A pilot study of two-day cognitive-behavioral therapy for panic disorder

The present study investigated the short-term efficacy of brief, intensive cognitive-behavioral therapy (CBT) for panic disorder (PD). The treatment involved 9h of therapist contact over two consecutive days and was developed for the purpose of delivering CBT for PD to a largely rural patient population that must travel long distances to find a treatment provider. Ten patients who elected to participate in brief, intensive CBT instead of weekly CBT were recruited from routine clinical practice in a hospital-based anxiety disorders clinic. Patients were not excluded based on the presence of agoraphobia, diagnostic comorbidity, concurrent use of PRN benzodiazepine medications, or previous nonresponse to psychotherapy for PD. Assessments conducted at pre-treatment and 1-month follow-up revealed large, clinically significant reductions in PD symptoms, anxiety sensitivity, body vigilance, and anxiety and depressive symptoms. Most patients (60%) were panic-free after treatment and evidenced normative levels of symptomatology at follow-up. The present study suggests that brief, intensive treatment may be an effective means of delivering CBT for PD.     

Coping strategies for auditory hallucinations: A review

This article reviews the literature on the strategies which psychiatric patients spontaneously use in order to cope with their auditory hallucinations. The common strategies found between studies are described and these are grouped according to four categories: (i) social contact; (ii) sensory stimulation; (iii) physiological arousal; and (iv) cognitive strategies. An attempt is made to relate these strategies to the theoretical and experimental literature on auditory hallucinations and, finally, the role of the counselling psychologist in fostering the development of effective coping strategies is outlined.     

A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression

In some cases, insomnia and depression may have a reciprocal relationship, in which each aggravates and maintains the other. To test the hypothesis that reduction of insomnia would result in reduction of depression in patients (N=10) with both disorders, a repeated-measures design was used comparing depression and insomnia levels before and after 6 sessions of cognitive-behavioral therapy of insomnia. Posttreatment, 100% of completers (n=8) had a normalized sleeping pattern, and 87.5% had normalized depression scores. Significant posttreatment improvement was seen in sleep onset latency (-31 min), wake time after sleep onset (-24 min), total sleep time (+65 min), sleep efficiency (+14%), and sleep quality (+19%), which was maintained at 3-month follow-up. A decreasing trend occurred in depression scores from pre- to posttreatment, which reached significance at 3-month follow-up. Intent-to-treat analyses showed similar results.     

Group cognitive-behavioral therapy for hoarding disorder: an open trial

Although cognitive-behavioral therapy (CBT) appears to be a promising treatment approach for hoarding disorder, treatment to date has been quite labor intensive. The goal of this study, therefore, was to assess the potential effectiveness of group CBT for hoarding, without home visits by the clinician. Forty-five individuals with hoarding disorder enrolled in either a 16 or 20 session program of group CBT; 30 (67%) completed treatment. Using mixed-effects models to account for missing data, we report data from 35 (78%) participants who provided enough data for analysis. Participants demonstrated significant improvements in hoarding symptoms, as well as symptoms of depression and anxiety, and quality of life. Improvements in hoarding symptoms were comparable to two published clinical trials on individual CBT for hoarding disorder. Results of this study suggest that group CBT for hoarding, without home discarding sessions by the clinician, may be an effective treatment option with the potential advantage of increasing treatment access by reducing clinician burden and cost of treatment.     

Group rational-emotive and cognitive-behavioral therapy.

The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.     

Interactive voice response for relapse prevention following cognitive-behavioral therapy for alcohol use disorders: a pilot study

Relapse after alcoholism treatment is high. Alcohol Therapeutic Interactive Voice Response (ATIVR) is an automated telephone program for posttreatment self-monitoring, skills practice, and feedback. This pilot study examined feasibility of ATIVR. Participants (n = 21; 57% male) had access to ATIVR for 90 days following outpatient group cognitive-behavioral therapy (CBT) to make daily reports of mood, confidence in sobriety, urges to use substances, and actual use. Reports of relapse or risk were followed with additional questions. Participants received personalized therapist feedback based on responses, and could access recorded CBT skill reviews. Pre-post assessments included: alcohol consumption (Timeline Follow-Back), self-efficacy (Situational Confidence Questionnaire), and perceived coping ability (Effectiveness of Coping Behaviors Inventory). Participants called on 59% of scheduled days and continued making calls for an average of 84 days. Following ATIVR, participants gave feedback that ATIVR was easy to use and increased self-awareness. Participants particularly liked the therapist feedback component. Abstinence rate increased significantly during ATIVR (p = .03), and both self-efficacy and coping significantly improved from pre-CBT to post-ATIVR (p < .01). Results indicate ATIVR is feasible and acceptable. Its efficacy should be evaluated in a randomized controlled trial.     

Group cohesion in cognitive-behavioral group therapy for social phobia

Cognitive-behavior therapy (CBT) for Social Phobia is effective in both group and individual formats. However, the impact of group processes on treatment efficacy remains relatively unexplored. In this study we examined group cohesion ratings made by individuals at the midpoint and endpoint of CBT groups for social phobia. Symptom measures were also completed at the beginning and end of treatment. We found that cohesion ratings significantly increased over the course of the group and were associated with improvement over time in social anxiety symptoms, as well as improvement on measures of general anxiety, depression, and functional impairment. In conclusion, findings are consistent with the idea that changes in group cohesion are related to social anxiety symptom reduction and, therefore, speak to the importance of nonspecific therapeutic factors in treatment outcome.     

A verbal behavior analysis of auditory hallucinations

A review of recent research on the non-medical control of auditory hallucinations is presented. It is suggested that the decreases in hallucinatory behavior obtained in studies using aversive contingencies may be attributable to the disruption of the chains of behavior involved. The results of several additional studies are interpreted as indicating that methods of stimulus control and the use of incompatible behaviors may be effective in reducing the rate of auditory hallucinations. Research relating auditory hallucinations to subvocalizations is presented in support of the view that hallucinatory phenomena are sometimes related to the subject's own vocal productions. Skinner's views (1934, 1936, 1953, 1957, 1980) are then presented as possible explanations of some hallucinatory behavior. It is suggested that some auditory hallucinations consit of the mishearing of environmental and physiological stimuli as voices in a fashion similar to that which Skinner observed in his work with the verbal summator. The maintenance of long chains of such responses may be largely attributable to self-intraverbal influences (such as are present during automatic writing). With some auditory hallucinations, this progression involves first mishearing ambiguous stimuli as voices and then attributing the voices to some cause (e.g., insanity, the television, radio, or God). Later, the frequent and ongoing chains of such behavior may contaminate other verbal responses. Such verbal behavior may be parasitic on "normal verbal behavior" (and hence, not directly dependent on consquences for maintenance), may be cued by various stimuli (including respiration), and may interfere with other covert and overt behavior. Several studies to investigate this view are presented. It is hoped that such research will lead to a better understanding of the major issues involved in the etiology and treatment of auditory hallucinations in particular and perhaps of psychosis in general.     

Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple-baseline evaluation

Examined the efficacy of an Emotion-focused Cognitive-Behavioral Therapy (ECBT) for six anxious youths ages 7–13 years. All participants had a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia) based on the Anxiety Disorder Interview Schedule for Children—Child and Parent versions. Children and parents reported on anxious symptomatology using the Multidimensional Anxiety Scale for Children (MASC). To assess emotion-related competencies, children were administered the Kusche Affective Interview—Revised and children and parents completed the Emotion Expression Scale for Children (EESC) and Emotion Regulation Checklist (ERC), respectively. Cases began treatment after baselines of 0, 2, or 3 weeks. At posttreatment, the majority of children demonstrated improvements in anxious symptomatology, emotion understanding and regulation skills, and overall functioning. Such improvements in emotion-related skills, in addition to anxiety, are significant given that emotional competence is a crucial component in children's adaptive social functioning and psychological adjustment. These findings provide initial support for ECBT.     

Engaging families in therapy: A pilot study

Engagement is reviewed as a central component of marriage and family therapy and presented as a viable means of assessing the nature and outcome of therapy. A tentative model containing six differentiated engagement categories is described and documented with clinical data and case examples. Conclusions drawn indicate engagement has merit as a construct for evaluating marriage and family therapy and as a means of generating process hypotheses in research. Recommendations to validate, refine and revise the model are posited and further research relative to engagement is advocated.James P. Trotzer, Ph.D. is Professor of Counselor Education at the University of Visconsin-River Falls, River Falls, Wisconsin 54022, marriage and family therapist in private practice     

Intrusive thoughts and auditory hallucinations: a comparative study of intrusions in psychosis

Several theories of auditory hallucinations implicate the involvement of intrusive thoughts and other theories suggest that the interpretation of voices determines the distress associated with them. This study tested the hypotheses that patients who experience auditory hallucinations will experience more intrusive thoughts and be more distressed by them and interpret them as more uncontrollable and unacceptable than the control groups. It also examines whether the interpretation of hallucinations is associated with the distress caused by them and whether there are differences in the way that patients respond to and interpret their thoughts and voices. A questionnaire examining the frequency of intrusive thoughts and the reactions to them was administered to a group of patients with a diagnosis of schizophrenia who experienced auditory hallucinations, a psychiatric control group and a non-patient control group. In addition, the patients in the first group completed a similar questionnaire in relation to their voices. Analyses of covariance showed that patients who experienced auditory hallucinations had more intrusive thoughts than the control groups and that they found their intrusive thoughts more distressing, uncontrollable and unacceptable than the control groups. Correlational analyses revealed that patients' interpretations of their voices were associated with the measures of distress in relation to them. Repeated measures analyses of covariance found no differences between thoughts and voices on the dimensions assessed. The theoretical and clinical implications of these findings are discussed.     

Self-focused attention in schizophrenic patients with and without auditory hallucinations and normal subjects: A comparative study

Self-focused attention has been implicated in a number of psychiatric disorders, but little research has examined this in schizophrenic subjects. In this study, a sample of schizophrenic patients experiencing auditory hallucinations, schizophrenic patients not experiencing auditory hallucinations and normal controls were asked to complete the private self-consciousness subscale of the Self Consciousness Scale. It was found that patients experiencing auditory hallucinations exhibited significantly higher levels of self-focus than those not experiencing hallucinations, although they did not differ from normal subjects. It was also shown that level of self-focus predicted whether or not subjects experienced hallucinations. These results, and their implications, are discussed with reference to the literature.     

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.     

Group-based problem-solving therapy in self-poisoning females: A pilot study

Aims: The treatment of suicidal behaviour remains limited in efficacy. This pilot study assessed the effectiveness of a time-limited, group-based problem-solving therapy intervention compared with a treatment as usual control group, in females who self-poison. Method: A total of 18 clients were equally randomised to treatment or control groups. All clients were assessed using standardised questionnaires for depression, hopelessness, suicidal ideation and social problem-solving skills, at pre-treatment, post-treatment and two months follow-up. Results: The treatment group experienced significant reductions in levels of depression, hopelessness, suicidal ideation and improvements in self-assessed social problem-solving skills. Improvements in mental health and aspects of self-assessed problem-solving skills for the treatment group continued to be evident at two months follow-up. The control group did not change significantly over time on mental health measures or social problem solving abilities. Conclusion: Although limited by small sample size, the results suggest that group-based problem-solving therapy is effective in the management of deliberate self-poisoning. This paper is a unique contribution in that it examines the implementation of problem solving therapy with a homogenous population and in a group format. Methodological concerns and directions for future research are discussed.