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Results for “Cognitive Behavioral Therapy”

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PubMedDate not supplied

Is cognitive behavior therapy just a 'nonspecific' intervention for depression? A retrospective comparison of consecutive cohorts treated with cognitive behavior therapy or supportive counseling and pill placebo.

BACKGROUND: There is a dearth of placebo-controlled studies of cognitive behavior therapy (CBT) of depression and the largest such study, by Elkin et al. (Arch. Gen. Psychiatry 46 (1989) 971-982), failed to find a significant difference between CBT and a clinical management plus placebo condition. METHODS: The outcomes of two consecutive cohorts of out-patients with major depressive disorder, treated with either CBT (n=90) or a nonspecific control condition (support-counseling-placebo; SCP: n=100), were compared. Although the principal comparisons between the CBT and SCP conditions were delimited to the first 4 weeks of treatment, a secondary set of analyses addressed the subset of 16 patients who received 12 additional weeks of supportive therapy. RESULTS: A consistent pattern of statistically and clinically significant differences favoring CBT over SCP was found in both weeks 4 and 16. LIMITATIONS: Interpretation of these findings are subject to several potential confounds, including the non-randomized nature of the groups and the greater amount of therapeutic contact during the first 4 weeks of CBT. CONCLUSIONS: While these results do not lessen the need for additional prospective studies, our findings do suggest that CBT has therapeutic effects beyond those attributable to placebo-expectancy and other nonspecific factors.

Adult↗
PubMed1998

Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression.

OBJECTIVE: Alcohol dependence and major depression have been associated with heavy cigarette use and poor smoking-treatment outcomes. This preliminary study examined the efficacy of a mood management intervention for smoking cessation in abstinent alcoholics with a history of major depression. METHOD: Participants were 29 (15 female, 14 male) heavy smokers (mean cigs/day = 30.2), with an average of 6.8 years of continuous abstinence from alcohol and drugs, randomized to behavioral counseling (BC) (n = 16) or behavioral counseling + cognitive-behavioral mood management (CBT) (n = 13). A 2 x 5 repeated measures design was used to evaluate the effectiveness of the interventions on smoking outcome at baseline, posttreatment and at 1-, 3- and 12-month-follow-up. Self-reported smoking status was verified with biochemical (COa) and informant report. RESULTS: Verified self-report indicated that significantly more smokers in CBT quit by posttreatment (69.2%; 9 of 13) than in BC (31.3%; 5 of 16) (chi2 = 4.14, 1 df, p = .04). These abstinence rates remained unchanged at 1-month follow-up. At 3-month follow-up, differences in smoking abstinence rates were nonsignificant between CBT (46.2%; 6 of 13) and BC (25.0%; 4 of 16) conditions. However, at 12-month follow-up, significantly more participants in CBT were abstinent from smoking (46.2%; 6 of 13) than in BC (12.5%; 2 of 16) (chi2 = 4.07, 1 df, p = .04). CONCLUSIONS: The results suggest that interventions focused on managing negative mood may benefit these high-risk, comorbid smokers.

Adult↗
PubMed2001

Basic principles for applying cognitive-behavioral therapy to anorexia nervosa.

Cognitive-behavioral therapy continues to be one of the recommended evidenced-based interventions in the treatment of eating disorders. Cognitive-behavioral therapy is clearly of benefit in anorexia and bulimia nervosa, can be learned in a reasonable time, and is guided by manuals on cognitive-behavioral therapy. This article looks at theoretic and clinical interventions in the treatment of anorexia nervosa and suggests strategies related to effective psychotherapeutic treatment that can be used across a continuum of care.

Anorexia Nervosa↗
PubMed1991

Cognitive processes and cognitive behavior therapy in the treatment of problem drinking.

Cognitive behavior Therapy has been shown to be an effective therapy for a wide range of clinical problems. However, the efficacy of CBT on addictive behavior is still unknown. This paper reviews the evidence for the efficacy of cognitive behavior therapy treatment for problem drinkers and examines its relationship with cognitive models of problem drinking. A computer search of the literature showed that only 13 studies met the criteria for inclusion in this review. This review indicated that there is evidence to show that cognitive behavior therapy can be successfully applied to addictive behaviors, in particular, problem drinking. However, there is lack of evidence to show that cognitive behavior therapy supports cognitive models of problem drinking. Future direction for research in this area is suggested.

Alcoholism↗
PubMed2005

Multiple channel exposure therapy: combining cognitive-behavioral therapies for the treatment of posttraumatic stress disorder with panic attacks.

A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet it is unclear to what extent currently available PTSD treatment programs address this problem. Here we describe a newly developed treatment, multiple-channel exposure therapy (M-CET), for comorbid PTSD and panic attacks. The treatment utilizes elements of cognitive processing therapy treatment for PTSD and elements of panic control treatment to target physiological, cognitive, and behavioral symptoms. Preliminary results suggest that M-CET may provide a promising treatment program for a subset of patients with PTSD who experience panic attacks. In addition, guidelines for conducting M-CET with clients who have been exposed to diverse traumatic events are provided.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

[Specifics of cognitive behavioral therapy in schizophrenia. Integrated program of psychological therapy].

According to the authors, information processing disorders contribute essentially to the vulnerability of the schizophrenic patient. Attentional/perceptual and cognitive disorders exert a pervasive influence on more complex levels of overt behavior in schizophrenia. Conversely, behavioral deficits influence cognitive functioning as well. Psychosocial rehabilitation of patients with schizophrenia must therefore address the impact of disordered attentional/perceptual and conceptual processes and their integrating organization on behavior as well as the effects of behavioral dysfunctions on cognition. The Integrated Psychological Treatment Program (IPT) for schizophrenic patients provides means of addressing these interactions. The designation "integrated" implies that the treatment is directed at cognitive disorders as well as behavioral/social deficits by using highly structured interventions, and is carried out with "reality-oriented" material. This treatment approach has been developed by Brenner and al., since 1976. The original IPT includes five subprograms: Cognitive Differentiation, Social Perception, Verbal Communication, Social Skills and Interpersonal Problem Solving. Patients first work on improving disordered basic cognitive functions in the Cognitive Differentiation subprogram. Exercises are directed at impairments in attentional/perceptual and conceptual processes. Mastery of this subprogram leads to the Social Perception subprogram, which aims at disturbances in processes of stimulus discrimination and interpretation on perceiving and assessing social interactions. The Verbal Communication subprogram follows successful completion of the previous subprograms and trains associative-semantic processes as well as basic skills necessary for conversation. In the Social Skills subprogram, interpersonal behaviors and self-instructions required for gaining instrumental and emotional aims are taught.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective Symptoms↗
PubMed2004

On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse.

AIMS: Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse. METHOD: Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide. FINDINGS AND CONCLUSIONS: Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.

Adolescent↗
PubMed2003

Cognitive behavior therapy for depression? Choose horses for courses.

OBJECTIVE: Although cognitive behavior therapy is a widely accepted treatment for depression, the problematic nature of efficacy studies is insufficiently recognized. METHOD: The authors reviewed original studies and quantitative analyses on the use of cognitive behavior therapy for depression. RESULTS: The authors suggested that claims for cognitive behavior therapy's efficacy on depression have been overstated, questioned whether its efficacy fits within its theoretical underpinning, and argued against viewing cognitive behavior therapy as a universal rather than a targeted strategy. CONCLUSIONS: Although cognitive behavior therapy may act more by its nonspecific therapeutic ingredients, the authors argued that by testing cognitive behavior therapy's efficacy in heterogeneous study groups, rather than in specific subgroups, failure to differentiate it from control therapies may have been ensured.

Antidepressive Agents↗
PubMed2003

Cognitive-behavioral therapy: tailored to the individual.

Cognitive-behavioral therapy focuses on the cognitive, affective, and behavioral components of the pain experience. Cognitive-behavioral strategies can be used to treat chronic pain and chronic intermittent pain. The strategies concentrate on emotional, behavioral, and social responses, helping patients to increase their feelings of control or feelings of self efficacy regarding control.

Adaptation, Psychological↗
PubMed2003

Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy.

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function. DESIGN: Randomized, prospective, controlled intervention. SETTING: Clinical research center in an academic medical institution. PATIENT(S): Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise. INTERVENTION(S): Subjects were randomized to CBT or observation for 20 weeks. MAIN OUTCOME MEASURE(S): Serum levels of E(2) and P and vaginal bleeding were monitored. RESULT(S): Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), chi(2) = 7.14. CONCLUSION(S): A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.

Adult↗
PubMed2005

Should parents be co-clients in cognitive-behavioral therapy for anxious youth?

Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials (RCTs), and recent studies have sought to determine if the effects can be enhanced by an adjunctive parent component. The rationale for adding parents as active participants to treatment for anxious youth includes the notions that parenting factors (a) can contribute to the maintenance of anxiety, (b) could facilitate the generalization of treatment gains, and (c) have had favorable results in treatment of other childhood disorders. To date, there have been 9 CBT treatment outcome trials with anxious youth that included parents in treatment. This article (a) provides a critical review of the research on active parent involvement in CBT of anxious youth, (b) calculates and reports effect sizes emerging from these studies, and (c) recommends areas for future research.

Adolescent↗
PubMedDate not supplied

Enhanced cognitive-behavioral therapy for vocational rehabilitation in schizophrenia: Effects on hope and work.

To address the effects of dysfunctional cognitions on vocational outcome of people with schizophrenia spectrum disorders, we developed the Indianapolis Vocational Intervention Program (IVIP), a cognitive-behavioral program of group and individual interventions. Fifty participants with schizophrenia or schizoaffective disorder were offered 6-month work placements and randomized to receive IVIP (n = 25) or standard support services (n = 25). Hours worked were measured weekly, and work performance was assessed biweekly with the use of the Work Behavior Inventory. Hope and self-esteem were assessed at baseline and at 5 months with the Beck Hopelessness Scale and the Rosenberg Self-Esteem Schedule. Analysis of variance (ANOVA) revealed that the IVIP group worked significantly more weeks and had better average work performance than the standard support group. Repeated measures ANOVA of baseline and follow-up scores indicated that the IVIP group sustained baseline levels of hope and self-esteem through follow-up, while the standard support group experienced declines. Results provide initial evidence of the effectiveness of the IVIP.

Adult↗
PubMed1997

Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial.

OBJECTIVE: Cognitive behavior therapy for chronic fatigue syndrome was compared with relaxation in a randomized controlled trial. METHODS: Sixty patients with chronic fatigue syndrome were randomly assigned to 13 sessions of either cognitive behavior therapy (graded activity and cognitive restructuring) or relaxation. Outcome was evaluated by using measures of functional impairment, fatigue, mood, and global improvement. RESULTS: Treatment was completed by 53 patients. Functional impairment and fatigue improved more in the group that received cognitive behavior therapy. At final follow-up, 70% of the completers in the cognitive behavior therapy group achieved good outcomes (substantial improvement in physical functioning) compared with 19% of those in the relaxation group who completed treatment. CONCLUSIONS: Cognitive behavior therapy was more effective than a relaxation control in the management of patients with chronic fatigue syndrome. Improvements were sustained over 6 months of follow-up.

Adult↗
PubMed1995

Cognitive-behavior therapy for generalized anxiety disorder.

Overall, cognitive-behavior therapy shows promise as a treatment for GAD. The modest treatment gains reported to date may be in part due to the characterologic nature of GAD and the high rate of comorbidity. An important trend emerging in studies that provide long-term outcome data, however, is the substantial reduction in the use of anxiolytic medication in treated subjects. As a result, Brown et al have suggested that such cognitive-behavior therapy may offer an approach for discontinuing these medications in patients with GAD. Because the benefits of cognitive-behavioral treatment appear to be maintained at long-term follow-up assessment, cognitive-behavior therapy may provide a long-term and cost-effective solution to GAD. The maintenance of treatment gains following a relatively short period of intervention (5-20 sessions) is particularly impressive given that the GAD population is characterized by individuals who say that they have "always been worriers" and who previously have been very difficult to treat. Future research is required to explore the specific effects that "nonspecific" methods offer. In addition, because some studies (e.g., Barlow et al) reported that dropouts in treatment were high and that many patients were left with some residual anxiety, there is clearly still a need for further research to find more focused and successful treatments.

Adaptation, Psychological↗
PubMed2000

Cognitive-behavioral therapy for medication-resistant symptoms.

Cognitive-behavioral therapy for psychosis is described. It draws on the cognitive models and therapy approach of Beck and colleagues, combined with an application of stress-vulnerability models of schizophrenia and cognitive models of psychotic symptoms. There is encouraging evidence for the efficacy of this approach. Four controlled trials have found that cognitive-behavioral therapy reduces symptoms of psychosis, and there is some evidence that it may contribute to relapse reduction. Studies that have examined factors that predict treatment response are reviewed. There is preliminary evidence that a good outcome is partially predicted by a measure of cognitive flexibility or a "chink of insight." People who present with only negative symptoms may show poorer outcome. However, there is no evidence that intelligence or symptom severity is associated with outcome. Implications for selecting patients and for optimal duration of treatment are discussed. Finally, the importance of taking account of the heterogeneity of people with psychosis, so that individual treatment goals are identified, is discussed.

Adaptation, Psychological↗
PubMed2005

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement.

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Adult↗