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[Behavioral therapy, cognitive behavioral therapy and cognitive-analytic methods in treatment of anorexia].

This paper describes the current state of behavioural, cognitive-behavioural and cognitive-analytical treatments of anorexia nervosa and the underlying theoretical models. Purely behavioural treatment methods have been evaluated in a number of single case studies. Although effective in terms of increasing body weight, these methods are obsolete in view of their unpleasant side-effects. Cognitive-behavioural and cognitive-analytical therapies are much more appropriate for these patients given their complex symptomatology and frequently ambivalent attitude to treatment. However, so far evaluations of these treatments are rare. The reasons for this are discussed.

Adolescent↗
PubMed1997

An interactive computer-administered self-assessment and self-help program for behavior therapy.

Behavior therapy for obsessive-compulsive disorder (OCD) is extremely effective and usually conveys lasting benefits. Unfortunately, behavior therapy is not widely available and is usually quite costly in the few settings where it can be obtained. The essential features of effective behavior therapy are identifying triggers of obsessions, rituals, and discomfort; designing personalized exposure and ritual prevention (E & RP) goals; and encouraging and monitoring E & RP sessions of sufficient frequency and duration for habituation to occur. A computer program (BT STEPS) was designed to assist OCD sufferers in carrying out self-assessment and self-help behavior therapy. The program has nine clinical steps, 12 computer-controlled interactive voice response (IVR) telephone calls (some used repeatedly), and more than 1000 digitized voice files that depend on the progress that patients report during calls. BT STEPS has been studied in two trials at three sites with a total of 65 patients. In both trials, patients who experienced behavior therapy had substantial reductions in OCD severity as assessed by the Yale-Brown Obsessive Compulsive Scale. Approximately two thirds of those who participated in two or more E & RP sessions were much or very much improved. Patients liked using the program, and 71% thought their lives improved as a result. BT STEPS makes behavior therapy for OCD patients potentially available to anyone with a touch-tone telephone. It is intended for use under the supervision of a clinician and can be used in conjunction with pharmacotherapy.

Behavior Therapy↗
PubMed1976

Behavior therapy and sex therapy.

Behavior therapy is characterized by the way in which clinical data are collected, analyzed, and used in the treatment program-specifically, the application of the methods of experimental and social psychology. A case history of the behavioral treatment of a sexual problem is presented to illustrate this process. Many people have assumed that the "new sex therapy" is behavior therapy because of its focus on the here and now and similarities in particular treatment maneuvers. However, the author notes that sex therapy is behavior therapy only to the extent that it deals comprehensively with environmental, interpersonal, and organismic factors that operate to maintain the sexual problem.

Adult↗
PubMed1997

The behavior analytic perspective: its nature, prospects, and limitations for behavior therapy.

Behavior analysis is defined as a natural science approach to behavior--with both basic and applied branches--and contrasted with cognitive psychology. Behavior analysis is described as an integrated science that views a person's interactions with the environment as selecting certain behaviors--or rather, environment-behavior relations--making them more probable, given certain subsequent stimulus situations. It seeks an understanding that promotes effective action, which fits the clinical interests of behavior therapy. It promotes persistent searching for environmental causes, which has resulted in a remarkable range of successes, clinical and other. We explore the reasons that all behavior therapists are not behavior analysts and suggest needed future developments.

Behavior Therapy↗
PubMed1993

Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy.

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment. DESIGN: Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors. SETTING: Secondary referral center. PATIENTS: Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded. INTERVENTIONS: Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment. MAIN OUTCOME MEASURE: Frequency of binge eating and purging. RESULTS: High rate (48%) of attrition and withdrawal among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects. CONCLUSIONS: Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.

Adolescent↗
PubMed1993

Insight in behavior therapy.

Behavior therapists make frequent use of insight, but avoid the term because dynamic therapists have formulated it in terms of the unconscious. Insight does not necessarily imply belief in the existence of the "unconscious mind." Behavioral insight consists of making the client aware of the antecedents and consequences of target behavior. Case studies are presented in which behavioral insight was involved in therapeutic change. Implications of behavioral insight for behavior therapy are discussed.

Adolescent↗
PubMed2004

A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients.

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21-25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had "good" outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

Journal Article↗
PubMed1991

Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder.

In a controlled clinical trial, 57 Ss meeting DSM-III-R criteria for generalized anxiety disorder, and fulfilling an additional severity criterion, were randomly allocated to cognitive behavior therapy (CBT), behavior therapy (BT), or a waiting-list control group. Individual treatment lasted 4-12 sessions; independent assessments were made before treatment, after treatment, and 6 months later, and additional follow-up data were collected after an interval of approximately 18 months. Results show a clear advantage for CBT over BT. A consistent pattern of change favoring CBT was evident in measures of anxiety, depression, and cognition. Ss were lost from the BT group, but there was no attrition from the CBT group. Treatment integrity was double-checked in England and in Holland, and special efforts were made to reduce error variance. Possible explanations for the superiority of CBT are discussed.

Analysis of Variance↗
PubMed1993

Information processing and classical conditioning: implications for exposure therapy and the integration of cognitive therapy and behavior therapy.

This article reviews Wagner's standard operating procedures (SOP) model, an information processing model of conditioning, and some of its supporting evidence. The implications of this model for behavior therapy are explored. Applying the SOP model to the anxiety reduction technique of exposure, it is predicted that: (1) rehearsal and attention-focusing should facilitate whereas distraction should attenuate the long-term benefits of exposure; and (2) successful exposure therapy should be associated with a demonstrable allocation of cognitive processing resources and indications of enhanced elaborative processing of the feared stimuli. At a more general level, the SOP model may provide a bridge between traditional behavior therapy techniques and the principles that underly cognitive therapy. That is, the SOP model suggests that even those behavior therapy techniques which represent the most straightforward applications of conditioning procedures can be seen as being mediated by information processing mechanisms.

Anxiety Disorders↗
PubMed2005

A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder.

We performed a randomized controlled study to test the relative efficacy of guided self-help (gsh) cognitive-behavioral therapy (CBTgsh) and behavioral weight loss treatment (BWLgsh) treatments for binge eating disorder (BED). To provide an additional partial control for non-specific influences of attention, a third control (CON) treatment condition was included. We tested the treatments using a guided self-help approach given the promising results from initial studies using minimal therapist guidance. Ninety consecutive overweight patients (19 males, 71 females) with BED were randomly assigned (5:5:2 ratio) to one of three treatments: CBTgsh (N=37), BWLgsh (N=38), or CON (N=15). The three 12-week treatment conditions were administered individually following guided self-help protocols. Overall, 70 (78%) completed treatments; CBTgsh (87%) and CON (87%) had significantly higher completion rates than BWLgsh (67%). Intent-to-treat analyses revealed that CBTgsh had significantly higher remission rates (46%) than either BWLgsh (18%) or CON (13%). Weight loss was minimal and differed little across treatments. The findings suggest that CBT, administered via guided self-help, demonstrates efficacy for BED, but not for obesity. The findings support CBT administered via guided self-help as a first step in the treatment of BED and provide evidence for its specific effects.

Adult↗
PubMed2007

A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder.

OBJECTIVES: The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). METHOD: Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. RESULTS: At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed. CONCLUSION: CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice.

Adult↗
PubMed2007

Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference?

Current practice guidelines for management of overweight and obesity recommend a program of diet, exercise, and behavior therapy for all persons with a body mass index (calculated as kg/m(2)) of at least 30 (and those with body mass index > or =25 plus two weight-related comorbidities). In this tripartite treatment--often referred to as lifestyle modification--behavior therapy provides a structure that facilitates meeting goals for energy intake and expenditure. Although standard behavior therapy reliably induces mean weight losses of approximately 10% of initial weight, these reductions are difficult to maintain. Some authors argue that a shift in focus from behavior change to cognitive change will improve long-term results of lifestyle modification programs. This review describes, in detail, the standard behavioral treatment of obesity and compares it with an alternative treatment model that is based in a cognitive conceptualization of weight control. A review of the literature suggests that the differences between standard behavior therapy and cognitive-behavioral therapy of obesity lie more in their underlying theories than in their implementation. Empirical comparisons of the long-term effects of these approaches are needed.

Behavior Therapy↗
PubMed1993

From behavior theory to behavior therapy: the contributions of behavioral theories and research to the advancement of behavior therapy.

As we approach the latter years of the twentieth century, a century that witnessed the birth of the behavior therapy movement, it becomes increasingly important to understand the forces that shaped the development, advancement, and success of behavior therapy. This paper is an introduction to a series of articles analyzing how major behavioral theories and research have contributed to the advancement of behavior therapy. In view of the fact that many behavior therapists have lost touch with the relation between behavior theory and behavior therapy and the challenges of the "cognitive revolution", we argue that the field would benefit conceptually and practically from integrating and utilizing the resources provided by recent advances in basic behavioral theory and research. The articles in this symposium attempt to build conceptual, methodological, and practical bridges to help behavior therapists recognize and utilize basic behavioral research and concepts.

Behavior Therapy↗
PubMed2003

The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis.

OBJECTIVE: The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included. RESULTS: Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders. CONCLUSIONS: There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included.

Cognitive Behavioral Therapy↗
PubMed1989

Behavior therapy: a clinical update.

Through refinements from research and judicious combination with other therapies, behavior therapy has become increasingly relevant in the treatment of psychiatric disorders. After outlining the four models that serve as a framework for behavior therapy (classical conditioning, operant conditioning, social learning theory, and cognitive behavior modification), the authors provide an update for clinicians on developments in the behavioral treatment of anxiety disorders, sexual disorders, depression, and schizophrenia. Most advances have been made in the treatment of anxiety disorders, including definition of variables for successful use of exposure to phobic stimuli in the treatment of phobic disorders and the use of flooding for post-traumatic stress disorder. By becoming better acquainted with cognitive and behavioral therapies, clinicians may be able to offer their patients more effective treatment options.

Anxiety Disorders↗
PubMed1995

[A meta-theoretical scope model of psychotherapeutic theories. Consequences for human image and therapy in behavior therapy].

Proceeding on the science-theoretical units Handeln, Tun and Verhalten, developed by Groeben 1986 connected with an integration of empirical and hermeneutical investigation, a metatheoretic frame model of psychotherapeutic theories is presented and its relevance for the practice is explained. The model integrates different therapeutic ways with another and lays down an ethic-sequential order of rank for the choice of theories and methods, which orientates itself according to the basic main assumptions (qua assumptions of man-picture) of the different theories. Starting out from the epistemological subject model (Groeben & Scheele, 1977) as another derivation of the model, an embedding of therapeutic action in a therapist-client-relationship is required, which is characterized with mutual structural parallelism. Goal of therapeutic intervention is the re-establishment of Handlungs-capacity of the client, as postulated in the self management approach. Because of its initial behaviouristic tradition especially the behaviour therapy has to struggle with immense image problems concerning its assumptions of man-picture. Up to now a science-theoretical clarification of these problems has only been occurred in dissatisfied approaches. The present work should fill in this desideratum.

Adaptation, Psychological↗