EMDR for panic disorder with agoraphobia: Comparison with waiting list and credible attention-placebo control conditions.

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measure, (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (η?=?.00–.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive–behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral body image therapy for body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of A cognitive behavioural therapy program for problem gambling, therapist manual.

Reviews the book, A cognitive behavioural therapy program for problem gambling, therapist manual by Namrata Raylu and Tian Po Oei (2010). This book provides a session by session protocol for outpatient treatment of problem gambling. The protocol was developed for an efficacy study comparing individual and group treatment but has been repackaged for a broader audience. In the research study, both the individual and group participants showed good outcomes in comparison with a waiting list control with no differences between individual and group formats. This work adds to the growing evidence base for cognitive–behavioural and motivational treatments for gambling disorders. The treatment program comprises 10 core and 3 elective sessions. As with many CBT protocols, the first two sessions focus on assessment and psychoeducation. The remaining eight core sessions cover cognitive and behavioural strategies, relaxation, imaginal exposure, problem-solving skills, management of negative emotions, and relapse prevention. The three elective sessions focus on helping clients with assertiveness and dealing with debt, and helping concerned significant others cope with the gambling problems. As is indicated in the Preface, this manual is written for professional health workers with some knowledge of CBT but limited knowledge of problem gambling. The aim of providing the relevant background in gambling disorders is accomplished effectively in two ways. First, the book provides a concise but comprehensive review of the research literature on the etiology, maintenance, and treatment of gambling disorders in the second chapter. Second, a connection is made to the background literature in providing the rationale for specific areas of focus, interventions, and topics for each session. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A self-control behavior therapy program for depression.

A behavior therapy program based on a self-control model of depression was evaluated against a nonspecific group therapy condition and a waiting list control group, 28 depressed volunteer female Ss ages 18–48 were administered a psychological test battery including the Beck Depression Inventory and the MMPI and randomly assigned to 1 of the 3 experimental conditions. The experimental therapy procedure consisted of a 6-wk group treatment program that sequentially focused on modifying self-monitoring, self-evaluation, and self-control skills. In each phase specific self-control principles were discussed in conjunction with behavioral homework assignments involving activity schedules. The self-control therapy Ss showed significantly greater reduction in depression on self-report and behavioral measures. Self-control Ss also showed greater improvement in overall pathology on the MMPI. There was some evidence that self-control Ss improved on specific measures of self-control behavior. A 6-wk follow-up generally confirmed maintenance of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Cognitive-behavioral body image therapy for body dysmorphic disorder": Correction.

Reports 2 errors in the original article by J. C. Rosen et al (Journal of Consulting and Counseling Psychology, 1995[Apr], 63[2], 263–269). On page 263, the correct prevalence of body dysmorphic disorder is 1.5% among women. On page 265, NHANES II stands for National Health and Nutrition Examination Surveys, Study 2. (The following abstract of this article originally appeared in record 1995-26170-001). Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. … (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of Socially Anxious College Men Using Cognitive Counseling and Skills Training.

The major purpose of this study was to compare the effects of three treatments of social anxiety: cognitive counseling, skills training, and a treatment that combined these two approaches. The results showed that compared with a wait-list control, the three treatments produced significantly greater improvement on three of the five outcome measures. All three procedures appeared equally effective, since no significant differences were obtained on any of the five general outcome measures. Changes in the targets of counseling (i.e., maladaptive cognitions and conversational skill) were also assessed. Whereas all treatments produced more change on maladaptive cognitions compared with the waiting list control group, the treatments providing cognitive counseling produced the most change. No differences between treatments or between the waiting list and the treatments were obtained on measures of conversational skill. These results are discussed in terms of Bandura's self-efficacy theory and the influence of both specific and nonspecific sources of improvement in counseling. The study also raises several potential hypotheses for future research, including the relation between type of deficit and treatment outcome and the pervasive versus situation-specific nature of anxiety problems for minimal daters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of clinical characteristics in obsessive-compulsive disorder and body dysmorphic disorder

Recent research has suggested that body dysmorphic disorder (BDD) is part of the spectrum of obsessive-compulsive disorders. In order to determine the extent of similarity for psychopathology measures, patients diagnosed with BDD were compared to a group of patients diagnosed with obsessive-compulsive disorder (OCD) on obsessionality, compulsivity, overvalued ideas, depression, and anxiety. Results indicate that BDD patients are similar to OCD patients for measures of obsessionality and compulsivity when BDD symptoms are assessed as such. BDD and OCD patients were also similar for measures of depression, and state and trait anxiety. OCD patients had higher levels of anxiety when measuring common physical symptoms associated with this affective reaction. BDD patients had higher levels of overvalued ideas, but fewer obsessive and compulsive symptoms. Overall, the results suggest that BDD is a variant of OCD, with special considerations given to degree of belief conviction (overvalued ideas.     

Evaluation of a palliative care service: problems and pitfalls

OBJECTIVE: To evaluate a palliative care home support team based on an inpatient unit. DESIGN: Randomised controlled trial with waiting list. Patients in the study group received the service immediately, those in the control group received it after one month. Main comparison point was at one month. SETTING: A city of 300,000 people with a publicly funded home care service and about 200 general practitioners, most of whom provide home care. MAIN OUTCOME MEASURES: Pain and nausea levels were measured at entry to trial and at one month, as were quality of life for patients and care givers' health. RESULTS: Because of early deaths, problems with recruitment, and a low compliance rate for completion of questionnaires, the required sample size was not attained. CONCLUSION: In designing evaluations of palliative care services, investigators should be prepared to deal with the following issues: attrition due to early death, opposition to randomisation by patients and referral sources, ethical problems raised by randomisation of dying patients, the appropriate timing of comparison points, and difficulties of collecting data from sick or exhausted patients and care givers. Investigators may choose to evaluate a service from various perspectives using different methods: controlled trials, qualitative studies, surveys, and audits. Randomised trials may prove to be impracticable for evaluation of palliative care.     

Comparison of cognitive style in bulimia nervosa and depression

This study investigated the global and specific cognitive style associated with bulimia nervosa. Three groups of women (women with bulimia nervosa, women with major depression, and controls) completed measures of eating disorder severity, depression, dysfunctional cognitions and irrational beliefs. The control group was found to report significantly lower levels of cognitive distortions and irrational beliefs overall than both women with bulimia nervosa and women with depression. However, no difference was found between the latter two groups. Furthermore, the pattern of individual cognitions and beliefs was exactly the same. When depression was statistically controlled, cognitive style no longer differentiated between the control group and two clinical groups. These results have implications for improving the effectiveness of cognitive behaviour therapy for bulimia nervosa.     

A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome

This study compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia nervosa. Participants were 76 women who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met DSM-III-R criteria for bulimia nervosa. Subjects were randomly assigned to receive fluoxetine alone, cognitive behavior therapy alone, or the two in combination and were treated over 16 weeks. Short-term outcome revealed that all three treatment conditions were associated with clinical improvement across a wide range of parameters. The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone. Limitations to the study include the absence of a placebo pill group and a waiting list control group as well as a substantial dropout rate across all three treatment conditions.     

Behavioral medicine approaches to somatoform disorders.

This article reviews the research evidence for the efficacy of cognitive-behavioral therapy (CBT) for somatoform disorders. Randomized controlled studies support the efficacy of individual CBT for the treatment of hypochondriasis, body dysmorphic disorder (BDD), and undifferentiated somatoform disorders including medically unexplained symptoms, chronic fatigue syndrome, and noncardiac chest pain, and group CBT for the treatment of BDD and somatization disorder. On the basis of this review of the existing research and a theoretical model of the processes involved in somatoform disorders, the authors offer suggestions for future research and effective treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity of cognitive impairment in Alzheimer's disease affects list learning using the California Verbal Learning Test (CVLT)

Impairment in list learning is considered a primary symptom of Alzheimer's disease (AD), yet there are no published reports examining the relationship between list learning and severity of cognitive impairment. We gave nine-item and 16-item versions of the California Verbal Learning Test (CVLT; Delis et al., 1987), a standardized shopping list assessment of memory, to 24 AD patients (mean age = 76.2 +/- 8.1; mean years of education = 13.8 +/- 2.4), who were stratified into four groups based on MMSE scores (mean = 16.0 +/- 5.6). ANOVAs revealed severity effects for total list learning (p < 0.001), the first trial (p < 0.001), the last trial (p < 0.001) and short- and long-delay recall measures. Most of these differences seemed due to floor effects. For example, the modal number of words recalled after a delay was 0 by subjects with MMSE scores below 21. Severity of cognitive impairment was associated with the proportion of intrusions such that the most severely demented subjects gave almost entirely intrusion responses. Surprisingly, list length did not significantly affect any of the free recall measures. Our results suggest that list learning and recall seem to be lost relatively early in AD. Measures of list recall like the CVLT may not be useful in tracking severity of cognitive impairment over time.     

Body dysmorphic disorder in patients with acne

There is growing evidence that the prevalence of body dysmorphic disorder (BDD) is significantly higher in specially selected populations as compared to the general population. The goal of the current study was to evaluate prevalence of BDD in Turkish patients with mild acne presenting to a dermatologist for treatment. This study was the first empirical investigation of BDD in acne patients in Turkey. One hundred fifty-nine outpatients diagnosed with acne who consulted to the dermatology clinic were included in the study. The diagnosis of BDD was based on DSM-IV criteria and the Structured Clinical Interview for DSM-IV (SCID-I). A study-specific questionnaire was administered to document and investigate the demographic and clinical characteristics of the cases. Fourteen (8.8%) patients were diagnosed with BDD. Three (21.4%) patients with acne and BDD also had concomitant psychiatric diagnoses. All of the patients were psychiatric management-naive, never received any psychological or physical treatments. BDD was a common psychiatric condition in acne cases. We suggest that dermatologists should routinely explore symptoms and screen such patients for BDD.     

Effects of aerobic exercise on cognitive and psychosocial functioning in patients with mild hypertension.

The effects of 16 wks of physical exercise training on the psychological functioning of 90 patients with mild hypertension were examined. At baseline and after 16 wks of training, patients completed a psychometric test battery that included objective measures of neuropsychological performance and standardized self-report measures of psychosocial functioning. Patients were randomly assigned to 1 of 3 groups: aerobic exercise, strength training and flexibility exercise, or a waiting list control group. After training, there were no group differences on any of the psychological measures, even though patients who engaged in exercise perceived themselves as functioning better in a number of psychological domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Danger ideation reduction therapy (DIRT) for obsessive-compulsive washers. A controlled trial

Twenty-one OCD sufferers with washing/contamination concerns took part in a controlled treatment trial at the Anxiety Disorders Clinic, University of Sydney. Eleven of the subjects received danger ideation reduction therapy (DIRT) over eight, 1 h weekly group sessions conducted by the second author. Ten subjects were placed on a wait list and did not receive DIRT or any other treatment. DIRT procedures were solely directed at decreasing danger-related expectancies concerning contamination and did not include exposure, response prevention or behavioral experiments. Components of DIRT include attentional focusing, filmed interviews, corrective information, cognitive restructuring, expert testimony, microbiological experiments and a probability of catastrophe assessment task. All subjects were assessed at pre-treatment, post-treatment and three-month follow-up using the Maudsley Obsessional-Compulsive Inventory, Leyton Obsessionality Inventory, Beck Depression Inventory and a Self Rating of Severity Scale. Changes from pre-treatment to after treatment (post-treatment and follow-up scores averaged) were significantly greater in the DIRT condition than in the control condition for all measures. No significant differences were obtained between groups on post-treatment to follow-up change on any measure. The implications of these findings for theoretical models of OCD and its management are discussed.     

Antibody responses to tetanus toxoid and Haemophilus influenzae type b conjugate vaccines following autologous peripheral blood stem cell transplantation (PBSCT)

OBJECTIVE: Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury (SCI), there are little data to support this assertion. To date, reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation. DESIGN: The study employed a nonrandomized controlled trial, and measures were taken on three occasions: before, immediately after, and 12 months after treatment. SETTING, OUTCOME MEASURES, AND INTERVENTION: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation. CONTROLS: The intervention group's responses on the measures were compared with a control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization. RESULTS: There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury, compared to similar persons in the control group. CONCLUSIONS: While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT.     

Rational restructuring versus desensitization with clients of diverse conceptual levels: A test of a client-treatment matching model.

Examined the efficacy of matching treatment orientations differing in structure with clients differing in conceptual level (CL). Theoretically, "matched" conditions (i.e., high-structure treatment with low-CL clients and low structure treatment with high-CL clients) should be more effective than "mismatched" conditions (i.e., high-structure treatment with high-CL clients and low structure treatments with low-CL clients). 59 socially anxious males (as determined by the Social Anxiety Scale) were assessed as either high or low on CL (Paragraph Completion Test) and randomly assigned to rational cognitive restructuring (low structure), systematic desensitization (high structure), or a waiting list control group. After 5 1-hr-per-wk treatment sessions, analyses of the Social Avoidance and Distress Scale, Fear of Negative Evaluation Questionnaire, Behavioral Checklist for Interpersonal Anxiety, and a cognitive response assessment failed to confirm the matching model. Superiority of treatment effects relative to controls was obtained, with rational restructuring emerging as a preferred treatment. Discussion focuses on a comparison of this study with one in which the matching effect was obtained. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An attempt to establish the experimental construct validity of cognitive and behavioral approaches to assertiveness training.

Cognitive, behavioral, and combined assertiveness treatments for dysfunctional job-interviewing skills were evaluated in a design that included high-demand and waiting list control treatments as well. Cognitive, behavioral, generalization, and control measures were used to determine the construct validity of hypothesized improvements. The cognitive treatment had no impact on any outcome variable. Some evidence to favor the behavioral treatment appeared on the cognitive assessment battery. However, given the failure of the behavioral treatment to register parallel changes on the behavioral battery, these cognitive improvements are not clearly attributable to behavioral theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient characteristics and outcome in psychotherapy and behavior therapy.

94 psychoneurotic or personality disordered patients received 4 mo of analytically oriented psychotherapy, behavior therapy, or waiting list treatment. The demographic variables included age (early twenties), sex (60% female), marital status (26% married), number of siblings (2), and birth order. Neither active treatment was more effective than the other with any type of symptom (including affective ones), although both were more consistently effective than the waiting list. With psychotherapy, relatively greater success was associated with less overall pathology on the MMPI and higher socioeconomic status. Psychotherapy was least effective with Ss who scored high on the Hysteria and Psychopathic Deviate scales. There was also a strong but nonsignificant trend for more improvement in psychotherapy Ss who were younger, female, married, later born, more intelligent, and from smaller families. Behavior therapy was more effective with those who scored high on the Hysteria and Mania scales and seemed to be effective with a broader range of patients. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)