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Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗

Behavior therapy.

Explore the source record for details and available documents.

Aversive Therapy↗

Behavior therapy vs insight-oriented therapy for repeated suicide attempters.

A behavior therapy package was compared with insight-oriented therapy in a clinical trial for repeated suicide attempters. Self-report measures of depression, anxiety, and assertiveness were obtained before and after ten days of inpatient treatment and at follow-up intervals for nine moths. Interviews with patients during a two-year follow-up period elicited frequency of suicidal attempts and ideation. Results indicated the superiority of the behavior therapy package, with the structured, brief hospitalization and assertive follow-up likely contributing to the main effects.

Adolescent↗

[Behavior therapy in pediatrics].

30-40% of children presented to pediatricians are afflicted with psychophysiological, behavioral and learning disorders. The child behavior therapy is an empirical approach of understanding and treating these complaints. Many tables and examples demonstrate the basics of learning theory as well as behavior therapy methods derived from behavior analysis. The review closes by reporting the hypothetical issues and objects of behavior therapy und its significance for pediatrics. The bibliography refer to recent trends of child behavior therapy.

Behavior Therapy↗

Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.

OBJECTIVE: This study evaluated the long-term outcome of cognitive behavior therapy versus relaxation therapy for patients with chronic fatigue syndrome. METHOD: Sixty patients who participated in a randomized controlled trial of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome were invited to complete self-rated measures and participate in a 5-year follow-up interview with an assessor who was blind to treatment type. RESULTS: Fifty-three patients (88%) participated in the follow-up study: 25 received cognitive behavior therapy and 28 received relaxation therapy. A total of 68% of the patients who received cognitive behavior therapy and 36% who received relaxation therapy rated themselves as "much improved" or "very much improved" at the 5-year follow-up. Significantly more patients receiving cognitive behavior therapy, in relation to those in relaxation therapy, met criteria for complete recovery, were free of relapse, and experienced symptoms that had steadily improved or were consistently mild or absent since treatment ended. Similar proportions were employed, but patients in the cognitive behavior therapy group worked significantly more mean hours per week. Few patients crossed the threshold for "normal" fatigue, despite achieving a good outcome on other measures. Cognitive behavior therapy was positively evaluated and was still used by over 80% of the patients. CONCLUSIONS: Cognitive behavior therapy for chronic fatigue syndrome can produce some lasting benefits but is not a cure. Once therapy ends, some patients have difficulty making further improvements. In the future, attention should be directed toward ensuring that gains are maintained and extended after regular treatment ends.

Activities of Daily Living↗

Cognitive-behavior therapy for generalized anxiety disorder.

Overall, cognitive-behavior therapy shows promise as a treatment for GAD. The modest treatment gains reported to date may be in part due to the characterologic nature of GAD and the high rate of comorbidity. An important trend emerging in studies that provide long-term outcome data, however, is the substantial reduction in the use of anxiolytic medication in treated subjects. As a result, Brown et al have suggested that such cognitive-behavior therapy may offer an approach for discontinuing these medications in patients with GAD. Because the benefits of cognitive-behavioral treatment appear to be maintained at long-term follow-up assessment, cognitive-behavior therapy may provide a long-term and cost-effective solution to GAD. The maintenance of treatment gains following a relatively short period of intervention (5-20 sessions) is particularly impressive given that the GAD population is characterized by individuals who say that they have "always been worriers" and who previously have been very difficult to treat. Future research is required to explore the specific effects that "nonspecific" methods offer. In addition, because some studies (e.g., Barlow et al) reported that dropouts in treatment were high and that many patients were left with some residual anxiety, there is clearly still a need for further research to find more focused and successful treatments.

Adaptation, Psychological↗

Effects of diet and behavior therapy on social and motor behavior of retarded phenylketonuric adults: an experimental analysis.

The effects of a low phenylalanine diet on six retarded phenylketonuric adults were assessed. An ABA individual-subject design was used in experiment I to assess the effects of a low phenylalanine diet on social and motor behavior. Following a baseline during which the subjects ingested a normal phenylalanine diet (phase A), a low phenylalanine diet (phase B) was administered in a double blind fashion. Finally, the baseline condition (phase A) was reinstated (normal diet). The low phenylalanine diet resulted in few significant behavioral changes for those subjects with which proper methodologic controls were employed. However, for two of six subjects motor behavior, including stereotypy and tremor, seem to have ameliorated. In experiment II, applied behavior analysis techniques, including differential reinforcement of other behavior and time out, were combined to radically reduce the frequency of stereotypy and self-abuse exhibited by one of the six subjects of experiment I.

Adult↗

Can we mix behavioral therapy with hypnotics when treating insomniacs?

This study asks whether insomniacs undergoing behavioral training need to do so while totally free of hypnotics. Twenty-six insomniacs participated in the study, which included extensive monitoring of sleep both in the laboratory and at home. All subjects received six sessions of training in sleep hygiene and relaxation. About half the subjects were also given a hypnotic for occasional use; the others were asked to abstain from all hypnotics. Follow-up was performed immediately after treatment and again 10 months later. When compared with a waiting list, 6 hours of behavioral therapy improved insomniacs' sleep latency and sleep efficiency immediately after treatment, whether or not hypnotics were given concomitantly. Immediately following the 6 hours of therapy, those who had combined pharmacotherapy and behavior therapy improved about the same as those who had received behavior therapy alone. However, on the 10-month follow-up, those who had learned sleep hygiene and relaxation without the help of occasional hypnotics had more sleep and a better sleep efficiency than those who had been allowed an occasional hypnotic. We conclude that when teaching sleep hygiene and behavioral therapy to insomniacs, it might be advantageous to disallow the concomitant use of hypnotics as needed.

Adult↗

The ethical foundations of behavior therapy.

In this article, I am concerned with the ethical foundations of behavior therapy, that is, with the normative ethics and the meta-ethics underlying behavior therapy. In particular, I am concerned with questions concerning the very possibilty of providing an ethical justification for things done in the context of therapy. Because behavior therapists must be able to provide an ethical justification for various actions (if the need arises), certain meta-ethical views widely accepted by behavior therapists must be abandoned; in particular, one must give up ethical subjectivism, ethical skepticism, and ethical relativism. An additional task is to show how it is possible to provide a nonsubjective, nonskeptical, and nonrelativistic moral justification for an ethical statement. Although this is a monumental task, I provide a rough sketch of such a model, one that is congenial to the value judgments underlying behavior therapy.

Behavior↗

The effect of behavioral therapy on urinary incontinence: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women. METHODS: A randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n = 77) or a control group (n = 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses, t and chi(2) tests were used to compare the treatment and control groups, and paired t tests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy). RESULTS: Women in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P =.001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P =.001), which was maintained over 6 months (P <.004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 75% improved, and 50 (52%) at least 50% improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control). CONCLUSION: A low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.

Aged↗

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↗

[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↗

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↗

Does brief, clinically based, intensive multimodal behavior therapy enhance the effects of methylphenidate in children with ADHD?

OBJECTIVE: The additional value of a short-term, clinically based, intensive multimodal behavior therapy to optimally titrated methylphenidate in children with attention-deficit hyperactivity disorder (ADHD) was investigated. METHOD: Fifty children with ADHD (ages 8-12) were randomized to treatment of methylphenidate or treatment with methylphenidate combined with 10 weeks of multimodal behavior therapy. The multimodal behavior therapy consisted of a child and parent behavioral therapy and a teacher behavioral training. Assessments included parent, teacher and child ratings of ADHD symptoms, oppositional and conduct behavior, social skills, parenting stress, anxiety and self-worth. RESULTS: Both treatment conditions yielded significant improvements on all outcome domains. No significant differences were found between both treatments. CONCLUSIONS: No evidence was found for the additive effect of multimodal behavior therapy next to optimally titrated methylphenidate. CLINICAL IMPLICATIONS: This study does not support the expectation that optimally dosed stimulant treated children with ADHD should routinely receive psychosocial treatment to further reduce ADHD- and related symptoms.

Adrenergic Uptake Inhibitors↗