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)     

Treatment of generalized anxiety disorder in older adults.

Older adults with generalized anxiety disorder (GAD; N=75; M age=67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only 1 significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects. Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies.

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990; Hamilton Anxiety Rating Scale; M. Hamilton, 1959; assessor severity rating; State–Trait Anxiety Inventory-Trait Version; C. D. Spielberger, R. L. Gorsuch, R. Lushene, P. R. Vagg, & G. A. Jacobs, 1983) as well as with indices of clinically significant change. Results: Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [?.40, ?.28], d = 1.86) with no significant differences at post (CI = [?.09, .07], d = .07) or 2-year follow-up (CI = [?.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. Conclusions: Interpersonal and emotional processing techniques may not augment CBT for all GAD participants. Trial Registry name: Clinical Trials.gov, Identifier: NCT00951652. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive-behavioral treatment of late-life generalized anxiety disorder.

This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning. (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 treatment of women's body-image dissatisfaction.

Body-image dissatisfaction is a problem that affects a substantial minority of women and cuts across various diagnostic groups. College women with a significant level of body-image dissatisfaction were randomly assigned to either a cognitive–behavioral treatment (CBT) program (n?=?15) or to a waiting-list control group (n?=?16). The CBT program consisted of six structured, individual sessions that applied cognitive–behavioral procedures to the problem of negative body image. At pretest, posttest, and 7-week follow-up, multiple aspects of body image and other areas of psychosocial functioning were assessed. Relative to the control condition, the CBT program successfully improved affective body image, weakened maladaptive body-image cognitions, and enhanced social self-esteem and feelings about physical fitness and sexuality. Treatment effects were largely maintained at follow-up. After posttest, the control group received a 3-week treatment with immediate effects that generally replicated those obtained in the 6-week program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy plus contingency management for cocaine use: Findings during treatment and across 12-month follow-up.

Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive–behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of cognitive-behavioral treatment on quality of life in panic disorder patients.

Panic disorder (PD) is associated with significant social and health consequences. The present study examined the impact of treatment on PD patients' quality of life. Patients (N?=?156) meeting DSM-III—R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]; American Psychiatric Association, 1987) criteria for PD with agoraphobia were randomly assigned to group cognitive behavioral treatment (CBT) or a delayed-treatment control. An assessment battery measuring the major clinical features of PD as well as quality of life was administered at baseline (Week 0), post treatment (Week 9) and 6-month follow-up (Week 35). Consistent with previous studies, PD patients displayed significant impairment in quality of life at intake. Compared with delayed-treatment control participants, CBT-treated participants showed significant reductions in impairment that were maintained at follow-up. Consistent with prediction, anxiety and phobic avoidance were significantly associated with quality of life, whereas frequency of panic attacks was not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (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)     

One-year follow-up of cognitive-behavioral therapy for obese individuals with binge eating disorder.

The results of a 1-year posttreatment follow-up of 93 obese women diagnosed as having binge eating disorder (BED) and treated with group cognitive–behavior therapy (CBT) followed by weight loss treatment are described. The group as a whole maintained both reductions in binge eating and abstinence rates fairly well. However, they regained the weight lost during treatment. Those who stopped binge eating during CBT maintained a weight lost of 4.0 kg over the follow-up period. In contrast, those who continued to binge gained 3.6 kg. Twenty-six percent of those abstinent after CBT met criteria for BED at follow-up and had gained weight, whereas the remaining 74% had lost weight. Stopping binge eating appears critical to sustained weight loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice Makes Progress? Homework Assignments and Outcome in Treatment of Cocaine Dependence.

The relationship between treatment outcome and the extent to which participants completed homework assignments was evaluated among 60 cocaine-dependent individuals assigned to cognitive-behavioral therapy (CBT). Homework was assigned in 72% of all sessions and initiated by participants in 48% of the sessions in which it was assigned. Completion of homework was unrelated to participants' baseline characteristics and several indicators of treatment compliance. Participants who completed more homework assignments demonstrated significantly greater increases in the quantity and quality of their coping skills and used significantly less cocaine during treatment and through a 1-year follow-up. These data suggest that the extent to which participants are willing to complete extrasession assignments may be an important mediator of response to CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving quality of life in diverse rural older adults: A randomized trial of a psychological treatment.

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment of insomnia secondary to chronic pain.

Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive–behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of parental anxiety in the treatment of childhood anxiety

Sixty-seven children aged 7 to 14 who met diagnostic criteria for an anxiety disorder were assigned to conditions according to parental anxiety level. Within these conditions, children were randomly assigned to 1 of 2 treatments: child-focused cognitive-behavioral therapy (CBT) or child-focused CBT plus parental anxiety management (CBT + PAM). At posttreatment, results indicated that within the child-anxiety-only condition, 82% of the children in the CBT condition no longer met criteria for an anxiety disorder compared with 80% in the CBT + PAM condition. Within the child + parental anxiety condition, 39% in the CBT condition no longer met criteria compared with 77% in the CBT + PAM condition. At follow-up, these differences were maintained, with some weakening over time. Results were not consistent across outcome measures. The interpretation and potential clinical implications of these findings are discussed.     

Computer-assisted cognitive behavioral therapy for child anxiety: Results of a randomized clinical trial.

Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7–13 (M = 10.1 ± 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. Results: At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Conclusions: Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral therapy, behavioral weight loss, and sequential treatment for obese patients with binge-eating disorder: A randomized controlled trial.

Objective: Cognitive–behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL). Method: 125 obese patients with BED were randomly assigned to 1 of the 3 manualized treatments delivered in groups. Independent assessments were performed posttreatment and at 6- and 12-month follow-ups. Results: At 12-month follow-up, intent-to-treat binge-eating remission rates were 51% (CBT), 36% (BWL), and 40% (CBT + BWL), and mean percent BMI losses were ?0.9, ?2.1, and 1.5, respectively. Mixed-models analyses revealed that CBT produced significantly greater reductions in binge eating than BWL through 12-month follow-up and that BWL produced significantly greater percent BMI loss during treatment. The overall significant percent BMI loss in CBT + BWL was attributable to the significant effects during the BWL component. Binge-eating remission at major assessment points was associated significantly with greater percent BMI loss cross-sectionally and prospectively (i.e., at subsequent follow-ups). Conclusions: CBT was superior to BWL for producing reductions in binge eating through 12-month follow-up, while BWL produced statistically greater, albeit modest, weight losses during treatment. Results do not support the utility of the sequential approach of providing BWL following CBT. Remission from binge eating was associated with significantly greater percent BMI loss. Findings support BWL as an alternative treatment option to CBT for BED. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.

The present study tested cognitive-behavioral therapy (CBT) for insomnia in older adults with osteoarthritis, coronary artery disease, or pulmonary disease. Ninety-two participants (mean age = 69 years) were randomly assigned to classroom CBT or stress management and wellness (SMW) training, which served as a placebo condition. Compared with SMW, CBT participants had larger improvements on 8 out of 10 self-report measures of sleep. The type of chronic disease had no impact on these outcomes. The hypothesis that CBT would improve daytime functioning more than SMW was only supported by a global rating measure. These results add to findings that challenge the dichotomy between primary and secondary insomnia and suggest that psychological factors are likely involved in insomnias that are presumed to be secondary to medical conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: Within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive- behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N=252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)