A Special Feature in Commemoration of Aaron T. Beck’s Contributions to the Science and Practice of CBT

This special feature in Cognitive and Behavioral Practice is a commemoration to Aaron T. Beck’s contributions to the science and practice of CBT. The fact that so many leading scholars participated, including several Past Presidents of the Association for Behavioral and Cognitive Therapies, speaks volumes about the high regard held for Beck. Included are papers that cover the Beckian model of depression, its refinement and application to obsessions, compulsions, hoarding, as well as how the model addresses interpretational biases in emotional psychopathology and has been adapted for youth. Additionally there are papers conveying how Beck’s phenomenological approach to understanding the client’s perspective is useful in attending to cultural differences, and in mitigating the mental health impact of marginalization and discrimination. Expert commentaries are extended to relational processes (case formulation, therapeutic relationship, collaboration and guided discovery, alliance, rupture repair, homework), change processes (cognitive reappraisal, dialectical thinking, acceptance and defusion, emotional schemas), and to important scientific advances (conceptualizing processes within techniques, data analytic advances that bridge the scientist-practitioner gap, and technology augmentation). Many of the contributions herein also include brief personal stories to help illustrate the enormity of Beck’s contributions.     

Can a Single Measure Estimate Protocol Adherence for Two Psychosocial Treatments for Youth Anxiety Delivered in Community Mental Health Settings?

Treatment adherence measurement can be time and resource-intensive in clinical trials, so the ability to measure protocol adherence for two distinct treatment programs with a single measure may benefit the field. The present study sought to determine if the Therapy Process Observational Coding System – Revised Strategies Scale (TPOCS-RS) could assess protocol adherence to two youth treatment programs. Treatment sessions (N = 796) from 55 youth (M age = 9.89 years, SD = 1.71; range 7–15 years; 55.0% White; 46.0% female) with primary anxiety problems treatment by 39 clinicians (M age = 40.54 years, SD = 9.56; 50.0% White; 80.0% female) were independently scored by coders using observational treatment adherence and alliance measures. The youth received one of three treatments: (a) Standard (i.e., cognitive-behavioral treatment program), (b) Modular (i.e., a program with cognitive-behavioral and parent training components), or (c) Usual Care. Consultants filled out a self-report measure of protocol adherence within the Standard and Modular conditions. Interrater reliability, ICC(2,2) for the various items for the full sample ranged from .17 to .92 (M ICC = .67; SD = .17). Scores from a TPOCS-RS subscale that mapped onto the specific content of the treatment protocols used in the Standard and Modular conditions evidenced convergent validity with the consultant-report adherence measure and discriminant validity with the alliance measure. The model-specific TPOCS-RS subscales also discriminated between the Standard and Modular treatments and Usual Care. This study provides initial evidence that (a) the TPOCS-RS has utility in estimating protocol adherence in different treatment programs and (b) support the score validity of the self-report consultation records.     

Treating Youth Depression and Anxiety: A Randomised Controlled Trial Examining the Efficacy of Computerised versus Face‐to‐face Cognitive Behaviour Therapy

Barriers to accessing psychologists for the treatment of depression and anxiety include a shortage of specialised therapists, long waiting lists, and the affordability of therapy. This study examined the efficacy of a computerised‐based self‐help program (MoodGYM) delivered in‐conjunction with face‐to‐face cognitive behavioural therapy (CBT) to expand the delivery avenues of psychological treatment for young adults (aged 18–25 years). Eighty‐nine participants suffering from depression and/or generalised anxiety were randomly allocated to a control intervention or to one of three experimental groups: receiving face‐to‐face CBT, receiving computerised CBT (cCBT), or receiving treatment in‐conjunction (face‐to‐face CBT and cCBT). While MoodGYM did not significantly decrease depression in comparison to the control group, significant decreases were found for anxiety. MoodGYM delivered in‐conjunction with face‐to‐face CBT is more effective in treating symptoms of depression and anxiety compared with standalone face‐to‐face or cCBT. This study suggests that for youth who are unable to access face‐to‐face therapy—such as those in rural or remote regions, or for communities in which there is stigma attached to seeking help—computerised therapy may be a viable option. This is an important finding, especially in light of the current capacity‐to‐treat and accessibility problems faced by youth when seeking treatment for depression and/or anxiety.     

The Beck Anxiety Inventory in nonclinical samples: Initial psychometric properties

The Beck Anxiety Inventory (BAI) was recently developed to assess clinical anxiety. Because one of its main features is a focus upon physiological sequelae of anxiety, the inventory may prove useful in nonclinical samples as well. The current paper provides initial psychometric properties with a nonclinical sample. Two studies are presented. The first presents scores and factor structure. A five factor solution was obtained, with one subjective and four somatic factors accounting for approximately 60% of the variance. The second study utilizes the total and factor scores to assess concordance with physiological responding. The total BAI correlated moderately with several physiological domains and with subjective distress. Factor scores were not consistently correlated with corresponding physiological domains. When subjects were divided into high- and low-anxiety groups, the relationships between self-report and physiological response increased in subjects with higher levels of anxiety. Results are discussed in terms of comparing clinical and nonclinical findings, use of the BAI in nonclinical samples, and future research.This research was supported in part by a grant to the first author from the Commission on Academic Excellence, University of Louisville.     

Treatment Outcome Studies With Children: Principles of Proper Practice

This article addresses ethical issues in conducting randomized clinical trials (RCTs) with youth. Ethical considerations that occur prior to treatment (matters of research design, the risk–benefit ratio, issues concerning assent/consent, the influence of payment for participation), during treatment (issues of privacy, protocol adherence, premature termination), and following treatment (needs for posttreatment referrals and/or follow-up contacts, archiving of treatment data) are reviewed. Recommendations, based on empirical evidence and clinical experience, are offered for conducting ethical treatment research with youth and future directions for carrying out research on the ethics of conducting RCTs with youth are offered.