Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder

Distorted negative self-images and impressions appear to play a key role in maintaining Social Anxiety Disorder (SAD). In previous research, McManus et al. (2009) found that video feedback can help people undergoing cognitive therapy for SAD (CT-SAD) to develop a more realistic impression of how they appear to others, and this was associated with significant improvement in their social anxiety. In this paper we first present new data from 47 patients that confirms the value of video feedback. Ninety-eighty percent of the patients indicated that they came across more favorably than they had predicted after viewing a video of their social interactions. Significant reductions in social anxiety were observed during the following week and these reductions were larger than those observed after control periods. Comparison with our earlier data (McManus et al., 2009) suggests we may have improved the effectiveness of video feedback by refining and developing our procedures over time. The second part of the paper outlines our current strategies for maximizing the impact of video feedback. The strategies have evolved in order to help patients with SAD overcome a range of processing biases that could otherwise make it difficult for them to spot discrepancies between their negative self-imagery and the way they appear on video.     

Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder

In spite of a growth in cognitive conceptualizations of obsessive‐compulsive symptoms, relatively little has been done to extend such concepts to childhood. This study investigated the relationship between responsibility attitudes and obsessive‐compulsive symptoms in normal children. A measure of responsibility attitudes in children was constructed on the basis of Salkovskis' Responsibility Attitudes Scale. This measure (Responsibility Attitudes Scale for Children) was administered together with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory to a sample of two hundred and two 10–14‐year‐old schoolchildren in Iceland. The responsibility measure correlated moderately and similarly with the Leyton Obsessive Inventory Child Version and the Children's Depression Inventory. In a hierarchical regression analysis predicting Leyton Obsessive Inventory Child Version scores, age and gender were entered in the equation first, followed by Children's Depression Inventory scores and, finally, Responsibility Attitudes Scale for Children scores. It was shown that Responsibility Attitudes Scale for Children scores added significantly to the prediction of Leyton Obsessive Inventory Child Version over and above the other variables. It is concluded that the study of the role of responsibility attitudes in children's obsessive‐compulsive symptoms is at least promising.     

The Use of Homework in Cognitive Behavior Therapy: Working with Complex Anxiety and Insomnia

Homework, or self-help, is an essential and required part of cognitive behavioral treatment. It offers several opportunities for the therapist to extend and increase therapy contact by having the patient “live” the therapy outside of the consulting room. It can also serve as a measure of the patient’s motivation for therapy or for change. Homework offers the patient an opportunity to practice what has been developed and discussed in the therapy session. By trying out new behaviors, new ideas, or new emotional responses, the patient can make “real” what has been an abstraction in the therapeutic dialogue. The homework becomes an opportunity for gathering data. Inasmuch as the homework grows “organically” from the session content, it is relevant and timely. Homework provides continuity between sessions. Rather than sessions being discrete moments in time, they are chained together by the homework from the previous session being included in the agenda for the subsequent session. The homework can be structured to involve significant others. This is essential in many therapeutic situations, and having the significant others involved can substantially aid in relapse prevention. Finally, effective homework helps to build therapeutic collaboration and afford the patient the opportunity for building self-efficacy. Using several case examples, this paper describes the functions and impediments to using homework in CBT.     

Development and Evolution of Cognitive Behavior Therapy for Depressed Adolescents

Since the 1980’s cognitive behavior therapy (CBT) has been developed and tested with adolescents experiencing depression. Early studies demonstrated that CBT was more effective than no intervention for young people with depressive symptoms. Beginning in the 1990’s CBT has been proven to be efficacious for adolescents with diagnosed depressive disorders, specifically Major Depressive Disorder (MDD). A series of increasingly challenging and methodologically rigorous trials showed that CBT was an effective intervention for mild to moderate MDD, and enhanced the benefits of anti-depressant medication, even for those adolescents who had already failed to respond to an initial medication. Simultaneously, some limitations of CBT were suggested by these studies. Results of CBT alone were not encouraging with severely depressed adolescents, and the combination of CBT plus medication was not uniformly supported. As CBT investigators worked with more challenging, complex clinical cases, such as depressed adolescents who were abusing substances or engaging in suicidal or self-harm behaviors, standard components of CBT were augmented by increased emphasis placed on emotion regulation, safety planning, and by more intensive outpatient treatment models. Newer developments include “third wave” models, which have shown initial promise.     

Cognitive Behavior Therapy for Women With Generalized Anxiety Disorder in the Perinatal Period: Impact on Problematic Behaviors

Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder among women in the perinatal period (pregnancy to one year postpartum). Recent studies have examined the relationship between problematic behaviors and GAD symptoms. Studies in nonperinatal samples indicate that adults with GAD engage in avoidance and safety behaviors and these behaviors are associated with greater symptom severity. Little research has examined the use of problematic behaviors among pregnant or postpartum women. However, preliminary research suggests that these behaviors may have a negative impact on both anxious women and their children. Our aim was to examine the extent to which women with GAD in pregnancy or the postpartum engage in problematic behaviors and whether cognitive behavioral therapy is effective in reducing these behaviors. Fifty-eight women with GAD in pregnancy or postpartum were recruited from a larger clinical trial (Clinicaltrials.gov ID NCT02850523) evaluating the effectiveness of group-based cognitive behavioral therapy (CBGT) for perinatal anxiety disorders. The results indicated that women with perinatal GAD reported high levels of avoidance and safety behaviors and greater engagement in these behaviors was associated with higher levels of worry and related symptoms. CBGT was effective in reducing GAD symptoms and problematic behaviors and a bidirectional relationship was found between changes in worry and problematic behaviors during treatment. Limitations and future directions are discussed.     

The Importance of Theory in Cognitive Behavior Therapy: A Perspective of Contextual Behavioral Science

For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called “third generation” models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture.     

箱庭疗法缓解初中生考试焦虑的有效性

以18名考试焦虑初中生为被试,采用等组前后测设计,以考察箱庭疗法缓解考试焦虑的效果,并与放松训练进行比较。结果表明:箱庭疗法与放松训练一样能够有效地缓解初中生的考试焦虑情绪,但其干预效果的保持性要优于放松训练。     

Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature

Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.     

Cognitive Behavior Therapy for Older Adults: Practical Guidelines for Adapting Therapy Structure

Cognitive behavioral therapy (CBT) has been shown to be an effective approach for a wide range of problems affecting older adults. While a variety of empirical and clinical papers have examined modifications to the content and delivery of CBT to enhance its efficacy with older adults, changes to the structure of therapy with this population have not been as widely discussed. Issues around optimizing the structure of CBT with older adults are presented, along with suggestions for realizing these changes within a clinical context.     

Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.     

Effects of Cognitive Restructuring Intervention Program of Rational-Emotive Behavior Therapy on Adverse Childhood Stress in Nigeria

This study examined the effects of cognitive restructuring intervention program of rational-emotive behavior therapy on irrational thoughts/behaviors arising from adverse childhood stress in Nigeria. The participants (n = 26) are the identified victims of adverse childhood stress who met the criteria for inclusion through self-report questionnaire. The treatment process is guided by the adverse childhood stress management manual. It consists of 12 weeks of full intervention and 2 weeks of follow-up meetings. The study used repeated measures ANOVA in order to see the improvement of each participant and across control and treatment groups’ thoughts/behaviors after the intervention program. The results show that sex differences do not determine experience of adverse childhood stress. Through cognitive restructuring intervention program of rational-emotive behavior therapy, irrational thoughts/behaviors arising from adverse childhood stress experience were significantly reduced in the treatment group when compared to the control group. Significant improvement was also observed at the end of the intervention of the treatment group. The implication for research and practice were discussed in line with these outcomes. Finally, the study stressed the importance of a follow-up study in Nigeria that would assess irrational beliefs and one or more measures of PTSD symptoms or emotional disturbance.     

Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial

The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n = 85) or direct FtF CBT (n = 88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients’ access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.     

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI_asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI_asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.     

The Death of a Spouse: Using Rational Emotive and Cognitive Behavior Therapy to Cope

This article discusses a personal experience of the death of a spouse. Examples of how rational emotive and cognitive behavior therapy assisted and failed in helping to cope with the diagnosis of a terminal illness, the treatment phase, and following death are addressed.     

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Objective

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method

Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.

Results

Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions

Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.     

Efficacy of Rational Emotive Behavior Therapy on Depression Among Children with Learning Disabilities: Implications for Evaluation in Science Teaching

Journal of Rational-Emotive & Cognitive-Behavior Therapy - Owing to the prevalence of mental health issues among Nigerian in-school children, the effect of Rational Emotive Behavior...     

Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%–50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9–14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.     

Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study

This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient’s perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.