by Tim Brunson, PhD

This article discusses the relevance of hypnotherapy in the Age of Science while covering the rationale behind incorporating hypnotherapy into counseling techniques such as Cognitive Behavioral Therapy (CBT).

As individuals and as societies, we live in a subjectively delusional world of our own making while simultaneously claiming that we have the ability to remove the rough edges that come in the form of suffering. Due to the limits of our perceptual abilities, the fact that our memories are constantly being updated, and coupled with our constant desire to paint our future in our minds, we exist in a cocoon that we only believe to be real. Yet this existence is often fraught with feelings of inadequacies or physical and mental suffering. Those who consider themselves to be professionals in the healing and helping fields seek to move their subjects toward a stasis of reality that is likewise subjectively delusional. They call the process therapy. Cognitive Behavioral Therapy is widely considered one of the most capable methods for achieving these therapeutic goals. It is in this environment that if looked at appropriately, there is a high probability that the proper use of the hypnotic process can enhance mental health interventions.

In the Western world, the history of mankind has always been dominated by a desire to discern truth and reality. Before the 1300's, this effort was largely a religious one. However, since the Black Death, the belief that empiricism and rationality (i.e. science) alone could help us find a reality to which we must align has been our predominant mindset. This bias decries the fact that historical epistemological tendencies also include historical, idealism, and constructivism, which leads me to believe that science may in fact not have all the answers. While scientific thinking predominates at the moment, it is limited by human sensory capabilities and the current state of perceptual instrument technology in conjunction with the restrictions of contemporary rational methodologies. Therefore, scientists are most likely not seeing a complete picture while too often pontificating what is good science and what is pseudoscience. Nevertheless, as science is the predominant mode of analysis when it comes to discovering reality, it must be respected.

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FULL TITLE: Treatment of music performance anxiety via psychological approaches: a review of selected CBT and psychodynamic literature.

Performance anxiety, or stage fright, is anxiety aroused about potential mishaps in performance that expose feared inadequacies before an audience and which evoke feelings of embarrassment and humiliation. For affected musicians, performance anxiety can be emotionally devastating, as their career choice in music may be terminated or severely compromised. This paper focuses on the cognitive and psychodynamic literature about music performance anxiety, with the emphasis that for treatment "one size does not fit all." It reviews the factors underlying performance anxiety and those factors which can exacerbate the condition in musicians. The two major clinical treatment modalities within contemporary psychology, cognitive behavior therapy (CBT) and psychodynamic treatments, are reviewed. While there are more empirical studies of CBT in various populations in the literature, until recently there was an indifference to empirical research by psychodynamic investigators. However, meta-analyses show strong efficacy for psychodynamic psychotherapy (in various disorders, not specifically music performance anxiety), but also that the benefits of psychodynamic psychotherapy may endure longer and increase with time.

Med Probl Perform Art. 2010 Dec;25(4):141-8. Nagel JJ. 400 Maynard St., Ste. 706, Ann Arbor, MI 48104, USA. Tel 734-761-4764. jjnagel@comcast.net.

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.

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.

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

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.

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

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.

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.

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.

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.

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

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

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.

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.

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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

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

Negative symptoms account for much of the functional disability associated with schizophrenia and often persist despite pharmacological treatment. Cognitive behavioral therapy (CBT) is a promising adjunctive psychotherapy for negative symptoms. The treatment is based on a cognitive formulation in which negative symptoms arise and are maintained by dysfunctional beliefs that are a reaction to the neurocognitive impairment and discouraging life events frequently experienced by individuals with schizophrenia. This article outlines recent innovations in tailoring CBT for negative symptoms and functioning, including the use of a strong goal-oriented recovery approach, in-session exercises designed to disconfirm dysfunctional beliefs, and adaptations to circumvent neurocognitive and engagement difficulties. A case illustration is provided.

J Clin Psychol. 2009 Aug;65(8):815-30. Perivoliotis D, Cather C. University of Pennsylvania, 3535 Market St., Room 2032, Philadelphia, PA 19104, USA. dimitrip@mail.med.upenn.edu

Full Title: A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive-behavioral therapy for social anxiety

Despite the efficacy of cognitive-behavioral therapy (CBT), most socially anxious individuals do not seek treatment or seek treatment only after many years of suffering. This study evaluated the efficacy of a three-session motivation enhancement therapy (MET) designed to increase CBT utilization among socially anxious individuals. Twenty-seven non-treatment-seeking socially anxious individuals (92.6% met current DSM-IV criteria for social anxiety disorder) were randomly assigned to either MET for CBT (n = 12) or a control condition (n = 15). The primary outcome was attendance at first CBT appointment. Secondary outcomes included openness to therapist contact and willingness to schedule a CBT appointment. After the intervention, seven of the 12 (58.3%) participants in the MET condition attended a CBT appointment compared to two of 15 (13.3%) control participants. Eight of 11 (72.7%) participants in the MET condition indicated they would like a CBT therapist to contact them compared to four of 12 (33.3%) controls. Further, willingness to schedule a CBT appointment increased at a significantly greater rate in the MET condition. Results suggest MET for CBT may be a time-efficient means to increase CBT utilization among socially anxious individuals.

Behav Res Ther. 2009 Aug;47(8):710-5. Epub 2009 May 7. Buckner JD, Schmidt NB. Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA. jbuckner@lsu.edu

Full Title: Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain

Cognitive-behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, aged 11-17years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability, and their parents. Children were randomly assigned to a wait-list control group or an Internet treatment group. Primary treatment outcomes were pain intensity ratings (0-10 NRS) and activity limitations on the Child Activity Limitations Interview, both completed via an online daily diary. In addition to their medical care, the Internet treatment group completed 8weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions. Youth randomized to the wait-list control group continued with the current medical care only. Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at the three-month follow-up. Rate of clinically significant improvement in pain was also greater for the Internet treatment group than for the wait-list control group. There were no significant group differences in parental protectiveness or child depressive symptoms post-treatment. Internet treatment was rated as acceptable by all children and parents. Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain.

Pain. 2009 Aug 18. Palermo TM, Wilson AC, Peters M, Lewandowski A, Somhegyi H. Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.

Full Title: Social disinterest attitudes and group cognitive-behavioral social skills training for functional disability in schizophrenia

The majority of clinical trials of cognitive-behavioral therapy (CBT) for schizophrenia have used individual therapy to target positive symptoms. Promising results have been found, however, for group CBT interventions and other treatment targets like psychosocial functioning. CBT for functioning in schizophrenia is based on a cognitive model of functional outcome in schizophrenia that incorporates dysfunctional attitudes (eg, social disinterest, defeatist performance beliefs) as mediators between neurocognitive impairment and functional outcome. In this report, 18 clinical trials of CBT for schizophrenia that included measures of psychosocial functioning were reviewed, and two-thirds showed improvements in functioning in CBT. The cognitive model of functional outcome was also tested by examining the relationship between social disinterest attitudes and functional outcome in 79 people with schizophrenia randomized to either group cognitive-behavioral social skills training or a goal-focused supportive contact intervention. Consistent with the cognitive model, lower social disinterest attitudes at baseline and greater reduction in social disinterest during group therapy predicted better functional outcome at end of treatment for both groups. However, the groups did not differ significantly with regard to overall change in social disinterest attitudes during treatment, suggesting that nonspecific social interactions during group therapy can lead to changes in social disinterest, regardless of whether these attitudes are directly targeted by cognitive therapy interventions.

Schizophr Bull. 2009 Sep;35(5):874-83. Epub 2009 Jul 23. Granholm E, Ben-Zeev D, Link PC. Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, USA. egranholm@ucsd.edu

Full Title: Telephone-administered cognitive behavioral therapy: a case study of anxiety and depression in Parkinson's disease

Parkinson's disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially attractive. Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment option that has been successful in other chronically medically ill populations with comorbid depression and anxiety. The current research had two aims. The first was to pilot the feasibility of screening and identifying PD patients with symptoms of anxiety and depression in a specialized outpatient clinic. The second aim was to pilot the feasibility of telephone-administered CBT for the treatment of depression and anxiety in persons with PD, which was done through a case series comparing telephone-administered CBT to a Support strategy. A fairly large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression. Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone to persons with PD.

J Clin Psychol Med Settings. 2009 Sep;16(3):243-53. Epub 2009 Apr 29. Veazey C, Cook KF, Stanley M, Lai EC, Kunik ME. Department of Psychology, University of Louisiana at Lafayette, Lafayette, LA 70504-3131, USA. veazey@louisiana.edu

Full Title: Winter depression recurrence one year after cognitive-behavioral therapy, light therapy, or combination treatment

The central public health challenge in the management of seasonal affective disorder (SAD) is prevention of depression recurrence each fall/winter season. The need for time-limited treatments with enduring effects is underscored by questionable long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year. We previously developed a SAD-tailored group cognitive-behavioral therapy (CBT) and tested its acute efficacy in 2 pilot studies. Here, we report an intent-to-treat (ITT) analysis of outcomes during the subsequent winter season (i.e., approximately 1 year after acute treatment) using participants randomized to CBT, light therapy, and combination treatment across our pilot studies (N=69). We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment, were withdrawn from protocol, or were lost to follow-up. The CBT (7.0%) and combination treatment (5.5%) groups had significantly smaller proportions of winter depression recurrences than the light therapy group (36.7%). CBT alone, but not combination treatment, was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone. Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy. If these findings are replicated, CBT could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy.

Behav Ther. 2009 Sep;40(3):225-38. Epub 2008 Nov 3. Rohan KJ, Roecklein KA, Lacy TJ, Vacek PM. Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA. kelly.rohan@uvm.edu

BACKGROUND: The present maintenance study investigated whether the reduction in hypochondriacal complaints after initial treatment with CBT or paroxetine sustained during a follow-up period and whether psychiatric severity at pretest predicted the course of hypochondriacal symptoms. METHOD: A naturalistic follow-up period of 18 months after a 16-week RCT consisting of 33 patients initially allocated to a CBT condition and 29 patients to a paroxetine condition. The main outcome measure was the Whiteley Index. RESULTS: The initial treatment effect of CBT and paroxetine sustained during the follow-up period. No significant differences between CBT and paroxetine were found. Treatment course could not be predicted by psychiatric comorbidity. CONCLUSION: CBT and paroxetine are both effective treatments for hypochondriasis in the long term.

J Behav Ther Exp Psychiatry. 2009 Sep;40(3):487-96. Epub 2009 Jun 28. Greeven A, van Balkom AJ, van der Leeden R, Merkelbach JW, van den Heuvel OA, Spinhoven P. Faculty of Social Sciences, Department of Clinical, Health and Neuropsychology, Leiden University, Leiden, The Netherlands. greeven@fsw.leidenuniv.nl

Full Title: Clinical effectiveness of a cognitive behavioral group treatment program for anxiety disorders: a benchmarking study

Previous research has established efficacy of cognitive behavioral therapy (CBT) for anxiety disorders, yet it has not been widely assessed in routine community clinic practices. Efficacy research sacrifices external validity to achieve maximum internal validity. Recently, effectiveness research has been advocated as more ecologically valid for assessing routine clinical work in community clinics. Furthermore, there is a lack of effectiveness research in group CBT. This study aims to extend existing research on the effectiveness of CBT from individual therapy into group therapy delivery. It aimed also to examine outcome using not only symptom measures, but also measures of related symptoms, cognitions, and life quality and satisfaction. Results from a cohort of patients with various anxiety disorders demonstrated that treatment was effective in reducing anxiety symptoms to an extent comparable with other effectiveness studies. Despite this, only 43% of individuals showed reliable change, and 17% were 'recovered' from their anxiety symptoms, and the post-treatment measures were still significantly different from the level of anxiety symptoms observed in the general population.

J Anxiety Disord. 2009 Oct;23(7):950-7. Epub 2009 Jun 18. Oei TP, Boschen MJ. School of Psychology, The University of Queensland, Brisbane, Australia. oei@psy.uq.edu.au

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