Mood Disorders: Effects of Intensive CBT

NewStudy-Graphic-72x72_edited-3A recent study in the Journal of Psychiatric Practice found that Cognitive Behavioral Therapy (CBT) interventions used in an intensive partial-hospital (PH) setting are effective in treating severe mood disorders.

PH settings differ from inpatient treatment in that they are more flexible and less expensive. In this study, with CBT as the primary treatment, the length of stay was only 2 weeks. The researchers’ aims were to find the specific aspects of CBT that were successful in the treatment of mood disorders in a short-term PH setting.

The treatment included group and individual psychotherapy. Patients attended 12-20 group sessions per week. A written treatment contract was used and reviewed weekly to set specific goals and promote collaboration between patients and staff.

Group therapy was primarily CBT-oriented. The goals of therapy included teaching self-assessment (such as challenging maladaptive thoughts), behavioral coping (such as behavioral scheduling and behavioral activation), and developing better and more effective communication strategies.

The two-week treatment was divided into two stages. In the first, patients learned to identify triggers and utilize cognitive restructuring, among other interventions. The second stage included relapse prevention plans for a crisis situation and future plans (such as returning to work or school).

The researchers showed that both behavioral activation and a decrease in negative cognitions are associated with a decrease in depressive symptomatology at discharge. Additionally a decrease in negative thinking is associated with reduced general psychological distress at discharge.

Study Authors: M. S. Christopher, K. L. Jacob, E. C. Neuhaus, T. J. Neary, L. A. Fiola

Generalized Anxiety Disorder — CBT Benefits Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3 The results of a randomized clinical trial published in JAMA indicate that cognitive behavior therapy (CBT) can be effective for older adults with symptoms of worry and depression.

The 3-month CBT protocol was conducted in primary care clinics and included education, cognitive therapy, and problem-solving skills. Measures included the Beck Anxiety Inventory and Beck Depression Inventory II. Post-treatment assessments were conducted every three months over fifteen months.

Compared with the control group, patients who received treatment showed improvement in worry severity, depressive symptoms, and general mental health. A measure of GAD severity, however, did not indicate greater improvement with CBT.

The authors concluded that CBT is useful for this population especially in primary care settings, “where older adults most often seek treatment.”

Study authors: M. A. Stanley, N. L. Wilson, D. M. Novy, H. M. Rhoades, et al.

Group CBT for Inpatients

NewStudy-Graphic-72x72_edited-3 In a study published in the Journal of Psychiatric Practice, researchers investigated the effectiveness of Cognitive Behavioral Group Therapy (CBGT) incorporated into the typical routine treatment of an inpatient psychiatric unit. Typically the aim of inpatient treatment is to stabilize patients and prevent crises. The goals of CBGT in this study were to decrease violent and aggressive behavior, to improve relations among patients and between patients and professionals, to normalize patients’ experience of their disorder, to improve self-esteem, and to decrease patients’ feelings of isolation.

Typical goals of CBGT, which also applied to this study, are stress management, setting of specific goals (including plans for when patients are discharged from the unit), and homework assignments.

In this study, patients took part in CBGT for approximately 2 hours a day, 5 days a week. The structure of the therapy included setting goals, a review of previous homework assignments, a discussion about the topic of the day, and a new homework assignment. The therapy attempted to improve communication, help patients understand how their cognitions, emotions, and behaviors interact, and teach patients skills through strategies such as modeling, role playing, and structured problem solving.

The researchers measured efficacy based on readmission to the hospital, patient satisfaction, use of physical restraint, ward atmosphere, length of stay, and the number of beds needed. They compared years 1, 2, 3, and 4 with the control (year 0, where CBGT was not used). Results of the study included a significant reduction in readmission, especially for those suffering from schizophrenia and bipolar disorder. Additionally there was a significant increase in patient satisfaction at discharge. There was an overall decrease in the use of physical restraint, length of stay, and beds needed. The results suggest that the use of CBGT was an effective method in the achievement of the goals (listed above) for inpatients.

CBGT elicited the active participation of patients in therapy, helped normalize their illness, and helped them with problem solving. Interestingly, having patients teach other patients how to manage their problems was especially helpful. All these factors had a “large and immediate impact on patients.”

Study authors: F. Veltro, N. Vendittelli, I. Oricchio, F. Addona, et al.