International Hypnosis Research Institute - Cognitive Based Therapy

Cognitive behavioral therapy for depression among adults in Japanese clinical settings

Sun, 01 Aug 2010 12:22:00 -0500

Full Title: Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study ABSTRACT: BACKGROUND: Empirical support for cognitive behavioral therapy (CBT) for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. FINDINGS: A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96%) completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II) for all patients (Intention-to-treat sample) improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8). Within-group effect size at the endpoint assessment was 2.64 (Cohen's d). Twenty-one patients (77.7%) showed treatment response and 17 patients (63.0%) achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale), dysfunctional attitude (assessed by Dysfunctional Attitude Scale), global functioning (assessed by Global Assessment of Functioning of DSM-IV) and subjective well-being (assessed by WHO Subjective Well-being Inventory) (all p values < 0.001). CONCLUSIONS: Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. TRIAL REGISTRATION: UMIN-CTR UMIN000002542. BMC Res Notes. 2010 Jun 7;3:160. Fujisawa D, Nakagawa A, Tajima M, Sado M, Kikuchi T, Hanaoka M, Ono Y. Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. dai_fujisawa@yahoo.co.jp.

Peaceful mind: an open trial of cognitive-behavioral therapy for anxiety in persons with dementia

Sun, 25 Jul 2010 16:23:00 -0500

ABSTRACTBackground: Anxiety has a high prevalence among individuals with dementia, and it has a significant negative impact on their functioning; yet intervention studies are lacking. We developed Peaceful Mind, a cognitive-behavioral intervention for persons with dementia. In this paper, we describe the intervention and results of an open trial evaluating the feasibility and utility of the intervention and assessment procedures.Methods: Peaceful Mind is implemented over a period of three months in the participant's home with involvement of a caregiver or "collateral." Dyads are followed for an additional three months via telephone. An assortment of simplified skills is offered, including self-awareness, breathing, behavioral activation, calming thoughts, and sleep skills.Results: Nine participants were enrolled, eight completed the three-month assessment, and seven completed the six-month assessment. Overall, participants and collaterals were satisfied with the intervention and reported that they benefited in terms of anxiety, depression, and collateral distress.Conclusions: A randomized controlled trial would help determine whether this promising new treatment has a statistically significant impact on anxiety in this population. Int Psychogeriatr. 2010 Jun 16:1-10. Paukert AL, Calleo J, Kraus-Schuman C, Snow L, Wilson N, Petersen NJ, Kunik ME, Stanley MA. Department of Veterans Affairs Medical Center, Seattle, Washington, U.S.A.

Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT

Sun, 18 Jul 2010 16:22:00 -0500

OBJECTIVE: To compare cognitive-behavioral therapy (CBT) and standard medical care (SMC) as treatments for psychogenic nonepileptic seizures (PNES). METHODS: Our randomized controlled trial (RCT) compared CBT with SMC in an outpatient neuropsychiatric setting. Sixty-six PNES patients were randomized to either CBT (plus SMC) or SMC alone, scheduled to occur over 4 months. PNES diagnosis was established by video-EEG telemetry for most patients. Exclusion criteria included comorbid history of epilepsy, <2 PNES/month, and IQ <70. The primary outcome was seizure frequency at end of treatment and at 6-month follow-up. Secondary outcomes included 3 months of seizure freedom at 6-month follow-up, measures of psychosocial functioning, health service use, and employment. RESULTS: In an intention-to-treat analysis, seizure reduction following CBT was superior at treatment end (group x time interaction p < 0.0001; large to medium effect sizes). At follow-up, the CBT group tended to be more likely to have experienced 3 months of seizure freedom (odds ratio 3.125, p = 0.086). Both groups improved in some health service use measures and on the Work and Social Adjustment Scale. Mood and employment status showed no change. CONCLUSIONS: Our findings suggest that cognitive-behavioral therapy is more effective than standard medical care alone in reducing seizure frequency in PNES patients. Classification of evidence: This study provides Class III evidence that CBT in addition to SMC, as compared to SMC alone, significantly reduces seizure frequency in patients with PNES (change in median monthly seizure frequency: baseline to 6 months follow-up, CBT group, 12 to 1.5; SMC alone group, 8 to 5). Neurology. 2010 Jun 15;74(24):1986-94. Goldstein LH, Chalder T, Chigwedere C, Khondoker MR, Moriarty J, Toone BK, Mellers JD. Department of Psychology, King's College London, Institute of Psychiatry, London, UK. laura.goldstein@kcl.ac.uk

Group cognitive-behavioral therapy for depression in Spanish

Sun, 11 Jul 2010 16:10:00 -0500

Full Title: Group cognitive-behavioral therapy for depression in Spanish: culture-sensitive manualized treatment in practice The authors applied cognitive-behavioral therapy (CBT) for depression using the Healthy Management of Reality treatment manual. This 16-week group treatment comprised four 4-week modules: thoughts (cognitive restructuring), activities (behavioral activation), people (interpersonal skills training), and health (addresses physical health and depression). They illustrated the use of the culture-sensitive treatment manuals by way of the member characteristics and clinical process of a Spanish-language CBT group for depression. They highlighted the challenges and satisfactions of working with a Spanish-speaking population in the public sector, and focused on how culture and socioeconomic status influence patients, and how to adapt treatment to these factors. Last, they demonstrated how technological advances integrate with culture-sensitive, evidence-based treatments to better serve this population and reduce disparities. (c) 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1-11, 2010. J Clin Psychol. 2010 Aug;66(8):857-67. Aguilera A, Garza MJ, Muñoz RF. University of California, San Francisco.

Interoceptive hypersensitivity as prognostic factor among patients with panic disorder...

Sun, 04 Jul 2010 12:40:00 -0500

Full Title: Interoceptive hypersensitivity as prognostic factor among patients with panic disorder who have received cognitive behavioral therapy The efficacy of cognitive behavioral therapy (CBT) in the acute-phase treatment of panic disorder is well established. However, there are data to show CBT may not always be able to prevent recurrence after treatment. The central cognitive component of panic disorder psychopathology is thought to be hypersensitivity to physical sensations. The present study reports that some aspects of interoceptive hypersensitivity, gastrointestinal fears in particular, were predictive of the course of panic disorder after end of CBT. Clinically it is suggested that new interoceptive tasks related to gastrointestinal fears are needed. (c) 2010 Elsevier Ltd. All rights reserved. J Behav Ther Exp Psychiatry. 2010 Sep;41(3):325-9. Epub 2010 Mar 20. Ogawa S, Furukawa TA, Nakano Y, Funayama T, Watanabe N, Noguchi Y, Sasaki M. Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. seiogawa1964@nifty.com

A randomized controlled trial of the safety and promise of cognitive-behavioral therapy...

Sun, 27 Jun 2010 11:19:00 -0500

Full Title:A randomized controlled trial of the safety and promise of cognitive-behavioral therapy using imaginal exposure in patients with posttraumatic stress disorder resulting from cardiovascular illness OBJECTIVE: We investigated the physical safety of cognitive-behavioral therapy (CBT) utilizing imaginal exposure in patients who suffered from posttraumatic stress disorder (PTSD) following a life-threatening cardiovascular event. METHOD: In this phase I, prospective, single-blind trial conducted from April 2006 through April 2008, we randomly assigned 60 patients to receive either 3 to 5 sessions of imaginal exposure therapy (experimental group) or 1 to 3 educational sessions only (control group). Criteria for PTSD and other mental health disorders were evaluated according to DSM-IV using the full Structured Clinical Interview for DSM-IV (SCID). Safety assessments included patients' blood pressure and pulse before and after each study session and the occurrence of deaths, hospitalizations, repeat myocardial infarctions, or invasive procedures. We also investigated the effects of the treatment on PTSD symptoms (Impact of Event Scale and Posttraumatic Stress Disorder Scale), depression (Beck Depression Inventory-II), and the Clinical Global Impressions-Severity of Illness (CGI-S) scale. RESULTS: There were no significant differences between the experimental and control groups and between exposure and nonexposure sessions in any of the safety measures. In addition, confidence intervals were such that the nonsignificant effects of exposure therapy were not of clinical concern. For example, the mean difference in systolic pressure between control and exposure sessions was 0.5 mm Hg (95% CI, -6.1 to 7.1 mm Hg). Nonsignificant improvements were found on all psychiatric measures in the experimental group, with a significant improvement in CGI-S in the entire cohort (mean score difference, -0.6; 95% CI, -1.1 to -0.1; P = .02) and a significant improvement in PTSD symptoms in a subgroup of patients with acute unscheduled cardiovascular events and high baseline PTSD symptoms (mean score difference, -1.2; 95% CI, -2.0 to -0.3; P = .01). CONCLUSIONS: Cognitive-behavioral therapy that includes imaginal exposure is safe and promising for the treatment of posttraumatic stress in patients with cardiovascular illnesses who are traumatized by their illness. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00364910. © Copyright 2010 Physicians Postgraduate Press, Inc. Shemesh E, Annunziato RA, Weatherley BD, Cotter G, Feaganes JR, Santra M, Yehuda R, Rubinstein D. Division of Developmental and Behavioral Health, Department of Pediatrics, Box 1198, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. eyal.shemesh@mssm.edu. J Clin Psychiatry. 2010 Apr 6.

Twelve-Step Facilitated Versus Mapping-Enhanced Cognitive-Behavioral Therapy for Pathological...

Sun, 20 Jun 2010 11:18:00 -0500

Full Title: Twelve-Step Facilitated Versus Mapping-Enhanced Cognitive-Behavioral Therapy for Pathological Gambling: A Controlled Study This study examined the efficacy of two group treatments for pathological gambling, a node-link mapping-enhanced cognitive-behavioral group therapy (CBGT-mapping) and twelve-step facilitated (TSF) group treatment. Forty-nine participants meeting criteria for pathological gambling were recruited from local newspaper advertisements. These participants were randomly assigned to one of three conditions: TSF (n = 11), CBGT-mapping (n = 18), and Wait-List control (n = 9); 11 refused treatment prior to randomization. Outcome measures included number of DSM-IV criteria met, perception of control/self-efficacy, desire to gamble, and frequency of gambling episodes. Analyses revealed a significant treatment group x time interaction (eta(2)(partial) = .39). Specifically, the group treatments resulted in significant improvements in the dependent measures, while the Wait-List group remained relatively stable. Overall, CBGT-mapping and TSF had no significant differences on any outcome measure at follow-up assessments. Analysis of post-treatment and 6-month follow-up reveal a significant improvement in gambling outcomes (i.e., fewer DSM-IV criteria met, greater self-efficacy, and fewer gambling episodes (eta(2)(partial) = .35), with treatment gains maintained at 6 months. These results are consistent with previous research for group treatment for pathological gambling and provide support for the utility of TSF and a mapping-based CBT therapy as viable intervention for pathological gambling. J Gambl Stud. 2010 May 19. Marceaux JC, Melville CL. McNeese State University, 4205 Ryan St., Lake Charles, LA, 70609, USA, janice23@uab.edu.

Cognitive-Behavioral Therapy for Threshold and Subthreshold Anorexia Nervosa

Sun, 13 Jun 2010 11:15:00 -0500

Full Title: Cognitive-Behavioral Therapy for Threshold and Subthreshold Anorexia Nervosa: A Three-Year Follow-Up Study Background: Few long-term follow-up studies have evaluated the response to psychotherapeutical interventions in anorexia nervosa (AN). The effectiveness of individual cognitive-behavioral therapy (CBT) and the possible predictors of outcome in outpatients suffering from threshold and subthreshold AN (s-AN) were evaluated. Methods: At the beginning (T0) and at the end of treatment (T1), and 3 years after the end of treatment (T2), 53 subjects with AN and 50 with s-AN (all DSM-IV criteria except amenorrhea or underweight) were assessed by a face-to-face clinical interview and by self-reported questionnaires for eating attitudes and behavior (Eating Disorder Examination Questionnaire), body uneasiness (Body Uneasiness Test) and general psychopathology (Symptom Checklist, Beck Depression Inventory, State-Trait Anxiety Inventory). Results: No deaths occurred during the treatment and the follow-up period. At the end of the follow-up 34 subjects (33%) initially enrolled in the study obtained a full recovery. AN and s-AN patients did not show significant differences on most of the clinical measures at baseline and in terms of treatment response (T1, T2). The reduction in weight and shape concerns was associated with weight gain at T1 and T2, and the shape concern level at baseline represented the main risk factor for recovery and treatment resistance. According to survival analysis, patients with high shape concern had a lower probability of remission across time. Conclusions: The distinction between threshold and subthreshold AN does not seem to be of clinical relevance in terms of response to CBT. Shape concern rather than demographic or general psychopathological features represents the best predictor of outcome for CBT. Copyright © 2010 S. Karger AG, Basel. Psychother Psychosom. 2010 May 25;79(4):238-248. Ricca V, Castellini G, Lo Sauro C, Mannucci E, Ravaldi C, Rotella F, Faravelli C. Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University, Florence, Italy.

Effects of Cognitive Behavioral Therapy on Daily Living Skills in Children with...

Sun, 06 Jun 2010 11:52:00 -0500

Full Title: Effects of Cognitive Behavioral Therapy on Daily Living Skills in Children with High-Functioning Autism and Concurrent Anxiety Disorders CBT is a promising treatment for children with autism spectrum disorders (ASD) and focuses, in part, on children's independence and self-help skills. In a trial of CBT for anxiety in ASD (Wood et al. in J Child Psychol Psychiatry 50:224-234, 2009), children's daily living skills and related parental intrusiveness were assessed. Forty children with ASD (7-11 years) and their primary caregiver were randomly assigned to an immediate treatment (IT; n = 17) or 3-month waitlist (WL; n = 23) condition. In comparison to WL, IT parents reported increases in children's total and personal daily living skills, and reduced involvement in their children's private daily routines. Reductions correlated with reduced anxiety severity. These results provide preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD. J Autism Dev Disord. 2010 May 28. Drahota A, Wood JJ, Sze KM, Van Dyke M. Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (MC: 0603), La Jolla, CA, 92093-0603, USA, adrahota@ucsd.edu.

Successful treatment of OCD with a micronutrient formula following partial response...

Sat, 29 May 2010 12:38:00 -0500

Full Title: Successful treatment of OCD with a micronutrient formula following partial response to Cognitive Behavioral Therapy (CBT): a case study Obsessive Compulsive Disorder (OCD) affects 0.5-2% of young people many of whom are resistant to conventional treatments. This case study describes an 18-year-old male with OCD who first underwent cognitive behavioral therapy (CBT) for a 1-year period with a modest response (his OCD had shifted from severe to moderate). Within a year, his anxiety had deteriorated back to the severe range and he now had major depression. He then entered an ABAB design trial using a nutritional formula consisting mainly of minerals and vitamins (together, known as micronutrients). After 8 weeks on the formula, his mood was stabilized, his anxiety reduced, and his obsessions were in remission. The treatment was then discontinued for 8 weeks, during which time his obsessions and anxiety worsened and his mood dropped. Reintroduction of the formula again improved the symptoms. This case illustrates the importance of considering the effect micronutrients have on mental illness. J Anxiety Disord. 2009 Aug;23(6):836-40. Epub 2009 Mar 9. Rucklidge JJ. Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. julia.rucklidge@canterbury.ac.nz

Cognitive-behavioral therapy for individuals at high risk of developing psychosis

Sat, 22 May 2010 12:36:00 -0500

Early intervention for psychosis has become an established clinical practice. Research is now focusing on identifying individuals in the pre-psychotic period when they appear to be putatively prodromal for psychosis. Criteria have been established for identifying these young people who are at clinical high risk, and there have been some early studies testing both pharmacological and psychological treatments. Cognitive behavioral therapy (CBT) has been tested as a potentially effective intervention in this group. Here, we describe two cases that were treated with CBT. J Clin Psychol. 2009 Aug;65(8):879-90. Addington J, Mancuso E. Department of Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada. jmadding@ucalgary.ca

Cognitive Behavioral Therapy Plus Motivational Interviewing Improves Outcome for...

Sat, 15 May 2010 12:33:00 -0500

Full Title: Cognitive Behavioral Therapy Plus Motivational Interviewing Improves Outcome for Pediatric Obsessive-Compulsive Disorder: A Preliminary Study Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Delta = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Delta = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families. Cogn Behav Ther. 2009 Aug 12:1. Merlo LJ, Storch EA, Lehmkuhl HD, Jacob ML, Murphy TK, Goodman WK, Geffken GR. Department of Psychiatry, University of Florida, Gainesville, Florida, USA.

The Power of Mental Flexibility

Fri, 14 May 2010 11:44:00 -0500

by Tim Brunson, PhD Ever since Stephen Covey mandated in his book The Seven Habits of Highly Effective People that people should learn to "think outside the box" and Bill O'Hanlon, LMFT, explained to Oprah Winfrey the central theme of his book Do One Thing Different, mental flexibility has been the popular buzz phrase for business consultants and therapists alike. Even during my coursework with the highly doctrine-oriented US Army War College, they too espoused the value of what is often called "critical thinking" among academics. Indeed, mental flexibility is both taught and explored. Yet, somehow I still feel that, despite the ubiquity of the concept, mental flexibility still needs further examination if its clinical applications are to be fully appreciated. In the Neurology of Suggestion and Advanced Neuro-Noetic Hypnosis certification courses, I frequently mention that everything around us and within us is made up of patterns ? which in turn have structure, encoding, and may be recalled. Neurologically this can be easily seen in the organization of neural networks. They are structured largely as a reflection of their environment ? which can also be considered as learning. The late Canadian psychologist Donald Hebb, PhD, gave us the "Use it or Lose it" concept, which states that networks that are repetitively used are reinforced (as evidenced by additional connections between neurons in that network) and those that are neglected tend to wither or otherwise become subordinate. [More]

Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression

Sat, 08 May 2010 12:31:00 -0500

Full Title: Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome BACKGROUND: In a recent randomized trial, we were unable to confirm the previously reported high effectiveness of CCBT. Therefore, the aim of the current study was to have a closer look at usage and acceptability (i.e. expectancy, credibility, and satisfaction) of the intervention. METHODS: Depressed participants (N=200) were given login codes for unsupported online CCBT. A track-and-trace system tracked which components were used. We used a 9-month follow-up period. RESULTS: Uptake was sufficient, but dropout was high. Many usage indices were positively associated with short-term depressive improvement, whereas only homework was related to long-term improvement. Acceptability was good and expectancy could predict long-term, but not short-term outcome. LIMITATIONS: Associations between use of CCBT and improvement are merely correlational. Our sample was too depressed in relation to the scope of the intervention. We relied on online self-report measures. Analyses were exploratory in nature. CONCLUSIONS: Although CCBT might be a feasible and acceptable treatment for depression, means to improve treatment adherence are needed for moderately to severely depressed individuals. J Affect Disord. 2009 Aug;116(3):227-31. Epub 2009 Jan 22. de Graaf LE, Huibers MJ, Riper H, Gerhards SA, Arntz A. Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands. E.deGraaf@dmkep.unimaas.nl

Predictors of the effect of cognitive behavioral therapy for chronic insomnia...

Sat, 01 May 2010 12:27:00 -0500

Full Title: Predictors of the effect of cognitive behavioral therapy for chronic insomnia comorbid with breast cancer Prior studies have supported the efficacy of cognitive behavioral therapy (CBT) for insomnia comorbid with cancer. This article reports secondary analyses that were performed on one of these studies to investigate the predictive role of changes in dysfunctional beliefs about sleep, adherence to behavioral strategies, and some nonspecific factors on sleep changes assessed subjectively and objectively. Fifty-seven women with chronic insomnia comorbid with breast cancer received CBT for insomnia. At posttreatment, subjective sleep improvements were best predicted by higher initial levels of treatment expectancies, but also by decreased dysfunctional beliefs about sleep; the most consistent predictors of polysomnography (PSG) assessed sleep improvements were reduced dysfunctional beliefs about sleep and a higher avoidance of day napping. At 6-month follow-up, subjectively assessed sleep improvements were best predicted by adherence to behavioral strategies, whereas none of the predictors was significantly associated with PSG-assessed sleep improvements. This study gives some support to the importance of targeting erroneous beliefs about sleep and poor sleep habits in the treatment of cancer-related insomnia, but also to the importance of enhancing patients' expectancies for improvement. J Consult Clin Psychol. 2009 Aug;77(4):742-50. Tremblay V, Savard J, Ivers H. Laval University Cancer Research Center and School of Psychology, Université Laval, Québec, Canada