Showing papers on "Cognitive behavioral therapy published in 1989"

National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.

Abstract: • We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depressive disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed signifi-cant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on intial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.

Management of chronic (post-viral) fatigue syndrome.

Abstract: Simple rehabilitative strategies are proposed to help patients with the chronic fatigue syndrome. A model is outlined of an acute illness giving way to a chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity, deterioration in exercise tolerance and further symptoms. This is compounded by the depressive illness that is often part of the syndrome. The result is a self-perpetuating cycle of exercise avoidance. Effective treatment depends upon an understanding of the interaction between physical and psychological factors. Cognitive behavioural therapy is suggested. Cognitive therapy helps the patient understand how genuine symptoms arise from the frequent combination of physical inactivity and depression, rather than continuing infection, while a behavioural approach enables the treatment of avoidance behaviour and a gradual return to normal physical activity.

The College Student-Athlete: Psychological Considerations and Interventions

Abstract: This article reviews the literature dealing with problems brought by student-athletes to college counseling and mental health centers. Among the issues discussed are fear of success; identity conflict; social isolation; poor athletic performance; academic problems; and career or vocational concerns. In addition, the authors examine the paradox that although athletes experience as much or more psychological distress as nonathletes, research indicates that athletes use professional services less often than nonathletes. Finally, the authors review approaches to psychological intervention, including short-term psychotherapy, very brief interventions, cognitive behavioral therapy, and career/vocational counseling, and discuss special considerations for conducting therapy with athletes.

Cognitive therapy of panic disorder. A nonpharmacological alternative.

Abstract: A naturalistic study with no predetermined duration of treatment was undertaken in order to examine the effectiveness of cognitive therapy in the treatment of panic disorder. Seventeen patients diagnosed as having panic disorder according to the Structured Clinical Interview for DSM-III Personality Disorders received a mean of 18 individual cognitive therapy sessions. Patients with personality disorder or depression required a longer duration of treatment to become symptom-free. As measured by a self-report weekly panic log, the mean number of panic attacks was reduced significantly to zero at the end of treatment. There was a concomitant reduction in self-report measures of depression and anxiety. Further, there was a significant reduction on a measure of cognitive dysfunction during panic attacks. Treatment results were maintained at 12-month follow-up.

Marriage Counseling: A Christian Approach to Counseling Couples

Abstract: An approach to marriage counseling aimed at Christian couples is described. The theoretical bases of the approach are cognitive behavioral therapy and structural and strategic marital therapies. Techniques are drawn from various schools of marriage therapy. Shared Christian values between counselor and clients are used to promote increased marital commitment, marital satisfaction, and personal spiritual growth. Marital satisfaction might be increased through helping the couple increase their intimacy, enhance their communication, improve their conflict management, and forgive each other for past and present hurts.

Psychotherapy With Persons Suffering From Schizophrenia: The Need for a New Agenda

Abstract: The success of the biological revolution in our understanding of schizophrenia, along with the lack of convincing evidence for the efficacy of global approaches to individual psychotherapy with schizophrenia, has led to the virtual disappearance of research and theory in this area. However, it seems timely to reexamine alternative approaches to psychotherapy that are based on an informed understanding of schizophrenia as a biological distortion of certain aspects of human experiencing. The purposes and unique role of psychotherapy within the broader range of treatments must be clarified, and more phenomenologically based, empirically tested problem-specific interventions developed. Three areas seem particularly suited for psychotherapy; (1) the human issues raised by having a chronic debilitating disorder that affects one's psychological experiencing, (2) attempts to help the patient manage the disorder, and (3) the normal psychological problems that persons with schizophrenia also face. Finally, suggestions are made about rethinking the therapeutic enterprise.

Cognitive-behavioral therapy for primary fibromyalgia.

Abstract: The purpose of cognitive-behavioral therapy is to teach individuals the skills necessary to control pain and disability as well as to believe that they can successfully employ these skills. Cognitive-behavioral therapy has been used successfully in patients with back pain and rheumatoid arthritis and represents a potentially effective intervention for patients with primary fibromyalgia. This article describes cognitive-behavioral treatment procedures, presents 2 experimental designs that may be used in randomized, controlled clinical trials of cognitive-behavioral therapy in patients with primary fibromyalgia and identifies the methodological features that should be included in the trials.

Cognitive-behavioral therapy with and without exposure plus response prevention in treatment of bulimia nervosa: comment on Agras, Schneider, Arnow, Raeburn, and Telch.

Abstract: Critique de l'article de AGRAS et al. (1989) sur la nevrose boulimique. Cet article proposait des traitements de cette pathologie. Les critiques s'attachent a montrer des differences procedurales existant entre cette etude et les recherches anterieures

Changing Resistant Assumptions in Christian Cognitive-Behavioral Therapy:

Abstract: Drawing upon a large secular literature, Christian approaches to cognitive-behavioral therapy have emphasized the importance of helping clients to change false assumptions about themselves, their f...

Effects and limitations of cognitive behavior therapy in bulimia inpatients.

Abstract: Cognitive behavior therapy was applied to 8 inpatients with bulimia (DSM-III). Improvement of bulimia was superior when compared to 6 bulimics treated with nonspecific psychotherapy. Social maladjustment was linked to the maintenance of bulimia. The effectiveness of cognitive behavior therapy seemed to be impaired by co-morbidity and dysphoric mood. Therefore a more structured externally controlled behavioral hospital treatment program is recommended.

A pilot study of a modified Balint group using cognitive approaches to physician attitudes about somatoform disorder patients.

Abstract: This is a pilot study of the use of cognitive therapy theories and techniques in a time-limited Balint group of family physicians with a focus on the care of the somatoform disorders. Family physicians often find these patients difficult and unpleasant to treat. Physicians in the group were compared with other family physicians in a pre and post test of attitudes towards patients with somatoform disorders. In addition, the beliefs of the physicians were elicited. After the 13 session Balint group was completed, attitudes of the family physicians in the group improved so that they were less likely to feel that somatizing patients take up too much of their time (p less than 0.05). Underlying beliefs about somatoform disorder patients were identified in the group and subsequently modified. This study suggests that a time-limited cognitive therapy Balint group, focusing on somatoform disorder patients, results in improved attitudes toward the care of these patients.

Evaluating the efficacy of psychotherapy for depression: the USA experience.

Abstract: New forms of psychotherapy have been developed in North America specifically focused on the treatment of depressed patients, usually “neurotic depressives” treated on an ambulatory basis. The widely studied treatments have been cognitive behavioral therapy and interpersonal therapy (IPT). The theoretical background and empirical basis of IPT is reviewed along with the available evidence for efficacy based on studies of acute treatment and maintenance treatment. The recently completed NIMH multi-center study provides evidence for the overall efficacy of treatment of outpatient depressives, whether by drugs or by brief psychotherapy. Future developments will likely increase the focus of psychotherapy for depression alone and in combination with medication.

Behavioral treatment of children after severe head injury: a pilot study

Abstract: Little has been written on the treatment of cognitive and behavioral disorders in children following serious head injuries with coma. We have used the behavioral modification method known as Token Economy in 20 head-injured patients having a mean age of 11 years. The treatment, which involved the children's families, proved at one-year follow-up to be highly successful in normalizing maladaptive behavior.

A treatment strategy for psychogenic vomiting

Abstract: Although the literature supports the existence of psychogenic vomiting as a distinct psychiatric disorder, the DSM III-R does not include it as a diagnostic category. Of the numerous articles in the literature which describe this disorder, few discuss treatment. The purposes of this paper are to review the existing literature, to describe the family dynamics which are thought to precipitate the evolution of psychogenic vomiting in the identified patient, and to describe a treatment protocol which has been successfully employed in an outpatient setting. The illness is characterized as an eating disorder in terms of etiology, symptomatology, and treatment. A treatment strategy is described which includes insight-oriented psychotherapy with cognitive/behavioral interventions and family therapy. Two case studies are included which illustrate that a combined therapy approach is efficacious in treating psychogenic vomiting.

Behavioral Treatment in Migraine with Cognitive-Behavioral Therapy and BVP-Biofeedback: A Cross-Over Study with Two Years Follow Up

Abstract: In recent years several behaviour therapy procedures have been developed to treat migraine. Behavioral techniques like stress-inoculation-training, cognitive-behavioral treatment as well as biofeedback procedures (i.g. Blood-Volume-Pulse (BVP)Biofeedbacktraining) turned out to be very efficient in the treatment of migraine (Turner & Chapman 1982; Andrasik, 1987). But the majority of studies only report percentage improvement of short-term effectiveness, long-term follow ups were not published (Feuerstein & Gainer, 1982; Laessle & Wittchen, 1986). Allthough individual behavioral techniques implemented in the management of migraine, combined approaches seem to be more effective. The influence of specific sequences of behavioral interventions has not been investigated. The present paper is confined to a cross-over study investigating the longterm effectiveness of the sequential combination of two behavioral treatments (cognitive-behavioral therapy, BVP-biofeedback) in migraine. 38 migraine patients suffering from migraine with and without aura symptoms were randomly assigned to two treatment groups. Group I received after a 2 months baseline period the treatment sequence BVP-biofeedbacktraining (10 sessions; 3 months) and then after a two months intermission cognitive-behavioral treatment (10 sessions, 3 months). Group I1 obtained the treatment in reverse order. The cognitive-behavioral therapy was a program which contained elements of stress-inoculation training, cognitive approaches and social skill training. BVP-biofeedback was directed to learn the selfregulation of the blood volume pulse activity of the superficial temporal artery. The patients were trained to reduce the BVP-activity of the extracranial artery in order to prevent an extreme vasodilatation at the beginning attack. For this purpose the patients obtained a visual and acoustic feedback signal which represented the activity of the BVP. All patients received headache diaries for recording migraine frequency, headache duration and intensity, daily mood, and consumption of acute medications. The diaries were analyzed by convential statistics (ANOVA) and time series analysis (ARIMA). Before and during the treatment as well as within two follow up periods (one year and two year follow up) psychological and psychophysiological examinations were introduced.