Showing papers on "Cognitive behavioral therapy published in 2008"
TL;DR: The review of randomized placebo-controlled trials indicates that CBT is efficacious for adult anxiety disorders, and there is, however, considerable room for improvement.
Abstract: Objective
Cognitive-behavioral therapy (CBT) is frequently used for various adult anxiety disorders, but there has been no systematic review of randomized placebo-controlled trials. The present study meta-analytically reviewed the efficacy of CBT versus placebo for adult anxiety disorders.
1,265 citations
TL;DR: Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate.
Abstract: Background Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. Methods In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. Results The percentages of children who were rated as very much or much improved on the Clinician Global Impression–Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. Conclusions Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.)
1,185 citations
Journal Article•
TL;DR: The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety, and intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed.
Abstract: Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.
728 citations
TL;DR: Patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment, but there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition.
Abstract: The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components—cognitive therapy only (CPT-C) and written accounts (WA)—for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition.
678 citations
TL;DR: Although there are fundamental differences in the philosophical foundation, ACT techniques are fully compatible with CBT and may lead to improved interventions for some disorders and areas of future treatment research are discussed.
609 citations
TL;DR: Mindfulness-based cognitive therapy may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD.
565 citations
TL;DR: Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome.
556 citations
TL;DR: Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and IC BT outperformedFCBT and FESA on teacher reports of child anxiety.
Abstract: This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.
532 citations
TL;DR: These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
Abstract: A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.
517 citations
TL;DR: Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes.
Abstract: Context Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. Objective To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings. Data sources MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles. Study selection We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes. Data extraction Methodological characteristics and outcomes were extracted by 2 investigators. Results We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively). Conclusions Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.
485 citations
TL;DR: Both acceptance of pain and values-based action improved, and increases in these processes were associated with improvements in the primary outcome domains.
Abstract: Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of chronic pain and also examined 2 processes from this model, acceptance and values-based action. Participants included 171 completers of an interdisciplinary treatment program, 66.7% of whom completed a 3-month follow-up assessment as well. Results indicated significant improvements for pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance. Effect size statistics were uniformly medium or larger. According to reliable change analyses, 75.4% of patients demonstrated improvement in at least one key domain. Both acceptance of pain and values-based action improved, and increases in these processes were associated with improvements in the primary outcome domains.
TL;DR: In this paper, the authors conducted a meta-analysis of 19 randomized controlled studies in which the incidence of depressive disorders (based on diagnostic criteria) in an experimental group could be compared with that of a control group.
Abstract: Objective: A growing number of studies have tested the efficacy of preventive interventions in reducing the incidence of depressive disorders. Until now, no meta-analysis has integrated the results of these studies. Method: The authors conducted a meta-analysis. After a comprehensive literature search, 19 studies were identified that met inclusion criteria. The studies had to be randomized controlled studies in which the incidence of depressive disorders (based on diagnostic criteria) in an experimental group could be compared with that of a control group. Results: The mean incidence rate ratio was 0.78, indicating a reduction of the incidence of depressive disorders by 22% in experimental compared with control groups. Heterogeneity was low to moderate (I 2 =33%). The number needed to treat to prevent one case of depressive disorder was 22. Moderator analyses revealed no systematic differences between target populations or types of prevention (universal, selective, or indicated). The data included indicat...
TL;DR: RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.
Abstract: This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress, pain, and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis (RA). The 144 RA participants were clustered into groups of 6-10 participants and randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E), which served as an attention placebo control. The authors took a multimethod approach, employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 (IL-6), a proinflammatory cytokine. Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. The relative value of the treatments varied as a function of depression history. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.
TL;DR: Behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention, and future research needs to address issues of parsimony of such interventions.
Abstract: Background Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect.
Method Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively.
Results Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD) −0.70, 95% CI −1.00 to −0.39, k=12, n=459], brief psychotherapy (SMD −0.56, 95% CI −1.0 to −0.12, k=3, n=166), supportive therapy (SMD −0.75, 95% CI −1.37 to −0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95% CI −0.14 to 0.30, k=12, n=476).
Conclusions The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions.
TL;DR: It is concluded that exposure therapy is a form of cognitive intervention that specifically changes the expectancy of harm.
TL;DR: Although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans, and behaviors, evidence of a publication bias tempers such optimism.
Abstract: Suicide behavior is a serious clinical problem worldwide, and understanding ways of reducing it is a priority. A systematic review and meta-analysis were carried out to investigate whether Cognitive-behavioral therapies (CBTs) would reduce suicide behavior. From 123 potential articles, 28 studies met the entry criteria. Overall, there was a highly significant effect for CBT in reducing suicide behavior. Subgroup analysis indicates a significant treatment effect for adult samples (but not adolescent), for individual treatments (but not group), and for CBT when compared to minimal treatment or treatment as usual (but not when compared to another active treatment). There was evidence for treatment effects, albeit reduced, over the medium term. Although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans, and behaviors, evidence of a publication bias tempers such optimism.
TL;DR: In this paper, a randomized clinical trial was conducted to evaluate the effect of ser-traline (60 mg/d) and placebo (n=67) on post-stroke depression.
Abstract: Prevention is a goal to which every field of medicine aspires because it reduces morbidity, may alleviate suffering, and reduces the cost of health care. Although the Commission on Chronic Illness proposed the classification of primary, secondary, and tertiary prevention1 in 1957, the Institute of Medicine Committee on Prevention of Mental Disorders recommended a new terminology2 in 1995. According to the new terminology, preventive intervention is defined as an intervention before the patient receives a diagnosis. Alternatively, treatment is an intervention for patients already with a diagnosis, and maintenance is the care of patients with chronic illnesses including relapse prevention. Furthermore, preventive interventions are categorized as (1) indicated, addressing high-risk individuals with premorbid signs or symptoms; (2) selective, for select individuals with demonstrated increased risk of developing illness; and (3) universal, for a whole population in a group with all levels of risk.
Although the ultimate goal of preventive intervention in mental disorders is universal, the major problem is identifying a population at sufficiently high risk to justify the expense and risk of pharmacological or psychological intervention.
The annual incidence of stroke (ischemic and hemorrhagic cerebral infarction), which exceeds 700 000 in the United States,3 represents a major public health problem. Patients who survive acute stroke may constitute a particularly good population for preventive intervention for depression because of their high risk of developing depression. Among combined studies of 2178 patients hospitalized for acute stroke or rehabilitation, 22% were diagnosed with major depression and 17% were diagnosed with minor depression.4–9 Furthermore, among patients without depression during the acute stroke period, 14% developed major depression and 23% developed minor depression during the first 2 years following stroke.9 Thus, approximately 37% of stroke survivors developed depression after the acute stroke period and represent a sizeable population in which to assess a selective preventive intervention strategy.
Several investigators have previously attempted to prevent the development of poststroke depression without success.10–12 Palomaki et al10 conducted a randomized placebo-controlled study of 100 patients younger than 71 years who were admitted to the hospital for acute ischemic stroke. Patients received either mianserin (60 mg/d) or placebo for 1 year and were examined at 2, 6, 12, and 18 months follow-up. At no time during the 18-month follow-up did the prevalence rate for major depression according to the Diagnostic and Statistical Manual of Mental Disorders, (Third Edition, Revised) differ between treatment groups. Rasmussen et al,12 using double-blind methods and random assignment, treated 137 patients without depression over 12 months following acute stroke with ser-traline (mean dose 63 mg/d; n=70) or placebo (n=67). The depression occurrence rate over the 12 months, based on a Hamilton-17 Depression Rating Scale13 score of greater than 18, was 8.2% for sertraline (90% confidence interval [CI], 2.4%–13.9%; 3 of 35 completers) vs 22.8% for placebo (90% CI, 13.7%–32.0%; 7 of 32 completers). Based on the number of completers, the power of this study to find significant intergroup differences was 0.44, which indicates that the study was underpowered.
The most recent report was by Almeida et al11 in which 111 patients within 2 weeks following stroke were randomized to treatment with sertraline (50 mg/d; n=55) or placebo (n=56) in a 24-week double-blind clinical trial. Results demonstrated no significant intergroup difference in the prevalence of scores of 8 or greater on the Hospital Depression and Anxiety Scale during the 24 weeks of treatment. Among sertraline-treated patients, 8 out of 48 (16.7%) developed depression compared with 11 out of 51 placebo-treated patients (21.6%) (rate ratio, 0.8; 95% CI, 0.3–2.1; P=.59). A recent meta-analysis, however, reported significant effect of antidepressants across 10 studies with duration of treatment ranging from 4 to 52 weeks. Some studies, however, were designed for prophylaxis while other studies were acute treatment studies in which nondepressed patients were assessed for measurement of recovery.14
Although 3 double-blind trials failed to show a significant effect of active treatment in preventing poststroke depression, we undertook the current preventive treatment study to assess the efficacy of escitalopram or psychological problem-solving therapy. Our rationale included larger numbers of patients to increase statistical power, multisite enrollment to achieve a more varied sample, and comparison of both psychological and pharmacological interventions to prevent poststroke depression. Problem-solving therapy was selected because it had been developed for use in elderly patients with depression15 and cognitive behavioral therapy had been shown to be unsuccessful in treating poststroke depression.16 We hypothesized that both escitalopram and problem-solving therapy would constitute effective preventive interventions.
TL;DR: It is suggested that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations.
Abstract: A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations.
TL;DR: STEPPS, an adjunctive group treatment, can deliver clinically meaningful improvements in borderline personality disorder-related symptoms and behaviors, enhance global functioning, and relieve depression.
Abstract: Objective: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial. Method: Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in the analysis. Results: Data pertaining to 124 subjects (STEPPS plus treatment as usual [N=65]; treatment as usual alone...
TL;DR: Data provide further support for elevated amygdala activity in depression and suggest that anterior cingulate activity may be a predictor of treatment response to both pharmacotherapy and CBT.
TL;DR: Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-Syndrome bipolar personality disorder.
Abstract: Background
No accepted intervention exists for borderline personality disorder presenting in adolescence.
Aims
To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care.
Method
In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months.
Results
Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment.
Conclusions
Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.
TL;DR: In this article, the authors examined proposed differences between CBT and ACT for anxiety disorders, including aspects of treatment components, processes, and outcomes, and concluded that the treatments are more similar than distinct.
Abstract: Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) researchers and scholars carry assumptions about the characteristics of these therapies, and the extent to which they differ from one another. This article examines proposed differences between CBT and ACT for anxiety disorders, including aspects of treatment components, processes, and outcomes. The general conclusion is that the treatments are more similar than distinct. Potential treatment mediators and issues related to the identification of mediators are considered in depth, and directions for future research are explored.
TL;DR: Excessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD and this factor may limit optimal response to therapy.
Abstract: BackgroundAlthough cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), approximately half of patients do not respond to CBT. No studies have investigated the capacity for neural responses during fear processing to predict treatment response in PTSD.MethodFunctional magnetic resonance imaging (fMRI) responses of the brain were examined in individuals with PTSD (n=14). fMRI was examined in response to fearful and neutral facial expressions presented rapidly in a backwards masking paradigm adapted for a 1.5 T scanner. Patients then received eight sessions of CBT that comprised education, imaginal and in vivo exposure, and cognitive therapy. Treatment response was assessed 6 months after therapy completion.ResultsSeven patients were treatment responders (defined as a reduction of 50% of pretreatment scores) and seven were non-responders. Poor improvement after treatment was associated with greater bilateral amygdala and ventral anterior cingulate activation in response to masked fearful faces.ConclusionsExcessive fear responses in response to fear-eliciting stimuli may be a key factor in limiting responses to CBT for PTSD. This excessive amygdala response to fear may reflect difficulty in managing anxiety reactions elicited during CBT, and this factor may limit optimal response to therapy.
TL;DR: Randomized trials of adjunctive psychotherapy for bipolar disorder found individual psychoeducational and systematic care programs were more effective for manic than depressive symptoms, whereas family therapy and cognitive-behavioral therapy were moreeffective for depressive than manic symptoms.
Abstract: Objective: Psychotherapy has long been recommended as adjunctive to pharmacotherapy for bipolar disorder, but it is unclear which interventions are effective for which patients, over what intervals, and for what domains of outcome. This article reviews randomized trials of adjunctive psychotherapy for bipolar disorder. Method: Eighteen trials of individual and group psychoeducation, systematic care, family therapy, interpersonal therapy, and cognitive-behavioral therapy are described. Relevant outcome variables include time to recovery, recurrence, duration of episodes, symptom severity, and psychosocial functioning. Results: The effects of the treatment modalities varied according to the clinical condition of patients at the time of random assignment and the polarity of symptoms at follow-up. Family therapy, interpersonal therapy, and systematic care appeared to be most effective in preventing recurrences when initiated after an acute episode, whereas cognitive-behavioral therapy and group psychoeducatio...
TL;DR: CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms and showed a greater ES than pharmacotherapy, in the first meta-analysis of treatment RCTs for pediatric OCD.
Abstract: Objective: To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD). Method: Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N ¼ 1016) and five cognitive-behavioral therapy (CBT) to control comparisons (N ¼ 161). Results: Random effects modeling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES ¼ .48, 95% CI ¼ .36 to .61, p < .00001) and CBT (ES ¼ 1.45, 95% CI ¼ .68 to 2.22, p ¼ .002). The results were robust to publication bias. Conclusions: This is the first meta-analysis of treatment RCTs for pediatric OCD. CBT and pharmacotherapy were the only treatments effective beyond control in alleviating OCD symptoms. CBT showed a greater ES than pharmacotherapy. Previous meta-analyses that included uncontrolled trials exaggerated the efficacy of both treatments. Keywords: Child/adolescent obsessive-compulsive disorder, pediatric, meta-analysis, cognitive-behavioral therapy, drug therapy, pharmacology, psychotherapy.
TL;DR: Depression is associated with nonadherence to diabetes self-care--including following dietary restrictions, medication compliance, and blood glucose monitoring--resulting in worse overall clinical outcomes, and both conditions should be optimally treated to maximize patient outcomes.
TL;DR: Overall, BCT shows better outcomes than more typical individual-based treatment for married or cohabiting individuals who seek help for alcohol dependence or drug dependence problems and the benefit for BCT with low severity problem drinkers has received little attention.
TL;DR: For example, this paper found that children with generalized anxiety disorder, social phobia, and separation anxiety disorder exhibited a greater attention bias toward threat faces compared to healthy participants. But, there was no group difference in attention bias towards happy faces.
Abstract: Objective To examine attention bias toward threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task. Method Study participants included 101 children and adolescents (ages 7–18 years) with generalized anxiety disorder, social phobia, and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Nonanxious youths ( n = 51; ages 9–18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy), and neutral expressions. They pressed a response key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type. Results Compared to healthy youths, anxious participants demonstrated a greater attention bias toward threat faces. This threat bias in anxious patients did not significantly vary across the anxiety disorders. There was no group difference in attention bias toward happy faces. Conclusions These results suggest that pediatric anxiety disorders are associated with an attention bias toward threat. Future research may examine the manner in which cognitive bias in anxious youths changes with treatment. J. Am. Acad. Child Adolesc. Psychiatry , 2008;47(10):1189–1196.
TL;DR: Significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life were found.