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PubMed1982

International developments in behavior therapy in Latin America.

The development of behaviour therapy in Latin America is presented, beginning with the work of Keller and Bijou in Brazil and Mexico respectively. In the decade of the 70's the experimental analysis of behaviour and interventions to change undesired behavior were considered scientific and professional alternatives to psychoanalysis. Psychologists trained in objective methodology began work on clinical problems, and were followed by psychiatrists not satisfied with traditional approaches. Today behavior therapy and behavior modifications are known and practiced in the majority of the Latin American countries. Important basic research is in progress.

Behavior Therapy↗

PubMed2005

Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder.

OBJECTIVE: To compare the effectiveness of group cognitive-behavioral therapy (GCBT) and of sertraline in treatment-naïve 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 manual-based 12-week cognitive-behavioral protocol adapted for groups, and treatment with sertraline involved medication intake for 12 weeks. Subjects were assessed before, during, and after treatment (at 1, 3, 6, and 9 months after treatment conclusion). Primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale. Repeated-measures analyses of variance were done. RESULTS: Both GCBT and sertraline conditions had significant improvement in obsessive-compulsive disorder symptoms as measured by the Children's Yale-Brown Obsessive-Compulsive Scale after 12 weeks of treatment. After the 9-month follow-up period, subjects in the GCBT condition had a significantly lower rate of symptom relapse than those in the sertraline group. CONCLUSIONS: The treatment with GCBT may be effective in decreasing obsessive-compulsive symptoms in childhood obsessive-compulsive disorder and should be considered as an alternative to either individual cognitive-behavioral therapy or a medication, such as sertraline. Results support the effectiveness and the maintenance of gains of GCBT in the treatment of youngsters with obsessive-compulsive disorder.

Adolescent↗

PubMedDate not supplied

Cognitive behavioral therapy delays relapse in female socially phobic alcoholics.

The present study was conducted to test the hypothesis that socially phobic alcoholics treated with Cognitive Behavioral therapy (CBT) will have better drinking outcomes than those treated with Twelve-Step Facilitation therapy (TSF). Three hundred ninety-seven treatment-seeking alcoholics with concurrent social phobia were compared retrospectively to a matched sample of 397 alcoholics without social phobia. Treatment was delivered in an outpatient setting, and patients were randomized to either CBT, TSF, or Motivational Enhancement therapy (MET). The groups were compared on self-reported drinking measures (e.g., quantity and frequency of drinking, and time-to-event measures) during treatment period and monthly for 1 year following treatment. Survival analyses revealed that female outpatients with social phobia showed delayed relapse to drinking when treated with CBT rather than TSF; the reverse was true for female outpatients without social phobia. Survival analyses in male outpatients with and without social phobia revealed an opposite trend, though it was not statistically significant. These data suggest that Cognitive Behavioral therapy is superior to Twelve-Step Facilitation therapy for the treatment of alcohol problems in specific populations. namely socially phobic women seeking outpatient treatment.

Adult↗

PubMed2001

Cognitive-behavioral therapy with gay, lesbian, and bisexual clients.

Cognitive-behavioral therapy (CBT) can be adapted to a wide range of clinical difficulties and presenting problems that face lesbians, gay men, and bisexual persons. The following article presents general guidelines for and two case examples of the use of CBT. The first case is a gay male struggling with social phobia. This case is an example of how to adapt a structured, empirically supported cognitive-behavioral treatment focusing on social phobia to situations that are associated with his sexual orientation. The second is a woman struggling with multiple issues including coming out. This case provides an example of how to add specific cognitive-behavioral techniques to coming-out issues within the context of a more eclectic, longer-term therapy.

Adult↗

PubMed1975

Treatment of anorexia nervosa by the integration of behavior therapy and psychotherapy.

Anorexia nervosa has been approached by a variety of therapeutic regimens. These regimens have addressed themselves to either the underlying psychological problems or the eating disorder. By integrating behavior therapy and psychotherapy, the author proposes a treatment plan which addresses both problems simultaneously. Psychotherapy and behavior therapy are theoretically integrable; their integration produces a treatment consistent with dynamics underlying anorexia nervosa; and this treatment produces, during a relatively short hospital stay, rapid weight gain and a foundation for continued psychotherapy. The case of a 22-year-old female is presented which describes the treatment by the proposed intergrated model with documentation of the results at discharge and at 3 months and 1 year follow-up.

Adult↗

PubMed2003

A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: an international multicenter trial.

Cognitive-behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at posttreatment, the outcome for CBT 12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation.

Adult↗

PubMed2000

The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy. A review of empirical studies.

Empirical studies are reviewed, the aim being to investigate characteristics of the therapeutic relationship in cognitive-behavior therapy (CBT) and to identify therapist or patient interpersonal behavior that affects treatment outcome. CBT is characterized by a more active and directive stance on the part of the therapists and higher levels of emotional support than are found in insight-oriented psychotherapies. Therapists express high levels of empathy and unconditional positive regard, similar to those expressed by insight-oriented psychotherapists. Two clusters of interpersonal behavior have been identified that are clearly associated with CBT outcome: (a) the Rogerian therapist variables--empathy, nonpossessive warmth, positive regard, and genuineness; and (b) therapeutic alliance. There is some evidence for the impact on outcome of three additional clusters of patient behavior: (a) the patients' perception of the therapist as being self-confident, skillful, and active; (b) the patients' openness to discuss their problems; and (c) the patients' pretreatment predisposition to change and to accept psychological treatment as a means of achieving this. It is further concluded that relationship factors in general have a consistent but moderate impact on CBT outcome.

Behavior Therapy↗

PubMed1997

Comparison of behavior therapy with and without very-low-energy diet in the treatment of morbid obesity. A 5-year outcome.

BACKGROUND: Very-low-energy diets (VLEDs) together with behavior therapy (BT) are widely used in the treatment of morbid obesity, but there is no evidence of their long-term effectiveness as compared with behavior therapy alone. METHODS: Fifty-nine morbidly obese patients (25 men and 34 women; mean weight, 132.8 +/- 20.7 kg; mean age, 43.1 +/- 9.2 years) were treated with combined therapy of VLED and BT or BT alone. No maintenance program was used. Eighty-seven percent of eligible patients were contacted 4.8 to 6.2 years after the program. RESULTS: During treatment, 56% of patients dropped out of the VLED + BT group and 28% from the BT group (P = .03). High scores on the Symptom Checklist-90R before treatment predicted dropout from the VLED+BT group, but not from BT. At the end of therapy, mean weight change was -22.9 kg in the VLED+BT group and -8.9 kg in the BT group (P < .001). The overall weight change from pretreatment to the 5-year follow-up was greater in the VLED+BT group than in the BT group (-16.9 kg vs -4.9 kg, respectively; P = .03). Men succeeded better in the VLED+BT group than in BT. Among the dropouts, the mean weight change from baseline was +5.2 kg in the VLED+BT group and +13.0 kg in the BT group. CONCLUSIONS: Our data suggest that in the treatment of morbid obesity, VLED combined with BT may produce a better 5-year maintenance than BT alone, especially among men. A satisfactory weight loss can be achieved without a maintenance program.

Adult↗

PubMed2000

Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder--a prospective study.

Dialectical-Behavioral Therapy for Borderline Personality Disorder (DBT) developed by M. Linehan is specifically designed for the outpatient treatment of chronically suicidal patients with borderline personality disorder. Research on DBT therapy, its course and its results has focused to date on treatments in an outpatient setting. Hypothesizing that the course of therapy could be accelerated and improved by an inpatient setting at the beginning of outpatient DBT, we developed a treatment program of inpatient therapy for this patient group according to the guidelines of DBT. It consists of a three-month inpatient treatment prior to long-term outpatient therapy. In this pilot study 24 female patients were compared at admission to the hospital, and at one month after discharge with respect to psychopathology and frequency of self-injuries. Significant improvements in ratings of depression, dissociation, anxiety and global stress were found. A highly significant decrease in the number of parasuicidal acts was also reported. Analysis of the average effect sizes shows a strong effect which prompts the development of a randomized controlled design.

Adult↗

PubMed2005

Cognitive-behavioral therapy for management of anxiety and medication taper in older adults.

OBJECTIVE: The authors hypothesized that patients with late-life anxiety undergoing cognitive-behavioral therapy plus medical management for medication taper (CBT-MM) would realize greater reduction in medication use and greater improvement in psychological symptoms than a control group undergoing medical management alone (MM). METHODS: Forty-two patients (age >60) who wanted to reduce anxiolytic medication were allocated to the two groups (CBT-MM versus MM), using a randomization plus difference-minimization procedure (to equate for medication use). RESULTS: CBT-MM completers significantly reduced medication use, but not at a greater rate than MM completers. At the same time, CBT-MM completers experienced significantly greater alleviation of psychological symptoms than did MM completers. Some, but not all, treatment gains were maintained at 6-month follow-up. Intention-to-treat analyses using the mixed-effects model showed similar, but weaker, treatment effects than completer analyses. CONCLUSIONS: Cognitive-behavioral therapy can alleviate psychological symptoms in elderly patients with anxiety even as patients reduce anxiolytic medication.

Aged↗

PubMed2005

Cognitive behavioral therapy for obsessive-compulsive disorder: an update.

Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has been shown to be a highly effective treatment for children and adults. In the current review, we briefly describe the historical developments of the treatment, and recent findings related to five areas of inquiry: 1) Does intensity of CBT impact outcome? 2) Does CBT work better on some subtypes of OCD than others? 3) How do cognitive and behavioral strategies relate to outcome? 4) How well does CBT work for children and adolescents with OCD? and 5) Does the combination of CBT and medication work better than CBT alone? After a discussion of these questions, we mention some areas currently being examined.

Cognitive Behavioral Therapy↗

PubMed2003

Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: no additional effect of a cognitive parent training.

OBJECTIVE: To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders and the additional value of a seven-session cognitive parent training program. METHOD: Seventy-nine children with an anxiety disorder (aged 7-18 years) were randomly assigned to a cognitive behavioral treatment condition or a wait-list control condition. Families in the active treatment condition were randomly assigned to an additional seven-session cognitive parent training program. Semistructured diagnostic interviews were conducted with parents and children separately, before and after treatment and at 3 months follow-up. Questionnaires included child self-reports on anxiety and depression and parent reports on child's anxiety and behavioral problems. RESULTS: Children with anxiety disorders showed more treatment gains from cognitive-behavioral therapy than from a wait-list control condition. These results were substantial and significant in parent measures and with regard to diagnostic status, but not in child self-reports. In the active treatment condition, children improved on self-reported anxiety and depression, as well as on parent reports on their child's anxiety problems. These results were equal for clinically referred and recruited children. Child self-reports decreased to the normal mean, whereas parents reported scores that were lower than before treatment but were still elevated from the normal means. No significant outcome differences were found between families with or without additional parent training. CONCLUSIONS: Children with anxiety disorders profited from cognitive-behavioral therapy. Children improved equally whether or not additional parent training was offered.

Adolescent↗

PubMed1975

[The use of videotape recordings in behavior therapy in children (author's transl)].

The vast majority of disturbances of child behavior are due to improper methods of upbringing. Alteration of the child's misbehavior is therefore best done by re-education of the parents. In this paper, a model for the modification of the behavior of mother and child by means of videotape recordings is described and illustrated by a report of treatment. Because of the high efficiency of video feedback for the conversion of parental educational style, its use in behavior therapy work is recommended unconditionally in spite of the very high costs and a considerable expenditure of time.

Behavior Therapy↗

PubMed2005

[Application of dialectical behavior therapy as in-patient treatment for alcohol dependency].

Dialectical behavior therapy (DBT) was originally developed for suicidal female patients with borderline personality disorder (BPD). Meanwhile, DBT-based approaches to psychotherapy have also been successfully applied in other clinical groups. Previous studies of DBT in patients suffering from BPD and comorbid drug addiction are discussed, and an approach to DBT that has been devised by the authors for use in the treatment of alcoholics with comorbid BPD is described. As these patients have more severe clinical problems and less satisfactory treatment responses than do alcoholics without comorbid BPD, we must hope that this new approach will improve clinical outcomes in these severely ill patients.

Alcoholism↗

PubMed2004

Anger and the ABC model underlying Rational-Emotive Behavior Therapy.

The ABC model underlying Ellis's Rational-Emotive Behavior Therapy predicts that people who think more irrationally should display greater trait anger than do people who think less irrationally. This study tested this prediction regarding the ABC model. 186 college students were administered the Survey of Personal Beliefs and the State-Trait Anger Expression Inventory-Second Edition to measure irrational thinking and trait anger, respectively. Students who scored higher on Overall Irrational Thinking and Low Frustration Tolerance scored significantly higher on Trait Anger than did those who scored lower on Overall Irrational Thinking and Low Frustration Tolerance. This indicates support for the ABC model, especially Ellis's construct of irrational beliefs which is central to the model.

Adult↗

PubMed1982

Cost effectiveness of individual vs. group cognitive behavior therapy for problems of depression and anxiety in an HMO population.

Randomly assigned 44 outpatient Ss, enrollees of the George Washington University Health Plan, a Health Maintenance Organization (HMO), to one of three treatment modalities: (1) a cognitive behavior therapy group; (2) a traditional process-oriented interpersonal group; and (3) cognitive behavior therapy in an individual format. All Ss were referred by their physicians to the HMO Mental Health Practice for treatment for anxiety and/or depression. Beck's Depression Inventory, Speilberger's State-Trait Anxiety Inventory and Gay and Galassi's Adult Self-Expression Scale (an assertion measure) were administered pre- and post-treatment to all Ss. A subsample of these Ss also were rated pre- and post-treatment on the Hamilton Rating Scale for Depression by experienced clinicians blind to the treatment groups. All three experimental groups significantly improved on all dependent measures from pre- to post-treatment, and no differential treatment effects were found.

Anxiety Disorders↗

PubMed2006

Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy.

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 the experimental conditions. Nearly 75% of patients in the CBT condition completely ceased benzodiazepine intake, as compared with 37% in the control condition. Results of the 3-, 6-, and 12-month follow-ups confirmed the maintenance of complete cessation. Discontinuation rates remained twice as high in the CBT condition. The number of patients who no longer met GAD criteria was also greater in the CBT condition. The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD.

Adolescent↗

PubMed2005

Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice.

This study assessed rates of imaginal exposure therapy (ET) utilization and completion of cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in a clinical setting and examined variables associated with CBT completion. Using a clinical definition, the completion rate of CBT was markedly lower than rates reported in randomized trials. CBT completion was inversely related to severity of overall pretreatment measures of PTSD, avoidance, hyperarousal, depression, impaired social functioning, and borderline personality disorder. Regression yielded avoidance and depression as unique predictors of completion. Most dropouts occurred before starting imaginal ET, although initiating ET was associated with greater likelihood of completion. Results highlight methodological differences between research and practice notions of treatment completion and the need for further study of variables influencing CBT completion in practice settings.

Adult↗