Cognitive-behavioral Procedures Research Articles

Evidence-based psychotherapy of posttraumatic stress syndrome-An update

The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. Arange of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. Alarge selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.

10 kHz Spinal Cord Stimulation for the Treatment of Non-Surgical Refractory Back Pain: A Case Report.

Back pain is one of the most common healthcare burdens in the United States and is the number one cause of disability worldwide. Treatment options for back pain usually emphasizes conservative modalities such as reassurance, education, physical therapy, cognitive behavioral therapy, medication management, and interventional pain procedures. Spinal cord stimulation (SCS) is a minimally invasive and reversible therapy used to treat various pain syndromes. The primary indications for SCS therapy are failed back surgery syndrome and complex regional pain syndrome. However, recent advances in therapy have expanded the use of SCS for a variety of chronic pain conditions including nonsurgical back pain and radiculopathy. We present the case of a patient with low back and lumbar radicular pain complaints that were not responsive to traditional conservative and interventional options who was successfully treated with 10 kHz spinal cord stimulation.

CBT WITH YOUTH IN UNCERTAIN TIMES: INTERVENING EFFECTIVELY WITH FLEXIBILITY AND CREATIVITY

This clinician-friendly Workshop aims to equip attendees with portable tools that are ready to use in their practices during the peri- and postpandemic periods. Participants will learn a conceptual framework upon which to base brief cognitive-behavioral interventions for youth and their caregivers in multiple settings. The Workshop will employ a variety of teaching and learning methods. These procedures will include didactic material, demonstrations, sanitized case material, and experiential learning exercises. Further, the instruction will be augmented by including numerous techniques to propel attendee engagement, such as music, video clips, linking visuals with texts, and eye-catching infographics. Attendees will be provided with helpful handouts and clinical materials. Workshop participants will learn a simple scheme for conceptualizing patients during these uncertain times, several handy metrics for planning and tracking treatment, and many cognitive-behavioral procedures. When clinical care is delivered effectively in a flexible, creative, and equitable manner, young patients are better served during uncertain times.

Depression and dementia: differentiation and comorbidity

The relationship between cognitive impairment (CI) and depression is complicated: h\the latter can be one of the symptoms of Alzheimer’s disease or may precede the onset of CI. Depression also has cognitive symptoms that alter the clinical presentation of the disease. Patients with depressive pseudodementia experience difficulties concentrating, confusion concurrent with impaired memory and thinking, whereas the patient’s answers to certain questions often resemble the vague pseudoamnestic pattern of the impairment. Mnestic disorders occur in at least 40% of patients with depression, and if the latter is diagnosed in the patient who already has dementia, the rate of cognitive decline may be faster. The mechanisms underlying the development of CI can also affect the development of depression. When assessing the risk of dementia in depression, it is necessary to take into account the time from the onset of a major depressive episode until moderate CI appears, to carry out a detailed analysis of neuropsychological testing for Alzheimer’s disease and to use the current lifetime markers for amyloidosis and neurodegeneration. Serotonergic antidepressants and non-pharmacological cognitive behavioral and psychotherapeutic procedures play the most important role in the treatment of depression and dementia.

Fit to Practice: Augmenting Modular Cognitive Behavioral Procedures with Case Conceptualization

Modular Cognitive Behavioral Therapy (mCBT) is guiding child psychotherapy into the future. mCBT is founded on a growing body of empirical research and clinical applications. Despite its compelling advantages, there are some potential cautions. In order to fit children’s diverse presentations mCBT must be individually tailored via case conceptualization. Case conceptualization is widely regarded as an essential CBT competency area and a pivotal component of evidence based procedures. Nonetheless, case conceptualization is a demanding task and the literature suggests that inter-related reliability is suspected. This article addresses these issues and offers several recommendations for improving inter-clinician reliability. Finally, the paper ends with a presentation of a bench-to-bedside confabulated case to illustrate the cognitive behavioral case conceptualization process. Keywords: Case conceptualization, child and adolescent therapy, cognitive-behavioral therapy, modular cognitive behavioral therapy.

Management of Severe Rhabdomyolysis and Exercise-Associated Hyponatremia in a Female with Anorexia Nervosa and Excessive Compulsive Exercising.

This case report describes the management of a 49-year-old female with restricting-type anorexia nervosa and excessive compulsive exercising associated with rhabdomyolysis, high levels of serum creatine kinase (CK) (3,238 U/L), and marked hyponatremia (Na+: 123 mEq/L) in the absence of purging behaviours or psychogenic polydipsia; it is the first case report to describe exercise-associated hyponatremia in a patient with anorexia nervosa. The patient, who presented with a body mass index (BMI) of 13.4 kg/m2, was successfully treated by means of an adapted inpatient version of an enhanced form of cognitive behavioural therapy (CBT-E). Within a few days, careful water restriction, solute refeeding, and the specific cognitive behavioural strategies and procedures used to address the patient's excessive compulsive exercising and undereating produced a marked reduction in CK levels, which normalised within one week. Exercise-associated hyponatremia also gradually improved, with serum sodium levels returning to normal within two weeks. The patient thereby avoided severe complications such as cerebral or pulmonary oedema or acute renal failure and was discharged after 20 weeks of treatment with a BMI of 19.0 kg/m2 and improved eating disorder psychopathology.

Sexual Functioning and Cognitions During Sexual Activity in Men With Genital Pain: A Comparative Study

Male genital pain is frequently associated with sexual dysfunction, and some studies suggest it is influenced by cognitive factors. However, there is little evidence on how these factors discriminate male genital pain from other sexual problems. This study intends to explore differences on sexual functioning and self-reported cognitions during sexual activity between men with genital pain, men with sexual dysfunction, and sexually healthy men. A total of 134 men divided in three groups based on their clinical condition (i.e., genital pain, sexual dysfunction, or no sexual/pain complaints) and matched for demographic variables completed measures of sexual functioning (IIEF) and thoughts during sexual activity (SMQ). Findings showed that men with genital pain and men with sexual dysfunctions reported significantly lower levels of overall satisfaction with sexual life, compared to men without sexual problems. Additionally, men with genital pain and men with sexual dysfunctions presented significantly more failure anticipation thoughts in comparison to sexually healthy men. Overall, findings emphasize the role of negative cognitions as a common factor associated with male genital pain and sexual dysfunctions, suggesting that genital pain should be regarded as a sexual problem and that clinical interventions should include sex therapy techniques as well as cognitive-behavioral procedures.

Treating Emotionally Dysregulated and Perfectionistic Youth with Transdiagnostic Cognitive Behavioral Procedures

In clinical child psychology, co-morbidity is the norm rather than exception. Single disorder manuals are limited in their scope and applicability to patients with several presenting problems. Emotion dysregulation and perfectionism are two salient pathways to various internalizing and externalizing mental health disorders in youth. In order to treat these children efficiently and effectively, psychotherapists must be equipped with an approach that is able to target these common corridors to psychopathology. Transdiagnostic modular cognitive behavioral procedures are matched to the individual patients’ contexts. The article begins with a brief discussion of emotional regulation, perfectionism, and transdiagnostic modular cognitive behavior therapy. Three confabulated clinical case examples are presented to illustrate the case conceptualization process and the application of modular CBT.

843 – Group cognitive behavioral therapy for patients with panic disorder

Panic disorder is a severe and often disabling condition with a lifetime prevalence rate of 4.1% to 8.8%. The treatment of choice is cognitive behavioral therapy (CBT). Over past 20 years, behavioral, cognitive, and cognitive behavioral procedures (primarily exposure and cognitive reconstruction based treatments) were found to be effective in the treatment of panic disorder. CBT is the best studied non-pharmacological approach and can be applied to many patients, depending on its availability. CBT of panic disorder was most studied in individual setting, but group format of treatment could be also effective. We describe step by step the cognitive-behavioral group therapy of patients with panic disorder. We are explaning the concept of cognitive model of panic disorder, vicious circle, cognitive reconstruction, control of breathing and exposure. We also present personal experience with group cognitive-behavioral therapy and possible complications that may occur. The results of our research in this group concerning the efficacy of the program, changes in the heart rate variability during program and EEG changes (using sLORETA) are presented. We also try to point on possible complications that may occur during the therapy and coping with them. Supported by: Project IGA MZ ČR NS 10301-3/2009

Intervenção baseada na psicoterapia analítica funcional em um caso de transtorno de pânico com agorafobia

Estratégias terapêuticas descritas como eficazes em transtornos de ansiedade envolvem procedimentos comportamentais e cognitivo-comportamentais de exposição a enfrentamento de situações aversivas. Entretanto, considerando-se que o padrão comportamental comum a estes transtornos é a esquiva fóbica, o uso de tais estratégias pode dificultar a adesão ou promover fuga/esquiva do e no processo terapêutico. A Psicoterapia Analítica Funcional surge como alternativa para manejo dos comportamentos de esquiva e para promoção de respostas de enfrentamento. Este estudo apresenta a análise da relação terapêutica de um caso de Transtorno de Pânico com Agorafobia. A intervenção baseada na FAP foi adotada para auxiliar no manejo do padrão de esquiva do processo terapêutico apresentado pela cliente. Os resultados demonstram a efetividade dos procedimentos adotados e confirmam a possibilidade de utilização da FAP para aumento da eficácia de terapias empiricamente baseadas.

Intervention based on functional analytic psychotherapy in a case of panic disorder with agoraphobia

Therapeutic strategies described as effective for anxiety disorders include behavioral and cognitive-behavioral procedures of exposure and coping of aversive situations. However, considering that the behavioral pattern common in anxiety disorders is the phobic avoidance, the application of these strategies may difficult the adhesion or promote escape and avoidance of the therapeutic process. The Functional Analytic Psychotherapy is an alternative for dealing with these avoidance/escape behaviors and it can promote coping responses. This case report describes an analysis of the therapeutic relationship of a client with Panic Disorder and Agoraphobia. The intervention based on FAP was considered to help dealing with the avoidance behavior in the therapeutic process. Results show the efficacy of the procedures adopted and confirm the possibility of using FAP for improving the effectiveness of the empirically based psychotherapies.

Child and adolescent therapy: Cognitive‐behavioural procedures, by Philip C. Kendall

Child and adolescent therapy: Cognitive‐behavioural procedures, by Philip C. Kendall

Self-Management of Pain in Older Persons: Helping People Help Themselves

This article has the following two primary objectives: 1) to provide a discussion of the self-management of pain for older adults in relation to therapist-assisted cognitive behavioral procedures; and 2) to review the main features of a recently developed manualized pain self-management program for older adults. Literature review. The term self-management has been used loosely in the pain literature to describe a wide variety of programs in which the individual plays an active role in the management of his or her pain. Many of these programs are therapist-/facilitator-assisted and have many commonalities with cognitive behavior therapy. Efficacy evidence for self-management in older adults is mixed although arthritis self-management programs show considerable promise. The incorporation of a therapist/facilitator appears to enhance the effects of self-management programs. Self-management outcomes may be inconsistent across studies partly because there is very limited standardization and manualization of self-management approaches. A manualized self-management program is described as an example of an approach that could easily be standardized and facilitate future investigations. It would be important for subsequent research to focus on the identification of subgroups of older patients who are most likely to benefit from self-management, and to determine whether self-management improves outcomes of future professionally administered treatments.

O-46 - Group CBT of anxiety disorders

Anxiety disorders are chronic psychiatric conditions with a low rate of natural remission, producing substantial decreases in the quality of life and numerous specific social role impairment and disabilities. Over past 15 years, behavioral, cognitive, and cognitive behavioral procedures (primarily exposure and cognitive reconstruction based treatments) were found to be effective in the treatment of anxiety disorders.The purpose of this mini workshop is to present the main principals and techniques of a short-term group cognitive behavioral therapy for these patients. In our work, we combine education, cognitive reconstruction, behavioural experiments, exposure therapy, social skills training and problem solving approach. This program will demonstrate how to provide significant improvement even for those with the most severe anxiety disorders.Participants will learn theoretically and practically in exercises:(1) The cognitive and behavioral models of anxiety disorders(2) The main principles of group cognitive behavioral therapy for anxiety disorders(3) How to use CBT techniques useful for anxiety disorders in group:(4) Cognitive reconstruction; - social skills training with role playing; - behavioral experiments and exposure (including imaginal exposure); - problem solving. By the project IGA, MZ CR NT 11047-4/2010.

Integrating Psychotherapeutic Processes with Cognitive Behavioral Procedures

There has been a recent focus on the processes that underlie intervention delivery for children and adolescents throughout the Cognitive-Behavioral Therapy (CBT) literature. Certain process variables have been associated with treatment outcome among youth receiving CBT. Data for these process variables including: the therapeutic alliance or therapeutic relationship, child and parent involvement, other child and therapist variables, and issues of diversity, are reviewed. Based on this data, specific clinical recommendations are made. The treatment relationship as a very important process (VIP), and the facilitation of CBT so that it is real and relevant to youth are emphatically discussed. Process issues in modular CBT are identified. Ultimately, genuine collaborative empiricism and guided discovery preserve the therapeutic relationship as a VIP, and foster the customization of therapeutic tools and the treatment trajectory.

“What works” with mentally disordered offenders

Treatment and rehabilitation of mentally disordered offenders has traditionally been a function of high security hospitals, but is increasingly based in community settings. Evidence for the effectiveness of psychological interventions remains scarce, and for secure hospitals, is limited to demonstrations of short-term effects using a conventional range of behavioural and cognitive–behavioural procedures. Some findings support the use of directive community programmes in meeting the needs of public safety and improved reintegration of the individual. Long-term services are required, and more complex psychological contributions are needed to meet the multiple needs of this client group.

Are nonparaphilic sexual addictions a variant of obsessive-compulsive disorder? A pilot study

Nonparaphilic sexual addictions (NPSAs), which are characterized by repetitive sexual thoughts and behaviors, have been proposed as an obsessive-compulsive spectrum disorder. In the present study we examined the functional differences in repetitive sexual thoughts and compulsive behaviors between patients with OCD (n = 6) and with NPSAs (n = 6). Compared to patients with NPSAs, those with OCD reported significantly more fear and avoidance related to their sexual thoughts. Individuals with NPSAs reported higher levels of sexual arousal associated with their thoughts and a greater degree of sexual pleasure from performing compulsive behaviors. These preliminary findings challenge the notion that NPSAs are related to OCD. Results are discussed in terms of their implications for treatment using cognitive-behavioral procedures.

Client Readiness for Change, Cultural Concerns, and Risk Taking

This is a straightforward case in which several interrelated components nevertheless called for specific therapeutic attention. Matters pertaining to racial discrimination, cultural limits, and readiness for change had to be factored into the treatment trajectory. The anxiety, depression, and self-denigrating tendencies that had brought the client to therapy called for careful timing, some audacious advice, and several standard cognitivebehavioral procedures.

Child and Adolescent Therapy: Cognitive Behavioral Procedures (Second Edition)

Child and Adolescent Therapy: Cognitive Behavioral Procedures (Second Edition) Philip C. Kendall (Ed.). New York: Guilford Press (www.guilford.com). 2000, 425 pp., $46.00 (hardcover). There have been many recent advances in the application of cognitive-behavior therapy (CBT) as a treatment for child and adolescent clinical populations. Innovative conceptual models, new intervention strategies, and several manual-based treatment protocols have been introduced. The second edition of Phil Kendall's Child and Adolescent Therapy offers an easy-to-read description of these cutting-edge psychotherapy interventions for youth, with full coverage of relevant theory, research, and practice basics. Like the first edition, this follow-up text provides a scholarly account of cognitive behavioral treatments targeting children and adolescents with a variety of disorders and behavioral problems. Covering the most recent developments in the field, the editor has assembled a series of critical reviews that are timely, informative, and comprehensive in scope. The book is purposeful in its emphasis on evidence-based treatments and fully promotes a scientist-practitioner agenda. The first chapter, written by the editor, provides a guiding theoretical framework for conducting treatment with children and adolescents. Kendall's model effectively integrates developmental and experiential factors (e.g., problem solving, cognitive abilities, emotional and interpersonal functioning) in an attempt to explain processes of therapeutic change. Whereas leading experts in the field of treatment outcome research (Kazdin, 2000) continue to highlight the need for discussion and investigation of psychotherapy change mechanisms, Kendall explicitly addresses this limitation by proposing a temporal model that considers behavioral contingencies in the development of a cognitive coping template. The chapter also addresses issues relevant to understanding potential limitations and expectations for therapeutic change when working with this population, for example, normal developmental trajectories. Subsequent chapters cover specific problem areas including aggression, attention deficit/hyperactivity disorder, anger management, depression, anxiety disorders, and chronic health conditions. While this list is not exhaustive, these conditions are certainly representative of clinical child populations and include those disorders found to be most prevalent in this age group. …

Developmental Considerations in the Use of Cognitive Therapy for Posttraumtic Stress Disorder

This article discusses empirical support for cognitive behavioral therapy with children and adolescents experiencing posttraumatic stress disorder (PTSD) symptoms. Developmental features influencing the presentation of PTSD symptoms include age-related differences in arousal modulation, cause and effect reasoning, language and conceptual skills, and social information processing. Basic cognitive behavioral procedures for treating PTSD in children and adolescents include coping skills training, exposure to traumarelated stimuli, cognitive restructuring, and education and information giving. These procedures must be adapted to match developmental capabilities in language and conceptual skills, emotion regulation and coping skills, and memory. Family, contextual influences, and comorbidity should be evaluated and included in treatment planning. When indicated, treatment of PTSD should be imbedded in a broader conceptualization of the child or adolescent’s adaptive functioning, comorbid conditions, and caretaking environment.