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Results for “Cognitive-behavioral interventions”

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PubMed1996

Intervention strategies for students with ADHD: creating a holistic approach.

An overview of therapy approaches commonly used by speech-language pathologists with students having ADHD and their primary intervention responsibilities with these students is presented. Several strategies for establishing the kinds of learning contexts necessary for success are described, which emphasize the importance of empowering students in meaningful and relevant contexts. Five major intervention strategies for working with ADHD students are reviewed briefly--modifying learning environments, pharmacological therapy, behavioral management, cognitive-behavior modification, and classroom academic management--and detailed references for each are provided.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

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↗
PubMed1999

'Instilling the strength to fight the pain and get on with life': learning to become an arthritis self-manager through an adult education programme.

The aim of this study was to determine whether the Arthritis Self-Management Programme (ASMP) is effective in promoting perceived control and self-management ability when delivered in an adult education setting. The study was a pre-test-post-test design based on a sample of 89 people attending an ASMP. Data were collected by self-administered questionnaires prior to the intervention and after the intervention, 4 months from baseline. The sample comprised 80% women, with a mean age of 57 years and a mean disease duration of 13 years. Most participants had either osteoarthritis or rheumatoid arthritis. After 4 months, participants demonstrated significant increases in arthritis self-efficacy (P < 0.0005), cognitive symptom management (P < 0.0005), communication with doctors (P = 0.018), exercise (P = 0.003) and relaxation (P < 0.00005). In addition, significant decreases were found in terms of pain (P = 0.034) and visits to other health professionals (P = 0.004). The first evaluation of the ASMP, delivered within the context of adult education, suggests that this form of community health education programme can offer substantial benefits for participants, particularly in terms of perceived ability to control various aspects of arthritis and in greater utilization of cognitive-behavioral techniques.

Adaptation, Psychological↗
PubMed2001

Treatment preference and patient satisfaction in chronic insomnia.

STUDY OBJECTIVES: The purposes of this study were to examine treatment preference and satisfaction with group treatment in individual with chronic insomnia. DESIGN: Correlational. SETTING: The study was conducted in an outpatient hospital setting. PATIENTS OR PARTICIPANTS: Participants were 43 adult volunteers from the community. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Prior to treatment, participants were presented with descriptions of behavioral and pharmacological treatment for the problem of insomnia and asked to rate the acceptability, presumed effectiveness, and presumed side-effects of treatment. A sub-sample of these individuals (n = 37) participated in a 6-week cognitive behavioral treatment group for insomnia. Sleep diary and questionnaire data were collected prior to and following treatment. Results showed that cognitive-behavioral therapy was significantly preferred over pharmacological therapy at pre-treatment and that more favorable assessments of cognitive-behavioral therapy at pre-treatment were associated with better adherence but not improved outcome. Of treatment techniques, participants least liked sleep restriction and most liked sleep hygiene. Results indicated that more favorable ratings of the usefulness of sleep restriction were associated with improvements in sleep efficiency, sleep-related impairment, and quality of life. CONCLUSIONS: Implications of these findings are that patient preference is important to assess prior to treating insomnia and that more work may be needed to increase patients' awareness of the benefits of sleep restriction.

Adult↗
PubMed1998

Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression.

OBJECTIVE: To assess the predictors of treatment outcome across treatments, as well as those associated with differential treatment response. METHOD: One hundred seven adolescent outpatients, aged 13 to 18 years, with DSM-III-R major depression were randomly assigned to one of three manual-based, brief (12 to 16 sessions) psychosocial treatments: cognitive-behavioral therapy (CBT), systemic-behavioral family therapy, or nondirective supportive therapy. Those with good and poor outcomes were compared. RESULTS: Continued depression was predicted by clinical referral (versus via advertisement) and was in part mediated by hopelessness. Other predictors of depression were comorbid anxiety disorder and higher levels of cognitive distortion and hopelessness at intake. Achievement of clinical remission was predicted by a higher level of self-reported depression. Poorer functional status was predicted by a higher level of initial interviewer-rated depression. Comorbid anxiety and maternal depressive symptoms predicted differential treatment efficacy. CBT's performance continued to be robust with respect to nondirective supportive therapy, even in the presence of the above-noted adverse predictors. CONCLUSION: Predictors of poor outcome may give clues as to how to boost treatment response. Subjects who come to treatment for clinical trials via advertisement (versus clinical referral) may show more favorable treatment responses. CBT is likely to be a robust intervention even in more complex and difficult-to-treat patients.

Adolescent↗
PubMed1999

Psychological strategies for discontinuing benzodiazepine treatment.

Successful discontinuation of therapeutic drugs requires patients to negotiate two potentially difficult phases. First, they must complete the drug discontinuation procedure itself, which may entail coping with rebound and withdrawal symptoms as well as anxiety due to stopping a treatment on which they depend psychologically. Second, they must maintain drug abstinence over time, despite possible exacerbations or recurrences of the disorder that the drug was treating. For optimal success, interventions aimed at assisting patients to discontinue drug use must address both of those tasks. Patients' ability to discontinue benzodiazepines seems to be strongly influenced by cognitive appraisals of the threat represented by symptoms and of their own competence to cope with it without medication. For problems of that kind, cognitive and behavioral techniques such as those developed for the treatment of panic disorder may be especially well-suited. Currently, the most successful approaches to benzodiazepine discontinuation include the following components: (1) assisting with initial drug discontinuation, educating patients about benzodiazepine dependence and withdrawal, and about the kinds of symptoms that can emerge as the drug dose is decreased, combined with a flexible drug taper conducted in supportive collaboration with the patient; and (2) dealing with exacerbations of the illness, and providing disorder-specific cognitive-behavioral treatment as an alternative to the resumption of pharmacotherapy. It seems to be crucial that the drug taper be completed before psychological treatment concludes.

Anti-Anxiety Agents↗
PubMed2001

Posttreatment results of combining naltrexone with cognitive-behavior therapy for the treatment of alcoholism.

Naltrexone, an opiate antagonist medication, has been reported to be efficacious in the treatment of alcohol dependence when added to psychosocial treatments. Although the within-treatment efficacy of naltrexone has received primary attention, there has been little published on the outcome of individuals once the medication is discontinued. Animal studies have led to concern regarding a quick rebound to heavy drinking. This report extends the data previously reported by evaluating the outcome in alcoholic subjects during the 14 weeks after a 12-week treatment with naltrexone or placebo in conjunction with cognitive behavioral therapy. Of the 131 subjects evaluated during the treatment phase, 124 (95%) had up to 14 weeks of posttreatment drinking data available for analysis. Measures of craving and blood markers of heavy drinking were also evaluated. By the end of treatment, naltrexone demonstrated significantly greater efficacy than placebo. However, once the medication was discontinued, there was a gradual increase in relapse rates, heavy drinking days, and drinks per drinking day, and fewer days of abstinence were reported. By the end of the 14-week follow-up period, although naltrexone-treated subjects were, on average, still doing better than control subjects, the effectiveness of naltrexone was no longer statistically significant. There was no evidence that naltrexone subjects had an immediate return to heavy alcohol use as suggested in animals. These data suggest that, for a number of alcoholic subjects, continued treatment with naltrexone, or perhaps psychosocial intervention, for longer than 3 months is indicated. Future research should identify which alcohol-dependent individuals may need prolonged treatment to improve treatment success in the long term.

Adult↗
PubMed1998

Cognitive-behavioral play therapy.

Discusses cognitive-behavioral play therapy (CBPT), a developmentally sensitive treatment for young children that relies on flexibility, decreased expectation for verbalizations by the child, and increased reliance on experiential approaches. The development of CBPT for preschool-age children provides a relatively unique adaptation of cognitive therapy as it was originally developed for adults. CBPT typically contains a modeling component through which adaptive coping skills are demonstrated. Through the use of play, cognitive change is communicated indirectly, and more adaptive behaviors can be introduced to the child. Modeling is tailored for use with many specific cognitive and behavioral interventions. Generalization and response prevention are important features of CBPT. With minor modifications, many of the principles of cognitive therapy, as delineated for use with adults, are applicable to young children. Case examples are presented to highlight the application of CBPT. Although CBPT has a sound therapeutic base and utilizes proven techniques, more rigorous empirical scrutiny is needed.

Child↗
PubMed1989

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↗
PubMed1994

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↗
PubMed1999

Alcoholism treatment in the United States. An overview.

On any given day, more than 700,000 people in the United States receive alcoholism treatment in either inpatient or outpatient settings. For many of those patients, detoxification--with or without pharmacotherapy--is the first step of treatment. The major behavioral approaches currently used in alcoholism treatment include cognitive-behavioral therapy, motivational enhancement therapy, and Alcoholics Anonymous (AA) or related 12-step programs. Clinical studies, such as the Project MATCH trial, have compared the effectiveness of these approaches. Overall, that study detected no significant differences among the three treatments in patient outcome, although certain treatment methodologies may be most appropriate for patients with certain characteristics. Pharmacotherapy with aversive or anticraving medications may supplement behavioral treatment approaches. Brief interventions that are delivered by primary health care providers also have been shown to reduce drinking levels, particularly in nondependent drinkers.

Alcohol Deterrents↗
PubMed2000

Cognitive-behavioral therapy for anxiety disorders: why and how it works.

Cognitive-behavioral therapy (CBT) has been found to be effective in the treatment of anxiety disorders such as obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). There is a gap, however, between reports of controlled clinical trials and actual clinical use of the methods of CBT in general medical and psychiatric settings. While psychiatric medications are commonly the first line of treatment, pharmacotherapy may not completely eradicate symptomatology or may have a delayed effectiveness, during which time patients continue to suffer. Cognitive and behavioral interventions can complement, if not replace, pharmacotherapy for relief of symptoms of OCD and PTSD. This article explains how CBT works in the treatment of OCD and PTSD. Basic instructions for implementing these treatment methods are provided.

Adult↗
PubMed2000

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital.

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Adaptation, Psychological↗
PubMed1995

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↗
PubMed1995

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↗
PubMedDate not supplied

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↗
PubMed1995

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↗