The angry cognitions scale: a new inventory for assessing cognitions in anger

Although cognitive–behavioral therapy is the preferred anger management treatment, research on the cognitive processes associated with anger is relatively sparse. One reason for this has been a lack of adequate measures of the cognitive processes associated with anger. The current study addresses this limitation by developing a theoretically derived instrument to measure the cognitive processes thought to be associated with maladaptive anger. Pilot work identified a set of 72 items written to reflect 5 domains that cut across cognitive theories of anger: overgeneralizing, inflammatory labeling, demandingness, catastrophic evaluation, and misattributing causation. Items were administered to 362 participants and statistical analyses yielded the 54-item Angry Cognitions Scale (ACS). Evidence supporting the construct validity of the ACS was demonstrated through relationships with the experience and expression/control of anger, hostile thoughts, anger consequences, depression and anxiety, and other measures of positive and negative cognitions.     

An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.     

Comparing different boosters of planning interventions on changes in fat consumption in overweight and obese individuals: A randomized controlled trial

Single planning interventions have been found to promote short‐term dietary change. Repeated planning interventions may foster long‐term effects on behavior change. It remains unknown whether there is a critical number of boosters to establish long‐term maintenance of behavioral changes. This study aimed at investigating what social‐cognitive variables mediate the effects of the interventions on dietary behavior change. Overall, 373 participants (n = 270 women, 72.4%; age M = 52.42, SD = 12.79) were randomly allocated to one of five groups: a control group, a single planning group, and three groups with 3, 6, or 9 weeks’ repeated planning interventions. Follow‐ups took place 4, 6, and 12 months after baseline. Change in fat consumption was not promoted by any of the interventions. In terms of social‐cognitive variables, intentions, self‐efficacy and coping planning displayed a time × group interaction, with the 9 weeks’ planning group showing the most beneficial effects. Effect sizes, however, were very small. None of the tested planning interventions successfully promoted change in fat consumption across the 12 month period. This, however, could not be explained by problems with adherence to the intervention protocol. Potential explanations for this unexpected result are discussed.     

Treatment of Depression and Suicide in Older Adults

This article describes a cognitive behavior therapy (CBT) intervention for suicide prevention in older adults. Although many studies have found that CBT interventions are efficacious for reducing depressive symptoms in the elderly, researchers have yet to evaluate the efficacy of such interventions for preventing suicide or reducing suicide risk in older adults. In this article we describe a 12-session CBT protocol for reducing depression, suicide ideation, and other risk factors of late-life suicide. The following aspects of the treatment are described: assessing suicide risk, conceptualizing the problem through a cognitive behavioral framework, developing a safety plan, increasing hope and reasons for living, improving social resources, improving problem-solving skills and efficacy, improving adherence to medical regimen, and relapse prevention. In addition, we review other behavioral and cognitive strategies such as activity scheduling and cognitive restructuring that are commonly associated with CBT interventions for depression. We illustrate the application of these strategies through the use of case examples.     

A Randomized Trial of Cognitive Behaviour Therapy and Cognitive Therapy for Children with Posttraumatic Stress Disorder Following Single-Incident Trauma

The present study compared the efficacy of trauma-focused cognitive behavior therapy (CBT) with trauma-focused cognitive therapy (without exposure; CT) for children and youth with posttraumatic stress disorder (PTSD). Children and youth who had experienced single-incident trauma (N = 33; 7–17 years old) were randomly assigned to receive 9 weeks of either CBT or CT which was administered individually to children and their parents. Intent-to-treat analyses demonstrated that both interventions significantly reduced severity of PTSD, depression, and general anxiety. At posttreatment 65% of CBT and 56% of the CT group no longer met criteria for PTSD. Treatment completers showed a better response (CBT: 91%; CT: 90%), and gains were maintained at 6-month follow-up. Maternal depressive symptoms and unhelpful trauma beliefs moderated children’s outcome. It is concluded that PTSD secondary to single-incident trauma can be successfully treated with trauma-focused cognitive behavioural methods and the use of exposure is not a prerequisite for good outcome.     

Examining the Experience of Undergoing Group Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: An Interpretative Phenomenological Analysis

This study used interpretative phenomenological analysis (IPA) to explore the lived experiences of five individuals diagnosed with obsessive-compulsive disorder (OCD) who underwent a group cognitive behavioral therapy (CBT) intervention program to address their symptoms. Two master themes were identified: experiences and processes of change and reflections on change. For all participants, the degree of group cohesion or connectedness they established with group members emerged as highly important in facilitating therapeutic progress. A number of technical elements of cognitive behavioral therapy (CBT) were also notable therapeutic factors, including questioning/rationalizing maladaptive interpretations about intrusions. However, the commonality of non-specific group processes as key features for subsequent therapeutic change prompts the need for further research in dynamics within CBT group interventions for OCD.     

Exposure to Parental Cigarette Smoking and Child Problem Behaviors: A Longitudinal Study

This study examined exposure to environmental tobacco smoke (ETS), a major public health problem. ETS has been found to be associated with an increased risk of adverse health effects in children. This study utilizes data from a community-based, longitudinal investigation examining the relation between children’s exposure to ETS and later internalizing symptoms and externalizing behaviors. Interviews were administered to a representative community sample of participants from two New York State counties in 1983, with subsequent interviews in 1985–1986, 1992, 1997, and 2002–2003 (when the participants’ mean age was 32). Data was collected on various personality and behavioral characteristics of the participants, and on internalizing symptoms and externalizing behaviors demonstrated by their children. Results indicated that children’s exposure to ETS was associated with an increased risk for both internalizing symptoms and externalizing behaviors. This relationship was maintained despite control on a number of parental psychosocial risk factors (e.g., demographic variables, personality and behavioral attributes) that have been found to be associated with both parental cigarette smoking and behavior problems among children. These data, which indicate an association between exposure to ETS and internalizing symptoms and externalizing behaviors among children, support public health policies to further restrict children’s exposure to ETS.     

An Open Trial of an Acceptance-Based Behavioral Intervention for Weight Loss

Innovative approaches are urgently needed to improve behavioral treatment for weight loss. The weight regain that is so common after treatment may be a result of an environment that makes it challenging to adhere, long-term, to a dietary and physical activity regimen. This study was designed to test, via a 12-week open trial, the preliminary feasibility, acceptability, effectiveness, and possible mechanisms of action of a behavioral treatment that was modified to incorporate acceptance-based therapy components designed to (a) bolster participants’ commitment to behavior change, (b) build distress-tolerance skills, and (c) promote mindful awareness of eating behaviors and goals. Participants (n = 29) were overweight or obese women. Among completers (n = 19; 34% attrition), weight loss averaged 6.6% of body weight at posttreatment and 9.6% at 6-month follow-up (n = 14; 52% attrition). Intention-to-treat weight losses were 4.5% at posttreatment and 6.6% at 6-month follow-up. Psychological variables targeted by the intervention (e.g., cognitive restraint, disinhibition, urge-related eating behavior, emotional eating, eating-related experiential acceptance, mindfulness and motivation) changed in the expected directions, and many of these changes were consistent with decreases in weight loss. Moreover, despite the limitations of the single-group design, this pilot study demonstrated the preliminary feasibility, acceptability, and effectiveness of a novel, acceptance-based behavioral treatment for obesity. One potential implication is that behaviorally based weight loss interventions might be improved by overlaying an acceptance-based framework.     

Chronic Fatigue Syndrome Severity and Depression: The Role of Secondary Beliefs

Chronic fatigue syndrome (CFS) is a poorly understood illness that is characterized by profound and prolonged exhaustion and has no clear pathological marker. This study investigated the role of illness severity and secondary beliefs in depression among a CFS cohort, using the A–B–C framework of Rational Emotive Behavioral Therapy. Empirical research has consistently found that CFS patients tend to hold more negative cognitions about their illness, which could be associated with greater severity and emotional deficits. Specifically, secondary beliefs were explored as a mediating factor; as evidence suggests that secondary beliefs can result in dysfunctional emotions and/or behaviors, such as depression. Furthermore, it is estimated that up to 80% of CFS patients concurrently have depression. There were 156 participants with CFS who completed a questionnaire pack, which included the revised version of the Illness Perception Questionnaire, the Secondary Beliefs Scale (SBS), and the Cardiac Depression Scale. Hierarchical regression analysis revealed that secondary beliefs mediated the relationship between illness severity and depression. Specifically, the approval and comfort subscales of the SBS were significantly associated with depression. The current findings indicated that secondary beliefs could be an important focus in treatment of depression in chronic illness. As the mediating role of secondary beliefs is a new research finding, it is advised that further exploratory research is required.     

Introduction: Using Evidence-Based Cognitive and Behavioral Principles to Improve HIV-Related Psychosocial Interventions

Behavioral interventions have been, and continue to be, a cornerstone of efforts to prevent new HIV infections, as well as to improve the physical and mental health of people living with the virus. Most existing efficacious behavioral interventions, many based on the principles of cognitive behavior therapy, have been developed and disseminated to focus on reducing unprotected sex, given that the HIV epidemic in the United States is primarily facilitated through sexual contact, and improving adherence to life-saving HIV medications. The new wave of behavioral HIV interventions builds on that strong foundation by integrating cognitive and behavioral techniques to ameliorate mental health symptoms, focusing content to be culturally tailored to unique subpopulations, and implementing novel delivery methods (telephone, family-based, etc.). The articles that appear in this special series report on the details of several novel, evidence-based, cognitive behavioral interventions related to HIV prevention or treatment.     

Cognitive-behavioral Strategies for Parkinson’s Disease: A Report of Three Cases

Three patients diagnosed with idiopathic Parkinson’s disease (PD) were treated with cognitive-behavioral therapy (CBT): a 43-year-old woman suffering from depression and social anxiety, a 45-year-old man with sexual problems and maladaptive coping strategies, and a 78-year-old man with freezing of gait. On the basis of functional analyses, interventions were selected, including cognitive methods, social skills training, paradoxical instructions and strategies to improve management of freezing. The interventions were related to improved adaptation to motor impairments and better ability to cope with the disease. These case presentations suggest that CBT can improve quality of life in PD by modifying maladaptive cognitive, emotional and behavioral reactions to the disease and its symptoms.     

Three applications of functional analysis with group dynamic cognitive behavioral group therapy

Case illustrations from group dynamic cognitive behavioral group therapy are presented to demonstrate three applications of functional analysis and the resulting cognitive behavioral interventions. The principles of group dynamic cognitive behavioral group therapy are explained. A functional analysis is applied first to the problem behavior of an individual group member. A clinical case illustrates how the group members help to change this individual group member's behavior from a learning theory perspective. Next, the circular interactional problem behavior between two group members is reduced to the individual functional analysis of each of the two member's problem behaviors. It is then illustrated how the two group member's problem behaviors, as well as feedback from others, contribute toward helping to change each others behavior. The paper concludes that functional analysis and ensuing behavioral interventions can be also applied to group as a whole behavior.     

A Systematic Review of Behavioral Interventions to Reduce Restricted or Repetitive Behavior of Individuals with Visual Impairment

Restricted or repetitive behavior (RRB) is common for individuals with visual impairment (VI), autism spectrum disorder (ASD), and intellectual disability. Previous reviews have suggested that VI may moderate the effectiveness of behavioral interventions to decrease RRB. A search of the single case literature resulted in 30 studies and 40 experiments involving participants with VI to test behavioral interventions to reduce RRBs. Nearly all participants had significant intellectual disability, half were deafblind, and only two had an ASD diagnosis. Success rates were higher for participants with low vision (88.9%) than for participants with blindness (68.4%) and to reduce non-self-injurious behavior (81%) than for self-injurious behavior (68.4%). Although most interventions in this review involved punishment and more research on reinforcement-based interventions is needed, multi-component interventions combining differential reinforcement with brief restraint or specific response contingent on RRB appear to hold the most promise for reducing RRBs for individuals with VI.

     

A randomized controlled trial of an internet-based treatment for chronic headache

Chronic headache is a significant public health problem in Western nations. Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy, most headache sufferers have limited access to these treatments. Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease. This randomized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation, limited biofeedback with autogenic training, and stress management versus a symptom monitoring waitlist control. Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone. Thirty-nine percent of treated individuals showed clinically significant improvement on self-report measures of headache symptoms at post-treatment. At two-month follow-up, 47% of participants maintained improvement. Treatment had a significant impact on general headache symptoms and headache-related disability. There was a 35% within-group reduction of medication usage among the treated subjects. The Internet program was more time-efficient than traditional clinical treatment. Treatment and follow-up dropout rates, 38.1% and 64.8%, respectively, were typical of behavioral self-help studies. This approach to self-management of headache is promising; however, several methodological and ethical challenges need to be addressed.     

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.     

The Association of Externalizing Behavior and Parent–Child Relationships: An Intergenerational Study

We investigated the influence of the child’s behavior on the quality of the mutual parent–child attachment relationships across three generations. We did so using a prospective longitudinal study which spanned 20 years from adolescence through adulthood. Study participants completed in-class questionnaires as students in the East Harlem area of New York City at the first wave and provided follow-up data at 4 additional points in time. 390 participants were included in these analyses; 59% female, 45% African American, and 55% Puerto Rican. Using structural equation modeling, we determined that externalizing behavior in the child was negatively related to the mutual parent–child attachment relationship for two generations of children. We also found continuity in externalizing behavior for the participant over time and from the participant to his/her child. Additionally, we found continuity in the quality of the mutual attachment relationship from the participant’s relationship with his/her parents to the participant’s relationship with his/her child. Finally, the mutual attachment relationship of the participant with his/her parents had a negative association with the participant’s externalizing behavior in adulthood. Based on these results, we propose that family interventions should focus on the role of the child’s externalizing behavior in the context of the parent–child attachment relationship. Furthermore, we suggest that prevention programs should address externalizing behavior as early as possible, as the effects of externalizing behavior in adolescence can persist into adulthood and extend to the next generation.     

The effect of a self-monitored relaxation breathing exercise on male adolescent aggressive behavior

This study sought to contribute to the identification of effective interventions in the area of male adolescent aggressive behavior. Existing research includes both group- and single-case studies implementing treatments which typically include an anger-management component and its attendant relaxation and stress-reduction techniques. The design of this study was single-subject with multiple baselines across 6 subjects on 2 behavioral measures. The setting was a residential juvenile justice program for male adolescents, and the treatment was a relaxation breathing exercise. The results of the study were mixed, with improvement on both behavioral measures in 2 of the 6 participants.     

The Freudian Antecedents of Cognitive–Behavioral Therapy

The writings of Sigmund Freud are reviewed, showing the similarities of many of his concepts with those of cognitive–behavioral therapy (CBT). Automatic thoughts, core beliefs, and the desire to please the therapist are shown to have parallels in Freud's ideas about involuntary thoughts, the preconsdous, the unconscious, and transference. Similarities in technique are noted, especially in light of Freud's original ideas about suggestion and influence as well as latter-day discoveries regarding Freud's actual practices. In certain ways, CBT is closer to Freud than is classical psychoanalysis. A brief history of the attempts to integrate behaviorism with Freud is given, showing how Freud's objectifying of dream reports presaged the viewing of verbal reports as behavior. Other developments in cognitive psychology are also discussed with regards to Freud's ideas about information processing and the production of memories.     

Improving cognitive therapy for depression with functional analytic psychotherapy: Theory and case study

A behavioral reconceptualization of cognitive therapy is presented to illustrate that clinical behavior analysis (CBA) has much to offer traditional cognitive behavior therapy. Particular attention is given to the distinction between cognitive structures and products and the theoretical dilemma facing cognitive therapists when they attempt to devise interventions aimed at changing nonbehavioral entities. The distinction between rule-governed and contingency-shaped behavior and the implications of functional analytic psychotherapy (Kohlenberg & Tsai, 1991) are used to resolve the dilemma and to suggest methods for enhancing cognitive therapy. In a case study, a CBA-enhanced version of cognitive therapy was introduced after 7 weeks of standard cognitive treatment for a 35-year-old depressed male. The client-therapist relationship provided opportunities during the therapy session for learning new behavior called for in the behaviorally reconceptualized cognitive therapy. The enhanced treatment improved clinical efficacy and increased the client's focus on his deficits in interpersonal repertoires. Because the present case study involved only one of several enhancements suggested by CBA, the possibility of increased efficacy from a more comprehensive application is discussed.