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Whither cognitive-behavioral therapy for schizophrenia?

Clinical studies of cognitive therapy and rehabilitation for persons with schizophrenia have generated promising findings of improvements in patients' cognitive and clinical status. However, the results do not appear to be specific to a particular form of intervention, and long-term evaluations of cognitive therapy, as an element in a comprehensive system of care, need to be conducted for clinical validation. Rehabilitation efforts should be congruent with laboratory findings of specific cognitive deficits, including those that are "vulnerability indicators" and endure beyond symptomatic episodes. With the demonstration that chronic schizophrenic patients can learn a variety of cognitive and behavioral skills through Integrated Psychological Therapy and other psychosocial treatments, the future appears bright for a profusion of new modalities aimed at cognitive-behavioral rehabilitation, especially those that emerge from what is known about information-processing deficits in schizophrenia.

Brain Injuries↗

Etiology of postpartum depression--a review.

The literature on the etiology of postpartum depression was explored, including demographic, gynecologic-obstetric, biological, psychopathological, cognitive-behavioral, sociocultural and psychosocial factors. Prevailing views about the causation of postpartum depression reflect a multifactorial theory in which all of the selected factors contribute. Empirically derived evidence in support of such a theory is, however, not yet readily available. The emphasis in investigative work regarding the etiology of postpartum depression now appears to be in the psychosocial areas. The underlying assumption from a psychosocial perspective is that postpartum depression results from the stress of the peripartum period and adjustments to child-care responsibilities. In Taiwan, Chen (1994) confirmed the basic Postpartum Depression Model, supporting the predicted relationships between perceived stress, social support, self-esteem and postpartum depression. This model can be incorporated into the nursing body of knowledge. Based on this predictive theory, scientifically valid nursing interventions can be developed and tested.

Depression↗

Clinical monitoring of treatment course in child physical abuse: psychometric characteristics and treatment comparisons.

Weekly reports of high-risk indicators designed to monitor the course of treatment were obtained from physically abused, school-aged children and their parents/guardians who were randomly assigned to Individual Child and Parent Cognitive-Behavioral Treatment (CBT) or Family Therapy (FT). Measures of parental anger and physical discipline/force, and family problems were obtained each session. The measures showed moderate stability and parent-child correspondence. Between 20% and 23% of the two informant's reports acknowledged high levels of physical discipline/force during the early and late phases of treatment, respectively, and an even higher percentage of cases reported heightened parental anger and family problems. Early treatment reports from both informants predicted late period reports, but only parent reports were related to validity measures. The overall levels of parental anger and physical discipline/force were lower in CBT than FT families, though each group showed a reduction on these items from the early to late treatment sessions. The importance of routine monitoring of clinical course during intervention, especially in the identification of cases at-risk of reabuse, is discussed.

Adolescent↗

Brief cognitive-behavioral treatment for adolescent suicide attempters and their families.

OBJECTIVE: This article describes a brief, standardized, cognitive-behavioral treatment program for adolescent suicide attempters and their families. METHOD: Successful Negotiation Acting Positively (SNAP) treatment consists of a series of structured activities that create a positive family atmosphere, teach problem-solving skills, shift the family's understanding of their problems to troublesome situations rather than difficult individuals, and build confidence in the treatment professional, thereby reducing conditions associated with future attempts. RESULTS: SNAP treatment has been systematically administered to more than 100 suicidal adolescents and their families as part of an ongoing treatment study. Although these results are not yet available, our initial experience suggests that SNAP treatment can be delivered in a reliable fashion and is well accepted by both patients and therapists. CONCLUSIONS: Although suicidality in youth constitutes a major public health problem, few therapeutic interventions have been developed specifically for suicidal adolescents. SNAP treatment addresses a number of issues critical to successful interventions with this population, including their historically poor treatment compliance, the need for family involvement in treatment, and an emphasis on coping and problem-solving strategies. Moreover, the brief, structured format of SNAP treatment is consistent with the growing trend toward standardized, empirically tested, and cost-efficient interventions.

Adolescent↗

Prognostic indicators in bulimia nervosa treated with cognitive-behavioral group therapy.

Prognostic indicators of short-term outcome were identified in 69 women with the DSM-III-R diagnosis of bulimia nervosa who participated in a weekly 10-session structured cognitive-behavioral outpatient group program. Prior to treatment, all subjects completed the computerized Diagnostic Interview Schedule (DIS), the Moos Family Environment Scale (FES), the Diagnostic Survey for Eating Disorders (DSED), the Beck Depression Inventory (BDI), the Hopkins Symptom Checklist, Revised (SCL-90-R), the Bulimic Cognitive Distortions Scale (BCDS), the Eating Disorders Inventory (EDI), and the Bulimic Symptoms Checklist (BSCL). The latter three scales were readministered on completion of the 10-week group. Symptom improvement was assessed by examining percentage reduction in binge frequency, purge frequency, and summed scores for the EDI subscales Bulimia, Drive for Thinness, and Body Dissatisfaction. The only significant predictor of improvement in binge frequency and bulimic cognitions was family environment. Conflicted, controlling, and over-organized family environments appear to impede both reductions in binge frequency and changes in bulimic cognitions. Reduction in vomit frequency was associated with weight history and with laxative or diuretic use. The implications for planning psychotherapeutic interventions in bulimia nervosa are discussed.

Adolescent↗

The effects of cognitive-behavior modification on private speech and task performance during problem solving among learning-disabled and normally achieving children.

Recent research has supported the hypothesis that poor performance among learning-disabled (LD) children is frequently the result of deficits in self-regulation of strategic behaviors, rather than structural or ability deficits. As a result, cognitive-behavior modification (CBM) techniques that emphasize development of self-regulation through self-verbalizations (private speech) have been strongly recommended. The present study examined the natural occurrence of regulatory private speech among LD and normally achieving children during problem solving, as well as the effects of CBM training on private speech and task performance. Results indicated significant deficiencies in private speech and task performance among LD children; CBM training resulted in significant improvements. These results provide further verification of deficits in self-regulation of cognitive activity among LD children and import implications for intervention.

Behavior Therapy↗

Social Responsiveness as a Mediator in Adapted Cognitive Behavioral Therapy for Autistic Youth with Maladaptive and Interfering Anxiety.

Numerous adaptations to interventions have been included in cognitive behavioral therapy (CBT) for autistic youth. This study examines the degree to which CBT adapted to the social needs of autistic youth confers significant benefit by promoting social responsiveness. A secondary analysis was conducted on a multisite randomized clinical trial (Wood et al. in JAMA Psychiatry 77:474-483, 2020) comparing adapted CBT with standard-of-practice CBT and treatment-as-usual (TA). Autistic youth (N = 167; aged 7-13) with maladaptive and interfering anxiety participated. The adapted CBT (BIACA) uses a modular format, with an emphasis on supplementing common CBT practice elements (reframing and graded exposure) with social skill supports. The primary outcome measure was the Pediatric Anxiety Rating Scale. Social responsiveness was assessed with the Social Responsiveness Scale, Second Edition. Participants' general mental health was assessed as a secondary outcome using the Brief Problem Checklist. Mediation was tested using the SPSS PROCESS macro. Analyses suggested that the effect of adapted CBT on anxiety was mediated by its effects on social responsiveness, with a statistically significant indirect effect. Youth randomly assigned to adapted CBT exhibited better overall mental health at posttreatment compared to those randomized to the other conditions, and this effect was also mediated by improved social responsiveness. CBT adapted to address some of the social needs of autistic youth may enhance mental health outcomes by supporting social responsiveness, perhaps increasing the ease and effectiveness with which some youth can navigate potentially stressful situations such as entering and participating in group activities.

Humans↗

Relapse prevention in psychoeducational groups for compulsive crack cocaine smokers.

The paper presents a model of relapse prevention that utilizes metaphor, education, and psychodynamic and cognitive-behavioral principles in psychoeducational groups for compulsive crack cocaine smokers during inpatient detoxification. Relapse prevention teaches engagement in preventive alternative behaviors after inpatient detoxification. Clinical interventions impress patients with the nature of their psychological vulnerability to internal and external dangers and the importance of aftercare treatment post detoxification to receive needed support negotiating high risk situations. The paper provides a detailed description of the group process and of the actual interventions the clinician utilizes, thereby expanding clinical options on what to do and say when educating patients on relapse. Interventions prepare patients to negotiate the numerous high risk situations they will encounter after inpatient treatment that could easily trigger relapse. Psychoeducation provides patients with a cognitive and intellectual framework in which to understand the process of psychotherapy, the difficulties regulating affect and self esteem, and how aftercare treatment addresses their psychological problems and decreases chances of relapse.

Cocaine↗

Stress and coping in the context of psychoneuroimmunology: a holistic framework for nursing practice and research.

Nurses who specialize in mental health routinely deal with stress and coping as priority issues. Yet there has been no consensus on an overriding framework for organizing and interpreting knowledge concerning the influences of stress on health and well-being. In addition, stress-management interventions have often been piecemeal. This article surveys traditional and emerging conceptualizations of stress and stress management, with a special focus on the transactional model and psychoneuroimmunology as complementary integrative frameworks. The authors recommend a comprehensive approach for stress management that includes behavioral, cognitive, and combination strategies for active coping as well as cognitive-behavioral techniques for relaxation.

Adaptation, Psychological↗

Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents.

Substance-dependent adolescents (N = 34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases. The results from this pilot demonstration effort suggest that skills training based on cognitive-behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection and warrant evaluation in a controlled comparison with a larger sample.

Acquired Immunodeficiency Syndrome↗

An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures.

In previous research, a cognitive-behavioral therapy (CBT) package was found to be effective in reducing children's distress associated with the painful medical procedures of bone marrow aspirations (BMAs) and lumbar punctures (LPs). Orally administered Valium demonstrated less effectiveness but was helpful in reducing behavioral distress before the medical procedure. In the present study, we investigated whether the combination of oral Valium and CBT would result in increased efficacy of the CBT. Eighty-three subjects were randomly assigned to receive either CBT or CBT plus Valium while undergoing either a BMA or an LP. Dependent variables included observed behavioral distress, self-reported fear and pain, and pulse rate. Results failed to support the value of such a combination but did provide additional evidence in regard to the effectiveness of the CBT. The need for more potent medical interventions for some children is discussed.

Arousal↗

Psychosocial treatment of phobia and panic disorders.

Intervention packages combining cognitive restructuring techniques and exposure exercises have become the psychosocial treatments of choice for panic, agoraphobia, and social phobia. Exposure and related desensitization techniques are the treatment of choice for all variants of simple phobia. Combining psychotropic medication and cognitive-behavior therapy suggests strategies that offer new opportunities for increasing the number of individuals with anxiety disorders who can be effectively treated with a biobehavioral approach.

Antidepressive Agents↗

Ephedrine-induced thermogenesis as an adjunct to cognitive restructuring and covert conditioning: a proposal for treatment of obese individuals.

Experimental investigators have discussed the therapeutic potential of ephedrine as a thermogenic agent in the treatment of obese individuals. Because research into thermogenesis and the role of sympathetic nervous system stimulation in weight control primarily has emphasized pharmacological interventions, the authors suggest that cognitive restructuring and covert conditioning procedures could be valuable psychotherapeutic additions to a pharmacologically derived weight-loss regimen. Furthermore, it is concluded that additional clinical research is necessary to determine the efficacy of integrating ephedrine therapy and cognitive-behavioral psychotherapeutic procedures as adjuncts to a multidimensional program for treating obesity.

Adipose Tissue↗

The role of node-link mapping in individual and group counseling.

The value of using a visual representation strategy, called node-linking mapping, was evaluated in individual and group drug abuse counseling settings. Methadone maintenance clients were randomly assigned to counselors trained to use mapping techniques (n = 57), and those who used standard counseling (n = 51). Clients in the mapping counseling group had more favorable perceptions of their own therapeutic engagement and progress as indicated by ratings of cognitive-behavioral and motivational attributes than did those in standard counseling. Overall, individual sessions were viewed by clients as being more valuable than group counseling, but the use of mapping increased the helpfulness attributed to group counseling to near the same level as individual counseling.

Adult↗

Tailoring treatment approaches to the individualized needs of cancer patients with pain.

Cognitive-behavioral and behavioral interventions, which have been successfully used to manage chronic pain unrelated to cancer, are an acceptable treatment for the psychobiological factors, including the expression of feelings, associated with pain in cancer patients. However, testing the effectiveness of complex multidimensional programs is difficult because of confounding factors such as progression of disease and measurement of potentially reactive outcomes. Patients were enrolled in theoretically strong individualized treatment programs for 5 weeks, with follow-up observation at 9 and 17 weeks. Weekly strategies were chosen to contribute to the achievement of patient-selected pretreatment goals. Interventions were designed to achieve psychobiological outcomes such as a decrease in inaccurate expectations, an increase in the use of positive comparisons and positive self-statements, a decrease in autonomic arousal, and promotion of self-efficacy. Two case studies provide examples of individual differences in treatment needs and the realities of clinical care.

Breast Neoplasms↗

Development and evaluation of an HIV-risk reduction program for female college students.

College students are engaging in high rates of behavior related to risk of infection from Human Immunodeficiency Virus (HIV) and other sexually transmitted diseases (STDs). A cognitive-behavioral skills training program for heterosexual college females focused on sexual assertiveness skills and the reduction of risk-related behaviors was designed and evaluated compared with an education-only program. Participants completed pre-intervention, post-intervention, and one-month follow-up assessments of: (a) HIV/STD-related knowledge and beliefs; (b) sexual, alcohol, and drug-related behaviors; and (c) sexual assertiveness role-plays. Skills training participants compared to education-only participants scored higher on sexual assertiveness skills, specific knowledge of HIV infection, and self-efficacy to perform lower risk sexual behaviors and reported a reduction in risk-related behaviors at post-intervention and follow-up assessments. The effectiveness of behavioral skills in HIV risk-reduction programs for college students is discussed.

Adolescent↗

Sexually transmitted disease prevention approaches that work. Interventions to reduce risk behavior among individuals, groups, and communities.

Behavior change remains the only available means to curtail new HIV infections. Although much remains to be learned about the effectiveness of different prevention strategies, there has already been evidence that both face-to-face interventions focused on individuals and community-level interventions focused on vulnerable communities can produce substantial reductions in high-risk sexual behavior. This article briefly describes the results of controlled outcome studies that have employed cognitive-behavioral and norm change elements to reduce HIV risk behaviors in face-to-face and community-level trials with both inner-city women and homosexual men.

Clinical Trials as Topic↗

A school-based anger management program for developmentally and emotionally disabled high school students.

Using Novaco's cognitive-behavioral conceptualization of anger, several practitioners developed cognitive-behavioral approaches for effectively intervening with aggressive youth. However, little attention has been paid to using these approaches with young people whose cognitive, emotional, and behavioral limitations appear to preclude them from benefiting from these interventions. A group program at a special school has demonstrated that older adolescents and young adults with diagnoses such as pervasive developmental delay, mental retardation, and autism can benefit from such a model if it is modified to meet their special learning needs. Through the use of daily logs, group reinforcement, role playing, skill building and relaxation techniques, normalizing anger, and providing liaison to classrooms, multiply handicapped students were able to learn the physiology, triggers, and consequences of anger as well as to develop coping strategies for managing their anger, while reducing aggressive acting out. Most of these students will enter protective work and residential settings in the future, and possessing these skills will facilitate their successful placement and increase the likelihood that some will succeed in entering some aspect of the adult mainstream.

Adolescent↗