Efficacy Of Cognitive Therapy Research Articles

Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: a systematic review and meta-analysis.

T long-term effects of cognitive therapy and behavior therapy (CTBT) for menopausal symptoms are unknown, and whether the effects are different between natural menopause and treatment-induced menopause are currently unclear. Therefore, we sought to conduct an accurate estimate of the efficacy of CTBT for menopausal symptoms. We conducted searches of Cochrane Library, EMBASE, PsycINFO, PubMed, and Web of Science databases for studies from 1 January 1977 to 1 November 2021. Randomized controlled trials (RCTs) comparing intervention groups to control groups for menopausal symptoms were included. Hedge's g was used as the standardized between-group effect size with a random-effects model. We included 14 RCTs comprising 1618 patients with a mean sample size of 116. CTBT significantly outperformed control groups in terms of reducing hot flushes [g = 0.39, 95% confidence interval (CI) 0.23-0.55, I2 = 45], night sweats, depression (g = 0.50, 95% CI 0.34-0.66, I2 = 51), anxiety (g = 0.38, 95% CI 0.23-0.54, I2 = 49), fatigue, and quality of life. Egger's test indicated no publication bias. CTBT is an effective psychological treatment for menopausal symptoms, with predominantly small to moderate effects. The efficacy is sustained long-term, although it declines somewhat over time. The efficacy was stronger for natural menopause symptoms, such as vasomotor symptoms, than for treatment-induced menopause symptoms. These findings provide support for treatment guidelines recommending CTBT as a treatment option for menopausal symptoms.

Efficacy of Behavioral Experiments in Cognitive Therapy for Social Anxiety Disorder: Study protocol for a randomized controlled trial

BackgroundWhile the efficacy of cognitive therapy (CT) has been well established for social anxiety disorder (SAD) in several randomized controlled trials, there are still large differences between trials with respect to effect sizes. The present study investigates the question of whether enhanced training and the use of behavioral experiments (BEs) increases the efficacy of traditional CT, based on verbal methods of cognitive restructuring.Methods/designA mixed within/between conditions design will be applied, with therapists and patients being randomly allocated to one of two conditions: (1) training of CT plus BEs, (2) training of CT “as usual”.Sixty patients with the primary diagnosis of SAD will be recruited and treated in the outpatient clinic of the Department of Psychology, University of Frankfurt. To ensure adherence to therapist protocols, all therapists will be trained and supervised by the project coordinators. In addition, videotaped treatment sessions will be independently evaluated to guarantee both adherence to protocols and the quality of the intervention. Treatment effects will be assessed by independent SAD symptom ratings using the Liebowitz Social Anxiety Scale as the primary outcome measure and self-report measures as secondary outcome measures.DiscussionThe present cognitive behavioral therapy (CBT) trial will be the first to clarify the contribution of BEs to the efficacy of CT in a randomized controlled design. Study results are relevant to clinical training and implementation of evidence-based treatments.Trial registrationGerman Clinical Trials Register International Clinical Trials Registry Platform (ICTRP) identifier: DRKS00014349. Trial status: recruiting.

Thérapie cognitive basée sur le concept de rétablissement pour la schizophrénie : un cas clinique

Resume Si l’on sait depuis de nombreuses annees qu’un travail axe sur le retablissement s’avere primordial dans la prise en soin des patients souffrant de schizophrenie, il n’est pas toujours evident d’en traduire les principes dans nos interventions. La therapie cognitive orientee sur le retablissement, developpee par l’equipe d’Aaron T. Beck, est une approche particulierement interessante et novatrice puisqu’elle se propose de fusionner les principes du retablissement psychologique avec ceux de la therapie cognitive. Elle propose une conceptualisation et une planification du traitement cognitivo-comportemental base les objectifs de retablissement du patient, qui se revele efficace sur les symptomes positifs, negatifs ainsi que sur le fonctionnement general des patients souffrant de schizophrenie. Cet article expose une application de cette approche aupres d’un patient souffrant d’une schizophrenie paranoide, dont l’anosognosie, le refus de suivi et les frequentes hospitalisations conduisirent a un suivi assertif par une equipe mobile. Le cas clinique illustre comment l’identification d’un objectif de retablissement personnel puis son fractionnement en sous-etapes quantifiables a permis a ce patient de definir une trajectoire de retablissement et viser une action positive. Ce travail oriente sur le retablissement a egalement servi de cadre au therapeute pour cibler les croyances dysfonctionnelles sous-jacentes aux symptomes negatifs de ce patient.

The self-reference effect in memory: an implicit way to assess affective self-representations in social anxiety

ABSTRACTThis study was designed to assess, through the self-reference effect in memory, whether affective self-representations were modulated by the retrieval conditions and the severity of social anxiety. Three groups (high socially anxious, low socially anxious and non-anxious) were compared on a self-referential task that involved encoding affective trait adjectives under three conditions: self-reference encoding, encoding with reference to the perception of self by others, and other-reference encoding. Memory for trait adjectives was tested on both a free recall task and a Remember/Know/Guess recognition task. The results revealed that while socially anxious individuals explicitly rated as self-descriptive and recalled more positive than negative trait adjectives like non-anxious participants, this positivity bias was respectively reduced and erased among low and high socially anxious participants when recollecting the same adjectives encoded in reference to the self. These findings are discussed in relation to their contribution to the understanding of the emotional memory biases related to the retrieval of self-knowledge in social anxiety. In particular, they highlight the necessity of using the self-reference effect in memory rather than mere self-endorsement of trait adjectives when assessing the efficacy of cognitive therapies for social anxiety.

In cognitive therapy for depression, early focus on maladaptive beliefs may be especially efficacious for patients with personality disorders.

Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no investigations that have specifically tested whether increased focus on maladaptive beliefs contributes to CT's efficacy for these patients. CT technique use from an early CT session was assessed for 59 patients (33 without PD, 26 with PD-predominantly Cluster C) who participated in a randomized controlled trial for moderate to severe MDD. Scores were calculated for directive CT techniques (CT-Concrete) and a set of belief-focused items (CT-Belief) as rated by the Collaborative Study Process Rating Scale. Robust regressions were conducted to estimate relations between scores on each of these measures and change in depressive and PD symptoms. A PD status by CT-Belief use interaction tested the hypothesis that therapist use of CT-Belief techniques would exhibit a stronger association with symptom change in the PD group relative to the non-PD group. As hypothesized, a significant interaction between PD status and use of CT-Belief techniques emerged in the prediction of depressive and PD symptom change. Among PD patients, higher early CT-Belief interventions were found to predict significantly greater improvement. CT-Belief use did not predict greater symptom change among those without PD. Early focus on CT-Belief interventions may facilitate changes in depression and PD symptoms for patients with MDD-PD comorbidity.

Efficacy of Cognitive Therapy in Reducing the Rate of Depression in Women with Type 2 Diabetes

The present study attempts to examine the impact of cognitive therapy in reducing depression in diabetic women. It is an experimental method research and pre-test - post-test and follow-up type together with the control group. 16 of diabetic women are randomly selected and homogeneously placed in two 8-member groups. Background information questionnaire and standard questionnaire Beck Depression Inventory, 2 nd Edition, (BDI II) are used for data collection. In this study, Cronbach's Alpha obtained for the questionnaire is 83/0. For treating depression, 8 sessions of group therapy are implemented based on the treatment of Major Depressive Disorder (MDD) consistent with cognitive therapy protocol of Wales and Papa Georgiou. The findings demonstrate that cognitive therapy has some impacts in reducing depression. The results of multivariate covariance analysis test show that there exists a significant difference between mean of depression in follow-up stage in proportion to that of pre-treatment stage; and reducing depression at three-month follow-up stage is stable.

Cognitive-behavioral therapy for body dysmorphic disorder: a review of its efficacy

The aim of this study was to review the efficacy of different methods of cognitive and/or behavioral therapies used to treat body dysmorphic disorder. We evaluated all case series, open studies, controlled trials, and meta-analyses of cognitive and/or behavioral treatment approaches to body dysmorphic disorder published up to July 2012, identified through a search in the PubMed/Medline, PsycINFO, ISI Web of Knowledge, and Scopus databases. Our findings indicate that individual and group cognitive behavioral therapies are superior to waiting list for the treatment of body dysmorphic disorder. While the efficacy of cognitive therapy is supported by one controlled trial, utility of behavioral therapy is suggested by one open study and one controlled relapse prevention follow-up study. There is a pressing need to conduct head-to-head studies, with appropriate, active, control treatment groups, in order to examine further the efficacy of cognitive and/or behavioral therapies for body dysmorphic disorder.

Test Anxiety, Depression and Academic Performance: Assessment and Management Using Relaxation and Cognitive Restructuring Techniques

Examination as a word evokes varying degrees of anxiety in students depending on the importance of the examination, perceived difficulty level of the subject, and degree of preparedness for the examination. A perceived difficult subject would elicit higher anxiety levels, and test anxiety as a psychological condition can adversely affect people in every field of life (Cohen, 2004), and especially it adversely affects students who face different examinations. The suspicion is that test anxiety may not exist alone but co-exist with other forms of psychological distress such as depression, and psychological intervention such as cognitive therapy is expected to reduce students’ anxieties and any other psychological distress and consequently improve their academic performance. In an attempt to verify our suspicion and confirm the expectation, 420 senior secondary school students made up of 210 males and 210 females aged between 13 and 19 years responded to test anxiety, trait anxiety, and depressive symptoms inventories. 72 of the students whose test anxiety scores were higher than the group’s average score were divided into three groups and treated under three conditions of “no treatment”, “relaxation treatment alone”, and combined “relaxation and cognitive restructuring treatment”. Results obtained show that test anxiety, trait anxiety, and depression co-exist and are positively related, and they are negatively related to academic performance. In addition the combination of relaxation and cognitive restructuring treatment reduced anxiety and depression better than relaxation treatment alone or no treatment and improved test performance of the students much more than any of the other two conditions. The findings thus confirm the effectiveness and efficacy of cognitive therapy in managing anxiety and depression and improving academic performance, and when combined with relaxation technique, the combination optimizes academic performance.

Regulation of Emotion in Major Depressive Disorder

The ability to regulate emotion is central to everyday functioning and has been studied extensively in healthy adults in the last two decades. One conclusion supported by this research is that various cognitive strategies can be used to effectively regulate both positive and negative emotion (which is consistent with a wealth of clinical work on the efficacy of cognitive therapy). More recently, basic neuroimaging work using now-well-established experimental paradigms has increased our understanding of the neural systems involved in the cognitive regulation of emotion. The majority of this research has focused on a specific cognitive regulation strategy known as reappraisal, which involves reinterpreting the meaning of stimuli in ways that alter one's affective responses to them. Taken together, more than 35 neuroimaging studies of reappraisal in healthy adults published in the past 9 years have highlighted the interaction between subcortical systems thought to generate emotion and prefrontal systems thought to implement various kinds of cognitive control processes (for reviews see [ 1 Kalisch R. The functional neuroanatomy of reappraisal: time matters. Neurosci Biobehav Rev. 2009; 33: 1215-1226 Crossref PubMed Scopus (272) Google Scholar , 2 Ochsner K.N. Gross J.J. Cognitive emotion regulation: insights from social cognitive and affective neuroscience. Curr Dir Psychol Sci. 2008; 17: 153-158 Crossref Scopus (656) Google Scholar ]). Reduced Right Ventrolateral Prefrontal Cortex Activity While Inhibiting Positive Affect Is Associated with Improvement in Hedonic Capacity After 8 Weeks of Antidepressant Treatment in Major Depressive DisorderBiological PsychiatryVol. 70Issue 10PreviewAnhedonia, a reduced ability to experience pleasure, is a chief symptom of major depressive disorder and is related to reduced frontostriatal connectivity when attempting to upregulate positive emotion. The present study examined another facet of positive emotion regulation associated with anhedonia—namely, the downregulation of positive affect—and its relation to prefrontal cortex (PFC) activity. Full-Text PDF

Clinical efficacy of individual cognitive therapy in reducing psychiatric symptoms in people at ultra-high risk for psychosis

Recently, cognitive therapy in people at ultra-high risk (UHR) for psychosis has been reported to show modest treatment benefits. The aim of this study was to assess the feasibility and efficacy of cognitive therapy in reducing psychiatric symptoms in UHR people in Korea. We developed cognitive therapy for people at UHR for psychosis inspired by Morrison in 2004. Twenty-two UHR subjects were assigned to cognitive therapy, and 18 subjects completed the 10-session therapy. Psychopathology scores were assessed at baseline and post-treatment. Cognitive therapy significantly reduced the severity of psychopathology including positive, negative and depressive symptoms. The within-group effect sizes indicated large treatment benefits for these psychopathologies. These findings suggest that cognitive therapy can be administered to people at UHR for psychosis in non-western culture.

FC16-01 - Efficacy of cognitive therapy in the regulation of hypothalamic-pituitary-adrenal activity in patients with generalized anxiety disorder

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, with the consequent hypercortisolism, is one of the most consistent findings in chronic stress and depression. The stress response will depend on characteristics of stressors, their subjective appraisal and the resulting coping strategies. The aim of this study was to evaluate the efficacy of cognitive therapy (CT) in the treatment of a chronic stress condition, such as generalized anxiety disorder (GAD), as it would be reflected through both psychological and biological parameters. For this purpose, a group of outpatients with GAD were treated with CT for up to a maximum of 24 sessions. In order to assess psychological and biological changes, anxiety-related symptoms were evaluated according to the Hamilton Anxiety Rating Scale (HAM-A), and the HPA function was determined through assessment of circulating cortisol levels.Upon completion of the treatment, a significant decrease in HAM-A scores, along with significant changes in plasma cortisol levels, were observed in treated subjects. These observations contribute to demonstrate that CT may be effective to treat a chronic stress disorder, such as GAD, as it was observed at both psychological and biological levels, and moreover, this could represent an effective approach to treat hypercortisolism due to hyperactivity of the HPA axis. Therapeutic and preventive strategies will also be discussed.

Therapist competence in cognitive therapy for depression: Predicting subsequent symptom change.

The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes. In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). These findings provide support for the potential utility of CT competence ratings in applied settings.

An investigation of extreme responding as a mediator of cognitive therapy for depression

Although the efficacy of Cognitive Therapy (CT) for depression is well documented, questions remain about the conditions under which CT is maximally effective, and the mechanisms by which CT is efficacious. This study examined the role of extreme responding (ER) as a mediator and predictor of relapse, as well as a predictor of acute treatment outcome. To test mediation, ER of participants in CT was compared to ER of participants receiving Behavioral Activation (BA). Results indicated that ER was not a mediator of relapse in either condition. Both CT and BA showed reductions in depression severity, however neither group showed significant changes in ER over the course of treatment. Finally, ER did not predict or moderate acute treatment outcome. The implications of these results, strengths and limitations of the current study, and future research directions are discussed.

Book Review: Psychotherapy, Contemporary Cognitive Therapy: Theory, Research, and Practice

Psychotherapy Contemporary Cognitive Therapy: Theory, Research, and Practice Robert L Leahy, editor. New York (NY): The Guilford Press; 2004. 416 p. CDNS49.95. Reviewer rating: Good In honor of Aaron Beck and his fundamental impact on psychotherapy, several disciples in the field have contributed to editor Robert Leahy's Contemporary Cognitive Therapy: Theory, Research, and Practice. The diverse nature of this book results in a somewhat eclectic volume that includes both clinical and research chapters which will appeal to different audiences. The book is organized into 5 parts, ranging from conceptual and theoretical issues to the specific applications of cognitive therapy (CT) for various disorders. The diversity of topics discussed in the book is both its strength and weakness. Moreover, the reader who chooses to read this book from start to finish may find the vast range of topics both tedious and stimulating as the book carries him or her through a collection of the most recent developments in the clinical and research domains. Christine Padesky starts the book with an excellent overview of Aaron Beck, the man, and provides the reader with a good sense of who he is and the impact he has continued to have on those around him. Chapter 2 reviews Beck's theory of depression in a concise manner and presents some of the studies supporting this model. Unfortunately, the chapter's latter part, which reviews future directions, is somewhat weak, and the overall discussion of the mentioned studies is not critical enough, leaving the reader without a full appreciation of the actual impact these studies had on Beck's hypothesis of depression. Chapter 3 provides a generally good critical review of the studies on CT's efficacy and effectiveness in the acute treatment and prevention of relapse for depression. Unfortunately, it is somewhat disappointing that the processes of changes in CT is too briefly mentioned, leaving the reader wondering whether there is something unique to that differentiates it from other empirically-based psychotherapies. Chapter 4 presents the model of looming cognitive vulnerability, a negative cognitive style that functions as a danger schema predicting anxiety states but also helps in differentiating anxiety from depression. Although a difficult topic, the author presents it in a well-written and accessible fashion. Chapter 5 reviews a metaanalysis of between 1993 and 2001 for both generalized anxiety disorder (GAD) and panic disorder. …

Cognitive Therapy for Command Hallucinations: Not a Quasi-Neuroleptic

Command hallucinations (CH) are a distressing and high-risk group of symptoms that have long been recognised but little understood, with few effective treatments. In this paper we report and discuss the efficacy of cognitive therapy (CT) modified in accordance with ‘social rank theory,’ in a single blind randomised controlled trial. 38 patients with command hallucinations were randomly allocated to CT or treatment as usual and followed up for 6 then 12 months. Large reductions in compliance behaviour were obtained (effect size = 0.97) favouring the CT group. Other significant differences were found and maintained at 6 months follow up.

Implicit cognition and the maintenance and treatment of major depression

Although extensive research has identified the role of consciously expressed cognition in the onset and maintenance of depression, much less work has directly examined the role of nonconscious, automatic, implicit cognition biases and depression. Further, whereas there is evidence of changes in self-report measures of cognition following cognitive therapy, there has been little work that identifies the specific therapeutic techniques that may directly modify nonconscious implicit cognition among depressed individuals. Improving our understanding of the role of implicit cognition in depression and how to manage these cognitive processes may help add to the efficacy of cognitive therapy. We review the literature examining the association between implicit cognition and depression and then describe potential therapeutic strategies for managing nonconscious implicit cognition biases in depression. Finally, we propose future directions of study, including a proposed cognitive-interpersonal framework for understanding therapeutic interactions in managing implicit cognition biases.

A cognitive approach to understanding and treating anxiety

Cognitive therapy is a short-term, problem-solving, educative psychotherapy originally developed in the 1960s by Aaron T. Beck, M.D. for the treatment of depression. Beck and colleagues later adapted the therapy for anxiety. Over the past decade, the efficacy of cognitive therapy has been established empirically for several anxiety disorders and new applications continue to be developed and tested. This paper has three objectives. The first is to provide a brief overview of treatment outcome research on cognitive therapy for several anxiety disorders including panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. The second objective is to present Beck's cognitive theory of anxiety and the cognitive models used to explain various anxiety disorders. The third and final objective is to outline the treatment strategies that are commonly used in cognitive therapy for anxiety. Copyright © 1999 John Wiley & Sons, Ltd.

Should I Relax or Change My Thoughts? A Preliminary Examination of Cognitive Therapy, Relaxation Training, and their Combination with Overanxious Children

This investigation examined the efficacy of cognitive therapy, relaxation training, and their combination with 4 children (6-15 years of age) diagnosed with DSM-III-R overanxious disorder using a multiple baseline design across subjects. Each intervention contained an exposure component equalized across treatments. All children improved on child and parent pre-post self-report measures as well as parent and independent clinician’s ratings. Treatment gains were maintained at six month follow-up. While all three treatments were associated with diminished anxiety, evidence suggested that interventions were most effective when “matched” to a child’s problematic response class (i.e. cognitive symptoms, somatic symptoms or both). Implications for treatment of childhood anxiety disorders are discussed.

A meta-analysis of the efficacy of cognitive therapy for depression.

In meta-analysis format the effectiveness of Beck's cognitive therapy for depression was reviewed. Twenty-eight studies were identified that used a common outcome measure of depression, and comparisons of cognitive therapy with other therapeutic modalities were made. The results document a greater degree of change for cognitive therapy compared with a waiting list or no-treatment control, pharmacotherapy, behavior therapy, and other psychotherapies. The degree of change associated with cognitive therapy was not significantly related to the length of therapy or the proportion of women in the studies, and although it was related to the age of the clientele, a lack of adequate representativeness of various age groups renders these results equivocal. Implications for further outcome and process studies in cognitive therapy are discussed.

Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting

The efficacy of cognitive therapy was examined for 70 depressed private practice patients. Although these patients had a broader range of psychopathology than patients in controlled outcome studies of cognitive therapy, they had comparably large reductions in Beck Depression Inventory (BDI) scores. Patients who completed treatment had an average reduction in BDI scores of 65.5%. Initial BDI scores, endogenous symptoms, compliance with homework, and the interaction between homework and initial BDI scores were statistically significant predictors of end-of-treatment BDI scores. The squared correlation between the observed end-of-treatment BDI scores and the estimated expected value was .81. Controlling for other factors, patients who did homework improved three times as much as those who did not. The effect of homework was substantially larger for patients with high initial BDI scores; thus, studies that include only patients with high initial BDI scores may overstate the importance of homework on a general population. In spite of significant improvement, 50% of patients terminated treatment prematurely, premature termination was most likely in patients with personality disorders, high initial BDI scores, and no endogeneous symptoms.