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PubMed2001

"Transcend": initial outcomes from a posttraumatic stress disorder/substance abuse treatment program.

This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.

Comorbidity↗

PubMed1993

A comparison of the generalization of behavioral marital therapy and enhanced behavioral marital therapy.

This study examined the generalization of behavioral marital therapy (BMT) and enhanced behavioral marital therapy (EBMT), which added cognitive restructuring, affect exploration, and generalization training to BMT. Couples' communication and cognitions were assessed in the clinic and at home. Both BMT and EBMT were effective in decreasing negative communication behaviors and cognition across settings, but there was little evidence of differential generalization or change between the treatments. A series of regression equations showed no significant association between the extent of change in communication or cognitions and change in frequency of marital disagreements or marital satisfaction. It is concluded that BMT results in impressive generalization of communication and cognitive change, but it remains to be demonstrated that these changes are crucial to improvements in marital satisfaction.

Adult↗

PubMed1993

Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children.

A sample of 52 Black aggressive, rejected and nonaggressive, rejected children were randomly assigned to receive a social relations intervention or to be in a nonintervention control group. The school-based intervention for fourth-grade children focused on positive social skill training and cognitive-behavioral strategies to promote deliberate, nonimpulsive problem solving. At both the post-treatment and the 1-year follow-up assessments, the social relations intervention was found to be effective only with the aggressive, rejected children. Implications for the importance of assessing subtypes of rejected children are discussed.

Black or African American↗

PubMed1991

Therapies for hyperactive children: comparisons, combinations, and compromises.

Comparative treatment studies of attention-deficit hyperactivity disorder (ADHD) are impeded by methodological quandaries, constricted focus, and the heterogeneity of ADHD children, research designs, measures, and treatment responsiveness. Comparisons are drawn among three major treatment modalities for ADHD: stimulant treatments, primarily methylphenidate; behavioral treatments, including contingency management and parent training; and cognitive-behavioral or self-regulation therapies. We identify a dozen "...abilities," such as communicability, controllability, and constrainability, that compel consideration and that convert either-or questions about the single best treatment into more comprehensive assessment and intervention strategies. The profusion of problems called ADHD mandates multimodal approaches not only to optimize therapeutic impact but also to inform theories of developmental psychopathology and therapeutic change.

Adolescent↗

PubMed2000

Psychological difficulties amongst plastic surgery ex-patients following surgery to the face: a survey.

Qualitative accounts suggest that social difficulties are a major source of psychological disturbance to disfigured people. However, there have been few systematic investigations of their psychological and social difficulties, and those which do exist are usually small studies with methodological difficulties. Social skills training and cognitive-behavioural therapy are promising interventions, particularly if it can be demonstrated that anxiety is a major element of the psychological difficulties experienced by disfigured people.A postal survey was sent to all ex-patients at a plastic surgery clinic who received plastic surgery to the face between 6 months and 5 years 6 months prior to the date of the survey. Of these, 105 ex-patients returned questionnaires, representing a 41.8% response rate. Respondents did not differ from non-respondents according to age, sex or diagnosis. The majority of respondents were not experiencing psychological difficulty, but GHQ caseness, HAD anxiety and HAD depression scores were generally higher than in general population samples. Their levels of social phobia appeared higher than prevalence in the general population, although direct comparison is hampered by the different instruments used. Women showed greater disturbance than men on many of the scales used, and patients who had undergone surgery for revision of scars showed greater disturbance than those who had undergone surgery for cancer. The current study may be considered more representative of disfigured people than previous surveys, since its subjects were neither awaiting nor receiving treatment, although the response rate was still low. Contrary to assertions in previous studies, standardised measures detected dysphoria in this sample. Anxiety, particularly in social situations, with associated phobic avoidance, was the most frequently reported difficulty, with depression considerably less common. Given the success of cognitive-behaviour therapy in addressing such difficulties, both via formal therapy and self-help methods, there are clear implications for treatment from this finding.

Adolescent↗

PubMed2006

Behavioral approaches to the treatment of migraine.

Behavioral interventions such as biofeedback training, relaxation training, and cognitive-behavior stress management therapy have been identified as efficacious treatments for migraine headache. These treatments, and the formats (clinic-based, limited-contact, and home-based) in which they are taught, are described in this article. Information about public health interventions (school, work, Internet, and mass media) is also briefly addressed. Results of studies examining the efficacy of behavioral treatments, how behavioral treatments compare in effectiveness, and how they can be integrated with pharmacotherapy are reviewed for both adult and pediatric populations. Finally, the role of behavioral treatments in migraine treatment guidelines is discussed, and factors that are associated with response to behavioral treatments are reviewed.

Behavior Therapy↗

PubMed1999

[Behavioral therapeutic methods in ambulatory treatment of alcoholism. Early results of an experimental study].

Outpatient alcoholism treatment programs are widespread especially in the United States and in Great Britain. However, there still exist only a few experimental studies investigating the numerous questions arising from this field. In this still ongoing project 120 patients were randomly assigned to 3 different outpatient group therapy programs: unspecific supportive therapy and 2 forms of behavioural therapy--coping skills training [17] and cognitive therapy according to Beck [2]. The main hypotheses to be tested are that both forms of behavioural therapy will prove superior to supportive treatment and that patients with a comorbidity of personality disorders will profit in a different way from these differentiated intervention strategies. Treatment lasted 6 months; first results obtained after the termination of this period demonstrate the feasibility of the study design; patients undergoing behavioural therapy showed good compliance with few drop-outs and significantly higher rates of abstinence compared with supportive therapy. 60% of the patients suffer from a concomitant personality disorder (mostly of the dependent, insecure, and masochistic type). Nevertheless, statistically significant differences between the 2 behavioural therapy techniques could not be established; a positive correlation between personality disorders and relapse or attrition could be confirmed only for relapses occurring within the first 3 months of treatment.

Adaptation, Psychological↗

PubMed1988

A behavioral perspective on conduct disorders.

THIS paper provides a selective overview of behavioral approaches for conduct-disordered behavior. Although no definitive statement can be made regarding etiology, some empirical support exists for behavioral strategies. Assessment approaches discussed include the behavioral interview, behavioral observations, and behavioral checklists. Decisions regarding types of behavioral interventions to be employed directly follow from assessment data. Assessment information can be formulated in terms of a behavioral excess/skill deficit model. Hence, conduct-disordered behavior can be a function of excessive disruptive behavior and/or a lack of requisite skills necessary to obtain satisfaction. Parental training strategies in contingency management and contingency contracting are discussed regarding behavioral excesses. Relative to skill deficits, contingency procedures along with skills training in communication, problem-solving and self-control are reviewed, using parental training and cognitive-behavioral frameworks. In general, these interventions have empirically demonstrated efficacy. However, future research is required to identify specific factors that account for successful treatment, and attention should be directed toward preventive issues. Important data could be obtained from the identification of high-risk environmental situations. A predictive understanding of high-risk populations could result in the development of early intervention programs, which might to some extent obviate the occurrence of conduct disorders.

Adolescent↗

PubMed2006

Differential efficacy of a cognitive-behavioral intervention versus pharmacological treatment in the management of fibromyalgic syndrome.

Given that studies about the differential efficacy of existing treatments in fibromyalgia syndrome are scarce, the aim of this study was to compare the differential efficacy of a cognitive-behavioral and a pharmacological therapy on fibromyalgia. Using a randomized controlled clinical trial, 28 fibromyalgic patients were assigned to one of following experimental conditions: (a) pharmacological treatment (i.e., cyclobenzaprine), (b) cognitive-behavioral intervention (i.e., stress inoculation training), (c) combined pharmacological and cognitive-behavioral treatment and (d) no treatment. The results show the superiority of cognitive-behavioral intervention to reduce the severity of fibromyalgia both at the end of the treatment and at follow-up. We conclude that cognitive-behavioral interventions must be considered a primary treatment of fibromyalgia syndrome.

Adult↗

PubMed1990

Perceived change among participants in an exercise program for older adults.

Data regarding perceived change were collected as part of a study of the effects of aerobic exercise training on psychological, cognitive, and physiological functioning among 101 healthy older adults. Subjects were assigned randomly to an aerobic exercise group, a yoga control group, or a waiting list group for 16 weeks, after which all subjects participated in aerobic exercise for another 16 weeks. Exercise participants perceived positive changes in a wide range of significant life areas, and perceived improvement was more closely related to objective improvement for physiological indicators than for indicators of cognitive functioning or psychological well-being.

Aged↗

PubMed1990

Attitudes of medical school faculty and students toward acquired immunodeficiency syndrome.

Attitudes of faculty and students will influence the success of educational programs to address acquired immunodeficiency syndrome (AIDS). In 1988-89, 170 medical school faculty and 227 students completed needs assessment questionnaires at the University of Louisville, and the results were compared to assess the respondents' attitudes about AIDS. Both the faculty and the students were found to be fearful of infection, had strong negative attitudes toward AIDS patients, and had low levels of confidence in the current knowledge about AIDS. Both cognitive and affective training strategies are recommended to help learners distinguish unwarranted from warranted fears of infection and to increase their empathy for patients with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial.

STUDY DESIGN: A randomized trial. OBJECTIVE: To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting. SUMMARY AND BACKGROUND DATA: Systematic reviews have shown that there is strong evidence that intensive multidisciplinary treatment (>100 hours), which includes functional restoration, improves function among chronic patients with low back pain, and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability. However, there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy. MATERIALS AND METHODS: A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers. The patients were randomized into two intervention programs. Multidisciplinary rehabilitation (n = 59) was conducted in groups and comprised of physical training, workplace interventions, back school, relaxation training, and cognitive-behavioral stress management methods for 70 hours. The individual physiotherapy (n = 61) included physical exercise and passive treatment methods administered for 10 hours. Main outcome measures were: back pain and sciatic pain intensity, disability, sick leaves, healthcare consumption, symptoms of depression, and beliefs of working ability after 2 years. RESULTS: There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation, at 6-, at 12-, or 24-month follow-up. In both intervention arms, however, the before-and-after comparison showed favorable effects, and the effects were still maintained at 2 years follow-up. CONCLUSIONS: The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment.

Adult↗

PubMed1984

Treatment of bulimia with brief psychoeducational group therapy.

Two groups of 10 normal-weight bulimic women received short-term, structured group treatment beginning 3 weeks apart in a multiple baseline design. The multifaceted treatment approach incorporated education, self-monitoring, goal setting, assertion training, relaxation, and cognitive restructuring. Results showed an overall reduction of 70% in binge/purge episodes. There were significant improvements in psychological functioning, including self-esteem, depression, assertiveness, and pathological attitudes about eating.

Adult↗

PubMed2002

Illness management and recovery: a review of the research.

Illness management is a broad set of strategies designed to help individuals with serious mental illness collaborate with professionals, reduce their susceptibility to the illness, and cope effectively with their symptoms. Recovery occurs when people with mental illness discover, or rediscover, their strengths and abilities for pursuing personal goals and develop a sense of identity that allows them to grow beyond their mental illness. The authors discuss the concept of recovery from psychiatric disorders and then review research on professional-based programs for helping people manage their mental illness. Research on illness management for persons with severe mental illness, including 40 randomized controlled studies, indicates that psychoeducation improves people's knowledge of mental illness; that behavioral tailoring helps people take medication as prescribed; that relapse prevention programs reduce symptom relapses and rehospitalizations; and that coping skills training using cognitive-behavioral techniques reduces the severity and distress of persistent symptoms. The authors discuss the implementation and dissemination of illness management programs from the perspectives of mental health administrators, program directors, people with a psychiatric illness, and family members.

Adaptation, Psychological↗

PubMed1993

Comparing two modes of teaching a question-answering strategy for enhancing reading comprehension: didactic and self-instructional training.

This study investigated the comparative efficacy of two instructional approaches--didactic teaching and self-instructional training--in teaching average and poor readers a comprehension question-answering strategy. Forty-five average students and 45 poor readers from Grades 5 and 6 participated. These 38 girls and 52 boys were equally and randomly assigned to one of three treatment conditions: didactic teaching of the strategy, self-instruction, or control (no training). Students in the first two treatment conditions learned a mnemonic strategy ("Here," "Hidden," and "in my Head") to indicate question-answer relationships that are text explicit, text implicit, or script implicit, respectively. Essentially, the 3H mnemonic cued students to use appropriate text and/or knowledge-base information in answering comprehension test questions. In addition, students in the self-instruction group learned three self-questions to guide their use of the 3H strategy. Specifically, the self-questions focused students' attention on the task, provided a basis for decision making concerning the categorization of comprehension test questions, and reminded students to check their answers. The results indicated that both didactic teaching and self-instructional training of the strategy effected significant improvements in students' reading comprehension performance. However, self-instructional training was more effective in enhancing and maintaining students' reading comprehension performance than didactic teaching. Moreover, results from the oral questionnaire indicated that the 3H strategy training increased students' general meta-cognitive knowledge. Lastly, of the 60 trained students, 52 wrote that they would encourage other children to learn the 3H strategy. Thus, the response to strategy learning was clearly positive.

Attention↗

PubMed2000

Predictors of treatment dropout from a spouse abuse abatement program.

This study evaluated predictors of dropout among men who began and attended at least 1 session of a cognitive-behavioral, skills training oriented spouse abuse abatement counseling program. Based on prior research, a number of demographic, criminal justice, partner violence pattern, and personality characteristics were studied. Dropout prediction was assessed at 2 phases of program participation, during assessment (early drop) and during intervention (late drop). Overall, few of the variables studied predicted dropout. Early dropout was predicted by high rates of police contact for violent crimes, failure to self-report an alcohol problem, and paranoid personality characteristics. Late dropout was predicted by both high and moderate levels of police contact for violent crimes, and borderline personality characteristics. An Age x Violent Crime interaction suggested that young violent offenders are more likely to complete treatment. The overall model accounted for only 7.15% of the variance. Clinical and research implications are discussed.

Adult↗

PubMed1990

A preliminary analysis of a functional model of assessment and treatment for school refusal behavior.

We assessed whether treatment of children and adolescents with school refusal behavior is effective when based upon an individualized, functional analysis. Seven children and adolescents, who were currently experiencing difficulties attending school, were evaluated with the School Refusal Assessment Scale (SRAS), an instrument designed to identify maintaining variables surrounding school refusal behavior. These included specific fearfulness/general overanxiousness, escape from aversive social situations, attention-getting or separation anxious behavior, and tangible reinforcement. Prescriptive treatment was given in accordance with the assessed motivating condition and included systematic desensitization/relaxation training, modeling and cognitive restructuring, shaping and differential reinforcement of other behavior, and contingency contracting for each condition, respectively. Daily measures of anxiety, depression, distress, and school attendance were taken, as well as pretreatment, posttreatment, and 6-month follow-up child and/or parent questionnaires. Results indicated that 6 of the subjects maintained full-time school attendance by posttreatment and at the 6-month follow-up. All reported moderate improvements in daily levels of anxiety, depression, and/or distress. The implications of a prescriptive treatment approach for school refusal behavior are discussed.

Adolescent↗

PubMed2005

Uncertainty management intervention for older African American and caucasian long-term breast cancer survivors.

The survivor uncertainty management intervention study is a randomized controlled study designed to test the efficacy of an intervention that combines training in audiotaped cognitive behavioral strategies to manage uncertainty about cancer recurrence with a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Specifically, women were taught to recognize their own personal triggers of uncertainty (places, events or surroundings, that bring back memories, feelings, or concerns about breast cancer), and then use coping skills such as relaxation, distraction, and calming self-talk to deal with uncertainty. Also, women were taught to use the manual as a resource for dealing with fatigue, lymphedema, pain and other symptoms. Treatment outcome data (Mishel et al., in press) indicated that the uncertainty management intervention resulted in improvements in cognitive reframing, cancer knowledge, social support, knowledge of symptoms and side effects, and coping skills when compared to a control condition. The purpose of the present paper was to report on the use and helpfulness of the intervention components by the 244 women who were in the intervention. Findings indicated that women regularly used the intervention components to deal with triggers of breast cancer recurrence and long-term treatment side effects and most women found the strategies very helpful.

Adult↗