Analytic complexities associated with group therapy in substance abuse treatment research: Problems, recommendations, and future directions.

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions. (PsycINFO Database Record (c) 2010 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)     

From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders.

A controversy exists over whether results of randomized controlled trials of psychological treatment methods generalize to routine clinical practice. To examine the generalizability of cognitive-behavioral interventions for anxiety disorders, a meta-analysis of 11 effectiveness studies was conducted. Only studies that closely approximated real-world clinical practice were included in the present meta-analysis (e.g., studies were conducted in a nonuniversity setting, practitioners had regular caseloads, clients were not excluded if they had comorbid conditions). Cognitive-behavioral interventions were associated with significant improvement in anxiety symptoms at the end of treatment (dw = 1.35) and again at follow-up (dw = 1.14). On the basis of these results, it seems that cognitive-behavioral interventions for anxiety disorders generalize to real-world clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focus of attention in the treatment of depression.

Current outcome studies indicate that cognitive-behavioral approaches are significantly more effective than nondirective strategies in treating depression. By reconceptualizing depression as an attentional deficit in self-focused attention, the present author provides an explanation for the nonspecific superiority of cognitive-behavioral strategies over nondirective techniques. It is suggested that reflection of affect may heighten self-awareness to detrimental levels in depressed patients already predisposed toward an internal (self) focus of attention. The state of self-focused attention is discussed in terms of its relationship to depression. Relevant research and clinical evidence support the hypothesis that an effective ingredient in treating depression lies in the negative reinforcement inherent in realigning client attention away from negative affect. Client–therapist interactions are discussed in relation to focus of attention. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation and moderation of psychological pain treatments: Response expectancies and hypnotic suggestibility.

The mediator role of response expectancies and the moderator role of hypnotic suggestibility were evaluated in the analogue treatment of pain. Approximately 1,000 participants were assessed for hypnotic suggestibility. Later, as part of a seemingly unrelated experiment, 188 of these individuals were randomly assigned to distraction, cognitive-behavioral package, hypnotic cognitive-behavioral package, hypnotic analgesia suggestion, placebo control, or no-treatment control conditions. Response expectancies partially mediated the effects of treatment on pain. Hypnotic suggestibility moderated treatment and was associated with the relief produced only by the hypnotic interventions. The results suggest that response expectancies are an important mechanism of hypnotic and cognitive-behavioral pain treatments and that hypnotic suggestibility is a trait variable that predicts hypnotic responding across situations, including hypnosis-based pain interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for distress in family caregivers of older adults.

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Role of Traumatic Experience in Panic Disorder and Agoraphobia.

Psychoanalytically oriented psychotherapy and psychoanalysis proper are widely considered by other clinicians to be inappropriate treatment modalities for patients with symptoms of agoraphobia and panic attack. The author presents a clinical hypothesis about the role of traumatic experience for these patients. The hypothesis is compatible with some ideas that have appeared in the clinical literature, and yet it has some distinctive features. Suggestions are offered as to some of the implications of this hypothesis for analytic treatment as well as for analytically oriented therapies that are integrated with psychopharmacological interventions and cognitive-behavioral approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancement of social learning family interventions for childhood conduct disorder.

Identifies approaches for maximizing treatment gains for the conduct-disordered child. Relevant studies were organized into 3 approaches: enhancements and expansions (a) within a dyadic (parent–child) interaction model, (b) within a broad-based model that acknowledges a wider range of family influences, and (c) through a multisystems model. Social learning family intervention (SLFI) enhancements within the dyadic model have centered on either the strengthening of parental skills already included in the SLFI regimen or the adding of new interactional strategies. Some gains, but only partial success, have been achieved with the dyadic model supplements. SLFI expansions from a broad-based model have focused on parental adjustment, parental expectations during treatment, and social-environmental stressors. The multisystems adjuncts to SLFI include cognitive-behavioral interventions to affect peer relations and ecological approaches to sweep across domains. The broad-based and multisystems expansions have produced promising but undertested treatment regimens. Related areas of investigation included therapy process research, medication combined with SLFI, and the involvement of fathers in treatment. Recommendations are offered for improvement of SLFI research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of sexual disorders in the 1990s: An integrated approach.

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral self-control therapy for children: A components analysis.

27 non-self-controlled 8–12 yr olds (as measured by the Self-Control Rating Scale) were randomly assigned to a cognitive-behavioral treatment, a behavioral treatment, or an attention-control condition. Ss were administered the Peabody Picture Vocabulary Test, Matching Familiar Figures Test, Piers-Harris Children's Self-Concept Scale, and Wide Range Achievement Test. All Ss received 12 sessions of individual therapist contact focusing on psychoeducational, play, and interpersonal tasks and situations, with the cognitive-behavioral treatment including self-instructional training via modeling and behavioral contingencies and the behavioral treatment involving modeling and contingencies. The cognitive-behavioral intervention improved teachers' blind ratings of self-control, and both the cognitive-behavioral and behavioral treatments improved teachers' blind ratings of hyperactivity. Several performance measures (cognitive style, academic achievement) showed improvements for the cognitive-behavioral and behavioral conditions, whereas only the cognitive-behavioral treatment improved children's self-concept. Normative comparisons and 10-wk follow-up provided additional support for the efficacy of the cognitive-behavioral treatment; 1-yr follow-up did not show significant differences across conditions. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and cognitive-behavioral approaches to chronic pain: Recent advances and future directions.

Behavioral and cognitive-behavioral approaches to chronic pain are receiving increasing attention from researchers and clinicians. This article reviews and highlights recent research advances and future research directions. Assessment research reviewed includes studies examining the social context of pain, the relationship of chronic pain to depression, cognitive variables affecting pain, and comprehensive assessment measures. Treatment outcome studies reviewed are those evaluating the effects of behavioral and cognitive-behavioral treatments for chronic pain. These studies focus on comparisons of behavioral treatment with control conditions, comparisons of 2 behavioral treatments, and prevention of chronic pain. Future directions for assessment and treatment research are outlined. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Acute and chronic pain in adults and children with cancer.

Reviews current research and clinical practice concerning pain experienced by cancer patients. Etiological subtypes of pain (disease related vs treatment related) are discussed, and an overview of assessment methodology for acute and chronic pain is presented. Also discussed are psychological interventions for pain in adult and pediatric cancer patients, including hypnosis, cognitive-behavioral therapy, biofeedback, relaxation, and operant conditioning. A review of the literature indicates a need for basic research, for controlled outcome studies of psychological interventions, and for education of health care professionals in the mechanisms and management of pain. Difficulties in conducting applied behavioral research in oncology units are noted, and the value of multidisciplinary collaboration is emphasized. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to group interventions for trauma survivors.

Group interventions for trauma survivors offer cost-efficient opportunities for members to join "fellow strugglers" in coping with trauma-related feelings of alienation and mistrust. For adults, supportive, psychodynamic, and cognitive-behavioral models have been described in the literature, each offering common as well as unique group therapy features. For older children and adolescents, integrated and cognitive-behavioral models are available, and there is general empirical support for the use of group therapy regardless of the model chosen. Group psychological debriefing immediately following trauma exposure may be useful for normalizing reactions, but evidence for its effectiveness in preventing trauma-related psychopathology is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic Stress Disorder in Youth: A Critical Review of the Cognitive and Behavioral Treatment Outcome Literature.

What treatments work for children who have posttraumatic stress disorder (PTSD)? Perhaps more important, what else do clinicians need to learn? In this article, the authors focus on treatment research in the area of trauma and PTSD in youth, in an attempt to highlight the clinical implications of such work and to identify the areas in which additional research is needed. Overall, there is emerging evidence that a variety of cognitive and behavioral programs are effective in treating youth with PTSD. In spite of such evidence, additional research is needed to shore up the scientific base for effective clinical practice with these youth. Psychologists working with traumatized youth will find this article a useful update on the state of evidence for cognitive-behavioral interventions in the treatment of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment adherence and differentiation in individual versus family therapy for adolescent substance abuse.

Treatment adherence and differentiation in dynamic cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse were evaluated with a treatment adherence process measure. Full-length videotapes of 90 treatment sessions (36 clients) were reviewed by nonparticipant raters. Adherence scales for each treatment generated through factor analysis of observational ratings demonstrated sound interrater reliability and internal consistency. Therapists in each condition used techniques unique to their own model and avoided those unique to the competing model. Individual therapists emphasized behavioral and substance-use interventions, whereas family therapists focused on interactional and affective interventions. Challenges in conducting adherence research that compares individual and family treatments are addressed, as are implications of these results for advancing treatment development for adolescent drug users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients": Correction to Kangas, Bovbjerg, and Montgomery (2008).

Reports an error in "Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients" by Maria Kangas, Dana H. Bovbjerg and Guy H. Montgomery (Psychological Bulletin, 2008[Sep], Vol 134[5], 700-741). The URL to the Supplemental Materials for the article is listed incorrectly in two places in the text. The incorrect listings appear on p. 704 (in the last two lines of the third paragraph) and on p. 705 (in the third and fourth lines of the first paragraph in the second column). The correct URL for the Supplemental Materials is http://dx.doi.org/10.1037/a0012825.supp, which is provided on the first page of the article beneath the abstract. (The following abstract of the original article appeared in record 2008-11487-005.) Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors. (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)     

Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients.

[Correction Notice: An erratum for this article was reported in Vol 135(1) of Psychological Bulletin (see record 2008-18777-005). The URL to the Supplemental Materials for the article is listed incorrectly in two places in the text. The incorrect listings appear on p. 704 (in the last two lines of the third paragraph) and on p. 705 (in the third and fourth lines of the first paragraph in the second column). The correct URL for the Supplemental Materials is http://dx.doi.org/10.1037/a0012825.supp, which is provided on the first page of the article beneath the abstract.] Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Meta-analyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between cognitions and performance in math anxious students: A failure of cognitive theory.

Investigated the cognitions of 34 high- and 37 low-anxious undergraduates in solving mathematical problems by asking them to think aloud while solving problems from the College Board Scholastic Aptitude Test. Cognitions generated from this procedure were examined for sex and anxiety-related differences and were used in a regression equation to predict performance. Results show that 2nd-step cognitive variables (review of information, strategic calculations, conclusions, neutral statements, and silence) did account for a significant amount of variance in the combined performance problems beyond that of the 1st step cognitions (attention control, self-facilitation, irrelevancies, and self-inhibition). It is suggested that cognitive and cognitive-behavioral approaches to counseling should be subject to empirical verification if a strong data base for these interventions is to be created. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)