Showing papers in "Behavioural and Cognitive Psychotherapy in 1999"

Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress

Abstract: The efficacy of CBT for psychosis will be enhanced by a greater understanding of the mechanisms underlying symptoms. Therefore, an investigation is reported that examined a role for a neglected factor, anxiety, in the maintenance of delusional beliefs. It was hypothesized that processes responsible for chronic worry, as detailed by Wells' (1994a) meta-cognitive model, contribute to delusional distress. Questionnaire measures of anxiety, chronic worry and of meta-worry and related processes were administered to individuals with persecutory delusions (NG15) and individuals with generalized anxiety disorder (GAD) (NG14). Evidence was found for the presence of dysfunctional meta- cognitive processes in the clinically anxious group, which adds to the growing support for the model of GAD. Moreover, it was found that many of the individuals with persecutory delusions had high levels of general worry, and the factors implicated in the meta-cognitive model of anxiety were also present in this group. The results indi- cated that delusional distress is not simply related to content but is associated with whether the individual experiences meta-worry concerning the control of delusion- relevant worries, that is, whether he or she worries about not being able to control thoughts about the belief. This is the first theoretical development of the important dimension of delusional distress.

Cognitive behavioural treatment of post traumatic stress disorder after motor vehicle accident

Abstract: Post traumatic stress disorder (PTSD) and other reactions including driving phobias and depression have in recent years been clearly identified as common motor vehicle accident (MVA) sequelae. To date, no treatment outcome data exist for PTSD following MVA beyond case study reports and one pilot investigation. The present study reports on the first randomized control trial for PTSD following MVA. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heat rate and subjective distress measured in reaction to idiosyneratic audio descriptions of their accident. Participants were randomly assigned to eight to ten hours of individual cognitive-behavoural therapy (n = 10) or to a wait list control group (n = 10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. Results demonstrated statistically and clinically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Treatment gains were maintained over a 6 month follow-up using self-report questionnaires.

The efficacy and cognitive processes of cognitive behaviour therapy in the treatment of panic disorder with agoraphobia

Abstract: The present paper aimed (1) to review the literature to examine the effectiveness of CBT as treatment for PDA and (2) to evaluate whether the efficacy of CBT treatments is related to the change to cognitive processes that are postulated to be important in the cognitive models of PDA. A literature review of CBT studies in the area of PDA was conducted using both descriptive and quantitative (meta-analysis) procedures. In all, 35 studies published between 1969 and 1996 were included. The results show that CBT is an effective treatment for PDA. However, the contribution of cognitive processes to this disorder and the role that they play in the successful outcome of CBT remain unclear and in need of further empirical investigation. At present, CBT treatment provides limited support to validate the cognitive models of PDA.

Preliminary results of a new instrument to assess patient motivation for treatment in cognitive-behaviour therapy

Abstract: The Nijmegen Motivation List 2 (NML2) is a new instrument to assess patient motivation for psychotherapy. A previous version of the instrument was associated with positive treatment outcome in cognitive-behaviour therapy in several studies but its psychometric properties were poor. The present study investigated the NML2’s factorial structure, psychometric properties, and predictive value for treatment outcome. The NML2 was completed by 133 outpatients. Three factors were found: preparedness, distress, and doubt. Internal consistencies and re-test reliabilities of the factors were reasonable. The NML2 total score and preparedness were associated with proximal treatment helpfulness and with treatment drop-out. Distress and doubt were not. These findings corroborate those found with the earlier NML version. Rather than assuming that the relationship between motivation factors and treatment outcome is mediated by the amount or quality of treatment or homework compliance, it is proposed that motivation for treatment is the first step in the patient’s change process itself.

Two routes to emotion: some implications of multi-level theories of emotion for therapeutic practice

Abstract: Traditional models of the relationship between cognition and emotion have typically presented the relationship between cognition and emotion as a single level of sequential processes. However, a number of more recent models have argued to the contrary that the relationship is complex and has to be modelled by multi-level processing systems. One such model, the SPAARS approach (Power & Dalgleish, 1997), is summarized, in particular, in relation to clinical theory and practice in the cognitive behaviour therapies. For example, the proposal in SPAARS that there are two parallel routes to the production of emotion has a number of interesting clinical consequences. Highlights are presented of what some of these consequences might be, and a number of recommendations are made for clinical practice.

The possibility of reducing therapist contact and total length of therapy in the treatment of panic disorder

Abstract: This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf. Barlow. Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

Cognitive-behavioural treatment of sexually abused children: a review of research

Abstract: Child sexual abuse is a prevalent form of child maltreatment that frequently occasions severe disturbance including posttraumatic stress disorder. This review focuses on recent cognitive-behavioural treatment initiatives designed specifically for sexually abused children, and the extent to which they are empirically supported. Our review draws on case studies, open clinical trials, multiple baseline investigations and randomized clinical trials. At first glance, the research findings are encouraging for the efficacy and acceptability of cognitive-behaviour therapy. However, more conservative conclusions are reached when stringent criteria are applied regarding evidentiary support for psychosocial interventions. Directions for future research are also explored.

The feasibility of a cognitive behavioural therapy group for men with mild/moderate cognitive impairment

Abstract: Memory aid groups have often been used as a method for teaching mnemonic strategies to older adults in early stages of dementia. This study describes the use of CBT to address unhelpful memory-related beliefs in three older men with mild/moderate dementia and associated low mood or anxiety. The members were able to participate and engage in the sessions, and changes in behaviour, cognition and affect were monitored over the course of a 7 week group intervention. Recommendations are made for further research.

Cognitive personality styles associated with depressive and obsessive compulsive phenomena in a non-clinical sample

Abstract: This study explored whether obsessive-compulsive (OC) and depressive phenomena share common cognitive personality vulnerabilities. Specifically, the study examined the relationship of OC phenomena to sociotropy, autonomy and aspects of perfectionism, which traditionally have been associated with depression. A non-clinical sample of 152 subjects, mostly undergraduate university students, completed four questionnaires. Results indicated a significant relationship between depression and OC variables, with both relating significantly to autonomy, sociotropy and socially prescribed perfectionism. Correlations between OC phenomena and these cognitive personality styles were still significant after controlling for depression. Sociotropy and socially prescribed perfectionism predicted unique OC variance. Depression also predicted unique OC variance, controlling for the cognitive personality styles. It was concluded that OC and depressive phenomena share vulnerability centred on desires for approval. It was also recognized that depression-specific processes account for some of the covariability between depression and OC phenomena. Therefore, it was suggested that treatment of obsessive-compulsive disorder may improve by attending to the reduction of depressive phenomena and to the modification of beliefs related to social-approval.

On, to, for, with – vulnerable people and the practices of the research community

Abstract: Following a disputed review of a paper submitted to this journal the present paper seeks to raise the profile of some of the issues involved when the research community engages with vulnerable people. The paper is unashamedly polemical. It argues that this is a dangerous time for vulnerable people and that current protections are inadequate. The paper suggests the need to re-evaluate the whole relationship between the scientific community and vulnerable people but also tries to identify some practical and immediate improvements that could be made.

One year follow-up of cognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder: symptom change, medication usage and attitudes to treatment

Abstract: A one year follow-up is reported of a randomized clinical trial with generalized anxiety disorder (GAD) in which the main comparison was between analytic psychotherapy (AP) and cognitive therapy (CT), each delivered at weekly or fortnightly intervals over a six month period. CT was found to be significantly more effective than AP. However, GAD is a chronic and relapsing condition and follow-up data are needed to assess the durability of improvement and the possibility that the benefits of analytic psychotherapy may be more apparent over the longer term. Data were collected in three areas: (1) symptomatology and overall improvement; (2) medication usage and contact with GPs; and (3) attitudes to therapy. CT was clearly superior to AP on the main outcome measures and only a minority of AP patients made significant improvements. CT but not AP was associated with significant reductions in medication usage, and patients receiving CT were generally more positive about treatment received. Differences between treatments were less evident in the less intensive treatment condition where overall results were relatively poor. The most positive outcomes were achieved in the more intensive CT condition in which approximately two-thirds of patients achieved clinically significant improvements.

What becomes of cognitive therapy trainees? A survey of trainees' opinions and current clinical practice after postgraduate cognitive therapy training

Abstract: Training in cognitive therapy includes a grounding in relevant empirical research, and the development of a range of clinical skills. It is recognized that this training will need to be continually updated in line with new developments. Several postgraduate training courses in cognitive therapy or cognitive behaviour therapy exist in the United Kingdom. Such courses are expensive in terms of both direct and indirect costs. A postal survey was employed to investigate the effects of the one-year post-qualification course in cognitive therapy at the Newcastle Cognitive Therapy Centre on trainees who had attended the course. The questionnaire examined trainees’ views about the course, of their current clinical skills in cognitive therapy and their use of cognitive therapy since leaving the course. Finally, continuing professional development, on-going supervision and further training in cognitive therapy were examined.

An exploratory study of the predictors of coping and psychological well-being in female partners of excessive drinkers

Abstract: The study was a cross-sectional questionnaire survey of 29 women with a recent experience of coping with excessive drinking in a male partner. A number of cognitive and environmental factors were studied to determine the extent to which they predicted coping style and psychological well-being in this group. Results of multiple regression analysis indicated that “engaged” coping (characterized by attempts to change the drinker) was best predicted by a single cognitive variable (self-demands). In contrast, “tolerant” coping was best predicted by a combination of participant’s beliefs about their ability to withdraw from the drinker and the degree of drink-related hardship experienced within the family. “Withdrawal” coping, characterized by avoidant and independent behaviours by the women, was best predicted by a combination of beliefs about the necessity of withdrawal and the duration of time the participants had been coping with the excessive drinking. Finally, psychological well-being was best predicted by a single environmental variable (the degree of hardship caused by the drinking). A number of significant correlations were found to exist between the predictor and criterion variables and are discussed. Limitations of the study and clinical implications of the findings are examined.

Using a cognitive rationale to conceptualize anxiety in people with dementia

Abstract: Dementia is characterized by a decline in cognitive abilities that is sufficient to impair functioning in daily living. There are a number of forms of dementia (Alzheimer’s, vascular, Lewy body, etc), each with its own cognitive profile and developmental course. The present paper deals with the progressive dementias, such as Dementia of the Alzheimer Type (DAT). The cognitive deterioration associated with advanced DAT is often accompanied by a decline in emotional control, social behaviour and motivation. The paper focuses particularly on the emotional features of the disorder, because this issue has a profound impact on both the sufferer and carer. A framework for conceptualizing anxiety is presented, and a model of how this conceptualization can be used effectively within a carer’s training programme is discussed.

Urine-triggered alarm signals and prompts to promote daytime urinary continence in a boy with severe intellectual disability

Abstract: A strategy involving urine-triggered alarm signals and prompts combined with positive reinforcement for appropriate urination was employed for promoting daytime urinary continence in a boy with severe intellectual disability. The strategy, which was applied only in the day centre the boy attended, seemed effective for promoting self-initiated toileting actions and for eliminating almost totally large urinary accidents. Some small urinary accidents (consisting of wetting small areas of the underpants) remained. Implications of the findings are discussed.

Social anxiety in adolescents and appraisal of negative events : Specificity or generality of bias?

Abstract: The role of appraisal of negative events in social anxiety of adolescents was studied. One-hundred and sixty-eight Icelandic pupils between the ages of 13 and 15 years completed the Social Phobia and Anxiety Inventory for Children (SPAI-C), Children’s Depression Inventory (CDI), and measures of situational appraisal. Social anxiety was found to be specifically related to the appraisal as threatening of negative social events happening to the self. These relationships remained when depression was partialized out, whereas the reverse was not true. On the whole, the results support the notion of judgmental specificity in relation to social anxiety in adolescents.

Power therapies: evidence vs miraculous claims

Abstract: Poole, de Jongh and Spector ask for empirical research rather than emotive arguments when evaluating EMDR. When one applies this standard, Poole et al.'s remaining points are devoid of substance. EMDR, like other Power Therapies, is a miracle' cure that has failed.

Conceptualizations of depression in older people: the interaction of positive and negative beliefs

Abstract: Empirical evidence for the efficacy of Cognitive Therapy (CT) treatments for older adults, when compared with other psychotherapies, is inconclusive (Davies & Collerton, 1997). The current authors suggest that one reason for the equivocal findings lies in the failure to adapt the cognitive rationale sufficiently to cater for the different presentation of depression in older people; particularly for those experiencing first-episode late onset-depression. It is argued that existing models tend to focus on the negative aspects of self-appraisal, and fail to fully conceptualize the functional role of positive beliefs (i.e. functional beliefs that have maintained the self-esteem over many years). The work presents an alternative conceptualization of depression for older people, along with implications for therapy. This framework does not represent a brand new approach, but emphasizes specific aspects of existing psychological conceptualizations.

The Treatment of Wheelchair-Bound Chronic Fatigue Syndrome Patients: Two Case Studies of a Pragmatic Rehabilitation Approach

Abstract: Chronic fatigue syndrome is a disabling condition characterized by persistent mental and physical fatigue. Its aetiology is controversial, and it has been attributed to both physical and psychological causes. Previous controlled trials with ambulatory patients have shown that a proportion of CFS patients respond to cognitive-behaviour therapy. In this paper, we report two case studies of patients who are wheelchair-bound, who have been treated by a pragmatic intervention designed to increase activity and challenge dysfunctional illness beliefs. The patients received 60 and 55 contacts with the therapist, some of which were face-to-face and some of which were by telephone. At the end of treatment, the patients experienced clinically significant reductions in fatigue, were not using wheelchairs, showed an increase in occupational and social functioning and were leading relatively independent existences.

The internet and its relevance to cognitive behavioural psychotherapists

Abstract: The potential uses of the Internet to behavioural and cognitive psychotherapists and researchers are manifold. This article summarizes what the Internet is, how to connect to it, searching the Web, on-line publishing, discussion forums, chat-rooms, literature searching, transfer of documents and creating a web-site. It considers the potential of Internet technology in therapy and enhancing patient/therapist contact. A web page containing links to many of the sites referred to in this article as well as additional links and resources is accessible through the BABCP website (www.babcp.org.uk).

Attentional focus and fear of blushing: A case study

Abstract: By means of a single case study, the effects of redirecting attention above exposure only on fear of blushing, avoidance, and idiosyncratic dysfunctional beliefs were tested. A social phobic patient with fear of blushing as the predominant complaint received sessions of Task Concentration Training (TCT) and Exposure in Vivo (EXP) alternately, after a steady baseline had been established. The treatment consisted of 14 individual sessions. Assessments were held before and after baseline, after treatment, after 4 weeks follow-up, and after 1-year follow-up. Continuous measurements were held throughout the treatment in order to measure the differential effects of TCT and EXP on fear, avoidance and beliefs. TCT and EXP together, turned out to be an effec- tive treatment for fear of blushing: large effects were observed on all three outcome measurements. When differential effects are closely looked at, EXP seemed more effec- tive in decreasing fear of blushing. However, the patient appeared to have used TCT strategies as well during the EXP weeks, which may have contributed to the favourable effects of EXP.

The effects of relaxation with and without imagery in reducing anxiety and itchy skin in patients with eczema

Abstract: Eczema is a skin condition with a multifaceted aetiology that includes both psychological and physiological components. A number of studies have indicated that cognitive-behavioural techniques (e.g. relaxation) are effective in the treatment of atopic eczema. However, it remains unclear from the literature whether different relaxation techniques have comparable treatment effects. The current study compared the efficacy of a single relaxation session with an imagery component with that of a comparable relaxation session without the imagery component. Eczema patients (n=9) who participated in relaxation with imagery reported significantly greater reductions in state anxiety and subjective ratings of itchiness and significantly greater increases in mental relaxation levels than eczema patients (n=9) who participated in relaxation without the imagery component. No group differences were found on changes in state anger. These results suggest that relaxation with an imagery component may be more effective than relaxation without an imagery component in lowering state anxiety levels and itchy sensations of atopic eczema patients.

Power therapies: evidence versus emotion a reply to rosen, lohr, mcnally and herbert

Abstract: Rosen, Lohr, McNally and Herbert's (1998) arguments directed at the so- called ''Power Therapies'' and, in particular, Eye Movement Desensitization and Reprocessing (EMDR) are examined. It is suggested that their paper does not adequately review the available research data and, therefore, draws unwarranted con- clusions. Based on published controlled studies it is concluded that there is evidence to support the use of EMDR in the treatment of post traumatic stress disorder (PTSD).

Depersonalization in a non-clinical sample

Abstract: Twenty participants self-referred from the general population as experiencing depersonalization were interviewed to determine the qualities of the experience and possible pathology. The participants and control group were also administered a battery of questionnaires measuring different aspects of psychopathology. There were no consistent diagnostic associations with depersonalization. In the majority of cases, onset was reported after a traumatic life event, or after sexual abuse or after giving birth. The most frequent experiences were related to derealization and participants did not score high on dissociation in general. The most common strategy to alleviate the problem was concentrating on a task. We distinguish between those clients who viewed the experience as a loss of or less than normal sensation, which we qualified as negative symptoms and others who evaluated the experience as an addition to their usual perceptions and sensations, which we qualified as positive symptoms.

“respect” in research with people with learning disabilities

Abstract: There would be broad agreement with the need to address the issues put forward by Clements, Rapley and Cummins amongst service providers and researchers in learning disability. However, these authors' presentation of their arguments may well unnecessarily antagonize both groups. Additionally, it is suggested, the authors fail to identify the different paradigmatic bases of their proposals and thereby miss the opportunity to air genuine ethical dilemmas in learning disability research.

The Psychobiological Correlates Of Panic Attacks During In Vivo Exposure

Abstract: This study examined in detail the psychobiological correlates of panic attacks experienced in panic disorder with agoraphobia. The cognitions, affect, and physiology of the six patients were monitored during in vivo exposure to their phobic situations. The results from these case studies showed that catastrophic cognitions are the key component of panic attacks. However, there was no clear-cut evidence to support an interaction among cognitions, affect, and physiology, which has been postulated by cognitive theories to be the central component of panic attacks and panic disorder with agoraphobia.

The eye movement desensitization and reprocessing debate: commentary on rosen et al. and poole et al.

Abstract: The debate conducted in this journal and elsewhere on the effectiveness of eye movement desensitization and reprocessing (EMDR) is characterized by incredulity, fervent belief and emotion. Theorists and clinical pragmatists, not to mention the “discovers” of EMDR, have often taken up oppositional stances that impede rationale debate. Whilst some may be offended by the overt commercialism and messianic fervour of the EMDR lobby, the best response is to engage in dialogue, collaboration and scientific experiment. These experiments should combine the best randomized clinical trial methods with experimental deconstruction of the complex mix that now comprises EMDR. Those who have developed EMDR should cease the commercial and empirical protectionism that has characterized the EMDR movement and open their methods to such investigation by the healthily sceptical.

Reinforcement schedules and the management of childhood behaviours

Abstract: Where a behaviour has been maintained on a variable schedule of reinforcement theoretically it should be possible to reduce resistance to extinction by first putting the behaviour onto a continuous schedule of reinforcement. This approach has been employed in animal research but rarely with human participants, and where it has, with little success. This study describes the use of the approach to overcome some minor problems in the behaviour of young children, the problems being sufficiently troublesome for the parents to consult their GP. All the families who used the approach were successful in remediating the behaviour. Some reasons for this success, in contrast with the disappointing outcomes of some of the earlier research, are discussed. Although the study lacks formal controls it is suggested that the approach could be usefully applied to other common childhood behaviours that have been subjected to variable reinforcement.

Factors Associated with Partial Remission in Depression

Abstract: We report a subgroup analysis of 24 out of 42 subjects who were hospitalized for non-psychotic major depressive disorder and who agreed to participate in interviews at admission and 2 years afterwards (as reported previously by Domken, Scott, & Kelly, 1994; Bothwell & Scott, 1997). At 2 year follow-up, these 24 subjects were categorized according to established criteria into clients meeting criteria for full remission (FR; n=9) and those meeting criteria for partial remission (PR; n=15). The most striking findings were that, over time, PR subjects showed significant loss of self-esteem and showed greater divergence in self-ratings compared to observer ratings of their depressive symptoms, whilst the same ratings in the FR group changed in the opposite direction. We suggest that the persistence of depression in PR subjects may provide evidence to support Teasdale’s (1988) hypothesis that some individuals “get depressed about being depressed”. The research and clinical implications of the results are noted.

Transformation of meaning and its effects on cognitive behavioural treatment of an injection phobia

Abstract: A five session cognitive behavioural treatment of an injection phobia is described, in which the patient's dysfunctional attitudes about not being able to control events played a central role. The extreme negative meaning of the phobic situation was explored, and then the patient was asked to say when in her life she could first remember having those types of thoughts and emotions. This helped her to understand some of the origins of her fear, and then to transform the negative meaning into a more realistic positive one. The Stress-In-Dynamic-Context model of acquisition of phobias was used to understand factors other than simple pairing of stimuli that might have been involved in the triggering of her phobia.