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PubMed2004

Cognitive-behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder.

An important problem with obese patients suffering from binge eating disorders (BED) is to treat their dysfunctional eating patterns while initiating a weight loss. We propose to assess a cognitive-behavioral therapy combined with a nutritional and a physical activity program. Our purpose is to verify that the addition of a nutritional and a physical program leads to a significant weight loss and enables psychological improvement. The patients (n=61) participated in a 12 weekly sessions group treatment of either a purely cognitive-behavioral therapy, or a cognitive-behavioral therapy associated to a nutritional approach mainly focused on fat restriction, or to a cognitive-behavioral therapy combined with a nutritional and a physical activity approach. The mean weight loss is significant (p<0.01) after the association of the cognitive-behavioral therapy and the nutritional education, but is even more significant (p<0.001) after the combination of a cognitive-behavioral therapy with a nutritional education and a physical activity program. Depression scores decrease in the three approaches, anxiety (p<0.05) results improve only in the combined nutritional, physical activity and cognitive-behavioral approach. Eating disorders improved significantly in all three approaches even if improvements in subscales seem more important in the combined approach. Finally, exercise seems to be a positive addition to the nutritional cognitive-behavioral therapy since it decreases negative mood, improves eating disorders and leads to an effective body weight loss.

Adult↗
PubMed2006

A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression.

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 not otherwise specified were randomly allocated to one of three treatments. Treatment outcome measures were administered before and after acute treatment, and at a 6-month follow-up. Depression diagnosis was the primary outcome measure; secondary measures were self- and other report and clinician rating of global functioning. The trial was conducted at three community-based clinics between July 2000 and December 2002. Data analyses used an intent-to-treat strategy. RESULTS: Following acute treatment, all treatment groups demonstrated statistically significant improvement on outcome measures (depressive diagnosis, Reynolds Adolescent Depression Scale, Revised Children's Manifest Anxiety Scale, Suicidal Ideation Questionnaire), and improvement was maintained at follow-up. Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone. Compared with antidepressant medication alone, participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response (odds ratio = 6.86; 95% confidence interval 1.12-41.82). Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth, this may have stemmed from the relatively low dose of sertraline used. CONCLUSIONS: All treatments led to a reduction in depression, but the advantages of a combined approach were not evident.

Adolescent↗
PubMed2005

Treatment of phobic postural vertigo. A controlled study of cognitive-behavioral therapy and self-controlled desensitization.

In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive-behavioral therapy is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders. This study compared the effect of additional cognitive-behavioral therapy for a population with phobic postural vertigo with the effect of self-administered vestibular rehabilitation exercises. 39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy. Fifteen patients with self treatment and 16 patients with cognitive- behavioral treatment completed the study. There was significantly larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap Questionnaire and the Hospital Anxiety and Depression scale and its subscales. Cognitive-behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo. A multidisciplinary approach including medical treatment, cognitive-behavioral therapy and physiotherapy is suggested.

Adult↗
PubMedDate not supplied

[In-patient treatment concept for acute crises of borderline patients on the basis of dialectical-behavioral therapy].

Whereas the Dialectical-Behavioral Therapy (DBT) by Marsha Linehan for chronic suicidal female patients with borderline personality disorder has also been successfully implemented for in-patient treatment, the management of recurrent crisis has continued to be a significant challenge especially for hospitals taking part in the mandatory health coverage. Therefore, we have established an acute, short-term crisis treatment concept for both genders on a locked unit which takes the different circumstances of acute crisis into account. It ought to be used under the conditions of acute psychiatry and at the same time meet psychotherapeutic demands of borderline treatment. The treatment basis is DBT. The treatment focus is to improve stress-tolerance, especially by skills-training, regarding the individual situation and problems at time of admittance. The in-patient treatment should not take more than three weeks. The short-time aim is a fast reintegration in ambulant treatment or motivation for a specific therapy as DBT, middle- and long-time aims are the improvement of the ability to cope with crises and to demand less in-patient care.

Behavior Therapy↗
PubMed1979

The problem-oriented system and record keeping in the behavioral therapies.

The Problem-Oriented System (POS) provides systematic guidelines for health care record keeping. Behavioral therapy records share, with health care records in general a quality of inadequacy for contemporary needs. Likewise, behavior therapy training shares with other health care training inadequate attention to record-keeping. This conclusion arises from a search of recent journals and books concerned with behavior therapy issues. This article reviews the POS and proposes that is guidelines and advantages are suited for incorporation into behavioral therapy training. The expected result of such training should be records more amenable to audit or review for such purposes as third party payment, supervision, and peer review. Research is needed to help select the record-keeping training methods that would best meet these contemporary needs for increased quality in the documentation of health care provision.

Ambulatory Care↗
PubMed2001

Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial.

CONTEXT: Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking. OBJECTIVE: To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997. PATIENTS: Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years). INTERVENTIONS: Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months. MAIN OUTCOME MEASURES: Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood. RESULTS: Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%. CONCLUSIONS: Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

Adult↗
PubMed1995

[Behavior therapy in children and adolescents: a utilization study].

Outpatient behavior therapy has been paid for in the Federal Republic of Germany since 1980 as a service of the health insurance system that covers most of the population. This therapeutic approach is used with children, adolescents and adults, but up to now it has played only a minor role in the treatment of psychological and psychiatric problems in children and adolescents. A content analysis of 221 applications for approval of long-term therapy for children or adolescents provided information on sociodemographic data, symptoms, diagnoses, treatment goals and treatment methods. Data were also obtained on the patients' social situation. The analysis suggests that mainly 7- to 11-year-old boys undergo treatment. The number of girls receiving treatment increases during puberty, and during adolescence more girls are treated than boys. Applications for outpatient behavior therapy are predominantly for developmental disorders, hyperkinetic disorders, emotional disorders, phobias, enuresis, adjustment disorders, conduct disorders and eating disorders. The main treatment goals are the development of new behavioral skills and the maintenance of or strengthening of behavior that is incompatible with the symptoms. Cognitive-behavioral methods are frequently used.

Adolescent↗
PubMed1994

Comparison of cognitive-behavior therapy and desipramine in the treatment of bulimia nervosa.

A comparison of cognitive-behavior therapy alone, desipramine alone, and cognitive-behavior therapy combined with desipramine was made in the treatment of bulimia nervosa. The study was terminated early with an N of only 7 subjects per condition because of a high drop-out rate and lack of positive response in the desipramine alone group compared to the other two groups. By this time it was also apparent that at posttreatment and at 6 months follow-up no benefit was being realized from combining cognitive-behavior therapy with desipramine.

Adolescent↗
PubMed1985

Behavior therapy techniques applied to eating, exercise, and diet modification in childhood obesity.

Behavior therapy techniques are receiving increasing attention in the treatment of childhood obesity. This paper provides a selective review of experimental studies of childhood obesity that have utilized behavior therapy techniques with preadolescent populations. It further defines and describes specific behavior therapy techniques utilized in the modification of eating, exercise, and diet patterns in childhood obesity, including stimulus control, stimulus and response generalization, prompting, positive reinforcement, shaping, contingency contracting, and generalization and maintenance strategies.

Behavior Therapy↗
PubMed1996

Behavior therapy and the transdermal nicotine patch: effects on cessation outcome, affect, and coping.

The process and outcome of a smoking cessation program using behavior therapy alone (BT) or behavior therapy plus the nicotine patch (BTP) was studied in 64 participants. Participants quit smoking on a target date after a period of ad libitum smoking, cognitive-behavior therapy preparing them for cessation, and behavioral rehearsal for high-risk situations, including stress management, and coping with negative affect. Abstinence was significantly higher for the BTP group versus the BT group from the end of behavioral treatment (79% vs. 63%) through the 3-month follow-up (p < .01), with the effects weakening at the 6- (p = .06) and 12-month marks (p = 38% vs. 22%). More general distress was observed among BT versus BTP participants (i.e., increased withdrawal, tension, fatigue, and coping frequency with decreased coping effort; coping-to-urge ratio). The coping behavior of the BTP group may have been more effective than that of the BT group, as indicated by their significantly higher level of self-efficacy.

Adaptation, Psychological↗
PubMed1993

Unifying the field: developing an integrative paradigm for behavior therapy.

The limitations of early conditioning models and treatments have led many behavior therapists to abandon conditioning principles and replace them with loosely defined cognitive theories and treatments. Systematic theory extensions to human behavior, using new concepts and processes derived from and built upon the basic principles, could have prevented the divisive debates over whether psychological dysfunctions are the results of conditioning or cognition and whether they should be treated with conditioning or cognitive techniques. Behavior therapy could also benefit from recent advances in experimental cognitive psychology that provide objective behavioral methods of studying dysfunctional processes. We suggest a unifying paradigm for explaining abnormal behavior that links and integrates different fields of study and processes that are frequently believed to be incompatible or antithetical such as biological vulnerability variables, learned behavioral repertoires, and that also links historical and current antecedents of the problem. An integrative paradigmatic behavioral approach may serve a unifying function in behavior therapy (a) by promoting an understanding of the dysfunctional processes involved in different disorders and (b) by helping clinicians conduct functional analyses that lead to theory-based, individualized, and effective treatments.

Behavior Therapy↗
PubMed1991

New developments in cognitive-behavioral therapy for social phobia.

Significant advances in cognitive-behavioral therapy for social phobia have occurred during the past 5 years. A new psychobiological model of social anxiety is described, and recent controlled clinical trials are reviewed. An effective cognitive-behavioral approach to therapy for social phobia developed in the authors' setting is described with case studies. Finally, future directions in cognitive-behavioral approaches to therapy for social anxiety, including clinical trials of interactive approaches that combine drug therapy with behavioral therapy and of intensive treatment of patients with avoidant personality disorder, are described briefly.

Adult↗
PubMed1997

Behavior therapy empowers persons with severe mental illness.

Behavior therapy has been viewed by some as disempowering persons with severe mental illness (i.e., undermining their ability to make independent decisions). This is ironic because various behavioral strategies actually promote independent decision making. Behavioral interventions (a) provide a safe place for persons to consider their life decisions; (b) simplify the range of choices that comprise many of these decisions; (c) help persons with severe mental illness learn behaviors so that they can better meet the demands of independent decision making: (d) teach family members skills so that they can provide more resources to support independent decision making; and (e) facilitate self-control over behaviors and the settings in which they occur. Behavior therapists need to assert the important role that behavioral principles assume in empowering persons with mental illness so that these principles are not discarded by professionals who misunderstand, or otherwise stereotype, behavioral interventions.

Behavior Therapy↗
PubMed2000

Cognitive-behavioral therapy for medication-resistant symptoms.

Cognitive-behavioral therapy for psychosis is described. It draws on the cognitive models and therapy approach of Beck and colleagues, combined with an application of stress-vulnerability models of schizophrenia and cognitive models of psychotic symptoms. There is encouraging evidence for the efficacy of this approach. Four controlled trials have found that cognitive-behavioral therapy reduces symptoms of psychosis, and there is some evidence that it may contribute to relapse reduction. Studies that have examined factors that predict treatment response are reviewed. There is preliminary evidence that a good outcome is partially predicted by a measure of cognitive flexibility or a "chink of insight." People who present with only negative symptoms may show poorer outcome. However, there is no evidence that intelligence or symptom severity is associated with outcome. Implications for selecting patients and for optimal duration of treatment are discussed. Finally, the importance of taking account of the heterogeneity of people with psychosis, so that individual treatment goals are identified, is discussed.

Adaptation, Psychological↗
PubMed2004

Behavioral therapy for primary nocturnal enuresis.

PURPOSE: Recent studies suggest the efficacy of behavioral therapy for enuresis, even in cases of minor daytime voiding problems. We describe our experience with the clinical followup and behavioral therapy of children with primary enuresis. MATERIALS AND METHODS: We followed 159 boys and 91 girls 5 to 17 years old with primary enuresis who were treated at 3 medical centers with a pediatric nephrology clinic during the last 3 years. A detailed voiding history was obtained. Each child was treated with a bladder training session, including an explanation of the enuretic process, daily diary recording and training to recognize bladder distention and increase voiding frequency. RESULTS: A total of 226 children (90%) presented with 1 or more symptoms of bladder maturation delay and 13% reported behavioral constipation. Of the patients 185 (74%) completed the proposed treatment, including 111 (60%) who reported a positive and 21 (11%) who reported a partial response. In 53 children (29%) the treatment failed. CONCLUSIONS: Most children with enuresis have daytime symptoms when an accurate history is recorded. As shown by our data, the efficacy of behavioral therapy is comparable to that of desmopressin or alarm therapy but it requires good compliance of the child with the therapeutic plan. Age is not a determining factor in the success rate.

Adolescent↗
PubMed1978

Behavior therapy, supportive psychotherapy, imipramine, and phobias.

In a controlled outcome study of phobias, 111 adult patients (69% women, 31% men) received a course of 26 weekly treatment sessions consisting of (1) behavior therapy and imipramine hydrochloride (2) behavior therapy and placebo, or (3) supportive psychotherapy and imipramine. Patients were classified as agoraphobic, mixed phobic, or simple phobic. The great majority of patients in all groups showed moderate to marked global improvement (70% to 86%, depending on rater). In agoraphobics and mixed phobics (both groups experiencing spontaneous panic attacks), imipramine was significantly superior to placebo. There was no difference between behavior therapy and supportive therapy, both resulting in high improvement rates (76% to 100%, depending on rater). In simple phobic patients, there was a high rate of improvement with all treatment regimens (72% to 93%, depending on rater), with no significant difference between imipramine and placebo or between behavior therapy and supportive therapy. Of 88 moderately to markedly improved patients followed up for one year after completing treatment, 83% maintained their gains and 17% relapsed. No patients showed symptom substitution. Eighteen percent of the patients receiving imipramine hydrochloride showed marked stimulant side effects on from 5 to 75 mg/day.

Adult↗
PubMed1998

Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents.

OBJECTIVE: To compare, via a pilot study, the effectiveness of behavior therapy and of drug treatment in children and adolescents with obsessive-compulsive disorder. METHOD: Twenty-two children aged between 8 and 18 years were randomly assigned to behavior therapy (n = 12) or open clomipramine (n = 10) in a parallel design lasting 12 weeks. Behavior therapy included exposure and response prevention administered in weekly sessions. The mean dosage of clomipramine was 2.5 mg/kg (range = 1.4-3.3 mg/kg). The main outcome variables were the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Leyton Obsessional Inventory-Child Version (LOI-CV). RESULTS: Significant improvement was obtained in both treatment conditions. Behavior therapy produced stronger therapeutic changes than clomipramine on the CY-BOCS (p < .05), whereas on the LOI-CV no significant differences between the results of the two treatments were found. Five of the nine initial nonresponders showed significant changes after extension of treatment for another 12 weeks. CONCLUSION: Behavior therapy is shown to be a good alternative for drug treatment and deserves further study in larger samples of children with obsessive-compulsive disorder.

Behavior Therapy↗