One-session treatment of specific phobias in youth: A randomized clinical trial in the United States and Sweden.

One hundred and ninety-six youth, ages 7–16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Posttraumatic Stress Symptoms in Adolescent Survivors of Childhood Cancer and Their Families: A Randomized Clinical Trial.

Posttraumatic stress symptoms (PTSS), particularly intrusive thoughts, avoidance, and arousal, are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers. We conducted a randomized wait-list control trial of a newly developed 4-session, 1-day intervention aimed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches-the Surviving Cancer Competently Intervention Program (SCCIP). Participants were 150 adolescent survivors and their mothers, fathers, and adolescent siblings. Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group. A multiple imputations approach was used to address nonrandom missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained. The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Mediation of Treatment Change in Social Phobia.

Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre- to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating anxiety disorders in children: Results of a randomized clinical trial.

Investigated a psychosocial treatment for 47 Ss (aged 9–13 yrs) with anxiety disorders. A 16-session cognitive-behavioral treatment was compared with a wait-list condition. Outcome was evaluated using child self-report, parent report, teacher report, cognitive assessment, and behavioral observations. Pretreatment–posttreatment changes and maintenance of gains at 1-yr follow-up were examined. Results revealed that many treated Ss were found to be without a diagnosis at posttest and at follow-up and to be within normal limits on many measures. The child's perception of the therapeutic relationship and the therapist's perception of parental involvement were measured but were not related to outcome. Discussion focuses on characteristics of effective child therapy and the need for further research on treatment components and alternative treatment methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral and response-prevention treatments for bulimia nervosa.

This study was designed to assess the additive effects of major components of cognitive-behavioral treatment for bulimia nervosa. Seventy-seven female patients with bulimia nervosa were allocated at random to one of four conditions: wait-list control, self-monitoring of caloric intake and purging behaviors, cognitive-behavioral treatment, and cognitive-behavioral treatment combined with response prevention of vomiting. In the treatment conditions, participants were seen individually for fourteen 1-hr sessions over a 4-month period. All the treatment groups showed significant improvement, whereas the wait-list control group did not. Cognitive-behavioral treatment was, however, the most successful in reducing purging and in promoting positive psychological changes. Fifty-six percent of participants in this condition ceased binge eating and purging by the end of treatment, and the frequency of purging declined by 77.2% during the same period. Of the three treatment conditions, only cognitive-behavioral treatment was superior to the wait-list control. At the 6-month follow-up, 59% of the cognitive-behavioral group were abstinent, and purging had declined by 80%. Cognitive-behavioral treatment was significantly superior to the other treatment groups at this time. Thus, the addition of response prevention of vomiting did not enhance the efficacy of cognitive-behavioral treatment, and the evidence suggests that it may have had a deleterious effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanism of Change in Cognitive-Behavioral Treatment of Panic Disorder: Evidence for the Fear of Fear Mediational Hypothesis.

Numerous clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder. However, studies investigating the mechanisms responsible for improvement with CBT are lacking. The authors used regression analyses outlined by R. M. Baron and D. A. Kenny (1986) to test whether a reduction in fear of fear (FOF) underlies improvement resulting from CBT. Pre- and posttreatment measures were collected from 90 CBT-treated patients and 40 wait-list control participants. Overall, treatment accounted for 31% of the variance in symptom reduction. The potency of FOF as a mediator varied as a function of symptom facet, as full mediation was observed for the change in global disability, whereas the effects of CBT on agoraphobia, anxiety, and panic frequency were partially accounted for by reductions in FOF. Clinical implications and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Socially Anxious College Men Using Cognitive Counseling and Skills Training.

The major purpose of this study was to compare the effects of three treatments of social anxiety: cognitive counseling, skills training, and a treatment that combined these two approaches. The results showed that compared with a wait-list control, the three treatments produced significantly greater improvement on three of the five outcome measures. All three procedures appeared equally effective, since no significant differences were obtained on any of the five general outcome measures. Changes in the targets of counseling (i.e., maladaptive cognitions and conversational skill) were also assessed. Whereas all treatments produced more change on maladaptive cognitions compared with the waiting list control group, the treatments providing cognitive counseling produced the most change. No differences between treatments or between the waiting list and the treatments were obtained on measures of conversational skill. These results are discussed in terms of Bandura's self-efficacy theory and the influence of both specific and nonspecific sources of improvement in counseling. The study also raises several potential hypotheses for future research, including the relation between type of deficit and treatment outcome and the pervasive versus situation-specific nature of anxiety problems for minimal daters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy.

Investigated the extent and mechanisms of therapeutic generalization across distinct areas of agoraphobic dysfunction. Twenty-seven severe agoraphobics were each given performance-based treatment for some phobic areas while leaving their other phobias untreated. Behavioral tests revealed that (a) the treated phobias improved significantly more than the untreated (transfer) phobias, (b) the transfer phobias improved significantly more than control phobias, and (c) the transfer benefits were highly variable within and between subjects. Analyses of possible cognitive mechanisms revealed that perceived self-efficacy accurately predicted treatment and transfer effects even when alternative factors such as previous behavior, anticipated anxiety, anticipated panic, perceived danger, and subjective anxiety were held constant. In contrast, these alternative factors lost most or all predictive value when self-efficacy was held constant. Agoraphobia thus appears to be neither a unitary entity nor a mere collection of independent phobias, but a complexly patterned problem governed largely by self-perceptions of coping efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of guided mastery and exposure treatments for intractable phobias.

Compared the exposure model and the self-efficacy model by randomly assigning 32 18–76 yr old individuals with driving or height phobias to 1 of the treatment conditions or to a control condition. Results show that treatments were equivalent in duration of exposure and in degree of inducement to confront threats rapidly, but the self-efficacy (mastery) model was significantly more effective than exposure in restoring Ss' behavioral functioning and diminishing their anticipated anxiety and performance-related anxiety. Both treatments were more effective than the control condition. It is suggested that self-efficacy predicted therapeutic behavior change significantly better than did anxiety, exposure duration, or performance level achieved during treatment. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptation of imagery rehearsal therapy for nightmares in children: A brief report.

This study investigated the effectiveness of a psychotherapeutic treatment for nightmares that was adapted for 6- to 11-year-old children from imagery rehearsal therapy. Ten child–mother dyads took part in a 3-session, 8-week treatment protocol. Participation in the study (contact with clinician, keeping a prospective dream log) was associated with decreases unpleasant dreams frequency, nightmare distress, and manifest anxiety. Providing educational information about nightmares did contribute to this positive effect. Results also suggest that drawing modified versions of nightmares for 1 month was associated with further reductions in nightmare distress and anxiety, but with no changes in unpleasant dreams frequency. Follow-ups at 3 and 6 months posttreatment suggest that the intervention had maintained effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of a sexual enhancement and a communication training program on sexual and marital satisfaction.

A total of 30 volunteer couples were randomly assigned to a sexual enrichment, a communication training, or a wait-list control condition. The sexual enrichment and communication training groups met for 3-hr sessions, 1 day per week for 4 consecutive weeks. All three conditions were assessed immediately before, immediately after, and again 3 months after completion of the programs. Analyses of covariance revealed that wives who participated in the sexual enhancement program derived more pleasure from their sexual relationships than did wives in the other two groups. In addition, participants in the sexual enhancement program felt there was a greater amount of affectional expression, and rated their overall marital satisfaction as significantly improved. Couples participating in the communication training program also evinced limited changes in their sexual and marital relationships, whereas couples in the wait-list control condition reported no changes. We conclude that communication training is an important component in sexual enrichment programs and that more evaluative research is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a self-coping cognitive treatment for test anxiety.

Examined the effects of a self-coping cognitive treatment for test anxiety delivered in a massed format and a spaced format. 93 test-anxious university students were randomly assigned to 1 of 3 conditions: (a) workshop, (b) 6-session treatment, or (c) control. Ss were pre- and posttested utilizing the Achievement Anxiety Test, the Test Attitude Inventory, and the Wonderlic Personnel Test. The 2 treatment formats both produced significant improvements on all dependent measures relative to the control condition. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medications prescribed for children with mood disorders: Effects of a family-based psychoeducation program.

Few controlled trials have examined psychotropic medications in children with mood disorders. Multiple medications are often prescribed for these children, who frequently suffer from several comorbid conditions. However, this polypharmacy has been infrequently studied and may lead to adverse drug-drug interactions. Multi-Family Psychoeducation Groups (MFPGs) are an 8-session, manual-driven treatment for children with mood disorders, designed as an adjunct to current medications and psychotherapy. In part, MFPG teaches parents and children to be better consumers of mental health care, including medications. This study examined the effect of MFPG on medications taken by 165 children, ages 8-11, with mood disorders. The authors hypothesized that MFPG would not affect the mean number of medications taken but that the variance in number of medications would decrease from pre- to posttreatment (i.e., the number of medications prescribed for any given child should become more closely distributed around the sample mean). Approximately 70% of participants were diagnosed with bipolar spectrum disorders, and 30% were diagnosed with depressive spectrum disorders. Most had both comorbid behavioral (97%) and anxiety (69%) disorders. Information regarding medications was gathered 4 times: at baseline, 6, 12, and 18 months. Approximately half (n=78) of the participants were randomized into immediate treatment, and half (n=87) were randomized into a 1-year wait-list condition. All were encouraged to continue treatment as usual throughout the study. As hypothesized, no significant pre- to posttreatment differences were found between groups for the mean number of current medications, but variance declined significantly from pre- to posttreatment. Implications and future research goals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in caffeine states enhance return of fear in spider phobia.

Treatment of phobias is sometimes followed by a return of fear. Animal and human research has shown that changes in external and internal contexts between the time of treatment and follow-up tests often enhance return of fear. The present study examined whether shifts in caffeine (C) state would enhance return of fear. Participants who were highly afraid of spiders (n=43) were treated in 1-session exposure-based therapy and tested for follow-up 1 week later. Participants were randomly assigned to 1 of 4 groups and received either placebo (P) or C at treatment and follow-up sessions: CC, PP, CP, and PC. Results demonstrated state-dependent learning. Participants experiencing incongruent drug states during treatment and follow-up (CP and PC) exhibited greater return of fear than those experiencing congruent drug states (CC and PP). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Anxiety disorders and phobias: A cognitive perspective.

Reviews the book, Anxiety disorders and phobias: A cognitive perspective by Aaron T. Beck, Gary Emery, and Ruth L. Greenberg (see record 2006-01301-000). Aaron Beck and colleagues have done an excellent job in their attempt to present a comprehensive cognitive model for understanding and treating anxiety disorders and phobias. The authors set out to present a comprehensive cognitive model for the understanding and treating of anxiety disorders and phobias. What they covered is presented with scholarly thoroughness and depth. What seems to be lacking in their presentation is an attempt to address the impact of interpersonal context. Thus, while the cognitive model promises to be an extremely helpful component to the understanding and treatment of anxiety disorders and phobias, a comprehensive treatment regimen will often require attention to additional aspects. The book is well written and richly illustrated with case histories and examples. It provides important perspectives in the understanding and treatment of anxiety disorders and phobias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial.

Objective: This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) for individuals with a diagnosis of cancer. Method: Participants (N = 115) diagnosed with cancer, across site and stage, were randomly allocated to either the treatment or the wait-list condition. Treatment was conducted at 1 site, by a single therapist, and involved participation in 8 weekly 2-hr sessions that focused on mindfulness. Participants meditated for up to 1 hr daily and attended an additional full-day session during the course. Participants were assessed before treatment and 10 weeks later; this second assessment occurred immediately after completion of the program for the treatment condition. The treatment condition was also assessed at 3 months postintervention. All postinitial assessments were completed by assessors who were blind to treatment allocation. Results: There were large and significant improvements in mindfulness (effect size [ES] = 0.55), depression (ES = 0.83), anxiety (ES = 0.59), and distress (ES = 0.53) as well as a trend for quality of life (ES = 0.30) for MBCT participants compared to those who had not received the training. The wait-list group was assessed before and after receiving the intervention and demonstrated similar change. Conclusions: These improvements represent clinically meaningful change and provide evidence for the provision of MBCT within oncology settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety disorders and marital quality.

Compared perceived marital quality among couples in which neither, one, or both spouses met criteria for an anxiety disorder. Phobic husbands and their wives reported poorer marital quality than did other spouses. Husbands' panic disorders had similar but weaker effects on perceived marital quality, and wives' panic disorders predicted poor perceived marital quality by husbands. Wives with generalized anxiety disorder perceived their marriages to be less satisfying than did other wives. The effects of husbands' generalized anxiety disorders were strongest in the presence of comorbid depression or alcohol or drug dependence but the effects of husbands' phobias and of panic disorders did not vary with comorbidity. Spouse concordance for phobias was related to more favorable marital reports but concordance for other anxiety disorders was unrelated to marital quality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating anxiety disorders in children with group cognitive-behavioral therapy: A randomized clinical trial.

A randomized clinical trial evaluated the therapeutic efficacy of group cognitive-behavioral therapy (GCBT) versus a wait-list control (WLC) condition to treat anxiety disorders in children. Results indicated that GCBT, with concurrent parent sessions, was highly efficacious in producing and maintaining treatment gains. Children in GCBT showed substantial improvement on all the main outcome measures, and these gains were maintained at 3-, 6-, and 12-month follow-ups. Children in the WLC condition did not show improvements from the pre- to postwait assessment point. These findings are discussed in terms of the need to continue to advance the development of practical, as well as conceptual, knowledge of efficacious treatment for anxiety disorders in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)