Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression.

Distilled versions of A. T. Beck's (1967, 1976) cognitive and P. M. Lewinsohn's (1974) behavioral treatments for depression were crossed in a 2?×?2 design that included combined and high-demand treatments. Ss were 40 clients seeking services at a university counseling center. Measures included the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression, an automatic thoughts questionnaire, and social skills ratings. Data reveal that the Cognitive Treatment factor produced a consistent and durable impact on instruments reflecting cognitive manifestations of depression; some generalization to the behavioral domain occurred as well. The Behavioral Treatment factor failed to produce improvement within the corresponding behavioral assessment battery or on any cognitive device. Analysis of BDI data suggested possible evidence favoring each factor. Both conditions generated equivalent demand characteristics and counselor ratings of client adherence to treatment. No interactions involving the treatments occurred. The obtained pattern of convergent and divergent outcomes indicates considerable construct-valid strength for cognitive therapy applied to a moderately depressed population. Possible reasons for behavior therapy's comparatively weak showing are discussed. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching stress inoculation's treatment components to client's anxiety mode.

65 speech-anxious undergraduates (determined by the Personal Report of Confidence as a Speaker) were classified as experiencing primarily cognitive or somatic symptoms of anxiety as measured on the Cognitive–Somatic Anxiety Questionnaire. Ss received cognitive restructuring, coping relaxation, a combined cognitive–somatic treatment (stress inoculation), or no treatment. Indices of anxiety (e.g., the Anxiety scale of the Affect Adjective Check List) were obtained. The cognitive indices of anxiety provided the strongest support for the "matching" hypothesis, in that matched treatments resulted in more facilitative patterns of cognitions relevant to the stressor. All treatments were more effective than the no-treatment control in reducing behavioral indicants of anxiety, although a self-report measure of speech anxiety failed to show such treatment effects. Results are discussed in the context of treating focused anxieties by attending to the individual's concerns in the anxiety-arousing situation. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults.

The efficacy of bibliotherapy for mildly and moderately depressed older adults was examined. Cognitive bibliotherapy and behavioral bibliotherapy were compared with a delayed-treatment control condition. Results indicate that the two experimental conditions were superior to the control condition, but that the cognitive and behavioral bibliotherapies were nondifferentially efficacious. Sixty-six percent of the subjects demonstrated clinically significant change. There were no specific effects associated with either the cognitive or the behavioral interventions. Treatment gains were maintained at 6-month follow-up. The implications of bibliotherapy for geriatric depression as an alternative or adjunct to traditional treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Judgments about estrogen replacement therapy: The role of age, cognitive abilities, and beliefs.

This study investigated age, cognitive abilities, health beliefs, and other factors in women's judgments about effective treatments for menopause. Women (N?=?102) ranging in age from 20 to 79 read a vignette about a woman facing a decision about Estrogen Replacement Therapy (ERT) and then made judgments about what should be done. Participants also completed a battery of questions pertaining to ERT and cognitive abilities. Path-analytic techniques were used to determine the role of specific cognitive abilities and the representation of menopause and its treatment in making judgments about ERT treatments. Cognitive abilities had direct effects on treatment decisions. Education affected the number of perceived options for treatment. Age and education indirectly affected treatment decisions, operating through cognitive abilities. Factors related to the mental representation of menopause had no direct effects and few indirect effects on treatment decisions. Potential mechanisms that can help older adults compensate for declines in cognitive abilities in medical decisions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and cognitive treatments of geriatric insomnia.

Geriatric insomnia is a prevalent problem that has not received adequate controlled evaluation of psychological treatments. The present study evaluated behavioral and cognitive methods, relative to a wait-list control condition, for treating 27 elderly subjects (mean age?=?67 years) with sleep-maintenance insomnia. Both treatment methods, stimulus control and imagery training, produced significant improvement on the main outcome measure of awakening duration. Stimulus control yielded higher improvement rates than either imagery training or the control condition on awakening duration and total sleep-time measures. Sleep improvements were maintained by the two treatment methods at 3- and 12-month follow-ups. The results were corroborated by collateral ratings obtained from significant others. Subjective estimates of awakening duration and sleep latency correlated highly with objective measures recorded on an electromechanical timer. The findings suggest that geriatric insomnia can be effectively treated with psychological interventions and that behavioral procedures are more beneficial than cognitive procedures for sleep maintenance problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educational and behavioral interventions for back pain in primary care

STUDY DESIGN AND OBJECTIVES: A review of the literature was undertaken to identify and summarize randomized trials of educational, cognitive, and behavioral interventions for people with chronic low back pain. SUMMARY OF BACKGROUND DATA: Studies of back schools have varied widely in patient characteristics, back school length and content, and comparison treatment. The available evidence suggests that back schools do not affect long-term outcomes of people with back pain. METHODS: MEDLINE and PsycLIT databases were searched to identify randomized trials of cognitive and behavioral treatments for chronic low back pain. Outcome data were extracted from articles that met the meta-analysis inclusion criteria. RESULTS: The meta-analysis found that cognitive and behavioral treatments were superior to control conditions after treatment on measures of chronic low back pain, pain behavior, and disability. Follow-up comparisons of cognitive and behavioral treatments versus control conditions were not available. This meta-analysis did not find cognitive and behavioral therapies to differ from other active treatments on specific outcome measures, although only a few studies were available for each measure. CONCLUSION: It may be useful to incorporate cognitive-behavioral interventions in primary care settings, but additional research is needed to evaluate their efficacy in improving specific outcomes.     

Effects of behavioral, cognitive, and combined treatments for assertion as a function of differential deficits.

Investigated the interaction of demonstrated knowledge of assertive behavior with treatments for nonassertive behavior to help clarify the interaction of deficits with treatments. 88 female undergraduates were classified as low or high on knowledge of assertive behavior and randomly assigned to 1 of 4 treatment conditions: behavioral rehearsal, cognitive self-statement, combined behavioral rehearsal/cognitive self-statement, and a waiting-list control group. Multiple measures were administered over time (e.g., Conflict Resolution Inventory). Results support the effectiveness of each treatment and the stability of treatment effect over a long-term follow-up but failed to support a differential treatment approach to assertion based on demonstrated knowledge. Behavioral and cognitive treatments seemed to have the greatest effect on measures that were similar to the treatment focus, but also registered effects on measures similar to the other treatment. Treatment groups had significantly higher self-efficacy scores than the controls, and self-efficacy correlated significantly with many dependent variables. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive–behavioral treatments in reducing Type A behavior among university faculty: One year later.

Conducted 6-mo and 1-yr follow-up evaluations of a study in which the effectiveness of cognitive–behavior modification (CBM) and cognitive–behavior modification plus assertion training (CBM/AT) treatments were compared with a minimal treatment (MT) control in reducing Type A (coronary prone) behavior and related characteristics among 31 university faculty members. Ss completed a battery of measures, including the Jenkins Activity Survey, a Type A self-rating scale, and the Manifest Hostility Scale. At both follow-ups, CBM and CBM/AT groups continued to report significantly less Type A behavior and Type A irrational beliefs than controls. Also, CBM and CBM/AT groups reported significantly less speed and impatience behavior at both follow-ups than did the control group, differences that were not found at posttreatment. No significant differences among groups were found for hard-driving/competitive, trait anger, or hostility levels, with the exception that CBM Ss reported significantly less hostility at the 1-yr follow-up than did MT Ss. Results support the long-term effectiveness of brief cognitive–behavioral treatments in reducing Type A behavior. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of weight control and weight control plus body image therapy for obese men and women.

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive–behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive–behavioral weight control program is effective as well. (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)     

Status epilepticus causes long-term NMDA receptor-dependent behavioral changes and cognitive deficits

PURPOSE: The role of N-methyl-D-aspartate (NMDA)-receptor activation on behavioral and cognitive changes after status epilepticus (SE) is unknown. In this study, behavioral and cognitive changes after SE were evaluated in the short and long term and in rats in which the NMDA receptor was inactivated during SE. METHODS: Pilocarpine (350 mg/kg) was injected to induce SE. Inhibition of the NMDA receptor during SE was achieved with MK-801 (4 mg/kg). Seizure intensity during SE was monitored by electroencephalography (EEG). After SE, behavioral studies were performed to identify abnormal behavior by using behavioral tests adapted from Moser's functional observational battery. Cognitive changes were assessed by using the Morris Water Maze (MWM). RESULTS: Pilocarpine-treated animals scored significantly higher on two of the behavioral tests: the Touch test and the Pick-Up test. These behavioral changes occurred very soon after SE, with the earliest changes observed 2 days after SE and persisting for the life of the animal. Inhibition of the NMDA receptor with MK-801 completely inhibited these behavioral changes under conditions that did not alter the duration of SE. In addition, pilocarpine-treated animals exhibited cognitive deficits as determined by using the MWM. Six weeks after SE, the animals displayed significantly longer latencies to locate the hidden platform on this test. The impaired performance on the MWM also occurred as early as 5 days after SE. These cognitive deficits were prevented in animals treated with MK-801 during SE. CONCLUSIONS: The results indicate that behavioral and cognitive changes occur soon after SE, are permanent, and are dependent on NMDA-receptor activation during SE. NMDA-receptor activation may play an important role in causing cognitive and behavioral morbidity after recovery from SE.     

Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast cancer

OBJECTIVE: The authors' goal was to determine whether cognitive behavioral treatment of residual symptoms of depression might have a significant effect on relapse rate. METHOD: A 6-year follow-up assessment was conducted of 40 patients with primary major depressive disorder who had been successfully treated with antidepressants and were randomly assigned to either cognitive behavioral treatment of residual symptoms or standard clinical management. RESULTS: Ten of the patients (50%) in the cognitive behavioral treatment group and 15 (75%) in the standard clinical management group relapsed. The difference did not attain statistical significance. When multiple relapses were considered, patients in the cognitive behavioral treatment group had a significantly lower number of depressive episodes than those in the standard clinical management group. Patients responded to the same antidepressant drug used in the index episode; in two cases (4%), resistance occurred. CONCLUSIONS: The protective effects of cognitive behavioral treatment that were evident at 4-year follow-up faded afterward. Cognitive behavioral treatment of residual symptoms, however, improved the long-term outcome of major depression in terms of total number of episodes during the follow-up period.     

Supportive versus cognitive–behavioral intervention programs in achieving adjustment to home peritoneal kidney dialysis.

Two psychological interventions given for 8 weeks, supportive and cognitive–behavioral, were compared in achieving psychosocial adjustment to home peritoneal kidney dialysis. Participants were divided into 3 groups of patients and their spouses: a supportive group (18 couples), a cognitive–behavioral group (18 couples), and a no-intervention control group (24 couples). A group of 97 healthy participants served as a baseline control group. Self-report measurements were made before treatment (T?), halfway through (T?), and after treatment (T?). Results indicated that, without treatment, the no-intervention control group demonstrated a deterioration of psychosocial adjustment going from T? to T?. Both interventions were effective in aiding patients and spouses in maintaining psychosocial adjustment in comparison with the no-intervention control group, with few differences between treatments. Most improvement was obtained in the emotional, cognitive, and interpersonal areas, with smaller gains made in the behavioral area. (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)     

Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis.

A meta-analysis was performed on 18 studies in which a cognitive–behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive–behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring impulsivity and examining its relationship to delinquency.

A multimethod, multisource assessment of impulsivity was conducted in a sample of more than 400 boys (mean age 10.2 yrs at screening) who were members of a longitudinal study of the development of antisocial behavior. Exploratory and confirmatory factor analysis of the 11 different impulsivity measures revealed 2 impulsivity factors: Cognitive and Behavioral. Cognitive and behavioral impulsivity had similar correlations with socioeconomic status. Cognitive impulsivity was more strongly related to IQ than was behavioral impulsivity. Behavioral impulsivity was more strongly related to delinquency at ages 10 yrs and 12–23 yrs than was cognitive impulsivity. Consistent with theoretical prediction, results also indicate that behavioral impulsivity was especially related to serious delinquency that is stable over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain.

Cognitive–behavioral and physical therapies are incorporated into multidisciplinary chronic pain programs because changes in pain cognitions and physical capacity may represent therapeutic processes that facilitate favorable outcome. Decreases in depression, however, may explain treatment responses more parsimoniously. Measures of pain helplessness, lifting capacity, walking endurance, depression, pain severity, and activity level were collected from 94 chronic pain patients at pre- and posttreatment and at 3- to 6-month follow-up evaluations. Decreases in pain helplessness were linked to pain severity reduction, whereas walking endurance increases were related to improvements in activity levels and downtime even after controlling for effects of depression decreases. Thus, cognitive and physical capacity changes that occur through pain treatment may make unique contributions to long-term outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognition, commitment language, and behavioral change among cocaine-dependent patients.

Patients' cognitive abilities and verbal expressions of commitment to behavioral change predict different aspects of substance abuse treatment outcome, but these 2 traits have never been examined conjointly. The authors therefore investigated patients' cognitive abilities and verbal expressions of commitment to behavioral change as predictors of retention and drug use outcomes in an outpatient cognitive behavioral treatment (CBT) of adult cocaine-dependent patients. A neuropsychological battery was administered at baseline. Two independent raters used recordings of CBT sessions to code commitment language strength across the temporal segments (e.g., beginning, middle, and end) of 1 session per patient. Better cognitive abilities predicted treatment retention (p     

The effects of experimental socialization paradigms upon two moral responses to transgression.

In an initial experiment on the antecedents of self-criticism and reparation, 57 5th-grade girls were equally assigned to 2 treatments: High Cognitive Structure High Control and Low Cognitive Structure-Low Control. Each S was repeatedly punished for an aggressive act on 10 training trials. On the test trial, a more destructive act was contrived to elicit internalized moral responses. In a 2nd experiment, using the same techniques but designed to distinguish independent antecedents, 68 5th-grade boys were equally assigned to each of 4 treatments: High Cognitive Structure-High Control, High Cognitive Structure-Low Control, Low Cognitive Structure-High Control, and Low Cognitive Structure-Low Control. Induction of self-criticism was significantly related to E's cognitive structuring during training. Reparative responses were a function of whether S or E controlled punishment. The 2 moral responses were concluded to be the consequences of distinct patterns of social reinforcement and not attributable to a unitary entity such as "conscience" or "superego." (33 ref.) (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)