Cognitive-behavioral Framework Research Articles

Experiences of implementing an Adapted Sex Offender Treatment Programme for people with learning disabilities in a secure setting

In 2006 the Brooklands' Adapted Sex Offender Treatment Programme (ASOTP) was adopted by Calderstones Partnership NHS Foundation Trust. To date, two groups of men (n = 10) have completed the programme and one group (n = 6) is currently in progress. This treatment model uses a cognitive behavioural framework and is a nurse‐led initiative, utilising trained ward staff. This paper discusses experiences of initiating and delivering the ASOTP programme. Several issues were encountered, including staff retention, clients discontinuing the group, the length of the group, the length of wait for clients to commence their treatment and high levels of administration. As a result of these, and developments to the Brooklands' model, several changes were made before the commencement of the second wave in 2008.The paper discusses how the ASOTP were able to overcome some, but not all, of the initial difficulties and highlights potential pitfalls for future groups.

Salient components of a comprehensive service for eating disorders.

Eating disorders are challenging and difficult to treat, because of the necessity of a multidisciplinary treatment team for effective outcomes and the high mortality rate of anorexia nervosa. An adequate initial assessment and evaluation requires a psychiatric assessment, a medical history and medical examination, a social history and an interview of family members or collateral informants. A comprehensive eating disorder treatment team includes a psychiatrist coordinating the treatment and appropriate medical physician specialists, nutritionists, and psychotherapists. An adequate outpatient eating disorder clinic needs to provide individual psychotherapy with cognitive behavioral techniques specific for anorexia nervosa and bulimia nervosa, family therapy, pharmacological treatment and the resources to obtain appropriate laboratory tests. Eating disorder patients requiring inpatient care are best treated in a specialized eating disorder inpatient unit. A cognitive behavioral framework is most useful for the overall unit milieu. Medical management and nutritional rehabilitation are the primary goals for inpatient treatment. Various group therapies can cover common core eating disorder psychopathology problems and dialectical behavior therapy groups can be useful for managing emotional dysregulation. Residential, partial hospitalization and day treatment programs are useful for transitioning patients from an inpatient program or for patients needing some monitoring. In these programs, at least one structured meal is advisable as well as nutritional counseling, group therapy or individual counseling sessions. Group therapies usually address issues such as social skills training, social anxiety, body image distortion or maturity fears. Unfortunately there is s paucity of evidence based randomized control trials to recommend the salient components for a comprehensive service for eating disorders. Experienced eating disorder clinicians have come to the conclusion that a multidisciplinary team approach provides the most effective treatment.

Technologically-assisted behaviour change: a systematic review of studies of novel technologies for the management of chronic illness

A systematic review was conducted to investigate the use of technology in achieving behaviour change in chronic illness. The areas reviewed were: (1) methods employed to adapt traditional therapy from a face-to-face medium to a computer-assisted platform; (2) targets of behaviour change; and (3) level of human (e.g. therapist) involvement. The initial literature search produced 2032 articles. A total of 45 articles reporting 33 separate interventions met the inclusion/exclusion criteria and were reviewed in detail. The majority of interventions reported a theoretical basis, with many arising from a cognitive-behavioural framework. There was a wide range of therapy content. Therapist involvement was reported in 73% of the interventions. A common problem was high participant attrition, which may have been related to reduced levels of human interaction. Instigating successful behaviour change through technological interventions poses many difficulties. However, there are potential benefits of delivering therapy in this way. For people with long-term health conditions, technological self-management systems could provide a practical method of understanding and monitoring their condition, as well as therapeutic guidance to alter maladaptive behaviour.

Co-creating an optimal coaching alliance: A Cognitive Behavioural Coaching perspective

This paper reviews the coaching relationship from a Cognitive Behavioural Coaching (CBC) perspective. Using empathy as one example of a key relationship component it identifies how building, establishing and maintaining an optimal coaching alliance for the specific coachee, through an explicit process of negotiation and renegotiation epitomises ‘the collaborative relationship’ a central tenet of the Cognitive Behavioural framework. It also highlights how extending to the relationship itself an emphasis on the cognitive-behavioural dynamics of the coachee and the coach, individually and in interaction can potentially assist in fostering, maintaining, and where necessary managing disruptions in, the coaching alliance. Power dynamics and time constraints are highlighted as themes possibly differentiating the coaching alliance from the therapeutic alliance. The broader-based explicit stance of the coach resulting in a reciprocal requirement for greater adaptability to the coachee’s needs are tentatively proposed as further differentiators of the coaching alliance from a CBC perspective.

Menopausal symptoms following breast cancer treatment: A qualitative investigation of cognitive and behavioural responses

Objectives Menopausal symptoms – hot flushes and night sweats (HF/NS) – are particularly troublesome for women who have undergone breast cancer treatment. Non-medical treatments, such as cognitive behaviour therapy, are being developed but there is a lack of information about cognitive and behavioural reactions to HF/NS in breast cancer patients. Methods Thirty-five women who had completed active breast cancer treatment with at least 10 HF/NS per week completed questionnaires assessing HF/NS, mood and beliefs, and took part in interviews to elicit cognitive and behavioural reactions and a thematic content analysis used to analyse the data. Results The mean weekly frequency of HF/NS was 76 (SD = 46) (57 HF and 19 NS). Smokers reported significantly more night sweats, but BMI and mood were not associated with HF/NS frequency. Cognitive and behavioural responses were varied but broadly similar to those of well women. The main cognitive themes were: embarrassment/social anxiety, loss of control, beliefs about NS, sleep and tiredness, and the main behaviours were: carry on and ignore them, cool down, avoidance, communication with others. Conclusions The results are discussed within a cognitive behavioural framework and might inform the development of psychological interventions for these treatment related symptoms.

A randomized controlled trial to assess an anger management group programme

AbstractWe describe the results of a randomized controlled trial to assess effectiveness of an anger management group programme, employing a cognitive behavioural framework that was run by the Psychology Service. The treatment group was compared with a control group on a waiting list. The trial was performed at the Southampton CBT Service. The treatment group received a cognitive behavioural anger management programme, initially based on Novaco's approach, but with further development of the motivational components. The control group received no treatment and was on a waiting list. The Novaco Anger Assessment Scale (NAS), State-Trait Anger Expression Inventory (STAXI), Evaluative Beliefs Scale (EBS), Hospital Anxiety and Depression Scale (HAD) and the Clinical Outcomes in Routine Evaluations (CORE) were used to measure anger, belief about self and others, anxiety and depression, and physical and psychological wellbeing. Clients in the anger management group showed statistically significant changes on STAXI, NAS, CORE and EBS subscales at the end of the therapy. The change in depression and anxiety on HAD (depression and anxiety) was not statistically significant. It was not possible to carry out analyses at follow-up due to high dropout rates. We concluded that an anger management programme using CBT was helpful in reducing anger and overall psychopathology.

Efficacy of an Emotion-Focused Treatment for Prolonged Fatigue

Previous research findings have suggested a relationship between less adaptive emotional functioning and fatigue. The present study used a research design involving multiple baselines across participants to evaluate the efficacy of a new emotion-focused treatment for prolonged fatigue delivered in a cognitive behavioral therapy framework. The 13 adults participating in the study met the criteria for prolonged fatigue and provided fatigue baselines of 2, 5, or 8 weeks. The results indicated that the treatment was effective, with fatigue severity levels after the initiation of treatment significantly lower than that predicted by baseline patterns, as determined by the split median method of trend estimation. At 3-4 months after treatment, 8 of 11 clients who completed the treatment no longer met the criteria for prolonged fatigue.

Prayer and subjective well-being: The application of a cognitive-behavioural framework

The aim of the present study was to examine the relationship between a model of prayer and a measure of subjective well-being within the context of a cognitive-behavioural framework. A community sample of 173 (77 males and 96 females) British adults completed measures of prayer activity and the General Health Questionnaire-28. The present findings suggest that meditative prayer, frequency of prayer, and prayer experience account for unique variance (among other measures of prayer) in a general measure of subjective well-being. The results demonstrate the potential usefulness of a cognitive-behavioural framework to help better understand the relationship between prayer and subjective well-being.

Using Orff-based techniques in children's bereavement groups: A cognitive-behavioral music therapy approach

Children affected by the death of a loved one can face multiple challenges including difficulties identifying and dealing with emotions, impaired social interactions, distorted thoughts, and behavioral problems. The inclusive and engaging nature of music-based therapeutic experiences provides children with a developmentally appropriate way to address a variety of needs. This article describes the use of Orff-based music therapy interventions in a cognitive-behavioral framework to assist children through the grieving process. The Orff-based music therapy program provides opportunities for emotional healing, building positive social relationships, cognitive reframing, and decreasing behavioral problems. The philosophy of cognitive-behavioral music therapy is articulated, and session goals and objectives are stated. Sample Orff-based music therapy sessions are provided with a rationale for their use.

Treating Somatization: A Cognitive-Behavioral Approachby Robert L. Woolfolk and Lesley A. Allen. New York, Guilford Press, 2006, 218 pp., $32.00.

Treating Somatization: A Cognitive-Behavioral Approachby Robert L. Woolfolk and Lesley A. Allen. New York, Guilford Press, 2006, 218 pp., $32.00.

A cognitive behavioral case formulation framework for treatment planning in anxiety disorders

A cognitive behavioral case formulation framework (CBCFF) for anxiety disorders is presented, in which the etiological and maintaining factors for the anxiety disorders are outlined in a single, simple, visual framework. This CBCFF is then used to demonstrate the specific links of different cognitive and behavioural treatment components to aspects of the case formulation. An example is used to illustrate the use of the CBCFF, highlighting its utility with novel presentations for which no manualized treatments exist.

Psychological approaches for the nursing management of chronic pain: part 2

The aim of this article was to present the ways that nurses can integrate psychological approaches into their management of chronic pain conditions using a biopsychosocial framework. Communication, the importance of the patient-practitioner interaction, the role of education and provision of information, reassurance and reduction of anxiety and the use of coping strategies training in the management of chronic pain are reviewed alongside the key skills of nursing. This is the second part of a two-part article. Part 1 was a discussion of psychosocial factors associated with chronic pain conditions and the psychological approaches used in the management of these conditions. It is identified that key nursing skills often equate to the requirements of the psychological approaches, therefore specific techniques from a cognitive-behavioural framework can be readily applied, integrated and used by nurses in the management of chronic pain conditions. Commonly utilized nursing skills are similar to those required for cognitive-behavioural therapy. It is reasonable to assume therefore that nurses can and should be involved in effectively managing the psychological aspects associated with chronic pain conditions.

Performance Anxiety Among African-American College Students

This article examines the etiology of social phobia, and proposes that the sensitivity to self-scrutiny common to social phobics can be exacerbated by the effects of longstanding racial bias. The impact of racism on identity and the importance of context are explored as salient factors in the onset of a case of social phobia for an African-American woman at a prestigious university. The importance of attending to both overt and subtle forms of racism is illustrated within the typical cognitive-behavioral framework for the treatment of social phobia.

Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours (2nd edition), * G. Alan Marlatt and Dennis M. Donovan (eds), * New York, The Guilford Press, 2005, pp. 416, ISBN 1593851766, 32.50

The overall theme of the book is relapse prevention for behaviours that are considered to be addictive. These include alcohol and substance misuse, eating disorders, smoking, gambling and sexual behaviours. The relapse prevention approach is located clearly within a cognitive behavioural therapy (CBT) model, so although the chapters are ‘disorder’ specific, the approaches described and advocated in each are transferable and readers may experience some degree of repetition. Throughout the book, motivational interviewing (Miller and Rollnick, 2002) and the transtheoretical approach to behaviour change (Prochaska and Di Climente, 1984) are continually referenced and reinforced. Social workers in the addiction field and more generally may be well acquainted with these models which will act as a useful starting point for the focus of relapse prevention more specifically. From the start of the book, the authors assume a fairly significant knowledge of the cognitive behavioural framework including basic tenets such as coping skills enhancement, development of self-efficacy, harm reduction techniques, motivational approaches and contingency management. References are made throughout to Donovan and Marlatt (2005), The Assessment of Addictive Behaviours. Whilst useful concepts relating to cognitive behavioural assessments are available in other texts such as Hawton et al. (1989), Cigno and Bourn (1998) and Straussner (2004), I would suggest that because of an assumed familiarity with the related work by the editors, the two books might best be used together in terms of the overall approach.

Are Cognitive Problem-solving Skills Programmes Really Not Working? A Response to 'Evaluating Evidence for the Effectiveness of the Reasoning and Rehabilitation Programme'

: Many believe that offenders are involved in criminal activities because they make poor decisions. Accordingly, problem-solving skills programmes have been delivered to literally thousands of offenders on both sides of the Atlantic. In ‘Evaluating evidence for the effectiveness of the Reasoning and Rehabilitation Programme’ (Wilkinson 2005), the authors cite outcome research suggesting that involvement in Reasoning and Rehabilitation does not significantly reduce reoffending in comparison to untreated control subjects. This article proposes that it may not be the underlying premise that is faulty. Rather, it is possible that a proliferation of cognitive-behavioural interventions, most of which include aspects of problem-solving skills development, has washed out any potential differences. Simply put, being managed in a cognitive-behavioural framework that adheres to the principles of effective correctional interventions (for example, Andrews and Bonta 2003) affords offenders an opportunity to develop better problem-solving skills.

The Case of "Ben": A Flexible, Holistic Application of Multimodal Therapy

"Ben," a white, male executive who was 50 years old at the beginning of therapy, presented with anxiety, depressive mood, anger, and relationship and career problems. The case, involving therapy in a private practice setting, illustrates some of the diverse individual client needs, life complexities, and accompanying twists and turns that can emerge in treatment. While grounded in a cognitive-behavioral framework, the "Multimodal Therapy" model employed in Ben's case is designed to be responsive to such challenges by drawing procedures from other traditions, when necessary, within the framework of a "technical eclecticism." In addition, the case illustrates attempts within the multimodal model to balance science versus artistry, and planned structure vs. creativity and flexibility.

A COGNITIVE BEHAVIOURAL FRAMEWORK FOR THE TREATMENT OF DISTRESSING VISUAL HALLUCINATIONS IN OLDER PEOPLE

This paper summarizes a recently developed model for understanding the genesis of visual hallucinations, shows how this can be incorporated into a cognitive behavioural framework, and then illustrates possible ways in which this may be used to successfully treat the emotional distress that some older people experience as a consequence of their hallucinations. These ideas have been developed as a model-based clinical response to patients distressed by their hallucinations. The purpose of this paper is to outline this approach in order to stimulate discussion and empirical evaluation.

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.

Latent structure of the social anxiety scale and relations between social anxiety and irrational beliefs

The research which was realized belongs to one of three research fields within framework of rational-emotional-behavioral therapy (REBT) - to the theory of emotional disorders. It was undertaken with the aim to establish presence and nature of relations between social anxiety, treated as dimension and the construct of irrational beliefs from REBT theory. The research was carried out on the sample of 261 students of Novi Sad University, both genders, age 18 to 26. First of all, the latent structure of newly constructed Scale of Social Anxiety (SA) of the author Tovilovic S. was tested. SA scale was proved to be of satisfying reliability (? =0.92). Principal-component factor analysis was conducted under gathered data. Four factors of social anxiety, which explain 44,09% of total variance of the items of SA scale, were named: social-evaluation anxiety, inhibition in social-uncertain situations, low self-respect and hypersensitivity on rejection. The other test that was used is Scale of General Attitudes and Beliefs of the author Maric Z. Reliability of the sub-scale of irrational beliefs that was got on our sample is ? =0.91 yet the subscale of rational beliefs is ? =0.70. Canonical correlational analysis was conducted under manifest variables of both scales. Three pairs of statistically significant canonical factors were got, with correlations within the span between Rc=0.78 and Rc=0.64. We discussed nature of correlation between social anxiety and irrational beliefs in the light of REBT model of social phobia, REBT theory of emotional disorder, researches and model of social anxiety in wider, cognitive-behavioral framework.

Religion and mental health: towards a cognitive-behavioural framework.

Religion is frequently ignored within the clinical domain. Yet when examined, empirical evidence indicates that specific aspects of religiosity are correlated with mental health. The established associations between religious dimensions and mental health could be mediated by cognitive-behavioural mechanisms. This paper proposes a preliminary conceptual framework in which two types of cognitive and behavioural mechanisms are described, (1). generic mental models that provide a basis for guiding appraisals of life events and (2). self-regulation of thinking processes (metacognitive control). A critical analysis of extant literature was employed to examine support for each of the mechanisms. Evidence supports the idea that a religious framework can serve as a generic mental model that influences appraisals and affects well-being. The benefits derived depend on the salience of the framework, level of certainty with which attributions can be accepted, and the content of the information. Evidence for the self-regulation mechanism is weaker. Although consistent with this supposition, it requires further empirical evaluation. The relationships between religious variables and mental health may depend on cognitive-behavioural mechanisms. Developments in this area might encourage clinicians to consider further the ways in which religious variables might be utilized and assessed in therapy. However, there is a need for further efforts to incorporate religious and spiritual factors in the clinical arena.