The Therapeutic Alliance in Cognitive-Behavioral Treatment of Children Referred for Oppositional, Aggressive, and Antisocial Behavior.

The authors examined the therapeutic alliance in evidence-based treatment for children (N = 185, 47 girls, 138 boys; ages 3-14 years) referred clinically for oppositional, aggressive, and antisocial behavior. Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at 2 points over the course of treatment. As predicted, both child-therapist and parent-therapist alliances related to therapeutic change, family experience of barriers to participation in treatment, and treatment acceptability. Greater alliance was associated with greater therapeutic change, fewer perceived barriers, and greater treatment acceptability. The findings could not be attributed to the influence of socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction or to rater effects (common rater variance in the predictors and criteria). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive Association of Child Involvement and Treatment Outcome Within a Manual-Based Cognitive-Behavioral Treatment for Children With Anxiety.

Ratings of child involvement in manual-based cognitive-behavioral treatment for anxiety were associated with the absence of primary anxiety diagnosis and reductions in impairment ratings at posttreatment for 59 children with anxiety (ages 8-14 years). Good-to-excellent interrater reliability was established for the independent ratings of 237 therapy sessions, and strong psychometrics were established for the involvement measure. Child involvement at midtreatment, just prior to in vivo exposures, was positively associated with treatment gains but earlier involvement was not. Increased involvement during therapy (positive involvement shifts) may provide a useful index of change and may also predict outcomes. Involvement was not associated with client demographics or diagnostic category. Implications for treatment and measurement of psychotherapy process within manual-based treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Examination of Therapist and Client Behavior in High- and Low-Alliance Sessions In Cognitive-Behavioral Therapy and Process Experiential Therapy.

This study examined therapist and client behaviors in cognitive-behavioral therapy (CBT) and process experiential therapy (PET) in 24 high- and 24 low-alliance sessions. Sequential analyses revealed that client resistance was not a function of therapist directiveness in either therapy. Repeated measures analysis of variance revealed that overall, CBT therapists taught more and asked more directive questions, whereas PET therapists offered more support. However, both CBT and PET therapists provided more support during low-alliance than high-alliance sessions. Clients in PET challenged more and showed greater resistance in low-alliance sessions than clients in CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-Analysis of Cognitive-Behavioral Treatments for Generalized Anxiety Disorder: A Comparison With Pharmacotherapy.

The efficacy of (cognitive) behavioral therapy ([C]BT) for generalized anxiety disorder was investigated and compared with the efficacy of pharmacological therapy using meta-analytic techniques. A total of 65 (C)BT studies and pharmacological studies were included. (C)BT was more effective than control conditions. The results of the comparison between (C)BT and pharmacotherapy varied according to the meta-analytic methods used. Conclusions about differences in efficacy between therapy approaches are limited when all available studies are included owing to a number of factors that influence effect sizes. When only those studies that directly compared both therapies were included in the analysis, there were no significant differences in efficacy. Attrition rates were lower for (C)BT, indicating that it is better tolerated by patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How Does Motivational Interviewing Work? Therapist Interpersonal Skill Predicts Client Involvement Within Motivational Interviewing Sessions.

Although many studies have shown that motivational interviewing (MI) is effective in reducing problem behaviors, few have investigated purported causal mechanisms. Therapist interpersonal skills have been proposed as an influence on client involvement during MI sessions and as a necessary precursor to client commitment language. Using the Motivational Interviewing Skills Code (MISC; Version 1.0) rating system, the authors investigated 103 unique MI sessions for substance abuse and found that therapist interpersonal skills were positively associated with client involvement as defined by cooperation, disclosure and expression of affect. An unexpected finding indicated that behaviors inconsistent with MI enhanced the impact of therapist interpersonal skills upon client involvement. Drawbacks to the study include a potential sampling bias and uneven reliability of the variables measured. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral Analysis System of Psychotherapy as a Maintenance Treatment for Chronic Depression.

Although the efficacy of maintenance pharmacotherapy for the prevention of recurrence in major depressive disorder (MDD) is well documented, few studies have tested the efficacy of psychotherapy as a maintenance treatment. The authors examined the efficacy of the cognitive-behavioral analysis system of psychotherapy (CBASP) as a maintenance treatment for chronic forms of MDD. Eighty-two patients who had responded to acute and continuation phase CBASP were randomized to monthly CBASP or assessment only for 1 year. Significantly fewer patients in the CBASP than assessment only condition experienced a recurrence. The 2 conditions also differed significantly on change in depressive symptoms over time. These findings support the use of CBASP as a maintenance treatment for chronic forms of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges Into Opportunities for Change.

This article provides a review of "Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges Into Opportunities for Change" (see record 2004-00137-000). In the nearly 50 years since cognitive-behavioral treatment (CBT) models were pioneered by Albert Ellis and Aaron Beck, CBT approaches have enjoyed a wide range of applications and considerable empirical and clinical success. A frequent criticism of the CBT model has been that its approaches favor technique and behavioral change over the "substance" of psychotherapy (e.g., therapeutic alliance, resistance, engagement). Designed primarily for clinicians, "Roadblocks in Cognitive-Behavioral Therapy" is well-written and easy to read. In keeping with the tradition of CBT, the authors rely on empirical research to support their tenets, while keeping the emphasis of each chapter on clinical utility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy.

This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1- and 6-month follow-up. Frequency of outcome expectancies (OE), stimulus-response prevention (SRP), and social support-seeking (SSS) strategies significantly increased by end of treatment. By 1-month follow-up, use of SSS, not OE or SRP, declined significantly relative to treatment end. Although frequency of coping strategy use at treatment end did not predict 1-month BN symptom remission, SSS use at 1-month follow-up predicted 6-month remission. Findings highlight the importance of social support to maintain treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Association Between Patient Characteristics and the Therapeutic Alliance in Cognitive-Behavioral and Interpersonal Therapy for Bulimia Nervosa.

The therapeutic alliance is an established predictor of psychotherapy outcome. However, alliance research in the treatment of eating disorders has been scant, with even less attention paid to correlates of alliance development. The goal of this study was to examine the relation between specific patient characteristics and the development of the alliance in 2 different treatments for bulimia nervosa (BN). Data derive from a large, randomized clinical trial comparing cognitive- behavioral therapy (CBT) and interpersonal therapy (IPT) for BN. Across both treatments, patient expectation of improvement was positively associated with early- and middle-treatment alliance quality. In CBT, baseline symptom severity was negatively related to middle alliance. In IPT, more baseline interpersonal problems were associated with poorer alliance quality at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy (M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

In Response to "Hypnotic Enhancement of Cognitive-Behavioral Interventions for Pain: An Analogue Treatment Study".

Comments that the article by Milling, Levine, and Meunier (2003; see record 2003-05896-014) regarding hypnotic analgesia overlooked important relevant research, including at least one study that challenges their conclusions. Milling and colleagues stated that they know of only three studies that compared the pain-reducing effects of cognitivebehavioral interventions with those that added the element of hypnosis. They further pointed out that they must examine whether their findings, "based on the analogue treatment of experimental pain, apply to the treatment of clinical pain" (Milling et al., 2003, p. 412). However, other researchers (Faymonville et al., 1995) have already compared the analgesic effects of a hypnotic and a nonhypnotic relaxation intervention in patients undergoing plastic surgery. The present author further asserts that the work of Faymonville et al., may actually be superior to the work of Milling and colleagues. It is also commented that there have also been other clinical studies in the medical literature and their omission from the article's literature review was "disappointing." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome.

The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome variable. There were no significant therapist or Therapist × Treatment effects on outcome. Although results showed high levels of alliance and adherence across treatments, CBT was associated with greater adherence. Across treatments and time points, better adherence was associated with enhanced alliance. Treatment condition and baseline purging frequency, but not adherence, predicted outcome. Early alliance predicted posttreatment purging frequency. In temporal analyses, prior symptom change assessed early in treatment was significantly related to subsequent adherence at midtreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influences of beliefs and personality disorders on treatment outcome in anxiety patients.

The present study investigated the effects of personality disorders (PDs) and specific PD-related beliefs on the results of (cognitive-)behavioral therapy for anxiety disorders in a sample of 398 outpatients. The authors used a prospective design in which relationships between PD variables before treatment and outcome measures at posttest and follow-up were evaluated with multilevel analyses. People with PDs and PD-related beliefs reported higher symptom levels at outcome. However, these effects were not as strong as might be expected on the basis of prevailing clinical thought in this area. Dropout rates were not influenced by the presence of 1 or more PDs or PD-related beliefs. Results indicate that treatment of anxiety disorders in patients with concomitant one or more PDs is appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist Alienation: Foreseeing and Forestalling Third-Party Dynamics Undermining Psychotherapy With Children of Conflicted Caregivers.

The phenomena of impasse and rupture in the psychotherapy relationship have been discussed mostly in terms of the dynamics of the therapist-patient dyad. Therapist alienation identifies the disruptive impact of third-party contamination of the patient's therapeutic alliance with the therapist. Therapist alienation and its intrafamilial cousin, parental alienation, are examined here from an attachment perspective, emphasizing the role of the cognitive schemas underlying each relationship. Case examples are drawn from the author's experience conducting psychotherapy with children of highly conflicted caregivers. Specific recommendations are offered to minimize the likelihood of therapeutic rupture due to therapist alienation. How to respond when and if therapist alienation is suspected and future directions for clinical work, empirical research, and legal process are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change.

Objective: The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. Method: In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Results: Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). Conclusions: These findings provide support for the potential utility of CT competence ratings in applied settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinical implications of research on brief dynamic psychotherapy II. How the therapist helps or hinders therapeutic progress.

In this second of a two-part article, we describe how the therapist's interpretations promote therapeutic progress. Any therapist behavior that is in accord with the patient's plan will be helpful to the patient, but interventions that are at cross purposes with the patient's plan will not be helpful. The implications of the plan concept for brief dynamic therapy are described and contrasted with other key technical, concepts such as transference interpretations, therapeutic alliance, and interpretive activity. The importance of understanding the patient's plan and intervening in accord with it are illustrated in several case vignettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Update on and Advances in Assessment and Cognitive-Behavioral Treatment of Anxiety Disorders in Children and Adolescents.

Most child psychologists would agree that treating anxiety disorders in children is extremely challenging at times but also rewarding. This article provides an updated look at assessment strategies and promising psychosocial treatment techniques for children with 3 common anxiety disorders: separation anxiety disorder, social phobia, and generalized anxiety disorder. The need for comprehensive diagnostic evaluations is highlighted through information on the wide range of assessment procedures and instruments available to practicing psychologists interested in treating anxious youth. In addition, a treatment approach shown to be empirically efficacious for treating anxious children, cognitive-behavioral therapy, is described. We provide practical examples of assessment and treatment techniques for clinical practice. Tables are included that can serve as useful quick references for the 3 areas covered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Les troubles anxieux: Approche cognitive et comportementale.

Reviews the book, Les troubles anxieux: Approche cognitive et comportementale by Robert Ladouceur, André Marchand, and Jean-Marie Boisvert (1999). This volume offers an excellent source of information for private practitioners, students, and trainees. After a brief introduction, each chapter describes a particular anxiety disorder and explores the following topics: DSM-IV diagnosis, prevalence and comorbidity, major elements of differential diagnosis, evaluation and instrumental measures, intervention strategies, and future research. Case studies are included. The authors clearly transmit current scientific knowledge on anxiety disorders and therapeutic applications. The cognitive behavioral approach integrates therapeutic strategies with demonstrated effectiveness. Therefore, this book is impossible to circumvent. Any professional who is interested in anxiety disorders should read and re-read this volume. (PsycINFO Database Record (c) 2010 APA, all rights reserved)