CBT and its family of structured treatments.
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776 to 800 of 2,546Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up.
Objective: The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties.
Method: A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition.
Results: Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited s…
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Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project.
Background: The ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up.
Method: Two therapists treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed by independent raters on four primary outcome meas…
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Predictors of outcome of group and internet-based cognitive behavior therapy.
Background: Little is known about which participant characteristics determine the effectiveness of various types of cognitive behavior therapy for sub-threshold depression. The aim of this study was to investigate which characteristics predict treatment outcome of group and internet-based interventions for sub-threshold depression, with a special focus on (i) the five main personality factors, and (ii) their different predictive power in the different types of treatment.
Methods: Eighty-five women and 45 men (mean age=55 years, S.D.=4.4) were randomly assigned to a group treatment and an internet-based treatment. The outcome measure was the difference between pre-treatment and post-treatment BDI scores. Analyses of Covariance were conducted to examine which participant characteristics could predict outcome for the two different types of treatment.
Results: Higher baseline BDI scores (F(1…
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Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: a randomised controlled trial.
Background: The majority of randomised controlled trials examining the effectiveness of antenatal group interventions at preventing postnatal depression in "at risk" women have used a "psychoeducational" intervention. The aim of the present study is to evaluate the effectiveness of an antenatal cognitive behavioural group intervention in a primary care setting for pregnant women identified with mild to moderate symptoms in pregnancy and/or at risk of developing depression or anxiety in the perinatal period.
Method: Subjects were randomised to a CBT group intervention or control condition (information booklet) and administered the EPDS and STAI at pre (Time 1) and post intervention (Time 2), and at 2 months (Time 3) and 4 months postpartum (Time 4). MINIs were administered at Times 1, 3 and 4.
Results: Of the 774 women approached, 277 accepted and were suitable; thus 191 were randomised t…
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O'Connor K, Marchand A, Brousseau L, Aardema F, Mainguy N, Landry P, Savard P, Léveillé C, Lafrance V, Boivin S, Pitre D, Robillard S, Bouthillier D (2008)randomised controlled trialMEDLINE-indexed journal, not yet read by usClinical psychology & psychotherapy26 citations Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine.
Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive-behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow-up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper. Over all 86 participants, a high-baseline level of psychological distres…
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Steele AL, Wade TD (2008)randomised controlled trialMEDLINE-indexed journal, not yet read by usBehaviour research and therapy63 citations A randomised trial investigating guided self-help to reduce perfectionism and its impact on bulimia nervosa: a pilot study.
Aim: The purpose of the present study was to evaluate reducing perfectionism as a potential treatment target for individuals with Bulimia Nervosa (BN).
Method: Forty-eight individuals meeting DSM-IV criteria for BN or eating disorder - not otherwise specified with binge eating [objective or subjective] or purging at least once per week were recruited. Participants were randomly assigned to receive 8 sessions of manual-based guided self-help (GSH) over a 6-week period that was focused on either cognitive behaviour therapy (CBT) for perfectionism, CBT for BN, or a placebo. Individuals were assessed at baseline, pre-treatment, post-treatment and at six-month follow-up on 12 outcome variables, including diagnostic criteria and psychological variables.
Results: There was no significant change in any of the outcome variables over a 6-week no-treatment period but at post-treatment and 6-month f…
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Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy.
Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-sleeping age-matched subjects. Secondly, we investigated the performance response to sleep therapy using a waiting-list controlled design. Sleep therapy consisted of a…
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Cognitive-behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial.
Background: Little is known about the management of health anxiety and hypochondriasis in secondary care settings.
Aims: To determine whether cognitive-behavioural therapy (CBT) along with a supplementary manual was effective in reducing symptoms and health consultations in patients with high health anxiety in a genitourinary medicine clinic.
Method: Patients with high health anxiety were randomly assigned to brief CBT and compared with a control group.
Results: Greater improvement was seen in Health Anxiety Inventory (HAI) scores (primary outcome) in patients treated with CBT (n=23) than in the control group (n=26) (P=0.001). Similar but less marked differences were found for secondary outcomes of generalised anxiety, depression and social function, and there were fewer health service consultations. The CBT intervention resulted in improvements in outcomes alongside higher costs, with a…
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Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study.
Purpose: To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women.
Materials and methods: We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approxi…
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Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy.
Aim: To examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT).
Design: A 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling.
Setting: Community-based drug abuse clinic in the northeastern United States.
Participants: A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse.
Measurements: Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day fre…
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Is cognitive-behavioural therapy more effective than psychoeducation in bipolar disorder?
Objective: Psychosocial research in bipolar disorder (BD) has not yet assessed the relative benefits of a short course of psychoeducation (PE), compared with a longer course of cognitive-behavioural therapy (CBT) containing psychoeducational principles. This pilot study evaluated the efficacy and added benefit of adding a course of CBT to a standard course of brief PE, as maintenance therapy for BD.
Method: Seventy-nine consenting adult men and women with BD on stable medication regimens, who were in full or partial remission from an index episode (BD I = 52; BD II = 27), were randomized to receive either 7 sessions of individual PE, or 7 sessions of PE followed by 13 additional individual sessions of CBT. Weekly mood and medication adherence was rated using the National Institute of Mental Health's Life Chart Method, while psychosocial functioning and mental health use were assessed mon…
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Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems.
This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of a…
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Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.
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 cop…
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Treatment of acute stress disorder: a randomized controlled trial.
Context: Recent trauma survivors with acute stress disorder (ASD) are likely to subsequently develop chronic posttraumatic stress disorder (PTSD). Cognitive behavioral therapy for ASD may prevent PTSD, but trauma survivors may not tolerate exposure-based therapy in the acute phase. There is a need to compare nonexposure therapy techniques with prolonged exposure for ASD.
Objective: To determine the efficacy of exposure therapy or trauma-focused cognitive restructuring in preventing chronic PTSD relative to a wait-list control group.
Design, setting, and participants: A randomized controlled trial of civilians who experienced trauma and who met the diagnostic criteria for ASD (N = 90) seen at an outpatient clinic between March 1, 2002, and June 30, 2006.
Intervention: Patients were randomly assigned to receive 5 weekly 90-minute sessions of either imaginal and in vivo exposure (n = 30) or…
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Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia.
Study objective: Insomnia impacts the course of major depressive disorder (MDD), hinders response to treatment, and increases risk for depressive relapse. This study is an initial evaluation of adding cognitive behavioral therapy for insomnia (CBTI) to the antidepressant medication escitalopram (EsCIT) in individuals with both disorders.
Design and setting: A randomized, controlled, pilot study in a single academic medical center.
Participants: 30 individuals (61% female, mean age 35 +/- 18) with MDD and insomnia.
Interventions: EsCIT and 7 individual therapy sessions of CBTI or CTRL (quasi-desensitization).
Measurements and results: Depression was assessed with the HRSD17 and the depression portion of the SCID, administered by raters masked to treatment assignment, at baseline and after 2, 4, 6, 8, and 12 weeks of treatment. The primary outcome was remission of MDD at study exit, which …
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Daytime functioning in older patients suffering from chronic insomnia: treatment outcome in a randomized controlled trial comparing CBT with Zopiclone.
The paper presents data from a randomized controlled trial comparing treatment effects of cognitive behavioural therapy (CBT), hypnotic treatment (Zopiclone), and placebo in a sample of insomnia patients. Data from the same trial have already demonstrated that CBT was more efficient in improving sleep than Zopiclone. The novel outcomes that are reported here concern daytime functioning. Forty-six older patients (age >or= 55) qualifying for a diagnosis of primary insomnia were recruited to participate. Assessments were completed at baseline, post-treatment, and at a 6-months follow-up, and measures of worry, anxiety, depression, interpersonal relationships, subjective alertness, vigilance, and quality of life were used. The participants in both treatment conditions scored within the normal range on the outcome measures at baseline with the exception of reporting less alertness, relative t…
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Mueser KT, Rosenberg SD, Xie H, Jankowski MK, Bolton EE, Lu W, Hamblen JL, Rosenberg HJ, McHugo GJ, Wolfe R (2008)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of consulting and clinical psychology195 citations A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.
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…
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A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face.
Objective: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine.
Method: One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT f…
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No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial.
Background: The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n = 37), Social Phobia (n = 22) or Specific Phobia (n = 16) were randomly assigned to individual (n = 65) or group (n = 62) treatment.
Method: Analyses were conducted separately for the intent-to-treat sample and the sample of children who completed treatment. Analyses included chi-square comparisons and regression analyses with treatment format as a predictor.
Results: Forty-eight percent of the children in the individual versus 41% in the group treatment were free of any anxiety disorder at post-treatment; 62% versus 54% were free of their primary anxiety disorder. Regression analys…
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Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy.
The present study examined the mediators of change accounting for outcomes of a previously published study on acceptance and commitment therapy for the self-management of epilepsy and its life restricting impact. Conducted with 27 poor South Africans, a 9-h ACT protocol that included seizure management methods was shown to greatly reduce epileptic seizures and to increase quality of life over the next year as compared to an attention placebo control. A series of bootstrapped non-parametric multiple mediator tests showed that pre to follow-up changes in: seizures, quality of life, and well-being outcomes were mediated to a degree by ACT process measures of epilepsy-related acceptance or defusion, values attainment, persistence in the face of barriers, or their combination. The results of this study contribute to the understanding of the contextual conditioning mechanisms at work for those…
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Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors.
Aim: This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue, mood and quality of life in breast cancer survivors.
Background: Women who receive primary treatment for breast cancer often complain of insomnia. Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue, mood and quality of life.
Method: Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease. Women were randomly assigned to either the cognitive behavioural therapy for insomnia group, which received stimulus control instructions, sleep restriction therapy and sleep education and hygiene, or the component control group which received sleep education and hygiene only. The 10-…
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Self-criticism predicts differential response to treatment for major depression.
The authors examined the relationship between self-criticism, dependency, and treatment outcome for 102 participants who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) criteria for major depressive disorder. The participants were randomly assigned to receive either cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), or pharmacotherapy with clinical management (PHT-CM) and completed the Depressive Experiences Questionnaire (Blatt, D'Affilitti, & Quinlan, 1976), a measure of self-criticism and dependency, as part of a broader research protocol. Regression analyses indicated that among individuals in IPT, self-criticism predicted poorer treatment outcome based on depressive symptom severity measured using the 17-item Hamilton Rating Scale for Depression (Hamilton, 1960, 1967). In a…
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Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain.
Although cognitive-behavioral therapies (CBT) have been demonstrated to be effective for a variety of chronic pain problems, patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects. Furthermore, although cognitive-behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes, little research has systematically tested this. Therefore, we examined mediators, moderators, and predictors of treatment effects in a randomized controlled trial of CBT for chronic temporomandibular disorder (TMD) pain. Pre- to post-treatment changes in pain beliefs (control over pain, disability, and pain signals harm), catastrophizing, and self-efficacy for managing pain mediated the effects of CBT on pain, activity interference, and jaw use limitations at one year. In individual mediator anal…
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A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression.
Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall,…
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Symptom provocation and reduction in patients suffering from spider phobia: an fMRI study on exposure therapy.
Neurofunctional mechanisms underlying cognitive behavior therapy (CBT) are still not clearly understood. This functional magnetic resonance imaging (fMRI) study focused on changes in brain activation as a result of one-session CBT in patients suffering from spider phobia. Twenty-six female spider phobics and 25 non-phobic subjects were presented with spider pictures, generally disgust-inducing, generally fear-inducing and affectively neutral scenes in an initial fMRI session. Afterwards, the patients were randomly assigned to either a therapy group (TG) or a waiting list group (WG). The scans were repeated one week after the treatment or after a one-week waiting period. Relative to the non-phobic participants, the patients displayed increased activation in the amygdala and the fusiform gyrus as well as decreased activation in the medial orbitofrontal cortex (OFC) during the first exposur…
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