[Cognitive behavioral therapies].
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Cognitive Behavioral Therapy↗
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Drug compliance and cognitive-behavioral therapy in schizophrenia.
The cognitive-behavioral profession provides a theoretical model to understand the drug-compliance problem in schizophrenia and to enhance its therapeutic approach. The main components of this approach include continuous behavioral analysis, enhancement of therapeutic alliance, psychoeducation of the patient and significant others, perceptual and attitudinal strategies, behavioral strategies and cognitive restructuring.
Antipsychotic Agents↗
A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa.
BACKGROUND: Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison. METHOD: Two hundred twenty patients meeting DSM-III-R criteria for bulimia nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study. RESULTS: Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=71), the percentage remitted (48% [n=53] vs 28% [n = 31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n= 29) for CBT and 8% (n= 5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers. CONCLUSIONS: Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with bulimia nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for bulimia nervosa.
Adult↗
Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons.
OBJECTIVE: The purpose of this study was to compare the acute outcomes of antidepressant medication and cognitive behavior therapy in the severely depressed outpatient subgroups of four major randomized trials. A secondary objective was to compare the results obtained in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, upon which treatment guidelines have been based, with those obtained in the other three studies. METHOD: Outcomes of antidepressant medication and cognitive behavior therapy were compared within each of the four studies separately and for patients aggregated across the four studies. In addition, the outcomes in the antidepressant medication and cognitive behavior therapy conditions of the Treatment of Depression Collaborative Research Program were compared with those obtained in the other three studies. RESULTS: The overall effect sizes comparing antidepressant medication to cognitive behavior therapy favored cognitive behavior therapy, but tests comparing the two modalities did not reveal a significant advantage for either modality overall. CONCLUSIONS: Cognitive behavior therapy has fared as well as antidepressant medication with severely depressed outpatients in four major comparisons. Until findings emerge from current or future comparative trials, antidepressant medication should not be considered, on the basis of empirical evidence, to be superior to cognitive behavior therapy for the acute treatment of severely depressed outpatients.
Adult↗
Severity of depression and response to cognitive behavior therapy.
OBJECTIVE: The authors studied the relationship between clinical severity of depression and response to cognitive behavior therapy. METHOD: Fifty-nine outpatients with major depression with endogenous features, according to Research Diagnostic Criteria, were stratified into more severe (score of 20 or more on the Hamilton Rating Scale for Depression; N = 38) or less severe (Hamilton score of 19 or less; N = 21) subgroups. Patients were treated with a 16-week, 20-session cognitive behavior therapy protocol. Outcome was assessed with the Hamilton scale, the Global Adjustment Scale, and the Beck Depression Inventory. RESULTS: The more severe group was significantly more symptomatic across the 16-week protocol and had a significantly lower response rate on the Beck inventory (50% versus 81%). However, the groups did not significantly differ at end point on any of the three measures, and they showed comparable rates of symptomatic improvement (i.e., percent change in scores and interactions between severity classification and time). CONCLUSIONS: These results partially replicate the National Institute of Mental Health's Treatment of Depression Collaborative Research Program's findings of poorer response to cognitive behavior therapy in patients with Hamilton scale scores of 20 or more. However, both groups experienced robust and clinically significant reductions in depressive symptoms, and the response of the more severe patients in the current study could hardly be considered poor. While these findings do not support the view that a Hamilton scale score of 20 or more is a relative contraindication for cognitive behavior therapy, the symptoms of the more severely depressed patients did tend to remit less completely (particularly on the Beck inventory) and thus these patients may benefit from a more intensive or extended course of therapy.
Adult↗
Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder.
Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder--particularly those living in rural areas--do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.
Journal Article↗
Cognitive behavior therapy for eating disorders: progress and problems.
Beginning with the application of operant conditioning principles as part of inpatient treatment, cognitive behavior therapy (CBT) for anorexia nervosa (AN) has been insufficiently studied. Its efficacy remains in question. By contrast, manual-based CBT is the first-line treatment of choice for bulimia nervosa (BN) although its effects are limited. More effective methods are needed for non-responders to current therapy. Despite its well-established efficacy, CBT for BN is relatively rarely used in the US. Research on dissemination is a priority. Modified CBT and behavioral weight control programs seem comparably effective in reducing binge eating in Binge Eating Disorder (BED). Long-term maintenance of weight loss in these obese patients, however, remains a challenge. Self-help and other brief, cost-effective methods work for subsets of both BN and BED patients, demonstrating that treatment be administered within a stepped-care framework.
Behavior Therapy↗
[Changes in clinically relevant goals and therapy outcome: a study with inpatients undergoing cognitive behavioral therapy].
According to the consistency theory clinically relevant goals, as explicated by Grosse Holtforth and Grawe, play a prominent role in the development, maintenance and therapy of psychological disorders. Thus effective psychotherapies should "normalize" the subjective importance of these goals. These changes should be positively associated with the success of psychotherapy. To test these assumptions, clinically relevant goals of 64 inpatients undergoing cognitive behavioral therapy were assessed by the Inventory of Approach and Avoidance Goals (German: Fragebogen zur Analyse motivationaler Schemata, FAMOS) before and after therapy. Results show effects of normalization, as expected, especially on scales associated with psychopathology in former studies.
Cognitive Behavioral Therapy↗
Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores.
BACKGROUND: Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face, via self-help books (bibliotherapy), and through computer administration. The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners. We have developed a free Internet-based cognitive behavior therapy intervention (MoodGYM, http://moodgym.anu.edu.au) designed to treat and prevent depression in young people, available to all Internet users, and targeted to those who may have no formal contact with professional help services. OBJECTIVE: To document site usage, visitor characteristics, and changes in depression and anxiety symptoms among users of MoodGYM, a Web site delivering a cognitive-behavioral-based preventive intervention to the general public. METHODS: All visitors to the MoodGYM site over about 6 months were investigated, including 2909 registrants of whom 1503 had completed at least one online assessment. Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately. The main outcome measures were (1) site-usage measures including number of sessions, hits and average time on the server, and number of page views; (2) visitor characteristics including age, gender, and initial Goldberg self-report anxiety and depression scores; and (3) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions. RESULTS: Over the first almost-6-month period of operation, the server recorded 817284 hits and 17646 separate sessions. Approximately 20% of sessions lasted more than 16 minutes. Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population-based surveys and those characterizing a sample of University students. For the Web-based population, both anxiety and depression scores decreased significantly as individuals progressed through the modules. CONCLUSIONS Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public. However, randomized controlled trials are required to establish the effectiveness of these interventions.
Adolescent↗
Sudden gains and critical sessions in cognitive-behavioral therapy for depression.
In this study of cognitive-behavioral therapy for depression, many patients experienced large symptom improvements in a single between-sessions interval. These sudden gains' average magnitude was 11 Beck Depression Inventory points, accounting for 50% of these patients' total improvement. Patients who experienced sudden gains were less depressed than the other patients at posttreatment, and they remained so 18 months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cognitive changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains. Improved therapeutic alliances were also observed in the therapy sessions immediately after the sudden gains, as were additional cognitive changes, suggesting a three-stage model for these patients' recovery: preparation-->critical session/sudden gain-->upward spiral.
Adult↗
Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia.
OBJECTIVE: This study evaluated the effectiveness of a supervised benzodiazepine taper, singly and combined with cognitive behavior therapy, for benzodiazepine discontinuation in older adults with chronic insomnia. METHOD: Seventy-six older adult outpatients (38 women, 38 men; mean age of 62.5 years) with chronic insomnia and prolonged use (mean duration of 19.3 years) of benzodiazepine medication for sleep were randomly assigned for a 10-week intervention consisting of a supervised benzodiazepine withdrawal program (N=25), cognitive behavior therapy for insomnia (N=24), or supervised withdrawal plus cognitive behavior therapy (N=27). Follow-up assessments were conducted at 3 and 12 months. The main outcome measures were benzodiazepine use, sleep parameters, and anxiety and depressive symptoms. RESULTS: All three interventions produced significant reductions in both the quantity (90% reduction) and frequency (80% reduction) of benzodiazepine use, and 63% of the patients were drug-free within an average of 7 weeks. More patients who received medication taper plus cognitive behavior therapy (85%) were benzodiazepine-free after the initial intervention, compared to those who received medication taper alone (48%) and cognitive behavior therapy alone (54%). The patients in the two groups that received cognitive behavior therapy perceived greater subjective sleep improvements than those who received medication taper alone. Polysomnographic data showed an increase in the amount of time spent in stages 3 and 4 sleep and REM sleep and a decrease in total sleep time across all three conditions from baseline to posttreatment. Initial benzodiazepine reductions were well maintained up to the 12-month follow-up, and sleep improvements became more noticeable over this period. No significant withdrawal symptoms or adverse events were associated with benzodiazepine tapering. CONCLUSIONS: A structured, time-limited intervention is effective in assisting chronic users of benzodiazepine medication to discontinue or reduce their use of medication. The addition of cognitive behavior therapy alleviates insomnia, but sleep improvements may become noticeable only after several months of benzodiazepine abstinence.
Anti-Anxiety Agents↗
Cognitive behavior therapy for chronic fatigue syndrome: efficacy and implications.
Cognitive behavior therapy (CBT) is a form of non-pharmacologic treatment. It is based on a model of chronic fatigue syndrome (CFS) that hypothesizes that certain cognitions and behavior may perpetuate symptoms and disability--that is, act as obstacles to recovery. Treatment emphasizes self-help and aims to help the patient to recover by changing these unhelpful cognitions and behavior. There is now good evidence from 2 independent randomized clinical trials to support the efficacy of CBT in patients with CFS. The treatment effect is substantial, although few patients are cured. The urgent clinical need is to make this form of treatment available to patients with CFS. One approach is to incorporate the principles of CBT into routine clinical practice. The preliminary evaluation of these simpler forms of CBT are promising, although the results of controlled trials are awaited. At present, intensive individual CBT administered by a skilled therapist remains the treatment of choice for patients with CFS.
Cognitive Behavioral Therapy↗
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↗
Case study: successful medication withdrawal using cognitive-behavioral therapy for a preadolescent with OCD.
The aim of this study was to evaluate the effectiveness of the addition of manual-based cognitive-behavioral therapy to a medication regimen of clomipramine and fluoxetine and the withdrawal of medication during cognitive-behavioral therapy. The participant was an 11-year-old girl with symptoms of obsessive thoughts about germs and illness and handwashing compulsions. The addition of cognitive-behavioral therapy reduced the participant's daily number of obsessions and avoidance behaviors after three sessions. When medication was tapered during the cognitive-behavioral therapy program, the participant's symptoms continued to decline, and after treatment, she no longer met diagnostic criteria for obsessive-compulsive disorder. Impressively, the participant remained medication free and treatment gains were maintained at 4 months' follow-up.
Child↗
Cognitive-behavior therapy with adult patients with epilepsy: a controlled outcome study.
The present study evaluated the efficacy of group cognitive-behavior therapy for the alleviation of psychosocial problems and reduction of seizures with adult epileptic patients. Twenty-seven outpatients were randomly assigned to one of three groups: Cognitive-Behavior Therapy, Supportive Counseling (attention-placebo control), and Waiting list (no treatment control). The major outcome measures used were: patient's, neurologist's, and therapist's global ratings of psychological adjustment, patient's target complaints and weekly seizure frequency, patient's and neurologist's ratings of seizure control, the Minnesota Multiphasic Personality Inventory, the Washington Psychosocial Seizure Inventory, and the Beck Depression Inventory. No significant differences were found among the three groups on these measures except for therapist's global ratings of psychological adjustment, on which both the Cognitive-Behavior Therapy and Supportive Counseling groups improved significantly after therapy, but the Waiting List control group did not. Overall, little support was found for the efficacy of group cognitive behavior therapy (eight 2-h weekly sessions) for the reduction of psychosocial difficulties or seizures. Implications of the present findings are discussed, with the need for further controlled outcome research stressed.
Adult↗
Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial.
OBJECTIVE: The opiate antagonist drug naltrexone has been shown in a few studies with limited sample sizes to be effective when combined with psychosocial therapies for the treatment of alcohol dependence. The goal of this study was to obtain additional information regarding its efficacy in pertinent alcoholic populations and with a well-defined therapy. METHOD: In this study, 131 recently abstinent alcohol-dependent outpatients were treated with 12 weekly sessions of manual-guided cognitive behavioral therapy and either 50 mg/day of naltrexone (N = 68) or placebo (N = 63) (with riboflavin added as a marker of compliance) in a double-blind, randomized clinical trial. Alcohol consumption, craving, adverse events, and urinary riboflavin levels were assessed weekly. Levels of blood markers of alcohol abuse were also ascertained during the trial. RESULTS: The study completion, therapy participation, and medication compliance rates in the trial were high, with no differences between treatment groups. Naltrexone-treated subjects drank less, took longer to relapse, and had more time between relapses. They also exhibited more resistance to and control over alcohol-related thoughts and urges, as measured by a subscale of the Obsessive Compulsive Drinking Scale. Over the study period, 62% of the naltrexone group did not relapse into heavy drinking, in comparison with 40% of the placebo group. CONCLUSIONS: Motivated individuals with moderate alcohol dependence can be treated with greater effectiveness when naltrexone is used in conjunction with weekly outpatient cognitive behavioral therapy. Naltrexone increases control over alcohol urges and improves cognitive resistance to thoughts about drinking. Thus, the therapeutic effects of cognitive behavioral therapy and naltrexone may be synergistic.
Adult↗
Randomized controlled trial of vestibular rehabilitation combined with cognitive-behavioral therapy for dizziness in older people.
OBJECTIVE: To evaluate the effectiveness of vestibular rehabilitation combined with cognitive behavioral therapy in the treatment of dizziness in older people. STUDY DESIGN AND SETTING: A randomized controlled design was used with patients recruited via an advertisement. Nine patients completed treatment and 10 served as waiting-list controls. The intervention lasted 7 weeks with 5 weekly group sessions and consisted of vestibular exercises. Cognitive behavioral therapy components were added to promote relaxation, reduce anxiety, and avoidance of feared situations and movements. RESULTS: Statistically significant improvements on walking time, 2 dizziness provocative movements, and on the Dizziness Handicap Inventory, but no effects on the Romberg or anxiety and depression. Of the treated patients, 89% reached statistical significant improvement on the total inventory score. CONCLUSION: Cognitive behavioral therapy combined with vestibular rehabilitation decreases dizziness in older people. SIGNIFICANCE: These findings indicate that cognitive behavioral therapy can be combined with vestibular rehabilitation in the treatment of dizziness.
Aged↗
Comparing the process in psychodynamic and cognitive-behavioral therapies.
Archival records were used to compare the therapy process in 30 brief psychodynamic and 32 cognitive-behavioral therapies. Verbatim transcripts of 186 treatment sessions were rated with the Psychotherapy Process Q-set, designed to provide a standard language for the description of process. Results demonstrated that although some features were common to both treatments, there were important differences. Cognitive-behavioral therapy promoted control of negative affect through the use of intellect and rationality combined with vigorous encouragement, support, and reassurance from therapists. In psychodynamic psychotherapies, there was an emphasis on the evocation of affect, on bringing troublesome feelings into awareness, and on integrating current difficulties with previous life experience, using the therapist-patient relationship as a change agent. The clinical theoretical precepts underlying psychodynamic treatments received considerable support. In cognitive-behavioral therapies, there was evidence for the importance of developmental, as opposed to rationalist, intervention strategies for treatment outcome.
Adaptation, Psychological↗