Cognitive processing therapy for sexual assault victims.

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. 19 sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-mo follow-up. CPT Ss were compared with a 20-S comparison sample, drawn from the same pool who waited for group therapy for at least 12 wks. CPT Ss improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 mo. The comparison sample did not change from the pre- to the posttreatment assessment sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Changes During Prolonged Exposure Versus Prolonged Exposure Plus Cognitive Restructuring in Female Assault Survivors With Posttraumatic Stress Disorder.

The authors report on changes in cognitions related to posttraumatic stress disorder (PTSD) among 54 female survivors of sexual and nonsexual assault with chronic PTSD who completed either prolonged exposure alone or in combination with cognitive restructuring. Treatment included 9-12 weekly sessions, and assessment was conducted at pretreatment, posttreatment, and a modal 12-month follow-up. As hypothesized, treatment that included prolonged exposure resulted in clinically significant, reliable, and lasting reductions in negative cognitions about self, world, and self-blame as measured by the Posttraumatic Cognitions Inventory. The hypothesis that the addition of cognitive restructuring would augment cognitive changes was not supported. Reductions in these negative cognitions were significantly related to reductions in PTSD symptoms. The addition of cognitive restructuring did not significantly augment the cognitive changes. Theoretical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia

The aim of this work was to test the contribution of cognitive therapy to exposure in vivo in the group treatment of generalized social phobia. Seventy-one severely disabled social phobics, selected according to DSM-III-R criteria, were assigned at random to: (a) self-exposure in vivo, (b) self-exposure in vivo with cognitive therapy, or (c) a waiting-list control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-ups) was used. Additionally, half of the patients in both therapeutic groups were given self-help manuals for managing anxiety. Most patients that were treated (64%) showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic models. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of adding cognitive therapy or a self-help manual to exposure alone. Finally, several topics that may contribute to future research in this field are discussed.     

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Therapy Versus Fluoxetine in Generalized Social Phobia: A Randomized Placebo-Controlled Trial.

Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for generalized social phobia were assigned to cognitive therapy (CT), fluoxetine plus self-exposure (FLU + SE), or placebo plus self-exposure (PLA + SE). At posttreatment (16 weeks), the medication blind was broken. CT and FLU + SE patients then entered a 3-month booster phase. Assessments were at pretreatment, midtreatment, posttreatment, end of booster phase, and 12-month follow-up. Significant improvements were observed on most measures in all 3 treatments. On measures of social phobia, CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment. FLU + SE and PLA + SE did not differ. CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up. On general mood measures, there were few differences between the treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative study using orgasm consistency training in the treatment of women reporting hypoactive sexual desire

In an experimental study, a standard group intervention for treating women with hypoactive sexual desire was compared to a standard group intervention plus orgasm consistency training. Specificity of sexual change following treatment was assessed in 39 women with hypoactive sexual desire disorder who completed either treatment. Following treatment, women in both groups reported significantly positive sexual changes on two of the four measures of sexual behavior. Compared with the women receiving only standard treatment, the women who also received orgasm consistency training reported greater sexual arousal and sexual assertiveness at posttreatment and at three-month and six-month follow-up evaluations and greater sexual satisfaction at the six-month follow-up. Implications for these findings, study limitations, and future research directions are explored.     

A pilot study of a cognitive restructuring program for treating posttraumatic disorders in adolescents.

The study explored the feasibility and efficacy of a manualized cognitive restructuring program for treating adolescents suffering from posttraumatic stress disorder (PTSD). Nine girls and 3 boys (mean age 16 years; range = 14–18), with PTSD, were recruited from a community mental health center and a tertiary health care center and enrolled in a pilot study. The adolescents were seen weekly for 12–16 weeks of individual treatment. Variables assessed included: trauma history, PTSD diagnosis and severity, depression, substance abuse, and client satisfaction. Twelve adolescents consented to treatment; 9 completed the program. The number of types of traumas reported averaged 6.5 (range = 1–13). Paired t tests were used to test prepost change for PTSD symptoms and depression, in completers. From baseline to posttreatment, there were statistically significant improvements in PTSD and depression. Treatment gains were maintained at 3 month follow-up. Preliminary results suggest the feasibility of implementing a manualized cognitive restructuring program to treat PTSD in adolescents. Completers rated themselves as improved and satisfied at posttreatment and 3-month follow-up. Feedback from referring clinicians also indicated high satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Measuring abuse stress and negative cognitive appraisals in child sexual abuse: validity data on two new scales

The validity of two measures assessing degree of stress associated with sexual abuse was examined in a sample of 48 girls who had been sexually abused. The Checklist of Sexual Abuse and Related Stressors (C-SARS) assessed negative life events that were part of or were related to the abuse, and the Negative Appraisals of Sexual Abuse Scale (NASAS) assessed negative cognitive appraisals of threat, harm, or loss associated with the abuse. Total scores for victim reports of both stressful events and negative appraisals were positively and significantly related to two other measures of abuse severity: therapist ratings of abuse stress and the number of types of sexual abuse reported. Stressful event scores were also related to aggressive behavior problems, sexual concerns, and total symptom scores on the Child Behavior Checklist. Negative cognitive appraisal scores were related to victims' self-reports of depression, anxiety, and posttraumatic stress symptoms, and to parents reports of child depression and total symptoms. Regression analyses indicated that there were significant effects of negative appraisals on internalizing symptoms when controlling for the level of stressful events experienced. The results suggest that negative life events and negative appraisals associated with sexual abuse are valid constructs that help account for variability in mental health outcomes among child victims. The implications of these results and future research directions in examining variable outcomes among sexual abuse victims are discussed.     

Psychological investigation of genital herpes recurrence: Prospective assessment of cognitive-behavioral intervention for a chronic physical disorder.

Assessed factors associated with genital herpes and investigated the impact of psychological therapy on 16 patients who received 5 wks of structured discussion or cognitive restructuring (CR) group therapy. Measures of attitude about herpes, global coping, distress, loneliness, health locus of control, and recurrence were administered at pre- and posttreatment and at 3 mo follow-up. Information was extracted from daily self-reports regarding herpes symptoms, dysphoria, anxiety, and ongoing coping. Therapy did not produce expected reductions in distress or loneliness. CR, however, was associated with reduced frequency of lesion recurrence at follow-up. Avoidant coping was associated with lower recurrence rates, and loneliness scores with higher rates. Results show that recurrences were preceded by elevated anxiety independent of prodromal symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.

This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N = 87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n = 69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improvements in partner support predict sexual satisfaction among individuals with multiple sclerosis.

Purpose: Sexual dysfunction and low sexual satisfaction are common among individuals with multiple sclerosis (MS); however, little is known about factors that influence sexual satisfaction within this population. As such, the purpose of this study was to investigate the extent to which changes in negative and positive partner support predict sexual satisfaction levels over time in individuals with MS. Design: Eighty-one individuals with MS completed measures of sexual dysfunction, sexual satisfaction, partner social support, and depression. Data from baseline and posttreatment follow-up were obtained from a larger randomized clinical trial of telephone-administered psychotherapy for depression in a population with MS. Multiple regression analyses were conducted with change in overall sexual satisfaction from baseline to posttreatment as the outcome variable. Results: After controlling for age, gender, sexual dysfunction, years diagnosed with MS, and depression severity, those with increased positive partner support reported significant improvement in sexual satisfaction over time (β = .50, p     

Psychological Treatment of Musical Performance Anxiety: Current Status and Future Directions.

A comprehensive review of research evaluating psychological treatments of musical performance anxiety is provided. Studies were evaluated against key methodological criteria for psychotherapy outcome research. Available literature points to the utility of exposure and cognitive therapies, although there is no clear-cut evidence suggesting the superiority of one approach or benefits of combining the two. Past research is characterized by recurring methodological limitations, particularly overreliance on self-report outcome measures. Future investigations should consider screening out individuals who do not evidence marked dysfunction and whose anxiety results from weak technical ability, as well as including treatment manuals, multiple therapists, multichannel outcome measures, and follow-up data. Clinicians working with musicians experiencing performance anxiety may wish to incorporate exposure and cognitive restructuring in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of computer-based cognitive restructuring on rationally mediated self-esteem.

Fifty-six 11th- and 12th-grade students with below-average self-esteem were classified by gender and randomly assigned to either computer-based cognitive restructuring or a relaxation-training control condition. The computer intervention (laden with multimedia features such as color video clips, stereo music, digitized speech, and engaging graphics) targeted irrational beliefs linked in previous research to low self-esteem. Participants were assessed repeatedly as they progressed through the program; depending on the tenacity of each belief held, the program provided a variety of cognitive restructuring responses. Multivariate and univariate effects on 4 measures of rationality and self-esteem favored computer-based cognitive restructuring. (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)     

Exposure plus response-prevention treatment of bulimia nervosa.

A controlled study evaluating the effectiveness of exposure plus response-prevention treatment of bulimia nervosa was conducted in a sample of 47 women. This was a four-group comparison involving three treatment conditions and a waiting-list control group. The three treatment conditions were (a) exposure plus response prevention conducted in a single setting (clinic), (b) exposure plus response prevention conducted in multiple settings (clinic, patients' homes, and restaurants), and (c) cognitive–behavioral therapy without exposure plus response prevention. All treatment was provided to groups of 3 patients at a time. Outcome was evaluated at posttreatment and at a 6-month follow-up. The three treatment groups improved significantly on most outcome measures, whereas the waiting-list control group showed little change. At follow-up, there was a slightly better outcome on vomiting behavior and amount of food consumed in one of the test meals for the exposure plus response-prevention groups relative to the no-exposure group. However, on all other measures, the degree of improvement from pretreatment to follow-up was the same for all three treatment groups. (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)     

Response-acquisition and cognitive self-statement modification approaches to dating-skills training.

Three training programs for girl-shy males were designed using an empirically derived domain of problem situations from shy males and response alternatives from a "competent" population. The effectiveness of a response-acquisition treatment was compared with a cognitive self-statement modification treatment, a combination of these 2 treatments, and a waiting-list control group (no treatment). Two enhanced-treatment groups were used to control for the longer time of the combined-treatment group. 61 college men replying to the program announcement were randomly assigned to 1 of the 6 groups. Assessment included in vivo measures made by women phoned by the Ss, questionnaire measures, and ratings of role-play performance in taped, laboratory, problem situations. A 6-mo follow-up assessment was also included. Results indicate that Ss trained in cognitive self-statement modification showed significantly better performance in role-play situations for which they were not trained, made significantly more phone calls, and made a significantly better impression on the women than Ss in other groups. These effects were generally maintained at follow-up, and the cognitive self-statement groups' performance on the role-play measures improved from posttreatment to follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feasibility of a Cognitive Restructuring Intervention for Treatment of Chronic Pain in Persons With Disabilities.

Objective: To determine the feasibility of a cognitive restructuring intervention relative to an education intervention for treatment of pain in persons with chronic pain secondary to disability. Study Design: Quasi-experimental. Participants: 18 adults with chronic pain and disability. Interventions: Cognitive restructuring (n = 13) or education (n = 5) group intervention. Main Outcome Measure: Average pain intensity. Results: Participants in the cognitive group reported greater pre- to posttreatment decreases in pain than those in the education group. Participants rated both interventions positively and expressed enthusiasm for psychosocial interventions for pain. Conclusions: Preliminary findings suggest that decreases in pain can occur as a result of a cognitive restructuring intervention and support the feasibility of conducting intervention trials in persons with disability-related chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder.

With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-month follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)