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)     

Sudden gains during therapy of social phobia.

The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in Self-Perception During Treatment of Social Phobia.

Ninety individuals with social phobia were randomly assigned to a waitlist control group, a cognitive-behavioral therapy group, or an exposure therapy group without explicit cognitive intervention. Two independent raters classified more than 2,000 thoughts that were reported by participants while anticipating socially stressful situations at pretest and posttest. Each thought was classified on the basis of its valence (positive, negative, or neutral) and attentional focus (self or other). The 2 treatments demonstrated a greater reduction in the frequency of negative self-focused thoughts than the control group. Changes in negative self-focused thoughts and changes in social anxiety were significantly correlated only in the cognitive-behavioral therapy group. The implications of these findings for the cognitive model of social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation of changes in anxiety and depression during treatment of social phobia.

To investigate the interactive process of changes in social anxiety and depression during treatment, the authors assessed weekly symptoms in 66 adult outpatients with social phobia (social anxiety disorder) who participated in cognitive- behavioral group therapy. Multilevel mediational analyses revealed that improvements in social anxiety mediated 91% of the improvements in depression over time. Conversely, decreases in depression only accounted for 6% of the decreases in social anxiety over time. Changes in social anxiety fully mediated changes in depression during the course of treatment. The theoretical and clinical implications of these findings for the relationship between anxiety and depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group climate development in cognitive and interpersonal group therapy for social phobia.

This study was designed as a longitudinal study of 80 participants in cognitive group therapy (RCT, n = 40) and interpersonal group therapy (RIPT, n = 40) for social phobia during 10 weeks of residential therapy. The aim was to investigate the patterns of group climate development and its impact on treatment outcome. Data were collected using MacKenzie's Group Climate Questionnaire (GCQ) 4 times during treatment, and a multilevel (mixed) model approach was used in the analyses. Engagement in RCT groups showed a linear increase during treatment in contrast to a linear decline among patients in RIPT groups. This divergence might be explained by the focus on extragroup and intragroup relationships in RCT and RIPT, respectively. Neither conflict nor avoidance followed the expected pattern, nor did their mean levels influence outcome. However, when 6 extreme values of conflict were removed, there was support for a low–high–low pattern of conflict. In general, these results do not support MacKenzie's generic model of group climate development but suggest that sample characteristics, treatment models, and setting can play major roles in determining the group climate. Of the group climate variables, only the mean level of engagement predicted a change in social anxiety over the course of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive-behavioral interventions with older adults: Integrating clinical and gerontological research.

Psychotherapeutic interventions utilizing cognitive-behavioral strategies have been used widely with older adults. To appropriately adapt these techniques, characteristics unique to older adults must be taken into account. These factors include aspects of the social environment, cohort effects, cognitive changes with aging, personality, and emotional development, which have been described in an emerging body of research literature from the field of gerontology. In addition, clinical studies have examined the efficacy of cognitive-behavioral interventions in treating older clients for anxiety, depression, insomnia, and other disorders. This review describes current empirical evidence in gerontology and treatment outcome research that informs the practice of psychotherapy in this population and provides recommendations for conducting therapy with older adults. (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)     

A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents.

30 moderately depressed high school students were randomly assigned to either cognitive-behavioral treatment, relaxation training, or a wait-list control condition. Treatment Ss met in small groups for 10 50-min sessions over 5 wks in a high school setting. Outcome measures included a modified Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the State-Trait Anxiety Inventory. The cognitive-behavioral and relaxation training groups were superior to the wait-list control group in the reduction of depressive symptoms at both posttest and 5-wk follow-up assessments. There was no significant difference between active treatments in their effectiveness for reducing depression. Ss in the cognitive-behavioral and relaxation training conditions went from moderate levels of depression at pretest to nondepressed levels at posttest, and they maintained these levels at follow-up. Improvements in anxiety and academic self-concept were also demonstrated by the active treatments. Findings demonstrate that these short-term group-administered therapies are effective in significantly decreasing depression in adolescents. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the efficacy of theoretically derived improvements in the treatment of social phobia.

Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an “enhanced” treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

évaluation économique de la thérapie cognitivo-comportementale des troubles anxieux.

This literature review examines the results of cost-effectiveness studies of cognitive-behaviour therapies published up to June 2003. Cost offsets likely to be derived from effective treatment of anxiety problems are also examined. A summary of results suggests the following: 1) cognitive-behaviour therapy is cost-effective compared to drug therapy for the treatment of panic disorder and social phobia; 2) group treatments and short courses as well as new technologies are promising alternatives to conventional therapy; 3) the existence of cost offsets for anxiety disorders has yet to be ascertained. Research approaches are suggested to cover significant shortcomings in the methodologies of studies conducted to date. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The feasibility and outcome of clinic plus Internet delivery of cognitive-behavior therapy for childhood anxiety.

Seventy-two clinically anxious children, aged 7 to 14 years, were randomly allocated to clinic-based, cognitive-behavior therapy, the same treatment partially delivered via the Internet, or a wait-list control (WL). Children in the clinic and clinic-plus-Internet conditions showed significantly greater reductions in anxiety from pre- to posttreatment and were more likely to be free of their anxiety diagnoses, compared with the WL group. Improvements were maintained at 12-month follow-up for both therapy conditions, with minimal difference in outcomes between interventions. The Internet treatment content was highly acceptable to families, with minimal dropout and a high level of therapy compliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial.

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for intermittent explosive disorder: A pilot randomized clinical trial.

No randomized clinical trials have evaluated the efficacy of psychotherapy for intermittent explosive disorder (IED). In the present study, the authors tested the efficacy of 12-week group and individual cognitive-behavioral therapies (adapted from J. L. Deffenbacher & M. McKay, 2000) by comparing them with a wait-list control in a randomized clinical trial among adults with IED (N = 45). Aggression, anger, and associated symptoms were assessed at baseline, midtreatment, posttreatment, and 3-month follow-up. Group and individual cognitive-behavioral therapy tended not to differ, with each reducing aggression, anger, hostile thinking, and depressive symptoms, while improving anger control relative to wait-list participants. Posttreatment effect sizes were large. These effects were maintained at 3-month follow-up. Findings provide initial support for the use of multicomponent cognitive-behavioral therapy in the treatment of IED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive therapy of anxiety disorders.

A review of studies of cognitive-behavioral therapy (CBT) for generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia indicates that CBT is consistently more effective than waiting-list and placebo control groups. In general, CBT has proved more beneficial than supportive therapy as well. Comparisons with active behavioral treatments provide more variable results. Converging evidence suggests that cognitive change may be a strong predictor of treatment outcome, but that such change may be produced by a number of therapeutic approaches. Pretest–posttest change with CBT is depicted in meta-analytic summary form for each disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

Female assault survivors (N = 171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Réussir à surmonter la timidité et la peur des autres.

Reviews the book, Réussir à surmonter la timidité et la peur des autres by Gillian Butler (2007). This book is a personal guide for people who suffer with social anxiety. It is based on a cognitive-behavioral approach and takes into account the most recent developments in the field. The book covers the nature of social anxiety, its manifestations and differences and probable causes as well as cognitive behavioral strategies to overcome social anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial.

A new cognitive therapy (CT) program was compared with an established behavioral treatment. Sixty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for social phobia were randomly assigned to CT, exposure plus applied relaxation (EXP = AR), or wait-list (WAIT). CT and EXP = AR were superior to WAIT on all measures. On measures of social phobia, CT led to greater improvement than did EXP = AR. Percentages of patients who no longer met diagnostic criteria for social phobia at posttreatment-wait were as follows: 84% in CT, 42% in EXP = AR, and 0% in WAIT. At the 1-year follow-up, differences in outcome persisted. In addition, patients in EXP = AR were more likely to have sought additional treatment. Therapist effects were small and nonsignificant. CT appears to be superior to EXP = AR in the treatment of social phobia. (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)     

Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial.

Objective: To examine the efficacy of a developmentally appropriate parent–child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4–7 years. Method: Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent–child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires. Analysis: Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions. Results: The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p     

Cognitive-behavioral therapy for women with lifelong vaginismus: A randomized waiting-list controlled trial of efficacy.

Women with lifelong vaginismus (N = 117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9 participants per group. Assistance with minimal-contact bibliotherapy consisted of 6 biweekly, 15-min telephone contacts. Twenty-one percent of the participants left the study before posttreatment assessment. Intent-to-treat analysis revealed that successful intercourse at posttreatment was reported by 14% of the treated participants compared with none of the participants in the control condition. At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants, respectively, reported successful intercourse. Cognitive-behavioral treatment of lifelong vaginismus was thus found to be efficacious, but the small effect size of the treatment warrants future efforts to improve the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)