Characteristics and effectiveness of stand-alone body image treatments: a review of the empirical literature

This literature review examined the characteristics and effectiveness of treatments dedicated exclusively to body image. A total of 18 studies met selection criteria. All but one involved at least one cognitive-behavioural therapy (CBT) condition and only three compared CBT to another treatment approach. Twelve studies were conducted with non-clinical, body dissatisfied, participants and only one focussed on eating disordered women. Overall, the interventions were highly effective in improving body image and psychological variables and, to a lesser extent, eating attitude and behaviour. Changes were generally maintained at follow-up. Given their efficacy, more controlled trials of stand-alone body image treatments in clinical populations are needed. Investigating approaches other than CBT may open fruitful avenues of body image treatment.     

Chronisches Ersch?pfungssyndrom

The treatment of chronic fatigue syndrome (CFS) may pose a challenge as controversial concepts of its aetiology are discussed. Psychotherapy and graded exercise therapy have been suggested for the treatment of CFS. The aim of the present literature review is to summarize the evidence for these treatments based on two meta-analyses and more recently published randomized controlled trials. There is robust evidence for the efficacy of cognitive-behavioural therapy for CFS, showing moderate effects especially on fatigue severity and physical functioning at post-treatment and at short to medium term follow-up. Other psychological treatments have mainly been tested as control conditions and not as bona fide psychotherapy; however, single trials suggest benefits of non-directive counselling and psycho-education. To further improve treatment results and their maintenance, relapse prevention strategies are important and a stronger empirical foundation of long-term effects is needed.     

A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa

This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a standard behavioural treatment, in the outpatient therapy of patients with anorexia nervosa. The two treatments were also compared with a control treatment procedure consisting of routine outpatient management. Each group consisted of eight subjects. All the groups showed some improvement, but the findings did not provide support for the prediction that cognitive-behavioural treatment, designed specifically to manipulate both attitudes and behaviour, was superior to the other types of treatment. The implications of the findings are considered.     

Efficacy of a psychological treatment for sex offenders

The aims of the present paper are the following: firstly, to describe the psychological treatment administered to sexual offenders in Spain; secondly, to assess the effectiveness of the application of this psychological treatment in the prison of Brians (Barcelona). For this purpose, two equivalent groups were selected: a treatment group of 49 subjects who received the whole treatment program, and an untreated control group of 74 subjects. These groups were selected taking into account various risk factors in order to guarantee group comparability. The main results not only show the efficacy of the cognitive-behavioural program for sexual offenders but also that the effectiveness of this program exceeds the average of similar programs in the meta-analytic reviews performed to date.     

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.     

Cognitive-Behavioural Treatment of School-Refusing Children: Maintenance of improvement at 3- to 5-year follow-up

Although evidence is accumulating on the immediate or short-term efficacy of cognitive-behavioural strategies in the treatment of school refusal, no studies have been reported on the long-term efficacy of this treatment approach. An earlier randomized clinical trial conducted by the authors demonstrated the efficacy of a manual-based cognitive-behavioural treatment program for school refusal relative to waiting list controls. We now report findings of a 3- to 5-year follow-up investigation of the treatment group. In general, results support the long-term efficacy of the treatment program, with children showing maintenance of improvements in school attendance and school adjustment. Methodological limitations of the follow-up investigation are emphasized.     

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.     

Unexplained chest pain: a review of psychological conceptualizations and treatment efficacy

This review critically considers psychological theories and models used to understand unexplained chest pain, and efficacy of treatment strategies. It discusses the strengths and limitations of current perspectives, and highlights implications for future research and interventions. A comprehensive range of literature examining unexplained chest pain, and published over the last three decades, was thus reviewed finding that, although unexplained chest pain has been examined as a psychological phenomenon for over 100 years, explanatory models have emerged only in the last two decades. Neither psychophysiological nor psychodynamic models have been significantly advanced. Only cognitive-behavioural models have been explicitly derived to explain and manage the condition, and require further refinement to address conceptual and methodological limitations. Studies assessing treatment efficacy suggest cognitive-behavioural therapy as a first-line therapy, but have failed to establish whether the approach is acceptable and effective in routine care. Comprehensive psychological understanding of unexplained chest pain, and its management, is therefore developing but is far from complete. Cognitive-behavioural interventions show promise but are likely to be enhanced by greater theoretical clarity and understanding of resistance to their implementation.     

Is there anybody there? A psychodynamic view of panic attack

The effectiveness of cognitive-behavioural therapy is frequently cited when adopting this model as treatment of choice for panic attacks and anxiety disorders. However, Frank (1974), in discussing treatment effectiveness and patient compliance, argues that 'the more closely the conceptual framework of therapy fits that of the patient, the more readily he can accept it' (p. 370). In the following process analysis, my client's clear requirement for an exploratory approach meant that it was a psychodynamic understanding of the complex aetiology of her panic attacks that ultimately produced improved coping skills and a subjective sense of improvement for her. Process analysis has been chosen to illustrate the theoretical base, clinical impact and experiential immediacy of psychodynamic work; attention is drawn to the importance of transference and countertransference experiences in the choice of clinical interventions which tally with the client's sense of internal reality.     

Psychotherapie der Psychosen

In this paper the psychotherapy of patients with schizophrenic, schizoaffective and affective psychoses is outlined. Psychoanalytic, cognitive-behavioural and systemic approaches and their theoretical concepts as well as the therapeutic techniques are de- scribed. The settings of individual, group and family therapy are also presented. A survey of the types of psychoanalytic therapy with their eldest historic roots is given with the development of the various psychodynamic concepts for schizophrenic and affective psychoses including schizoaffective psycho-ses. The different kinds of psychotherapy are compared to each other with respect to the aims. Finally this paper deals with the effectiveness of the therapies and discusses the pros and cons of relatively short randomised controlled trials compared with long term psychotherapies without control groups.     

Hypochondriasis

Hypochondriasis and other syndromes in which health anxiety is prominent are frequently seen in clinical practice and often pose problems of management. In contrast with other anxiety problems, the conceptualization and treatment of health anxiety has developed very little in recent years. Behavioural approaches to treatment have only recently been applied. In the present paper, current theoretical models are critically evaluated and a cognitive-behavioural approach is proposed to account for the development and maintenance of hypochondriacal problems. Principles of cognitive-behavioural treatment based on this approach are outlined, together with some suggestions for research.     

Sexually abused children and post-traumatic stress disorder

Sexually abused children often develop post-traumatic stress disorder, a distressing and debilitating condition that is typically unresponsive to non-directive counselling. Empirically supported abuse-confronting, structured interventions are urgently required for use by counselling psychologists responsible for the management of this challenging clinical population. Given the success of cognitive-behavioural interventions with adult trauma victims, it has been suggested that this treatment approach be applied to sexually abused children. This paper presents a cognitive-behavioural treatment framework comprising two levels of intervention: child therapy and parent training. We selectively review emerging empirical support for the efficacy and acceptability of this treatment approach.     

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).     

The interpretation of negative social events in social phobia: changes during treatment and relationship to outcome

Catastrophic interpretations of negative social events are considered to be an important factor underlying social phobia. This study investigated the extent to which these interpretative biases change during cognitive-behavioural treatment for social phobia, and examined whether within-treatment changes in different types of interpretations predict longer-term treatment outcome. Results showed that treatment was associated with decreases in various types of maladaptive interpretations of negative social events, but that social phobia symptoms 3 months after treatment were independently predicted only by within-treatment reductions in the degree to which individuals personally believed that negative social events were indicative of unfavourable self-characteristics. These findings are discussed in relation to cognitive models of the maintenance of social anxiety, and implications for treatment are considered.     

An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa

The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating.     

Meta-analysis of the Long-Term Treatment Effects of Psychological Interventions in Youth with PTSD Symptoms

To date, the long-term effectiveness of psychological treatments in reducing post-traumatic stress disorder symptoms in children and adolescents has not been investigated extensively. This meta-analysis quantifies the long-term effects of psychological interventions in children and adolescents with PTSD symptoms and examines the period-dependent follow-up (FU) effects based on 47 studies. The mean FU effect sizes (ESs) for PTSD symptoms ranged from medium (between treatment ESs for controlled studies) to large (within treatment ESs for uncontrolled studies; pooled analysis including all studies). These effects were comparable to the post-treatment ESs, which suggests that the treatment effects remained stable. ESs did not differ depending on the length of the FU period (</>6 months). In randomized controlled trials (RCTs), as well as trials conducted with treatment as usual or active control groups, the long-term treatment effects for the reduction of PTSD symptoms were small. These results demonstrate the long-term effectiveness of psychological interventions in the treatment of PTSD in youth. However, more studies should include a FU assessment. Further research should focus on RCTs with long-term assessments, report comorbid symptoms and investigate the influence of potential moderators. Research is also warranted to determine how to improve the long-term effects of treatments for PTSD in youth.     

The Treatment Acceptability/Adherence Scale: Moving Beyond the Assessment of Treatment Effectiveness

It is becoming more broadly recognized that beyond effectiveness, the acceptability of interventions for anxiety disorders is an important consideration for evidence-based practice. Although advances in treatments for anxious psychopathologies have demonstrated that cognitive-behavioural interventions are more desirable than other types of psychotherapy or pharmacotherapy, there continue to be problems with adherence and dropout. It has been suggested that low treatment acceptability may be partially responsible for high dropout rates. Although a number of preliminary investigations in this domain have been conducted, further progress is hampered by the absence of a single self-report measure that assesses both acceptability and anticipated adherence. Therefore, the current paper aimed to test the psychometric properties of the newly developed Treatment Acceptability/Adherence Scale (TAAS). In two studies of brief cognitive-behavioural interventions, the TAAS was administered immediately following the therapy session. In Study 1 (N = 120 non-clinical undergraduates), the therapy included two variants of an exposure-based intervention for contamination fear. In Study 2 (N = 27 individuals with obsessive-compulsive disorder), the therapy was a cognitively based intervention evaluating a novel treatment technique for checking compulsions. Measures of convergent and divergent validity were included. Results demonstrated that the TAAS exhibited sound psychometric properties across the two samples. It is hoped that this measure will help clinicians to predict and intervene when a treatment is not acceptable and/or when the client anticipates poor adherence to it. Furthermore, the TAAS may aid researchers in continuing to improve upon effective interventions for anxiety and related disorders.     

The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice

There is increasing interest in questions about how far the demonstrated efficacy of psychological therapies in research trials can be translated into clinical effectiveness in routine practice. This paper summarises outcome data from several hundred patients treated with CBT in routine clinical practice in a National Health Service psychology service, and compares their outcomes with some of the published research. Although the data have flaws common in ordinary clinical practice (no untreated controls, missing data, uncontrolled pharmacotherapy, etc.), the analyses suggest that CBT in this context is an effective treatment, albeit with probably not quite such good results as it achieves in research trials. Using clinical significance statistics on standardised measures, about half of the sample reliably improved over a course of therapy, including about a third who recovered to normal range.     

Comparison of cognitive-behavioural therapy and psychodynamic therapy in the treatment of anxiety among university students: an effectiveness study

The aim of the present study was to compare the effectiveness of cognitive-behavioural (CBT) and psychodynamic (PDT) therapies in the treatment of anxiety among university students. To this aim, the Symptom Questionnaire (SQ) was completed by 30 students assigned to CBT and by 24 students assigned to PDT, both at the beginning and at the end of treatment. The main problem presented by all patients was anxiety. Except for one sub-scale, we observed significant differences in the scores of all sub-scales and scales of SQ, with lower scores at the end of the therapy, indicating lower distress, regardless of the type of treatment. The present findings suggest that both therapies are effective in the treatment of anxiety among university students.