Effects of a Cognitive-Behavioral Self-Help Program on Depressed Mood for People with Peripheral Arterial Disease

The aim of the present study was to examine whether a new low-cost psychological self-help intervention program with minimal coaching could be effective in improving depressed mood in people with peripheral arterial disease (PAD). Thirteen persons with PAD and depressive symptoms participated in the self-help program, grounded in cognitive-behavioral therapy. They completed pre-test, post-test and follow-up questionnaires, including the PHQ-9, to measure symptoms of depression. To evaluate changes in depression scores from pre- to post-test to follow-up measurement, non-parametric repeated measures Wilcoxon signed rank tests were performed. The results showed that participants’ depression scores significantly improved from pre-test to post-test and that there was no relapse from post-test to follow-up. The cognitive-behavioral self-help intervention could be an effective tool in people with PAD, to reduce symptoms of depression.     

Self-Administered Treatments of Public Speaking Anxiety

This article reports on two do-it-yourself treatment programs for dealing with stage fright. One program followed a systematic desensitization paradigm; the other was a handout listing 16 strategies for understanding stage fright.     

A Self-Modeling Intervention for High School Students with Public Speaking Anxiety

ABSTRACT

The study investigated the effectiveness of self-modeling as an intervention for public speaking anxiety. The participants were six high school students with elevated levels of self-reported public speaking anxiety. Students presented public speeches to randomly selected peer audiences. Direct observations measured the behavioral manifestations of public speaking anxiety. In the intervention phase, students viewed self-modeling videotapes that were edited to remove speech dysfluencies and behavioral symptoms of speech anxiety. The self-modeling tapes depicted only adaptive, exemplary behavior with an edited-in audience feature making it appear that the students were producing a fluent speech to an audience of their peers. All of the participants evidenced substantial decreases in behavioral symptoms of speech anxiety and these changes were maintained throughout follow-up. The range of the participants' effect sizes was 2.7 to 4.9. Self-report measures of state anxiety and confidence as a speaker were used to assess additional effects of treatment. For all participants, there were also substantial decreases in self-reported public speaking anxiety and state anxiety from baseline to follow-up. A post-treatment interview revealed high social validity and self-reported generalization of treatment.     

A Brief,Early Cognitive-Behavioral Program for Cancer-Related PTSD,Anxiety, and Comorbid Depression

Depression and anxiety disorders, including PTSD, are highly prevalent and frequently co-occur in newly diagnosed head and neck cancer (HNC) patients, as well as in longer-term survivors. There is, however, scant empirical evidence to inform clinicians how to best treat distressed HNC patients, particularly in the initial months following their diagnosis. The present article describes the development of a brief, early cognitive-behavioral intervention (the HNC-CBT program) in treating cancer-related PTSD and/or comorbid anxiety and depressive disorders in recently diagnosed HNC patients. The program was developed to be implemented concurrently with patients’ medical treatment(s) to help individuals manage their acute anxiety and PTSD reactions, as well as prevent chronic psychopathology in the postmedical treatment recovery phase. A case study is also presented to illustrate how to apply this intervention with clinically distressed HNC patients. Feasibility issues are also discussed in the implementation of this program during the course of medical treatment.     

Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking

Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.     

Development of a Cognitive-Behavioral Intervention Program to Treat Anxiety and Social Deficits in Teens with High-Functioning Autism

Anxiety is a common co-occurring problem among young people with autism spectrum disorders (ASD). Characterized by deficits in social interaction, communication problems, and stereotyped behavior and restricted interests, this group of disorders is more prevalent than previously realized. When present, anxiety may compound the social deficits of young people with ASD. Given the additional disability and common co-occurrence of anxiety in ASD, we developed a manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD [Multimodal Anxiety and Social Skills Intervention: MASSI]. In this paper, we describe the foundation, content, and development of MASSI. We also summarize data on treatment feasibility based on a pilot study that implemented the intervention.     

Effects of Public Speaking Trait Anxiety and Intensity of Speaking Task on Heart Rate During Performance

The extant research examining the relationship between public speaking trait anxiety and heart rate has produced mixed findings. Some studies observe only weak relationships, whereas others report significant relationships between these variables. H. J. Eysetick has maintained that the degree of relationship between traits and heart rate depends on the stress levels under which the respondents perform when heart rate data are collected. An inspection of the existing studies shows that, consistent with Eysenck's observation, the studies reporting relationships between public speaking trait anxiety and heart rate were conducted under relatively low-intensity conditions in comparison to those reporting no such relationships. In the present study, heart rates of both anxious and nonanxious speakers were measured under both high- and low-intensity conditions. Results indicated that (a) heart rates of anxious speakers were significantly higher than those of nonanxious speakers when both performed under low-intensity conditions, but (b) heart rates were not different for anxious and nonanxious speakers when performing in high-intensity environments. These results provide a reconciliation of the inconsistent research findings and partially support the extension of Eysenck's conceptualization to communication apprehension theory and research.     

Cognitive-Behavioral Treatment of Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) can be treated effectively with cognitive-behavioral therapy. When working with clients who have GAD, therapy can focus on four central areas that help to promote therapeutic change. The initial focus of therapy is on developing a sound therapeutic alliance and educating the client about anxiety symptoms. Skills training focuses on relaxation training and cognitive changes that can help clients confront their worries in a constructive manner. Then, exposure to internal and external aspects of the anxiety can help clients test and refine their coping skills. Finally, because of the chronic nature of GAD, relapse prevention strategies can be used to help maintain treatment gains over time. These strategies allow a broad but flexible treatment plan that can be adapted to the unique needs of each individual client.     

Cognitive-Behavioral Strategies and Precompetitive Anxiety Among Recreational Athletes

The Psychological Record - Although cognitive-behavioral strategies have been demonstrated relatively effective in improving sport performance and regulating various affective states among highly...     

A Rumination-Focused Cognitive-Behavioral Therapy Self-Help Program to Reduce Depressive Rumination in High-Ruminating Japanese Female University Students: A Case Series Study

The present case series reports the preliminary test of a rumination-focused cognitive-behavioral therapy (RFCBT) self-help program to reduce depressive rumination among Japanese female undergraduates. A workbook-type self-help program based on RFCBT was implemented with 39 participants showing a high tendency toward rumination/worry. Data from 30 participants who completed one or more modules were analyzed quantitatively. The results showed significant reductions of rumination, worry, and anxiety at post-intervention. Further, semistructured interviews were conducted with 13 participants who completed the program, and verbatim data were examined using content analysis. The contents found to be useful and difficult differed for each participant and each module. Based on these results, the future implementation and dissemination of RFCBT is discussed.     

Adult Asperger Syndrome and the Utility of Cognitive-Behavioral Therapy

Asperger syndrome (AS) is a developmental disorder that was first recognized in the United States in 1994 with the publication of DSM-IV (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 1994). As a relatively new concept to the United States, both within the professional community and public awareness, the diagnosis has most often applied to children, but there is a large cohort of affected adults who have never been diagnosed or properly treated. Many of these individuals are now seeking treatment for the symptoms of AS and/or comorbid mental health problems (e.g., mood and anxiety disorders). Clinicians are in need of practical and evidence-based interventions to address the problems presented by this growing patient population, but there are few such resources available. This article will present a framework for conceptualizing the mental health needs of adults with AS, using the evidence-based approaches found in the cognitive-behavior therapy (CBT) literature to inform treatment.     

Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients With Depression and Anxiety

Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention.     

SPECIAL SERIES: Intensive Cognitive-Behavioral Treatments for Child and Adolescent Anxiety Disorders

Cognitive-behavioral treatments are efficacious intervention choices for anxious youth, yet the lack of access to and usage of evidence-based treatments outside of a research context continues to challenge efforts to disseminate and implement such interventions. One potential avenue for reconciling effective care and that most readily accessed by children and their families may be to offer treatment in an intensive format, typically consisting of a more concentrated dose of cognitive-behavioral treatment components. This special series in Cognitive and Behavioral Practice aims to explore the evolution of intensive cognitive-behavioral treatments currently under investigation across a variety of child and adolescent anxiety disorder populations, including specific phobias, obsessive-compulsive disorder, separation anxiety disorder, school refusal, and panic disorder. In addition to delineating the research support to date for intensive cognitive-behavioral treatment among children and adolescents with anxiety disorders, the articles included in this series provide detail on the application of each intensive intervention, highlight innovative treatment elements, and explore clinical and systematic issues unique to an abbreviated treatment format.     

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.     

Using Retrieval Cues to Attenuate Return of Fear in Individuals With Public Speaking Anxiety

Even after successful exposure, relapse is not uncommon. Based on the retrieval model of fear extinction (e.g., Vervliet, Craske, & Hermans, 2013), return of fear can occur after exposure due to an elapse of time (spontaneous recovery) or change in context (contextual renewal). The use of external salient stimuli presented throughout extinction (i.e., retrieval cues [RCs]) has been suggested as a potential solution to this problem (Bouton, 2002). The current study examined whether RCs attenuated return of fear in individuals with public speaking anxiety. Sixty-five participants completed a brief exposure while presented with two RC stimuli aimed at a variety of senses (visual, tactile, olfactory, and auditory). Later, half the participants were tested for return of fear in a context different from the exposure context, and the other half in the same context. Half of each context group were presented with the same cues as in exposure, while the other half were not. Return of fear due to an elapse of time, change in context, and effects of RCs were evaluated on subjective, behavioral, and physiological measures of anxiety. Although contextual renewal was not observed, results supported effects of RCs in reducing spontaneous recovery on behavioral and physiological measures of anxiety. There was also evidence that participants who were reminded of feeling anxious during exposure by the RCs benefited more from using them at follow-up, whereas those who perceived the cues as comforting (safety signals) benefited less. Clinical implications of the findings are discussed.     

Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group

There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from .74 to .79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.     

Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety

Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children’s treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre- to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method—in-person CCBT versus parent-mediated bibliotherapy—influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.     

Therapist Awareness of Client Resistance in Cognitive-Behavioral Therapy for Generalized Anxiety Disorder

Clients' resistance relates negatively to their retention and outcomes in psychotherapy; thus, it has been increasingly identified as a key process marker in both research and practice. This study compared therapists' postsession ratings of resistance with those of trained observers in the context of 40 therapist–client dyads receiving 15 sessions of cognitive-behavioral therapy for generalized anxiety disorder. Therapist and observer ratings were then examined as correlates of proximal (therapeutic alliance quality and homework compliance) and distal (posttreatment worry severity) outcomes. Although there was reasonable concordance between rater perspectives, observer ratings were highly and consistently related to both proximal and distal outcomes, while therapist ratings were not. These findings underscore the need to enhance therapists' proficiency in identifying important and often covert in-session clinical phenomena such as the cues reflecting resistance and noncollaboration.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.