Showing papers on "Cognitive behavioral therapy published in 1994"

Treating anxiety disorders in children: Results of a randomized clinical trial.

Abstract: In this study a psychosocial treatment for 47 Ss (aged 9-13 years) with anxiety disorders was investigated. A 16-session cognitive-behavioral treatment was compared with a wait-list condition. Outcome was evaluated using child self-report, parent report, teacher report, cognitive assessment, and behavioral observations. Pretreatment-posttreatment changes and maintenance of gains at 1-year follow-up were examined. Results revealed that many treated Ss were found to be without a diagnosis at posttest and at follow-up and to be within normal limits on many measures. The child's perception of the therapeutic relationship and the therapist's perception of parental involvement were measured but were not related to outcome. Discussion focuses on characteristics of effective child therapy and the need for further research on treatment components and alternative treatment methods.

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.

Abstract: Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

Abstract: A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.

Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients

Abstract: Objective: This study reports the efficacy ofa cognitive behavioral outpatient treatment on interpersonal outcome variables for patients diagnosed with borderline personality disorder. Method: In a 1-year clinical trial, 26 female patients with borderline personality disorder were randomly assigned to either dialectical behavior therapy or a treatment-as-usual comparison condition. All subjects met criteria of DSM-III-R and Diagnostic Interview for Borderline Patients for borderline personality disorder and were chronically suicidal. Results: In both the intent-to-treat and treatment completion groups, dialectical behavior therapy subjects had significantly better scores on measures of anger, interviewer-rated global social adjustment, and the Global Assessment Scale and tended to rate themselves better on overall socialadjustment than treatment-as-usual subjects. Conclusions: These results suggest that dialectical behavior therapy is a promising psychosocial intervention for improving interpersonal functioning among severely dysfunctional patients with borderline personality disorder. (Am J Psychiatry 1994; 15 1:1771-1776)

Correlates of Improvement in Multidisciplinary Treatment of Chronic Pain

Abstract: Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 months after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement.

Cognitive behavioral treatment of residual symptoms in primary major depressive disorder.

Abstract: Objective Cognitive behavioral treatment has been used extensively in the acute phase of depression. The purpose of this study was to determine the applicability and effectiveness of this treatment modality in addressing the residual symptoms of primary major depressive illness. Method The subjects were 40 patients with major depressive disorder who were successfully treated with antidepressant drugs. They were then randomly assigned to either cognitive behavioral treatment or clinical management of residual symptoms. In both subgroups, antidepressant drugs were tapered and discontinued. Results The group that received cognitive behavioral treatment had a significantly lower level of residual symptoms after drug discontinuation in comparison with the clinical management group. Cognitive behavioral treatment also resulted in a lower rate of relapse (15%) at a 2-year follow-up than did clinical management (35%), although this difference did not reach statistical significance. Most of the residual symptoms were found to have occurred also in the prodromal phase of illness. Conclusions This preliminary study points to the potential clinical advantages of cognitive behavioral treatment targeted to the residual symptoms of depression.

Diagnosis, Assessment, and Treatment of Internalizing Problems in Children: The Role of Longitudinal Data.

Abstract: This review examines the role of longitudinal data in the diagnosis, assessment, and treatment of internalizing disorders in children and adolescents On the basis of the limited longitudinal data available, it is suggested that internalizing disorders in children and adolescents are highly prevalent, frequently comorbid with other childhood disorders, and, arguably so, persistent over time However, it is also noted that a considerable amount of instability characterizes these disorders and that the developmental course is not fully understood at this time In addition, these disorders are responsive to treatment, at least on a short-term basis Finally, a plea is made for longitudinal studies that use a developmental perspective in examining internalizing disorders in children and adolescents

A Controlled Study of a Stress-Reduction, Cognitive-Behavioral Treatment Program in Fibromyalgia

Abstract: Objective: To determine the results of a stress-reduction, cognitive behavioral treatment [SR-CBT] program in fibromyalgia. Methods: Seventy-nine patients with fibromyalgia completed a 10 week meditation based SR-CBT program that met once weekly for 2 hours per session. Controls consisted of 42 fibromyalgia patients, 18 of whom had been placed on a waiting list for the treatment program and 24 randomly selected patients who had not expressed an interest in enrolling in the program. Medications and other treatments were not altered during the 10 week study. Fibromyalgia symptoms were evaluated at the beginning and at the end of the study in patients and controls by self-administered visual analog scales [VAS] for global well-being, pain, sleep, fatigue, and tiredness upon awakening. Functional status was evaluated by the Fibromyalgia Impact Questionnaire [FIQ], and psychological status by the SCL-90-R. Participants and controls were comparable at study entry. Results: Fibromyalgia symptoms improved in 67% ...

Cognitive behavioural therapy for drug-resistant psychosis

Abstract: A small controlled trial of cognitive behaviour therapy for drug-resistant psychosis is reported. The study was designed as a pilot study for a future larger and longer randomized controlled trial. The therapy was offered to patients with a diagnosis of schizophrenia or schizo-affective psychosis who presented unremitting positive symptoms. An average of 16 sessions were delivered over a six-month period. The results of this pilot study are promising. Rates of engagement in therapy were high. The treatment group also improved significantly on a number of key symptom measures when compared with the controls. These were reductions in delusional conviction, general symptomatology and depression scores. Future studies should offer therapy over a longer period, targeting social as well as symptom change, and considering factors which will enhance maintenance of improvement.

Cognitive-behavioral therapy for depression in low-income and minority medical outpatients: description of a program and exploratory analyses

Abstract: This article describes the treatment of depression in low-income and ethnic minority medical outpatients with cognitive-behavioral therapy and also reports on preliminary analyses of effectiveness as well as predictors of treatment outcome and dropout. One hundred and seventy-five patients were treated and showed significant pre- to posttreatment reductions in Beck Depression Inventory scores but not to the same extent as results reported in the treatment outcome literature. Patients with the poorest outcome were those with initially high symptoms of depression and not living with spouses/partners. Dropout was most likely in patients who were younger, minority, and treated with group therapy. Clinic procedures designed to reduce traditional barriers to mental health service utilization encountered by ethnic minorities resulted in 14% of referrals coming to one session of evaluation, 29% starting therapy, and 12% completing treatment, for a total service utilization rate of 55%.

A comparison of bibliotherapy and group therapy in the treatment of panic disorder.

Abstract: This study investigated 2 methods of disseminating a cognitive-behavioral intervention for panic disorder (PD). Thirty-six Ss who met diagnostic criteria for PD according to the Anxiety Disorders Interview Schedule-Revised were randomly assigned to 1 of 3 conditions: bibliotherapy (BT), group therapy (GT), or a waiting-list control (WL) condition. Interventions lasted 8 weeks and were followed by a posttest, along with 3- and 6-month follow-up assessments. Results indicated that both the BT and GT treatments were more effective than the WL condition in reducing frequency of panic attacks, severity of physical panic symptoms, catastrophic cognitions, agoraphobic avoidance, and depression and that the BT and GT treatments were more effective in increasing self-efficacy. Both interventions maintained their effects throughout the follow-up periods and produced clinically significant levels of change among the majority of treated Ss.

Ways of coping in women with eating disorders.

Abstract: The aim of this study was to investigate the strategies used for coping with stress in eating disorder patients. Twenty-four anorexia nervosa (AN) patients, 66 bulimia nervosa (BN) patients, and 30 female control subjects completed a revised Ways of Coping Checklist, indicating how they dealt with a self-nominated stressor. The AN and BN patients used proportionately more avoidance than control subjects. The BN patients used proportionately more wishful thinking and sought less social support than control subjects but patients with AN did not differ significantly from either BN or control groups. Patient groups did not differ significantly from control subjects on their use of problem-focused coping or self-blame, although the use of problem-focused coping was significantly lower, and self-blame significantly higher, with psychological problems than with relationship and general problems in all groups. Coping failed to predict severity of eating pathology but, in the patient groups, Beck Depression scores were related positively to avoidant coping (avoidance in BN patients and wishful thinking in AN patients) and inversely to problem-focused coping and seeking social support (although the latter just failed to reach significance in the AN group). It is concluded that a treatment approach that teaches coping strategies, as well as removing the obstacles (cognitive, emotional, or practical) that preclude the use of more effective coping, may be a useful component of treatment.

Does cognitive behavior therapy assist slow-taper alprazolam discontinuation in panic disorder ?

Abstract: Objective The authors investigated whether cognitive behavioral treatment could facilitate discontinuation of alprazolam therapy and maintenance of drug abstinence among panic disorder patients treated with alprazolam doses sufficient to suppress spontaneous panic attacks. Method Twenty-one outpatients who met DSM-III-R criteria for panic disorder with mild to severe agoraphobia were made panic-free with alprazolam (mean dose = 2.2 mg/day) and were then randomly assigned to receive either supportive drug maintenance and slow, flexible drug taper or an identical medication treatment plus 12 weeks of concurrent, individual cognitive behavioral treatment. Taper in the combined treatment group was sequenced to conclude before cognitive behavioral treatment ended. Results Twenty subjects completed the study. There was no significant difference between groups in the rate of alprazolam discontinuation (80% and 90%, respectively, in the alprazolam-only group and the combined treatment group). However, during the 6-month follow-up period, half of the subjects who discontinued alprazolam without cognitive behavior therapy, but none of those who were given cognitive behavior therapy, relapsed and resumed alprazolam treatment. Conclusions Cognitive behavioral treatment administered in parallel with alprazolam maintenance and taper was effective in preventing relapse after drug discontinuation. The results warrant further research on the thoughtful integration of these two therapeutic modalities.

Dialectical behavior therapy for borderline personality disorder: theoretical and empirical foundations.

Abstract: Dialectical behavior therapy (DBT) is a cognitive-behavioral psychotherapy developed by Linehan for parasuicidal patients with a diagnosis of borderline personality disorder (BPD). DBT is based on a biosocial theory that views BPD as primarily a dysfunction of the emotion regulation system. The treatment is organized around a hierarchy of behavioral goals that vary in different modes of therapy. In two randomized trials, DBT has shown superiority in reducing parasuicide, medical risk of parasuicides, number of hospital days, dropout from treatment and anger while improving social adjustment. Most gains were maintained through a 1-year follow-up. In one process study testing DBT theory, dialectical techniques balancing acceptance and change were more effective than pure change or acceptance techniques in reducing suicidal behavior.

Psychotherapy of dysthymia.

Abstract: Objective The author reviews empirical research on the psychotherapy of dysthymia. Dysthymia, a prevalent mood disorder, has been shown frequently to respond to antidepressant medication. The need for a treatment for dysthymic subjects unable or unwilling to take, or unresponsive to, medication still remains. Methods Studies were located by computerized search and the author's knowledge of the literature. All reports of studies on psychotherapy outcome for dysthymic patients, except studies of late-life chronic major depression, were included. Results Psychotherapy research on dysthymia has been confined to small, usually uncontrolled studies with varying methods and limited follow-up. Cognitive approaches have been most frequently studied; the results have not been dramatic but do suggest that some dysthymic patients respond to brief cognitive therapies. Preliminary results of an ongoing study of interpersonal psychotherapy are promising. Conclusions Given the public health importance of dysthymia and the availability of treatments, the time is ripe for clinical trials of antidysthymic psychotherapy. The author proposes the following guidelines for such trials: time-limited, manual-based psychotherapy, interpersonal focus, serial design, continuation and maintenance treatment, combined treatments, and follow-up assessments.

Do depressed men and women respond similarly to cognitive behavior therapy

Abstract: Objective A great majority of the evidence pertaining to the effectiveness of the time-limited psychotherapies as treatments of major depression are derived from studies of either predominantly or entirely female subject groups. Depressed men and women differ in a number of important respects that may alter the course of affective disorder, and as a result, they may also differ in their responses to psychotherapy. In this study the outcomes of 40 men and 44 women treated with cognitive behavior therapy were compared. Method The patients were interviewed with the Schedule for Affective Disorders and Schizophrenia and diagnosed according to the Research Diagnostic Criteria and DSM-III-R criteria. Subsequently, they were assessed every other week (with the Hamilton Depression Rating Scale, Beck Depression Inventory, and Global Assessment Scale) during a standardized, time-limited cognitive behavior therapy protocol. The outcomes of the men and women were compared by means of a series of analyses of variance and covariance and survival analyses. Results There were several significant pretreatment differences, and the men attended significantly fewer therapy sessions than the women. Although the men and women generally had comparable responses, patients with higher pretreatment levels of depressive symptoms, particularly women, had poorer outcomes. Conclusions This study provides further evidence of gender-specific differences in depressed patients' symptoms and treatment utilization. Cognitive behavior therapy appears to be a comparably useful outpatient treatment for men and women. However, either more intensive cognitive behavior therapy or alternative methods of treatment may be warranted for patients with more severe syndromes.

First step in managing bulimia nervosa: controlled trial of therapeutic manual.

Abstract: Objective: To test the short term efficacy of a self directed treatment manual for bulimia nervosa. Design: Randomised controlled trial of the manual against cognitive behavioural therapy and a waiting list. Setting: Tertiary referral centre. Subjects: 81 consecutive referrals presenting with bulimia nervosa or atypical bulimia nervosa. Main outcome measures: Frequency of binge eating, vomiting, and other behaviours to control weight as well as abstinence from these behaviours. Results: Cognitive behavioural treatment produced a significant reduction in the frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list. Conclusions: A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.

Intimate relationships and depression: is there a causal connection?

Abstract: The causal pathways that link depression and dissatisfaction in intimate relationships were estimated in 115 patients during the first 12 weeks of treatment with cognitive-behavioral therapy for depression. Depression severity, as measured by the Beck Depression Inventory, was negatively correlated with relationship satisfaction at intake and at 12 weeks. However, structural equation modeling was not consistent with the hypothesis that depression severity has a causal effect on relationship satisfaction levels and suggested that relationship satisfaction may have only a weak reciprocal effect on depression severity. As predicted, married patients were substantially less depressed 12 weeks after the beginning of treatment, when controlling for initial depression severity. Contrary to expectations, marital status predicted improvement even when relationship satisfaction was controlled. Unexpectedly, dysthymia at intake was associated with low relationship satisfaction after 12 weeks, when initial relationship satisfaction was controlled, suggesting that chronic, low-level depression may have a stronger association with interpersonal problems than other forms of depression, such as major depressive episodes. The theoretical and clinical implications of the findings are discussed.

Generalized Anxiety Disorder

Abstract: Generalized anxiety disorder (GAD) involves excessive or unrealistic anxiety and worry over multiple life circumstances, with accompanying symptoms of autonomic hyperactivity, motor tension, and vigilance and scanning (DSM-III-R; American Psychiatric Association, 1987). From a cognitive-behavioral perspective, the disorder represents perhaps the most diffuse and complex cognitive/ affective state among the anxiety disorders (Barlow, 1988). To the person with GAD, the world and especially the future are seen as dangerous much of the time, and the individual feels that he or she does not have resources to cope. A vicious cycle of threat cue detection (Mathews, in press), a mixture of somatic activation and inhibition (Borkovec, Shadick, & Hopkins, in press), and worrisome thought activity (Borkovec & Inz, 1990) perpetuates habitual anxious responding.

Compliance with homework assignments in cognitive-behavioral psychotherapy for depression: Relation to outcome and methods of enhancement.

Abstract: Despite the importance attached to homework in cognitive-behavioral therapy for depression, quantitative studies of its impact on outcome have been limited. One aim of the present study was to replicate a previous finding suggesting that improvement can be predicted from the quality of the client's compliance early in treatment. If homework is indeed an effective ingredient in this form of treatment, it is important to know how compliance can be influenced. The second aim of the present study was to examine the effectiveness of several methods of enhancing compliance that have frequently been recommended to therapists. The data were drawn from 235 sessions received by 25 clients. Therapists' ratings of compliance following the first two sessions of treatment contributed significantly to the prediction of improvement at termination (though not at followup). However, compliance itself could not be predicted from any of the clients' ratings of therapist behavior in recommending the assignments.

Short-term psychotherapy of depressive disorders: current status and future directions

Abstract: Depressive disorders can affect all aspects of a person's functioning and are often associated with significant psychosocial impairment. Such psychosocial problems promote studies of the efficacy of short-term psychotherapy for depressive disorders. This report summarizes the literature on acute-phase, short-term psychotherapy for adult outpatients with major depressive disorder and is an updated component of a larger review commissioned by the United States Public Health Services Agency for Health Care Policy and Research (AHCPR review on "Short-term Psychotherapy for Depression," Jarrett and Maguire [1991]; Jarrett and Down [in press] during the preparation of the Clinical Practice Guidelines in primary care (Depression Guideline Panel 1993). The short-term psychotherapies reviewed here and studied most often include behavior therapy, cognitive therapy, interpersonal psychotherapy, and brief dynamic psychotherapy, which all aim to reduce depressive symptoms. We comment on the state of the literature and raise some of the questions which await data.

A Comparative Evaluation of Cognitive-Behavioral Therapy (CBT) Versus Exercise Therapy (ET) for the Treatment of Body Image Disturbance Preliminary Findings

Abstract: Cognitive-behavioral therapy (CBT) was compared to a combination of aerobic/anaerobic exercise therapy (ET) for the treatment of elevated levels of body image disturbance in college females. CBT consisted of a modification of the 1987 Butters and Cash procedure that was tailored for group intervention; ET consisted of weightlifting and aerobic dancing. Using a counterbalancing procedure, the same therapists conducted both 6-week interventions, which were compared to a nontreated control group. Results revealed equivalent reductions for both treatment groups when compared to controls on measures of body image disturbance reflective of trait and state body weight anxiety, cognitive-behavioral aspects of appearance, and overall body dissatisfaction. Unfortunately, few subjects were available for follow-up analyses, preventing an evaluation of the stability of changes. The findings are discussed with regard to the potential role of fitness training as an adjunct to cognitive-behavioral interventions for body image disturbance.

Preparing Patients for Invasive Medical and Surgical Procedures 1: Adding Behavioral and Cognitive Interventions

Abstract: The authors of three related articles look at various aspects of preparing adult and child patients psychologically for invasive surgical procedures. The first article is a review of the literature in the field, primarily from the last 30 years. Researchers have examined anxiety and coping mechanisms, patient-practitioner relationships, medical phobias, and the effectiveness of different types of psychological intervention. In the second article, the authors offer practical suggestions for implementing preparatory psychological interventions, describing effective communication techniques such as active listening, role plays, imaging, modeling, and progressive relaxation. In the final article in the series, the author considers policy, practice, and educational implications of the use of behavioral and cognitive interventions for patients, medical practitioners, and healthcare planners.

Polysomnographic studies of unmedicated depressed men before and after cognitive behavioral therapy.

Abstract: OBJECTIVE Differentiation of stable, trait-like characteristics from more episodic or state-dependent disturbances will be helpful in gaining a better understanding of the pathophysiology of depression. However, research in this area has been complicated by artifactual and clinical problems associated with pharmacologic treatment. In this investigation the authors used EEG sleep studies to assess medication-free depressed male patients before and after cognitive behavioral therapy. METHOD Forty-five male patients with the diagnosis of major depression according to the DSM-III-R criteria and the Research Diagnostic Criteria underwent EEG sleep studies before and after 16 weeks of cognitive behavioral therapy, during which they were free of medication. In addition to the documentation of changes within these patients, the findings were compared with those for 47 healthy subjects, including 15 who were restudied 12-24 months after their baseline assessments. RESULTS The EEG sleep profiles of the depressed patients showed a significant reduction in REM sleep density after treatment, suggesting "normalization" of an abnormal state-dependent process. By contrast, slow wave sleep and tonic REM measures, including reduced REM latency, were unchanged after treatment. CONCLUSIONS These findings suggest that early in remission there is disaggregation of irreversible, trait-like correlates of depression (e.g., diminished slow wave sleep and reduced REM latency) from more reversible disturbances (e.g., increased REM density).