Twelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying.

This study reports the 12-mo follow-up from patients with the fear of flying who were treated in a controlled study and randomly assigned (n=49) to virtual reality exposure (VRE) therapy, standard exposure (SE) therapy, or to a wait-list control (WL). VRE and SE were equally superior to WL. At 12 mo posttreatment, data were gathered on 24 of the 30 (80%) patients who were assigned to VRE or SE. Patients maintained their treatment gains, and 92% of VRE participants and 91% of SE participants had flown on a real airplane since the graduation flight. This is the 1st year-long follow-up of patients having been treated with VRE and indicates that short-term treatment can have lasting effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Virtual reality exposure therapy for the treatment of fear of flying: A controlled investigation.

Forty-five participants who refused to fly during a screening test and who also met Diagnostic and Statistical Manual of Mental Disorders criteria for specific phobia, agoraphobia, or panic disorder with agoraphobia were randomly assigned to 5 sessions of either virtual reality exposure (VRE) or attention-placebo group treatment (GT). At posttreatment, 65% of VRE participants and 57% of GT participants flew during a test flight. Both groups showed significant improvement following treatment on standardized self-report measures of flight anxiety, with a better outcome for the VRE group on 4 of 5 of these measures. At 6-month follow-up, however, most group differences had disappeared; VRE resulted in a better outcome on only 1 of 5 standardized flight anxiety measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.

This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N = 87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n = 69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for women with lifelong vaginismus: A randomized waiting-list controlled trial of efficacy.

Women with lifelong vaginismus (N = 117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9 participants per group. Assistance with minimal-contact bibliotherapy consisted of 6 biweekly, 15-min telephone contacts. Twenty-one percent of the participants left the study before posttreatment assessment. Intent-to-treat analysis revealed that successful intercourse at posttreatment was reported by 14% of the treated participants compared with none of the participants in the control condition. At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants, respectively, reported successful intercourse. Cognitive-behavioral treatment of lifelong vaginismus was thus found to be efficacious, but the small effect size of the treatment warrants future efforts to improve the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanism of Change in Cognitive-Behavioral Treatment of Panic Disorder: Evidence for the Fear of Fear Mediational Hypothesis.

Numerous clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder. However, studies investigating the mechanisms responsible for improvement with CBT are lacking. The authors used regression analyses outlined by R. M. Baron and D. A. Kenny (1986) to test whether a reduction in fear of fear (FOF) underlies improvement resulting from CBT. Pre- and posttreatment measures were collected from 90 CBT-treated patients and 40 wait-list control participants. Overall, treatment accounted for 31% of the variance in symptom reduction. The potency of FOF as a mediator varied as a function of symptom facet, as full mediation was observed for the change in global disability, whereas the effects of CBT on agoraphobia, anxiety, and panic frequency were partially accounted for by reductions in FOF. Clinical implications and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The feasibility and outcome of clinic plus Internet delivery of cognitive-behavior therapy for childhood anxiety.

Seventy-two clinically anxious children, aged 7 to 14 years, were randomly allocated to clinic-based, cognitive-behavior therapy, the same treatment partially delivered via the Internet, or a wait-list control (WL). Children in the clinic and clinic-plus-Internet conditions showed significantly greater reductions in anxiety from pre- to posttreatment and were more likely to be free of their anxiety diagnoses, compared with the WL group. Improvements were maintained at 12-month follow-up for both therapy conditions, with minimal difference in outcomes between interventions. The Internet treatment content was highly acceptable to families, with minimal dropout and a high level of therapy compliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral treatment for the nonpurging bulimic: An initial evaluation.

This study tested the initial effects of cognitive-behavioral therapy for binge eating in Ss who do not purge. Forty-four female binge eaters were randomized to either cognitive-behavioral treatment (CB) or a waiting-list (WL) control. Treatment was administered in small groups that met for 10 weekly sessions. At posttreatment a significant difference was found, with 79% of CB Ss reporting abstinence from binge eating and a 94% decrease in binge eating compared with a nonsignificant reduction (9%) in binge eating and zero abstinence rate in WL Ss. Following the posttest assessment, WL Ss were treated and evidenced an 85% reduction in binge episodes and a 73% abstinence rate. Binge eating significantly increased at 10-week follow-up for initially treated Ss; however, the frequency remained significantly improved compared with baseline levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-help treatment for insomnia: Bibliotherapy with and without professional guidance.

Fifty-four adults with primary insomnia were randomly assigned to a self-help treatment (cognitive-behavioral bibliotherapy [BT]), BT with weekly phone consultations, or a waiting-list control (WL) group. Treated participants were mailed 6 treatment booklets at the rate of 1 booklet per week; 1/2 of them also received minimal professional guidance through a 15-min weekly phone consultation. The WL group members continued to monitor their sleep during this period. Participants in both treatment conditions improved significantly on the main outcome variables (total wake time and sleep efficiency) at posttreatment, whereas WL participants remained unchanged. The addition of weekly phone calls slightly enhanced improvements at posttreatment. However, both treatment conditions were comparable at follow-up. These results suggest that BT, with or without minimal professional guidance, is an effective approach for treating primary insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Three- and 6-Month Follow-Up of EMDR Treatment of PTSD in an HMO Setting.

Eye movement desensitization and reprocessing (EMDR) treatment was found to maintain superiority to newly initiated standard Kaiser Care, which consisted of individual therapy plus variations of medication and group therapy. A 3- and 6-month follow-up of individuals randomly assigned to either EMDR treatment or standard care (SC) treatment for posttraumatlc stress disorder (PTSD) indicates that significantly greater improvements found with EMDR at posttreatment in an earlier article (S. Marcus, P. Marquis, & C. Sakai, 1997) were maintained on measures of PTSD, depression, anxiety, and general symptoms. Of the original 67 participants in this large HMO study, 44 were assessed at 3-month follow-up and 36 were assessed at 6-month follow-up by an independent assessor. The study indicates that a relatively small number of EMDR treatment sessions result in substantial benefits that are maintained over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating comorbid panic disorder in veterans with posttraumatic stress disorder.

This study compares the effectiveness of panic control treatment (PCT) with that of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of systematic desensitization and directed masturbation in the treatment of primary orgasmic dysfunction in females.

Assigned 30 females (19–42 yrs) seeking treatment for primary inorgasmia accompanied by sexual anxiety or aversion to 1 of 3 groups: systematic desensitization (SD), directed masturbation (DM), or waiting list control (WL). Following treatment, Ss were retested, and the WL group then received directed masturbation treatment. A 3rd testing constituted a follow-up for the SD and DM groups and a posttreatment testing for the WL. Both treatments were equally effective in improving Ss' sexual self-acceptance and increasing sexual pleasure. Changes in anxiety were negligible; however, sexual arousal and orgasm for DM and WL Ss increased. The gains of the WL group not only replicated the findings of the DM group but also were of greater magnitude. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia

The aim of this work was to test the contribution of cognitive therapy to exposure in vivo in the group treatment of generalized social phobia. Seventy-one severely disabled social phobics, selected according to DSM-III-R criteria, were assigned at random to: (a) self-exposure in vivo, (b) self-exposure in vivo with cognitive therapy, or (c) a waiting-list control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-ups) was used. Additionally, half of the patients in both therapeutic groups were given self-help manuals for managing anxiety. Most patients that were treated (64%) showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic models. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of adding cognitive therapy or a self-help manual to exposure alone. Finally, several topics that may contribute to future research in this field are discussed.     

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.     

Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure.

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.

Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’s g = 0.63) and mood symptoms (Hedges’s g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’s g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

Female assault survivors (N = 171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of behavioral therapy for chronic low back pain: A component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildy disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Success and failure in the behavioral treatment of obsessive-compulsives.

Attempted to construct a model for predicting success and failure in the behavioral treatment (exposure and response prevention) of obsessive-compulsives (N?=?50, mean age 34 yrs). Three sets of variables—demographic, pretreatment level of neurotic symptomatology, and S's responses during exposure sessions—were examined. Seven variables were found to be related to outcome at posttreatment and/or at follow-up: Pretreatment level of depression and of anxiety, reactivity, and habituation of reported anxiety to feared stimuli within- and between-sessions were all found to affect outcome at posttreatment. Posttreatment outcome as well as age at symptom onset were significantly related to maintenance of gains. A model of the interrelationships of these variables was constructed and tested by a path analysis. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)