Cognitive Behavioral Therapy For Adults Research Articles

The effectiveness of routinely delivered cognitive behavioural therapy for obsessive‐compulsive disorder: A benchmarking study

There is often difficulty in generalizing the results of randomized controlled trials (RCTs) to routine clinical practice given the rigid design features of such studies. The purpose of this study is to describe the effectiveness of routinely delivered, formulation-based cognitive behavioural therapy (CBT) within a publicly funded clinic for adults with obsessive-compulsive disorder (OCD) and offer a comparison against the outcomes achieved in efficacy studies for the same population. Practice-based prospective study. Routine data collected from a National Health Service out-patient clinic for adult clients with OCD is benchmarked against the findings of RCTs. The comparison RCTs were identified using a systematic review methodology. The mean (95% confidence interval) change in Yale-Brown Obsessive Compulsive Scale score pre- to post-therapy in the Sheffield clinic was 10.2 (7.1 - 13.3), which compares well with changes of 11.4 (10.5 - 12.2) for exposure and response prevention trials, 12.9 (11.2 - 14.7) for cognitive therapy trials, and 10.6 (8.5 - 12.8) for CBT trials. The Sheffield results fell within the benchmarks derived from the included RCTs. These results indicate that CBT for adults with OCD delivered outside the constraints of a clinical trial is equivalently effective but that this conclusion should be tested further on a larger group of patients.

Group cognitive behaviour therapy for adults with Asperger syndrome and anxiety or mood disorder: a case series

Individuals with Asperger syndrome are at increased risk for mental health problems compared with the general population, especially with regard to mood and anxiety disorders. Generic mental health services are often ill-equipped to offer psychotherapeutic treatments to this population, and specialized supports are difficult to find. This case series used a manualized cognitive behaviour therapy group programme (Mind Over Mood) with three adults diagnosed with Asperger syndrome, who were each unable to access psychotherapy through mainstream mental health services. This review highlights the benefits of a cognitive behaviour therapy (CBT) group approach for adults with Asperger syndrome and suggests some potential modifications to traditional CBT provision.

Cognitive Behavioral Therapy in Adults with Obsessive–Compulsive Disorder and Borderline Intellectual Functioning: A Case Series of Three Patients

Cognitive-behavior therapy (CBT) is widely accepted as the most effective psychological treatment for obsessive–compulsive disorder (OCD). Although this modality flexibly treats a variety of OCD symptom subtypes, it is unclear how CBT should be adapted to meet the needs of individuals with OCD and limitations in their cognitive functioning. In this paper, we report on three adults with borderline intellectual functioning who received CBT following a protocol that was adapted to meet their unique developmental and intellectual needs. For the purposes of this case study, the following modifications were made to a standard treatment CBT protocol: 1) increased parental involvement, 2) simplified language, 3) decreased reliance on cognitive techniques, and 4) the addition of contingency management strategies and role modeling by caregivers. All three adult patients benefited from treatment as evidenced by significant reductions in their OCD symptoms at post-treatment. Conclusions from these cases are drawn, as well as directions for future research.

Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists

This paper explores the relationships between anxiety and stuttering and provides an overview of cognitive-behavior therapy (CBT) strategies that can be applied by speech-language pathologists. There is much support for the idea that adults who stutter (AWS) may need CBT. First, approximately 50% of AWS may be suffering from social anxiety disorder. A difficult developmental history marked by problematic peer relationships and bullying may contribute to this. Stereotypes in the general community lead AWS to have occasional experiences that confirm their fears of negative evaluation. This can leave AWS with significant social and occupational avoidance and can impact on their quality of life. Second, in a recent large study of behavioral treatment for AWS, participants who had a mental health disorder, including social anxiety, failed to maintain the benefits of treatment. Available evidence supports the contention that CBT can effectively decrease anxiety and social avoidance, and increase engagement in everyday speaking situations for AWS. The components of CBT presented here are drawn from a model widely used in clinical psychology, and existing supportive data reviewed. Worksheets for speech-language pathologists undertaking CBT in this population are provided. CBT procedures, in their essentials, are straightforward to implement. Hence, the present authors suggest that speech-language pathologists who have had training in conducting CBT should be able to apply the techniques described in this paper. Educational objectives: The reader will be able to explain: (1) the relation between stuttering and anxiety; (2) the nature of Social Anxiety Disorder; (3) why those who stutter are often diagnosed with Social Anxiety Disorder; (4) the four components of cognitive behavior therapy; (5) how cognitive behavior therapy is adapted for the management of speech-related anxiety in those who stutter.

Evaluation of Group Cognitive Behavioral Therapy for Adults With ADHD

Objective: A brief cognitive behavioral therapy (CBT) group intervention was designed to treat comorbid anxiety, depression, and low self-esteem and self-efficacy in adults with ADHD. It was hypothesised that participants would gain knowledge about ADHD, experience a reduction in comorbid symptoms, and benefit from the supportive aspect of group treatment. Method: Participants in the study formed a CBT treatment group that attended six workshops and a waiting list control group. The intervention was evaluated with measures assessing knowledge about ADHD, psychological symptoms, and support received. The groups were compared using repeated measures ANOVAs. Results: The CBT group had significantly greater improvement on measures of knowledge about ADHD, self-efficacy, and self-esteem than the control group. Participants' evaluations of the sessions suggested that sharing personal experiences with other adults with ADHD was an important aspect of the intervention. Conclusion: Brief CBT group treatments may be an acceptable and cost-effective intervention for adults with ADHD. (J. of Att. Dis. 2009; 12(5) 434-441)

Adapting an Emerging Empirically Supported Cognitive-Behavioral Therapy for Adults With ADHD and Comorbid Complications

Attention-deficit/hyperactivity disorder (ADHD) is commonly considered a disorder that affects children and adolescents; however, follow-up studies of those diagnosed with ADHD indicate significant continuation and impairment into adulthood. For these adults, pharmacotherapy is effective in some cases, but residual symptoms and secondary problematic behaviors resulting from ADHD symptoms (e.g., depressed mood) are typical. Several researchers have identified cognitive-behavioral approaches as a promising adjunct to pharmacotherapy. In particular, a recently manualized cognitive-behavioral therapy has demonstrated significant reductions in ADHD symptoms in a controlled study. The primary purpose of this article is to demonstrate the potential of this approach. To do so, we review two case studies of adults diagnosed with ADHD to illustrate (a) the heterogeneity associated with ADHD cases and the unique challenges they present, (b) issues related to comorbid disorders and symptoms with ADHD, and (c) how to adapt this emerging empirically supported treatment.

Client discontinuation of NHS psychological therapy revisited

We report a service evaluation that found that younger adults were more likely to discontinue from National Health Service cognitive behavioural therapy for adults.

Status of Computerized Cognitive Behavioural Therapy for Adults

A growing body of evidence supports the efficacy of computerized cognitive behavioural therapy (CCBT). This technology has the potential to increase the capacity of mental health services, and to overcome some of the barriers to accessing mental health services, including stigma, traveling time for rural patients, treatment delays, and the low availability of skilled clinicians. This review discusses key issues around the implementation of CCBT in current mental health services, and summarizes recent evidence for the efficacy of CCBT in anxiety and depression. Many CCBT systems exist, and the evidence for each varies in quality and quantity. It is concluded that CCBT, particularly guided by a therapist, represents a promising resource. However, considerable work needs to be done to develop CCBT techniques that are appropriate to Australasian populations, acceptable to patients and clinicians, easy to use, and are clinically and cost effective. Suggestions are made for further research and useful website addresses are provided to assist clinicians in familiarizing themselves with CCBT.

Early Psychological Intervention for Auditory Hallucinations: An Exploratory Study of Young People's Voices Groups

Twenty to fifty percent of people with a diagnosis of schizophrenia continue to hear voices despite taking neuroleptic medication. Trials of group cognitive behavioral therapy for adults with auditory hallucinations have shown promising results. Auditory hallucinations may be most amenable to psychological intervention during a 3-year critical period after symptom onset. This study evaluates the effectiveness of group cognitive behavioral therapy (CBT) for young people with recent-onset auditory hallucinations (N = 22), using a waiting list control. Outcome measures were administered at four separate time points. Significant reductions in auditory hallucinations occurred over the total treatment phase, but not over the waiting period. Further investigations in the form of randomized controlled trials are warranted.

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p<.01) and global severity (p<.002), as well as self-reported ADHD symptoms (p<.0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's<.04), lower IE-rated depression (p<.01), and a trend to have lower self-reported depression (p=.06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p<.02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.

Effective Treatments for PTSD

Foa, Keane, Friedman, Cohen, Introduction. Part I: Assessment and Diagnosis of PTSD. Weathers, Keane, Foa, Assessment and Diagnosis of Adults. Balaban, Assessment of Children. Part II: Early Interventions: Treatment of ASD and Prevention of Chronic PTSD. Bisson, McFarlane, Rose, Ruzek, Watson, Psychological Debriefing for Adults. Brymer, Steinberg, Vernberg, Layne, Watson, Jacobs, Ruzek, Pynoos, Acute Interventions for Children and Adolescents. Litz, Bryant, Early Cognitive-Behavioral Interventions for Adults. Part III: Treatment Approaches for Chronic PTSD. Cahill, Rothbaum, Resick, Follette, Cognitive-Behavioral Therapy for Adults. Cohen, Mannarino, Deblinger, Berliner, Cognitive-Behavioral Therapy for Children and Adolescents. Friedman, Davidson, Stein, Psychopharmacotherapy for Adults. Donnelly, Psychopharmacotherapy for Children and Adolescents. Spates, Koch, Cusack, Pagoto, Waller, Eye Movement Desensitization and Reprocessing. Shea, McDevitt-Murphy, Ready, Schnurr, Group Therapy. Jaycox, Stein, Amaya-Jackson, School-Based Treatment for Children and Adolescents. Kudler, Krupnick, Blank Jr., Herman, Horowitz, Psychodynamic Therapy for Adults. Lieberman, Ippen, Marans, Psychodynamic Therapy for Child Trauma. Glynn, Drebing, Penk, Psychosocial Rehabilitation. Cardena, Maldonado, van der Hart, Spiegel, Hypnosis. Riggs, Monson, Glynn, Canterino, Couple and Family Therapy for Adults. Johnson, Lahad, Gray, Creative Therapies for Adults. Goodman, Chapman, Gantt, Creative Arts Therapies for Children. Najavits, Ryngala, Back, Bolton, Mueser, Brady, Treatment of PTSD and Comorbid Disorders. Part IV: Treatment Guidelines. Psychological Debriefing for Adults. Acute Interventions for Children and Adolescents. Early Cognitive-Behavioral Interventions for Adults. Cognitive-Behavioral Therapy for Adults. Cognitive-Behavioral Therapy for Children and Adolescents. Psychopharmacotherapy for Adults. Psychopharmacotherapy for Children and Adolescents. Eye Movement Desensitization and Reprocessing. Group Therapy. School-Based Treatment for Children and Adolescents. Psychodynamic Therapy for Adults. Psychodynamic Therapy for Child Trauma. Psychosocial Rehabilitation. Hypnosis. Couple and Family Therapy for Adults. Creative Therapies for Adults. Creative Arts Therapies for Children. Treatment of PTSD and Comorbid Disorders. Part V: Conclusion. Friedman, Cohen, Foa, Keane, Integration and Summary.

Role of psychology in pain management

Psychological factors are central to the experience of pain, the delivery of effective analgesia and for the specific treatment of chronic pain and disability. Improvement in pain management can often be brought about by very simple, if subtle, changes in clinical practice. Although simple, these changes can have significant effects in the experience of pain, distress and use of health-care resources. For the chronic pain patient, the presentation is much more complex and the treatment interdisciplinary and programmatic. The evidence for the effectiveness of cognitive behaviour therapy for adults with chronic pain is now well established. This treatment should be available as a core part of any chronic pain service.

Cognitive--Behavioral Therapy with a Six-Year-Old Boy with Separation Anxiety Disorder: A Case Study

Cognitive-behavioral therapy (CBT) has become a respected and empirically established model of psychotherapy. A review of the experimental literature, by a task force established by the American Psychological Association, demonstrated the effectiveness of CBT for adults. In their review, CBT was efficacious for depression, generalized anxiety disorder, social phobia, obsessive compulsive disorder, substance abuse and dependence, agoraphobia, and panic disorder (DeRubeis & Crits-Christoph, 1998). Treating children with emotional and behavioral disorders using CBT has recently been receiving more research and clinical attention (Eisen, Kearney, & Schaefer, 1995; Jayson, Wood, Kroll, Fraser, & Harrington, 1998; Kendall, 1991; March & Mulle, 1998; Reincke, Ryan, & DuBois, 1998). The fundamental principles of CBT that apply to adult disorders can be applied to children, of course, with developmental modifications. Children, as well as adults, with psychological problems make systematic errors in thinking (cognitive distortions) and have skill deficits that maintain the problem (Kendall, 1991). The cognitive model hypothesizes that a person's thinking influences his or her mood and thus, modifications to thinking will result in changes in mood and behavior (Beck, Rush, Shaw, & Emery, 1979). This article is an exploratory study examining the use of cognitive--behavioral therapy in the treatment of separation anxiety disorder (SAD). The main clinical feature of this disorder is excessive worry about the separation from home or from the person to whom the affected person is attached (American Psychiatric Association [APA], 1994). The anxiety must be beyond what is expected for the developmental level and have been present for at least four weeks. Onset of the disorder must occur before 18 years of age. A child with SAD frequently reports fears that involve being kidnapped, becoming lost, or having his or her caretaker become hurt, killed, or kidnapped. When a child with SAD expects to be separated from his or her caretaker or when separation has just occurred, the child displays significant subjective distress. The child may cry, shake, express terror, and have autonomic symptoms of anxiety such as palpitations and hyperventilation (Black, 1995). The prevalence of SAD is estimated to be about 4 percent in children and young adolescents (APA, 1994). CONCEPTUALIZATION Separation anxiety disorder in children has similar clinical features as adults with panic disorder with agoraphobia, such as phobic avoidance, catastrophic interpretations, and panic symptoms. For example, a child with SAD tries to avoid separation from his or her caretaker (phobic avoidance), believes that if separated something terrible will happen and he or she will not be able to handle it (catastrophic interpretations), and experiences autonomic arousal such as palpitations, perspiration, hyperventilation, shaking, and fear (panic symptoms). A child with SAD makes catastrophic interpretations about being separated from his parents. This activates the child's autonomic nervous system, which creates anxiety symptoms, which then serve to reinforce the catastrophic interpretations. The cycle then becomes self-perpetuating. The treatment of panic disorder with agoraphobia in adults typically includes explanation of the nature of anxiety and panic, anxiety-management strategies (breathing, retraining, and relaxation), and cognitive restructuring (Barlow, Craske, Cerny, & Klosko, 1989; Otto & Deckersbach, 1998). Two new features to the treatment of panic by Craske, Meadows, and Barlow (1994) included prescriptive treatment for agoraphobia and the integration of a spouse or partner in exposure-based treatment. Barlow et al. (1989) found that about 90 percent of panic-disordered patients were panic free following their panic-control treatment. Previous treatment of children with SAD focused on medication and psychodynamic, family, or behavioral interventions (Drobes & Strauss, 1993; March, 1995). …

Cognitive behaviour therapy for adults with chronic fatigue syndrome.

1. To systematically review all randomised controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS); 2. To test the hypothesis that CBT is more effective than orthodox medical management or other interventions in adults with CFS. 1. Electronic searching of bibliographic databases, including Medline, PsycLIT, Biological Abstracts, Embase, SIGLE, Index to Theses, Index to Scientific and Technical Proceedings, and Science Citation Index, using multiple search terms in order to perform a highly sensitive search. 2. Electronic searching of the Trials Register of the Depression, Anxiety and Neurosis group. 3. Citation lists of relevant studies and reviews were perused for other relevant trials. 4. Contact with the principal authors of relevant studies, and with researchers in the field. All randomised controlled trials were included in which - adult patients with CFS; - received CBT or a control intervention, being either orthodox medical management or another intervention; - and whose outcomes were assessed in an appropriate way. CBT could be either type 'A' (encouraging return to 'normal' levels of rest and activity) or type 'B' (encouraging rest and activity which were within levels imposed by the disorder). The two reviewers worked independently throughout the selection of trials and data extraction, comparing findings only when there was disagreement. Relevant trials were allocated to one of three quality categories. Full data extraction, using a standardised data extraction sheet, was performed on studies which were of high or moderate quality. Trials of low quality were excluded from the review. The comparisons made to test the review hypothesis were of type 'A' CBT versus other intervention(s), and of type 'B' CBT versus other intervention(s). Functional outcome was used as the main outcome for comparison, but other appropriate outcomes were compared where possible. Results were synthesised using the Review Manager software. For dichotomous data, the odds ratio was calculated for each study. For continuous data, effect sizes were obtained and the standardised mean difference, with 95% confidence intervals, was calculated. Only three relevant trials of adequate quality were found. These trials demonstrated that CBT significantly benefits physical functioning in adult out-patients with CFS when compared to orthodox medical management or relaxation. It is necessary to treat about two patients to prevent one additional unsatisfactory physical outcome about six months after treatment end. CBT appeared highly acceptable to the patients in these trials. There is no satisfactory evidence for the effectiveness of CBT in patients with the milder forms of CFS found in primary care or in patients who are so disabled that they are unable to attend out-patients. Additionally, there is no satisfactory evidence for the effectiveness of group CBT. Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. CFS is a common and disabling disorder. Its sufferers deserve the medical profession to be more aware of the potential of this therapy to bring lasting functional benefit, and health service managers to increase its availability. Further research is needed in this important area. Trials should conform to accepted standards of reporting and methodology. The effectiveness of CBT in more and less severely disabled patients than those usually seen in out-patient clinics needs to be assessed. Trials of group CBT and in-patient CBT compared to orthodox medical management, and of CBT compared to graded activity alone, also need to be conducted.

The long-term outcome of cognitive behaviour therapy for adults in routine clinical practice

It is recognised that there is a comparative lack of evidence on the long-term outcome of cognitive behavioural therapy for patients seen in ordinary clinical settings, as opposed to research trials. This paper presents some data on the outcome of 36 adult patients followed up an average of nearly two years after the end of therapy in a National Health Service CBT clinic. Whilst the vagaries of data collection in clinical practice mean that the generalisability of these results is still tentative, they suggest that the outcome at the end of treatment was generally well-maintained over the follow-up period, with most patients maintaining fairly stable scores on the measures used, and the rest roughly equally divided between those who deteriorated and those who improved further. A high proportion of patients at follow-up reported that they were still using various CBT strategies which they had learnt during therapy.