Use Of Cognitive Behavioral Therapy Research Articles

The use of cognitive behavioral therapy in the treatment of resistant depression in adolescents

Major depressive disorder often begins in adolescence, is chronic and recurrent, and heightens an individual’s risk for major depressive disorder in adulthood. Treatment-resistant depression is a problem for a significant minority of adolescents. Few studies have examined treatments for treatment-resistant depression among adolescents, and even fewer have examined the use of cognitive-behavioral therapy as a monotherapy or in combination with pharmacological treatments. Mental health professionals have a strong interest in understanding what treatments are appropriate for adolescents who are treatment resistant. Preliminary evidence from current published trials indicates that the use of cognitive-behavioral therapy in combination with antidepressant medication yields the best outcome for treatment-resistant depression in adolescents. Secondary analyses also suggest that the utility of cognitive behavioral therapy can be increased by ensuring adolescents receive a therapeutic dose of treatment sessions (more than nine sessions) and the inclusion of two treatment components: social skills and problem solving training. Guidelines for clinicians as well as areas for future research are discussed.

Non-pharmacological treatment of insomnia.

Insomnia is one of the most common sleep disorders, which is characterized by nocturnal symptoms of difficulties initiating and/or maintaining sleep, and by daytime symptoms that impair occupational, social, or other areas of functioning. Insomnia disorder can exist alone or in conjunction with comorbid medical and/or psychiatric conditions. The incidence of insomnia is higher in women and can increase during certain junctures of a woman's life (e.g., pregnancy, postpartum, and menopause). This article will focus on an overview of cognitive behavioral therapy for insomnia, evidence of effectiveness for this treatment when insomnia disorder is experienced alone or in parallel with a comorbidity, and a review with promising data on the use of cognitive behavioral therapy for insomnia when present during postpartum and menopause.

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.

Conceptual and Pragmatic Considerations in the Use of Cognitive-Behavioral Therapy with Muslim Clients

Islam is one of the leading religions of the world. Its adherents, who number approximately one billion, are present in all parts of the world and can be found in all ethnic and racial categories. Cognitive-behavioral therapy (CBT) is one of the most prominent and empirically-supported of all psychological treatments. In light of such facts, a discussion of the relationship between the philosophical underpinnings of CBT and the Islamic worldview is in order. In this paper, some of the philosophical and theoretical tenets of both Islam and CBT are first discussed. Secondly, and as to heighten clinical awareness, several points of concordance and dissonance between these systems are discussed and highlighted through an illustrative case study. Finally, the authors conclude by offering a number of suggestions for future research.

Critical Reflections on Ethical Practice

This paper critically reflects on a social work student placement experience at an Improving Access to Psychological Therapies (IAPT) service. It utilises ethical concepts to analyse the goals and working methods of the medical-dominated service alongside the professional and personal values taken to the role. Discussion focuses on the organisation's assessment process and use of Cognitive Behaviour Therapy (CBT), concluding that the utilitarian and managerialist principles embodied in their procedure conflict with anti-oppressive social work ethics. Particular attention is given to the role and power of a student including personal reflection on the social work methods used and how practice would be changed in the future.

Using group cognitive behavioural therapy intervention in school settings with pupils who have externalizing behavioural difficulties: an unexpected result

There has been a growing interest in the use of cognitive behavioural therapy (CBT) in school settings by educational psychologists in England. This small-scale study set out to explore the effectiveness of a school-based, eight-session CBT intervention for 12–13-year-old children with externalizing behavioural difficulties. Twelve pupils were referred by a school's pastoral manager as having externalizing behavioural difficulties. Pupils were matched in pairs and then randomly assigned to two groups. One group received cognitive-behavioural intervention, while the other continued with normal school support (control group). Participants in both groups and their teachers completed a pre- and post-intervention assessment taken from the Behaviour Assessment System for Children (BASC-2). Pupil self-ratings showed a large differential effect size (Cohen's d = 0.818) between the CBT group and the control group (F (1,8) = 7.080, p = 0.029). This indicates a positive change for pupils' self-perceptions of their behaviour. However, an unexpected result was found for teacher ratings, which positively changed for all pupils in the study and no differential effect was noted with all pupils reported to be better behaved at the end of the study. Our hypothesis is thus that there is a systemic effect of a targeted intervention by reducing the cumulative effect of low-level challenges that teachers experience.

Case study of cognitive behavioural therapy awareness educational programme using blended learning, UK

This paper examined the opportunities as well as challenges in relation to the use of cognitive behavioural therapy (CBT). The opportunities include the increased range of mental health conditions and other disorders where CBT (in isolation or with other interventions) could be effective to address them, as well as policies around workforce education and training that support the expansion of psychological therapies, particularly CBT services. The challenges include the urgent need of heightened awareness among the wider platform of health and social care workers about CBT principles, structure, framework, methods of delivery, wider applications, evaluation and appropriate referral of clients, and stepped model of care. In response to such needs, the paper described CBT awareness educational award at the University of Gloucestershire, UK: the Certificate of Professional Studies in Awareness of Cognitive and Behavioural Therapies Practice delivered at Level III and M level. The challenges associated with the initiation and running of such educational programmes are highlighted, as well as suggestions for the way forward considering the learners', employers' and educational providers' perspectives.

Cognitive Behavioral Therapy for Pediatric Chronic Pain: The Problem, Research, and Practice

The purpose of this article is to outline the rationale and use of cognitive behavioral therapy (CBT) for the treatment of pediatric chronic pain. The article begins by demonstrating the scope and impact of the problem of pediatric chronic pain. It then provides an overview of the framework of CBT for pediatric chronic pain and standard treatment components are outlined. A summary of the current state of research and its efficacy is provided. The article concludes by presenting outcome data from a specific example of a CBT group for pediatric recurrent abdominal pain. Future directions for research in this area are discussed.

Treatment of comorbid anxiety and autism spectrum disorders

Clinically significant anxiety occurs frequently among individuals with autism spectrum disorders (ASDs) and is linked to increased psychosocial, familial, behavioral and academic impairment beyond the core autism symptoms when present. Although efforts are underway to establish empirically supported treatments for anxiety among individuals with ASDs, this remains an emerging research area. This literature review summarizes available information on the efficacy of pharmacological and psychosocial approaches for treating anxiety and repetitive behaviors in children, adolescents and adults with ASDs. Specifically, we evaluate evidence for the use of cognitive-behavioral therapy and selective serotonin-reuptake inhibitors. Evidence is growing in support of using cognitive-behavioral therapy to treat anxiety in youths with ASDs; however, mixed evidence exists for its application in treating repetitive behaviors, as well as the use of selective serotonin-reuptake inhibitors for anxiety in youths with ASDs. We conclude the article with a discussion of the strength of current information and next steps in research.

The Use of Cognitive Behavioral Therapy for Secondary Prevention in Patients With Coronary Heart Disease

Gulliksson et al1 report the results of a randomized controlled trial of cognitive behavioral therapy (CBT), measuring its effects on Cardiovascular Disease (CVD) recurrence in 362 patients with coronary artery disease. The authors found that, after 94 months, the CBT group had a 41% lower rate of fatal and nonfatal recurrent CVD events and 45% fewer recurrent acute myocardial infarctions (AMIs) after adjustment for covariates. As the authors acknowledge, a large body of evidence exists to link psychosocial factors such as depression, anxiety, and low social support to adverse cardiovascular outcomes. There is compelling evidence that up to 42% of coronary patients experience depression.2 Comorbid depression, even mild symptoms, can predict mortality,3 morbidity, and poorer clinical and well-being outcomes. Indeed, the intervention detailed by Gulliksson and colleagues, which comprised a group-based CBT program, addressed these psychosocial influences. Twenty-two–hour sessions were conducted over 1 year (plus usual medical care), with the overall goal of treatment to develop emotional and behavioral coping strategies for dealing with stress. The focus was particularly on stress reactivity and stress behaviors characterized by negative affect like hostility, anxiety, and depressive mood reactions [see eAppendix1] However, in the absence of depression, anxiety, and social support outcome measures documented in this study, ascertaining the components of this group-based CBT intervention that led to these improvements is particularly difficult. Post-AMI depression has been identified as a predictor of 1-year cardiac mortality, and moreover, high levels of social support have been found to provide a protective influence from depression on mortality.4 Because the authors have not discussed the mediating role of these variables, readers can only speculate about their influence. Furthermore, while this study highlights the benefits of a protocol-driven program, whether its effectiveness is fully explained by the CBT approach to treatment, from enhanced social support via regular, face-to-face, group-based contact with peers or via improvements in anxiety and depression as a direct consequence of therapy or as a byproduct of other behavioral modifications, remains unanswered. Unlike other trials using CBT in cardiac populations that have failed to produce significant survival benefits,5 this study demonstrates the positive effects of a CBT approach in the secondary prevention of CAD. However, we hypothesize that while the contribution of putative influences such as depression, anxiety, and social support remains unaccounted for in this study, it is likely that they are, in fact, elucidating the observed relationship between survival and treatment.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A discussion of cognitive behavioural therapy, mindfulness, and mindfulness based cognitive therapy

Content and FocusThis article explores the acceptability and usefulness of cognitive behavioural therapy, mindfulness, and mindfulness-based cognitive therapy for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Issues specific to researching this particular group are discussed also. Both peer reviewed literature and surveys from support groups are considered.ConclusionsThe article argues that mindfulness and mindfulness-based cognitive therapy – an integration of mindfulness and cognitive therapy – may be acceptable and beneficial to people with ME/CFS. Particular advantages lie in a flexible and cost-efficient application. The author concludes that further research into mindfulness and mindfulness-based cognitive therapy is warranted in this population. The article also highlights that a representative sample of people with ME/CFS is difficult to generate, and that findings can be hard to generalise.

Therapeutic options in treatment-resistant depression

The phenomenon of treatment-resistant depression (TRD), described as the occurrence of an inadequate response after an adequate treatment with antidepressant agents (in terms of dose, duration, and adherence), is very common in clinical practice. It has been broadly defined in the context of unipolar major depression, but alternative definitions for bipolar depression have also been suggested. In both cases, there is a remarkable lack of consensus amongst professionals concerning its operative definition. A relatively wide variety of treatment options for unipolar TRD are available, whilst the evidence is very scanty for bipolar TRD. TRD is associated to poor clinical, functional, and social outcomes. Several novel therapeutic options are currently being investigated as promising alternatives, targeting the neurotransmitter system outside of the standard monoamine hypothesis. Augmentation or combination with lithium or atypical antipsychotics appears as a valid option for both conditions, and the same occurs with electroconvulsive therapy. Other non-pharmacological strategies such as deep brain stimulation may be promising alternatives for the future. The use of cognitive behaviour therapy is recommended for unipolar TRD, but there is no evidence supporting its use in bipolar TRD.

Cognitive-Behavioral Therapy for Children with Comorbid Physical Illness

In addition to the usual developmental challenges, children and adolescents with chronic physical illness face psychosocial challenges that affect their quality of life. This review describes different aspects of coping with chronic physical illness in childhood and the empirical evidence examining the usefulness of cognitive-behavioral therapy (CBT) for the treatment of children and adolescents with chronic physical illnesses and related psychological comorbidities. Four diseases (diabetes, inflammatory bowel disease, cancer, and sickle cell disease) were chosen as model illnesses to demonstrate key CBT findings in more detail. Future research recommendations in this challenging population are also addressed.

The Use of Cognitive Behavioral Therapy for Secondary Prevention in Patients With Coronary Heart Disease—Reply

The Use of Cognitive Behavioral Therapy for Secondary Prevention in Patients With Coronary Heart Disease—Reply : Reply

The Cognitive-behavior therapy in public clinic: possibilities and challenges

This article aims to discuss the presence of the Psychology professional in the area of Public Health which is becoming more common every day. It establishes suggestions based on experiences of work in a Public Mental Health Clinic in the interior of the State of Paraiba in Brazil. It will deal with the use of Cognitive Behavioral Therapy as an instrument in the activities of this mental health unit. The positive results of these interventions prove that the Psychologist has an important role to play in the area of Public Health.

Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses

Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses

Cognitive-Behavioral Therapy as an Adjunct to Second-Generation Antipsychotics in the Treatment of Schizophrenia

This study determined whether adding cognitive-behavioral therapy to treatment for outpatients with schizophrenia would be more effective than the use of second-generation antipsychotics alone. Thirty-three patients were randomly assigned to receive either second-generation antipsychotics alone (N=18) or second-generation antipsychotics plus cognitive-behavioral therapy (N=15). All patients received pharmacotherapy from a single provider and in a predetermined standard manner. Psychopathology ratings were done at baseline, at the end of treatment (12 weeks) and three months after completion of treatment (24 weeks). Twenty-five (76%) patients completed baseline and 12-week evaluations, and 17 (68%) patients who finished treatment also completed evaluations at 24 weeks. At the end of treatment persons in the second-generation antipsychotics plus cognitive-behavioral therapy group were rated as having less severe delusions than patients in the group receiving second-generation antipsychotics only, and this difference was maintained three months after treatment ended. Adding cognitive-behavioral therapy may help with reducing the severity of delusions among patients with schizophrenia.

Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. clinicaltrials.gov Identifier: NCT00118911.

Training the Wider Workforce in Cognitive Behavioural Self-Help: The SPIRIT (Structured Psychosocial InteRventions in Teams) Training Course

The use of Cognitive Behavioural Therapy (CBT) self-help materials for depression is increasingly recommended as part of stepped care service models. Such resources can be delivered by both new specialist workers (such as the IAPT services in England), or by introducing this style of working into an existing workforce as described in the current paper. The Structured Psychosocial InteRventions in Teams (SPIRIT) course consists of 38.5 hours of workshops, and 5 hours of clinical supervision in the use of CBT self-help (CBSH). This study describes an evaluation of the effectiveness of the course when offered to community and inpatient mental health staff from a wide range of adult and older adult mental health teams in NHS Greater Glasgow Mental Health Division. Training resulted in both subjective and objective knowledge and skills gains at the end of training that were largely sustained 3 months later. At that time point, 40% of staff still reported use of CBSH in the last week. Satisfaction with the training is high, using validated rating scales. The SPIRIT training has gone some way to increasing access to CBSH for use in everyday clinical practice.

Coping Responses in Obsessive-Compulsive Disorder: Avoidance, Treatment, and Lifestyle Factors

Obsessive-compulsive disorder (OCD) is characterized by recurrent, distressing obsessions and repetitive compulsive behaviors or mental rituals frequently performed to reduce the distress associated with the obsessions. This paper reviews maladaptive and adaptive coping responses used by individuals with OCD, including compulsions as an avoidant coping response, psychotherapeutic and pharmacological treatments, social and family support, lifestyle changes, and stress management. Although several gaps in the extant literature on coping with OCD were identified, a considerable body of research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) as an effective therapeutic technique for teaching long-lasting coping skills. Increased research is needed in the role of social support, exercise and dietary changes, and stress management skills on daily functioning in individuals with OCD. Implications and recommendations for future research are discussed. Keywords: Obsessive-compulsive disorder, OCD, SSRI, CBT, exposure, coping, anxiety