Role Of Cognitive Behavioral Therapy Research Articles

P02-143 - Cognitive behavior therapy in patients with binge eating disorder

IntroductionWith the growing epidemic of obesity many treatments are aimed at reducing weight like diets, exercise, pharmacotherapy and bariatric surgery. All of these can reduce weight at least for a period; however none of them adequately address the behavior of binge eating/eating disorder.Aimassessed the role of Cognitive Behavior therapy in reducing disordered eating behavior.MethodThe subjects were enrolled in 12 weeks CBT. They were all obese and had a score of > 20 on the BES. They completed a BDI, MBSRQ, and BES before and after the groups. Their weight was recorded before and after the 12 weeks. 79 patients were enrolled in groups over a period of 3 years. Of those 56 patients completed the groups and questionnaires. Most groups consisted of 6–8 patients.Discussion70% of patients had psychiatric symptoms psychotropic medications like antidepressants. More than 70% felt their eating habits were more in control and felt more informed about themselves since attending CBT groups. All of the patients who stayed and attended groups felt that the connection helped them sustain better eating habits. 67% of patients had lost 4–30 lbs during the 12 weeks of CBT, none had gained weight.ConclusionCBT helps the patient reduce disordered eating behaviors by understanding the cause of their self sabotage. CBT addresses the core of the problem i.e. disordered behavior as opposed to its consequences (viz. obesity and its multiple medical comorbidities); while affecting weight indirectly.

The Role of Cognitive-Behavioural Therapy for Patients with Depression in Parkinson's Disease

Depression is a common complication of Parkinson's disease (PD) with considerable impact on patients' quality of life. However, at present the most appropriate treatment approach is unclear. There are limited data on antidepressant medications in PD-associated depression (dPD) and those available suggest limited efficacy and tolerability of these drugs. Cognitive behavioural therapy (CBT) has been shown to be an effective treatment of depressive disorders. Treatment of dPD with CBT may pose particular challenges, including possible different pathophysiology, physical and mental comorbidities, and barriers to treatment through disability, which do not allow simple transfer of these results to patients with dPD. However, a number of case reports, case series, and small pilot studies suggest that this is a promising treatment for patients with PD. We here summarise the published evidence on this treatment in dPD.

The Role of Cognitive-Behavioral Therapy in Behavioral Medicine: Introduction to the Special Issue

Behavioral medicine focuses on assessment, treatment, and prevention of medical problems and promotion of health, using the behavioral sciences (e.g., International Society of Behavioral Medicine). Behavioral medicine is strongly rooted in cognitive-behavioral therapy (CBT) both historically and in its use of CBT theories and techniques. The articles from the present special issue present the relation between cognition and behavior in both basic research and intervention studies. These articles extend the role of CBT into medical and public health settings, thereby expanding the ability of CBT therapists to help patients with medical problems and those who are at high risk for developing medical problems.

Cognitive Behaviour Therapy for Withdrawal from Antidepressant Medication: A Single Case Series

Research has clearly established the efficacy of pharmacotherapy and cognitive behaviour therapy (CBT) for depression. There is less literature addressing cessation of treatment, such as relapse during withdrawal from antidepressant medication. The current study examines the role of psychological constructs that may influence relapse or fear of relapse and lead to resumption of medication. This hypothesizes that during withdrawal individuals may misinterpret normal variations in mood and dysphoric or other symptoms as reduced levels of medication in their bodies in keeping with a simplistic rationale for antidepressants. The study uses an intensive single case AB style design in three cases during the withdrawal process. All participants had been treated with CBT plus antidepressants and had previously attempted to withdraw from antidepressants. The first part of the study naturalistically tracks belief changes as medication decreases; the second examines changes in these if/when a CBT intervention is introduced due to relapse or potential near-relapse. Daily self-monitoring diaries were used to measure target variables, together with standardized questionnaires up to 6 months follow-up. Changes in symptoms, appraisal of symptoms, and beliefs about medication changed throughout the study. All participants remained medication free at 6 months follow-up. Two cases received CBT intervention due to possible relapse; the third underwent an unproblematic withdrawal. Patterns of change are discussed in terms of current approaches to medication cessation and the role of CBT during withdrawal.

A critical evaluation of the role of cognitive behaviour therapy in children and adolescents with depression

AbstractDepressive disorders are relatively common in adolescents although less so in younger children. They accrue significant morbidity and frequent long-term sequelae as well as increased suicide risk in sufferers. Evidence-based treatment of depression in children and adolescents is the subject of intense investigation and debate. This article reviews the current evidence base for cognitive behaviour therapy in this group and makes recommendations for further areas of research.

Elements of Evidence-based Healthcare

Elements of Evidence-based Healthcare

Cognitive behaviour therapy for acute inpatient mental health unitsCognitive behaviour therapy for acute inpatient mental health units Isabel Clarke and HannahWilson Routledge2008£24.99248978 0 415 42212 30415422124

The authors begin by outlining the challenge to the provision of psychological therapies in acute inpatient settings as a perception that it cannot be done or that is not worth doing. They outline the difficulties in enhancing the role of cognitive behaviour therapy (CBT) in particular as an integrated aspect of inpatient care and treatment.

Palliative care inParkinson′s disease: Role of cognitive behavior therapy

Background:Parkinson's disease (PD) is a chronic, progressive, neurodegenerative disorder that leads to the classic features of akinesia (encompassing hypokinesia and bradykinesia), tremor, rigidity and postural instability. Other non-motor complications include depression, fatigue, pain, and sleep disturbances. For the management of these complications, non-pharmacological techniques, such as Cognitive-behavioral therapy (CBT) can be used. This can focus on overt behavior and underlying cognitions and train the patient in coping strategies to obtain better symptom control.Objectives:To review studies on CBT as palliative care in PD patients.Materials and Methods:A survey was conducted for all available English-language studies by means of a MEDLINE search. Keywords in the searches included Parkinson's disease, palliative care, and cognitive behavior therapy. All articles that reported the cognitive behavior therapy and palliative care in a group of PD patients regardless of the method used by the researchers were identified and analyzed.Result and Conclusion:CBT has a strong evidence base for its use and has proven to be an effective treatment in management of people with chronic pain, fatigue syndrome, depression and sleep disturbances, with efficacy that lasts beyond the duration of treatment. Although PD patients suffer from these complications, there are only a few studies on administration of CBT on them. Considering its effectiveness, CBT can be used as an option for palliative care for PD patients, directed toward improving the patient's functional status, clinical disability and quality of life. Further studies are required in this area.

Using talking therapies in the treatment of depression

Depression is prevalent in older people in longterm care, however, it should not be considered a normal part of ageing. Dawn Weaver discusses depression in older people and the role of cognitive behavioural therapy in treating the condition.

The diagnosis and management of globus pharyngeus: our perspective from the United Kingdom

To review recent literature on diagnostic and treatment options for globus pharyngeus. There are no controlled studies looking at the use of proton pump inhibitors specifically for globus. The small volume of level I evidence has failed to demonstrate superiority of proton pump inhibitors over placebo for treatment of laryngopharyngeal reflux symptoms (including globus). A recent pilot nonplacebo-controlled study has shown promising results for treating laryngopharyngeal reflux symptoms with liquid alginate suspension. The role of cognitive-behavioural therapy may hold hope for patients with refractory symptoms. A small randomized trial showed promising results for treating globus with speech therapy, but larger trials are required. There is no evidence for the use of antidepressants or anxiolytics. After many decades of interest, the most popular organic theory that 'a lump in the throat' is reflux related is still challenged by lack of strong evidence for empiric antacid treatment of this symptom. Globus pharyngeus is a clinical diagnosis and not a diagnosis of exclusion and overinvestigating these patients is unnecessary. Complete history and otolaryngological examination, fibreoptic laryngoscopy or transnasal oesophagoscopy with reassurance and monitoring of symptom progress with validated symptom questionnaires appear to remain the mainstay of management.

Screening, Diagnosis, and Treatment of Depression in Patients with End-Stage Renal Disease

Depression is common in patients with end-stage renal disease and has been linked to increased mortality. Screening for depression in the general medical population remains controversial; however, given the high prevalence of depression and its significant impact on morbidity and mortality, a strong case for depression screening in patients with end-stage renal disease can be made. Several studies have been performed to validate the more common depression screening measures in patients with chronic kidney disease. The Beck Depression Inventory, the Hamilton Rating Scale for Depression, the Nine-Question Patient Health Questionnaire, and the Center for Epidemiologic Studies Depression Scale are some of the measures that have been used to screen for depression in patients with end-stage renal disease. Data suggest a higher Beck Depression Inventory cutoff score, of >14 to 16, will have increased positive predictive value at diagnosing depression in patients with end-stage renal disease. There are limited data on the treatment of depression in this patient population. Pharmacotherapy, including selective serotonin reuptake inhibitors, can be used if deemed clinically indicated, and no active contraindication exists. There are even fewer data to support the role of cognitive behavioral therapy, social support group interventions, and electroconvulsive therapy for treatment of depression in patients with chronic kidney disease. Larger randomized, controlled clinical trials aimed at the treatment of depression in patients with end-stage renal disease are desperately needed.

Evidence Based Research in CBT with Adolescent Eating Disorders.

Cognitive behaviour therapy (CBT) is increasingly becoming the treatment of choice for a number of adolescent mental health problems, including depression (Harrington etal., 1998) and obsessive compulsive disorder (OCD), (March, 1995). In considering the role of CBT in the treatment of adolescent eating disorders, it is helpful to review the phenomenology of anorexia and bulimia nervosa in this age group and to assess the theoretical relevance of a cognitive behavioural approach to their management. The evidence base has been reviewed in the recently published National Institute of Clinical Excellence (NICE) Guidelines on the treatment of eating disorders (NICE, 2004). To date, CBT approaches have not been widely tested in controlled trials in this age group. However, a randomised controlled treatment trial is under way in the North West of England (The TOuCAN Trial), in which CBT is an important component of one of the interventions being studied and this will be described.

A Randomized Controlled Study of Cognitive Behavior Therapy and Behavioral Family Therapy for Anorexia Nervosa Patients

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21–25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had “good” outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

Crisis Intervention and Trauma: New Approaches to Evidence-Based Practice

Crisis Intervention and Trauma: New Approaches to Evidence-Based Practice

Cognitive behavioural therapy: a study of rural general practitioners' understanding and expectations.

Cognitive behavioural therapy (CBT) has been extensively used to manage depression and anxiety. It has been offered to general practitioners (GPs) as a technique suited to primary care. Forty-two GPs, who had participated in workshops on CBT, in rural Victoria, were surveyed about their use, expectations and understanding of CBT. Most of the GPs either occasionally or regularly used CBT. Respondents expressed concern that CBT would lengthen their consultations, while recognising its usefulness in their practice and capacity to enhance doctor-patient communication. The GPs in this study, while regarding CBT as an appropriate technique in general practice, expressed both broad outcome expectations from its use and concerns about its time management impact. This study indicates the need for further research on the role of CBT in rural general practice.

THE ROLE OF COGNITIVE BEHAVIOURAL THERAPY IN FACILITATING ADAPTATION TO ILLNESS IN RHEUMATOID ARTHRITIS: A CASE SERIES

A considerable literature has developed over the past two decades that has investigated the utility of cognitive behavioural treatments for a variety of medical disorders, including rheumatoid arthritis. Research has consistently found that psychological variables affect the course of the illness and that cognitive behavioural approaches can improve psychological and physical function. However, the literature has focused almost exclusively on chronic illness. There is little literature that has investigated the role of cognitive behavioural therapy in facilitating the adjustment early in the disease course to diagnosis and subsequent illness. The diagnosis of any potentially chronic illness has enormous ramifications for a person's life and it is well documented that many people become depressed even early in the disease course. Theoretical accounts have been put forward that allow a model for understanding the process of adaptation and offer a foundation for the use of cognitive and behavioural strategies with a recently diagnosed group of patients. The present paper reports the use of a cognitive and behavioural intervention to facilitate coping and adjustment to illness.

Severe depression: is there a best approach?

A major depressive episode can be categorised as severe based on depressive symptoms, scores on depression rating scales, the need for hospitalisation, depressive subtypes, functional capacity, level of suicidality and the impact that the depression has on the patient. Several biological, psychological and social factors, and the presence of comorbid psychiatric or medical illnesses, impact on depression severity. A number of factors are reported to influence outcome in severe depression, including duration of illness before treatment, severity of the index episode, treatment modality used, and dosage and duration of and compliance with treatment. Potential complications of untreated severe depression include suicide, self-mutilation and refusal to eat, and treatment resistance. Several antidepressants have been studied in the treatment of severe depression. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, serotonin 5-HT(2) receptor antagonists, monoamine oxidase inhibitors, and amfebutamone (bupropion). More recently, atypical antipsychotics have shown some utility in the management of severe and resistant depression. Data on the differential efficacy of TCAs versus SSRIs and the newer antidepressants in severe depression are mixed. Some studies have reported that TCAs are more efficacious than SSRIs; however, more recent studies have shown that TCAs and SSRIs have equivalent efficacy. There are reports that some of the newer antidepressants may be more effective than SSRIs in the treatment of severe depression, although the sample sizes in some of these studies were small. Combination therapy has been reported to be effective. The use of an SSRI-TCA combination, while somewhat controversial, may rapidly reduce depressive symptoms in some patients with severe depression. The combination of an antidepressant and an antipsychotic drug is promising and may be considered for severe depression with psychotic features. Although the role of cognitive behaviour therapy (CBT) in severe depression has not been adequately studied, a trial of CBT may be considered in severely depressed patients whose symptoms respond poorly to an adequate antidepressant trial, who are intolerant of antidepressants, have contraindications to pharmacotherapy, and who refuse medication or other somatic therapy. A combination of CBT and antidepressants may also be beneficial in some patients. Electroconvulsive therapy (ECT) may be indicated in severe psychotic depression, severe melancholic depression, resistant depression, and in patients intolerant of antidepressant medications and those with medical illnesses which contraindicate the use of antidepressants (e.g. renal, cardiac or hepatic disease).

The role of cognitive behavioural therapy in the treatment of unipolar depression

The role of cognitive behavioural therapy in the treatment of unipolar depression

Coordinating Occupational Rehabilitation: The Role of Cognitive-Behavioral Therapy

A revolution in rehabilitation is occurring as the twentieth century gives way to a new millennium. It involves a renaissance of the integration of knowledge and techniques from different disciplines where the whole is thought to be greater than the mere sum of the parts. It is driven by the vital need to provide high quality, effective occupational rehabilitation. This special issue is dedicated to examining what contribution psychology may make in this noble effort. The role of cognitive-behavioral therapy (CBT) in occupational rehabilitation and pain management is seldom questioned, and yet there is surprisingly little written about how these techniques are incorporated into a program (1). Programs, however, vary greatly. Some traditional programs provide little in the way of psychological intervention while others limit the use to therapy with individual patients. At the other end of the gamut are centers that integrate the various disciplines so that a cooperative treatment is provided where cognitive-behavioral therapy penetrates the entire program. Integrating different disciplines unique contributions to rehabilitation is not always easy, however, and this may be why there is such variation. Although cognitive-behavioral therapy has been shown to be effective for chronic pain, few studies have addressed the question of its specific contribution to occupational rehabilitation. Several reviews show that cognitive-behavioral approaches, usually in multidimensional pain clinic settings, are relatively effective in reducing pain, increasing activity levels and returning patients to work (2-6). However, there is a need to gain more knowledge about how these techniques are best applied in an occupational rehabilitation setting. Advancements in the application of cognitive-behavioral techniques might be enhanced by developing new applications and empirically testing the results. Only a handful of the techniques commonly used in CBT are regularly used in the area of pain. Moreover, as pointed out above, little research has actually examined the specific effect of these. A disappointingly low level of interest has been shown for

The Role of Cognitive Behaviour Therapy in Bipolar Disorder

There is increasing support for the use of systematic psychological interventions in combination with pharmacotherapy in the treatment of bipolar disorder (BD). A “manualised” approach, such as cognitive behaviour therapy (CBT), can be used to facilitate adjustment to the disorder, increase the acceptability of prescribed medications and reduce morbidity. This paper outlines psychosocial issues of relevance to individuals with BD and a model to engage individuals in therapy is described. A brief overview is given of some of the interventions that may help sufferers identify and control the acute symptoms of BD, reduce the risk of relapse and improve how they cope with the disorder and its treatment. The available outcome data on the use of CBT and the need for research are also noted.