Cognitive-behavioral Treatment Program Research Articles

Changes in J-SOAP-II and SAVRY Scores Over the Course of Residential, Cognitive-Behavioral Treatment for Adolescent Sexual Offending.

Although the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) and the Structured Assessment of Violence Risk in Youth (SAVRY) include an emphasis on dynamic, or modifiable factors, there has been little research on dynamic changes on these tools. To help address this gap, we compared admission and discharge scores of 163 adolescents who attended a residential, cognitive-behavioral treatment program for sexual offending. Based on reliable change indices, one half of youth showed a reliable decrease on the J-SOAP-II Dynamic Risk Total Score and one third of youth showed a reliable decrease on the SAVRY Dynamic Risk Total Score. Contrary to expectations, decreases in risk factors and increases in protective factors did not predict reduced sexual, violent nonsexual, or any reoffending. In addition, no associations were found between scores on the Psychopathy Checklist:Youth Version and levels of change. Overall, the J-SOAP-II and the SAVRY hold promise in measuring change, but further research is needed.

Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder

Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab=−0.20; 95% CI [−.35, −.09]), but change in worry did not mediate change in IU (ab=−0.16; 95% CI [−.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD.

Association between three different cognitive behavioral alcohol treatment programs and recidivism rates among male offenders: findings from the United Kingdom.

Cognitive behavioral therapy-based alcohol treatment programs have been widely used to break the link between alcohol and crime. While evidence exists on the connection between alcohol and crime, there is little data that demonstrate the effectiveness of different alcohol treatment programs in reducing criminal behavior. We tested whether male offenders who participate in alcohol treatment programs show lower rates of recidivism than a matched offender group who did not participate in an alcohol prevention program. This is an observational matched case-control study. Participants were 564 male offenders with an alcohol problem related to offending. Participants were assigned by the courts to 1 of 3 alcohol treatment programs (141 offenders per treatment): Low Intensity Alcohol Program (LIAP), Alcohol Specified Activity Requirement, and Addressing Substance-Related Offending. A fourth matched group (n=141) was not assigned to a program and served as a control group. Survival analysis was used to calculate participants' charged and reconviction rates over 4 time periods (0 to 3, 4 to 6, 7 to 9, and 10 to 12months after completion of program or order). Offenders who did not participate in a program were more than twice as likely to be charged compared to offenders who participated in a program. Furthermore, offenders who did not participate in a program were over 2.5 times more likely to be reconvicted. Among the 3 alcohol treatment programs evaluated, the LIAP was the most cost-effective. Offenders enrolled in an alcohol treatment program showed a significant reduction in being charged with or reconvicted of a crime. With costs of keeping offenders in prison per year reaching close to £40,000 per offender per year (Mulheirn et al., 2010, www.smf.co.uk), assigning offenders to alcohol preventive programs-such as LIAP-are a promising way to reduce recidivism and reduce cost.

CBT for high anxiety sensitivity: Alcohol outcomes

IntroductionHigh anxiety sensitivity (AS) has been associated with greater alcohol consumption and alcohol-related problems as well as greater sensitivity to the anxiety-reducing effects of alcohol and greater risky negative reinforcement motives for drinking. The present study reported on the alcohol-related outcomes of a telephone-delivered cognitive behavioral treatment (CBT) designed to reduce high AS. MethodsEighty individuals with high AS (M age=36years; 79% women; 76% Caucasian) seeking treatment for their AS-related concerns participated in the study and were randomly assigned to an eight week telephone CBT program or a waiting list control. Participants completed measures of drinking motives and problem drinking at pre- and post-treatment. ResultsMultilevel modeling showed that the treatment was successful in reducing AS. The treatment also resulted in specific reductions in drinking to cope with anxiety motives as well as physical alcohol-related problems. Mediated moderation analyses showed treatment-related changes in AS mediated changes in drinking to cope with anxiety motives. Changes in drinking to cope with anxiety motives mediated changes in physical alcohol-related problems. ConclusionsResults of the present study suggest that an AS-targeted intervention may have implications for reducing risky alcohol use cognitions and behaviors. Further research is needed in a sample of problem drinkers.

Cognitive-behavioral group treatment for perinatal anxiety: a pilot study.

Along with physical and biological changes, a tremendous amount of upheaval and adjustment accompany the pregnancy and postpartum period of a woman's life that together can often result in what is commonly known as postpartum depression. However, anxiety disorders have been found to be more frequent than depression during pregnancy and at least as common, if not more so, during the postpartum period, e.g., Brockington et al., (Archieves Women's Ment Health 9:253-263, 2006; Wenzel et al. (J Anxiety Disord, 19:295-311, 2005). Cognitive-behavioral therapy (CBT) is a well-established psychological treatment of choice for anxiety; however, few studies have specifically examined a cognitive-behavioral intervention targeting perinatal anxiety. This pilot study examined the effectiveness of a cognitive-behavioral group treatment (CBGT) program specifically tailored to address perinatal anxiety in 10 women who were either pregnant or within 12months postpartum. Participants were recruited from a women's clinic at an academic hospital setting, with anxiety identified as their principal focus of distress. Following a diagnostic interview confirming a primary anxiety disorder and completion of assessment measures, participants completed a 6-week CBGT program. There was a statistically significant reduction in anxiety and depressive symptoms following the CBGT program (all p < 0.05). Participants also reported high acceptability and satisfaction with this treatment for addressing their perinatal anxiety. These findings suggest that CBGT for perinatal anxiety is a promising treatment for both anxiety and depressive symptoms experienced during the perinatal period. Further studies are needed to evaluate the treatment efficacy through larger controlled trials.

Effects of a cognitive-behavioral therapy-based immersion obesity treatment program for adolescents on weight, fitness, and cardiovascular risk factors: a pilot study.

Comprehensive, residential treatment for severe obesity in adolescents may be an alternative to bariatric surgery and more efficacious than outpatient treatment. The aim of this study was to evaluate the effects of a long-term cognitive-behavioral therapy-based immersion obesity treatment program for adolescents. Twelve obese adolescents with BMIs above the 95th percentile completed a 14- to 18-week multicomponent intervention. We observed significant improvements in BMI z-score, waist circumference, mile run time, and blood lipids. This study suggests that the tested program may be effective, at least in the short term; a randomized, controlled trial to further assess this model is warranted.

Psychological treatment of female sexual dysfunction: a critical review of the literature

Impairment of sexual functioning may have a significant impact on the person's quality of life. Despite the high prevalence of female sexual dysfunctions, it is still not clear what are the effective treatments for these disorders. The aim of this critical review is to provide an update on the efficacy of psychological treatments for female sexual dysfunctions. A thorough literature search was performed, using electronic database (PubMed and PsychINFO) and manual searches, selecting articles in English and Italian language published in peer-reviewed journals. Only randomized controlled trials were included. Most of the studies investigated the efficacy of sex therapy using techniques developed by Masters and Johnson and behavioral/ cognitive-behavioral treatment programs. Both approaches were effective for dyspareunia and vaginismus. Cognitive-behavioral and mindfulness based therapy showed significant improvement in hypoactive sexual desire but more research is needed for this disorder. Studies on the efficacy of treatment for orgasmic disorder are scarce and dated and they investigated mainly behavioral programs. The low methodological quality of many studies and the paucity of data for the most prevalent female dysfunctions calls for further research on psychological interventions for these disorders, using randomized, controlled designs and larger samples.

Tratamiento cognitivo-conductual en depresión mayor, distimia e ideación autolítica persistente

The following article presents an application of techniques coming from the cognitive behavioral therapy in a case of major depression, dysthymia and persistent suicidal ideation. The patient (66 years old woman) with a large history of resistant symptoms, signs in a psychiatric hospitalization plant after making a drug binge. Once we evaluated through a functional analysis the antecedents, consequences, personality, her biographical history and targeted problems into three areas (cognitive, behavioral and physiological), we designed a 3 months long cognitive behavioral treatment program, with a frequency of one hour three times per week. After that period we verified an improvement in the mental, emotional, functional and social areas, as well as a disappearance of suicidal ideation, so we proceeded to discharge the patient for improvement.

The Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial

Subclinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis. Since there is a lack of specific intervention concepts for this patient group, a self-management-oriented group program (DIAMOS [Diabetes Motivation Strengthening]) was newly developed and evaluated in a randomized trial. DIAMOS is composed of cognitive behavioral interventions aiming at the reduction of diabetes distress. The active control group (CG) received diabetes education. The primary outcome was depressive symptoms. Secondary outcomes were diabetes distress, well-being, self-care behavior, diabetes acceptance, diabetes treatment satisfaction, HbA1c, and subclinical inflammation. Two hundred fourteen participants (mean age 43.3 ± 13.3 years, female sex 56.5%, type 2 diabetes 34.1%, mean diabetes duration 14.2 ± 10.5 years, HbA1c 8.9 ± 1.8%, BMI 28.7 ± 71 kg/m(2)) were randomized. The 12-month follow-up revealed a significantly stronger reduction of depressive symptoms (Center for Epidemiologic Studies Depression Scale score) in the DIAMOS group compared with the CG (Δ3.9 [95% CI 0.6-7.3], P = 0.021). Of the secondary variables, the Patient Health Questionnaire-9 (Δ1.7 [95% CI 0.2-3.2], P = 0.023), Problem Areas in Diabetes scale (Δ8.2 [95% CI 3.1-13.3], P = 0.002), and Diabetes Distress Scale scores (Δ0.3 [95% CI 0.1-0.5], P = 0.012) displayed significant treatment effects. Moreover, the risk of incident major depression in the DIAMOS group was significantly reduced (odds ratio 0.63 [95% CI 0.42-0.96], P = 0.028). Inflammatory variables were not substantially affected. DIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with subclinical depression. DIAMOS also has a preventive effect with respect to the incidence of major depression.

Effects of a cognitive-behavioral intervention program on the health of caregivers of people with autism spectrum disorder

Caregivers of people with autism spectrum disorder (ASD) are chronically exposed to high levels of stress. In turn, such stress is associated with high rates of negative health outcomes. However, few studies have analyzed the effects of psychotherapeutic interventions in improving health in this population. The main aim of the present study was to evaluate the effectiveness of a cognitive-behavioral intervention program, based on the model proposed by Ruiz-Robledillo and Moya-Albiol (2014a). For this, we used a sample of 17 informal caregivers of people diagnosed with ASD. The study was based on a pre-post design. Caregivers had lower levels of burden immediately after the intervention than at baseline, while both immediately after the intervention and at 1 month of follow-up, they had fewer somatic symptoms, lower levels of depression, and better mood states than at baseline. These results provide evidence of the efficacy of the cognitive-behavioral intervention developed for reducing stress and health complaints in chronically stressed caregivers. Additionally, the program could be useful in early stages of the caring process, to provide caregivers with effective skills for preventing future health problems. The integration of the program in general psychosocial interventions would be highly beneficial for this population.

Pathological gambling: understanding relapses and dropouts

There is little available information on the factors that influence relapses and dropouts during therapy for pathological gambling (PG). The aim of this study was to determine socio-demographic, clinical, personality, and psychopathological predictors of relapse and dropout in a sample of pathological gamblers seeking treatment. A total of 566 consecutive outpatients diagnosed with PG according to DSM-IV-TR criteria were included. All patients underwent an individualized cognitive–behavioral treatment program. We analyzed predictors of relapse during 6months of treatment and during the subsequent 6months of follow-up, and predictors of dropout over the entire therapeutic program. Eighty patients (14.1%) experienced at least one relapse during the entire follow-up of the study: 50 (8.8%) within the treatment period and 12 (2.1%) during the subsequent 6-month follow-up period. The main predictors of relapse were single marital status, spending less than 100euros/week on gambling, active gambling behavior at treatment inclusion, and high scores on the TCI-R Harm Avoidance personality dimension. One hundred fifty-seven patients (27.8%) missed 3 or more therapeutic sessions over the entire therapeutic program. The main predictors of dropout were single marital status, younger age, and high scores on the TCI-R Novelty Seeking personality dimension. The presence of these factors at inclusion should be taken into account by physicians dealing with PG patients.

SY31-3 * TREATMENT OF SEXUAL ADDICTIONS

Sexual addictions treatment is one of the most challenging issues. We have developed a cognitive-behavioral treatment program targeting this population. The program is consisted of 24 sessions and is implemented once a week in a group format. The participants were 96 male with compulsive sexual problems. 73 participants received the program (mean age = 35.4, SD = 5.05) and those who did not participate in the program joined to a self-help group once a week (mean age = 35.0, SD = 5.87). The participants were followed up for one year after the treatment completion. No significant difference was found in the pre-treatment comparison between the 2 groups. During and after the treatment, no relapse was reported. The mean attendance rate of the treatment group was significantly higher than the control (t(71) = 5.53, p < .01). The psychological variables were measured at the pre and post treatment periods and the two-way repeated measures ANOVA was performed. The results showed that coping skills of the treatment group were significantly improved after treatment (F(1,49) = 10.37, p < .01). These findings suggested the effectiveness of the treatment program because both treatment attendance and coping skills are considered to be the powerful predictors of long term treatment success.

Effects of Tinnitus Duration and Concomitant Hearing Loss on the Cognitive-Behavioral Treatment Outcomes

Background and ObjectivesZZSeveral reports indicated that tinnitus treatment was influ enced by several factors including age of patients, concomitant hearing loss, onset and duration of tinnitus, etc. The purpose of this study was to investigate the effects of the duration of tinnitus and the degree of hearing loss on the treatment outcomes. Subjects and MethodZZSeventy-two subjects with tinnitus were divided into several groups according to the duration of tinnitus and the degree of hearing loss. All subjects were treated by cognitive-behavioral treatment program in tinnitus clinic. Treatment effects were studied by Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS), which were used to measure the loudness, awareness, and annoyance of tinnitus. ResultsZZTHI and VAS scores were decreased significantly after the treatment. Tinnitus of 12 months or shorter duration showed greater improvement than those cases of longer than 12 months. The lower degree of hearing loss also showed greater improvement when compared with the greater degree of hearing loss. ConclusionZZTinnitus of shorter duration and milder hearing loss showed better prognosis: the results of this study may help in treatment counseling for tinnitus patients.

Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain.

To explore the long-term outcomes of CONECSI (COping with NEuropathiC Spinal cord Injury pain), a multidisciplinary cognitive behavioural treatment programme in persons with spinal cord injury. Long-term follow-up pre-post-intervention design. A total of 29 subjects with a spinal cord injury and chronic neuropathic pain from 4 Dutch rehabilitation centres. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire). Secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Random coefficient analysis was used for the analyses of measurements before (t1), immediate post-intervention (t2), and 6 (t3), 9 (t4), and 12 (t5) months follow-up. The analyses showed significant improvements on pain intensity (t1-t2 and t1-t5) and pain-related disability (t1-t2, t1-t4, and t1-t5), anxiety and participation in activities (t1-t2, t1-t3, and t1-t5). This exploratory study suggests that a multidisciplinary cognitive behavioural programme might have lasting improvements on pain intensity, pain-related disability, anxiety, and participation in activities in people with chronic neuropathic spinal cord injury pain and highlights the potential of such programmes.

Culturally sensitive group therapy for Turkish patients suffering from chronic pain: a randomised controlled intervention trial

The incidence of chronic pain is higher among immigrants in Europe than among the native European population. Therapeutic interventions in this population are far less effective than in patients for whom these programmes were originally developed. In a randomised trial, we investigated whether a cognitive behavioural treatment (CBT) programme supplemented with culturally sensitive aspects (CsCBT) improves pain intensity, pain disability and quality of life among immigrant patients, compared with a treatment of culturally sensitive exercise therapy (CsET) alone. Furthermore, we investigated whether healthcare costs would decrease. First-generation Turkish immigrants residing in Switzerland (20-65 years of age) who suffered from chronic pain were enrolled in the trial. Patients were randomised to attend either CsCBT or CsET. The CsCBT intervention was based upon a manualised cognitive-behavioural group treatment programme for chronic pain patients and adapted to the needs of a Turkish immigrant population. The CsET intervention was based on principles of exercise therapy for treatment of nonspecific low back pain. A total of 116 outpatients were recruited between October 2004 and November 2006. The intervention was completed by 89 patients (77%). A total of 78 subjects (67%) completed follow-up, 12 months after the completion of the intervention programme. The intervention showed no effects in reducing pain, pain disability or quality of life. The analysis of healthcare utilisation yielded no intervention effect. Cognitive behavioural intervention is feasible with immigrants with chronic disabling pain, but the evidence-based CBT programme, as well as exercise therapy supplemented with culturally sensitive aspects, showed no improvement.

Increasing the appropriate demonstration of affectionate behavior, in children with Asperger syndrome, high functioning autism, and PDD-NOS: A randomized controlled trial

Individuals with Asperger syndrome (AS) can have difficulty understanding, receiving and expressing appropriate affectionate behavior (Attwood, 2007). The purpose of the current study was to further evaluate the effectiveness of a cognitive–behavioral intervention program aimed at improving affectionate communication and friendship skills in children with AS. The pilot study of this program (Sofronoff, Eloff, Sheffield, & Attwood, 2011) was extended in the current study in a randomized controlled trial. Fifty-eight children with AS (aged 7–12 years) participated in the program and were randomly assigned to the intervention (n=29) or waitlist (n=29) condition. Parent-report measures indicated that, relative to the waitlist group, children in the intervention group showed significantly greater improvements in the overall appropriateness of their affectionate behavior to others after the program. Specifically, improvements were reported in the appropriate expression of affection to others and this finding was maintained at three-month follow-up. Parent-report measures further demonstrated significant improvements in children's communication of empathy to others at follow-up. Children's understanding of the purpose of affection approached significance. Overall, this study indicates that children with AS can be taught to interact more appropriately. The limitations and suggestions for future research are discussed.

Brain Potentials Measured During a Go/NoGo Task Predict Completion of Substance Abuse Treatment

U.S. nationwide estimates indicate that 50% to 80% of prisoners have a history of substance abuse or dependence. Tailoring substance abuse treatment to specific needs of incarcerated individuals could improve effectiveness of treating substance dependence and preventing drug abuse relapse. We tested whether pretreatment neural measures of a response inhibition (Go/NoGo) task would predict which individuals would or would not complete a 12-week cognitive behavioral substance abuse treatment program. Adult incarcerated participants (n = 89; women n = 55) who volunteered for substance abuse treatment performed a Go/NoGo task while event-related potentials (ERPs) were recorded. Stimulus- and response-locked ERPs were compared between participants who completed (n = 68; women = 45) and discontinued (n = 21; women = 10) treatment. As predicted, stimulus-locked P2, response-locked error-related negativity (ERN/Ne), and response-locked error positivity (Pe), measured with windowed time-domain and principal component analysis, differed between groups. Using logistic regression and support-vector machine (i.e., pattern classifiers) models, P2 and Pe predicted treatment completion above and beyond other measures (i.e., N2, P300, ERN/Ne, age, sex, IQ, impulsivity, depression, anxiety, motivation for change, and years of drug abuse). Participants who discontinued treatment exhibited deficiencies in sensory gating, as indexed by smaller P2; error-monitoring, as indexed by smaller ERN/Ne; and adjusting response strategy posterror, as indexed by larger Pe. The combination of P2 and Pe reliably predicted 83.33% of individuals who discontinued treatment. These results may help in the development of individualized therapies, which could lead to more favorable, long-term outcomes.

Which Pain Coping Strategies and Cognitions Are Associated with Outcomes of a Cognitive Behavioral Intervention for Neuropathic Pain after Spinal Cord Injury?

Chronic neuropathic pain is one of the most difficult problems to manage after spinal cord injury (SCI). Pain coping and pain cognitions are known to be associated with the patient's experience of neuropathic pain, but they have not been studied in the context of a cognitive behavioral treatment program for coping with neuropathic pain after SCI. To explore associations of pain coping strategies and cognitions with pain intensity and pain-related disability and changes in pain coping strategies and cognitions with changes in pain intensity and pain-related disability. Forty-seven persons who participated in the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial completed questionnaires before the intervention (baseline) and 3 months after of the intervention (follow-up). Compared to baseline, participants showed more favorable scores on 2 pain coping scales (Pain Transformation and Worrying), the subtotal score Active Coping, and 3 pain cognitions scales (Catastrophizing, Optimism, and Reliance on Health Care) at follow-up. Baseline Reliance on Health Care was associated with change in pain intensity and pain-related disability. Change in Catastrophizing and change in Restriction cognitions were associated with change in pain-related disability. Our findings suggest that modifying pain coping strategies and cognitions by a cognitive behavioral intervention for chronic neuropathic pain after SCI may have some beneficial effects on pain intensity and pain-related disability. Further research should show how dysfunctional pain coping strategies and cognitions can be most effectively modified.

Brief Report: Problem Solving Therapy in College Students with Autism Spectrum Disorders: Feasibility and Preliminary Efficacy

Students with autism spectrum disorder (ASD), though academically capable, can have difficulty succeeding in college. Evidence-based intervention to promote effective problem solving may improve quality of life, as well as success and satisfaction in college. This study adapted and piloted a group-based cognitive-behavioral intervention program, Problem Solving Skills: 101 (PSS: 101), to teach effective problem solving ability in college students with ASD. Therapists met all treatment integrity objectives across sessions, four of the five participants completed at least eight of the nine sessions, and between-session assignments were generally completed (83 % completion rate), indicating a high level of treatment adherence. Two participants demonstrated reliable improvement post-intervention in problem solving ability and subjective distress. Further evaluation to assess efficacy of the intervention is warranted.

Moderators of Correctional Treatment Success

An important area in correctional rehabilitation research is to better understand how offenders differentially respond to correctional treatments. Potential treatment moderators forwarded in the literature are gender, race/ethnicity, and personality types. This exploratory study asked whether a group of parolees had demographic and personality moderators of treatment and, if so, were the moderating influences different by race? An experimental design was used to randomly assign a sample of 937 male parolees (n = 658 African American, n = 279 White) to the experimental group that received the cognitive-behavioral treatment program and the control group that did not. Discrete-time event history analysis independently tested the program-moderating effects of demographic and personality characteristics (age, prior employment status, educational attainment, marital status, social class, risk of recidivism, prior violence, IQ, reading level, cognitive maturity, personality type, residential urbanization) on recidivism for African American and White parolees. This study found that the age group and personality type of the parolees interacted with the cognitive-behavioral program in ways that created racially disparate recidivism outcomes.