Course Of Cognitive-behavioral Treatment Research Articles

Therapists' first impression of treatment motivation moderates the relationship between the client-rated therapeutic alliance and drinking outcomes during treatment.

First impressions can influence interpersonal relationships for extended periods, with negative first impressions leading to more negative judgments and behaviors between individuals months after their initial meeting. Although common factors such as therapeutic alliance (TA) are well studied, less is known of the potential influence of a therapist's first impression of their client's motivation on TA and drinking outcomes. Based on data from a prospective study of the perceptions of the TA among clients receiving cognitive-behavioral treatment (CBT), this study examined how therapists' first impressions may moderate the relationship between client-rated TA and drinking outcomes during treatment. One hundred fifty-four adults participated in a 12-week course of CBT and completed measures of TA and drinking behaviors following each treatment session. Additionally, therapists completed a measure of their first impression of their client's motivation for treatment following the first session. Time-lagged multilevel modeling revealed a significant within-person TA by therapists' first impression interaction that predicted percent days abstinent (PDA). Specifically, among participants rated as lower on first impressions of treatment motivation, higher within-person TA predicted greater PDA in the interval prior to the next treatment session. Within-person working alliance was not associated with PDA among individuals rated higher on first impressions of treatment motivation who demonstrated higher PDA throughout treatment. Furthermore, significant between-person TA by first impressions interactions were found for both PDA and drinks per drinking day (DDD), such that among individuals with lower treatment motivation, TA positively predicted PDA and negatively predicted DDD. Although therapists' first impressions of a client's treatment motivation are positively associated with treatment outcomes, clients' perception of the TA may mitigate the impact of poor first impressions. These findings highlight the need for additional nuanced examinations of the relationship between TA and treatment outcomes, emphasizing the contextual factors that influence this relationship.

The Association between Insomnia and Anxiety Symptoms in a Naturalistic Anxiety Treatment Setting

ABSTRACT Objective/Background: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine insomnia within a single anxiety diagnosis without accounting for the high overlap between disorders. Here we investigate the association between insomnia and multiple anxiety disorders over a course of cognitive behavioral treatment (CBT) in a naturalistic treatment setting. Participants: Insomnia was assessed in 326 patients seeking treatment at a clinic specializing in CBT for anxiety. Methods: Multilevel modeling was used to investigate whether insomnia moderated reductions in anxiety symptoms. A cross-lagged analysis tested for bidirectional effects between insomnia and anxiety. Multiple regression was used to investigate the relationship between insomnia and anxiety while controlling for the other anxiety disorders and depression. Results: While there was a significant reduction in insomnia during treatment in all anxiety disorders, the majority of the most severe patients remained in the clinical range at post-treatment. Baseline insomnia did not significantly moderate anxiety outcomes, suggesting that patients with high or low levels of insomnia will do equally well in CBT for anxiety. The bidirectional effect between insomnia and anxiety did not reach significance. Additionally, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder were associated with the greatest endorsement of insomnia, after controlling for the overlap between disorders. Conclusions: Sleep problems may persist after anxiety treatment, suggesting that CBT for insomnia may be warranted during or after a course of CBT for anxiety. Importantly, baseline insomnia does not impede anxiety reduction during CBT.

Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales

BackgroundAnxiety and depressive disorders are the most frequent disorders for which patients seek care in public health settings in Spain. This study aimed at validating the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), which are brief screening scales for anxiety and depression consisting of only five items each. MethodsThe study was conducted in a Spanish clinical sample receiving outpatient mental health treatment (N = 339). A subsample of participants (n = 219) was assessed before and after receiving a course of cognitive-behavioral treatment. ResultsThe results revealed excellent internal consistency estimates (Cronbach's alpha for the OASIS and the ODSIS was 0.87 and 0.94, respectively), along with promising convergent and discriminant validity and test-criterion relationships (i.e., moderate correlation with other measures of depression and anxiety, as well as with neuroticism, quality of life, adjustment, and negative affect). A one-dimensional structure was obtained for the OASIS and the ODSIS. The ROC analyses indicated an area under the curve of 0.83 for the OASIS and the ODSIS when predicting moderate-to-severe anxiety and depression, respectively. Good sensitivity to therapeutic change was also evidence and the analysis of the sensitivity as a function of 1-specificity area suggested a cutoff value of 10 for both scales. LimitationsInter-rater reliability of diagnoses with the ADIS-IV interview could not be investigated and the results obtained may not be generalizable to other samples and health settings. ConclusionsThe availability of these two short and psychometrically sound measures should make screening of anxiety and depressive symptoms in routine care more feasible.

Development and Preliminary Evaluation of a Positive Emotion Regulation Augmentation Module for Anxiety and Depression

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. Many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to disorder severity and prevent full recovery, and these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of adding a novel brief intervention module for enhancing positive emotion in anxiety and depressive disorders to existing evidence-based treatment. This intervention was evaluated in nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment, utilizing a multiple baseline experimental-across-participants design. Results indicated that the intervention was effective in improving positive emotion regulation skills for five of nine participants. The intervention was also associated with further improvements in anxiety and depressive symptoms, positive and negative emotion, functioning, quality of life, and well-being. Participants reported high acceptability and satisfaction with the study intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.

Brief group cognitive behavioral treatment in addition to prescriptive diet versus standard care in obese and overweight patients. A randomized controlled trial.

The beneficial effect of cognitive therapy was found particularly in eating disorders, but, to date, it has rarely been studied in obese patients without eating disorders. The aim of this pragmatic randomized clinical trial was to evaluate the effectiveness of a novel brief group cognitive behavioral treatment (CBT), accepted and performed in clinical practice, in addition to a prescriptive diet with respect to the prescriptive diet alone (standard care), in obese and overweight outpatients without eating disorders. One hundred sixty three patients [44 men and 119 women; 45 ± 11 yr; mean body mass index (BMI) of 32 ± 4 kg/m2] aged 18–65 years who were from overweight (BMI between 25 and 29.9) to 2° class obese (BMI between 35 and 39.9 kg/m2) were followed for 12 months in a public obesity ambulatory. The study was based on a nutritional intervention lasting for six months. Weight loss was obtained with a hypo caloric balanced diet. Standard care consisted in a low-calorie diet, and a control visit every three months. Group CBT patients received the same diet but in addition they attended a series of seven subsequent meetings divided in small groups. Primary outcome is defined as the percentage of patients in each group achieving a 10% reduction of body weight at 12 months in comparison with baseline value. After randomization, at baseline patients underwent laboratory tests, bioelectrical impedance analysis, ECG and psychometric tests, and they were followed-up at six and 12 months. The average weight loss obtained at six and 12 months was respectively 6.0% and 7.44% for all patients, and this is in accordance with other similar studies. The primary outcome has been reached by 19 patients (24%) out of 78 who concluded the follow-up. Considering an ITT univariate analysis, the primary outcome was independent from treatment arm (OR .854, CI .39–1.871, p = 0.633) and the two treatments were substantially similar. Metabolic parameters (glucose levels, lipid profile, blood pressure), as expected, ameliorated in both groups during follow-up. The only independent predictor of successful weight loss was baseline glucose levels (OR 1.05, CI 1.009–1.09, p = 0.04), thus representing a higher risk of disease perceived by patients. A brief group CBT, when added to standard care, was not superior to standard care alone in obese patients. The peculiar course of CBT planned only in the first six months, as well as the absence of a pure cognitive analysis may have impacted on the CBT success lower than expected. Further studies are needed in order to determine if longer intervention may be effective and feasible in a real-life primary care setting. Clinical trial.gov (n° NCT01686854).

A Cognitive-Behavioral Treatment Approach for Body Dysmorphic Disorder

Although body dysmorphic disorder (BDD) has been described in the literature for more than a century, there has been only a limited focus on the development of cognitive behavioral treatments for BDD. Our case report provides a detailed description of a course of cognitive behavioral treatment (CBT) for an individual with BDD. The patient was treated for 10 weekly 50-minute individual sessions. The treatment focused on psychoeducation, cognitive restructuring, exposure and response prevention, and perceptual retraining exercises. The patient's BDD symptoms significantly improved over the course of the treatment. This case study illustrates several clinical strategies and provides further support for CBT as a promising treatment for individuals suffering from BDD.

Neuropsychological Impairment in Obsessive-Compulsive Disorder—Improvement Over the Course of Cognitive Behavioral Treatment

A large body of studies demonstrates mild cognitive dysfunction in patients with Obsessive Compulsive Disorder (OCD). Few trials have investigated whether this dysfunction can be improved by treatment. Thirty unmedicated inpatients with OCD were administered a comprehensive neuropsychological test battery before and after 12 weeks of cognitive behavioral therapy (CBT). Thirty-nine carefully matched healthy controls were tested twice within the same interval. At baseline, patients exhibited significant impairments on several tests which normalized at follow-up. A significant group × time interaction was found for tests of nonverbal memory, set shifting and flexible, self guided behavior. Major responders improved significantly more than minor responders on the Rey-Osterrieth Figure immediate and delayed recall. Results suggest that cognitive dysfunction in OCD can improve in the course of treatment. We hypothesize that particularly cognitive behavioral treatment enables OCD patients to think and act in a more flexible way that helps them to develop more effective cognitive strategies.

Cognitive-Behavioral Treatment of Rape- and War-Related Posttraumatic Stress Disorder With a Female, Bosnian Refugee

Prevalence of posttraumatic stress disorder (PTSD) among rape victims and war refugees is high. Cognitive-behavioral interventions have demonstrated effectiveness in alleviating PTSD in rape survivors. Effectiveness of such interventions when rape is perpetrated as part of war hostilities has not been examined. Rape and plunder of civilian populations characterized the 1991 to 1995 war in the former Yugoslavia. Rape camps terrorized civilians on all sides of that conflict. This case study illustrates a course of cognitive-behavioral treatment for PTSD with a female, Bosnian refugee and rape survivor. At post treatment, the client no longer met criteria for PTSD, and improvements were evident at 6- and 12-month follow-ups. Approaches to treating PTSD in war refugees are discussed.

The Impact of Comorbidity of Depression on the Course of Anxiety Treatments

Although anxiety disorder patients often present with comorbid disorders, little is known about differences in the course of the treatment due to comorbidity. The present study investigated whether cooccurring major depression predicts individual differences in the course of cognitive-behavioral treatment for panic disorder or social anxiety disorder in a total of 179 patients. Additionally, changes in depression scores were analyzed using growth-curve models. Overall, the results show comparable improvement for comorbid and noncomorbid patients. However, for patients with panic disorder and comorbid depression, anxiety scores were higher than for patients without comorbid conditions throughout the treatment. The results suggest that comorbid depression does not have a detrimental effect on the course of the anxiety treatment, but that the depression scores remain elevated at posttreatment.

Characteristics and content of intrusive memories in PTSD and their changes with treatment

Although intrusive reexperiencing is a core symptom of postraumatic stress disorder (PTSD), relatively little is known about its phenomenology. The present study assessed the characteristics and content of intrusive trauma memories in 22 patients with PTSD, and followed their changes in the course of cognitive behavioral treatment. Patients had a small number of different intrusive memories (1-4, M = 2.2) that occurred in an invariable, repetitive way. The intrusions were distressing and had a vivid perceptual content. They appeared to the patient to be happening in the "here and now." With therapy, the frequency, vividness, distress, and nowness of the intrusions faded gradually. There was no exacerbation with imaginal reliving. The content of intrusions was classified by raters to test A. Ehlers et al.'s (2002) hypothesis that intrusive memories are usually of warning stimuli that signalled the moments with the greatest emotional impact. The results were consistent with this hypothesis.

Preliminary investigation of associations of illness schemata and treatment-induced reduction in headaches.

This study examined how illness schemata-ways people organize information about illness-change over the course of cognitive-behavioral treatment of chronic headache and the extent to which such changes predict reduction of headache. 73 subjects with chronic migraine, mixed migraine and tension, or tension headache were classified on the basis of outcome from imagery-based treatment as Treatment-responders (n = 24). Treatment nonresponders (n = 27), and Monitoring Controls (n = 22). Self-reported illness schemata related to the seriousness and changeability of headache were assessed at pretreatment and 8-wk. follow-up. While groups did not differ on pretreatment measures of illness schemata, at follow-up the Treatment responder group reported higher Changeability scores than Treatment-nonresponders and Control subjects and lower Seriousness scores than Control subjects. Headache reduction at follow-up was related to follow-up Changeability scores, in-session changes in systolic blood pressure and reported posttreatment expectations of headache activity, but not pretreatment measures of illness schemata. Findings indicate that improvements in headache activity are not influenced by the severity of headaches and may change prior to cognitive-behavioral treatment. Rather, among individuals who show decreases in headache activity, changes in beliefs about illness and headache reduction may have reciprocal relations both of which result from cognitive behavioral treatment.

Self-focused attention in the treatment of social phobia

For those with social phobia, self-focused attention has been linked with impairment in social performance, increased social anxiety, and a higher frequency of self-critical thoughts during social situations. The purpose of this investigation was to assess correlates of changes in situational self-focus over the course of cognitive-behavioral treatment (CBT). Focus of attention was assessed after in-session role-plays and after in vivo homework assignments during group CBT for social phobia. Analyses revealed a significant decrease in self-focused attention over time; focus on events and stimuli outside of the self remained unchanged. Treatment gains on anxiety during dyadic interactions, on negative self-judgments, and on personalized social fears were related to reduction in self-focused attention. Those with public speaking phobias showed a strong relationship between decreased self-focus and speech anxiety. These findings suggest that changes in self-focused attention during the course of CBT are related to important therapeutic gains. Specific interventions aimed at decreasing self-focus may be a useful treatment strategy.