An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures

In previous research, a cognitive-behavioral therapy (CBT) package was found to be effective in reducing children's distress associated with the painful medical procedures of bone marrow aspirations (BMAs) and lumbar punctures (LPs). Orally administered Valium demonstrated less effectiveness but was helpful in reducing behavioral distress before the medical procedure. In the present study, we investigated whether the combination of oral Valium and CBT would result in increased efficacy of the CBT. Eighty-three subjects were randomly assigned to receive either CBT or CBT plus Valium while undergoing either a BMA or an LP. Dependent variables included observed behavioral distress, self-reported fear and pain, and pulse rate. Results failed to support the value of such a combination but did provide additional evidence in regard to the effectiveness of the CBT. The need for more potent medical interventions for some children is discussed.     

A controlled trial of cognitive-behavior therapy combined with vestibular rehabilitation in the treatment of dizziness

Dizziness is a common and often untreated symptom in the general population. The aim of this study was to investigate the effects of a combined cognitive-behavioral/vestibular rehabilitation (VR) program, using a randomized control design. A total of 29 participants were randomized to treatment consisting of psychoeducation, vestibular exercises, relaxation and cognitive interventions, or to serve as waiting list controls. Measures of dizziness-related handicap, dizziness-provoking movements, and daily diary registrations of dizziness symptoms at pre- and post-treatment showed statistically significant improvements in many domains, which translated to moderate effect sizes. These findings provide preliminary support for the combination of Cognitive-behavioral therapy (CBT) and VR methods in the treatment of dizziness.     

A comparison of cognitive-behavior therapy with interpersonal and cognitive behavior therapy in the treatment of generalized anxiety disorder

Objective: The aim of this study was to compare the effectiveness of cognitive behavior therapy with the combination of cognitive behavior therapy and interpersonal therapy on decreasing the excessiveness of pathological worry and increasing happiness of the individuals with generalized anxiety disorder.

Method: The sample consisted of 36 female undergraduate students who referred themselves to the Isfahan University Counseling Center and met the criteria for GAD. They were randomly assigned into three groups; namely, two experimental groups and one control group. Before receiving the interventions all of the groups completed Penn State Worry Questionnaire and Oxford Happiness Inventory. One of the experimental groups underwent cognitive behavior therapy and the other one received the integration of cognitive behavior therapy and interpersonal therapy. The control group received no intervention.

Result: The statistical analyses indicated that the differences between the CBT and CBT+ IPT groups on excessive worry and happiness in the post tests were not significant. But significant mean differences were observed in the follow-ups regarding pathological worry and happiness between two groups.

Conclusion: It can be concluded that the integration of cognitive behavior therapy and interpersonal therapy can be applied as an effective intervention for decreasing the rate of GADs’ relapses after cognitive behavior therapy.     

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.     

An experimental investigation of the cognitive vulnerability to depression

The present study employed an experimental design, to examine the role of metacognitive processing in the prevention of relapse to depression. Eighty remitted depressed participants were randomly allocated to receive training in the metacognitive style of rumination, distraction, acceptance or no training control prior to a negative mood induction. Rumination prolonged the intensity of the negative mood consistent with no training, whereas both distraction and acceptance reduced the intensity of the negative mood. Changes in attitudes were only found in the acceptance condition, as participants in this condition reduced negative attitudes towards negative experiences. These results are consistent with information processing theory, and imply that acceptance-based preventative interventions may operate by both reducing the intensity of sad moods and altering one's attitudes towards temporary moments of sadness.     

An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

An investigation of the cognitive and experiential features of intrusive memories in depression

Intrusive autobiographical memories of negative past events are a clinical feature common to post-traumatic stress disorder (PTSD) and depression. Recent investigations provide increasing evidence that shared cognitive processes are linked to the maintenance of intrusive memories in both conditions. Still absent from the existing literature, however, is a systematic examination of the basic content and defining characteristics of intrusive memories in depression. This study sought to: (i) outline the content and features of intrusive memories in depression, and (ii) investigate whether intrusion characteristics linked to the persistence of intrusive memories in PTSD are also characteristic of intrusive memories in depression. A sample of undergraduate students (n=250) were interviewed and assessed for the presence of an intrusive memory in the past week, and completed a battery of measures that indexed cognitive and affective responses to the memory. Consistent with prediction, intrusive memories contained high levels of sensory experience and were marked by a sense of "nowness". In accord with studies with PTSD samples, sensory features accounted for unique variance in the prediction of depression severity, over and above that accounted for by intrusion frequency. This pattern of findings was replicated in a dysphoric (BDI-II>or=12) sub-sample of participants. Our results underscore the value of drawing on theoretical conceptualisations and empirical findings from the post-traumatic stress literature to extend our understanding of intrusive memories in depression.     

An investigation of the cognitive and experiential features of intrusive memories in depression

Intrusive autobiographical memories of negative past events are a clinical feature common to post-traumatic stress disorder (PTSD) and depression. Recent investigations provide increasing evidence that shared cognitive processes are linked to the maintenance of intrusive memories in both conditions. Still absent from the existing literature, however, is a systematic examination of the basic content and defining characteristics of intrusive memories in depression. This study sought to: (i) outline the content and features of intrusive memories in depression, and (ii) investigate whether intrusion characteristics linked to the persistence of intrusive memories in PTSD are also characteristic of intrusive memories in depression. A sample of undergraduate students (n=250) were interviewed and assessed for the presence of an intrusive memory in the past week, and completed a battery of measures that indexed cognitive and affective responses to the memory. Consistent with prediction, intrusive memories contained high levels of sensory experience and were marked by a sense of “nowness”. In accord with studies with PTSD samples, sensory features accounted for unique variance in the prediction of depression severity, over and above that accounted for by intrusion frequency. This pattern of findings was replicated in a dysphoric (BDI-II≥12) sub-sample of participants. Our results underscore the value of drawing on theoretical conceptualisations and empirical findings from the post-traumatic stress literature to extend our understanding of intrusive memories in depression.     

Mother-blaming in family therapy: An empirical investigation

Abstract

This study tested two hypotheses derived from the feminist critique of family therapy in a sample of AAMFT members. The stimulus was a brief vignette of an initial therapy session with a family presenting a teen-aged child as the identified patient. It was hypothesized that family therapists would rate the mothers in the vignette as more dysfunctional than fathers. It was also hypothesized that mothers would be asked to bear more of the burden of change in treatment plans written by subjects. Neither hypothesis was supported. However, respondents did rate the concerned parent, regardless of sex, as more dysfunctional. Since this is a role often occupied by women, this finding may indicate some gender bias.     

Outcome of group cognitive-behavior therapy for bulimia nervosa: the role of core beliefs

It is hypothesized that individuals who benefit less from CBT will be those who have more pathological core beliefs (unconditional beliefs, unrelated to food, shape and weight). Twenty bulimic women were treated using 12 sessions of conventional group CBT. Eating behavior and attitudes were assessed pre- and posttreatment. Core beliefs were assessed at the beginning of the programme, and were used as predictors of change across treatment (once any effect of pretreatment psychopathology was taken into account). Group CBT was effective, with reductions of over 50% in bulimic symptoms. Outcome on most indices was associated with pretreatment levels of pathological core beliefs. Possible reasons for these findings are discussed.     

Naturalistic outcome of case formulation-driven cognitive-behavior therapy for anxious depressed outpatients

This article describes a case formulation-driven approach to the treatment of anxious depressed outpatients and presents naturalistic outcome data evaluating its effectiveness. Fifty-eight patients who received case formulation-driven cognitive-behavior therapy (CBT) in a private practice setting were studied. All received individual CBT guided by a case formulation and weekly outcome monitoring; in addition, 40 patients received adjunct therapies, including pharmacotherapy, which were added as indicated by the case formulation and the results of weekly outcome monitoring. Patients treated with case formulation-driven CBT showed statistically and clinically significant changes in anxiety and depression that were generally comparable to those reported in published randomized controlled trials of empirically supported therapies (ESTs) for single mood and anxiety disorders. Findings support the proposal that anxious depressed patients who have multiple comorbidities and require multiple therapies can benefit from empirically supported treatments guided by a case formulation and weekly outcome monitoring.     

Effectiveness of cognitive-behavioral therapy for adolescent depression: a benchmarking investigation

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.     

An investigation into the client at the heart of therapy

This paper reports on an exploration of the experience of the client at the heart of therapy. A grounded theory analysis of clients' experiences of therapy provided through a voluntary sector counselling service was undertaken, and generated four main categories: permission, engagement, transparency and restructuring. The results of the study are presented in a way that hopefully retains much of the richness of what people have reported about their experience of counselling. The findings of the study are discussed in terms of the idea that counselling can provide a setting where people can have common therapeutic requirements met.     

Childhood depression: pharmacological therapy/treatment (pharmacotherapy of childhood depression)

Critiqued the published double-blind, placebo-controlled studies of antidepressant pharmacotherapy in child and adolescent major depressive disorder to assess their overall efficacy. The pharmacological mechanism of antidepressant action also was discussed. At best, antidepressant treatment for depressed youths is only modestly effective. In particular, the tricyclic antidepressants are not superior to placebo; however, early evidence with the selective serotonin reuptake inhibitors is more encouraging. The theoretical basis for this response pattern is discussed from a methodological perspective, from a neurodevelopmental status, and from a biological viewpoint. Study modifications are suggested which could improve some of the methodological limitations apparent in previous clinical drug trials.