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PubMed1977

[New problems and results in behavior therapy].

What is presently observed is not only a rapid increase in the number of publications, but also a major change in the theoretical principles of behavior therapy. The former onesidedness of a form of behavior therapy theoretically substantiated by classical conditioning only may be regarded as having been completely overcome. For example, this is evident from new approaches to behavior diagnosis as an essential prerequisite of differentiated therapy planning. Recent concepts of the theoretical substantiation of the effectiveness of behavior therapy lead to an increasing consideration of both cognitive and motivational aspects and also take into account the complexity of the patient's social relations. This, in turn, results in the availability of a wide range of indication-specific methods of behavior therapy.

Behavior Therapy↗
PubMed1988

[Ancient mental healing and cognitive behavior therapy in comparison].

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.

Behavior Therapy↗
PubMed2004

Skinner and the rise of behavior modification and behavior therapy.

Skinner is, without a doubt, one of the most predominant figures in the development of Behavior Modification and Behavior Therapy. Skinners' work is essential to the development of Behavior Modification and Behavior Therapy. Beginning with the social need for efficient psychotherapy, and after having generated a solid theoretical body of behavioral laws, Skinner indicated and also developed the appropriate path towards efficient interventions for unadaptive behavior. He developed a new theory regarding abnormal behavior (psychopathology), as well as a procedural model for evaluation (diagnosis) and intervention: "The functional analysis of behavior". His applications for this kind of work are pioneering and at the same time, he is the agglutinant figure of what we today call "Behavior Modification and/or Therapy". It is remarkable that a scientist could change the theories and practices of a discipline as radically as Skinner and his work did. His work, however, still has its limitations. The best way to acknowledge and pay tribute to Skinners' work is to overcome these limitations.

Behavior Therapy↗
PubMed2006

Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations.

Dialectical behavior therapy (DBT) can be considered a well-established treatment for borderline personality disorder (BPD) as evidenced by seven well-controlled randomized clinical trials across four independent research teams. The primary purpose of this article is to address a variety of potential mechanisms of change that may be associated with those aspects of DBT that are unique to the treatment and its theoretical underpinnings. Based on the biosocial theory of BPD, many of these mechanisms can be distilled down to the following process: the reduction of ineffective action tendencies linked with dysregulated emotions. Specifically we address the following interventions and associated mechanisms of change: mindfulness, validation, targeting and chain analysis, and dialectics. Patient change in BPD is conceptualized primarily as helping the patient to engage in functional, life-enhancing behavior, even when intense emotions are present. Ultimately, our goal was to provide guidance for theoretically and empirically grounded research on the mechanisms of change in DBT.

Affect↗
PubMed2003

Cognitive-behavioral therapy: tailored to the individual.

Cognitive-behavioral therapy focuses on the cognitive, affective, and behavioral components of the pain experience. Cognitive-behavioral strategies can be used to treat chronic pain and chronic intermittent pain. The strategies concentrate on emotional, behavioral, and social responses, helping patients to increase their feelings of control or feelings of self efficacy regarding control.

Adaptation, Psychological↗
PubMed2003

Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy.

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function. DESIGN: Randomized, prospective, controlled intervention. SETTING: Clinical research center in an academic medical institution. PATIENT(S): Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise. INTERVENTION(S): Subjects were randomized to CBT or observation for 20 weeks. MAIN OUTCOME MEASURE(S): Serum levels of E(2) and P and vaginal bleeding were monitored. RESULT(S): Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), chi(2) = 7.14. CONCLUSION(S): A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.

Adult↗
PubMed1994

Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy.

BACKGROUND: The present study examined a group of patients who have obsessive compulsive disorder (OCD) and certain comorbid personality disorders to provide data on types of clinical problems that complicate treatment. Data are presented on patient response to a comprehensive behavior therapy. METHOD: Forty-one consecutively referred, adult, nonpsychotic patients with OCD were evaluated independently by their attending psychiatrist and a consulting psychologist for presence of DSM-III-R personality disorder. Thirty-one of these patients, for whom there was 100% agreement on presence or absence of a comorbid personality disorder, participated in a course of comprehensive behavior therapy. OCD patients with comorbid personality disorder (OCD+PD) were compared with a group of OCD patients without comorbid personality disorder (nonPD OCD) on pretreatment and treatment-related variables. RESULTS: There was significantly high interrater reliability between psychiatrist and psychologist on diagnosis of personality disorder (p < .001). OCD+PD patients demonstrated poorer response to prior psychiatric treatments and greater psychosocial and psychiatric impairment at pretreatment than did nonPD OCD patients. The OCD+PD patients demonstrated a moderate response to comprehensive behavior therapy, but below that of nonPD OCD patients. OCD+PD patients were also rated as more difficult to treat, required more psychiatric hospitalizations during treatment, and were more likely to terminate behavior therapy prematurely than were nonPD OCD patients. CONCLUSION: In modest samples of OCD+PD patients (N = 26), and nonPD OCD patients (N = 5), this study found that OCD patients with personality disorder had greater psychopathology, fewer coping and living skills, and were more resistant to psychiatric treatment than the nonPD OCD patients. In addition, when treated with a comprehensive behavior therapy that focuses on other clinical problems in addition to the OCD symptoms, the OCD+PD patients had an enhanced response to treatment.

Activities of Daily Living↗
PubMed2004

On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse.

AIMS: Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse. METHOD: Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide. FINDINGS AND CONCLUSIONS: Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.

Adolescent↗
PubMed1990

Effectiveness of behavioral therapy for chronic low back pain: a component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.

Adult↗
PubMed2005

Should parents be co-clients in cognitive-behavioral therapy for anxious youth?

Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials (RCTs), and recent studies have sought to determine if the effects can be enhanced by an adjunctive parent component. The rationale for adding parents as active participants to treatment for anxious youth includes the notions that parenting factors (a) can contribute to the maintenance of anxiety, (b) could facilitate the generalization of treatment gains, and (c) have had favorable results in treatment of other childhood disorders. To date, there have been 9 CBT treatment outcome trials with anxious youth that included parents in treatment. This article (a) provides a critical review of the research on active parent involvement in CBT of anxious youth, (b) calculates and reports effect sizes emerging from these studies, and (c) recommends areas for future research.

Adolescent↗
PubMed1977

Patients' attitudes toward behavior therapy and psychotherapy.

A questionnaire survey of 50 patients treated by behavior therapy or short-term, analytically oriented psychotherapy revealed that both groups, as well as those patients who improved the most, placed a high value on insight, the patient-therapist relationship, catharsis, and trust. The findings suggest that behavior therapy patients tend to place more emphasis than do their therapists on factors that have traditionally been thought important in analytic psychotherapy.

Attitude to Health↗
PubMed2002

Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia.

OBJECTIVE: Although four meta-analytic reviews support the efficacy of pharmacotherapy and behavior therapy for the treatment of insomnia, no meta-analysis has evaluated whether these treatment modalities yield comparable outcomes during acute treatment. The authors conducted a quantitative review of the literature on the outcome of the two treatments to compare the short-term efficacy of pharmacotherapy and behavioral therapy in primary insomnia. METHOD: They identified studies from 1966 through 2000 using MEDLINE, psycINFO, and bibliographies. Investigations were limited to studies using prospective measures and within-subject designs to assess the efficacy of benzodiazepines or benzodiazepine receptor agonists or behavioral treatments for primary insomnia. Benzodiazepine receptor agonists included zolpidem, zopiclone, and zaleplon. Behavioral treatments included stimulus control and sleep restriction therapies. Twenty-one studies summarizing outcomes for 470 subjects met inclusion criteria. RESULTS: Weighted effect sizes for subjective measures of sleep latency, number of awakenings, wake time after sleep onset, total sleep time, and sleep quality before and after treatment were moderate to large. There were no differences in magnitude between pharmacological and behavioral treatments in any measures except latency to sleep onset. Behavior therapy resulted in a greater reduction in sleep latency than pharmacotherapy. CONCLUSIONS: Overall, behavior therapy and pharmacotherapy produce similar short-term treatment outcomes in primary insomnia.

Anti-Anxiety Agents↗
PubMed1997

The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy.

The quality of the therapeutic alliance was compared in sessions of psychodynamic-interpersonal and cognitive-behavioral therapy, and the alliance's relationship to various session impacts was investigated. As part of the Sheffield Psychotherapy Project 2 (D. A. Shapiro, M. Barkham, A. Rees, G. E. Hardy, S. Reynolds, & M. Startup, 1994), 57 clients diagnosed with major depression received 16 sessions of either psychodynamic-interpersonal or cognitive-behavioral therapy. Coders used the Working Alliance Inventory to rate 1 high-impact and 1 low-impact session from each client. Results indicated significantly greater alliance scores for cognitive-behavioral therapy sessions on the whole. Also, for the samples as a whole, high-impact sessions were characterized by higher alliance scores than those for low-impact sessions, and alliance was positively related to therapists' ratings of session depth and smoothness and to clients' ratings of mood.

Adult↗
PubMed1991

A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches.

Forty-one recurrent tension headache sufferers were randomly assigned to either cognitive-behavioral therapy (administered in a primarily home-based treatment protocol) or to amitriptyline therapy (with dosage individualized at 25, 50, or 75 mg/day). Cognitive-behavioral therapy and amitriptyline each yielded clinically significant improvements in headache activity, both when improvement was assessed with patient daily recordings (56% and 27% reduction in headache index, respectively), and when improvement was assessed with neurologist ratings of clinical improvement (94% and 69% of patients rated at least moderately improved, respectively). In instances where differences in treatment effectiveness were observed (headache index, somatic complaints, perceptions of control of headache activity), cognitive-behavioral therapy yielded somewhat more positive outcomes than did amitriptyline. Neither treatment, however, eliminated headache problems.

Adult↗
PubMed2005

A randomized controlled trial of Japanese patients with obsessive-compulsive disorder--effectiveness of behavior therapy and fluvoxamine.

BACKGROUND: The aim of this study was to confirm and compare the efficacy of fluvoxamine (the only licensed SSRI for treatment for OCD in Japan) and behavior therapy in treating Japanese patients with OCD. In addition, we investigated predictors of these treatments. METHODS: Thirty-one outpatients meeting the DSM-III-R criteria for OCD without any axis I disorder were randomly assigned to one of three treatment conditions: BT (behavior therapy +/- pill placebo), FLV [autogenic training (a psychological placebo for OCD) +/- fluvoxamine] and control group [autogenic training (psychological placebo) +/- pill placebo] for 12 weeks of treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression-Improvement Scale (CGI-I) were administered blindly at baseline and week 4, 8 and 12. RESULTS: Twenty-eight patients completed this study. Patients in the BT and FLV groups showed significantly more improvement than those in the control group in the mean score of total Y-BOCS; moreover, the BT group showed significantly more reduction in total Y-BOCS score at the end of treatment than the FLV group (BT > FLV, p < 0.01). Patients with lower baseline total Y-BOCS, past history of a major depressive episode and absence of cleaning compulsion improved more with fluvoxamine. CONCLUSIONS: We confirmed the effectiveness of behavior therapy and fluvoxamine for Japanese patients with OCD. Behavior therapy improved the condition of OCD patients more than fluvoxamine.

Adolescent↗
PubMed1993

Cognitive-behavioral therapy of panic disorder with secondary major depression: a preliminary investigation.

Controlled studies indicate that cognitive-behavioral therapy eliminates panic attacks in greater than 80% of patients who suffer from panic disorder. However, because most of the screening procedures used in those studies called for excluding patients who were depressed, a question arises as to the extent to which these results apply to patients who are clinically depressed in addition to having panic attacks. Accordingly, an attempt was made in the present study to determine whether or not panic patients who are clinically depressed could be treated as successfully as those who are not clinically depressed. Two multiple baseline A-A1-A-B across-subjects designs were used, one to test 8 panic Ss with major depression and the second to test 7 panic Ss without major depression. In Baseline (A), Ss monitored their panic attacks daily. During the A1 phase, a program of information on panic attacks presented as psychotherapy was instituted to assess the effects of nonspecific factors, followed by a second baseline phase (A). Cognitive-behavioral therapy (B) was then introduced. Results showed that cognitive-behavioral therapy was significantly superior to information-based therapy in the reduction of panic attacks. No significant differences were found between depressed and nondepressed patients.

Adult↗