CBT With Older People: Alterations and the Value of the Therapeutic Alliance.

Cognitive-behavioral therapy (CBT) is empirically supported for use with older people. Reasons for its efficacy are not fully understood--i.e., whether theory-driven techniques or nonspecific "common factors" (such as the therapeutic alliance) are responsible. In this article, the authors discuss age-related psychotherapy components. They address the difficulties of using CBT with older populations and the importance of the TA in therapy with the elderly. Finally, they identify 4 areas where the application of the TA may enhance CBT among older adults: philosophy or socialization, cognitive restructuring, resource building in the context of aging, and affect tolerance. The authors argue that a strong TA can facilitate each of these processes in the application of CBT to current cohorts of older people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies.

The efficacy of cognitive–behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest–posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized Trial of Cognitive-Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy with and without medication in the treatment of obsessive-compulsive disorder.

Cognitive-behavioral therapy (CBT) and pharmacotherapy with serotonin reuptake inhibitors (SRIs) are established monotherapies for obsessive-compulsive disorder (OCD), yet research on their combined efficacy is lacking. Practicing psychologists who treat OCD are thus unable to say definitively whether exposure and ritual prevention would be more successful with concomitant SRI pharmacotherapy. The authors explored this issue in a clinical sample of 56 outpatients who received fee-for-service CBT; 31 (55%) received CBT alone, and 25 (45%) received CBT plus SRI. Both groups made clinically significant and comparable posttreatment gains, suggesting that CBT is effective with or without concomitant pharmacotherapy. Clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapting cognitive behavioral therapy for the frail elderly

Depression is a common psychiatric disorder of the aged. This article briefly reviews the literature on the use of cognitive behavioral therapy (CBT) with the elderly, and suggests some changes in using CBT with the elderly based on the authors' clinical experiences. Recommended changes in technique and common themes when dealing with the frail elderly are described, including the use of "supportive CBT" for patients with mild cognitive impairment. The authors' experiences suggest that CBT is an effective treatment for depression and other affective disorders of the frail elderly, and is especially useful when somatic treatments are contraindicated or produce intolerable side effects.     

Observations on the cognitive behavioral treatment of panic disorder: Impact of benzodiazepines.

Examines whether or not benzodiazepines (BZDs) in general and alprazolam (ALP) in particular have a beneficial or negative impact on Cognitive Behavior Therapy (CBT). A survey of 2 panic disorder (PD) clinics revealed that approximately one-half of all PD patients receive combined treatment (usually CBT plus ALP). This strategy is the recommended treatment of choice for many. The rationale for such a treatment is that BZDs help to decrease anxiety and panic in the short run, making the patient amenable to psychotherapy, while CBT offers a long-term solution for coping with panic. However, the authors find that the concomitant use of BZDs throughout the course of CBT has an adverse effect on the psychotherapy. For CBT to be effective, anxiety must be elicited under the controlled circumstances of the therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical supervision from the standpoint of cognitive-behavior therapy.

This article presents an approach to supervising cognitive-behavior therapists that is closely related to the process and content of cognitive-behavior therapy (CBT). The goal of CBT is to help therapists adopt the philosophy of CBT as the basic approach for changing clients' cognitions, emotions, and behaviors. A secondary goal is to teach therapists specific techniques. The seven major features of CBT and their implications for supervision are described: therapy as a meaning-making process; systematic and goal directed therapy; practicing and experiencing; therapy as a collaborative effort; person-focused therapy; the therapists as a facilitator of change and development; and empowerment of the client with self-change skills. Some of the major dilemmas and constraints in CBT supervision that are derived from adapting the principles of therapy to supervision are discussed as well as the need for supervision outcome research and recommendations for its implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders.

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive–behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU), or TAU plus CBT4CBT, with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for panic disorder.

In the present study, the authors sought to determine whether the efficiency and cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder could be improved by adjunctive computer-assisted therapy. Eighteen participants who met Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) criteria for panic disorder were randomly assigned to a 12-session CBT (CBT12) condition (D. H. Barlow & M. G. Craske, 1989) or to a 4-session computer-assisted CBT (CBT4-CA) condition. Palmtop computers, with a program developed to incorporate basic principles of CBT, were used by CBT4-CA clients whenever they felt anxious or wanted to practice the therapy techniques and were used by all participants as a momentary assessment tool. CBT4-CA clients carried the computer at all times and continued to use it for 8 weeks after termination of therapy. Analyses of clinically significant change showed superiority of CBT12 at posttest on some measures; however, there were no differences at follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extreme response style in recurrent and chronically depressed patients: Change with antidepressant administration and stability during continuation treatment.

The authors examined extreme response style in recurrently and chronically depressed patients, assessing its role in therapeutic outcome. During the acute phase, outpatients with major depressive disorder (N = 384) were treated with fluoxetine for 8 weeks. Remitted patients (n = 132) entered a continuation phase during which their fluoxetine dose increased and they were randomly assigned to treatment with or without cognitive-behavioral therapy (CBT). Results showed a predictive relationship between extreme response style and clinical outcome. Patients in the medication-only group showed a significant increase in the frequency of extreme responses, whereas patients receiving CBT showed no significant change. These results are consistent with recent findings suggesting that metacognitive factors may be as important as changes in thought content when treating depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cognitive-behavioral therapy for impulsive children.

Reviews the book, Cognitive-behavioral therapy for impulsive children by Phillip C. Kendall and Lauren Braswell (see record 1985-97646-000). In the book's preface, the authors summarize its content in the following statement: "The program tries to teach impulsive kids to stop and think before they act." Although the volume's focus is specific to non-self-controlled children, it is also a clinical resource for professionals working with children with conduct disorders. The authors succeed at demonstrating the use of cognitive-behavioral self-control therapy by offering a conceptual framework aided by clinical material. Case vignettes not only demonstrate correct and successful applications of cognitive-behavioral therapy but also illustrate areas where difficulties arise, and recommendations are provided on how to handle them. Although the authors recommend that these techniques need to be individualized, the manual provides excellent clinical guidelines for the use of cognitive-behavioral self-control therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change.

Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established. In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action. Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting. Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 wks. No evidence was found that the therapeutic alliance mediated treatment outcome. CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and family therapies for adolescent depression: Treatment specificity, mediation, and moderation.

The specificity of cognitive and family therapies, and potential treatment mediators and moderators, was examined in a randomized clinical trial for adolescent depression. After acute treatment, cognitive-behavioral therapy (CBT) exerted specific effects on cognitive distortions relative to either systemic-behavioral family therapy (SBFT) or nondirective supportive therapy (NST). At 2-year follow-up, SBFT was found to impact family conflict and parent–child relationship problems more than CBT; NST and CBT tended to show a greater reduction in anxiety symptoms than SBFT. Nonspecific therapist variables qualified few outcome analyses. No measures of cognitive distortion or family dysfunction mediated or moderated treatment outcome. As in adult studies, relatively few areas of treatment specificity or mediation were identified. The implications of these findings for clinical treatment and research in adolescent depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirically supported treatments for panic disorder: Costs, benefits, and stepped care.

Treatment outcome findings suggest that cognitive-behavioral therapy (CBT) and pharmacotherapy offer similar short-term treatment gains for panic disorder and that CBT may afford more optimal maintenance of treatment gains without the need for ongoing treatment. However, efficacy is not the only consideration for patients, and because of limited health care resources, evaluation of the cost-benefit ratio of these treatments is important. In this article, the authors review estimates of the relative efficacy, acceptability, tolerability, and costs of these treatments; empirically examine the costs and outcome of cognitive-behavioral and pharmacologic interventions as they are delivered in an outpatient clinic specializing in these treatments; and comment on how these data inform a stepped care model of treatment. Analysis of the "services" data indicated that CBT was at least equal to pharmacotherapy in terms of pretreatment severity and acute treatment outcome and that CBT is an especially cost-effective treatment option. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive-behavioral therapy with adult ethnic minority clients: A review.

Practicing psychologists may question the relevance of cognitive- behavioral treatments for their ethnic minority clients. Many cognitive- behavioral treatments are listed as empirically supported treatments by the Task Force on the Promotion and Dissemination of Psychological Procedures (D. L. Chambless et al., 1998). However, the samples in these effectiveness studies are composed primarily of White European American individuals. There is a paucity of research examining the effectiveness of cognitive- behavioral therapy (CBT) for ethnic minority clients. The author reviews the current literature on the use of CBT with ethnic minority clients living in the United States, specifically those of African, Asian, and Hispanic/Latino descent. Twelve studies are reviewed that examined the effectiveness of CBT for ethnic minority participants with a variety of psychological disorders. Recommendations for conducting and evaluating clinical outcome research that includes ethnic minority participants are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges Into Opportunities for Change.

This article provides a review of "Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges Into Opportunities for Change" (see record 2004-00137-000). In the nearly 50 years since cognitive-behavioral treatment (CBT) models were pioneered by Albert Ellis and Aaron Beck, CBT approaches have enjoyed a wide range of applications and considerable empirical and clinical success. A frequent criticism of the CBT model has been that its approaches favor technique and behavioral change over the "substance" of psychotherapy (e.g., therapeutic alliance, resistance, engagement). Designed primarily for clinicians, "Roadblocks in Cognitive-Behavioral Therapy" is well-written and easy to read. In keeping with the tradition of CBT, the authors rely on empirical research to support their tenets, while keeping the emphasis of each chapter on clinical utility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems.

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive- behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Comparison of Delivery Methods of Cognitive-Behavioral Therapy for Panic Disorder: An International Multicenter Trial.

Cognitive-behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapist-delivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapist-delivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at posttreatment, the outcome for CBT 12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)