Cognitive-behavior therapy in the treatment of cancer patients

Cognitive-behavioral strategies are employed in the treatment of cancer patients to eliminate nausea, control anxiety, pain, and depression. Specific techniques including relaxation, systematic desensitization and hypnosis are discussed. It is shown how cognitive strategies can create a more favorable environment for treatment.William L. Golden, Ph.D. — Licensed psychologist in private practice in New York City and Westchester, New York. He also is on the faculty of Cornell Medical College, New York City, the Institute for Rational-Emotive Therapy, New York City, and the Institute for Behavior Therapy, New York City.Wayne Gersh, Ph.D. — Licensed psychologist and co-director of the Westchester Center for Behavior Therapy, White Plains, New York. He also is a psychologist for the American Cancer Society.     

Sex differences in expected guilt reactions to hypothetical behaviors of sexual, hostile, and moral substance.

Differences between male and female guilt reactions to hypothetical guilt-inducing situations of a sexual, hostile, and moral nature were investigated. Two independent samples of Ss (56 men, 56 women; and 34 men, 62 women) reported the intensity of their anticipated guilt reactions to 60 hypothetical behavior situations presented in sentence-completion format through the use of scaled response alternatives. Across both samples there were specific behaviors, in which stable sex differences were evidenced, i.e., females' reactions were more intense for those behaviors reflecting sexual transgressions. However, males and females were highly similar in their reactions to hostile and moral guilt-provoking situations. Implications of these results for research on trait-guilt were discussed.     

Parent,teacher, and peer ratings of physically abused and nonmaltreated Children's behavior

Behavior ratings by parents, teachers, and classmates of physically abused fourth to sixth graders, identified from the New York City Maltreatment Register, and case-matched classroom controls, showed substantial concurrence among informants: Parents and teachers both rated significantly more behavioral disturbance in the abused children, and peers' ratings were significantly correlated with adults' ratings, especially those by teachers. Children's exposure to spouse or partner physical abuse, which had a substantial prevalence among both child-abusing and control families, reduced the difference in disturbance ratings between children who were themselves physically abused and those who were not. Overall, we conclude that physically abused children show pervasive behavioral disturbance, in that parents, teachers, and classmates all see higher levels of behavior problems and lower levels of socially desirable behavior in them compared to their nonmaltreated peers.This research was supported in part by research grant R01MH38814 and Clinical Research Center grant MH30906 from the National Institute of Mental Health. The authors thank the New York City Child Welfare Administration, especially Terry Weiss, for facilitating access to the Maltreatment Register; the NYC Board of Education for access to schools; and the many participating superintendents, principals, and teachers. Some preliminary data were presented as a poster at the Meetings of the American Academy of Child Psychiatry, New York, 1989.     

Situational approach to assessment of guilt: Development and validation of a self-report measure

The present research developed and evaluated a self-report measure of guilt that encompassed diverse, typical guilt experiences. Behavior-analytic procedures were employed to construct the Situational Guilt Scale (SGS), in which 22 items assessed anticipated guilt feelings for a wide range of naturally occurring specific situations. The SGS was administered to young-adult college students (mean age, 24 years), along with measures of guilt in traditional moral contexts, depressive tendencies, and socially desirable responding. A test-retest study of the SGS was separately conducted. Results indicated that SGS scores had statisfactory internal consistencies and considerable stability. Correlational findings and comparisons of SGS scores in a typology of depressive experience showed relationships of SGS guilt scores with dependent and self-critical tendencies and support the validity of the measure. The findings and utility of the SGS are discussed.Grant 13487 from the PSC-CUNY Research Award Program of the City University of New York provided support for this project. The Committee on Research Computing of the City University of New York funded the use of computer facilities.     

Irrational thinking in humans: An evolutionary proposal for Ellis' genetic postulate

An evolutionary proposal is outlined for Ellis' genetic postulate for irrational thinking in the human species. Evolutionary bases are explored for demanding and grandiose thought constructs (cognitive products) which are either learned and/or created during one's lifetime due to a genetic potential to think irrationally (cognitive processes). Demandingness and grandiosity are emphasized because they serve as primary cognitive tendencies in rational-emotive therapy (RET) which appear to drive most other irrational belief systems. The main postulate is that a genetic potential to think irrationally has evolved and is genetically coded in humans because it facilitated adaptive behavioral and emotional responses as a means of securing critical advantages in early childhood development, increased reproductive success, and basic survival. Sociobiological and Darwinian principles are applied to support this hypothesis.William J. Ruth, Ph.D., Staff Psychologist and Practicum Supervisor, Institute for Rational-Emotive Therapy, New York City; School Psychologist, Board of Cooperative Educational Services, Westchester, New York; Private Practice, Hartsdale, New York.     

Last Words: Analysis of Suicide Notes from an RECBT Perspective: An Exploratory Study

A sample of 86 suicide notes was analyzed to identify the common cognitive and emotional themes contained in the text from a rational-emotive and cognitive behavior therapy (RECBT) perspective. Using grounded theory and statistical analysis to examine the data, this study found that the most frequent emotional categories to be present in these suicide notes are autonomous depression, sociotropic depression, guilt, shame, hurt and anger. It was also discovered that men, more than women, are likely to write about their experience of guilt in their suicide notes at the end of a relationship, while women are more likely to express feelings of hurt. This study may enable RECBT practitioners to better understand the cognitive and emotional factors of suicide behavior, and it may encourage future research into more specific suicide prevention protocols.     

Alleviating the distress of caregivers of Alzheimer's disease patients: A rational-emotive therapy model

Caring for a person with senile dementia of the Alzheimer type places an enormous emotional burden upon the caregiver. Common responses of caregivers include denial, anger, guilt, self-pity and depression. These negative emotions exacerbate the difficulties of caring for the patient, as well as constrict the caregiver's ability to develop appropriate coping skills for his/ her own life. Rational-emotive therapy (RET) specifies the maladaptive cognitions which elicit and sustain maladaptive emotions and behaviors, and provides a model for cognitive, affective and behavioral change. Excerpts from therapy sessions are presented to illustrate the process.Rose Oliver, private practice; Graduate Fellow and Supervisory Faculty, Institute for Rational Emotive Therapy, 45 East 65th Street, New York, NY 10021. Frances A. Bock, private practice; Adjunct Associate Professor, Psychology Department, Hofstra University, Hempstead, NY 11550; Graduate Fellow and Supervisory Faculty, Institute for Rational Emotive Therapy, 45 East 65th Street, New York, NY 10021.     

Using Television to Create More Favorable Attitudes Toward Community Facilities for Deinstitutionalized Psychiatric Patients

Prebroadcast screenings were organized to measure the impact of a TV documentary, "Back Wards to Back Streets", on information levels, attitudes toward community-based treatment facilities, and beliefs about mental illness. Audiences of mental health professionals, political decision makers, and public TV subscribers were invited to screenings in New York City and Albany, New York. Based on an experimental design, half of each audience was randomly selected to respond to both pre- and postfilm questionnaires; others responded to postfilm questionnaires only. Among the New York City audience the film raised information levels, created more favorable attitudes, and changed beliefs about mental illness. One methodological implication is that small-scale screenings are a viable technique for studying TV's impact.     

Guided and unguided self-help for binge eating

This study compared the relative short- and longer-term efficacy of therapist-guided and unguided use of a cognitive behavioral self-help manual for binge eating [Fairburn, C. G. (1995). Overcome binge eating. New York: The Guilford Press.] Forty women (82.5% with binge eating disorder) were randomized to one of the two treatment levels. Results indicate that both conditions represent viable means of treating binge eating. Overall, patients improved their eating behavior, eliminated any inappropriate compensatory behaviors, reduced their shape concern, weight concern, and other symptoms of eating-related psychopathology, and improved their general psychological functioning. The guided self-help condition was notably superior in reducing the occurrence of binge eating and its associated symptomatology, as well as lowering interpersonal sensitivity. A high degree of general psychopathology was a negative prognostic indicator. The implications for a stepped-care approach to treating binge eating are discussed.     

Eating disorders and obesity

The majority of patients with eating disorders are female. Most of those seeking treatment for weight loss are also women. Our culture views slenderness as beautiful, creating pressure to be thin. For some, however, the pursuit of thinness may be a way to avoid difficult developmental tasks, increase self-acceptance or get approval from others. Whatever its purpose, seeking slimness can lead to health problems as a result of starvation, binging and purging, or rapid cycles of weight loss and gain. Starvation and the binge-purge cycle themselves also create psychological problems. In this article, the etiology, maintenance and treatment of anorexia nervosa and bulimia are discussed from a cognitive-behavioral perspective. Attention is given to the interplay of physical, psychological and behavioral aspects of these disorders. Although obesity is a physical condition, not an emotional disorder, many women are distressed over their size due to the influence of cultural demands for thinness. The psychotherapist working with weight control may face the dilemma of whether to help a woman accept herself at her size or lose weight. Some guidelines for making a decision are discussed. Cognitions impeding weight loss are identified, and advances in cognitive-behavioral weight loss treatment are discussed.Jill Bresler is a psychologist in private practice and is on staff at the Institute for Rational-Emotive Therapy, New York City     

Cognitive-behavior therapy with children: Developmental reconsiderations

The present paper reconsiders the role of developmental theory in the use of cognitive-behavior therapy (CBT) with children. The implication of Piaget's theory of cognitive development and Selman's social perspectivetaking theory are reviewed briefly in regard to CBT. It is argued that the assessment of both logical/analytical thought structures and social perspective-taking abilities may be useful in planning a course of CBT with children.Andrew Kinney, Ph.D., is an Associate Fellow at the Institute for Rational-Emotive Therapy, New York City. He is an Assistant Professor of Psychology at Mohawk Valley Community College, Utica, NY, and an Adjunct Lecturer of psychology at the State University of New York Institute of Technology at Utica/Rome, NY.     

Gender Differences in the Organization of Guilt and Shame

Lewis [(1971) Shame in Guilt in Neurosis, New York: International Universities Press] argues that guilt and shame represent distinct modes of perceiving and experiencing information about the self that are congruent with gender-linked differences in socialization. We tested predictions from Lewis' model that shame-proneness in adult White females (n = 102), but guilt-proneness in adult White males (n = 99), would account for a substantial proportion of the variance in measures assessing their characteristic use of defense mechanisms and endorsement of gender roles. Certain results confirmed Lewis' broader claim that guilt for men, but shame for women, were predominant modes of organizing information about the self. Other results did not support certain specific predictions made by Lewis or they provided only equivocal support (e.g., in men, the joint positive relationship of guilt-proneness to communal orientations but its negative relationship to externalization). Similar discrepant findings emerged for females' construal of guilt, which also related positively to internalization. Although shame-proneness did emerge as the principal emotion variable for females, it was linked to both internalization and externalization. Lewis' model is reconsidered in light of recent empirical findings and the need to conduct more on-line investigations of transgression-emotion induction-emotion reduction cycles.     

Men,shame and antisocial behavior: A psychodynamic perspective

This paper discusses the psychosocial factors that contribute to male antisocial behavior. The role of shame and related affects is emphasized. Compensatory defenses associated with these affects are also described. Developmental concepts are reviewed in the light of recent research. Finally, some of the issues involved in doing psychotherapy with this population are discussed, with an emphasis on the value of group therapy.Parts of this paper were presented at the second annual conference onCulture, Race and Ethnicity in Group and Family Therapy which was sponsored by the Eastern Group Psychotherapy Society and New York University and was held in New York City, March 20–22, 1987.     

Cognitive coping with the threat of rape: vigilance and cognitive avoidance

Individual differences in women's avoidant and vigilant style in coping with the threat of rape were explored in four studies. In the first study, 97 women read a rape scenario and completed measures of cognitive vigilance and avoidance. They also provided ratings of fear of rape and anticipated coping problems in case of sexual assault. Vigilance was associated with significantly higher levels of fear of rape and anticipation of more severe coping problems. No effects were found for cognitive avoidance. Study 2 replicated these findings with a sample of 275 women. In addition, it showed that high vigilance was associated with significantly more rape-preventive behaviors. Study 3, including 172 women, was an online study on the effect of cognitive coping style on fear of rape, anticipated coping problems, and two behavioral measures of rape avoidance. High vigilance was related to higher levels of fear of rape, anticipation of more severe coping problems, and more rape-preventive behaviors. Finally, Study 4 (N=210) showed that individual differences in cognitive coping style affected rape-related affect and behavior in the absence of a rape scenario, underlining the chronic salience of the threat of rape for women. Vigilance was positively related to fear of rape, rape-avoidance behavior, and anticipated coping problems. In contrast, a negative relationship was found between cognitive avoidance and fear of rape, rape-avoidance strategies, and anticipated coping problems. Across the four studies, no evidence was found for an interactive effect of cognitive avoidance and vigilance, as suggested by the construct of repression versus sensitization. The findings are discussed in the light of previous research on repression-sensitization in coping with threatening information.     

Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity,Clinical Techniques,and Case Examples

Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This paper describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (a) functional analysis of behavior hroblems, (b) prosocial activity sampling, (c) cognitive monitoring and restructuring, (d) emotion regulation training, (e) problem-solving training, and (f) communication training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.     

Cognitive Behavioral Therapy for HIV-Negative Heterosexual Meth Users: The FASTLANE II Intervention

The purpose of this paper is to provide clinicians with a theoretical roadmap and practical toolkit for the FASTLANE II intervention, a 9-session behavior change intervention for HIV-negative meth-using heterosexual men and women that simultaneously targets depressive symptoms, meth use, and sexual risk behavior. The intervention was grounded in cognitive behavioral therapy (CBT), social cognitive theory (SCT), and the theory of reasoned action (TRA), and utilized a variety of cognitive and behavioral techniques. Examples of those techniques are provided, as well how those techniques map onto core theoretical elements of CBT, SCT, and TRA. We present three case studies with sample counseling session dialogue. Techniques and skills from FASTLANE II may be of use to clinicians interested in targeting depression, meth use, and high-risk sexual behavior.     

Individual Differences in Experiences of and Responses to Guilt and Shame: Examining the Lenses of Gender and Gender Role

How are experiences of and reactions to guilt and shame a function of gendered views of the self? Individual differences in guilt and shame responses were explored in a sample of 104 young adults, most of whom were European American. Results indicated that, although women reported greater proneness to guilt and shame, men reported more trait guilt. Heightened levels of guilt- and shame-proneness were observed among both men and women with traditionally feminine gender roles, whereas a more traditionally masculine self-concept was associated with decreased shame-proneness for women. Gender schematic women favored verbal responses to ameliorate the experience of guilt, whereas gender schematic men preferred action-oriented responses. These results are discussed as gendered outcomes of schematic versus aschematic gender role socialization.     

Men's fear of sex with women: A cross-cultural study

Anthropologists have described cultural beliefs in many societies that suggest men fear sex with women. In this paper I derive and cross-culturally test the implications of four theories that may help explain such fear. These theories suggest that men may fear sex with women because their wives come from enemy villages; population pressure on resources favors the avoidance of intercourse; males are conflicted about their sexual identity; or males have an exaggerated Oedipus complex. The cross-cultural evidence is generally consistent with all four theories. A tentative causal model is presented to account for the results.This article is a revised and enlarged version of a paper presented at the fifth annual meeting of the Society for Cross-Cultural Research, February 13–15, 1976, in New York City. The author wishes to thank Judith Berman and Melvin Ember for their help. She also thanks the Graduate School and University Center of the City University of New York for providing the funds to support this research.     

Barriers to condom use in primary and nonprimary relationships among Hispanic STD clinic patients

Some programs designed to reduce the spread of AIDS and other STDs encourage consistent condom use among sexually active, at-risk individuals. A random sample of 283 Hispanic men and women seeking services at a public STD clinic in New York City were surveyed in an examination of differences in their attitudinal patterns, normative beliefs, and practices related to condom use with primary and nonprimary sex partners. 60% of the participants were male. The group was of mean age 30.9 years, with 46% having graduated from high school. 44.5% were born in the US, although 73.8% had lived in mainland US for the previous ten years or longer. 52.7% were single, 19.8% married, and the remaining 27.5% were either divorced, separated, or widowed. Only 3.2% of men and women reported having same-sex relationships, although the authors suggest that the respondents may have underreported the extent of their bisexual and homosexual behavior. 58.3% of men and 53.3% of women reported having had a prior STD, 82.2% of men and 74.8% of women had experience using a condom, and 31.3% of men and 13.3% of women reported having nonprimary partners. Both the men and women report that they are more likely to use condoms in nonprimary than primary relationships and that they perceive fewer barriers to doing so. Issues related to trust and social acceptability are more salient in primary relationships. Interventions to promote condom use among Hispanics must acknowledge the different psychosocial influences upon condom use in different relationships and target the specific attitudinal and behavioral changes desired.     

Adolescent victimization and associated suicidal and violent behaviors

This study examined the relationship between victimization and both suicidal and violent behaviors among 1,569 public high school students in New York State (excluding New York City). They had participated in the 1997 Youth Risk Behavior Survey and, based on their responses, were divided into four groups: no suicidal or violent behavior, suicidal behavior only, violent behavior only, and both suicidal and violent behaviors. Males reported significantly more victimization, less suicidal behavior, and more violent behavior compared with females. Logistic regression analyses indicated that all categories of suicidal/violent behaviors were more frequent among those who had been victimized compared with the nonvictimized, for both males and females. In addition, victimized males were over two times more likely than victimized females to report violent behavior only. Gender differences were not significant for victimized students in two groups, suicidal behavior only and both suicidal and violent behaviors, although the results were in the hypothesized direction for suicidal behavior (e.g., females were more prone to suicidal behavior only). It was concluded that identifying and treating the victims of violence should be an integral component of suicide prevention programs and interventions aimed at reducing interpersonal violence in schools.