Efficacy Of Cognitive-behavioral Intervention Research Articles

Exercise and Cognitive-Behavioural Treatment in Fibromyalgia Syndrome

Fibromyalgia syndrome is a nonarticular rheumatic disorder characterised by diffuse musculoskeletal pain, stiffness, fatigue, disturbed sleep and tender points. The pathophysiology is not well understood and treatment remains a challenge. Although pharmacological therapy is still the primary treatment choice, a long-term effective intervention has not been demonstrated yet. Thus, besides pharmacotherapy, other multimodal interventions are often used. Exercise and cognitive-behavioural treatments which exist in the multimodal approach and encompass largely self-managed strategy, are reviewed in this article. Although, there is a great number of exercise studies, the large diversity of outcome measures and measurement instruments that have been used in studies, varying intensity and types of exercises, small sample sizes, high attrition rates, large variability in baseline function, symptom severity and psychosocial status limit to come to a conclusion about the efficacy of exercise in the treatment of fibromyalgia syndrome. There are also inconclusive results about the efficacy of cognitive-behavioural treatment because of limited number of studies with small sample sizes of patients with fibromyalgia syndrome. However, the results of the trials overall demonstrate the beneficial effects of both different types of exercise and cognitive-behavioural treatment, on the other hand, there is still a need for larger, more systematic and randomised controlled trials to evaluate the effectiveness.

A Critical Look at Dual-Focused Cognitive-Behavioral Treatments for Comorbid Substance Use and Psychiatric Disorders: Strengths, Limitations, and Future Directions

Several large-scale studies examining outcome predictors across various substance use treatments indicate a need to focus on psychiatric comorbidity as a very important predictor of poorer SUD treatment involvement and outcome. We have previously argued that current cognitive-behavioral treatments (CBT) approaches to SUD treatment do not focus on the necessary content in treatment in order to effectively address specific forms of psychiatric comorbidity, and thus only provide clients with generic coping strategies for managing psychiatric illness (as would be achieved in other SUD treatment approaches; Conrod et al., 2000). Furthermore, following our review of the literature on dual-focused CBT treatment programs for concurrent disorders in this article, we argue that combining CBT-oriented SUD treatments with specific CBT treatments for psychiatric disorders is not as straightforward as one would think. Rather, it requires very careful consideration of the functional relationship between specific disorders, patient reactions to specific treatment components, and certain barriers to treatment in order to achieve an integrated dual-diagnosis focus in treatment that is meaningful and to which clients can adhere. Keywords: substance abuse; cognitive-behavioral; diagnosis; psychiatric disorders; comorbidity The efficacy of cognitive-behavioral treatments (CBT) for substance use disorders (SUDs) is now indisputable. The articles presented in the current special issue on CBT approaches such as relapse prevention, guided self-change, behavioral couples therapy, and the community reinforcement approach, review evidence that clearly establishes that each produces significant improvements in SUD symptoms. The benefits of these various CBT approaches to SUD treatment are now also revealing themselves in other domains, such as in improving employment (Meyers, Villanueva, & Smith, this issue), family discord and partner aggression (Fals-Stewart et al., this issue), optimism and thought suppression (Witkiewitz, Mariait, & Walker, this issue), substance abuse in special populations (Sobell & Sobell, this issue), adaptive coping (Ouimette, Finney, & Moos, 1999), psychosocial functioning (Ouimette et al, 1999), criminal activity and use of health care services (Sacks & DeLeon, 1997), and comorbid psychiatric symptoms (Brown & Schuckit, 1988). Several large-scale studies examining outcome predictors across various substance use treatments (MacLellan et al., 1994; Ouimette, Gima, Moos, & Finney, 1999; Project MATCH, 1997) are now indicating that theoretical orientation of the treatment is not a strong determinant of SUD treatment outcome. Nonetheless, such studies have also identified a need to focus on psychiatric coniorbidity as a very important predictor of poorer SUD treatment involvement and outcome. Several reports indicate that individuals with SUDs who demonstrate psychiatric comorbidity are less likely to access addiction treatment services (Wu, Kouzis, & Leaf, 1999), demonstrate poor compliance with traditional substance use treatments (Drake, Mueser, Clark, & Wallach, 1996), and generally show a lesser response to such treatments with respect to rates of relapse to substance abuse, employment status, and psychosocial functioning (McLellan et al., 1994; Ouimette, Gima, Moos, & Finney, 1999; Project MATCH, 1997). The current article will examine the literature on the outcome of CBT approaches for the SUD client who suffers from a concurrent mental disorder. MODELS OF COMORBIDITY: How ARE SUD AND MENTAL DISORDERS RELATED? Before we examine different CBT approaches to treatment of concurrent SUD and mental disorders, it is worthwhile to consider various theoretical models of the relationship between SUDs and mental disorders. These models can inform ways of conceptualizing primary targets of therapy for dually diagnosed patients. The first model suggests that chronic and severe substance abuse is a strong contributor to the development of psychopathology and accounts for much of the co-occurrence between SUDs and other mental disorders. …

State-of-the-Art in Cognitive-Behavioral Interventions for Substance Use Disorders: Introduction to the Special Issue

Substance use disorders (SUDs) are among the most prevalent psychiatric disorders. According to the results of the recent National Epidemiologic Survey on Alcohol and Related Conditions (Grant et al., 2004), about 1 in 10 adults surveyed met DSM-IV (American Psychiatric Association, 1994) diagnostic criteria for an SUD in the previous 12 months. The sheer numbers of those affected suggest a high demand for SUD treatment services, as confirmed in recent surveys of need for treatment programs (e.g., Department of Health and Human Services, 2004). A variety of treatment orientations are represented among the programs available for those seeking treatment for an SUD in North America or Europe today. Common substance abuse program treatment orientations include Alcoholics Anonymous/12-Step, Therapeutic Community, Insight-Oriented, Rehabilitation, Dual Diagnosis, Medical/Disease Model, Marital/Family Systems, and Cognitive-Behavioral (Swindle, Peterson, Paradise, & Moos, 1995). As scientific evidence supporting the efficacy of cognitive-behavioral approaches has accumulated over the last 20 years or so, increasingly the alcohol and drug abuse treatment field has been shifting practices to include cognitive-behavioral techniques within their treatment programs. While medical/disease-based programming continues to predominate the substance abuse treatment field, cognitive-behavioral programs are one of the most commonly employed therapeutic orientations within this field today (e.g., Swindle et al., 1995). This special issue consists of a set of five articles that present reviews of the history, efficacy, and recent developments with respect to five specific subtypes of cognitive-behavioral treatment for SUDs: relapse prevention (Witkiewitz, Marlatt, & Walker, this issue), guided self-change (Sobell & Sobell, this issue), behavioral couples therapy (Fals-Stewart, O'Farrell, Birchler, Cordova, & Kelley, this issue), the community reinforcement approach (Meyers, Villanueva, & Smith, this issue), and dual diagnosis treatment approaches that employ cognitive-behavioral techniques (Conrod & Stewart, this issue). One important broad trend in substance abuse care that emerged about two decades ago and that continues today has been an increased emphasis on treatment outcome and process evaluation (e.g., examining the relative effects of different treatment orientations, and the relative benefits of different treatment components) (Moos & Finney, 1995). There is now indisputable evidence for the efficacy of cognitive-behavioral treatments for SUDs. Each of the articles contained in the current special issue reviews evidence that clearly establishes that these five subtypes of cognitive-behavioral SUD treatment produce significant improvements in SUD symptoms. Several large-scale studies examining predictors of outcome across various substance use treatments including cognitive-behavioral (e.g., McLellan et al., 1994; Ouimette, Gima, Moos, & Finney, 1999b; Project MATCH Research Group, 1997) are now indicating that theoretical orientation of the treatment is not a strong determinant of SUD treatment outcome. Now that several empirically supported treatments have been clearly established to be generally equally effective, researchers have begun moving in the direction of trying to understand what these treatments have in common. These attempts to identify the mediators of change that are common to these various interventions versus those that are potentially specific to individual approaches will bring the field forward. The articles presented in this issue provide a set of thorough, up-to-date reviews of the established efficacies of the various interventions. All contributions then go beyond the issue of efficacy by exploring potential active ingredients and mediators of change specific to each theoretical perspective. Given the cognitive focus of this journal, it appears appropriate to comment on the potential cognitive mediators of change within each of the five particular treatment approaches reviewed herein. …

Commentary: Conducting Randomized Controlled Trials of Psychological Treatment to Improve the Outcomes of Recurrent Abdominal Pain: Contributions and Challenges

In this issue, Robins and colleagues presented the results of a randomized controlled trial (RCT) that documented the efficacy of cognitive behavioral treatment (CBT) for reducing the frequency of pain and school absences in a group of children with recurrent abdominal pain (RAP). This is an important clinical population for several reasons: (a) relatively large numbers of children and adolescents are affected with RAP (Campo, Jansen-McWilliams, Comer, & Kelleher, 1999); (b) RAP has significant functional impact on children’s school, physical activities, and health care utilization (Wasserman, Whitington, & Rivara, 1988); and (c) RAP persists into adulthood among a relatively large percentage of patients (Walker, Guite, Duke, Barnard, & Greene, 1998). Despite its clinical importance, RAP is a complex condition that is very difficult to manage within current models of medical treatment (Tarkan, 2004). Although RAP commonly presents to primary care physicians and pediatric gastroenterologists as a “medical” condition, this condition reflects a heterogeneous constellation of symptoms with a multifactorial etiology (e.g., somatic lifestyle, critical life events, learned response patterns, and family environment) and does not typically improve with medical treatment alone (Friedrich & Jaworski, 1995). This is also the case for other pediatric conditions that involve recurrent pain, for which psychological treatments are emerging as effective front line interventions. However, as Eccleston, Morley, Williams, Yorke, and Mastroyannopoulou (2002) have highlighted, few RCTs have evaluated psychological treatments for nonheadache chronic pain in children, and available trials have had significant limitations, including the failure to assess nonpain-related outcomes such as functioning, mood, and quality of life. Robins et al. have addressed this need by using a short-term five-session model of family centered CBT that replicated and extended previous work by Sanders, Shepherd, Cleghorn, and Woolford (1994). One clear strength of this study is the potential clinical relevance of the treatment, which is brief, focused, manualized, and reproducible. One guiding principle of the intervention approach was a social learning conceptual model of RAP that fits well with current scientific knowledge of the importance of family reinforcement in influencing children’s experience of pain and subsequent disability (Chambers, 2003). The intervention was designed to interfere with the vicious cycle of maladaptive family interactions (e.g., the child’s maladaptive response to pain and the response of family members to the child’s symptoms) (Friedrich & Jaworski, 1995; Kazak, Simms, & Rourke, 2002) by combining conjoint parentchild sessions and individual sessions with children. Based on data from empirically supported interventions (Sanders et al., 1989, 1994; Janicke & Finney, 1999) and studies of influences on the functional impact of abdominal pain (Walker et al., 1998), sample themes of individual sessions included education concerning recurrent pain and its antecedents and consequences, education and practice in pain management, cognitive strategies to reduce catastrophizing, and increasing adaptive communication and partnership between parents and children. The emphasis on reducing negative functional consequences of RAP was a particularly salient feature of this intervention. To evaluate their intervention model, Robins et al. used a comprehensive measurement approach based on multiple sources (e.g., parent and child) and methods (subjective self-report and objective data) that included

Child physical abuse: risk for psychopathology and efficacy of interventions.

The emerging research on child physical abuse (CPA) is reviewed herewith. Incidence of CPA may be as high as 11% for adolescents in the US. Child physical abuse survivors vary in their symptom picture of severity and type. Children who have been physically abused may experience symptoms of post-traumatic stress disorder, anxiety disorders, depressive disorders, or disruptive behavior disorders. Additionally, developmental disturbances include problems with attachment, social skills, and affect regulation. Chronic abuse is associated with more severe psychopathology. Cognitive processing of the abuse may mediate the impact of CPA on development. Service delivery studies indicate that as many as half of children with substantiated cases of CPA do not receive mental health services. Emerging treatment outcome research reveals the potential efficacy of cognitive behavioral treatment for CPA. Reactions to existing literature and recommendations for future work are presented.

Efficacy of Cognitive-Behavioral Treatment and Fire Safety Education for Children Who Set Fires: Initial and Follow-up Outcomes

The efficacy of cognitive-behavioral treatment (CBT) and fire safety education (FSE) for children who had set a recent fire was evaluated. Assessments were conducted with 38 children who were randomly assigned to CBT or FSE and with another 16 children who received a brief intervention (home visit from a firefighter or HVF) that paralleled routine services. Measures in four domains related to the child's fire history were obtained from children and their parents at pre-treatment, post-assessment, and 1-year follow-up. There were several improvements at post-treatment for all conditions on measures of fire involvement, interest, and risk. However, CBT and FSE were more efficacious than HVF on certain measures, including the frequency of firesetting and proportion of children playing with matches, severity of individualized problems with fire, and involvement in fire-related acts and other deviant fire activities. These and other group differences, along with certain time effects, were evident at 1-year follow-up. The findings from this initial comparison study are discussed in the context of needed clinical and research directions for work with firesetters and their families.

Efficacy of Cognitive‐Behavioral Treatment and Fire Safety Education for Children Who Set Fires: Initial and Follow‐up Outcomes

The efficacy of cognitive-behavioral treatment (CBT) and fire safety education (FSE) for children who had set a recent fire was evaluated. Assessments were conducted with 38 children who were randomly assigned to CBT or FSE and with another 16 children who received a brief intervention (home visit from a firefighter or HVF) that paralleled routine services. Measures in four domains related to the child's fire history were obtained from children and their parents at pre-treatment, post-assessment, and 1-year follow-up. There were several improvements at post-treatment for all conditions on measures of fire involvement, interest, and risk. However, CBT and FSE were more efficacious than HVF on certain measures, including the frequency of firesetting and proportion of children playing with matches, severity of individualized problems with fire, and involvement in fire-related acts and other deviant fire activities. These and other group differences, along with certain time effects, were evident at 1-year follow-up. The findings from this initial comparison study are discussed in the context of needed clinical and research directions for work with firesetters and their families.

Family treatment of childhood anxiety

AbstractAnxiety disorders are the most common form of psychopathology reported by children and adolescents and significantly affect a child's ability to deal with normal developmental challenges. Fortunately, the efficacy of cognitive-behavioural interventions with anxmus children and adolescents has been clearly demonstrated. Most recently, however, treatment outcome research in this area has demonstrated the relative superiority of cognitive-behavioural interventions involving the family as well as the anxious child. Through the Child and Adolescent Anxiety Project at the University of Queensland, an integrated intervention involving a parent-focused component (the “Do as I Do” program) and a child-focused component (the “Facing your Fears” program) has been developed and is currently being evaluated. The present paper outlmes the type of research conducted within the Child and Adolescent Anxiety Project, the need for intervention in childhood anxiety, the treatment outcome data on which the development of this integrated intervention has been based, the content of each session in the intervention, and clinical observations and reflections made by clinicians involved in the administration of the intervention.

Cognitive behavioral treatment of older adults with obsessive-compulsive disorder

Despite substantial evidence supporting the general efficacy of cognitive behavioral treatment for obsessive-compulsive disorder (OCD), little has been written to guide practitioners treating older adults with this potentially disabling condition. The present article reviews the research literature on the cognitive behavioral treatment of elders with OCD and discusses adaptations of treatment that may be required to respond effectively to clinical issues and challenges associated with this disorder in later life. Though more research is clearly needed, preliminary findings suggest exposure and response prevention is effective with older adults. However, practitioners may need to adjust clinical procedure to address medical comorbidity and physical and cognitive limitations associated with aging, cultural issues and attitudes that may promote treatment resistance and nonadherence, the influence of family members and other caretakers, and complications presented by stressors and fears common in older adults.

Meta-analysis of CBT for Bulimia Nervosa: Investigating the Effects Using DSM-III-R and DSM-IV Criteria

This meta-analysis reports the effects of cognitive-behavioural treatment (CBT) on bulimia nervosa as defined by the DSM-III-R or DSM-IV criteria. In a previous meta-analysis, 26 studies were included using less strict diagnostic criteria for inclusion. The present meta-analysis only included randomized controlled studies fulfilling the DSM-III-R or DSM-IV criteria. Computer searches in MedLine, PsychLIT and references cited herein resulted in a large number articles, of which only seven fulfilled the criteria for inclusion. Effect sizes for binge eating and purging frequency were estimated using both between-group (treatment vs control) and within-group (pre- vs post-treatment) comparisons. The combined within-group effect size for binge eating was r = 0.55 ( d = 1.32) and for purging r = 0.61 ( d = 1.54). The corresponding combined effects for the between-group comparisons were r = 0.23 ( d = 0.47) and r = 0.28 ( d = 0.58), respectively. The combined probabilities for frequency of purging in between- and within-group comparisons were p = 0.00001 and p = 0.00000001, respectively. Although the number of studies included in the meta-analysis was limited, the obtained results are in line with the findings of the previous meta-analysis, and support the efficacy of CBT for the treatment of bulimia nervosa. This suggestion is also supported by the fact that in all the studies except one, comparison groups had received other active treatments.

Evaluating Cognitive-Behavioral Treatment of Schizophrenia: Four Single-Case Studies

Cognitive-behavioral treatment (CBT) has been used infrequently with persons with schizophre nia. This exploratory study delineates the use of CBT strategies, describes the process of treatment, and presents results from the single-subject A-B design (N = 4) that examined the efficacy of CBT of schizophrenia. Standardized measures of psychosocial functioning, severity of symptoms, attainment of treatment goals, and data regarding hospitalizations were used to assess change over the course of 18 months of treatment and follow-up. Analysis of data indicated that the clients experienced considerable reduction in symptomatology and rehospitalizations as well as improvement in psychosocial functioning and attainment of treatment goals. Treatment issues regarding the application of cognitive-behavioral methods with persons with schizophre nia and suggestions for future social work research and practice are discussed.

Research on the psychotherapy of bulimia nervosa: half empty or half full.

The current status of the research knowledge on the psychotherapy of bulimia nervosa is reviewed. Published studies using randomization to treatment are discussed. The existing research data speak convincingly to the efficacy of cognitive behavioral treatment (CBT); however, certain important questions remain unanswered. The current deficiencies in the field are underscored.

The Therapeutic Elements of Cognitive Therapy for Depression

The efficacy of cognitive behavioral treatment (CBT) for depression has been well documented. CBT uses a progressive series of interventions that focus on activating behavior, then changing specific distortions in thinking, and finally identifying and modifying more longstanding depressive schemas (or core depressive assumptions). This impressive study tested the relative efficacy of the three components of CBT by randomizing 150 patients with major depression …

Cognitive-Behavior Therapy and the Longitudinal Course of Panic Disorder

This article examines the nature and course of panic disorder as understood from a cognitive-behavioral perspective. A model of the causes and maintenance of panic disorder is presented, and is followed by a discussion of the elements and efficacy of cognitive-behavioral treatment. Treatment effects and factors associated with relapse are considered within the context of evidence for a differential course of panic disorder for patients treated with cognitive-behavioral therapy relative to those treated with pharmacotherapy. Issues of combined treatment, maintenance of treatment gains, and preventive interventions are discussed.

Cognitive Behavioral Treatment Compared With Nonprescriptive Treatment of Panic Disorder

The efficacy of cognitive behavioral treatment for panic disorder has been established in controlled studies. However, little is known about the efficacy of other psychological treatments. We report the results of a study comparing cognitive behavioral treatment with a focused nonprescriptive treatment for panic. Three sessions of panic-related information were provided in each treatment, followed by 12 sessions of either nonprescriptive, reflective listening (non-prescriptive treatment) or a treatment package that included breathing retraining, muscle relaxation, cognitive reframing, and exposure to interoceptive and agoraphobic stimuli (cognitive behavioral treatment). Posttreatment and 6-month follow-up assessments revealed a good response to both treatments. We observed a high rate of panic remission and significant improvement in associated symptoms in subjects in each treatment group. These findings raise questions about the specificity of cognitive behavioral treatment.

Goal Specification Enhances the Efficacy of Cognitive Behavioral Treatment of Headache

Goal Specification Enhances the Efficacy of Cognitive Behavioral Treatment of Headache

Cognitive-behavioral treatment with and without exposure plus response prevention in the treatment of bulimia nervosa: A reply to Leitenberg and Rosen.

In this reply to Leitenberg and Rosen (1989), we conclude that the evidence that response prevention of vomiting adds significantly to the efficacy of cognitive-behavioral treatment of bulimia nervosa is not strong. In this context and given the finding in our previous study (Agras, Schneider, Arnow, Raeburn, & Telch, 1989) that the addition of response prevention did not increase the efficacy of cognitive-behavioral treatment and may have reduced it, we believe that our cautionary note concerning the addition of response prevention to cognitive-behavioral treatment should stand.