Cognitive behavior therapy for driving fear: A pilot randomized controlled trial

Fear of driving is common in clinical practice, while its treatment programs are understudied. This is the first randomized controlled trial to evaluate a newly developed protocol for cognitive behavior therapy (CBT) for driving fear compared with a wait list and to use specific assessment scales. 34 participants (30 women, 4 men) in an outpatient psychotherapy clinic were randomly allocated to either 18 sessions of CBT or a wait list (n = 17 each). After treatment, CBT was significantly more efficacious than the wait list with large effect sizes on the Instrument for Fear of Driving (IFD) (Cohen’s d = 2.58) and on the Driving Cognitions Questionnaire (DCQ) (Cohen’s d = 2.14). Driving fear is a condition treatable by CBT and the suggested protocol is safe, feasible and acceptable. Further studies with larger samples and active controls (e.g., virtual reality therapy) are required to draw generalizable conclusions on effect sizes.     

Conducting analysis after September 11: implications for psychoanalytic technique

The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the population of New York City, including analysts and analysands. To study the effect of this event on the technique of psychoanalysts conducting ongoing analysis during the weeks after 9/11, confidential questionnaires were sent to all candidates and faculty at the Columbia University Center for Psychoanalytic Training and Research. Respondents indicated that in the days and weeks following 9/11 they initiated phone calls to their analysands, asked about their analysands' families, gave advice when it was requested, offered reassurance, and answered personal questions. They did not initiate physical contact, discontinue use of the couch, or give unsolicited advice. These responses suggest that these analysts made decisions to alter their technique in certain ways in the wake of a catastrophic event shared by the community.     

Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying

This controlled clinical trial tested virtual reality exposure (VRE) therapy for the fear of flying (FOF), a relatively new and innovative way to do exposure therapy, and compared it to standard (in vivo) exposure therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world.     

Consequences for road traffic fatalities of the reduction in flying following September 11, 2001

Gigerenzer [Gigerenzer, G. (2004). Dread risk, September 11, and fatal traffic accidents. Psychological Science, 15, 286–287] argued that the increased fear of flying in the U.S. after September 11 resulted in a partial shift from flying to driving on rural interstate highways, with a consequent increase of 353 road traffic fatalities for October through December 2001. We reevaluated the consequences of September 11 by utilizing the trends in road traffic fatalities from 2000 to 2001 for January through August. We also examined which road types and traffic participants contributed most to the increased road fatalities. We conclude that (1) the partial modal shift after September 11 resulted in 1018 additional road fatalities for the three months in question, which is substantially more than estimated by Gigerenzer, (2) the major part of the increased toll occurred on local roads, arguing against a simple modal shift from flying to driving to the same destinations, (3) driver fatalities did not increase more than in proportion to passenger fatalities, and (4) pedestrians and bicyclists bore a disproportionate share of the increased fatalities.     

Cognitive behavior therapy with Internet addicts: treatment outcomes and implications.

Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impact a user's ability to control online use to the extent that it can cause relational, occupational, and social problems. While much of the literature explores the psychological and social factors underlying Internet addiction, little if any empirical evidence exists that examines specific treatment outcomes to deal with this new client population. Researchers have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who suffered from Internet addiction and received CBT at the Center for Online Addiction. This study employed a survey research design, and outcome variables such as client motivation, online time management, improved social relationships, improved sexual functioning, engagement in offline activities, and ability to abstain from problematic applications were evaluated on the 3rd, 8th, and 12th sessions and over a 6-month follow-up. Results suggested that Caucasian, middle-aged males with at least a 4-year degree were most likely to suffer from some form of Internet addiction. Preliminary analyses indicated that most clients were able to manage their presenting complaints by the eighth session, and symptom management was sustained upon a 6-month follow-up. As the field of Internet addiction continues to grow, such outcome data will be useful in treatment planning with evidenced-based protocols unique to this emergent client population.     

Rebuilding security: group therapy with children affected by September 11

This article examines group therapy with children and adolescents impacted by the September 11 terrorist attacks on the World Trade Center, with a focus on the role of metaphor, enactment, and the creative arts therapies in trauma treatment. Attention is given to the importance of fantasies, family structure, and culture in determining how the child constructs and processes the events. Examples are derived from ongoing, trauma-focused groups with traumatically bereaved children who lost parents, as well as from ongoing drama therapy groups in which traumatic themes emerged.     

Group treatment for trichotillomania: behavior therapy versus supportive therapy

In this randomized controlled trial, group behavior therapy (BT; n = 12) was compared to group supportive therapy (ST; n = 12) in the treatment of trichotillomania (TTM). Both treatments were also compared to a naturally occurring waiting period, the time period that participants waited for groups to form. Participants completing group BT experienced significantly greater decreases in self-reported hair-pulling symptoms and clinician-rated hair loss severity than did those in group ST. Decreases were significantly greater after treatment than after the naturalistic waiting period. In addition, a significantly higher percentage of those in the BT than ST condition were rated as much improved or very much improved on the Clinical Global Impression scale at posttreatment. However, despite substantial symptom improvement, TTM severity remained problematic at posttreatment. Specifically, few participants in either treatment met criteria for clinically significant change at posttreatment. In addition, relapse of symptoms occurred over the 6-month follow-up period. Results provided partial support for the short-term efficacy of group BT. However, the group format may not maximize the efficacy of BT for TTM. Thus, it is recommended that future BT research test either individual therapy or a combination of group and individual formats for TTM.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.