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[Behavior therapy and neurotic behavior].

The first part of the lecture presents three classical aspects of behavior therapy: therapeutic efficiency, utilisation of well defined methods, rapidity of treatment. Emphasis is brought to the importance of behavior analysis and to the dangers arisen from insufficient knowledge or ignorance of learning theories and fundamental principles of behavior analysis. One insists on experimental analysis which is the basis for methods of action having as consequence for the therapeut: controlling strategy of treatment and direct responsibility concerning success and failure. Then, actual limitations of behaviour therapy are described. The second part deals with one of the most important working hypothesis on human neurosis originating from laboratory and clinical research. Behavior therapy refuses to elaborate hypothetical deductive constructions, unless working hypotheses to be verified. Then the four essential clues to behavioural psychotherapy are formulated. The main methods of action presently utilized are presented: aversive methods, operational and systematic desensitization technics through reciprocal inhibition. Finally, some of the main criticism usually made on behaviour therapy are being discussed.

Anxiety↗
PubMed2002

Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review.

Dialectical Behavior Therapy (DBT) is based on a transactional model of the etiology of borderline personality disorder (BPD). It assumes that the associated emotional dysregulation is not simply biological or family induced but the result of a dynamic interaction between the biology and characteristics of an individual with the individual's social environment. This paper discusses the theoretical issues and empirical research relating to a synthesis of family therapy and DBT with adolescents. A review of the literature identifies support for a greater understanding and inclusion of families in treatment, attention to relational aspects of affect, and a dialectical framework for synthesizing individual-oriented and systemic-oriented theories and practice. Some implications for the development of a DBT family therapy model are discussed.

Adolescent↗
PubMed1999

Valuable, but not maximal: it's time behavior therapy attend to its behaviorism.

The field of behavior therapy is not in touch with itself in terms of its overarching behaviorism. Many erroneously consider its basic behaviorism to have been radical behaviorism and continue to look to develop behavior therapy (including behavior analysis and behavioral assessment) within that framework. But that approach turns out to be much less than maximal because there is a more advanced, better developed behaviorism within which to conduct and project the field. There is much that behavior therapy is not doing in practice and research because it is not making full use of that behaviorism foundation.

Behavior Therapy↗
PubMed2006

Do we need to challenge thoughts in cognitive behavior therapy?

Cognitive behavior therapy (CBT) emphasizes the primacy of cognition in mediating psychological disorder. It aims to alleviate distress by modifying cognitive content and process, realigning thinking with reality. Recently, various authors have questioned the need for CBT therapists to use logico-rational strategies to directly challenge maladaptive thoughts. Hayes [Hayes, S.C. (2004). Acceptance and commitment therapy and the new behavior therapies. In S.C. Hayes, V.M. Follette, & M.M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition. (pp. 1-29). New York: Guilford] has identified three empirical anomalies in the research literature. Firstly, treatment component analyzes have failed to show that cognitive interventions provide significant added value to the therapy. Secondly, CBT treatments have been associated with a rapid symptomatic improvement prior to the introduction of specific cognitive interventions. Thirdly, there is a paucity of data that changes in cognitive mediators instigate symptomatic change. This paper critically reviews the empirical literature that addresses these significant challenges to CBT. A comprehensive review of component studies finds little evidence that specific cognitive interventions significantly increase the effectiveness of the therapy. Although evidence for the early rapid response phenomenon is lacking, there is little empirical support for the role of cognitive change as causal in the symptomatic improvements achieved in CBT. These findings are discussed with reference to the key question: Do we need to challenge thoughts in CBT?

Adaptation, Psychological↗
PubMed1991

Attention deficit hyperactivity disorder: does cognitive behavioral therapy improve home behavior?

This study evaluates the effectiveness of cognitive behavioral therapy (CBT) in improving the home behavior of children with attention deficit hyperactivity disorder (ADHD). Twenty-five boys (age 7 to 13) with a diagnosis of ADHD were randomized to a CBT or supportive therapy control group. Outcome measures included parent and teacher ratings of the child on the Behavior Problem Checklist-Attention Problem Subscale (BPC-AP), and the Self-Control Rating Scale (SCRS), parent ratings on the Modified Werry Weiss Activity Scale, and child ratings on the Piers Harris Self-Concept Scale and Matching Familiar Figures Task. Data were analyzed using a two-way analysis of variance for main effects. A significant improvement favoring CBT was found on the Werry Weiss Scale, which measures the parent's perception of the child's hyperactivity in the home, and the child's rating of his/her self-esteem on the Piers Harris Self-Concept Scale. Other outcome measures did not demonstrate statistical differences. This research provides support for the use of CBT in children with ADHD. CBT was found to improve the parent's perception of the child's hyperactivity in the home as well as the child's self-esteem.

Adolescent↗
PubMed2005

Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study.

Social phobia is one of the most frequent mental disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive behavior therapies (CBT). In this last case, graded exposure to feared social situations is one of the fundamental therapeutic ingredients. Virtual reality technologies are an interesting alternative to the standard exposure in social phobia, especially since studies have shown its usefulness for the fear of public speaking. This paper reports a preliminary study in which a virtual reality therapy (VRT), based on exposure to virtual environments, was used to treat social phobia. The sample consisted of 36 participants diagnosed with social phobia assigned to either VRT or a group-CBT (control condition). The virtual environments used in the treatment recreate four situations dealing with social anxiety: performance, intimacy, scrutiny, and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors in order to reduce anxiety in the corresponding real situations. Both treatments lasted 12 weeks, and sessions were delivered according to a treatment manual. Results showed statistically and clinically significant improvement in both conditions. The effect-sizes comparing the efficacy of VRT to the control traditional group-CBT revealed that the differences between the two treatments are trivial.

Adaptation, Psychological↗
PubMed2005

Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder.

OBJECTIVE: Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment. RESEARCH METHODS AND PROCEDURES: One hundred sixteen overweight/obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology. RESULTS: Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers. DISCUSSION: Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment.

Adult↗
PubMed2002

Implementing dialectical behavior therapy.

Dialectical behavior therapy (DBT) is a cognitive-behavioral approach to treating borderline personality disorder. Early empirical results are promising, although they are not sufficient to establish DBT as an evidence-based practice in community settings. Nevertheless, the treatment has been widely implemented by mental health authorities, program leaders, and clinicians. The authors describe DBT's four stages of treatment, the functional areas addressed, and the treatment modes used as well as the reasons for the appeal of DBT to practitioners. They review barriers encountered by those who have implemented the model and present strategies that have been developed to overcome the barriers.

Cognitive Behavioral Therapy↗
PubMed1995

A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa.

The aim of this study was to compare two forms of outpatient treatment, educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa. Thirty patients were randomly allocated to the two treatments. At one year, the group had gained 6.8 kg, 19/30 (63%) had a good or intermediate recovery in terms of nutritional outcome. The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters. In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases. Larger studies will be needed to determine the most effective form of treatment in this group.

Anorexia Nervosa↗
PubMed1991

Promoting healthy nutritional habits by paradigmatic behavior therapy.

Paradigmatic behavior therapy was applied to alter the maladaptive nutritional habits of a 41-year-old depressed female. The client's activities, affect, and cognitions were self-monitored, along with daily intake of processed sugar and fruits and vegetables. The intervention program included contingency contracting and the production of pleasant affective states. The program promoted a favorable attitude toward fruits and vegetables and led to a significant increase in their consumption with significant decrements in sugar intake. The client became less tense and depressed. The favorable effects were maintained at a 5-month follow-up.

Adult↗
PubMed2006

Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial.

PURPOSE: Persistent fatigue is a long-term adverse effect experienced by 30% to 40% of patients cured of cancer. The main objective of this randomized controlled trial was to show the effectiveness of cognitive behavior therapy (CBT) especially designed for fatigue in cancer survivors. PATIENTS AND METHODS: A total of 112 cancer survivors with somatically unexplained fatigue were allocated randomly to immediate cognitive behavior therapy or to a waiting list condition for therapy. Both conditions were assessed two times, at baseline and 6 months later. The primary outcome variables were fatigue severity (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). Data were analyzed by intention to treat. RESULTS: Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition. Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity (difference, 13.3; 95% CI, 8.6 to 18.1) and in functional impairment (difference, 383.2; 95% CI, 197.1 to 569.2). Clinically significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity (54% v 4% of the patients, respectively) and in functional impairment (50% v 18% of the patients, respectively). CONCLUSION: Cognitive behavior therapy has a clinically relevant effect in reducing fatigue and functional impairments in cancer survivors.

Aged↗
PubMed2006

Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder.

CONTEXT: Dialectical behavior therapy (DBT) is a treatment for suicidal behavior and borderline personality disorder with well-documented efficacy. OBJECTIVE: To evaluate the hypothesis that unique aspects of DBT are more efficacious compared with treatment offered by non-behavioral psychotherapy experts. DESIGN: One-year randomized controlled trial, plus 1 year of posttreatment follow-up. SETTING: University outpatient clinic and community practice. PARTICIPANTS: One hundred one clinically referred women with recent suicidal and self-injurious behaviors meeting DSM-IV criteria, matched to condition on age, suicide attempt history, negative prognostic indication, and number of lifetime intentional self-injuries and psychiatric hospitalizations. INTERVENTION: One year of DBT or 1 year of community treatment by experts (developed to maximize internal validity by controlling for therapist sex, availability, expertise, allegiance, training and experience, consultation availability, and institutional prestige). MAIN OUTCOME MEASURES: Trimester assessments of suicidal behaviors, emergency services use, and general psychological functioning. Measures were selected based on previous outcome studies of DBT. Outcome variables were evaluated by blinded assessors. RESULTS: Dialectical behavior therapy was associated with better outcomes in the intent-to-treat analysis than community treatment by experts in most target areas during the 2-year treatment and follow-up period. Subjects receiving DBT were half as likely to make a suicide attempt (hazard ratio, 2.66; P = .005), required less hospitalization for suicide ideation (F(1,92) = 7.3; P = .004), and had lower medical risk (F(1,50) = 3.2; P = .04) across all suicide attempts and self-injurious acts combined. Subjects receiving DBT were less likely to drop out of treatment (hazard ratio, 3.2; P < .001) and had fewer psychiatric hospitalizations (F(1,92) = 6.0; P = .007) and psychiatric emergency department visits (F(1,92) = 2.9; P = .04). CONCLUSIONS: Our findings replicate those of previous studies of DBT and suggest that the effectiveness of DBT cannot reasonably be attributed to general factors associated with expert psychotherapy. Dialectical behavior therapy appears to be uniquely effective in reducing suicide attempts.

Adaptation, Psychological↗
PubMed1986

[Future perspectives in diagnosis and therapy--contribution of behavior therapy].

Behavioural therapists increasingly take in account and apply scientific results and therapeutical methods of other branches of psychology. This has enlarged therapeutical possibilities. On the other hand the traditional techniques of behavioural therapy have found their way into many other schools of psychotherapy. Behavioural therapy and it's therapeutical efficacy has an impact on other schools of psychology and participates to a considerable degree in evaluation of therapeutical processes. In this procedure behavioural therapy undergoes a process leading to new ways out of the ordinary boundries of the traditional school of behavioural therapy. The behavioural therapy together with every other psychotherapeutic school reflects the social process and cannot be seen independently of changing social conditions.

Behavior Therapy↗
PubMed1995

[Use of hypnotherapy techniques within the scope of behavior therapy treatment of learning and behavior disorders in children--2 case reports].

Most of the children on our ward suffer from severe speech and language disorders, dyslexia, other learning disabilities and conduct disorders. We treated 10 selected children with cognitive behavior therapy combined with hypnotherapy. To demonstrate this treatment strategy we report on a 9-year-old girl and a 9-year-old boy from this group and give a short description of the hypnotic communication patterns used in conjunction with behavior therapy. The therapy combination proved to be a useful one. The children's social competence and learning motivation improved throughout the general therapeutic setting. The children's responses to relevant questionnaires confirmed these findings. Our results suggest that an increase in treatment efficacy can be achieved by using hypnotherapeutic patterns in conjunction with behavior therapy in the treatment of children with the disabilities mentioned.

Attention Deficit Disorder with Hyperactivity↗