Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are all cognitive therapies alike? A comparison of cognitive and noncognitive therapy process and implications for the application of empirically supported treatments.

The definition of an empirically supported treatment (EST) arguably embodies 2 untested assumptions: (a) that different manualized renditions of the same therapy are functionally equivalent and (b) that therapies can be reliably applied independently of therapist, setting, and format. These assumptions were tested as applied to cognitive therapy (CT), using process data from a large multisite study (N=235) that included 3 cognitive and 6 alternative therapies. Although the non-CTs were more variable than the CTs on 2 of 4 dimensions studied (directiveness and emotional arousal), there was considerable variation among the 3 CTs, even when implemented in the current context of rigorous training, manualization, and adherence checks. Results are discussed as related to the assumptions underlying EST criteria. (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)     

A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults.

The authors used a randomized trial to compare cognitive-behavioral therapy (CBT) and supportive counseling (SC) in the treatment of anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for anxiety disorders. Both conditions had a 6-week baseline no-treatment phase. Treatment was delivered primarily in patients' own homes and in an individual format. Outcomes were assessed at posttreatment and at 3-, 6-, and 12-month follow-ups. There was no spontaneous improvement during the baseline phase. Both groups showed improvement on anxiety measures following treatment, with a better outcome for the CBT group on self-rating of anxiety and depression. Over the follow-up period, the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure. Treatment response for anxiety was also superior for the CBT group, although there was no difference between groups in endstate functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder.

This first controlled psychotherapy trial for seasonal affective disorder (SAD) compared SAD-tailored cognitive-behavioral therapy (CBT), light therapy (LT), and their combination to a concurrent wait-list control. Adults (N = 61) with major depression, recurrent with seasonal pattern, were randomized to one of four 6-week conditions: CBT (1.5-hr twice-weekly group therapy), LT (10,000-lux for 90-min/day with administration time individually adjusted), combined CBT + LT, or a minimal contact/delayed LT control (MCDT; LT following 6 weeks of monitoring). CBT, LT, and CBT + LT significantly and comparably improved depression severity relative to MCDT in intent-to-treat and completer samples. CBT + LT (73%) had a significantly higher remission rate than MCDT (20%). Using prospectively measured summer mood status to estimate the "functional" population, CBT + LT also had a significantly larger proportion of participants with clinically significant change over treatment compared with MCDT. The LT condition outcomes virtually replicated results from prior trials. CBT, alone or combined with LT, holds promise as an efficacious SAD treatment and warrants further study. If replicated, CBT + LT's remission rate would represent a clinically meaningful improvement over the 53% observed across LT studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling.

Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues.

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computerized cognitive-behavioral therapy in a stepped care model of treatment.

A growing body of literature suggests that computerized cognitive-behavioral therapies (CCBT) are effective in community settings in terms of symptom reduction, favorable client satisfaction, attrition comparable to standard cognitive-behavioral therapy, reduced clinician time, high cost-effectiveness, and ease of integration into community clinics. Clinicians report lack of knowledge about computerized programs as the main reason that they have not used CCBT in their practice. To mitigate this disconnect between empirical evidence and dissemination, this article first reviews empirical studies focusing on the efficacy of CCBT for specific psychological disorders, followed by a review of research on the effectiveness of CCBT in community settings. Next, issues related to dissemination and barriers to CCBT adoption by clinicians are discussed. Finally, the implications of CCBT for research and practice and the possible role of CCBT in a stepped care model of treatment is discussed in terms of cost-effectiveness, standards of care, and implications for public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed, (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)     

Review of Family therapy with ethnic minorities.

Reviews the book, Family therapy with ethnic minorities by Man Keung Ho (see record 1987-98516-000). This book offers a coherent aggregation of theories for working with ethnic minority families in the United States. Its author focuses on an ecological family systemic approach, with emphasis on sociocultural and communication theories. Within this conceptual framework, he discusses six factors that distinguish ethnic minorities from the mainstream middle-class white American families and that bear implications for their treatment. Ho identifies them as: 1) ethnic minority reality, 2) impact of external system on minority cultures, 3) biculturalism, 4) ethnic differences in minority status, 5) ethnicity and language, and 6) ethnicity and social class. The book's strengths rest on the identification of the major ethnocultural issues affecting the treatment of ethnic minority families. Conversely, its weaknesses lie on the clinical illustrations of these issues. Although Ho states that he also utilizes psychodynamic and interpersonal perspectives, clinically he emphasizes sociocultural issues, neglecting other indexes, such as intrapsychic, interpersonal, and developmental variables. The major contribution of Family therapy with ethnic minorities lies in its efforts toward the development of a conceptualization of a family therapy model for working with ethnic minorities. Ho reviews existing theoretical paradigms and critically examines their applicability to ethnic minorities. He enriches the field by aiding in the development of a therapeutic structure that allows cultural diversity. Within this context, the book represents priority reading for the beginning family therapist working with ethnic minority individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improved treatment outcome associated with the shift to empirically supported treatments in an outpatient clinic is maintained over a ten-year period.

Recent years have seen an increase in emphasis on the use of psychological treatments that are supported by empirical data, as advocates have argued these treatments lead to better patient outcomes. We have previously shown that a shift to use of empirically supported treatments in a training clinic led to significant improvement in patient outcomes over four years (Cukrowicz et al., 2005). In the current study, we examined whether average patient outcomes at termination continued to be favorable over the six-year period following the initial shift. We examined data from 549 patients (M age = 25.78, SD = 10.08; 322 females and 227 males) treated prior to and after the shift to empirically supported treatments, all of whom were rated after termination using the Clinical Global Impression rating scale to track their improvement during treatment. The current study found that improvements in patient outcomes continued over the six-year follow-up period. Patients treated during the follow-up period had superior outcomes when compared to those treated following the initial shift to empirically supported treatments (effect size = .28, p     

Clinical implications of attentional bias in anxiety disorders: An integrative literature review.

Research on information processing biases has been motivated by the hope that it would lead to new and more efficient psychotherapeutic interventions. The literature is abundant with empirical data of attentional biases toward threat stimuli in anxiety disorders. This article aims to review the existing literature on the topic of attentional bias in anxiety disorders and discuss important implications for clinical practice. We adopted an integrative approach to link research data on attentional bias, information processing, and cognitive accounts (automaticity and controllability) with clinical practice in cognitive-behavioral therapy. It is important to develop and apply therapeutic interventions that can effectively reduce negative attentional biases while treating the main problems associated with anxiety disorders. However, it remains to be seen whether cognitive therapy interventions targeting more voluntary, strategic information processing can have a positive impact on automatic, involuntary processing involved in attentional biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary evidence for cognitive mediation during cognitive-behavioral therapy of panic disorder.

Cognitive-behavioral therapy (CBT) and pharmacotherapy are similarly effective for treating panic disorder with mild or no agoraphobia, but little is known about the mechanism through which these treatments work. The present study examined some of the criteria for cognitive mediation of treatment change in CBT alone, imipramine alone, CBT plus imipramine, and CBT plus placebo. Ninety-one individuals who received 1 of these interventions were assessed before and after acute treatment, and after a 6-month maintenance period. Multilevel moderated mediation analyses provided preliminary support for the notion that changes in panic-related cognitions mediate changes in panic severity only in treatments that include CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging the Gap Between Posttraumatic Stress Disorder Research and Clinical Practice: The Example of Exposure Therapy.

There are notable challenges in translating empirically supported psychosocial treatments (ESTs) into general routine clinical practice. However, there may be additional unique dissemination and implementation obstacles for ESTs for trauma-related disorders. For example, despite considerable evidence from randomized clinical trials that attests to the efficacy of exposure therapy for posttraumatic stress disorder, front-line clinicians in real-world settings rarely use this treatment. Perceived and actual barriers that interfere with adoption include clinician misconceptions about what exposure entails and complex cases to which ESTs may not be readily applicable. Specific suggestions for bridging the science-into-service gap in trauma ESTs (in general) and in exposure therapy (in particular) are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review.

Transdiagnostic cognitive-behavioral group treatments for anxiety, treatments that are designed to be applicable to diagnostically mixed groups of anxiety disorder clients, have been garnering interest in recent years. At least 7 independent research teams have developed transdiagnostic anxiety treatment protocols and reported preliminary outcomes data. In this review, we outline the basic theoretical rationale underlying transdiagnostic models of anxiety and review each of the treatment protocols that have been reported to date. Finally, the efficacy of these treatments is examined using meta-analytic methods. Results indicated that overall, transdiagnostic treatments are associated with a very large pre- to posttreatment effect size, and stable maintenance of gains through follow-up. Recommendations for transdiagnostic treatment implementation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The model minority stereotype: Adolescent experiences and links with adjustment.

The model minority stereotype (MMS) depicts Asian Americans as hardworking, intelligent, and reserved. MMS experiences and associations with adjustment and ethnic identity were examined for 165 adolescents from Asian backgrounds. Results revealed frequent MMS experiences. Through open-ended responses, youth disclosed negative, positive, mixed, or neutral feelings about these experiences. Adolescents who perceived more stereotyping had more positive academic and psychological outcomes, with neither ethnic centrality nor regard moderating these associations. Results imply that the MMS is a salient stereotype with links to adjustment for Asian American adolescents. Despite positive associations, discussion cautions against treating the MMS as a boon as it may still impose challenges to well-being and limits to adolescents' identity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequent use of psychiatric hospitalization for low-income, inner-city ethnic minority youth.

The clinical and demographic data of 664 youth (M age = 13.92, SD = 2.58) were used to identify factors associated with frequent use of psychiatric hospitalization. Clinical data included scores on the Self-Report of Personality (SRP) and Parent Rating Scales (PRS) of the Behavior Assessment System for Children, Second Edition (BASC-2). Demographic data included age, race/ethnicity, gender, and the presence or absence of surrogate care. Results indicated that those youth with frequent admissions to the hospital were generally between 13 and 18 years old (p = .01), African American (p = .03), and in surrogate care (p = .04). Relative to the other youth in our sample they were more aggressive (p p p p = .003). The implications of these findings and the recommended interventions for youth with disruptive behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The phoenix of empirically supported therapy relationships: The overlooked person-centered basis.

Argues that the findings of the American Psychological Association Division 29 Task Force on Empirically Supported Therapy Relationships (ESRs; J. C. Norcross, 2001) support the person-centered foundation of ESRs, a result generally overlooked. Although the special issue reporting the findings acknowledged that client characteristics are stronger predictors of outcome than are tailored techniques, it noticeably ignored the fact that person-centered therapy (PCT) intentionally uses the client's frame of reference and resources--extratherapeutic variables--in the context of demonstrably effective relationships. The task force downplayed the finding that general elements of therapy relationships are clearly more supported than customizing elements. Furthermore, PCT was misrepresented in the introduction and undervalued in the task force's hierarchical placements of positive regard and genuineness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals.

Clinical trials have seldom included adequate samples of people of color. Therefore, practitioners serving ethnic minorities often do not have access to readily available evidence-based interventions. This article summarizes the development and empirical evaluation of prevention and treatment manuals designed for low-income ethnic minority populations at San Francisco General Hospital. The manuals were often designed by people of color familiar with the communities for which they were developed. Independent research teams in multi-site national and international clinical trials have evaluated many of these manuals with encouraging results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)