Showing papers on "Cognitive behavioral therapy published in 2002"

Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms.

Abstract: BACKGROUND: Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period However, only recently has it been possible to engage people in treatment during this phase METHODS: A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 13 mg/d) and cognitive behavior therapy Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention Assessments were performed at baseline, 6 months, and 12 months RESULTS: By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=03) After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=24) However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use CONCLUSIONS: More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

Abstract: Background. While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. Method. Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two. Results. Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of 'important improvement' in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates. Conclusions. Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.

A Randomized Comparison of Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Treatment of Overweight Individuals With Binge-Eating Disorder

Abstract: Background: Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of bingeeating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BEDrelated symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED. Methods: One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment. Results: Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through followup. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients’ relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up. Conclusions: Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED. Arch Gen Psychiatry. 2002;59:713-721

A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems

Abstract: Clients with generalized anxiety disorder (GAD) received either (a) applied relaxation and self-control desensitization, (b) cognitive therapy, or (c) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 years. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness.

Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process.

Abstract: Study Design. A literature review was conducted. Objective. To examine the outcome of behavioral (BT) and cognitive-behavioral treatment (CBT), collectively referred to as BT-CBT, for chronic pain, to identify the predictors of treatment outcome, and to investigate the change processes associated with these treatments. of Background Data. Numerous controlled clinical trials of BT-CBT for chronic pain, alone or more commonly in multidisciplinary treatment contexts, suggest that these treatments are effective. However, further study is needed to examine which outcome variables change, when, for whom, and how. Methods. Published literature was gathered from Medline, PsychLit, and searches of relevant journals. Results. Overall, BT-CBT for chronic pain reduces patients' pain, distress, and pain behavior, and improves their daily functioning. Differences across studies in sample characteristics, treatment features, and assessment methods seem to produce varied treatment resuits. Also, some patients benefit more than others. Highly distressed patients who see their pain as an uncontrollable and highly negative life event derive less benefit than other patients. Decreased negative emotional responses to pain, decreased perceptions of disability, and increased orientation toward self-management during the course of treatment predict favorable treatment outcome. Conclusions. Current BT-CBT helps many patients with chronic pain. Continuing clinical research should improve the matching of treatments with patient characteristics and refine the focus of treatments on behavior changes most associated with positive outcome. Further study of fear, attention, readiness to adopt self-management strategies, acceptance of pain, and new combinations of interdisciplinary treatments may lead to improved interventions.

The Evaluation of a Mind/Body Intervention To Reduce Psychological Distress and Perceived Stress in College Students.

Abstract: The authors examined the effect of a 6-week mind/body intervention on college students' psychological distress, anxiety, and perception of stress. One hundred twenty-eight students were randomly assigned to an experimental group (n = 63) or a waitlist control group (n = 65). The experimental group received 6 90-minute group-training sessions in the relaxation response and cognitive behavioral skills. The Symptom Checklist-90-Revised, Spielberger State-Trait Anxiety Inventory, and the Perceived Stress Scale were used to assess the students' psychological state before and after the intervention. Ninety students (70% of the initial sample) completed the postassessment measure. Significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group. This brief mind/body training may be useful as a preventive intervention for college students, according to the authors, who called for further research to determine whether the observed treatment effect can be sustained over a longer period of time.

Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change.

Abstract: Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 weeks No evidence was found that the therapeutic alliance mediated treatment outcome CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6

Group and individual cognitive-behavioral therapy for childhood anxiety disorders: a randomized trial.

Abstract: Objective: To compare the efficacy of group and individual cognitive-behavioral therapy (CBT) in children with Axis I anxiety disorders. It was hypothesized that certain subgroups would respond preferentially to one modality. Method: Seventy-eight children aged 8–12 years with diagnosed anxiety disorders were randomly assigned to a 12-week, manual-based program of group or individual CBT, both with parental involvement. Outcomes included child anxiety (child and parent report) and global functioning as estimated by clinicians. Repeated-measures analyses of variance (ANOVAs) were done. The sample was then dichotomized by self-reported social anxiety (high/low) and parent-reported hyperactivity (high/low) using median splits, and diagnostically by generalized anxiety disorder versus phobic disorders. ANOVAs were repeated. Results: Children and parents reported significantly decreased anxiety and clinicians reported significantly improved global functioning regardless of treatment modality. Children reporting high social anxiety reported greater gains in individual treatment than in group treatment ( p Conclusions: Children with anxiety disorders appear to improve with CBT, whether administered in a group or individual format. A subgroup of children reporting high social anxiety may respond preferentially to individual treatment. Replication of these findings is indicated.

Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial.

Abstract: Recent developments in chronic pain research suggest that effectiveness of cognitive-behavioral therapy (CBT) may be optimized when applying early, customized treatments to patients at risk. For this purpose, a randomized, controlled trial with tailor-made treatment modules was conducted among patients with relatively early rheumatoid arthritis (RA disease duration of <8 years), who had been screened for psychosocial risk profiles. All participants received standard medical care from a rheumatologist and rheumatology nurse consultant. Patients in the CBT condition additionally received an individual CBT treatment with two out of four possible treatment modules. Choice of treatment modules was determined on the basis of patient priorities, which resulted in most frequent application of the fatigue module, followed by the negative mood, social relationships and pain and functional disability modules. Analyses of completers and of intention-to-treat revealed beneficial effects of CBT on physical, psychological and social functioning. Specifically, fatigue and depression were significantly reduced at post-treatment and at the 6-month follow-up in the CBT condition in comparison to the control condition, while perceived support increased at follow-up assessment. In addition, helplessness decreased at post-treatment and follow-up assessment, active coping with stress increased at post-treatment, and compliance with medication increased at follow-up assessment in the CBT condition in comparison to the control condition. Results indicate the effectiveness of tailor-made CBT for patients at risk in relatively early RA, and supply preliminary support for the idea that customizing treatments to patient characteristics may be a way to optimize CBT effectiveness in RA patients.

Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse

Abstract: The objective of this study was to compare the efficacy of cognitive behavioral therapy (CBT) versus psychoeducational therapy (PET) for adolescent substance abusers. Eighty-eight consecutively referred predominantly dually diagnosed adolescents were randomized to one of two eight-week, outpatient group psychotherapy conditions. Drug urinalysis and the Teen-Addiction Severity Index (T-ASI) were used as outcome measurements. Treatment completion rate was 86%, follow-up location rate was 95%, and rates of posttreatment at 3- and 9-month follow-up evaluation were 80% and 65%, respectively. Comorbid conduct disorder was significantly associated with treatment noncompletion and reduced follow-up rate. CBT subjects exhibited significantly lower rates of positive urinalysis than did PET subjects for older youth and male subjects at 3-month follow-up evaluation. Most T-ASI subscales indicated sound improvement from baseline to 3- and 9-month follow-up evaluation across conditions. Reduction in substance use was achieved regardless of treatment conditions. Replication of these findings, continued exploration of potential matching effects of conduct disorder, age, and gender to singular or integrative treatment modalities, and exploration of aftercare programs for the maintenance or enhancement of treatment gains are warranted.

Cognitive coping and depressive symptoms in the elderly: a longitudinal study.

Abstract: The objective of the present longitudinal study was to examine the relationship between cognitive coping strategies and depressive symptoms at old age. At the two and a half year follow-up study, a community sample of 99 people aged 67 years and older filled out a self-report questionnaire comprising the Geriatric Depression Scale, the Cognitive Emotion Regulation Questionnaire and a negative life events checklist. Cognitive coping strategies seemed to play an important role in relation to depressive symptoms in late life. Elderly persons with more depressive symptoms reported to use acceptance, rumination and catastrophizing to a significantly higher extent and positive reappraisal to a significantly lower extent than those with lower depression scores. After controlling for negative life events and prior depressive symptoms, acceptance and positive reappraisal retained their significant relationship with current depressive symptoms. It is suggested that intervention programs should pay attention to these aspects by challenging the 'maladaptive' strategies, and by supplying the more 'adaptive' strategies. This could be linked to the well-established cognitive therapies.

Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention

Abstract: OBJECTIVE: Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral therapy (CBT) protocol for fibromyalgia (FM). METHODS: One hundred forty-five patients with FM were randomly assigned to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of CBT aimed at improving physical functioning. Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain. Outcomes were treated dichotomously using a preestablished criterion for clinically significant success based upon the reliability of change index from baseline to one year posttreatment. RESULTS: Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups. CONCLUSION: Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM. These data suggest that the inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.

Rationale and principles for early intervention with young children at risk for anxiety disorders.

Abstract: Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.

Life in the future versus life in the present

Abstract: Roemer and Orsillo have provided an integrative perspective for developing more effective therapies for generalized anxiety disorder, based on existing knowledge about the disorder, cognitive behavioral approaches to its treatment, and conceptualizations and treatment methods from the acceptance/mindfulness tradition. The present commentary expands upon the notion of the adaptive value of focused attention on present-moment experience and cognitive perspectives that can facilitate that process.

Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors.

Abstract: Background There is interest in the possibility of indicated prevention of psychosis. There is a strong case for using psychological approaches to prevent transition to psychosis in high-risk patients. Aims To identify individuals at high risk of transition to psychosis, and psychological characteristics relevant to the development of psychosis in this group. Method The design of a randomised controlled trial of cognitive therapy for the prevention of psychosis in people at high risk (meeting operational criteria of brief or attenuated psychotic symptoms, or first-degree family history with functional decline) is outlined. The first patients recruited are compared with non-patient samples on cognitive and personality factors; an interim analysis of transition rate is reported. Results Cases ( n =31) were recruited mainly from primary care. Of the 23 high-risk patients monitored for 6-12 months, 5 (22%) made the transition to psychosis. The high-risk group scored significantly higher than non-patients on measures of schizotypy, metacognitive beliefs and dysfunctional self-schemas (sociotropy). Conclusions The findings validate the methods of identifying individuals at high risk of experiencing a psychotic episode. Compared with non-patient controls, the cases showed dysfunctional metacognitive beliefs and self-schemas.

Towards a cognitive-behavioral model of PTSD in children and adolescents.

Abstract: Posttraumatic stress disorder in children and adolescents has been studied only for the past 15-20 years and is the subject of a burgeoning corpus of research Much research has focused on examining whether children and adolescents have the same responses to trauma as those experienced by adults Many of the research tools used to investigate children's responses are taken from measures designed for use with adults, and these measures have proven to be useful However, it has not been established that children's responses to traumatic events are related to the same underlying processes as are adults' responses The possible application of 2 recent cognitive models of PTSD in adults to understanding PTSD in children and adolescents is discussed in this paper, within the context of what is already known about children's reaction to trauma and existing theoretical accounts of childhood PTSD Particular attention is paid toward the nature of children's memories of traumatic events and how these memories relate to the reexperiencing symptoms of PTSD, and cognitive processes that may play a role in the maintenance of PTSD It is proposed that the adoption of a more specific cognitive-behavioral framework in the study of this disorder may be beneficial and lead to better treatment outcomes

Psychosocial treatments for attention-deficit/hyperactivity disorder in children

Abstract: This article provides a brief overview of the major psychosocial treatments that have some efficacy for the management of attention-deficit/hyperactivity disorder (ADHD) in children. Parent training in effective child behavior management methods, classroom behavior modification methods and academic interventions, and special educational placement appear to have the greatest promise of efficacy. Augmenting these, additional family therapy in problem-solving and communication skills and the coordination of multiple school resources across the day may be necessary. To be effective in improving prognosis, treatments must be maintained over extended periods of time.