Implementation Of Cognitive Behavioral Therapy Research Articles

A Treatment-Refractory Case of Social Anxiety Disorder: Lessons Learned From a Failed Course of Cognitive-Behavioral Therapy

Over the past 25 years researchers have made enormous strides in the implementation of cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD), although considerable work remains to be done. The present paper discusses a treatment refractory case seen in our clinic. The young man presented numerous interrelated obstacles, such as low treatment expectations, poor homework compliance, and comorbid depression and alcohol dependence. We highlight the challenges presented by this complex presentation, as well as issues that arose over the course of treatment. We then elaborate on techniques that could have improved his outcome. The promise of motivational interviewing and behavioral activation techniques for these complex clients is discussed. Future research and treatment directions for refractory cases are considered.

Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review

Background:Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD.Methods:Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites.Results:The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT.Conclusion:There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action.

Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study

BackgroundAlthough for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT) in 20 Department of Veteran Affairs (VA) clinics.MethodsThe 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation.ResultsExamination of change scores showed that facilitated therapists averaged an increase of 19% [95% CI: (2, 36)] in self-reported CBT use from baseline, while control therapists averaged a 4% [95% CI: (-14, 21)] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35%) compared to a control therapist who was not providing CBT at baseline (10%) or to therapists in either condition who were providing CBT at baseline (average 3%). Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of control over their clinic schedule and poor communication with clinical leaders.ConclusionsThese findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence-based psychotherapy. Furthermore, the substantial increase in CBT usage among the facilitation group was achieved at a modest cost.

J. D. Otis, Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach

Chronic pain may develop as a result of injury or accompany a multitude of diseases and neuropathic conditions. When employees develop chronic pain, it presents a major challenge to all stakeholders involved such as patients, families, co-workers, employers, healthcare providers, insurance companies, and government programs. In particular, state workers’ compensation programs and the Social Security Administration have experienced significant increases in the frequency of chronic musculoskeletal conditions during the last several decades. Cognitivebehavioral therapy (CBT) has been shown to be effective in managing several chronic pain conditions including chronic back pain, tension/migraine headache, and some types of arthritis. Measurable end-points to the therapy have included improved physical and psychosocial functioning. Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach was published to assist readers in the implementation of CBT in a step-wise fashion. Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach consists of 13 chapters that are logically organized and sequenced. Chapters 3 through 13 provide session outlines, CBT interventions, sample dialogues, and homework assignments for each technique. The author provides sessions on chronic pain, diaphragmatic breathing, progressive muscle relaxation and visual imagery, automatic thoughts and pain, cognitive restructuring, stress management, time-based pacing, pleasant activity scheduling, anger management, sleep hygiene, and relapse prevention and flare-up planning. The techniques are written in an easy to understand style that facilitates skill learning, practice, and development. Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach, in conjunction with its corresponding workbook, portrays the positive attributes of being authoritative, succinct, and user friendly. Although stated to be evidence-based, actual research outcomes of the various techniques discussed were lacking but would have added substantial value to the book. Overall, the author has published an excellent introductory guide on CBT for healthcare providers of any discipline who are treating patients having chronic pain that are seeking to improve their function and quality of life.

South African Counsellors' Attitudes Towards Cognitive Behavioural Techniques to Ameliorate Trauma: Effects of a Training Workshop

Despite its successes in the United States and Europe, cognitive behavioural therapy (CBT) has a short history in South Africa. Local cultural realities and social conditions have been cited as obstacles to the implementation of CBT at community health centres. Yet, CBT's successes in ameliorating a variety of psychological conditions, including symptoms of PTSD, necessitate examination of its relevance and applicability in South African communities. The present study reports on counsellors' attitudes and opinions to CBT for the treatment of psychological trauma. We presented a two-day workshop on CBT and assessed counsellors' opinions and attitudes prior to and following the workshop. Results are discussed in the context of the high rate of traumatic events that occur in South African communities.

Treatment of pediatric obsessive-compulsive disorder: A case example of intensive cognitive-behavioral therapy involving exposure and ritual prevention

The development of effective pharmacotherapies for pediatric obsessive-compulsive disorder (OCD) has improved the clinical prognosis for children and adolescents who suffer from the disorder. Recent pilot work has also suggested that cognitive-behavioral therapy (CBT) involving exposure and ritual prevention (EX/RP) may prove particularly helpful in ameliorating OCD symptoms in children and adolescents. The application of intensive CBT of a 12-year-old boy with severe and unusual OCD symptoms is illustrated here. Case material is presented, illustrating the design and implementation of CBT involving EX/RP; recommendations to guide clinical decision making regarding session frequency, concomitant medication use, and maintenance of treatment gains are provided.