Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial

The efficacy of group cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD) has received relatively little research attention compared with the large number of studies that have investigated individual CBT. The current study is the first controlled study to compare an identical CBT protocol, containing both cognitive and behavioural elements, delivered either individually or in a group. Participants were randomly assigned to either 10 weeks of individual CBT, 10 weeks of group CBT or a 10 week wait-list. Participants with significant rates of secondary comorbidity were included in the study to enhance the generalisability of results. Intention-to-treat and completer analyses were carried out and indicated no differences between the group and individual treatments on outcome measures. Large effect sizes were found for both conditions. Analysis of clinically significant change indicated that the individual treatment was associated with a more rapid response but that both treatments had equivalent rates of recovered participants by brief follow-up. The importance of further investigations of the efficacy of group CBT for OCD is discussed.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis

This meta-analysis examined the effectiveness of stand-alone body image (BI) cognitive-behavioural therapy (CBT). Nineteen studies met inclusion criteria. The behavioural dimension of BI improves most after BI CBT while the investment dimension improves the least. Individuals with clinical BI disturbances improve more than do college student samples. Treatments addressing the attitudinal, behavioural, and perceptual components of BI are more effective than treatments addressing attitude and behaviour only. Therapist-assisted therapy is more effective than is self-directed therapy. BI variables improve somewhat more than do general psychological variables, while the latter show equivalent improvement. Finally, treatment gains are maintained at follow-up. More research is needed to better understand and treat the investment dimension of BI.     

Clinical perfectionism: a cognitive-behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.     

A comparison of individual and group cognitive-behavioural treatment for female pathological gambling

The current study aimed to determine the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered in individual and group format. Fifty-six female pathological gamblers with electronic gaming machine gambling problems were randomly assigned to the control (waiting list) group or one of the treatment groups (individual or group treatment). Treatment comprised a 12-session program including financial limit setting, alternative activity planning, cognitive correction, problem solving, communication training, relapse prevention, and imaginal desensitisation. Treatment outcome was evaluated with conceptually related measures within the areas of gambling behaviour and psychological functioning. While individual and group treatment formats generally produced comparable outcomes in terms of gambling behaviour and psychological functioning, group treatment failed to produce superior outcomes to the control group in relation to several measures of psychological functioning. Moreover, by the completion of the six-month follow-up, 92% of the gamblers allocated to individual treatment compared with 60% allocated to group treatment no longer satisfied the diagnostic criteria for pathological gambling. These findings suggest that some caution should be employed when delivering cognitive-behavioural treatment in a group format until further research is conducted to establish its efficacy.     

An experimental analysis of hypochondriasis

Hypochondriasis (HC) involves preoccupation with fears of having a serious medical illness based on the misinterpretation of benign bodily perturbations. Individuals with HC also perform behaviors such as checking and reassurance-seeking presumably to reduce health-related fears. Experimental behavioral analyses of HC symptoms, however, are lacking. In the present study, 27 patients with HC were exposed to personally relevant health-related stimuli under one of two conditions: (a) subsequently performing safety-seeking behaviors (e.g., checking) (n=14) or (b) subsequently being instructed not to perform such behaviors (n=13). In both groups, subjective anxiety and urges to perform safety behaviors were monitored for 1h. Results indicated that exposure to the personally relevant health trigger provoked anxiety and urges to perform safety behaviors. For patients who performed such behaviors, these feelings were reduced. For patients who did not, a more gradual reduction of anxiety and urges was observed. Findings are discussed in terms of the conceptualization and treatment of HC behavior, and are relevant to HC's possible relationship to panic and obsessive-compulsive disorder.     

Body image interventions in cognitive-behavioural therapy of binge-eating disorder: a component analysis

The present study sought to investigate effects of body exposure in the treatment of binge-eating disorder (BED). Cognitive-behavioural therapy with a body exposure component (CBT-E) was compared with CBT with a cognitive restructuring component focused on body image (CBT-C). Twenty-eight patients diagnosed with BED were randomly assigned to CBT-E or CBT-C, both delivered in a group format. Negative automatic thoughts about one's body, dysfunctional assumptions about shape and weight, and body dissatisfaction were assessed using experimental thought-sampling techniques, a clinical interview (Eating Disorder Examination), and self-report questionnaires. At posttreatment and at 4-month follow-up, CBT-E and CBT-C were equally effective in improving body image disturbance on all indicators assessed. Both CBT-E and CBT-C produced substantial and stable improvements in the specific and general eating disorder psychopathology. Results suggest that both treatment components are equally effective in the treatment of BED.     

Cognitive-behavioural therapy for young children with anxiety disorders: Comparison of a Child + Parent condition versus a Parent Only condition

The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery.     

The role of schizotypy and creativity in a group problem-solving task

The well-studied link between psychotic traits and creativity is a subject of much debate. The present study investigated the extent to which schizotypic personality traits – as measured by O-LIFE (Oxford–Liverpool Inventory of Feelings and Experiences) – equip healthy individuals to engage as groups in everyday tasks. From a sample of 69 students, eight groups of four participants – comprised of high, medium, or low-schizotypy individuals – were assembled to work as a team to complete a creative problem-solving task. Predictably, high scorers on the O-LIFE formulated a greater number of strategies to solve the task, indicative of creative divergent thinking. However, for task success (as measured by time taken to complete the problem) an inverted U shaped pattern emerged, whereby high and low-schizotypy groups were consistently faster than medium schizotypy groups. Intriguing data emerged concerning leadership within the groups, and other tangential findings relating to anxiety, competition and motivation were explored. These findings challenge the traditional cliché that psychotic personality traits are linearly related to creative performance, and suggest that the nature of the problem determines which thinking styles are optimally equipped to solve it.     

Treating chronic tinnitus: comparison of cognitive-behavioural and habituation-based treatments

Using a randomized control group trial the long-term efficacy of a habituation-based treatment as conceived by Jastreboff, and a cognitive-behavioural tinnitus coping training were compared. An educational intervention was administered as a control condition. Both treatments were conducted in a group format (habituation-based treatment, 5 sessions; tinnitus coping training, 11 sessions). Educational intervention was delivered in a single group session. Patients were categorized according to their level of disability due to tinnitus (low, high), age and gender and then randomly allocated to the treatment conditions (habituation-based treatment, n = 30; tinnitus coping training, n = 27; educational intervention, n = 20). Data assessment included follow-ups of up to 21 months. Several outcome variables including disability due to tinnitus were assessed either by questionnaire or diary. Findings reveal highly significant improvements in both tinnitus coping training and habituation-based treatment in comparison with the control group. While tinnitus coping training and habituation-based treatment do not differ significantly in reduction of tinnitus disability, improvement in general well-being and adaptive behaviour is greater in tinnitus coping training than habituation-based treatment. The decrease in disability remains stable throughout the last follow-up in both treatment conditions.     

Efficacy of a cognitive-behavioural therapy administered by videoconference for generalized anxiety disorder

IntroductionDelivering psychotherapy by videoconference could considerably extend the accessibility of empirically validated treatments.ObjectiveThe aim of this study was to evaluate the efficacy of a cognitive-behavioural therapy (CBT) for generalized anxiety disorder (GAD), administered via videoconference.MethodFive participants with a primary diagnosis of GAD took part in an experimental multiple baseline case study protocol. The efficacy of the treatment was evaluated using a semi-structured interview, self-report questionnaires, and daily self-monitoring diaries.ResultsThe results demonstrate that overall, participants’ conditions were improved following treatment and they no longer met the diagnostic criteria for GAD in the short-term. Participants’ conditions improved clinically and statistically at each follow-up point, achieving a greater global level of functioning at post-test, as well as at 3-month and 12-month follow-up.ConclusionClinical implications of this new treatment modality and directions for future research are discussed.     

Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: a pilot study

The current study aimed to test the clinical effectiveness of a cognitive-behavioural program (CBT) specifically adapted for pathological gamblers with chronic schizophrenia, carried out in a naturalistic setting of community Mental Health Centres. Forty-four pathological gamblers with chronic schizophrenia were assigned either to a standard drug therapy for schizophrenia (control group) or to cognitive-behavioural therapy for pathological gambling plus a standard drug therapy for schizophrenia (experimental group). Psychological treatment comprised a 20-session program including psychoeducation, stimulus control, gradual exposure and relapse prevention. Therapeutic success was defined as abstinence or the occurrence of only 1 or 2 episodes of gambling during the follow-up period. While the patients treated in the experimental group showed a rate of success of 73.9%, only 19% of the participants belonging to the control group gave up gambling at the 3-month follow-up. The CBT group also did better than the control group in the number of gambling episodes and in the amount of money spent on gambling. However, the improvement of the experimental group was weaker at the 6- and 12-month follow-up. These findings support the beneficial effects of CBT as adjunctive therapy for patients with dual diagnoses (schizophrenia and pathological gambling).     

Effects of cancer rehabilitation on problem-solving, anxiety and depression: a RCT comparing physical and cognitive-behavioural training versus physical training

We tested the effects on problem-solving, anxiety and depression of 12-week group-based self-management cancer rehabilitation, combining comprehensive physical training (PT) and cognitive-behavioural problem-solving training (CBT), compared with PT. We expected that PT + CBT would outperform PT in improvements in problem-solving (Social Problem-Solving Inventory-Revised (SPSI-R)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and that more anxious and/or depressed participants would benefit most from adding CBT to PT. Cancer survivors (aged 48.8 ± 10.9 years, all cancer types, medical treatment completed) were randomly assigned to PT + CBT (n = 76) or PT (n = 71). Measurement occasions were: before and post-rehabilitation (12 weeks), 3- and 9-month follow-up. A non-randomised usual care comparison group (UCC) (n = 62) was measured at baseline and after 12 weeks. Longitudinal intention-to-treat analyses showed no differential pattern in change between PT + CBT and PT. Post-rehabilitation, participants in PT and PT + CBT reported within-group improvements in problem-solving (negative problem orientation; p < 0.01), anxiety (p < 0.001) and depression (p < 0.001), which were maintained at 3- and 9-month follow-up (p < 0.05). Compared with UCC post-rehabilitation, PT and PT + CBT only improved in anxiety (p < 0.05). CBT did not add to the effects of PT and had no extra benefits for higher distressed participants. PT was feasible and sufficient for durably reducing cancer survivors' anxiety.     

Long-term outcome of Internet-delivered cognitive-behavioural therapy for social phobia: A 30-month follow-up

Internet-delivered guided cognitive behaviour therapy for social anxiety disorder has been found to generate promising short-term results, up to one year posttreatment. No study has however documented longer follow-up periods. In this 30-month follow-up we contacted 57 participants from the original study of which 77.2% (44/57) responded to the Internet-administered outcome measures and 66.7% (38/57) completed a telephone interview. Results showed large pretreatment to follow-up within-group effect sizes for the primary outcome measures (Cohen's d 1.10-1.71), and a majority (68.4%; 26/38) reported improvements in the interview. The findings suggest that the long-term effects seen in previous live treatment CBT trials can occur in Internet-delivered treatment as well.     

Parent-infant interaction: a growth model approach

The aim of this study is to compare the interaction of fathers and mothers with their 10–12 months old infants (n = 97; parental sensitivity and mood, and infant mood) during five structured contiguous play segments, and to examine the utility of individual growth modeling. Conventional comparison of means across play-segments showed that parents were equally responsive, but mothers were happier than fathers, and infants were equally happy during interaction with both parents. Sensitivity and mood were more strongly related for mothers than for fathers. Uni- and multivariate growth models revealed fine-grained patterns not seen in conventional analysis: (a) parental and infant mood decreased across play more for mothers than for fathers, (b) parental sensitivity in one play-segment predicted parental mood and infant mood in the next segment, (c) change in infants’ mood was related to change in sensitivity in mothers, and to change in mood in fathers, and (d) mothers’ sensitive interaction with the infant was predicted by family socio-demographic background.     

Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery

Background

The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.

Aims

To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.

Method

101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions (‘Overcoming Bulimia Online’), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.

Results

There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.

Conclusions

The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.     

Perfectionism is multidimensional: a reply to Shafran,Cooper and Fairburn

provided a cognitive-behavioural analysis of perfectionism that focused primarily on self-oriented perfectionism. They argued against studying perfectionism from a multidimensional perspective that they regard as inconsistent with prior work on perfectionism as a self-oriented phenomenon. We respond to by offering historical, empirical, and theoretical support for the usefulness and the importance of a multidimensional model of perfectionism involving both intrapersonal processes and interpersonal dynamics. It is concluded that a multidimensional approach to the study of perfectionism is still warranted.     

Searching for a common methodological ground for the study of politicians' perceived personality traits: A multilevel psycholexical approach

The aim of the three-stage psycholexical research was to systematize individual differences in voters’ perception of politicians’ personality traits and the differentiation dimensions of politicians’ images using the example of Ukraine. On the basis of 200 interviews, politicians’ personality lexicon was compiled and categorized. A representative sample of that lexicon was used in a study concerning the perception of several dozen politicians which allowed to identify four dimensions of politicians’ perceived personality traits at the individual and aggregate levels, distinct from the classic Big Five. Another study confirmed the stability of the structure of perception based on 2-level CFA and a strong relationship of personality image with preferences for politicians based on 2-level regression analysis.     

A Cognitive-Behavioural Treatment Programme for Conduct Disorder: The Case of Tumeleng

This article presents a case study of a teenager with conduct disorder (CD) using a cognitive-behavioural treatment programme for anger and aggression. Unique features of the case included comorbid expressive language disorder and a history of multiple traumatic brain injuries, and a Tswana (Botswana) ethnic/cultural background. Indications for successful treatment were the participant's intrinsic motivation to change and be accepted by his peers, and his good memory. Factors that contraindicated successful treatment were the absence of his parents, due to his attending boarding school and comorbidity. The case provides evidence for the efficacy of cognitive behavioral therapy (CBT) for CD in an adolescent of a Tswana background with comorbid expressive language disorder and history of multiple head injuries.