Cognitive-behavior therapy and exposure and response prevention are the most effective psychological treatments for obsessive-compulsive disorder (OCD). However, these approaches often produce variable results with the majority of treated individuals remaining symptomatic. This study evaluated a new form of cognitive therapy based on Wells' metacognitive model of OCD. Treatment efficacy was assessed using single case methodology in 4 consecutively referred individuals. At post-treatment, all participants made clinically significant change on a range of standardized outcome measures and these gains were largely maintained through to 6-month follow-up. Metacognitive therapy could be an effective and time efficient treatment for OCD.

J Behav Ther Exp Psychiatry. 2008 Jun;39(2):117-32. Fisher PL, Wells A. Department of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK.

Although there is evidence that cognitive behavioral therapy (CBT) is effective in the treatment for fear of flying (FOF), there are no studies that specifically examine which skills taught in treatment are being used by clients after treatment is completed. This study examines whether participants report using skills taught in treatment for FOF after treatment is completed and whether the reported use of these skills is associated with reduced flying anxiety in the face of fear-relevant event, the September 11th terrorist attacks, and over the long-term. One hundred fifteen participants were randomly assigned to and completed eight sessions of individual CBT treatment for FOF. Fifty-five participants were reassessed in June 2002, an average of 2.3 years after treatment. Surveys were also collected from 33 individuals who did not receive treatment for FOF. Results indicated that treatment completers were more likely to report using skills taught in treatment than individuals who had not received treatment. In addition, self-reported use of skills among previously treated individuals was associated with lower levels of flying anxiety. These findings suggest that use of skills taught in CBT treatment is associated with reduced flying anxiety in the face of a fear-relevant event and over the long term.

J Anxiety Disord. 2008;22(2):301-9. Kim S, Palin F, Anderson P, Edwards S, Lindner G, Rothbaum BO. Georgia State University, Atlanta, GA, USA.

This paper reviews predictors of treatment response in open and controlled trials of cognitive-behavioral therapy for obsessive-compulsive disorder (OCD). We focus on demographic characteristics, aspects of OCD symptoms, comorbidity, family factors, cognitive influences, and treatment-specific characteristics as predictor variables. Although inconsistent findings characterize much of the literature, several relatively consistent and salient predictors have emerged, including symptom severity, symptom subtype, severe depression, the presence of comorbid personality disorders, family dysfunction, and the therapeutic alliance. Implications of findings and recommendations for future research are discussed.

Clin Psychol Rev. 2008 Jan;28(1):118-30. Keeley ML, Storch EA, Merlo LJ, Geffken GR. Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, United States; Department of Psychiatry, University of Florida, Gainesville, Florida, United States.

To illustrate a multidisciplinary group treatment for patients with fibromyalgia (FM) tailored to the patient's cognitive-behavioral pattern. METHOD: In a case-study design the tailored treatment approaches of two FM patients were described. One patient characterized by avoidance behavior (pain-avoidance pattern) participated in a group treatment aimed at changing pain-avoidance mechanisms and one patient characterized by continuing with activities in spite of pain (pain-persistence pattern) participated in a group treatment aimed at changing pain-persistence mechanisms. Assessments were made at baseline, post-treatment and at 6-months follow-up. RESULTS: Comparison of the pretest, post-test and follow-up scores on pain, functional disability, fatigue and psychological distress showed clinically significant improvements for both patients. CONCLUSION: The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms has been proposed to underlie varying treatment outcomes in FM patients. These results demonstrate that a group treatment tailored to pain-avoidance and pain-persistence patterns is feasible and can result in clinically significant changes for FM patients. PRACTICE IMPLICATIONS: FM offers a great challenge for clinicians due to the lack of effective treatment options. These case studies suggests that tailored CBT and exercise training directed at specific patient patterns can contribute to the improvement of the care of FM patients.

Patient Educ Couns. 2008 Jan 8 van Koulil S, van Lankveld W, Kraaimaat FW, van Helmond T, Vedder A, van Hoorn H, Cats H, van Riel PL, Evers AW. Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

This study compared imagery rescripting, in vivo exposure therapy and their combination in the treatment of snake fear. Imaginal ability was assessed pre-treatment, and was correlated with baseline avoidance. Snake fearful individuals were randomly assigned to cognitive therapy involving imagery rescripting, in vivo exposure, a combination of the two, or a relaxation control. All active treatment groups improved significantly more than the control group in both fearfulness and behavioral approach. There were no significant differences between the active treatment groups, although the combined treatment tended to be slightly more efficacious.

J Behav Ther Exp Psychiatry. 2007 Sep 21 Hunt M, Fenton M. University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104-6241, USA.

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 exposure. The therapy effect consisted of increased medial OFC activity in the TG relative to the WG. Further, therapy-related reductions in experienced somatic anxiety symptoms were positively correlated with activation decreases in the amygdala and the insula. We conclude that successful treatment of spider phobia is primarily accompanied by functional changes of the medial OFC. This brain region is crucial for the self-regulation of emotions and the relearning of stimulus-reinforcement associations.

Eur Arch Psychiatry Clin Neurosci. 2007 Sep 27 Schienle A, Schäfer A, Hermann A, Rohrmann S, Vaitl D. Clinical Psychology, Karl-Franzens-Universität Graz, Universitätsplatz 2/III, 8010, Graz, Austria.

While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615-623). METHOD: Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment. RESULTS: Eleven subjects (six female and five male) with a mean age of 49 (range=36-72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment. CONCLUSION: MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD.

J Anxiety Disord. 2007 Jul 22 Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D. Department of Psychiatry, Weill Cornell Medical College, United States.

Attention-deficit/hyperactivity disorder (ADHD) has been commonly thought of as a childhood disorder that diminished over time. It is one of the most common developmental disorders and it is estimated that ADHD affects 5-10% of children. Two-thirds of children with ADHD will continue to have symptoms of ADHD that persist throughout adolescence. Longitudinal studies have demonstrated that symptoms of ADHD can also remain in adulthood, affecting 4.4% of the adult population. However, diagnosing adults with ADHD can prove difficult because they often find that their symptoms are egosyntonic. In addition, the development of comorbid conditions, such as anxiety, depression, personality disorders or substance abuse, can often overshadow underlying ADHD symptoms. Nonetheless, treatments such as stimulant and nonstimulant medication (e.g., atomoxetine), and cognitive-behavior therapy have been effective in treating adults with ADHD. This article reviews the prevalence of adults with ADHD, followed by a discussion of the neurobiological and genetic underpinnings of the disorder. Issues regarding the diagnosis and treatment of ADHD are also addressed.

Expert Rev Neurother. 2007 Oct;7(10):1375-90. Cumyn L, Kolar D, Keller A, Hechtman L. McGill University, Department of Educational & Counselling Psychology, 3700 McTavish St., Montreal, Quebec, H3A 1Y2. lucy.cumyn@mail.mcgill.ca

Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impact a user's ability to control online use to the extent that it can cause relational, occupational, and social problems. While much of the literature explores the psychological and social factors underlying Internet addiction, little if any empirical evidence exists that examines specific treatment outcomes to deal with this new client population. Researchers have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who suffered from Internet addiction and received CBT at the Center for Online Addiction. This study employed a survey research design, and outcome variables such as client motivation, online time management, improved social relationships, improved sexual functioning, engagement in offline activities, and ability to abstain from problematic applications were evaluated on the 3rd, 8th, and 12th sessions and over a 6-month follow-up. Results suggested that Caucasian, middle-aged males with at least a 4-year degree were most likely to suffer from some form of Internet addiction. Preliminary analyses indicated that most clients were able to manage their presenting complaints by the eighth session, and symptom management was sustained upon a 6-month follow-up. As the field of Internet addiction continues to grow, such outcome data will be useful in treatment planning with evidenced-based protocols unique to this emergent client population.

Cyberpsychol Behav. 2007 Oct;10(5):671-9. Young KS. Center for Online Addiction, Bradford, Pennsylvania.

PURPOSE: A dietitian-administered, shortened form of the Apple and Agras cognitive-behavioural therapy (CBT) method was evaluated in a group setting to determine its effect on improving obese women's self-esteem and reducing binge-eating behaviours, depression, and negative body image. METHODS: Participants were recruited through newspaper and radio advertisements. Respondents who met study selection criteria were randomly assigned to either a CBT group (n=13) or a delayed group (D-CBT) (n=9). The treatment was administered over six weekly sessions to the CBT group, and then twice weekly over three weeks to the D-CBT group. Two measures of bingeing behaviour (severity and frequency), three measures of mood (depression, body image, and self-esteem), and body weight were assessed. RESULTS: The intervention did not result in any changes in body weight. There were statistically significant and clinically important changes after treatment (p<0.05) for all five measures. Binge-eating severity and frequency decreased, depression decreased, body image improved, and self-esteem improved. All changes were greater in the six-week treatment group. CONCLUSIONS: The dietitian-administered, group setting CBT program is effective for reducing binge eating and improving emotional state in obese women.

Can J Diet Pract Res. 2007 Autumn;68(3):139-42. Shelley-Ummenhofer J, MacMillan PD. Integrated Health Centre, Penticton, BC.

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, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.

Behav Modif. 2007 Nov;31(6):772-99. Forman EM, Herbert JD, Moitra E, Yeomans PD, Geller PA. Department of Psychology, Drexel University. evan.forman@drexel.edu.

RATIONALE: This study examines the effect of Skill Training In Affect Regulation (STAIR) on a cohort of 24 inpatients with Schizophrenia with histories of significant trauma and Complex PTSD. METHOD: Using a model of Trauma Healing proposed by the NYS Office of Mental Health, 24 patients underwent 12 weeks of group-based Cognitive Behavior Therapy. Treatment modalities focused on trust, safety, affect-regulation, identification of trauma triggers, and disrupting abuse-driven behaviors. A comparison group of patients received 12 weeks of supportive psychotherapy by therapists unfamiliar with Trauma Management. Treatment outcome was compared using the Modified Impact of Events, and Brief Psychiatric Rating Scales. RESULTS: Following completion of 12 weeks of therapy, only those patients undergoing therapy in Trauma Recovery showed improvement on items such as tension, excitement, hostility, suspiciousness, and anger-control. CONCLUSION: These findings are an encouraging first step in trauma recovery of patients with chronic mental illness, histories of prolonged trauma, and Complex PTSD.

Psychiatr Q. 2007 Dec;78(4):317-25. Trappler B, Newville H. SUNY Downstate, Kingsboro Psychiatric Center, Clarkson Avenue, Brooklyn, NY, 11203, USA, kbmdbtt@omh.state.ny.us.

Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to conventional antipsychotic medication were randomized to CBT or befriending. They were assessed using the Comprehensive Psychopathological Rating Scale, including a rating of suicidal ideation at baseline, post intervention, and after 9 months. Post-hoc analysis revealed that CBT provided significant reductions in suicidal ideation at the end of therapy, and sustained at the follow-up. Further research is required to substantiate these findings and determine the process and mechanisms through which this reduction is achieved.

Suicide Life Threat Behav. 2007 Jun;37(3):284-90.

Bateman K, Hansen L, Turkington D, Kingdon D.

University of Newcastle, UK.

We describe the development of a cognitive therapy intervention for chronic insomnia. The therapy is based on a cognitive model which suggests that the processes that maintain insomnia include: (1) worry and rumination, (2) attentional bias and monitoring for sleep-related threat, (3) unhelpful beliefs about sleep, (4) misperception of sleep and daytime deficits and (5) the use of safety behaviors that maintain unhelpful beliefs. The aim of cognitive therapy for insomnia is to reverse all five maintaining processes during both the night and the day. In an open trial 19 patients meeting diagnostic criteria for primary insomnia were treated with cognitive therapy for insomnia. Assessments were completed pretreatment, posttreatment and at 3-, 6- and 12-month followup. The significant improvement in both nighttime and daytime impairment evident at the posttreatment assessment was retained up to the 12 month followup. Behav Res Ther. 2007 Apr 22; [Epub ahead of print]

Harvey AG, Sharpley AL, Ree MJ, Stinson K, Clark DM.

Department of Psychology, Sleep and Psychological Disorders Lab, University of California, 3210 Tolman Hall #1650, Berkeley, CA 94720-1650, USA.

Although several efficacious treatments for posttraumatic stress disorder (PTSD) exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment given a wide range of treatment options in an analog sample. One hundred and sixty individuals, with varying degrees of trauma history, were asked to imagine themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated seven different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive-behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors.

Behav Res Ther. 2007 May 31; [Epub ahead of print] Becker CB, Darius E, Schaumberg K.

Department of Psychology, Trinity University, One Trinity Place, San Antonio, TX 78212-7200, USA.