Nine Experts Describe the Essence of Rational-Emotive Therapy While Standing on One Foot

The purpose of this study was to determine the extent of agreement among a panel of rational-emotive therapy (RET) experts about the essence of RET. The panel of experts consisted of the 9 members of The International Training Standards and Review Committee of the Institute for Rational-Emotive Therapy in New York. The question that the experts were asked was an adaptation of a Talmudic story known in Jewish lore as “While Standing on One Foot.” Responses were assigned to either of 2 categories: general cognitive behavior therapy (CBT) or RET-specific. There seems to be a range of responses that capture the essence of RET. A strong case can be made for subsuming many aspects of CBT under RET because much of what is associated with CBT has its origins in RET. The confusion about where RET ends and general CBT begins goes to the very heart of RET's status today.     

NINE EXPERTS DESCRIBE THE ESSENCE OF RATIONAL-EMOTIVE THERAPY WHILE STANDING ON ONE FOOT

The purpose of this study was to determine the extent of agreement among a panel of rational-emotive therapy (RET) experts about the essence of RET. The panel of experts consisted of the 9 members of The International Training Standards and Review Committee of the Institute for Rational-Emotive Therapy in New York. The question that the experts were asked was an adaptation of a Talmudic story known in Jewish lore as “While Standing on One Foot.” Responses were assigned to either of 2 categories: general cognitive behavior therapy (CBT) or RET-specific. There seems to be a range of responses that capture the essence of RET. A strong case can be made for subsuming many aspects of CBT under RET because much of what is associated with CBT has its origins in RET. The confusion about where RET ends and general CBT begins goes to the very heart of RET’s status today. Reprinted from Journal of Counseling & Development, March/April 1996, Volume 74. ACA. Reprinted with permission. No further reproduction authorized without written permission from the American Counseling Association. Stephen G. Weinrach, who maintained a private practice in Havertown, Pennsylvania, was a professor of counseling and human relations at Villanova University, Villanova, Pennsylvania, and a Fellow of the Institute for Rational-Emotive Therapy in New York. The author was grateful to Michael Bernard, Raymond DiGiuseppe, Windy Dryden, Albert Ellis, Howard Kassinove, G. Barry Morris, Ann Vernon, and Janet Wolfe for their responses on which this article was based. The author expressed particular appreciation to Martin Gerstein, Jeffrey K. Messing, Ellen Finkelstein, Joanne Christopher, and Colleen Deeter, who provided valuable editorial assistance. Raymond DiGiuseppe and Windy Dryden made the publication of this study possible through their generous assistance and incisive knowledge of rational-emotive therapy.     

First-Order and Second-Order Change in Rational-Emotive Therapy: A Reply to Lyddon

Lyddon (1990) claimed that rational-emotive therapy (RET) and other kinds of cognitive-behavior therapy (CBT) are in “the rationalist camp,” are realistic rather than constructivist, and focus on the elimination of emotional responses to irrational cognitions. His allegations about CBT practices are questionable, and he ignores the fact that RET is not merely realistic and empirical in disputing clients' irrational beliefs but is in several respects one of the most constructivist of the psychotherapies.     

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.     

Cognitive Barriers to Successful Weight Management: 7 Stymie Beasts

This paper focuses on one of the most significant barriers, especially for teenagers and their families, to the effectiveness of cognitive behavioral therapy (CBT) for weight management: high rates of attrition. Cognitive barriers contribute to attrition and to decreasing commitment to full engagement in the process (deliberate practice). Excuses capture the essence of one type of those cognitive barriers. Excuses are defined as shifts in attribution from self-focused causes of struggles to achieve goals to more externally-focused causes—resulting in decreasing full engagement. Those excuses (shifts in attribution) do not just happen. People make decisions to implement those shifts away from personal responsibility. Ten cognitive biases lie at the heart of such problematic delusional decision making. This paper identifies seven excuses created by that biased decision making as anthropomorphisms called Stymie Beasts. Such unique simply worded visually distinctive creatures may help improve recall and focus on these powerful antagonists to successful weight control. Then, the use of two CBT techniques, Therapeutic Understanding of Science (TUS) and Rational Emotive Therapy (RET), illustrated with examples for all seven Stymie Beasts, shows how CBT may prevent and dismantle those Beasts (excuses). Ideas for future research using randomized controlled trials to test these notions are also presented.     

Evaluating the Effectiveness of a Group CBT for Parents of ADHD Children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26–58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and 3-month follow-up. Data were analysed using 2?×?3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children.     

Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to “enhance” treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.     

A Nonrandomized Effectiveness Comparison of Broad-Spectrum Group CBT to Individual CBT for Depressed Outpatients in a Community Mental Health Setting

Controlled trials have established the efficacy of cognitive-behavior therapy (CBT) for depression. However, the relative effectiveness of individual versus group treatment formats in real-world settings is less well established. The current study evaluated the effectiveness of group CBT (n = 157) compared to individual CBT (n = 77) for depressed outpatients in a naturalistic setting. Symptom improvements for depression, anxiety, and quality of life were compared between treatment formats in intent-to-treat and completer analyses. Effect sizes and rates of recovery were examined. Results showed that both individual and group CBT were effective, even in the presence of high levels of comorbidity. Whereas individual CBT was associated with larger effect sizes and significantly higher rates of recovery, group CBT compared favorably to outcomes established by past research. A broad-spectrum group CBT program may be a viable treatment option when depression symptoms are less severe and when this format of treatment delivery is desirable.     

Cognitive-Behavioral Body-Image Therapy: Extended Evidence of the Efficacy of a Self-Directed Program

Scientific investigations support the effectiveness of cognitive-behavioral therapy (CBT) in the treatment of body dissatisfaction across a range of populations. Grant and Cash (1995) used CBT with 23 extremely body-dissatisfied women and found equivalent and successful outcomes for body-image CBT administered in group therapy versus a self-directed format with only modest therapist contact. The present study compared Grant and Cash's data with those of an equally body-dissatisfied sample (n = 12) treated via Cash's (1995) CBT self-help book administered with minimal professional contact. The latter program produced significant improvements in body image and adjustment, without changes in body weight. Outcomes and levels of compliance were equivalent to those that Grant and Cash had found under conditions involving greater degrees of professional contact. The study's limitations and its scientific, clinical, and ethical implications for the use of body-image CBT are discussed.     

Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: results from a randomized controlled trial

Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to conventional antipsychotic medication were randomized to CBT or befriending. They were assessed using the Comprehensive Psychopathological Rating Scale, including a rating of suicidal ideation at baseline, post intervention, and after 9 months. Post-hoc analysis revealed that CBT provided significant reductions in suicidal ideation at the end of therapy, and sustained at the follow-up. Further research is required to substantiate these findings and determine the process and mechanisms through which this reduction is achieved.     

An evaluation of the effectiveness of Diploma-level training in cognitive behaviour therapy

Background

As part of the UK government’s initiative to Increase Access to Psychological Therapies (see http://www.iapt.nhs.uk/for full details of the IAPT programme) there has been an expansion in the provision of post-graduate Diploma training in cognitive behaviour therapy (CBT). Previous evaluations of such training programmes have yielded mixed results but have been limited by small sample sizes and/or limited assessment measures.

Aims

To evaluate the impact of a long-standing Diploma in CBT training programme on a variety of measures of CBT competence.

Method

Trainees’ levels of CBT skill are compared at the beginning and end of CBT training. The effect of therapist factors such as age, professional background and gender on the development of CBT competence is also examined.

Results

Results show that trainees demonstrate higher levels of CBT skills after completing the training than they did before, with the majority achieving pre-determined criteria for competence. Trainees’ gender was not related to their performance but trainees’ age showed a negative association with CBT skill (older trainees performed worse). Trainees’ professional background also had an impact on their level of CBT competence, with trainees who were clinical psychologists demonstrating the highest levels of competence across a range of measures.

Conclusions

CBT Diploma training leads to increases in the level of trainees’ CBT competence, with the majority achieving the levels demonstrated in research trials by the end of training. Thus, this training is likely to lead to improved outcomes for patients. Further research is needed to determine the most efficient ways of enhancing CBT skills.     

Randomized,placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive–compulsive disorder

Background

To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive–compulsive disorder (OCD).

Methods

Forty-seven children and adolescents with OCD (Range = 7–17 years) were randomized to 18-weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline, weeks 1–9, 13, and 17, and post-treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive–Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale–Parent/Child, Children's Depression Rating Scale-Revised, Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity.

Results

All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable.

Conclusions

Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT.

ClinicalTrials.gov Identifier

NCT00382291.     

Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy

Internet based cognitive behavioural therapy (CBT) is efficacious for the treatment of anxiety and depression. The current study aimed to examine the effectiveness of internet based CBT prescribed by primary care clinicians for the treatment of depression and generalised anxiety disorder. Psychological distress data from 302 patients who completed an online CBT course for depression and 361 patients who completed an online CBT course for generalised anxiety disorder were subjected to growth mixture analysis. For both disorders psychological distress decreased across each lesson in a quadratic trend. Two classes of individuals were identified with different trajectories of change: a large group of individuals who responded well to the courses and a smaller group of individuals with a lower response. Both groups were similar with respect to socio-demographic characteristics however the Low Responders tended to have higher levels of symptom severity and psychological distress at baseline in comparison to the responders. For the majority of patients (75-80%) the internet CBT courses for depression and generalised anxiety disorder were effective. Further research is required to identify and effectively treat the smaller proportion of patients who did not improve during internet CBT.     

Implementation of the Wolverine Mental Health Program,Part 2: Implementation Phase

To enhance mental health care for youth in a midwestern residential treatment facility, Wolverine Human Services partnered with the Beck Institute (an intermediary) and an implementation research team to implement cognitive-behavioral therapy (CBT). CBT has strong evidence supporting effectiveness for treating youth internalizing and externalizing problems, but it is a complex psychosocial intervention that demands a thoughtful implementation approach. This study outlines the implementation phase (2.5 years) of a 5-year collaborative effort. The implementation phase focused on (a) adapting CBT to fit the complex youth needs and the roles of the multidisciplinary team members resulting in a new comprehensive and coordinated care model, and (b) the strategies utilized to support its competent integration by all team members. Six blended implementation strategies were deployed in this phase: forging implementation teams, installing progress monitoring, adapting CBT, training, providing supervision and consultation, and training the trainers. A components-based approach to CBT yielded six core skills: active listening, problem solving, mood monitoring and intervention mapping, activity scheduling, distress tolerance, and cognitive restructuring. By the end of this phase, all staff had robust exposure to and experience with the adapted form of CBT. The work of our academic–community partnership has both research and clinical implications, with respect to integrating an adapted version of CBT for residential environments (CBT-RE).     

Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session.Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment.These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach.This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.     

Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment

The central public health challenge in the management of seasonal affective disorder (SAD) is prevention of depression recurrence each fall/winter season. The need for time-limited treatments with enduring effects is underscored by questionable long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year. We previously developed a SAD-tailored group cognitive-behavioral therapy (CBT) and tested its acute efficacy in 2 pilot studies. Here, we report an intent-to-treat (ITT) analysis of outcomes during the subsequent winter season (i.e., approximately 1 year after acute treatment) using participants randomized to CBT, light therapy, and combination treatment across our pilot studies (N = 69). We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment, were withdrawn from protocol, or were lost to follow-up. The CBT (7.0%) and combination treatment (5.5%) groups had significantly smaller proportions of winter depression recurrences than the light therapy group (36.7%). CBT alone, but not combination treatment, was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone. Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy. If these findings are replicated, CBT could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy.     

Effectiveness of cognitive-behavioral therapy for adolescent depression: a benchmarking investigation

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.     

Brief cognitive-behavioral phone-based intervention targeting anxiety about the threat of attack: a pilot study

A brief, cognitive-behavioral, phone-based intervention was employed with an Israeli sample experiencing anticipatory anxiety about potential war-related attacks. In this quasi-experimental controlled pilot study, the cognitive-behavioral therapy intervention (diaphragmatic breathing and a modified cognitive-restructuring technique) was compared with the standard hotline care administered when worried citizens called a mental health emergency hotline in Israel. Individuals (n=32) were administered anxiety and worry measures pre-intervention, post-intervention, and three days post-intervention. The results indicated that anxiety levels decreased for the experimental and control group immediately post-intervention; however, three days later, the levels of anxiety in the CBT group continued to decline, while anxiety levels in the control group reached pre-intervention levels on two of the three outcome measures. These results suggest that CBT can be effectively delivered by paraprofessionals over the phone, which is cost-effective and efficient. Limitations are considered, and implications for treating individuals coping with the threat of terrorism are discussed.