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Results for “Cognitive Behavioral Therapy”

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PubMed1995

Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression.

Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy. Treatment duration was 16 weeks. The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied. For both cognitive behavioral therapy and relaxation training, outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis. The posttreatment scores on the Beck Depression Inventory of 82% of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score < or = 9 which was not significantly greater than that for the group receiving relaxation training (73%), so a unique effect was not demonstrated for cognitive behavioral therapy. The outcome for tricyclic antidepressant medication (29% improved to criteria) was significantly worse than that for cognitive behavioral therapy. The patient's pretreatment initial expectancy was not predictive.

Adolescent↗
PubMed2004

[Introduction of cognitive-behavioral therapy for alcoholic inpatients at Kurihama National Hospital].

A new inpatient treatment program for alcoholism based on cognitive-behavioral therapy was introduced at Kurihama National Hospital in March 2000. We have classified the dysfunctional cognitions frequently exhibited by alcoholics into eight categories. The therapy is premised on the notion that the presence of one or more of the dysfunctional cognitions can trigger worsening of an alcoholic's drinking problem. We have devised a cognitive model in which the patients themselves examine their dysfunctional cognitions and recover from the vicious cycle of alcoholism. Cognitive-behavioral therapy is conducted at Kurihama National Hospital based on these hypotheses. The cognitive-behavioral therapy employed at Kurihama National Hospital is administered in group therapy in an inpatient treatment setting. Since the treatment is provided on an inpatient basis, dropouts from the program as a result of the patient starting to drink again can be prevented. Furthermore, since group therapy are used, cognitions of alcohol are examined not just in the context of the relationship between patient and therapist, but also in the context of the relationships among patients. It thus becomes easier to examine dysfunctional cognitions from a multifaceted perspective. It will be easier for patients to examine their future drinking behavior concretely through the introduction of cognitive-behavioral therapy, and improvements in outcome should be achieved. However, the relationship between change in cognitions and prognosis needs to be studied in the future.

Alcohol Drinking↗
PubMed2005

Cognitive changes, critical sessions, and sudden gains in cognitive-behavioral therapy for depression.

Using an independent cognitive-behavioral therapy (CBT) data set, the authors replicated T. Z. Tang and R. J. DeRubeis' (1999) discovery of sudden gains--sudden and large decreases in depression severity in a single between-session interval. By incorporating therapy session transcripts, the authors of this study improved the reliability of the Patient Cognitive Change Scale to .75 and found that these CBT sudden gains were also preceded by substantial cognitive changes in the pregain sessions.

Awareness↗
PubMed1994

Comparison of cognitive-behavior therapy and desipramine in the treatment of bulimia nervosa.

A comparison of cognitive-behavior therapy alone, desipramine alone, and cognitive-behavior therapy combined with desipramine was made in the treatment of bulimia nervosa. The study was terminated early with an N of only 7 subjects per condition because of a high drop-out rate and lack of positive response in the desipramine alone group compared to the other two groups. By this time it was also apparent that at posttreatment and at 6 months follow-up no benefit was being realized from combining cognitive-behavior therapy with desipramine.

Adolescent↗
PubMed2007

Treatment of acute posttraumatic stress disorder with brief cognitive behavioral therapy: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of brief cognitive behavioral therapy for patients with acute posttraumatic stress disorder (PTSD) resulting from various types of psychological trauma. METHOD: The authors randomly assigned 143 patients with acute PTSD (irrespective of the time criterion), within 3 months after experiencing a traumatic incident, to either brief cognitive behavioral therapy (N=79) or a waiting list comparison group (N=64). Cognitive behavioral therapy consisted of four weekly sessions containing education, relaxation exercises, imaginal exposure, in vivo exposure, and cognitive restructuring. Main outcome measure was PTSD score measured by structured interview; secondary outcomes were anxiety and depression measured by questionnaire. Assessments took place before the intervention and 1 week and 4 months after the intervention. RESULTS: Symptoms of PTSD, anxiety, and depression decreased in both groups over time. One week after the intervention, the cognitive behavioral therapy group had significantly fewer symptoms of PTSD than the comparison group, but this difference was smaller and no longer significant 4 months after the intervention. Similar results were found for anxiety and depression scores. Subgroup analyses showed that cognitive behavioral therapy led to significantly lower PTSD scores at 4 months in patients with baseline comorbid major depression and in patients who were included within the first month after the traumatic incident both at 1 week and at 4 months. CONCLUSIONS: Brief early cognitive behavioral therapy accelerated recovery from symptoms of acute PTSD but did not influence long-term results. Brief early cognitive behavioral therapy showed enhanced efficacy in patients with baseline comorbid depression and patients who were included within 1 month after their traumatic experience.

Acute Disease↗
PubMed1996

Cognitive-behavioral therapy and treatment for late-life depression.

Cognitive-behavioral therapy is a brief psychotherapy stemming from a model that emphasizes the importance of distorted thoughts and the lack of pleasurable activities in the development of affective disorders. The focus of the therapy can be on either eliminating distorted thought systems or increasing the number of pleasant events that occur on a daily basis, or both. The highly structured therapy presents various skills for patients to learn through class exercises and homework assignments. Older adults respond well to cognitive-behavioral therapy, reporting that they appreciate the structure and the opportunity to learn skills that can help when they are confronted with new stresses. Many also like the focus on here-and-now problems rather than the past. A few treatment modifications are necessary to accommodate community elders complaining of depression. Generally, information must be presented more slowly, taking advantage of multiple modes of presentation. To maintain an active learning process, elder patients should be asked frequently to summarize the material being presented. They should also be given handouts of complex materials and encouraged to maintain notebooks. Other modifications may be required for special populations of older patients.

Age Factors↗
PubMed2006

A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression.

OBJECTIVE: To evaluate cognitive-behavioral therapy, antidepressant medication alone, and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents. METHOD: Seventy-three adolescents (ages 12-18 years) with a primary diagnosis of DSM-IV major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified were randomly allocated to one of three treatments. Treatment outcome measures were administered before and after acute treatment, and at a 6-month follow-up. Depression diagnosis was the primary outcome measure; secondary measures were self- and other report and clinician rating of global functioning. The trial was conducted at three community-based clinics between July 2000 and December 2002. Data analyses used an intent-to-treat strategy. RESULTS: Following acute treatment, all treatment groups demonstrated statistically significant improvement on outcome measures (depressive diagnosis, Reynolds Adolescent Depression Scale, Revised Children's Manifest Anxiety Scale, Suicidal Ideation Questionnaire), and improvement was maintained at follow-up. Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone. Compared with antidepressant medication alone, participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response (odds ratio = 6.86; 95% confidence interval 1.12-41.82). Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth, this may have stemmed from the relatively low dose of sertraline used. CONCLUSIONS: All treatments led to a reduction in depression, but the advantages of a combined approach were not evident.

Adolescent↗
PubMed1998

Combined pharmacotherapy and cognitive behavior therapy in the treatment of panic disorder.

Cognitive behavior therapy (CBT) has been combined with pharmacotherapy in the treatment of panic disorder in three ways: (1) to treat agoraphobic symptoms in the condition of panic with agoraphobia; (2) to reduce withdrawal effects during drug taper; and (3) to treat panic attacks. Exposure treatment and pharmacotherapy have a modest additive effect, although more patients drop out of exposure therapy combined with imipramine treatment compared with exposure therapy alone. CBT reduces symptoms of withdrawal from alprazolam and other benzodiazepines and improves the outcome of drug treatment. At present, sufficient data are not available to determine whether the effects of CBT combined with drug therapy are additive in treating panic disorder. The results of a large trial are awaited. Current CBT consists of 12 sessions and is not widely offered to patients because of cost considerations. Efforts are being made to decrease the number of sessions necessary by improving cognitive techniques. One of these models is the subject of an ongoing trial. Finally, efforts to educate and counsel patients in the clinical setting regarding the psychopathology of panic attacks may improve the outcome of pharmacotherapy.

Agoraphobia↗
PubMed1991

New developments in cognitive-behavioral therapy for social phobia.

Significant advances in cognitive-behavioral therapy for social phobia have occurred during the past 5 years. A new psychobiological model of social anxiety is described, and recent controlled clinical trials are reviewed. An effective cognitive-behavioral approach to therapy for social phobia developed in the authors' setting is described with case studies. Finally, future directions in cognitive-behavioral approaches to therapy for social anxiety, including clinical trials of interactive approaches that combine drug therapy with behavioral therapy and of intensive treatment of patients with avoidant personality disorder, are described briefly.

Adult↗
PubMed1999

Cognitive-behavioral therapy for bulimia nervosa: an illustration.

Cognitive-behavioral therapy for bulimia nervosa (BN) is a well-developed, theoretically grounded treatment for BN with the strongest empirical support for its efficacy of any form of treatment for BN. The treatment package comprises three distinct phases typically delivered over 20 weeks. Incorporating a variety of specific interventions, these three phases of treatment focus systematically on (i) dietary restraint, (ii) dysfunctional beliefs about body weight and shape, and (iii) reactions to recurrence of symptoms, which are thought to be the primary operative mechanisms that cause and maintain BN symptoms. Case material is presented to illustrate cognitive-behavioral treatment principles.

Adult↗
PubMed2006

Cognitive behavioral therapy for depression in youth.

Without question, cognitive behavioral therapy (CBT) is the most studied non-pharmacological intervention for the treatment of depression in youth, with over 80% of published psychotherapy trials testing the effects of CBT protocols. Until quite recently, CBT also was widely proclaimed to be a highly effective intervention for youth depression, albeit with stronger data for adolescent than for child samples. However, within the past two years, a series of new findings have complicated this previously rosy picture of CBT. The most well-known results come from the Treatment of Adolescents with Depression Study (TADS, 2004). In the TADS investigation, CBT failed to outperform a pill placebo, while active medication treatments (fluoxetine alone and fluoxetine-plus-CBT) produced strong and consistent effects. In this article, the authors strive to make sense of these seemingly conflicting findings, provide direction for the appropriate use of CBT in practice given the current evidence base, and suggest areas of additional investigation that may help to clarify the current confusion on the effects of CBT.

Adaptation, Psychological↗
PubMed2004

Cognitive behavioral therapy in the treatment of schizophrenia.

This review outlines the role that cognitive behavioral therapy can play in specifically addressing the distress associated with the symptoms of schizophrenia, such as hallucinations and delusions. Some of the features that are given greater emphasis (or are a feature of working with people with psychotic illness), engagement, understanding the onset of the illness and work with hallucinations and delusional beliefs are outlined. The evidence base for the utility of cognitive behavioral therapy is considered, and the development and further application of cognitive behavioral therapy for schizophrenia and related disorders are outlined.

Cognitive Behavioral Therapy↗
PubMed2002

Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination?

Cognitive-behavioral therapy (CBT) and pharmacotherapy demonstrate efficacy across the anxiety disorders, but recognition of their limitations has sparked interest in combining modalities to maximize benefit. This article reviews the empirical literature to examine whether combining treatments influences efficacy of either monotherapy. We conducted a comprehensive literature search of published randomized trials that compared combined treatment with pharmacologic or CBT monotherapies. Ten studies that met our inclusion criteria were reviewed in detail, and within-subjects effect sizes were calculated to compare treatment conditions within and across studies. At posttreatment and follow-up, effect size and percentage responder data failed to clearly demonstrate an advantage or disadvantage of combined treatment over CBT alone for obsessive-compulsive disorder, social phobia, and generalized anxiety disorder. Some advantage of combined treatment over pharmacotherapy alone emerged from the few studies that allowed for such a direct comparison. In contrast, combined treatment for panic disorder seems to provide an advantage over CBT alone at posttreatment, but is associated with greater relapse after treatment discontinuation. The advantage of combined treatment may vary across the anxiety disorders. The potential differences in usefulness of combined treatment are discussed, directions for future research are suggested, and implications for clinical practice are considered.

Anxiety Disorders↗
PubMed2006

Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant?

Although cognitive-behavioral therapy (CBT) is becoming increasingly popular as an adjunctive treatment for psychosis, few studies to date have examined the clinical (in contrast to statistical) significance of treatment gains using standardized methods. The aim of the current study was to investigate the clinical significance of symptomatic reductions reported in trials of CBT for schizophrenia and related disorders using standardized group methods of analysis. An electronic literature search identified 12 studies that met the inclusion criteria of being randomized, controlled trials that compared CBT to routine care alone or to another comparison treatment. The analysis involved the following steps. First, reliable change on symptom measures was examined. Next, the proportion of patients in each study estimated to show clinically significant symptomatic reductions (i.e., two standard deviations) was calculated. When both post-treatment and follow-up data were considered, 42% of CBT conditions compared with only 25% of comparison conditions demonstrated reliable change on at least one psychotic symptom measure per study. Proportions of clinically significant symptomatic improvement in studies showing reliable change were similar between CBT and comparison conditions. Due to the adjunctive nature of CBT for schizophrenia and the limits imposed by the evaluation of group datasets, results of the current study are considered promising but preliminary. Future trials should examine clinical significance using similar standardized methods within studies, as well as broader functional outcome measures, to provide a clearer picture of the benefits derived from this type of intervention.

Cognitive Behavioral Therapy↗
PubMed2003

Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa.

OBJECTIVE: This study provides what the authors believe is the first empirical evaluation of cognitive behavior therapy as a posthospitalization treatment for anorexia nervosa in adults. METHOD: After hospitalization, 33 patients with DSM-IV anorexia nervosa were randomly assigned to 1 year of outpatient cognitive behavior therapy or nutritional counseling. RESULTS: The group receiving nutritional counseling relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy (53% versus 22%). The overall treatment failure rate (relapse and dropping out combined) was significantly lower for cognitive behavior therapy (22%) than for nutritional counseling (73%). The criteria for "good outcome" were met by significantly more of the patients receiving cognitive behavior therapy (44%) than nutritional counseling (7%). CONCLUSIONS: Cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse. To the authors' knowledge, these data provide the first empirical documentation of the efficacy of any psychotherapy, and cognitive behavior therapy in particular, in posthospitalization care and relapse prevention of adult anorexia nervosa.

Adolescent↗