Co-occurring posttraumatic stress disorder (PTSD) is prevalent in addiction treatment programs and a risk factor for negative outcomes. Although interventions have been developed to address substance use and PTSD, treatment options are needed that are effective, well tolerated by patients, and potentially integrated with existing program services. This paper describes a cognitive behavioral therapy (CBT) for PTSD that was adapted from a treatment for persons with severe mental illnesses and PTSD in community mental health settings. The new adaptation is for patients in community addiction treatment with co-occurring PTSD and substance use disorders. In this study, 5 community therapists delivered the CBT for PTSD. Outcome data are available on 11 patients who were assessed at baseline, post-CBT treatment, and at a 3-month follow-up post-treatment. Primary outcomes were substance use, PTSD severity, and retention, of which all were favorable for patients receiving the CBT for PTSD.

Addict Behav. 2009 Oct;34(10):892-7. Epub 2009 Mar 14. McGovern MP, Lambert-Harris C, Acquilano S, Xie H, Alterman AI, Weiss RD. Dartmouth Medical School, 2 Whipple Place, Lebanon, NH 03766, USA. mark.p.mcgovern@dartmouth.edu

Full Title: Cognitive-behavioral family treatment for childhood obsessive-compulsive disorder: a 7-year follow-up study

This study evaluated the long-term durability of individual and group cognitive-behavioral family-based therapy (CBFT) for childhood obsessive-compulsive disorder (OCD). Thirty-eight participants (age 13-24 years) from a randomized controlled trial of individual or group CBFT for childhood OCD were assessed 7 years post-treatment. Diagnostic, symptom severity interviews and self-report measures of OCD, anxiety, and depression were administered. Seven years after treatment, 79% of participants from individual therapy and 95% from group therapy had no diagnosis of OCD. These results are near identical to results found at 12 and 18 months follow-ups of the same sample. No significant differences were found between treatment conditions, self-reports of symptom severity, except that depressive symptoms were significantly more pronounced for individual treatment condition, and those in the older age group (19-24 years of age). Results suggest that CBFT for obsessive-compulsive disorder is effective 7 years post-treatment.

J Anxiety Disord. 2009 Oct;23(7):973-8. Epub 2009 Jun 26. O'Leary EM, Barrett P, Fjermestad KW. Pathways Health and Research Centre, PO Box 5699, West End, Brisbane, QLD, 4101, Australia. emilyoleary@pathwayshrc.com.au

Full Title: Changes in maternal expressed emotion toward clinically anxious children following cognitive behavioral therapy

The aim of this study was to determine whether maternal expressed emotion (criticism and emotional overinvolvement) decreased across treatment for childhood anxiety. Mothers of 48 clinically anxious children (aged 6-14 years) were rated on levels of criticism (CRIT) and emotional overinvolvement (EOI), as measured by a Five Minute Speech Sample (FMSS) from mothers, prior to and following cognitive behavioral therapy (CBT) for their children's anxiety. Results showed a significant decrease in the proportion of mothers who expressed high levels of criticism and emotional overinvolvement from pretreatment to posttreatment. This finding suggests that interventions aimed at reducing symptoms of child anxiety can also result in a decrease of maternal expressed emotion (criticism and emotional overinvolvement).

J Exp Child Psychol. 2009 Nov;104(3):346-52. Epub 2009 Aug 5. Gar NS, Hudson JL. Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW 2109, Australia.

Full Title: Cognitive Behavioral Therapy for Anxiety and Depression: Possibilities and Limitations of a Transdiagnostic Perspective

In the last several years, a number of researchers have developed a transdiagnostic or unified group cognitive behavioral therapy (CBT) that is provided to a diagnostically heterogeneous group consisting of individuals with various anxiety disorders and/or depression. This article provides a review of recent developments within this transdiagnostic perspective to CBT. Three approaches to transdiagnostic CBT are considered that vary in their theoretical emphasis. At this time, the unified protocol for emotional disorders offers the most cogent theory-driven transdiagnostic treatment approach, although its efficacy has yet to be demonstrated. The advantages and challenges of transdiagnostic CBT are reviewed, and the article concludes with a proposal that future research on transdiagnostic CBT would be better served if viewed as complementary rather than antagonist to well-established manualized disorder-specific CBT for the anxiety disorders and depression.

Cogn Behav Ther. 2009 Aug 17:1. Clark DA. Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada.

Full Title: Cognitive behavioral management of Tourette's syndrome and chronic tic disorder in medicated and unmedicated samples

OBJECTIVE: Cognitive behavior therapy (CBT) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication. The current study compares the efficacy of CBT in combination with medication and without medication. METHOD: CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder. The sample was divided into a medicated and a non-medicated group. Twenty three were stabilized on medication and 53 were not receiving medication. Measures administered pre- and post-CBT in both groups included: main outcome measure of Tourette Syndrome Global Scale and measures of mood. RESULTS: Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome. A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences, either in treatment outcome on main tic outcome measures or on other clinically relevant questionnaires. DISCUSSION: CBT for tic disorders is an effective treatment administered either in combination with medication or alone.

Behav Res Ther. 2009 Aug 5. O'Connor KP, Laverdure A, Taillon A, Stip E, Borgeat F, Lavoie M. Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital 7331 Hochelaga St. Montreal (Quebec) H1N 3V2 Canada.

Full Title: Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: a randomized, controlled trial

OBJECTIVE: While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatment for generalized anxiety disorder, few studies have addressed the outcome of short-term psychodynamic psychotherapy, even though this treatment is widely used. The aim of this study was to compare short-term psychodynamic psychotherapy and CBT with regard to treatment outcome in generalized anxiety disorder. METHOD: Patients with generalized anxiety disorder according to DSM-IV were randomly assigned to receive either CBT (N=29) or short-term psychodynamic psychotherapy (N=28). Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. The primary outcome measure was the Hamilton Anxiety Rating Scale, which was applied by trained raters blind to the treatment conditions. Assessments were carried out at the completion of treatment and 6 months afterward. RESULTS: Both CBT and short-term psychodynamic psychotherapy yielded significant, large, and stable improvements with regard to symptoms of anxiety and depression. No significant differences in outcome were found between treatments in regard to the primary outcome measure. These results were corroborated by two self-report measures of anxiety. In measures of trait anxiety, worry, and depression, however, CBT was found to be superior. CONCLUSIONS: The results suggest that CBT and short-term psychodynamic psychotherapy are beneficial for patients with generalized anxiety disorder. In future research, large-scale multicenter studies should examine more subtle differences between treatments, including differences in the patients who benefit most from each form of therapy.

Am J Psychiatry. 2009 Aug;166(8):875-81. Epub 2009 Jul 1. Leichsenring F, Salzer S, Jaeger U, Kächele H, Kreische R, Leweke F, Rüger U, Winkelbach C, Leibing E. Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany. falk.leichsenring@psycho.med.uni-giessen.de

Central to psychotic disorders, delusions are associated with disability and often respond inadequately to pharmacotherapy. Cognitive-behavioral treatments have been developed over the last 20 years that successfully address delusions. However, meta-analyses suggest only a modest improvement in psychotic symptoms. Because delusions share considerable overlap with anxiety, adapting principles and techniques that have demonstrated efficacy in the treatment of anxiety disorders might improve the impact of cognitive-behavioral treatment of delusions. We report a case illustrating a cognitive-behavioral approach to delusions with an emphasis on mental imagery techniques. A 25-year-old male diagnosed with paranoid schizophrenia whose clinical presentation was dominated by paranoid delusions received 6 months of treatment. At the end of the follow-up period, the patient's delusions were minimal and his negative symptoms had significantly improved. Mental imagery may be an important treatment tool for delusions.

J Clin Psychol. 2009 Aug;65(8):791-802. Serruya G, Grant P. School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

This study investigated sudden gains, i.e., rapid and stable improvements, in posttraumatic stress disorder (PTSD) symptoms that may occur in cognitive-behavioral therapy. Twenty-nine of 72 participants (39.2%) experienced a sudden gain during treatment. Mixed model ANOVAs analyzed sudden gains impact on clinician-rated PTSD symptom severity, patient-rated PTSD symptom severity, and patient-rated depressive symptom severity. Sudden gains in PTSD symptomology were associated with greater reductions in PTSD symptom severity for the avoidance/numbing and hyperarousal symptom clusters at posttreatment. By 6-month follow-up, the sudden gains group had maintained those reductions in symptoms, but the nonsudden gains group had achieved equal reductions in symptom severity. Participants experiencing sudden gains on PTSD measures had lower depression severity at posttreatment and follow-up.

J Trauma Stress. 2009 Aug;22(4):287-93. Kelly KA, Rizvi SL, Monson CM, Resick PA. Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA.

Full Title: Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients

Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.

Kidney Int. 2009 Aug;76(4):414-21. Epub 2009 May 20. Duarte PS, Miyazaki MC, Blay SL, Sesso R. Department of Medicine, Division of Nephrology, Federal University of São Paulo, Sao Paulo, Brazil. psduarte@nefro.epm.br

BACKGROUND: Irritable bowel syndrome (IBS), a functional bowel disorder with symptoms of abdominal pain and disturbed defecation experienced by 10% of U.S. adults, results in significant disability, impaired quality of life, and health-care burden. Conventional medical care focusing on pharmacological approaches, diet, and lifestyle management has been partially effective in controlling symptoms. Behavioral treatments, such as cognitive-behavioral therapy and hypnosis, are promising. This paper describes an on-going feasibility study to assess the efficacy of mindfulness training, a behavioral treatment involving directing and sustaining attention to present-moment experience, for the treatment of IBS. METHODS/DESIGN: The study design involves randomization of adult women with IBS according to Rome II criteria, to either an eight-week mindfulness training group (based on a Mindfulness-based Stress Reduction [MBSR] format) or a previously validated IBS social-support group as an attention-control condition. The primary hypothesis is that, compared to Support Group participants, those in the Mindfulness Program will demonstrate significant improvement in IBS symptoms as measured by the IBS Symptom Severity Scale [1]. DISCUSSION: 214 individuals have been screened for eligibility, of whom 148 were eligible for the study. Of those, 87 were enrolled, with 21 withdrawing after having given consent. 66 have completed or are in the process of completing the interventions. It is feasible to undertake a rigorous randomized clinical trial of mindfulness training for people with IBS, using a standardized MBSR protocol adapted for those experiencing IBS, compared to a control social-support group previously utilized in IBS studies. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00680693.

BMC Complement Altern Med. 2009 Jul 28;9:24. Gaylord SA, Whitehead WE, Coble RS, Faurot KR, Palsson OS, Garland EL, Frey W, Mann JD. Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. susan_gaylord@med.unc.edu

Full Title: Cognitive Behavioral Therapy and Schizophrenia: A Survey of Clinical Practices and Views on Efficacy in the United States and United Kingdom

Research has shown that cognitive-behavioral therapy (CBT) is effective in the treatment of schizophrenia (Wykes et al. in Schizophr Bull 34(3):523-537, 2008). The majority of this research has been conducted in the United Kingdom (Beck and Rector in Am J Psychother 54:291-300, 2000) where the National Health Service recommends that CBT be delivered to all people with schizophrenia (NICE in Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care (update). http://www.nice.org.uk/Guidance/CG82/NiceGuidance/pdf/English , 2009). In contrast, the corresponding American Psychiatric Association guidelines describe CBT as an adjunctive technique that "may benefit" patients (Lehman et al. in Am J Psychiatry 161:1-56, 2004, p. 35). Anecdotal evidence also suggests a difference between UK and US clinicians' use of and views on CBT with schizophrenia (Tarrier in Clinical handbook of psychological disorders: a step-by-step treatment manual. Guilford, New York, 2008). In the present study 214 clinicians in the UK and US completed an internet survey examining this apparent discrepancy. UK and US participants were equally aware that empirical research supports the efficacy of CBT with schizophrenia. However, UK participants were more likely to practice CBT, rated CBT effectiveness more highly, and were more optimistic about the chances of recovery. These findings suggest fundamental differences in the attitudes and practices of UK and US clinicians.

Community Ment Health J. 2009 Jul 25. Kuller AM, Ott BD, Goisman RM, Wainwright LD, Rabin RJ. Massachusetts School of Professional Psychology, 221 Rivermoor Street, West Roxbury, MA, 02132, USA, andrew_kuller@mspp.edu.

Full Title: Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer

BACKGROUND: A diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients. METHODS: Women with Stages 1-3 breast cancer recruited 4-8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition. RESULTS: Of 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-gamma] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period. CONCLUSIONS: This intervention may have facilitated a "recovery or maintenance" of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.

Brain Behav Immun. 2009 Jul;23(5):580-91. Epub 2008 Sep 20. Antoni MH, Lechner S, Diaz A, Vargas S, Holley H, Phillips K, McGregor B, Carver CS, Blomberg B. Department of Psychology, University of Miami, Coral Gables, FL 33124, USA. ntoni@miami.edu

Full Title: Does the form or the amount of exposure make a difference in the cognitive-behavioral therapy treatment of social phobia?

Exposure is considered to be an essential ingredient of cognitive-behavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure.

J Nerv Ment Dis. 2009 Jul;197(7):507-13. Borgeat F, Stankovic M, Khazaal Y, Rouget BW, Baumann MC, Riquier F, O'Connor K, Jermann F, Zullino D, Bondolfi G. Department of Psychiatry, University of Lausanne, Lausanne, Switzerland. francois.borgeat@umontreal.ca

Full Title: Computer-assisted CBT for depression & anxiety: increasing accessibility to evidence-based mental health treatment

Cognitive-behavioral therapy (CBT) is the most effective nonpharmacological treatment for almost all mental disorders, especially anxiety and depression. The treatment is time limited, encourages self-help skills, is problem focused, is inductive, and requires that individuals develop and practice skills in their own environment through homework. However, most of those with mental health issues are unable to seek help because of factors related to treatment availability, accessibility, and cost. CBT is well suited to computerization and is easy to teach to nurses. In this article we describe outcome studies of computer-assisted CBT (cCBT), outline the current technologies available, discuss concerns and resistance associated with computerized therapy, and consider the role of nurses in using cCBT.

J Psychosoc Nurs Ment Health Serv. 2009 Jul;47(7):32-9. Stuhlmiller C, Tolchard B. School of Social Work, Office of Public Health Studies, University of Hawaii Manoa, Honolulu, HI 96822, USA. cstu@hawaii.edu

Full Title: The impact of cognitive behavioral group training on event-free survival in patients with myocardial infarction: the ENRICHD experience

OBJECTIVE: Although the Enhancing Recovery in Coronary Heart Disease (ENRICHD) treatment was designed to include individual therapy and cognitive behavioral group training for patients with depression and/or low perceived social support, only 31% of treated participants received group training. Secondary analyses classified intervention participants into two subgroups, (1) individual therapy only or (2) group training (i.e., coping skills training) plus individual therapy, to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care. METHODS: Secondary analyses of 1243 usual care, 781 individual therapy only, and 356 group plus individual therapy myocardial infarction (MI) patients were performed. Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; low perceived social support was determined by the ENRICHD Social Support Instrument. Psychosocial treatment followed MI, and for participants with severe or unremitting depression, was supplemented with a selective serotonin reuptake inhibitor. Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI. To control for confounding of group participation with survival (because individual sessions preceded group), we used risk set sampling to match minimal survival time of those receiving or not receiving group training. RESULTS: Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33% reduction (hazard ratio=0.67; 95% confidence interval, 0.49-0.92, P=.01) in medical outcome compared to usual care. No significant effect on event-free survival was associated with individual therapy alone. The group training benefit was reduced to 23% (hazard ratio=0.77; 95% confidence interval: 0.56-1.07, P=.11) in the multivariate-adjusted model. CONCLUSIONS: Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point. A randomized controlled trial is warranted to definitively resolve this issue.

J Psychosom Res. 2009 Jul;67(1):45-56. Epub 2009 Apr 1. Saab PG, Bang H, Williams RB, Powell LH, Schneiderman N, Thoresen C, Burg M, Keefe F; ENRICHD Investigators. Department of Psychology, University of Miami, Coral Gables, FL 33124, USA. psaab@miami.edu

Full Title: Cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity

OBJECTIVE: The Mediterranean dietary pattern improves cardiovascular disease factors. More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss. The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss. METHODS: A total of 1406 obese subjects (body mass index, 31+/-5kg/m(2)), aged 20-65 y, from a Mediterranean area in southeast Spain were subjected to a weight-reduction program. To evaluate effectiveness, weight loss, body fat distribution, biochemical variables, blood pressure changes, mean duration of treatment, percentage of attrition, and the ability to fulfill a Mediterranean diet pattern were assessed. To determine the main barriers to losing weight, a "Barriers to Weight Loss" checklist was completed. RESULTS: The behavioral therapy program was effective for the treatment of obesity. The average weight loss was 7.7kg. The duration of treatment was 34 wk. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Attrition was 4-9%, with the main reason being stress (37%). Main obstacles to weight loss were "losing motivation," being "prone to stress-related eating," and being liable to eat when bored. Recording food intake and assisting group therapy were also important tools for losing weight (P< or =0.05). CONCLUSIONS: Dietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice. Nutrition professionals should encourage their patients to record food intake and to attend group therapy.

Nutrition. 2009 Jul-Aug;25(7-8):861-9. Corbalán MD, Morales EM, Canteras M, Espallardo A, Hernández T, Garaulet M. Department of Physiology, University of Murcia, Spain.

Full Title: Preliminary Efficacy of a Cognitive-Behavioral Treatment Program for Anxious Youth with Autism Spectrum Disorders

Anxiety is a commonly occurring psychiatric concern in adolescents with autism spectrum disorders (ASD). This pilot study examined the preliminary efficacy of a manual-based intervention targeting anxiety and social competence in four adolescents with high-functioning ASD. Anxiety and social functioning were assessed at baseline, midpoint, endpoint, and 6 months following treatment. Treatment consisted of cognitive-behavioral therapy, supplemented with parent education and group social skills training. The treatment program was effective in reducing anxiety in three of the four subjects and improving the social skills in all four subjects. Recommendations for the assessment and treatment of anxiety youth with ASD such as use of self-report measures to complement clinician and parent-reports and adaptations to traditional child-based CBT, are offered.

J Autism Dev Disord. 2009 Jun 30. White SW, Ollendick T, Scahill L, Oswald D, Albano AM. Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall (0436), Blacksburg, VA, 24061, USA, sww@vt.edu.

Full Title: Brief Report: Effects of Cognitive Behavioral Therapy on Parent-Reported Autism Symptoms in School-Age Children with High-Functioning Autism

This pilot study tested the effect of cognitive behavioral therapy (CBT) on parent-reported autism symptoms. Nineteen children with autism spectrum disorders and an anxiety disorder (7-11 years old) were randomly assigned to 16 sessions of CBT or a waitlist condition. The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills. Parents completed a standardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessments. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms (Cohen's d effect size = .77). Treatment gains were maintained at 3-month follow-up. Further investigation of this intervention modality with larger samples and broader outcome measures appears to be indicated.

J Autism Dev Disord. 2009 Jun 27. Wood JJ, Drahota A, Sze K, Van Dyke M, Decker K, Fujii C, Bahng C, Renno P, Hwang WC, Spiker M. University of California, Moore Hall Box 951521, Los Angeles, CA, 90095, USA, jeffwood@ucla.edu.

Full Title: Dorsolateral Prefrontal Cortex Activity Predicts Responsiveness to Cognitive-Behavioral Therapy in Schizophrenia

BACKGROUND: Given the variable response to cognitive-behavioral therapy (CBT) when added to antipsychotic medication in psychosis and the evidence for a role of pretherapy level of frontal lobe-based cognitive function in responsiveness to CBT in other disorders, this study examined whether pretherapy brain activity associated with working memory neural network predicts clinical responsiveness to CBT in schizophrenia. METHODS: Fifty-two outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBT in addition to their usual treatment and 20 healthy participants underwent functional magnetic resonance imaging during a parametric n-back task. Subsequently, 26 patients received CBT for psychosis (CBT+treatment-as-usual [TAU], 19 completers) for 6-8 months, and 26 continued with TAU alone (17 completers). Symptoms in both patient groups were assessed (blindly) at entry and follow-up. RESULTS: The CBT+TAU and TAU-alone groups did not differ clinically or in performance at baseline. The CBT+TAU group showed significant improvement in relation to the TAU-alone group, which showed no change, at follow-up. Stronger dorsolateral prefrontal cortex (DLPFC) activity (within the normal range) and DLPFC-cerebellum connectivity during the highest memory load condition (2-back > 0-back) were associated with post-CBT clinical improvement. CONCLUSIONS: DLPFC activity and its connectivity with the cerebellum predict responsiveness to CBT for psychosis in schizophrenia. These effects may be mediated by PFC-cerebellum contributions to executive processing.

Biol Psychiatry. 2009 Jun 25. Kumari V, Peters ER, Fannon D, Antonova E, Premkumar P, Anilkumar AP, Williams SC, Kuipers E. Department of Psychology, Institute of Psychiatry, King's College London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom.

BACKGROUND: Data about quality of life (QoL) are important to estimate the impact of diseases on functioning and well-being. The present study was designed to assess the association of different aspects of panic disorder (PD) with QoL and to examine the relationship between QoL and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT). METHOD: The sample consisted of 55 consecutively recruited outpatients suffering from PD who underwent CBGT. QoL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) at baseline, post-treatment and six months follow-up. SF-36 baseline scores were compared with normative data obtained from a large German population sample. RESULTS: Agoraphobia, disability, and worries about health were significantly associated with decreased QoL, whereas frequency, severity and duration of panic attacks were not. Treatment responders showed significantly better QoL than non-responders. PD symptom reduction following CBGT was associated with considerable improvement in emotional and physical aspects of QoL. However, the vitality subscale of the SF-36 remained largely unchanged over time. CONCLUSIONS: Our results are encouraging for cognitive-behavior therapists who treat patients suffering from PD in groups, since decrease of PD symptoms appears to be associated with considerable improvements in QoL. Nevertheless, additional interventions designed to target specific aspects of QoL, in particular vitality, may be useful to enhance patients' well-being.

Eur Psychiatry. 2009 Jun 20. Rufer M, Albrecht R, Schmidt O, Zaum J, Schnyder U, Hand I, Mueller-Pfeiffer C. Department of Psychiatry, University Hospital of Zürich, Culmannstrasse 8, 8091 Zürich, Switzerland.

Full Title: Developing an integrated treatment for substance use and depression using cognitive-behavioral therapy

Providing a unified treatment approach to meet the substance abuse and mental health needs of clients is the preferred model for addressing co-occurring disorders. We developed a group-based cognitive-behavioral (CBT) integrated treatment for depression and substance use disorders (SUD) that could be delivered by counselors in SUD treatment settings and evaluated its feasibility and acceptability. We conducted an in-depth case study examining one implementation of the treatment using 15 focus groups with clients (n = 7) and semistructured interviews with counselors (n = 2) and administrators (n = 3). Using CBT as a treatment approach to integrate the treatment was widely accepted by clients, counselors, and administrators. Clients stated the treatment was applicable to multiple aspects of their lives and allowed them to recognize their clinical improvements over time. Counselors and administrators discussed challenges for long-term feasibility. Key decisions used to develop the treatment and recommendations for implementing integrated care in SUD settings are discussed.

J Subst Abuse Treat. 2009 Jun 19. Osilla KC, Hepner KA, Muñoz RF, Woo S, Watkins K. RAND Corporation, PO Box 2138, Santa Monica, CA 90407-2138, USA.

Full Title: Cognitive behavioral therapy and physical exercise for climacteric symptoms in breast cancer patients experiencing treatment-induced menopause: design of a multicenter trial

BACKGROUND: Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer. Hormone replacement therapy is contraindicated in women with a history of breast cancer. Non-hormonal medications show a range of bothersome side-effects. There is growing evidence that cognitive behavioral therapy (CBT) and physical exercise can have a positive impact on symptoms in naturally occurring menopause. The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause. METHODS/DESIGN: In a randomized, controlled, multicenter trial, we are evaluating the effectiveness of CBT/relaxation, of physical exercise and of these two program elements combined, in reducing menopausal symptoms, improving sexual functioning, reducing emotional distress, and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause. 325 breast cancer patients (aged < 50) are being recruited from hospitals in the Amsterdam region, and randomly allocated to one of the three treatment groups or a 'waiting list' control group. Self-administered questionnaires are completed by the patients at baseline, and at 12 weeks (T1) and 6 months (T2) post-study entry. Upon completion of the study, women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program. DISCUSSION: Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced, premature menopause. For these patients, hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects. Hence, research into these interventions is needed, before dissemination and implementation in the current health care system can take place.

BMC Womens Health. 2009 Jun 6;9:15. Duijts SF, Oldenburg HS, van Beurden M, Aaronson NK. The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands. s.duijts@nki.nl

Full Title: Randomized controlled trial of a cognitive-behavioral intervention for HIV-positive persons: an investigation of treatment effects on psychosocial adjustment

Questions remain regarding the clinical utility of psychological interventions for HIV-positive persons because randomized controlled trials have utilized stringent inclusion criteria and focused extensively on gay men. The present randomized controlled trial examined the efficacy of a 15-session, individually delivered cognitive-behavioral intervention (n = 467) compared to a wait-list control (n = 469) in a diverse sample of HIV-positive persons who reported HIV transmission risk behavior. Five intervention sessions that dealt with executing effective coping responses were delivered between baseline and the 5 months post-randomization. Additional assessments were completed through 25 months post-randomization. Despite previously documented reductions in HIV transmission risk, no intervention-related changes in psychosocial adjustment were observed across the 25-month investigation period. In addition, there were no intervention effects on psychosocial adjustment among individuals who presented with mild to moderate depressive symptoms. More intensive mental health interventions may be necessary to improve psychosocial adjustment among HIV-positive individuals.

AIDS Behav. 2009 Jun;13(3):555-63. Epub 2008 Jul 15. Carrico AW, Chesney MA, Johnson MO, Morin SF, Neilands TB, Remien RH, Rotheram-Borus MJ, Lennie Wong F; NIMH Healthy Living Project Team. Collaborators (43) Chesney MA, Ehrhardt AA, Kelly JA, Pequegnat W, Rotheram-Borus MJ, Benotsch EG, Brondino MJ, Catz SL, Charlebois ED, DesJarlais DC, Duan N, Exner TM, Goldstein RB, Gore-Felton C, Hirky AE, Johnson MO, Kertzner RM, Kirshenbaum SB, Kittel LE, Klitzman R, Lee M, Levin B, Lightfoot M, Morin SF, Pinkerton SD, Remien RH, Rhodes F, Tross S, Weinhardt LS, Weiss R, Wolfe H, Wolfe R, Wong L, Batterham P, Rogers T, Hackl K, Hong D, Huchting K, Mickalian JD, Peterson M, Gordon CM, Rausch D, Stover E. Department of Psychiatry, Health Psychology Program, University of California, San Francisco, 3333 California St., Suite 465, Box 0848, San Francisco, CA 94143-0848, USA. adam.carrico@ucsf.edu

Full Title: The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

OBJECTIVE: A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa. METHOD: A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted. RESULTS: The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results. DISCUSSION: In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.

Behav Res Ther. 2009 Jun;47(6):451-3. Epub 2009 Feb 20. Crow SJ, Mitchell JE, Crosby RD, Swanson SA, Wonderlich S, Lancanster K. Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454-1495, USA. crowx002@umn.edu

Full Title: A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients-A randomized controlled trial.

OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.

Patient Educ Couns. 2009 Mar 16. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins PE, Adamson U, Johansson UB. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, House 17, 4th floor, SE-182 88 Stockholm, Sweden; Sophiahemmet University College Stockholm, Sweden.

Research using theory-based interventions to promote regular physical activity (PA) has increased substantially over the past decade. The purpose of this article is to provide a review and summary of PA intervention research specific to fidelity to intervention theory, providing an overview of the concept of fidelity to intervention theory, defining the evaluative components of fidelity: (a) conceptualization of the problem, (b) operationalization of the theory, (c) specification of mediating processes, and (d) specification of outcome variables. Using journal scans and computerized literature database searches, the authors identified 470 PA activity intervention studies that incorporated a theoretical perspective. A validity framework explicated by was used to summarize intervention research in light of fidelity to intervention theory. In all, 15 intervention studies met the inclusion criteria and were incorporated into the review. Theoretical models for health behavior change, including social cognitive theory (SCT), cognitive behavioral theory (CBT), the transtheoretical model (TTM, the TTM combined with SCT), the reversal theory (theory of psychological reversals), and the disconnected values theory, were used as a basis for intervention design and evaluation.

West J Nurs Res. 2009 Apr;31(3):289-311. Keller C, Fleury J, Sidani S, Ainsworth B. Arizona State University, USA. colleen.keller@asu.edu

Full Title: Cognitive-behavioral therapy for anxiety-disordered youth: secondary outcomes from a randomized clinical trial evaluating child and family modalities.

This study examined secondary outcomes of a randomized clinical trial that evaluated an individual cognitive-behavioral (ICBT), family-based cognitive-behavioral (FCBT), and family-based education, support and attention (FESA) treatment for anxious youth. Participants (161) were between 7 and 14 years (M=10.27) of age and had a principal diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Hierarchical linear modeling examined youth-reported depressive symptomatology and parent- and teacher-reported externalizing behavior and adaptive functioning at pretreatment, posttreatment, and 1-year follow-up. In general, youth in all treatments evidenced improvements in most domains, with improvements maintained at follow-up. Overall, gender and age did not moderate treatment outcomes. The results suggest that both child and family cognitive-behavioral therapy, and the family-based supportive approach used in this study, can be effective in addressing some of the associated symptoms and adaptive functioning deficits typically linked to anxiety in youth.

J Anxiety Disord. 2009 Apr;23(3):341-9. Suveg C, Hudson JL, Brewer G, Flannery-Schroeder E, Gosch E, Kendall PC. Psychology Building, Department of Psychology, University of Georgia, Athens, GA 30602, USA. csuveg@uga.edu

Full Title; Maintenance treatment for anorexia nervosa: a comparison of cognitive behavior therapy and treatment as usual.

OBJECTIVE: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU). METHOD: This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse. RESULTS: When relapse was defined as a BMI Int J Eat Disord. 2009 Apr;42(3):202-7. Carter JC, McFarlane TL, Bewell C, Olmsted MP, Woodside DB, Kaplan AS, Crosby RD. Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada. jacqueline.carter@uhn.on.ca

BACKGROUND: Effective treatment of chronic fatigue syndrome (CFS) with cognitive behavioural therapy (CBT) relies on a correct classification of so called 'fluctuating active' versus 'passive' patients. For successful treatment with CBT is it especially important to recognise the passive patients and give them a tailored treatment protocol. In the present study it was evaluated whether CFS patient's physical activity pattern can be assessed most accurately with the 'Activity Pattern Interview' (API), the International Physical Activity Questionnaire (IPAQ) or the CFS-Activity Questionnaire (CFS-AQ). METHODS: The three instruments were validated compared to actometers. Actometers are until now the best and most objective instrument to measure physical activity, but they are too expensive and time consuming for most clinical practice settings. In total 226 CFS patients enrolled for CBT therapy answered the API at intake and filled in the two questionnaires. Directly after intake they wore the actometer for two weeks. Based on receiver operating characteristic (ROC) curves the validity of the three methods were assessed and compared. RESULTS: Both the API and the two questionnaires had an acceptable validity (0.64 to 0.71). None of the three instruments was significantly better than the others. The proportion of false predictions was rather high for all three instrument. The IPAQ had the highest proportion of correct passive predictions (sensitivity 70.1%). CONCLUSION: The validity of all three instruments appeared to be fair, and all showed rather high proportions of false classifications. Hence in fact none of the tested instruments could really be called satisfactory. Because the IPAQ showed to be the best in correctly predicting 'passive' CFS patients, which is most essentially related to treatment results, it was concluded that the IPAQ is the preferable alternative for an actometer when treating CFS patients in clinical practice.

Health Qual Life Outcomes. 2009 Apr 1;7:29. Scheeres K, Knoop H, Meer J, Bleijenberg G. Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre (4628), PO Box 9101, 6500 HB Nijmegen, The Netherlands. korinescheeres@gmail.com

BACKGROUND: Increasing evidence supports the use of cognitive-behavioral therapy (CBT) for patients with chronic pain. OBJECTIVE: This study determined whether physical therapists incorporate CBT techniques (eg, relaxation, activity pacing) when treating older patients with chronic pain, ascertained their interest in and barriers to using CBT, and identified participant-related factors associated with interest in CBT. DESIGN: This cross-sectional study used a telephone survey. METHODS: One hundred fifty-two members of the Geriatrics and Orthopaedics sections of the American Physical Therapy Association completed the survey. Associations between participant-related factors and interest in CBT were assessed in statistical general linear models. RESULTS: Commonly used CBT interventions included activity pacing and pleasurable activity scheduling, frequently used by 81% and 30% of the respondents, respectively. Non-CBT treatments included exercises focusing on joint stability (94%) and mobility (94%), and strengthening and stretching programs (91%). Respondents' overall interest in CBT techniques was 12.70 (SD=3.4, scale range=5-20). Barriers to use of CBT included lack of knowledge of and skill in the techniques, reimbursement concerns, and time constraints. Practice type and the interaction of percentage of patients with pain and educational degree of the physical therapist were independently associated with provider interest in CBT in a general linear model that also included 6 other variables specified a priori. LIMITATIONS: Data are based on self-report without regard to treatment emphasis. CONCLUSIONS: Although only a minority of physical therapists reported use of some CBT techniques when treating older patients with chronic pain, their interest in incorporating these techniques into practice is substantial. Concerns with their skill level using the techniques, time constraints, and reimbursement constitute barriers to use of the interventions.

Phys Ther. 2009 May;89(5):456-69. Beissner K, Henderson CR Jr, Papaleontiou M, Olkhovskaya Y, Wigglesworth J, Reid MC. Department of Physical Therapy, Ithaca College, 953 Danby Rd, Ithaca, NY 14850, USA. beissner@ithaca.edu

Full Title: Cognitive-behavioural therapy for young children with anxiety disorders: Comparison of a Child + Parent condition versus a Parent Only condition.

The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery.

Behav Res Ther. 2009 May 7. Waters AM, Ford LA, Wharton TA, Cobham VE. School of Psychology, Griffith University, Queensland, Gold Coast Campus, QLD 4222, Australia.

Cognitive deficits are routinely evident in schizophrenia, and are of sufficient magnitude to influence functional outcomes in work, social functioning and illness management. Cognitive remediation is an evidenced-based non-pharmacological treatment for the neurocognitive deficits seen in schizophrenia. Narrowly defined, cognitive remediation is a set of cognitive drills or compensatory interventions designed to enhance cognitive functioning, but from the vantage of the psychiatric rehabilitation field, cognitive remediation is a therapy which engages the patient in learning activities that enhance the neurocognitive skills relevant to their chosen recovery goals. Cognitive remediation programs vary in the extent to which they reflect these narrow or broader perspectives but six meta-analytic studies report moderate range effect sizes on cognitive test performance, and daily functioning. Reciprocal interactions between baseline ability level, the type of instructional techniques used, and motivation provide some explanatory power for the heterogeneity in patient response to cognitive remediation.

Neuropsychol Rev. 2009 May 15. Medalia A, Choi J. Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA, amedalia@aol.com.

There is a paucity of empirical study about the effects of evidence-based psychotherapy for posttraumatic stress disorder (PTSD) on concurrent health concerns including sleep impairment. This study compares the differential effects of cognitive processing therapy (CPT) and prolonged exposure (PE) on health-related concerns and sleep impairment within a PTSD sample of female, adult rape survivors (N = 108). Results showed that participants in both treatments reported lower health-related concerns over treatment and follow-up, but there were relatively more improvements in the CPT condition. Examination of sleep quality indicated significant improvement in both CPT and PE across treatment and follow-up and no significant differences between treatments. These results are discussed with regard to the different mechanisms thought to underlie the treatments and future innovations in PTSD treatment.

J Trauma Stress. 2009 May 22. Galovski TE, Monson C, Bruce SE, Resick PA. Department of Psychology, Center for Trauma Recovery, University of Missouri-St. Louis, St. Louis, MO.

OBJECTIVE: To rigorously evaluate the time course of cognitive change in a cohort of individuals with HIV-associated neurocognitive disorders (HAND) initiating combination antiretroviral therapy (CART), and to investigate which demographic, laboratory, and treatment factors are associated with neuropsychological (NP) outcome (or "any NP improvement"). METHODS: Study participants included 37 HIV+ individuals with mild to moderate NP impairment who initiated CART and underwent NP testing at 12, 24, 36, and 48 weeks thereafter. NP change was assessed using a regression-based change score that was normed on a separate NP-stable group thereby controlling for regression toward the mean and practice effect. Mixed-effect regression models adjusting for loss to follow-up were used to evaluate the time course of cognitive change and its association with baseline and time-varying predictors. RESULTS: In persons with HAND initiating CART, cognitive improvement happens soon after initiation (13% at week 12), but more often 24, 36, and up to 48 weeks after initiation (up to 41%), with fewer than 5% demonstrating significant worsening. In multivariate analyses, unique predictors of NP improvement included more severe baseline NP impairment and higher CART CNS penetration index. Greater viral load decrease was associated with NP improvement only in univariate analyses. CONCLUSION: Clinically meaningful neuropsychological improvement seemed to peak around 24-36 weeks after combination antiretroviral therapy initiation and was prolonged over the 1-year study period. This study also provides new evidence that benefit may be maximized by choosing antiretroviral medications that reach therapeutic concentrations in the CNS.

Neurology. 2009 May 27. Cysique LA, Vaida F, Letendre S, Gibson S, Cherner M, Woods SP, McCutchan JA, Heaton RK, Ellis RJ. >From the Department of Psychiatry (L.A.C., M.C., S.P.W., R.K.H.), Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine (F.V.), Department of Medicine (S.L., S.G., J.A.M.), and Department of Neurosciences (R.J.E.), University of California at San Diego; and Brain Sciences (L.A.C.), University of New South Wales, Sydney, Australia.

by Frederic Luskin, PhD, Ken Silvestri, EdD, and Jed Rosen, MSW, LCSW

Forgiveness is the word we use when we want to say we have let go of a particular wound or grievance that we were stuck on. When used properly it is the ultimate balm to heal fractured relationships. Unfortunately it is not practiced enough and too often misunderstood to be effectively utilized by suffering couples. In addition therapists who work with wounded clients are mostly untrained in how to help their clients forgive their past and present partners. Remember that John Gottman found that 70% of all marital issues that couples start with in their relationships remain. The bad news is trying to change our partners rarely works. The good news is that when appropriately understood forgiving them does work. Forgiveness was found by Gottman and other researchers to be a key factor in successful long term relationships.

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Full Title: Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery.

BACKGROUND: The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited. AIMS: To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology. METHOD: 101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions ('Overcoming Bulimia Online'), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined. RESULTS: There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive. CONCLUSIONS: The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.

Behav Res Ther. 2009 May 27. Pretorius N, Arcelus J, Beecham J, Dawson H, Doherty F, Eisler I, Gallagher C, Gowers S, Isaacs G, Johnson-Sabine E, Jones A, Newell C, Morris J, Richards L, Ringwood S, Rowlands L, Simic M, Treasure J, Waller G, Williams C, Yi I, Yoshioka M, Schmidt U. Section of Eating Disorders, Institute of Psychiatry, King's College, Box 059, De Crespigny Park, London SE5 8AZ, United Kingdom.

Full Title: Long-term effects on cancer survivors' quality of life of physical training versus physical training combined with cognitive-behavioral therapy: results from a randomized trial.

BACKGROUND: We compared the effect of a 12-week group-based multidisciplinary self-management rehabilitation program, combining physical training (twice weekly) and cognitive-behavioral therapy (once weekly) with the effect of 12-week group-based physical training (twice weekly) on cancer survivors' quality of life over a 1-year period. MATERIALS AND METHODS: One hundred forty-seven survivors [48.8 +/- 10.9 years (mean +/- SD), all cancer types, medical treatment >/=3 months ago] were randomly assigned to either physical training (PT, n = 71) or to physical training plus cognitive-behavioral therapy (PT + CBT, n = 76). Quality of life and physical activity levels were measured before and immediately after the intervention and at 3- and 9-month post-intervention using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 questionnaire and the Physical Activity Scale for the Elderly, respectively. RESULTS: Multilevel linear mixed-effects models revealed no differential pattern in change of quality of life and physical activity between PT and PT + CBT. In both PT and PT + CBT, quality of life and physical activity were significantly and clinically relevantly improved immediately following the intervention and also at 3- and 9-month post-intervention compared to pre-intervention (p < 0.001). CONCLUSION: Self-management physical training had substantial and durable positive effects on cancer survivors' quality of life. Participants maintained physical activity levels once the program was completed. Combining physical training with our cognitive-behavioral intervention did not add to these beneficial effects of physical training neither in the short-term nor in the long-term. Physical training should be implemented within the framework of standard care for cancer survivors.

Support Care Cancer. 2009 Jun;17(6):653-63. May AM, Korstjens I, van Weert E, van den Borne B, Hoekstra-Weebers JE, van der Schans CP, Mesters I, Passchier J, Grobbee DE, Ros WJ. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands, a.m.may@umcutrecht.nl.

Full Title: Brief report: Web-based management of adolescent chronic pain: development and usability testing of an online family cognitive behavioral therapy program.

OBJECTIVES: This study evaluates the usability and feasibility of a Web-based intervention (Web-MAP) to deliver cognitive behavioral therapy (CBT) to adolescents with chronic pain and their parents. METHODS: The Web site was evaluated in two stages. In stage one, recovered adolescents and parents (n = 5 dyads), who had completed office-based CBT through a pediatric pain management clinic, completed ratings of Web site content, usability, appearance, and theme. In stage two, treatment-seeking adolescents and their parents (n = 6 dyads) completed the full-length Web program. Program usage data were obtained to assess interaction with the Web site. RESULTS: Participants rated moderate to strong acceptability of the program. Usage data indicated that participants interacted with the site and used communication features. CONCLUSIONS: Feedback from usability testing provided important information in the process of designing a feasible Web-based treatment for adolescents with chronic pain for use in a randomized controlled trial.

J Pediatr Psychol. 2009 Jun;34(5):511-6. Long AC, Palermo TM. Oregon Health and Science University, Department of Anesthesiology and Peri-Operative Medicine, 3181 SW, Sam Jackson Park Rd, Mailstop UHS-2, Portland, OR 97239, USA. longann@ohsu.edu

OBJECTIVE: To evaluate the efficacy of an Internet-based cognitive-behavioral therapy (CBT) approach to the treatment of child anxiety disorders. METHODS: Seventy-three children with anxiety disorders, aged 7-12 years, and their parents were randomly assigned to either an Internet-based CBT (NET) or wait-list (WL) condition. Clinical diagnostic assessment and parent and child questionnaires were completed before and after treatment. The NET condition was reassessed at 6-month follow-up. RESULTS: At posttreatment assessment, children in the NET condition showed small but significantly greater reductions in anxiety symptoms and increases in functioning than WL participants. These improvements were enhanced during the 6-month follow-up period, with 75% of NET children free of their primary diagnosis. CONCLUSIONS: Internet delivery of CBT for child anxiety offers promise as a way of increasing access to treatment for this population. Future research is needed to examine ways to increase treatment compliance and further enhance the impact of treatment.

J Pediatr Psychol. 2009 Jun;34(5):474-87. March S, Spence SH, Donovan CL. School of Psychology, University of Queensland, QLD 4072, Australia. s.march@psy.uq.edu.au

Object Cell therapy has shown preclinical promise in the treatment of many diseases, and its application is being translated to the clinical arena. Intravenous mesenchymal stem cell (MSC) therapy has been shown to improve functional recovery after traumatic brain injury (TBI). Herein, the authors report on their attempts to reproduce such observations, including detailed characterizations of the MSC population, non-bromodeoxyuridine-based cell labeling, macroscopic and microscopic cell tracking, quantification of cells traversing the pulmonary microvasculature, and well-validated measurement of motor and cognitive function recovery. Methods Rat MSCs were isolated, expanded in vitro, immunophenotyped, and labeled. Four million MSCs were intravenously infused into Sprague-Dawley rats 24 hours after receiving a moderate, unilateral controlled cortical impact TBI. Infrared macroscopic cell tracking was used to identify cell distribution. Immunohistochemical analysis of brain and lung tissues 48 hours and 2 weeks postinfusion revealed transplanted cells in these locations, and these cells were quantified. Intraarterial blood sampling and flow cytometry were used to quantify the number of transplanted cells reaching the arterial circulation. Motor and cognitive behavioral testing was performed to evaluate functional recovery. Results At 48 hours post-MSC infusion, the majority of cells were localized to the lungs. Between 1.5 and 3.7% of the infused cells were estimated to traverse the lungs and reach the arterial circulation, 0.295% reached the carotid artery, and a very small percentage reached the cerebral parenchyma (0.0005%) and remained there. Almost no cells were identified in the brain tissue at 2 weeks postinfusion. No motor or cognitive functional improvements in recovery were identified. Conclusions The intravenous infusion of MSCs appeared neither to result in significant acute or prolonged cerebral engraftment of cells nor to modify the recovery of motor or cognitive function. Less than 4% of the infused cells were likely to traverse the pulmonary microvasculature and reach the arterial circulation, a phenomenon termed the "pulmonary first-pass effect," which may limit the efficacy of this therapeutic approach. The data in this study contradict the findings of previous reports and highlight the potential shortcomings of acute, single-dose, intravenous MSC therapy for TBI.

J Neurosurg. 2009 Jun;110(6):1189-97. Harting MT, Jimenez F, Xue H, Fischer UM, Baumgartner J, Dash PK, Cox CS. Departments of Pediatric Surgery and.