CBT and its family of structured treatments.
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2176 to 2200 of 2,546Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients?
Background: The provision of online counseling and online therapy is steadily increasing. The results of a number of controlled trials investigating the efficacy of online approaches indicate that some of these new treatment alternatives might indeed be effective. Yet, little is known about how the therapeutic relationship (or working alliance) evolves over the Internet and whether it influences treatment outcome as it does in traditional face-to-face therapy. The working alliance has been defined as the extent to which a patient and a therapist work collaboratively and purposefully and connect emotionally.
Objective: The aim of the study was to investigate the quality and predictive relevance of the therapeutic alliance for patients receiving a short-term, Internet-based, cognitive-behavioral therapy program for posttraumatic stress reactions.
Methods: After rigorous screening for exclu…
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A combined treatment approach for adults with ADHD--results of an open study of 43 patients.
Objective: Increasing numbers of adults are seeking treatment for ADHD. Pharmacotherapy is well established as the first line treatment for adult ADHD, although medications alone may be insufficient treatment for the myriad problems experienced by these patients. Few studies have examined the clinical outcomes of a combination of pharmacotherapy and psychotherapy for this clinical population. The purpose of the present study is to examine the potential effectiveness of the combination of pharmacotherapy and cognitive-behavior therapy modified to treat adult patients diagnosed with ADHD.
Method: Forty-three adults who underwent a structured diagnostic assessment for ADHD complete 6 months of combined treatment. Treatment outcome is assessed by comparing pre- and posttreatment measures of ADHD symptoms, comorbid symptoms, and ratings of overall functioning.
Results/conclusion: Results indi…
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Fenster J (2006)MEDLINE-indexed journal, not yet read by usDrug and alcohol dependence10 citations Characteristics of clinicians likely to refer clients to 12-Step programs versus a diversity of post-treatment options.
Most clients in substance abuse treatment are referred for continuing care. However, post-treatment services vary widely in their approaches to helping individuals achieve better substance use outcomes. This study examined the attitudes of outpatient treatment staff who refer clients exclusively to 12-Step groups (12-Step subgroup) and staff who refer clients both to 12-Step groups and to other continuing care options (Diversity subgroup) toward seven mutual-aid and professional psychosocial post-treatment options: Twelve-Step Programs (12-Step), Cognitive-Behavioral Therapy (CBT), Moderation Management (MM), Smart Recovery((R)) (SMART), Psychodynamic-oriented Therapy (PSY), Secular Organizations for Sobriety (SOS), and Women for Sobriety (WFS). A large percentage of clinicians lacked knowledge about the effectiveness of all alternatives to 12-Step programs with the exception of CBT. Cli…
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Dialectical behavioural therapy for oppositional defiant disorder in adolescents: a case series.
Background: Oppositional defiant disorder (ODD) is characterised as a recurrent pattern of defiant behaviour towards authority figures, irritability and difficulties in regulating emotions. ODD in adolescents presents similar symptomatology to borderline personality disorder (BPD). A treatment programme that has been shown to be effective for treating problems related to emotion dysregulation such as BPD is dialectical behavioural therapy (DBT). The aim of this article is to outline a case series in which we applied DBT to two adolescents diagnosed with ODD, in addition to psychiatric comorbidity and parasuicidal behaviours.
Method: We applied a training programme of 24 sessions in DBT skills, along with individual therapy.
Results: The results showed a decrease in impulsive behaviours, maladaptive behaviours to regulate affect, self-mutilation behaviour, number of hospitalisations, ange…
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Adaptation of the preventive intervention program for depression for use with predominantly low-income Latino families.
This paper describes the process for and safety/feasibility of adapting the Beardslee Preventive Intervention Program for Depression for use with predominantly low income, Latino families. Utilizing a Stage I model for protocol development, the adaptation involved literature review, focus groups, pilot testing of the adapted manual, and open trial of the adapted intervention with 9 families experiencing maternal depression. Adaptations included conducting the intervention in either Spanish or English, expanding the intervention to include the contextual experience of Latino families in the United States with special attention to cultural metaphors, and using a strength-based, family-centered approach. The families completed preintervention measures for maternal depression, child behavioral difficulties, global functioning, life stresses, and an interview that included questions about acc…
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Habit reversal training for tic disorders in children and adolescents.
Chronic tic disorders, including Tourette's syndrome (TS), affect approximately .5% of children and adolescents. Although strong evidence exists supporting a neurobiological etiology, operant factors may play a role in the maintenance of tic behaviors. Pharmacological approaches remain the most commonly used intervention for chronic tic disorder in children and adults. Nevertheless, the unpredictable efficacy and serious side effects associated with medication along with parental concerns about long-term medication use in children underlie the need for nonpharmacological interventions for tics in this age group. This article reviews the rationale and evidence base for the use of habit reversal training (HRT), a multicomponent behavioral treatment package, as a treatment for childhood tics. Each of the primary treatment components of HRT is described and implementation is illustrated in c…
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A school-based application of modified habit reversal for Tourette syndrome via a translator: a case study.
A school-based modified habit reversal intervention was utilized with an adolescent diagnosed with Tourette syndrome who recently immigrated from Mexico. Because the student possessed little proficiency of the English language, an interpreter was needed to help implement the procedure. The frequency of motor tics markedly decreased from baseline to intervention across classroom settings. Results of two follow-up phases revealed that motor tic levels remained below those observed in the baseline phase. Implications and limitations of these findings are noted.
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Exploring the effectiveness of combined mentalization-based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder - A pilot study.
Objectives: Borderline personality disorder (BPD) is characterized by emotional instability, interpersonal dysfunction, and other features that typically develop before a background of insecure attachment and traumatic experiences. Dialectical behaviour therapy (DBT) has proven highly effective in reducing self-harm and improving emotion regulation, whereby problems concerning social cognition, which are also characteristic of BPD, may need additional approaches such as mentalization-based treatment (MBT).
Methods: Here, we examined, in a pilot study, the effectiveness of MBT given adjunct to DBT, compared to DBT alone, in an inpatient sample with BPD, whereby mentalization was measured using a novel cartoon-based task.
Results: Both treatments were highly effective in reducing symptom severity. The combination of DBT and MBT was superior in reducing fearful attachment and in improving a…
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Examining challenging behaviors of clients with borderline personality disorder.
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% …
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Wade TD (2023)editorial or commentMEDLINE-indexed journal, not yet read by usThe International journal of eating disorders9 citations Developing the "single-session mindset" in eating disorder research: Commentary on Schleider et al., 2023 "Realizing the untapped promise of single-session interventions for eating disorders".
Schleider and colleagues' paper on the application of single-session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single-session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well-powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self-compassion or cog…
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Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study.
Background: Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety.
Objective: The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (iACT) program for patients with severe health anxiety using self-referral and a video-based assessment; and (2) examine the feasibility and potential clinical efficacy of iACT for severe health anxiety.
Methods: Self-referred patients (N=15) with severe health anxiety were diagnostically ass…
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Feasibility, acceptability and future adaptation of the Chinese translated Behavioural activation (C-BA) treatment for depression: A pilot study.
Background: Although depression is prevalent among Chinese international students (CIS), only 4% of CIS seek treatment. Behavioural activation (BA) has been suggested as a culturally sensitive treatment for depression that has the potential to meet the clinical needs of CIS. The current pilot study tested the feasibility, acceptability and themes for future cultural adaptations of a Chinese translated BA treatment (C-BA) among CIS.
Methods: Six CIS with elevated depressive symptoms (Beck Depression Inventory, BDI ≥ 14) completed a six-session individual C-BA treatment and assessments at pre- and post-treatment and a 1-month follow-up. Primary outcome measures included treatment feasibility, acceptability and qualitative interview data informing future adaption of C-BA. Exploratory analyses examined group changes in depressive symptoms over time and clinically significant symptom changes …
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Adapted behavioural activation for the treatment of depression in Muslims.
Background: Incorporating religious beliefs into mental health therapy is associated with positive treatment outcomes. However, evidence about faith-sensitive therapies for minority religious groups is limited.
Methods: Behavioural Activation (BA), an effective psychological therapy for depression emphasising client values, was adapted for Muslim patients using a robust process that retained core effective elements of BA. The adapted intervention built on evidence synthesised from a systematic review of the literature, qualitative interviews with 29 key informants and findings from a feasibility study involving 19 patients and 13 mental health practitioners.
Results: Core elements of the BA model were acceptable to Muslim patients. Religious teachings could potentially reinforce and enhance BA strategies and concepts were more familiar to patients and more valued than the standard approa…
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Lappalainen P, Kaipainen K, Lappalainen R, Hoffrén H, Myllymäki T, Kinnunen ML, Mattila E, Happonen AP, Rusko H, Korhonen I (2013)MEDLINE-indexed journal, not yet read by usJMIR research protocols42 citations Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: randomized controlled pilot trial.
Background: Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training.
Objective: The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices.
Methods: This pilot study design was a small-sca…
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Deckersbach T, Chou T, Britton JC, Carlson LE, Reese HE, Siev J, Scahill L, Piacentini JC, Woods DW, Walkup JT, Peterson AL, Dougherty DD, Wilhelm S (2014)MEDLINE-indexed journal, not yet read by usPsychiatry research39 citations Neural correlates of behavior therapy for Tourette's disorder.
Tourette's disorder, also called Tourette syndrome (TS), is characterized by motor and vocal tics that can cause significant impairment in daily functioning. Tics are believed to be due to failed inhibition of both associative and motor cortico-striato-thalamo-cortical pathways. Comprehensive Behavioral Intervention for Tics (CBIT), which is an extension of Habit Reversal Therapy (HRT), teaches patients to become more aware of sensations that reliably precede tics (premonitory urges) and to initiate competing movements that inhibit the occurrence of tics. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural changes associated with CBIT treatment in subjects with TS. Eight subjects with TS were matched with eight healthy controls in gender, education, age, and handedness. Subjects completed the Visuospatial Priming (VSP) task, a measure of response…
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Treatment feasibility of a digital tool for brief self-help behavioural therapy for insomnia (FastAsleep).
Cognitive behavioural therapy for insomnia is efficacious and recommended for insomnia, but availability is scarce. Cognitive behavioural therapy for insomnia self-help interventions could increase availability, especially if unguided. Optimizing cognitive behavioural therapy for insomnia methods and system user-friendliness, we developed a short, digital, self-help programme-FastAsleep-based on the behavioural components of sleep restriction and stimulus control. This study investigated its feasibility and preliminary effects. Thirty media-recruited participants with moderate to severe insomnia were assessed via telephone before using FastAsleep for 4 weeks, and were interviewed afterwards. Self-ratings with web questionnaires were conducted at screening, pre-, mid- and post-treatment, and at 3-month follow-up. Primary outcomes were feasibility (credibility, adherence, system user-frien…
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A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice.
Background: Chronic insomnia is a prevalent and debilitating disorder managed in Australian general practice. The most effective and recommended first-line treatment for insomnia is cognitive behavioural therapy. This treatment has been translated to a condensed brief behavioural therapy for insomnia (BBTi), which is suitable for delivery in the general practice setting. There is evidence that BBTi improves insomnia, daytime functioning and quality of life, with effects persisting far beyond treatment cessation. BBTi appears to be a cost-effective treatment that is superior to sedative-hypnotic management.
Objective: The aim of this article is to present a step-by-step approach for Australian general practitioners to administer BBTi.
Discussion: BBTi is an effective treatment for insomnia that may be administered in the Australian general practice setting. General practitioners may choos…
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Overcoming recruitment challenges of web-based interventions for tobacco use: the case of web-based acceptance and commitment therapy for smoking cessation.
Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard…
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Behavioral treatment of insomnia in bipolar disorder.
Sleep disturbance is common in bipolar disorder. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Both involve short-term sleep deprivation. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control. Total sleep time did not change for these individuals. Two of five patients …
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Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy.
There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed sig…
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Applying acceptance, mindfulness, and values to the reduction of prejudice: a pilot study.
Two classroom approaches to reducing racial and ethnic prejudice among college students were compared: a class session based on acceptance and commitment therapy (ACT) and an educational lecture drawn from a textbook on the psychology of racial differences. Undergraduates who were enrolled in two separate classes on racial differences were exposed to each approach in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model. Implications of a potentially new model of prejudice are briefly discussed.
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Commentary on cognitive fusion as a mediator between pain interference and depressive and anxiety symptoms among adults with spinal cord injury.
A recent study exploring the mediating relationship of cognitive fusion between pain interference and depressive/anxiety symptoms in individuals with SCI found that focusing on cognitive fusion intervention in psychotherapy can help to alleviate the psychological impact of pain interference (Cognitive Fusion as a Mediator Between Pain Interference and Depressive and Anxiety Symptoms Among Adults with spinal cord injury). We discuss the theoretical underpinnings of cognitive fusion and defusion as well as psychological flexibility which are points of focus in acceptance and commitment therapy. We review how each can impact quality of life, and outline additional factors which can mediate therapeutic success in individuals with SCI. Lastly, the difference between pain intensity and pain perception is highlighted, with a brief discussion as to how these two concepts, along with pain interfe…
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Cognitive Stimulation Therapy-Spain (CST-ES): Cultural Adaptation Process and Pilot Study.
Objectives: To assess the validity and acceptability of an adapted version of Cognitive Stimulation Therapy (CST) for the Spanish population and culturally adapt the original UK manuals.
Methods: The process followed the Formative Method for Adapting Psychotherapy (FMAP). Two focus groups were conducted with healthcare professionals specialized in the care of people with dementia, a pilot study with a small sample size (n = 6), and individual interviews with participants, family caregivers, and group facilitators. The study was conducted at the National Reference Center for Alzheimer's and Dementia Care (CREA), a specialized dementia care center in Spain. The participants included eight healthcare professionals for the focus groups, six persons with dementia from CREA outpatient programs for the pilot study, their family caregivers, and two group facilitators. Assessments for the pilot s…
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Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns.
Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes. Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatme…
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Posttraumatic stress disorder treatment outcomes for events related to institutional betrayal.
Institutional betrayal can occur when an organization fails to prevent or respond appropriately to traumatic events perpetrated within its ranks. This experience of violated trust can exacerbate posttraumatic stress disorder (PTSD) symptoms and related sequelae. The primary aim of this quality assurance project was to preliminarily assess whether our standard treatment approach and treatment dosing (single-treatment protocol, 12-15 sessions) was sufficient for patients presenting with institutional betrayal. We compared outcomes for individuals presenting for care following institutional betrayal events (n = 57) with outcomes for a control group of randomly selected nonbetrayed patients (n = 57). Individuals who endorsed a history of sexual abuse were excluded to better isolate the impact of institutional betrayal versus interpersonal factors. Betrayed individuals were more likely to lea…
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