Cognitive Restructuring Group Research Articles

The Effectiveness of Group Counseling Cognitive Restructuring Techniques to Increase the Self-confidence of Students

Students' lack of confidence in completing various assignments given by the teacher shows that students need more self-confidence. This study aims to determine the effectiveness of group counseling with cognitive restructuring techniques on students' self-confidence. This quantitative research study uses a quasi-experimental approach using a Nonequivalent Control Group design. The population is 314 from two different classes. Ten students were selected as samples from the two classes, and the selected subjects were identified as having low self-confidence. The pre-test and post-test were used to determine the difference in scores shown by the control and experimental classes. Data was collected through interviews and questionnaires and distributed to students involved as research subjects. Then, the data were analyzed with quantitative descriptive and inferential descriptive. The results show the difference in scores between the control and experimental groups. In the experimental class, a post-test score of 133.5 was obtained by the experimental class, and the control class obtained a post-test score of 112. The difference in the mean post-test scores indicated that the class that received the cognitive restructuring group counseling treatment showed a change in behavior as evidenced by the post-test scores, which were higher than the class that did not receive the cognitive restructuring group counseling treatment. It indicates the acceptance of Ha so that there is effectiveness contributed by group counseling with cognitive restructuring techniques in increasing student self-confidence.

Stress management versus cognitive restructuring in trauma-affected refugees — A follow-up study on a pragmatic randomised trial

BackgroundThere is a lack of research and consensus with respect to long-term effective treatments for trauma-affected refugees. The purpose of this follow-up study of a randomised clinical trial was to investigate the effectiveness of Stress Management (SM) versus Cognitive Restructuring (CR) in treating trauma-affected refugees, six and 18 months post-treatment, respectively. MethodsFrom a total of 126 refugees with PTSD, the intention-to-treat sample in the original trial, 74 patients were present at the six-month follow-up (SM; n = 37, CR; n = 37) and 34 patients at the 18-month follow-up (SM; n = 14, CR; n = 20). During the trial, the patients had been offered a total of 16 psychotherapy sessions and 10 sessions with a medical doctor. ResultsMixed regression analyses at six and 18-month follow-up showed a non-significant small reduction in PTSD symptoms at both follow-up points with no significant between-group differences between the two psychotherapeutic interventions. Statistically significant between-group treatment effects were, however, observed with the patients receiving SM having significantly reduced symptoms of somatisation measured by the Symptom Checklist (β = 0.40), depression (β = 0.29) and anxiety (β = 0.37) (measured by the Hamilton Depression and Anxiety ratings) at 18 months post-treatment compared to the CR group. LimitationsLimitations to the present study include the dropout rate at follow-up(s). ConclusionsThe findings suggest that the consolidation of coping strategies including relaxation, attention-diversion and behavioural activation in SM appears to be more beneficial than CR in reducing long-term somatisation, depression and anxiety symptoms for this population.

Cognitive Restructuring vs. Defusion: Impact on craving, healthy and unhealthy food intake

Coping with food cravings is crucial for weight management. Individuals tend to use avoidance strategies to resist food cravings and prevent overeating, but such strategies may not result in the benefits sought. This study compared the effects of two cognitive techniques (Restructuring vs. Defusion) for dealing with food cravings in terms of their impact on healthy vs. unhealthy eating behavior (i.e., consumption of chocolate and/or carrots following the intervention). Sixty-five participants (Mage = 19.65 years) received either a 30-minute face-to-face instruction on cognitive restructuring (CR) or cognitive defusion (CD) along with 15 min of practice, or 45 min of obesity education and discussion (control). To examine craving and eating choices following the intervention, participants received bags of chocolate and carrots and were asked to carry these with them at all times over the next week, exchanging the bags every 2 days. Participants in the CD group ate fewer chocolates (M = 11.74) compared to CR (M = 17.06) and Control groups (M = 29.18) during the experimental week. The groups did not differ in number of carrot pieces eaten, though the CD group ate more carrots than chocolates. CD resulted in fewer self-reported cravings compared to CR and CO groups. At a final taste test, both CD and CR groups ate significantly fewer chocolates compared to the CO group. CD appears to be an effective technique in managing food craving and to present some advantages over CR.

Effect of music therapy combined with cognitive restructuring therapy on emotional distress in a sample of Nigerian married couples.

Background:Music therapy combined with cognitive restructuring could provide a mechanism to improve patients’ sense of control over emotional distress. This study evaluates the effect of music therapy combined with cognitive restructuring therapy on emotional distress in a sample of Nigerian couples.Methods:The participants for the study were 280 couples in south-east Nigeria. Perceived emotional distress inventory (PEDI) was used to assess emotional symptoms. Repeated measures with analysis of variance were used to examine the effects of the intervention. Mean rank was also used to document the level of changes in emotional distress across groups. Effect sizes were also reported with partial η2.Results:There were no significant baseline differences in emotional distress level between participants in the music therapy with cognitive restructuring group and waitlisted group. Significant decreases in the level of emotional distress were observed in the music therapy with cognitive restructuring group, but the waitlisted group demonstrated no significant change in their score both at posttreatment and 3 follow-up assessments.Conclusion:Our findings suggest music therapy with cognitive restructuring therapy is effective for reducing emotional distress of couples. In addition, the positive effect of the music therapy with cognitive restructuring therapy program can persist at follow-up. Therefore, therapists have to continue to examine the beneficial effects of music therapy with cognitive restructuring therapy on emotional distress level of couples both in Nigeria and in other countries.

Stress management versus cognitive restructuring in trauma-affected refugees—A pragmatic randomised study

The aim of this randomised trial was to compare the effectiveness of stress management (SM) versus cognitive restructuring (CR) in trauma-affected refugees. The intention-to-treat sample comprised 126 refugees with PTSD (SM = 62, CR = 64). The treatment consisted of 16 sessions of psychotherapy with manualised SM or CR in addition to 10 sessions with a medical doctor (psychoeducation and pharmacological treatment). The primary outcome was PTSD symptom severity (Harvard Trauma Questionnaire). Secondary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist-25, Hamilton Depression and Anxiety Ratings), quality of life (WHO-5), functioning (Global Assessment of Functioning, Sheehan Disability Scale), pain (Visual Analogue Scale) and somatisation (Symptom Checklist). There was no difference in the primary outcome between groups. A significant group difference was found on the Hamilton Anxiety Rating with the SM group improving more than the CR group (effect size 0.46) indicating that methods in SM could potentially be helpful in this population.

Cognitive restructuring and detached mindfulness: Comparative impact on a compulsive checking task

Background and ObjectivesRepeated checking leads to a shift from perceptual to semantic level of information processing, increasing an individual׳s doubt in their memory. Cognitive restructuring (CR) targeting content of OCD cognitions has demonstrated efficacy in the treatment of OCD. Detached mindfulness (DM) is a novel metacognitive intervention that aims to suspend conceptual processing, thereby providing individuals with more objective meta-awareness, helping them to disengage from biased thinking. The present study compared the effects of DM and CR in reducing the doubt-inducing effect of compulsive checking on memory and checking behaviours. MethodsSixty-five undergraduates were randomly assigned into CR, DM and control groups. Participants completed a repeated checking task found previously to produce OCD-like effects of memory distrust and an increased urge to check. Following this, participants received either a brief CT or brief DM intervention, or an unrelated control task. Participants were provided with an opportunity to check their final responses. ResultsCompared to the control group, DM and CR interventions were comparable and significantly more effective in reducing rechecking, while DM had additional benefits in ameliorating effects of reduced memory distrust. LimitationsResults were based on non-clinical participants, and utilised low intensity CR and DM interventions. ConclusionsResults provide initial support for the use of CR and DM in reducing the effect of repeated checking.

Depression in Some Teenagers May Be Preventable

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessDepression in Some Teenagers May Be PreventableJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Aug 2009https://doi.org/10.1176/pn.44.15.0031The search for ways to prevent mental illness is gaining considerable ground as a field of scientific inquiry—and with some very encouraging results (Psychiatric News, April 3).Two new studies underscore this point, finding that depression can be prevented in teenagers who have risk factors for developing the disorder. One study was published by Judy Garber, Ph.D., of Vanderbilt University and colleagues in the June 3 Journal of the American Medical Association (JAMA). The other, conducted by Edward Craighead, Ph.D., director of the Child and Adolescent Mood Disorder Program at Emory University, and Eirikur Orn Arnarson, Ph.D., an associate professor at the University of Iceland Faculty of Medicine, was published in the July Behavior Research and Therapy.The foundation for the study by Garber and colleagues was laid eight years ago when Gregory Clarke, Ph.D., of the Kaiser Permanente Center for Health Research in Portland, Ore., and colleagues reported that a brief, group cognitive restructuring program could reduce the incidence of depression in teens with subdiagnostic depressive symptoms whose parents had a history of depression.In this program, teens were taught how to identify and challenge irrational, unrealistic, or overly negative thoughts, with a special focus on beliefs related to having a depressed parent—for instance, “I'm doomed to become depressed because my father is depressed, and there's nothing I can do about it.”Garber and her group decided that they would try to replicate and extend the findings by Clarke and colleagues.Theirs was a randomized, controlled trial conducted in four cities. Subjects were 316 teenagers who had parents with a history of depression and who themselves had a history of depression or subdiagnostic depressive symptoms.Half of the subjects were randomly assigned to usual care, which meant that they could access mental health services as they felt they needed them. The others were randomly assigned to a cognitive restructuring program. The program consisted of eight weekly group sessions followed by six months of“ booster” sessions. Subjects in both groups were evaluated for depression at the start of the study, at about 14 weeks into the study, and finally at approximately 42 weeks after the study had begun. The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidemiological Version, was used to assess depression.The rate of depression after 42 weeks was significantly lower in the cognitive restructuring group than in the usual-care one—21 percent versus 33 percent. So the program “had a significant prevention effect,” Garber and her team concluded. Moreover, their findings showed that the program can be “reliably and effectively delivered in different settings by clinicians outside of the group who originally developed the intervention.”As for the study conducted by Craighead and Arnarson, the sample included 171 14-year-olds at risk of depression either because of depressive symptoms or because of having indicated a negative outlook on life. Half served as controls and half received an experimental program. The program consisted of 14 group sessions conducted in school, but outside regular classroom time. Subjects learned strategies for coping with adversity—strategies that the researchers hypothesized would make the subjects resilient to depression.After the sessions were over, subjects in both groups were followed for six months to determine whether any developed depression. They were evaluated by psychologists in structured clinical interviews using the Child Assessment Scale.By the end of the follow-up period, 13 percent of the controls had been diagnosed with a full-blown depression or with dysthymia, while only 2 percent of the prevention program group received such a diagnosis—a significant difference. “Although I cannot [yet] disclose the exact one-year follow-up results, I can assure you that they are consistent with current data,” Craighead told Psychiatric News.“The outcomes of this project seem to indicate that age 14 is a good age to offer a [depression] prevention program,” Craighead and Arnarson concluded in their paper. “It could become a part of a health-class sequence, or it could be implemented, as we did, in a special class setting.”The study by Garber and her group was funded by the National Institute of Mental Health (NIMH). The study by Craighead and Arnarson was funded by NIMH and by several Icelandic grantors.An abstract of “Prevention of Depression in At-Risk Adolescents” is posted at<http://jama.ama-assn.org/cgi/content/abstract/301/21/2215>. An abstract of “Prevention of Depression Among Icelandic Adolescents” can be accessed at<www.sciencedirect.com> by clicking on “B,” then “Behavior and Therapy,” then the July issue. ▪ ISSUES NewArchived

Prolonged Exposure Therapy Helps Ward off PTSD

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessProlonged Exposure Therapy Helps Ward off PTSDAaron LevinAaron LevinSearch for more papers by this authorPublished Online:4 Jul 2008https://doi.org/10.1176/pn.43.13.0013aPatients with acute stress disorder had fewer posttraumatic stress disorder (PTSD) symptoms at follow-up after a clinical trial of exposure-based therapy than did patients getting cognitive restructuring therapy or placed on a treatment waiting list, according to Australian psychologist Richard Bryant, Ph.D.More attention in recent years to early intervention following traumatic events has increased interest in what the primary therapeutic approach should be, wrote Bryant and colleagues in the June Archives of General Psychiatry.The researchers studied 90 patients who had experienced nonsexual assault or a motor vehicle crash and were diagnosed with acute stress disorder (ASD) from 2002 to 2006. They were randomized to receive five 90-minute sessions of either prolonged exposure therapy or cognitive restructuring therapy. A third group was placed on a wait list and told they would be reassessed after six weeks and then offered active treatment.Prolonged exposure patients were told to “verbalize reliving the trauma experience in a vivid manner that involved all perceptual and emotional details.” They were given homework exercises. Later sessions and homework included visualizing images of trauma exposure and real-life exposure to associations with their trauma. The last session included relapse-prevention strategies to help patients damp down PTSD symptoms if they recurred.Cognitive restructuring (CR) treatment involved identifying and monitoring maladaptive thoughts by “Socratic questioning, probabilistic reasoning, and evidence-based thinking.” Some homework and relapse prevention were included in this treatment too.Prolonged exposure showed large effect sizes, and cognitive restructuring showed moderate effect sizes, compared with the wait-list group. After six weeks, 33 percent of the exposure group met PTSD criteria compared with 63 percent of the cognitive restructuring patients, and 77 percent of those on the wait list.At the six-month follow-up, 37 percent of the exposure group met PTSD criteria while 63 percent of the cognitive restructuring group did. The researchers did not compare a combination of the two therapies with the single treatments.The effect was seen early in the course of exposure treatment, even as cognitive restructuring patients continued experiencing distress.Many therapists hesitate to use exposure therapy because it can cause distress and possibly drive patients away from therapy, according to the researchers. However, only five subjects reported adverse effects, all due to high distress, and dropped out of the study. Two subjects were in the exposure arm, and two were in the CR arm. Overall, patients getting exposure therapy reported less distress at the end of the last three sessions than did patients getting CR therapy.“Dropout rates in the present study were comparable to dropout rates across chronic PTSD studies,” wrote Bryant and colleagues.In a rigorous review of treatments for PTSD, the U.S. Institute of Medicine last fall said that the only treatment for PTSD supported by a strong evidence base was exposure therapy.“The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with ASD,” they wrote. “[A]daptation occurs when the individual repeatedly engages with trauma reminders and learns that there is no aversive outcome.”The study showed that not only was using prolonged exposure treatment beneficial, but also it did not result in more therapy dropouts or aversive responses than other approaches.For Bryant and colleagues, the conclusions are clear. “[T]here is a need to better educate mental health care providers about the use of [prolonged exposure] as a frontline intervention for ASD,” they said.“Treatment of Acute Stress Disorder: A Randomized Controlled Trial” is posted at<http://archpsyc.ama-assn.org/cgi/content/short/65/6/659>.▪ ISSUES NewArchived

An Evaluation of Two Types of Cognitive Intervention in the Management of Chronic Tinnitus

Fifty-four subjects with chronic distressing tinnitus were randomly allocated to one of four experimental treatment conditions: (1) attention control and imagery training (AC1); (2) cognitive restructuring (CR); (3) combined attention control and imagery training plus cognitive restructuring (ACI + CR); and (4) a waiting list control (WLC). Significant overall improvements were found on measures of distress associated with tinnitus, and on a number of other measures of cognition and coping strategies. These improvements were maintained at the six-month follow-up. Relative to the WLC, the three treatment conditions (combined) were associated with improvements in tinnitus-related distress, reductions in tinnitus-related dysfunctional cognitions and an increase in the frequency of use of coping strategies. There was a significant effect in favour of the ACI group compared to the CR group on the measure of irrational beliefs. The analyses also revealed that the combined treatment condition (ACI + CR) showed significantly greater improvement on a measure of psychological distress and achieved a higher clinical response rate compared to the two single treatments. There were significant improvements from pretreatment to follow-up on some measures, although the mean scores revealed that some of the gains had been lost at this stage on the main measure of tinnitus-related distress. There were no significant group X time effects for any of the dependent variables at the six-month follow-up. The results were interpreted as supporting the practice of combining the two cognitive approaches.

Social Group Work in Community Corrections

Criminal justice agencies are increasingly using cognitive restructuring groups in correctional programs because current research suggests they are effective in reducing violent recidivism. However, social group workers are not at the forefront of this important work. This paper discusses a unique collaboration between an urban probation department and a school of social work to develop cognitive restructuring groups for offenders. It illustrates an important opportunity for social group workers to reach people at-risk for committing violent crime in urban communities.

The relative effectiveness of cognitive restructuring and coping desensitization in the treatment of self-reported worry

This clinical outcome study compared two therapeutic methods for the reduction of self-reported worry with a placebo and waiting-list control. In cognitive restructuring, participants were trained to realistically reevaluate imaginally presented worry situations. In coping desensitization, participants were taught to use relaxation in response to worry images within a coping framework. Progressive relaxation alone was used as the placebo condition. On the basis of questionaire measures of anxiety and self-reported worry, greater anxiety and worry reductions were found in the cognitive restructuring group, followed by minimal changes in the coping densensitization group, and no changes in the placebo and waiting-list control. Subjects in the restructuring condition also reported significant increases in attention and decreases in frequency of thought intrusions.

Controlling laboratory binging among restrained eaters through self-monitoring and cognitive restructuring procedures

In a laboratory analog procedure, this study evaluated the therapeutic effectiveness of self-monitoring and cognitive restructuring procedures on binge eating among restrained eaters. Sixty-two undergraduate women were identified as either restrained or unrestrained eaters by the Restrained Eating Questionnaire. The restrained subjects were randomly assigned to either the restrained control (RC), self-monitoring (SM), or cognitive restructuring (CR) conditions while the 14 unrestrained subjects formed the unrestrained control condition (UC). Subjects listened to either a five-minute SM, CR, or control audio-tape, consumed a 350-calorie milkshake, then tasted two eight-ounce servings of ice cream. The UC group consumed significantly fewer grams of ice cream than the RC group. The CR group consumed significantly fewer grams of ice cream than the RC group. These results suggest that cognitive restructuring procedures may be more effective than self-monitoring in reducing the magnitude of binge. Implications for therapeutic intervention are discussed.

Comparison of cue-controlled relaxation and cognitive restructuring versus study skills counseling in treatment of test-anxious college underachievers.

This investigation compared the relative efficacy of two multi-component strategies in the treatment of test anxiety for college underachievers. 30 test-anxious students with deficient study habits were assigned to one of three experimental conditions: (a) a combined cue-controlled relaxation and cognitive restructuring program, (b) a study-skills program incorporating a decision-making model, or (c) a waiting-list control. Analyses of pre-, post-, and follow-up data for several dependent measures indicated the superiority of the two active treatments relative to the no-treatment control. Between-group comparisons showed that both the cue-controlled relaxation and cognitive-restructuring group and the study-skills group demonstrated significant improvement over the waiting-list control on self-report debilitative test anxiety and irrational thinking. The study-skills program led to the most dramatic improvements in grade point averages. No significant differences between the two treatment techniques were observed on any of the dependent variables. A description of the two intervention strategies is provided, along with a discussion of the utility of these programs for the treatment of test anxiety with failing underachievers.

The relative contributions of covert reinforcement and cognitive restructuring to test anxiety reduction

Tested the relative contributions of two possibly active test anxiety treatment components, covert reinforcement (response relevant) and cognitive restructuring. Thirty-nine Ss were assigned to a covert modeling group, a cognitive restructuring group, a combination group, or a waiting list control group. The covert modeling consisted of imagining (a) the feared situations; (b) handling the stress in a coping manner; and (c) feeling good for having coped. The cognitive restructuring group's scenes consisted of imagining (a) the feared situation; (b) saying a negative self-statement; and (c) replacing it with a positive coping statement. Results showed that the covert modeling group was somewhat more improved than the cognitive restructuring group. This result is interpreted as evidence that cognitive restructuring may work by the mechanisms of covert rehearsal and response relevant covert positive reinforcement. Further research directions are suggested.

Cognitive restructuring treatment: A controlled trial with anxious patients

Cognitive restructuring, modified systematic desensitization and a combined treatment (cognitive behaviour modification) were compared with a no-treatment control group, using a simple randomized design. Twenty seven general anxiety out-patients selected from the hospital waiting list were used as subjects. Assessments were made at the beginning and end of treatment, and at follow-up 1 month later. The assessments included two subjective anxiety measures, the Zung self-rating anxiety scale and fear thermometer scores, a behavioural anxiety measure, a measure of cognitive anxiety as estimated by a diary recording of thinking time, fear survey schedule scores and I/E scores. Cognitive behaviour modification was found to be a superior form of treatment, relative to the no-treatment control and the other active treatment groups as assessed by FSS intensity score. The cognitive behaviour modification group showed greater improvement than the cognitive restructuring group on the diary anxiety scores. The results also demonstrated a relationship between outcome and initial severity of condition. The higher the subjects' initial scores on neurotic symptoms and subjective anxiety level, the greater the degree of positive change after treatment. Moreover, subjects with high levels of internal control prior to treatment responded most to therapy.