), 14 from anorexia nervosa bingeing-purging type (AN-BP), and 22 from bulimia nervosa (BN). The aim of the study was to see whether or not CBT modifies the secretion of central DA (blood homovanillic acid=HVA), NE (blood 3-methoxy-4-hydroxy-phenylglycol=MHPG) and the 5-HT transporter (as evaluated by the platelet paroxetine binding=[(3)H]-Par-binding), if the physical and psychological effects of CBT correlate with changes of the neurotransmitter secretion; and if the biological effects of CBT are linked to specific psychopathological aspect of the disorders. The treatment lasted 20 weeks. Body-mass Index, bingeing and purging, specific AN-BN psychopathological (EDE 12-OD), depression (Beck Inventory), anxiety (STAY Form-Y-1), impulsiveness (Barratt Impulsiveness Scale), self-esteem (Rosenberg Self-Biochemical Scale) and temperament (Temperament and Character Inventory, Cloninger Scale) were assessed at baseline and at the end of the treatment. CBT significantly improved the psychophysical aspects of the diseases. HVA and MHPG concentrations did not change. The [(3)H]-Par-binding parameters, the maximum binding capacity (B(max)) and dissociation constant (K(d)) values did not change in either AN-R or AN-BP patients, while the [(3)H]-Par B(max) (and not the K(d)) increased significantly in BN patients. Correlations emerged between basal and final [(3)H]-Par B(max) values and psychopathological scores, but not between CBT-induced differences between basal and final values. Our data suggest that only in BN CBT may act through changes in 5-HT system function. PMID:19962832
Hurt, Kelsi; Hurd-Brown, Tasia; Whalen, Margaret
Butyltins (BTs) have been in widespread use. Tributyltin (TBT) has been used as a biocide in a variety of applications and is found in human blood samples. Dibutyltin (DBT) has been used as a stabilizer in polyvinyl chloride plastics and as a de-worming agent in poultry. DBT, like TBT, is found in human blood. Human natural killer (NK) cells are the earliest defense against tumors and viral infections and secrete the cytokine tumor necrosis factor (TNF) alpha (?). TNF? is an important regulator of adaptive and innate immune responses. TNF? promotes inflammation and an association between malignant transformation and inflammation has been established. Previously, we have shown that TBT and DBT were able to interfere with the ability of NK cells to lyse tumor target cells. Here we show that BTs alter cytokine secretion by NK cells as well as a mixture of T and NK lymphocytes (T/NK cells). We examined 24 h, 48 h, and 6 day exposures to TBT (200- 2.5 nM) and DBT (5- 0.05 µM) on TNF? secretion by highly enriched human NK cells and T/NK cells. The results indicate that TBT (200 - 2.5 nM) decreased TNF? secretion from NK cells. In the T/NK cells 200 nM TBT decreased secretion while 100-5 nM TBT increased secretion of TNF?. NK cells or T/NK cells exposed to higher concentrations of DBT showed decreased TNF? secretion while lower concentrations showed increased secretion. The effects of BTs on TNF? secretion are seen at concentrations present in human blood. PMID:23047847
Sholomskas, Diane E.; Syracuse-Siewert, Gia; Rounsaville, Bruce J.; Ball, Samuel A.; Nuro, Kathryn F.; Carroll, Kathleen M.
There has been little research on the effectiveness of different training strategies or the impact of exposure to treatment manuals alone on clinicians' ability to effectively implement empirically supported therapies. Seventy-eight community-based clinicians were assigned to 1 of 3 training conditions: review of a cognitive-behavioral therapy…
Boutin, Daniel L.
A review of the literature revealed 20 studies that examined the extent to which cognitive behavioral therapy (CBT), supportive-expressive group therapy (SEGT), and a combination of these two treatments impact women with breast cancer. Based on this review, it is determined that CBT and SEGT have repeated experimental support for positively…
Wadden, Thomas A.; And Others
Treated obesity by very low calorie diet, behavior therapy, and combination. Mean weight loss for three conditions was 14.09, 14.26, and 19.25 kilograms, respectively. Three years later, and correcting for additional therapy in interim, mean weight losses for 45 of original 50 subjects declined to 2.20, 3.54, and 5.11 kilograms, respectively.…
de Haan, Hein A; Postel, Marloes G; van der Palen, Job; VanDerNagel, Joanne EL; DeJong, Cornelis AJ
Background Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective This study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eating disorders. Methods A two-arm open randomized controlled trial comparing a Web-based CBT intervention to a waiting list control condition (WL) was carried out among female patients with bulimia nervosa (BN), binge eating disorder (BED), and eating disorders not otherwise specified (EDNOS). The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and was established based on participants’ self-report. Participants were recruited from an open-access website, and the intervention consisted of a structured two-part program within a secure Web-based application. The aim of the first part was to analyze participant’s eating attitudes and behaviors, while the second part focused on behavioral change. Participants had asynchronous contact with a personal therapist twice a week, solely via the Internet. Self-report measures of eating disorder psychopathology (primary outcome), body dissatisfaction, physical health, mental health, self-esteem, quality of life, and social functioning were completed at baseline and posttest. Results A total of 214 participants were randomized to either the Web-based CBT group (n=108) or to the WL group (n=106) stratified by type of eating disorder (BN: n=44; BED: n=85; EDNOS: n=85). Study attrition was low with 94% of the participants completing the posttest assignment. Overall, Web-based CBT showed a significant improvement over time for eating disorder psychopathology (F 97=63.07, P<.001, d=.82) and all secondary outcome measures (effect sizes between d=.34 to d=.49), except for Body Mass Index. WL participants also improved on most outcomes; however, effects were smaller in this group with significant between-group effects for eating disorder psychopathology (F 201=9.42, P=.002, d=.44), body dissatisfaction (F 201=13.16, P<.001, d=.42), physical health (F 200=12.55, P<.001, d=.28), mental health (F 203=4.88, P=.028, d=.24), self-esteem (F 202=5.06, P=.026, d=.20), and social functioning (F 205=7.93, P=.005, d=.29). Analyses for the individual subgroups BN, BED, and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups; however, the between-group effect was significant only for participants with BED (F 78=4.25, P=.043, d=.61). Conclusions Web-based CBT proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders. Trial Registration Nederlands Trial Register (NTR): NTR2415; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 (Archived by WebCite at http://www.webcitation.org/6T2io3DnJ). PMID:26088580
Okamoto, Hidehiko; Fukushima, Munehisa; Teismann, Henning; Lagemann, Lothar; Kitahara, Tadashi; Inohara, Hidenori; Kakigi, Ryusuke; Pantev, Christo
Sudden sensorineural hearing loss is characterized by acute, idiopathic hearing deterioration. We report here the development and evaluation of “constraint-induced sound therapy”, which is based on a well-established neuro-rehabilitation approach, and which is characterized by the plugging of the intact ear (“constraint”) and the simultaneous, extensive stimulation of the affected ear with music. The sudden sensorineural hearing loss patients who received the constraint-induced sound therapy in addition to the standard corticosteroid therapy showed significantly better recovery of hearing function compared to those who had only received corticosteroid treatments. Additionally, the brain activity obtained in a subgroup of patients suggested that the constraint-induced sound therapy could have prevented maladaptive auditory cortex reorganization. Constraint-induced sound therapy thus appears to be an effective, practical, and safe treatment option for sudden sensorineural hearing loss. PMID:24473277
Okamoto, Hidehiko; Fukushima, Munehisa; Teismann, Henning; Lagemann, Lothar; Kitahara, Tadashi; Inohara, Hidenori; Kakigi, Ryusuke; Pantev, Christo
Sudden sensorineural hearing loss is characterized by acute, idiopathic hearing deterioration. We report here the development and evaluation of "constraint-induced sound therapy", which is based on a well-established neuro-rehabilitation approach, and which is characterized by the plugging of the intact ear ("constraint") and the simultaneous, extensive stimulation of the affected ear with music. The sudden sensorineural hearing loss patients who received the constraint-induced sound therapy in addition to the standard corticosteroid therapy showed significantly better recovery of hearing function compared to those who had only received corticosteroid treatments. Additionally, the brain activity obtained in a subgroup of patients suggested that the constraint-induced sound therapy could have prevented maladaptive auditory cortex reorganization. Constraint-induced sound therapy thus appears to be an effective, practical, and safe treatment option for sudden sensorineural hearing loss. PMID:24473277
Simpson, Helen Blair; Foa, Edna B.; Liebowitz, Michael R.; Huppert, Jonathan D.; Cahill, Shawn; Maher, Michael J.; McLean, Carmen P.; Bender, James; Marcus, Sue M.; Williams, Monnica T.; Weaver, Jamie; Vermes, Donna; Van Meter, Page E.; Rodriguez, Carolyn I.; Powers, Mark; Pinto, Anthony; Imms, Patricia; Hahn, Chang-Gyu; Campeas, Raphael
IMPORTANCE Obsessive-compulsive disorder (OCD) is one of the world’s most disabling illnesses according to the World Health Organization. Serotonin reuptake inhibitors (SRIs) are the only medications approved by the Food and Drug Administration to treat OCD, but few patients achieve minimal symptoms from an SRI alone. In such cases, practice guidelines recommend adding antipsychotics or cognitive-behavioral therapy consisting of exposure and ritual prevention (EX/RP). OBJECTIVE To compare the effects of these 2 SRI augmentation strategies vs pill placebo for the first time, to our knowledge, in adults with OCD. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (conducted January 2007–August 2012) at 2 academic outpatient research clinics that specialize in OCD and anxiety disorders. Patients (aged 18–70 years) were eligible if they had OCD of at least moderate severity despite a therapeutic SRI dose for at least 12 weeks prior to entry. Of 163 who were eligible, 100 were randomized (risperidone, n = 40; EX/RP, n = 40; and placebo, n = 20), and 86 completed the trial. INTERVENTIONS While continuing their SRI at the same dose, patients were randomized to the addition of 8 weeks of risperidone (up to 4 mg/d), EX/RP (17 sessions delivered twice weekly), or pill placebo. Independent assessments were conducted every 4 weeks. MAIN OUTCOME AND MEASURE The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to measure OCD severity. RESULTS Patients randomized to EX/RP had significantly greater reduction in week 8 Y-BOCS scores based on mixed-effects models (vs risperidone: mean [SE], ?9.72 [1.38]; P<.001 vs placebo: mean [SE], ?10.10 [1.68]; P < .001). Patients receiving risperidone did not significantly differ from those receiving placebo (mean [SE], ?0.38 [1.72]; P=.83). More patients receiving EX/RP responded (Y-BOCS score decrease ?25%: 80% for EX/RP, 23% for risperidone, and 15% for placebo; P < .001). More patients receiving EX/RP achieved minimal symptoms (Y-BOCS score ?12: 43% for EX/RP, 13% for risperidone, and 5% for placebo; P = .001). Adding EX/RP was also superior to risperidone and placebo in improving insight, functioning, and quality of life. CONCLUSIONS AND RELEVANCE Adding EX/RP to SRIs was superior to both risperidone and pill placebo. Patients with OCD receiving SRIs who continue to have clinically significant symptoms should be offered EX/RP before antipsychotics given its superior efficacy and less negative adverse effect profile. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00389493. PMID:24026523
Meany-Walen, Kristin K.; Bullis, Quinn; Kottman, Terry; Dillman Taylor, Dalena
Children who are off-task in schools struggle with completing their work and engage in disruptive behaviors. Without intervention, these behaviors tend to worsen, putting them at risk for more serious, ongoing problems throughout life. Group counseling provides opportunities for people to practice socially useful behaviors. Using a single case…
Farmer, Richard F.
Recent research in psychology, psychiatry and neuroscience has demonstrated reliable associations between temperament and individual differences in sensitivity and responsiveness to environmental cues and behavioral consequences. Temperament-influenced behavior patterns evident in infancy have also been found to predict behavioral tendencies in…
Thase, Michael E; Kingdon, David; Turkington, Douglas
Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research. PMID:25273290
Sava, Florin A; Yates, Brian T; Lupu, Viorel; Szentagotai, Aurora; David, Daniel
Cost-effectiveness and cost-utility of cognitive therapy (CT), rational emotive behavioral therapy (REBT), and fluoxetine (Prozac) for major depressive disorder (MDD) were compared in a randomized clinical trial with a Romanian sample of 170 clients. Each intervention was offered for 14 weeks, plus three booster sessions. Beck Depression Inventory (BDI) scores were obtained prior to intervention, 7 and 14 weeks following the start of intervention, and 6 months following completion of intervention. CT, REBT, and fluoxetine did not differ significantly in changes in the BDI, depression-free days (DFDs), or Quality-Adjusted Life Years (QALYs). Average BDI scores decreased from 31.1 before treatment to 9.7 six months following completion of treatment. Due to lower costs, both psychotherapies were more cost-effective, and had better cost-utility, than pharmacotherapy: median $26.44/DFD gained/month for CT and $23.77/DFD gained/month for REBT versus $34.93/DFD gained/month for pharmacotherapy, median $/QALYs=$1,638, $1,734, and $2,287 for CT, REBT, and fluoxetine (Prozac), respectively. PMID:19051275
Papas, Rebecca K.; Gakinya, Benson N.; Baliddawa, Joyce B.; Martino, Steve; Bryant, Kendall J.; Meslin, Eric M.; Sidle, John E.
Epidemics of both HIV/AIDS and alcohol abuse in sub-Saharan Africa have spurred the conduct of local behavioral therapy trials for these problems, but the ethical issues involved in these trials have not been fully examined. In this paper, we discuss ethical issues that emerged during the conduct of a behavioral intervention adaptation and trial using cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. The study was performed within our multinational collaboration, the USAID-Academic Model Providing Access to Healthcare Partnership. We discuss relevant ethical considerations and how we addressed them. PMID:22850141
Yokoyama, Akira; Matsushita, Sachio; Toyama, Tomomi; Nakayama, Hideki; Takimura, Tsuyoshi; Kimura, Mitsuru; Yoneda, Junichi; Maesato, Hitoshi; Mizukami, Takeshi; Higuchi, Susumu; Yokoyama, Tetsuji
Coping skills training (CST) and cue exposure treatment (CET) have yielded favorable outcomes when used to treat alcoholics. We conducted 6-week inpatient programs that consisted of 9 CST group sessions (n = 117) during 2005-2009 and 9 CST group sessions plus 4 CET group sessions (n = 49) during 2009-2011 and subsequent 1-year letter therapy for Japanese alcoholic men who had relapsed and been readmitted after standard cognitive-behavioral inpatient therapy. When patients received a letter containing encouraging words every 2 weeks, they were asked to reread their CST and CET records and to respond to the letter by marking drinking days on a calendar and naming the skills on a list of the 9 CST themes and CET that were useful for maintaining abstinence during that 2-week period. The estimated percentages of achievement of 30 or fewer drinking days during the one year of letter therapy were 36.1 - 45.8%. 'Non-smoking', '2nd admission', and 'After age-limit job retirement' were significant factors in achieving good outcomes. The 'usefulness' responses for 'Increasing pleasant activities', 'CET', 'Anger management', ' Managing negative thinking', 'Problem solving', and ' Seemingly irrelevant decisions' as percentages of overall responses to the letters were significantly higher, in order of decreasing percentages, in the achiever group than in the non-achiever group, but the differences between the groups in ' Managing urges to drink', ' Drink refusal skills', ' Planning for emergencies', and ' Receiving criticism about drinking' were not significant. The odds ratios for achievement of 30 or fewer drinking days during the 1-year period increased significantly by 1.15 -1.31 fold per 10% increment in the 'usefulness' ratio for 'Increasing pleasant activities'. The difference in percentage achievement between the group treated by CST alone and the group treated by CST plus CET was not significant. In conclusion, some coping skills were more useful for relapse prevention than others in this study population, and addition of CET to CST and subsequent letter therapy did not improve outcomes. PMID:26255433
Hinton, Devon E.; Otto, Michael W.
Among psychologically distressed Cambodian refugees, somatic complaints are particularly prominent. Cambodians interpret anxiety-related somatic sensations in terms of “Wind” (khyâl), an ethnophysiology that gives rise to multiple catastrophic interpretations; and they have prominent trauma-memory associations to anxiety-related somatic symptoms. In this article, we detail some of the common sensation-related dysphoric networks of Cambodian refugees, focusing on catastrophic cognitions and trauma associations. We argue that delineating symptom-related dysphoric networks is crucial to successfully adapt cognitive-behavioral interventions to treat panic disorder and posttraumatic stress disorder among Cambodian refugees, and that such an approach may be useful for the culturally sensitive adaptation of cognitive-behavior therapy for other traumatized non-Western groups. PMID:19823603
Bédard, Mathieu; Russell, Jennifer J; Myhr, Gail
Cognitive behavioral therapy (CBT) is efficacious for many Axis I disorders, though its effectiveness in the real world, for patients with Axis II comorbidity is less well known. This study examines the effectiveness of CBT for Axis I disorders in three groups of patients: those with personality disorders, those with personality disorder traits and those with no Axis II pathology. Consecutive referrals of patients with non-psychotic Axis I disorders were assessed for short-term CBT in a University Teaching Unit. While the acceptance rate was lower for individuals with personality disorders, there were no group differences in dropout rates. Of those who completed therapy (mean number of sessions=17.8, SD=11.2), those in the Personality Disorders group (n=45) had 4 sessions more on average than the Personality Disorder Traits group (n=42) or the No Axis II Group (n=266). All 3 groups were equally successful, whether the outcome was therapist opinion of success, the clinical global impression, or the reliable change index based on patient-reported symptom change. Intent to treat analysis results paralleled those of the completer analysis. Our findings indicate that the presence of a personality disorder does not negatively impact therapy adherence or success in short-term CBT for an Axis I disorder. PMID:26456894
Zidi, Mustapha; Allaire, Eric
Regenerative medicine to substitute conventional surgery or an endovascular stent constitutes currently a challenge to treat abdominal aneurysm artery (AAA). The present paper addresses the following question: Can a cellular therapy from mesenchymal stem cells reestablish the mechanical properties of damaged abdominal aorta? For that, the xenograft rat model that mimics arterial dilatation due to aneurysmal disease is used to study the effects of the proposed cellular therapy. To investigate the changes in the mechanical behavior of the arterial wall, the artery is assumed to be made of a hyperelastic and incompressible material characterized by a strain energy function fitted to the average data set of uniaxial tests of AAA tissue samples. In order to compute the stresses in the artery by using an analytical approach, the aneurysm is represented as a "parabolic-exponential" thin membrane. Thus, when compared to healthy, untreated and treated arteries, the obtained results demonstrate that the cellular therapy stabilizes the geometry of AAAs, improves the stiffness of the tissue and decreases stress variations in the arterial wall. PMID:24781283
Schechter, Julia C.; Brennan, Patricia A.; Cunningham, Phillippe B.; Foster, Sharon L.; Whitmore, Elizabeth
Stress and hypothalamic-pituitary-adrenal (HPA) axis dysregulation have been associated with externalizing behavior in adolescence, but few studies have examined these factors in a treatment context. This study investigated the relationship between stress, cortisol, and externalizing behavior among 120 adolescent males (mean age = 15) receiving…
Vallaire-Thomas, Lola; Hicks, Jamilah; Growe, Roslin
Inappropriate behaviors of elementary and middle school students are many times extremely difficult to change. These behaviors tend to be supported by reinforcement within the environment. When manifested in the classroom, these undesirable actions become the focus of negativity which translates into disciplinary problems and ultimately discipline…
Shadel, William G.
Personality, as a construct, has been largely ignored or misapplied in the clinical and/or cognitive-behavioral literature. This article discusses the history of the concept of personality in clinical psychology and in cognitive-behavioral approaches and provides the main rationale for this special series. The articles that comprise the series…
McManus, Freda; Waite, Polly; Shafran, Roz
Low self-esteem is a common, disabling, and distressing problem that has been shown to be involved in the etiology and maintenance of a range of Axis I disorders. Hence, it is a priority to develop effective treatments for low self-esteem. A cognitive-behavioral conceptualization of low self-esteem has been proposed and a cognitive-behavioral…
Shuper, Paul A; Kiene, Susan M; Mahlase, Gethwana; MacDonald, Susan; Christie, Sarah; Cornman, Deborah H; Fisher, William A; Greener, Ross; Lalloo, Umesh G; Pillay, Sandy; van Loggerenberg, Francois; Fisher, Jeffrey D
The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans. PMID:24158486
Christensen, Andrew; Atkins, David C; Yi, Jean; Baucom, Donald H; George, William H
Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy. PMID:17154747
Simpson, Helen Blair; Maher, Michael J.; Wang, Yuanjia; Bao, Yuanyuan; Foa, Edna B.; Franklin, Martin
Objective: To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Method: Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory…
Swan, Karrie L.
A growing disparity between the mental health needs of children and their lack of treatment served as the basis of this study. To address this existent gap, I proposed that child-centered play therapy (CCPT), a holistic treatment that fosters children's emotional, developmental, and social growth would serve as a viable treatment. The purpose of…
Lim, Hayoung A; Draper, Ellary
This study compared a common form of Applied Behavior Analysis Verbal Behavior (ABA VB) approach and music incorporated with ABA VB method as part of developmental speech-language training in the speech production of children with Autism Spectrum Disorders (ASD). This study explored how the perception of musical patterns incorporated in ABA VB operants impacted the production of speech in children with ASD. Participants were 22 children with ASD, age range 3 to 5 years, who were verbal or pre verbal with presence of immediate echolalia. They were randomly assigned a set of target words for each of the 3 training conditions: (a) music incorporated ABA VB, (b) speech (ABA VB) and (c) no-training. Results showed both music and speech trainings were effective for production of the four ABA verbal operants; however, the difference between music and speech training was not statistically different. Results also indicated that music incorporated ABA VB training was most effective in echoic production, and speech training was most effective in tact production. Music can be incorporated into the ABA VB training method, and musical stimuli can be used as successfully as ABA VB speech training to enhance the functional verbal production in children with ASD. PMID:22506303
McCart, Michael R.; Sheidow, Ashli J.; Letourneau, Elizabeth J.
This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth’s behavior problems. The treatment is criterion-based with treatment duration determined by the youth’s achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver’s participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population. PMID:25419101
Thomson, Domonique; Pinkston, Megan; Goggin, Kathy J.
Abstract Modified directly observed therapy (mDOT), in which a portion of doses in a medication regimen are ingested under supervision, has had some demonstrated success in improving the high levels of adherence necessary to achieve maximum benefit from antiretroviral medications. Consistent with the Information-Motivation-Behavioral skills (IMB) model, mDOT's success is likely due to its direct impact on patients' knowledge, motivation, and behaviors related to adherence. However, mDOT's potential impact on patients' information, motivation, and behaviors related to health activities other than adherence to antiretroviral medications has not been explored. Data from participants enrolled in Project MOTIV8, a randomized controlled trial to test the efficacy of novel behavioral adherence interventions, were analyzed to explore the potential impact of mDOT on health behaviors other than adherence. Participants were recruited from local HIV clinics from 2004–2008. Thirty-four percent of those approached, agreed to participate in the study. Data from all participants randomized to the mDOT intervention arm thus far (n?=?50, mean age 39.7 standard deviation [SD]?=?9.0, 78% male 64% African American, and 86% infected via sexual transmission) were included. Overall, participants reported a high level of satisfaction with the mDOT intervention. Qualitative data revealed that mDOT had a positive impact on participants' adherence to nonantiretroviral medications as well as their involvement and communication with health care providers. In addition, participants reported that the daily mDOT visits had indirect effects on their daily functioning, including improvements in their daily living activities (e.g., earlier awakenings, getting dressed, and cleaning their homes) and an increased level of community involvement. PMID:18627279
Xia, Jing; Du, Yanqiu; Han, Jiyang; Liu, Guo; Wang, Xumei
Objective To evaluate the overall effect of D-cycloserine (DCS) augmentation on exposure and response prevention (ERP) therapy for obsessive-compulsive disorder (OCD). Methods Clinical studies on the effect of DCS augmentation on ERP therapy for OCD compared to placebo were included for meta analysis. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Meta-analyses were performed with a random-effect model or a fixed-effect model using the Cochrane Review Manager (RevMan, version 5.2) to calculate the odds ratio and the mean difference, with their corresponding 95% confidence intervals. Results A total of six studies was included in the current meta-analyses, and their data were extracted. Among them, four were for analyses of DCS and Y-BOCS at midtreatment, six for analysis at posttreatment, and four at 3-month follow-up. Besides, three of the six eligible studies were included in the meta-analysis of the DCS and Clinical Global Impression–Severity Scale at posttreatment, and three in the meta-analysis of DCS and proportions of treatment responders and of subjects attaining clinical remission status criteria at posttreatment. Our meta-analyses do not reveal a significant effect of DCS augmentation in ERP therapy for OCD patients, except when measured at midtreatment. Compared to the placebo group, DCS augmentation did show a trend toward significantly lower/decreased Y-BOCS; when measured at posttreatment and in the subpopulation of DCS taken before some of the ERP sessions, DCS augmentation showed a trend toward significantly lower/decreased Y-BOCS. Conclusion Our result suggested that with the careful optimization of DCS-augmented ERP therapy by fine-tuning timing and dosing of DCS administration and number and frequency of ERP sessions, DCS may enhance the efficacy of ERP therapy in reducing the symptomatic severity of OCD patients, especially at early stage of the treatment; therefore, DCS augmentation could possibly reduce treatment cost, reduce treatment drop and refusal rate, and help to improve access to the limited number of experienced therapists. PMID:25960632
Wood, Jeffrey J; Fujii, Cori; Renno, Patricia; Van Dyke, Marilyn
This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7-11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34-1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6% of observed intervals at posttreatment, compared to 25% of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted. PMID:24671750
Irwin, Michael R.; Olmstead, Richard; Carrillo, Carmen; Sadeghi, Nina; Breen, Elizabeth C.; Witarama, Tuff; Yokomizo, Megumi; Lavretsky, Helen; Carroll, Judith E.; Motivala, Sarosh J.; Bootzin, Richard; Nicassio, Perry
Study Objectives: To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia. Design: Randomized controlled, comparative efficacy trial. Setting: Los Angeles community. Patients: 123 older adults with chronic and primary insomnia. Interventions: Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months. Measurements: Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels. Results: CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07–0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change. Conclusions: Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys. Clinical Trial Registration: ClinicalTrials.gov, NCT00280020 Citation: Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Breen EC, Witarama T, Yokomizo M, Lavretsky H, Carroll JE, Motivala SJ, Bootzin R, Nicassio P. Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial. SLEEP 2014;37(9):1543-1552. PMID:25142571
Ferwerda, Maaike; Hoeve, Dane; Rovers, Maroeska M; Spillekom-van Koulil, Saskia; van Middendorp, Henriët; Evers, Andrea WM
Background Patients with chronic somatic conditions face unique challenges accessing mental health care outside of their homes due to symptoms and physical limitations. Internet-based cognitive behavioral therapy (ICBT) has shown to be effective for various psychological conditions. The increasing number of recent trials need to be systematically evaluated and quantitatively analyzed to determine whether ICBT is also effective for chronic somatic conditions and to gain insight into the types of problems that could be targeted. Objective Our goal was to describe and evaluate the effectiveness of guided ICBT interventions for chronic somatic conditions on general psychological outcomes, disease-related physical outcomes, and disease-related impact on daily life outcomes. The role of treatment length was also examined. Methods PubMed, PsycINFO, and Embase were searched from inception until February 2012, by combining search terms indicative of effect studies, Internet, and cognitive behavioral therapy. Studies were included if they fulfilled the following six criteria: (1) randomized controlled trial, (2) Internet-based interventions, (3) based on cognitive behavioral therapy, (4) therapist-guided, (5) adult (?18 years old) patients with an existing chronic somatic condition, and (6) published in English. 23 randomized controlled trials of guided ICBT were selected by 2 independent raters after reviewing 4848 abstracts. Demographic, clinical, and methodological variables were extracted. Standardized mean differences were calculated between intervention and control conditions for each outcome and pooled using random effects models when appropriate. Results Guided ICBT was shown to improve all outcome categories with small effect sizes for generic psychological outcomes (effect size range 0.17-0.21) and occasionally larger effects for disease-specific physical outcomes (effect size range 0.07 to 1.19) and disease-related impact outcomes (effect size range 0.17-1.11). Interventions with a longer treatment duration (>6 weeks) led to more consistent effects on depression. Conclusions Guided ICBT appears to be a promising and effective treatment for chronic somatic conditions to improve psychological and physical functioning and disease-related impact. The most consistent improvements were found for disease-specific outcomes, which supports the possible relevance of tailoring interventions to specific patient groups. Explorative analyses revealed that longer treatment length holds the promise of larger treatment effects for the specific outcome of depression. While the current meta-analysis focused on several chronic somatic conditions, future meta-analyses for separate chronic somatic conditions can further consolidate these results, also in terms of cost-effectiveness. PMID:24675372
Ellis, Jason G.; Cushing, Toby; Germain, Anne
Study Objectives: Despite considerable evidence supporting cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia, it remains untested within the context of acute insomnia. This study examined the efficacy of a single session of CBT-I, with an accompanying self-help pamphlet, for individuals with acute insomnia. Design: A pragmatic parallel group randomized controlled trial. Setting: Community. Participants: Forty adults (mean age 32.9 ± 13.72 y) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined insomnia disorder, except a self-reported duration of less than 3 mo (i.e., acute insomnia), who reported no previous exposure to CBT-I and were not currently taking medication for sleep. Interventions: A single 60- to 70-min session of CBT-I (n = 20), with an accompanying self-help pamphlet, or wait list control group (n = 20). All subjects were offered a full individual course of CBT-I on completion of the study, regardless of group allocation. Measurements and Results: Subjects completed sleep diaries and the Insomnia Severity Index (ISI) pretreatment and 1 mo following treatment. There were no between-group differences on baseline ISI scores or subjective sleep continuity. The intervention group reported significantly lower ISI scores than controls (t(38) 2.24, P < 0.05) at follow-up. Further, using proposed ISI scores for identifying insomnia caseness (i.e., ? 10), 60% of those in the CBT-I group had remitted by 1 mo compared to 15% of those in the control group. Conclusions: This single session of cognitive behavioral therapy for insomnia (CBT-I) is sufficiently efficacious for a significant proportion of those with acute insomnia. The results are discussed in terms of integrating this brief form of CBT-I into the “stepped care” model of insomnia. Trial Registration: Testing the efficacy of an early intervention for acute insomnia (SRCTN05891695) http://www.controlled-trials.com/ISRCTN05891695. Citation: Ellis JG, Cushing T, Germain A. Treating acute insomnia: a randomized controlled trial of a “single-shot” of cognitive behavioral therapy for insomnia. SLEEP 2015;38(6):971–978. PMID:25515106
Roy, Prasanta Kumar
A 22-year-old female diagnosed with anorexia nervosa received brief psychotherapy within a span of 1.5 months. Detailed cognitive-behavioral assessment was done and eating attitude was rated. Intervention of eating behavior and cognitive restructuring were initiated along with regular practice of self-hypnosis with ego-strengthening suggestions. Age regression was done to identify conflicts. Significant improvement in eating attitude was noted after 8 sessions without relapse at 3 months. Details of the psychotherapy are discussed. PMID:24568328
Meyer, Joffre Denis
OF CONTENTS Chapter Page I. INTRODUCTION Definition of Terms II. EXISTENTIAL THERAPY AND NEO-CONFUCIANISM Introduction Part One: Conscience and Change ~L- hih S*1E-Th y Psychology Neo-Confucianism Changing with the Needs of Society Part Two... The Link Between Axioms Two and Three . 118 Appropriate Discernment of Thought: A Personality Model Axiom Three: Conscience and Appro- priateness Axiom Four: Rectifying Affairs ~L' - h'h "R s 1 ' g 1 t ty Cion" 120 123 128 132 ~L'aa ? hih gth' 1...
Pezzati, Rita; Molteni, Valentina; Bani, Marco; Settanta, Carmen; Di Maggio, Maria Grazia; Villa, Ivan; Poletti, Barbara; Ardito, Rita B.
Doll therapy is a non-pharmacological intervention aimed at reducing behavioral and psychological disorders in institutionalized patients with dementia. This therapy as a care tool has been integrated into the context of long-term care institutions, in which the need to find solutions to cognitive, behavioral and emotional problems showed by people with dementia meets the primary objective of developing good care practices focusing on patients and their needs. In the present work we adopt the Bowlby’s theory of attachment to investigate the effectiveness of Doll therapy. The hypothesis that we here propose is that the emotional experience of the person with dementia during Doll therapy activates caregiving and exploration systems together with the attachment one. To test this hypothesis we compared institutionalized patients with dementia undergoing Doll therapy with a control group and assessed measures of the relational dimension with the environment, such as gaze direction, behaviors of exploration, and behaviors of caregiving. We used an experimental protocol consisting of 10 non-consecutive sessions structured with the goal of recreating a situation of (1) separation from a known figure and (2) interaction with the environment in order to partially recreate the prototypical phases of the “Strange situation.” All sessions were videotaped and analyzed through an observational grid. Results support the effectiveness of Doll therapy in promoting and maintaining the affective-relational dimension of attachment-caregiving and the attentive dimension of exploration in patients with advanced stage of dementia. Thus, our results suggest that the use of Doll therapy promotes clinically significant improvements in the ability to relate with the surrounding world. This may be important for managing and caring for patients with dementia in institutionalized context. PMID:24795682
DePrince, Anne P.; Shirk, Stephen R.
A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports on the development of a modified CBT (mCBT) protocol that has been adapted for treating depressed adolescents who have been exposed to traumatic interpersonal events (physical/sexual abuse or witnessing domestic violence). First, we provide an empirical rationale for targeting executive function deficits and trauma-related cognitions in the mCBT protocol. Second, we present promising results from 2 community clinic cases. PMID:25598651
O’Neill, Joseph; Feusner, Jamie D
This article reviews issues related to a major challenge to the field for obsessive–compulsive disorder (OCD): improving access to cognitive-behavioral therapy (CBT). Patient-related barriers to access include the stigma of OCD and reluctance to take on the demands of CBT. Patient-external factors include the shortage of trained CBT therapists and the high costs of CBT. The second half of the review focuses on one partial, yet plausible aid to improve access – prediction of long-term response to CBT, particularly using neuroimaging methods. Recent pilot data are presented revealing a potential for pretreatment resting-state functional magnetic resonance imaging and magnetic resonance spectroscopy of the brain to forecast OCD symptom severity up to 1 year after completing CBT. PMID:26229514
Romero, Valerie; Allen, Daniel N.
Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were “blind” to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results. PMID:23226920
Engle, Erin; Gadischkie, Stephen; Roy, Nance; Nunziato, Dina
Trends in college mental health literature suggest many college and university counseling centers are facing increased demands for services. Moreover, survey data suggest that counseling center directors and staff perceive increases in serious psychopathology, suicidality, and nonsuicidal self-injurious behavior, along with other typical student…
Carey, Michael P.; Burish, Thomas G.
Determined if baseline anxiety levels are predictive of outcome on treatments associated with cancer chemotherapy. Results indicated low-anxiety patients reported less anxiety and depression before behavioral training but nonetheless exhibited significantly greater reductions in anxiety, depression, and diastolic blood pressure after training.…
Roemer, Lizabeth; Orsillo, Susan M.
Research suggests that experiential avoidance may play an important role in generalized anxiety disorder (GAD; see Roemer, L., & Orsillo, S.M. (2002). "Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models." "Clinical…
Weersing, V. Robin; Gonzalez, Araceli; Campo, John V.; Lucas, Amanda N.
Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral…
Hall, Alex S.; Parsons, Jeffrey
Internet Behavior Dependence (IBD), a form of Internet addiction, is a new disorder requiring informed response from addictions clinicians such as mental health counselors. Presents a working definition for IBD, overviews the prevalence rates and demographic profiles of dependent users, and reviews assessment criteria and treatment for IBD.…
Ginsburg, Golda S.; Albano, Anne Marie; Findling, Robert L.; Kratochvil, Christopher; Walkup, John
Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of…
Cohen, Miri; Fried, Georgeta
Objective: To assess the effectiveness of cognitive-behavior (CB) group intervention versus relaxation and guided imagery (RGI) group training. Method: A total of 114 early-stage breast cancer patients were randomly assigned to CB, RGI, or control groups, and instruments were completed at pre- and postintervention and 4 months later. Results:…
DeVoge, Susan D.
This paper describes a treatment approach which uses hypnotherapy techniques in combination with assertive training and behavioral rehearsal. It discusses the use of this treatment with a client who exhibited psychogenic symptoms due to personal anxiety. At the beginning of the treatment the client was shy, non-assertive and extremely…
Lufi, Dubi; Parish-Plass, Jim
A group of children with Attention Deficit Hyperactivity Disorder (ADHD) was compared to children with other behavior and emotional problems. All the participants participated together in 20 weekly sessions for 1 academic year. The participants were assessed with three questionnaires on three different occasions: before the beginning of the group,…
Wadden, Thomas A.; And Others
Explored the effectiveness of a very low calorie diet to induce rapid weight loss, combined with behavioral techniques to maintain this loss in 17 obese women. Results showed a substantial and sustained weight loss. Subjects did not experience increased anxiety or depression. (JAC)
Wadden, Thomas A.; And Others
Examined attrition and weight loss in 235 female obese binge eaters, episodic overeaters, and nonbingers in 26-week program of behavior modification/very low calorie diet. Found no significant differences among conditions in number of program completers. Episodic overeaters were more likely than others to drop out during last seven weeks of…
Farmer, Richard F.; Golden, Jeannie A.
Impulsivity is a central defining feature of several psychiatric disorders and a frequent correlate of many forms of psychopathology and maladjustment. Despite recognition of the importance of impulsivity to an understanding of a wide variety of clinically-relevant behaviors, this multifaceted construct remains ill-defined and not well understood.…
Naviaux, J C; Schuchbauer, M A; Li, K; Wang, L; Risbrough, V B; Powell, S B; Naviaux, R K
Autism spectrum disorders (ASDs) now affect 1–2% of the children born in the United States. Hundreds of genetic, metabolic and environmental factors are known to increase the risk of ASD. Similar factors are known to influence the risk of schizophrenia and bipolar disorder; however, a unifying mechanistic explanation has remained elusive. Here we used the maternal immune activation (MIA) mouse model of neurodevelopmental and neuropsychiatric disorders to study the effects of a single dose of the antipurinergic drug suramin on the behavior and metabolism of adult animals. We found that disturbances in social behavior, novelty preference and metabolism are not permanent but are treatable with antipurinergic therapy (APT) in this model of ASD and schizophrenia. A single dose of suramin (20?mg?kg?1 intraperitoneally (i.p.)) given to 6-month-old adults restored normal social behavior, novelty preference and metabolism. Comprehensive metabolomic analysis identified purine metabolism as the key regulatory pathway. Correction of purine metabolism normalized 17 of 18 metabolic pathways that were disturbed in the MIA model. Two days after treatment, the suramin concentration in the plasma and brainstem was 7.64??M pmol??l?1 (±0.50) and 5.15?pmol?mg?1 (±0.49), respectively. These data show good uptake of suramin into the central nervous system at the level of the brainstem. Most of the improvements associated with APT were lost after 5 weeks of drug washout, consistent with the 1-week plasma half-life of suramin in mice. Our results show that purine metabolism is a master regulator of behavior and metabolism in the MIA model, and that single-dose APT with suramin acutely reverses these abnormalities, even in adults. PMID:24937094
Resick, Patricia A; Suvak, Michael K; Wells, Stephanie Y
This study examined the effect of child sexual or physical abuse on brief cognitive-behavioral therapy treatments with adults with posttraumatic stress disorder (PTSD). We analyzed secondary data from two randomized controlled trials (Resick, Nishith, Weaver, Astin, & Feuer, 2002; Resick et al., 2008) that included women with PTSD who did or did not have child sexual abuse (CSA) or child physical abuse (CPA) histories to determine whether childhood abuse impacted dropout rate or reduction in PTSD symptoms. In Study 1, presence, duration, or severity of CSA was not associated with dropout; however, frequency of CSA significantly predicted dropout (OR = 1.23). A significant CPA Severity × Treatment Group interaction emerged such that CPA severity was associated with greater dropout for prolonged exposure (PE; OR = 1.45), but not cognitive processing therapy (CPT; OR = 0.90). Study 2 found no differences in dropout. Study 1, comparing CPT and PE among women who experienced at least 1 rape found no differences in outcome based on childhood abuse history (rp (2) s = .000-.009). Study 2, a dismantling study of CPT with women seeking treatment for adult or child sexual or physical abuse found that for those with no childhood abuse, CPT-C, the cognitive-only version of CPT, had an advantage, whereas both forms of CPT worked best for those with higher frequency of childhood abuse; the effect size was small. PMID:25322885
Riley, Andrew R; Gaynor, Scott T
This study examined therapeutic mechanisms of action at the single-participant level in a behavior therapy (BT) for youth depression. By controlling for non-specific early responses, identifying potential mechanisms of action a priori, taking frequent measures of hypothesized mechanisms and dependent variables, rigorously evaluating internal validity, and using a variety of analytic methods, a unique model for analysis of potential mediators was created. Eleven children (M age = 9.84) meeting criteria on the Children's Depression Rating Scale-Revised (M = 55.36) and Children's Depression Inventory (M = 23.45) received non-directive therapy (NDT), followed by BT for those still displaying significant symptoms. Four participants (36%) had a clinically significant response to NDT. For the remaining seven, statistically significant changes in depressive symptoms and family interactions during the BT interval were found at the group level. At the single-participant level, evidence suggesting that outcome was at least partially mediated by changes in treatment targets was obtained for four of seven (57%). As the field further embraces efforts to learn not only whether treatments work but also how they work, the single-participant approach to evaluating mediators provides a useful framework for evaluating theories of therapeutic change. PMID:24742468