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PubMed2006

Effect of cognitive behavior therapy on smokers' compensatory coping skills.

Cognitive behavior therapy for depression has been adapted for use in cigarette smoking cessation groups. CBT appears to be an effective treatment, though results are mixed as to whether it is especially helpful for smokers vulnerable to depression, and little is known about what mediates its effects. Based on the hypothesis that CBT works by way of teaching compensatory skills for coping with negative thinking and emotions, this study compared CBT with a time-matched comparison condition incorporating health education and scheduled, reduced smoking. There was a nonsignificant trend favoring CBT in achieving abstinence, but CBT did not enhance smokers' compensatory coping skills. Discussion focuses on the need to examine a wide range of possible mediating variables in future research on CBT for smoking cessation.

Adaptation, Psychological↗
PubMed1986

Behavior therapy and the elderly: a conceptual and ethical analysis.

This article examines several dimensions of the conceptual framework of the behavioral approach to the treatment of the elderly's problems in living that require emphasis. These dimensions are: 1) Within the behavioral approach behavior is viewed as not being a function of discontinuous, developmental stages each with a unique set of psychological processes; chronological age therefore is considered not to be a causal variable in psychological development, but rather a pure index of only certain physical events; 2) The level of analysis of the behavioral approach to the problems of the elderly is that of molar behavior, and therefore explanations which appeal to other levels of observation, described in different terms and measured in different dimensions, are not considered to be part of this approach; 3) The molar behavior of the elderly is viewed as a function of the contingencies of reinforcement, and behavior that is labeled abnormal is viewed as not quantitatively nor qualitatively different in its development and maintenance from other learned behavior; and 4) Behavior therapy, like all therapies, is a value-laden enterprise in which ends as well as means can be explicated and critically examined. Behavior therapy, in which the involvement of the elderly in the determination of treatment goals is maximized and in which the ability of the elderly to influence and design their environments is enhanced, is advocated.

Aged↗
PubMed1996

[Behavior therapy of schizophrenia patients during convalescent period].

58 of schizophrenia patients at restoration stage in the hospital were studied. The ineffective adaptive behaviors were assessed and behavior therapy plans were made. The behavior therapy was provided in group or individually. The result indicated that patients' ineffective adaptive behaviors such as laziness, passive, withdrawal, role conflict, sexual dysfunction, ineffective adaptation in the society, and aggressive were improved a lot than those before receiving therapy (P < 0.01).

Adaptation, Psychological↗
PubMed2004

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study.

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.

Adult↗
PubMed1980

The treatment of heroin addiction: naltrexone alone and with behavior therapy.

Recently, narcotic antagonists (drugs which block the euphoric effects of opiates) and behavior therapy have both been proposed as possible treatments for heroin addiction. In the present study the effectiveness of one particular antagonist, naltrexone, was examined under two conditions: (1) when administered alone, and (2) when administered in conjunction with behavior therapy. Measures of treatment effect included number of days on naltrexone, number of weeks in the program, reported side effects, and number of dirty urines in each treatment. While data initially indicated a superiority of the combined treatment program, this superiority faded over time. Results are discussed in terms of program start-up effects (especially when using experimental drugs), terms of process versus outcome measurement, and in terms of societal pressure operating against the success of heroin treatment in minority populations with poor job skills.

Adult↗
PubMed2005

A proposed trial of dialectical behavior therapy and trauma model therapy.

Dissociative identity disorder and borderline personality disorder resemble each other in trauma histories and comorbidity. Each disorder is frequently comorbid with the other. Treatment outcome data for Dialectical Behavior Therapy of borderline personality disorder and Trauma Model Therapy of dissociative identity disorder are reviewed. The author proposes a psychotherapy treatment study in which there are three subject groups and two treatment conditions. The subject groups are borderline personality disorder without dissociative identity disorder; dissociative identity disorder without borderline personality disorder; and both conditions present concurrently. Subjects would be randomized to receive Dialectical Behavior Therapy or Trauma Model Therapy. Such a study could provide answers to controversies in the field about a better treatment approach for dissociative identity disorder and potentially could broaden and strengthen the indications for Dialectical Behavior Therapy.

Adult↗
PubMed2006

Family cognitive behavioral therapy for child anxiety disorders.

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 therapy (CBT). Conditions were matched for therapist contact time. Both interventions included coping skills training and in vivo exposure, but the family CBT intervention also included parent communication training. Independent evaluator, parent, and child report measures with demonstrated validity and reliability were used to assess child anxiety symptom outcomes at pre- and posttreatment. The data analytic strategy involved an evaluable patient analysis. RESULTS: Compared with child-focused CBT, family CBT was associated with greater improvement on independent evaluators' ratings and parent reports of child anxiety--but not children's self-reports--at posttreatment. CONCLUSIONS: Both treatment groups showed improvement on all outcome measures, but family CBT may provide additional benefit over and above child-focused CBT. These findings provide preliminary support for the efficacy of the "Building Confidence" program and encourage further research in parental participation in treatment for childhood anxiety.

Adaptation, Psychological↗
PubMed1985

Behavior therapy and the anxiety disorders: some conceptual and methodological issues.

Some of the methodological and conceptual issues relevant to behavior therapy treatment outcome studies for anxiety disorders are presented. The practice among behavioral researchers of measuring anxiety from 3 response systems (verbal, physiological and motoric-behavioral) is discussed. It is emphasized that many of the popular methods used to assess the 3 response systems have unknown or poor reliability or validity. From the point of view of treatment variables, it is noted that many behavioral treatment procedures are not reported in sufficient detail to allow replication or comparisons to be made across studies. In addition, it is argued that in order to improve the existing treatment procedures, it will be necessary for each study to assess the subjects' adherence to the treatment regimen, as well as their proficiency with any skills required to carry out the treatment plan. Finally, the importance of 'placebo' control groups is discussed in the context of identifying the specific factors in behavioral treatments which are responsible for change in the targeted symptoms. It is concluded that behavior therapy holds promise as an effective treatment for the anxiety disorders.

Anxiety Disorders↗
PubMed1976

Sequential withdrawal of stimulant drugs and use of behavior therapy with two hyperactive boys.

The separate and combined effects of stimulant drugs, placebos, and behavior therapy were investigated with two hyperactive boys. In each case, sequential replacement of drugs (Ritalin and Dexedrine) with placebos demonstrated placebo effects of the drugs; behavior therapy, alone and in combination with drugs, was effective in controlling hyperactive behaviors. Implications in regard to drugs as treatment of choice are discussed.

Amphetamine↗
PubMed2006

[Tinnitus and cognitive-behavioral therapy: results after 1 year].

INTRODUCTION: Tinnitus is a common auditory symptom that interferes with activities of daily living and is often associated with anxiety and depression. METHOD: This study included consecutive patients with chronic intense tinnitus for more than six months who were treated with Tinnitus Retraining Therapy (TRT), a cognitive-behavioral therapy, after previous treatment failed and after a clinical evaluation based on standardized questionnaires, including the Tinnitus Handicap Questionnaire (THQ). One year after the end of the TRT, the treatment was evaluated by the same standardized questionnaires. RESULTS: This prospective study included 96 consecutive patients (49 women, 47 men, mean age: 48 years). Tinnitus improved significantly in 75%, where significant improvement was defined as a final THQ score of less than 500 after CBT. This improvement varied according to initial THQ scores and was seen in: all patients with moderate (THQ<500), 70.3% of the patients with intermediate (500 1001), and 34.8% of patients with severe (THQ>1000) tinnitus. CONCLUSION: CBT shows promise as a treatment of tinnitus-related distress.

Adult↗
PubMedDate not supplied

Can line clinicians master the conceptual complexities of dialectical behavior therapy? An evaluation of a State Department of Mental Health training program.

Dialectical behavior therapy for borderline personality disorder has rapidly attained wide-spread popularity, with one indication being the development of training initiatives by the Department of Mental Health within at least two States in USA. Efficacy data published by the originator of the treatment, Marsha Linehan, and her colleagues, probably accounts at least in part for this popularity. However, the complexity of DBT raises a fundamental question regarding these broader applications: can clinicians of diverse backgrounds acquire a shared and sophisticated understanding of the treatment theory? The clinical utility of a treatment rests heavily upon ease of dissemination (APA, Template for developing guidelines: Interventions for mental disorders and psychosocial aspects of physical disorders. Washington, DC: Author, 1995), and in that regard DBT--a complicated, multifaceted approach--could appear vulnerable. This vulnerability is heightened when institutional adoption involves the collaboration of numerous clinicians, who, despite occupying diverse roles, must nevertheless develop a shared understanding of the treatment. Using a detailed examination of DBT knowledge, we evaluated the conceptual mastery of 109 clinicians trained via a State Department of Mental Health initiative. Performance on the examination correlated specifically with DBT training. Prior education or background in behavior therapy accounted for little variance, indicating that clinicians occupying diverse roles acquired reasonable intellectual mastery over this complex model.

Adult↗
PubMed1994

Do depressed men and women respond similarly to cognitive behavior therapy?

OBJECTIVE: A great majority of the evidence pertaining to the effectiveness of the time-limited psychotherapies as treatments of major depression are derived from studies of either predominantly or entirely female subject groups. Depressed men and women differ in a number of important respects that may alter the course of affective disorder, and as a result, they may also differ in their responses to psychotherapy. In this study the outcomes of 40 men and 44 women treated with cognitive behavior therapy were compared. METHOD: The patients were interviewed with the Schedule for Affective Disorders and Schizophrenia and diagnosed according to the Research Diagnostic Criteria and DSM-III-R criteria. Subsequently, they were assessed every other week (with the Hamilton Depression Rating Scale, Beck Depression Inventory, and Global Assessment Scale) during a standardized, time-limited cognitive behavior therapy protocol. The outcomes of the men and women were compared by means of a series of analyses of variance and covariance and survival analyses. RESULTS: There were several significant pretreatment differences, and the men attended significantly fewer therapy sessions than the women. Although the men and women generally had comparable responses, patients with higher pretreatment levels of depressive symptoms, particularly women, had poorer outcomes. CONCLUSIONS: This study provides further evidence of gender-specific differences in depressed patients' symptoms and treatment utilization. Cognitive behavior therapy appears to be a comparably useful outpatient treatment for men and women. However, either more intensive cognitive behavior therapy or alternative methods of treatment may be warranted for patients with more severe syndromes.

Adult↗
PubMedDate not supplied

Cognitive behavioral therapy for chronic fatigue syndrome in a general hospital--feasible and effective.

Cognitive behavior therapy (CBT) has been shown to be effective in recent randomized controlled trials for chronic fatigue syndrome (CFS). We examined the effectiveness of CBT in a general hospital setting in a retrospective questionnaire follow-up study of 94 patients offered CBT by liaison psychiatry services. The questionnaire response rate was 61%. Eighteen percent had returned to normal functioning at follow-up. For the group as a whole, there was a significant improvement in the functional and social impairment and the number of frequently experienced symptoms. Those in work or study at follow-up was 53% (29% pretreatment), and 65% of patients mentioned occupational stress as a contributory factor in their illness. There was a significant reduction in the frequency of attendance at primary care in the year after the end of CBT. We conclude that cognitive behavioral therapy is an acceptable treatment for most patients and can be used in a general hospital outpatient setting by a variety of trained therapists. However, a proportion of patients do not benefit and remain significantly disabled by the condition.

Adult↗
PubMed2006

Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain.

Although cognitive-behavioral therapies (CBT) have been demonstrated to be effective for a variety of chronic pain problems, patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects. Furthermore, although cognitive-behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes, little research has systematically tested this. Therefore, we examined mediators, moderators, and predictors of treatment effects in a randomized controlled trial of CBT for chronic temporomandibular disorder (TMD) pain. Pre- to post-treatment changes in pain beliefs (control over pain, disability, and pain signals harm), catastrophizing, and self-efficacy for managing pain mediated the effects of CBT on pain, activity interference, and jaw use limitations at one year. In individual mediator analyses, change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome. Analyzing the mediators as a group, self-efficacy had unique mediating effects beyond those of control and the other mediators. Patients who reported more pain sites, depressive symptoms, non-specific physical problems, rumination, catastrophizing, and stress before treatment had higher activity interference at one year. The effects of CBT generally did not vary according to patient baseline characteristics, suggesting that all patients potentially may be helped by this therapy. The results provide further support for cognitive-behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain-related beliefs in CBT and in other health care encounters.

Adult↗
PubMed1989

Behavior therapy with children and adolescents: a twenty-year overview.

A twenty-year overview of behavior therapy with children and adolescents is presented. The various techniques and their application to relevant major DSM-III-R categories are critically discussed. It is concluded that behavior therapy has made great progress and has proven applications in child and adolescent disorders but that its precise roles, comparative efficacy, and complementarity to other forms of psychotherapy and other treatments remain to be demonstrated. Much uncertainty stems from the relatively poor state of research in other forms of psychotherapy.

Adolescent↗
PubMed1987

A computer simulation for behavior therapy training.

Computer simulation technology has been applied to a wide variety of learning tasks; however, behavior therapy training has not been among them. A computer simulation has recently been developed for use in behavior therapy training. The simulation written for Apple II microcomputers reflects possible referral, assessment, and intervention procedures encountered by a behavior therapist in a mental health center. Forty-two pieces of assessment information may be drawn from 8 general areas, while 6 different interventions may be chosen after a diagnosis is reached. Simulation content and utility were rated highly by both practicing behavior therapists and trainees.

Behavior Therapy↗