Adult ADHD: The Effects of Group CBT

NewStudy-Graphic-72x72_edited-3 A recent study in the Journal of Attention Disorders showed that brief Cognitive Behavioral Therapy (CBT) group sessions help to significantly decrease the psychological consequences of ADHD.

Adults diagnosed with ADHD are more likely than other adults to suffer from a range of social and emotional consequences, including co-morbid disorders. These comorbid disorders include anxiety, depression, personality disorder, substance abuse, academic underachievement, occupational problems, social interaction and relationship difficulties, low self-esteem, and poor self-identity. These additional symptoms are in large part due to adult patients’ late diagnosis and the adverse reactions their behavior prior to diagnosis aroused from others. Read more

Repeat Suicide Attempts Reduced by CBT

NewStudy-Graphic-72x72_edited-3A randomized control study in the Journal of the American Medical Association found cognitive behavioral therapy (CBT) to be effective in reducing the number of repeat suicide attempts in adults.

Past research had focused on intensive follow-up treatment or intensive case management, interpersonal psychotherapy, or cognitive behavioral therapy for the preventative treatment of suicide attempts, but empirical evidence for the efficacy of these therapies has been limited. The current study aimed to examine the efficacy of cognitive behavioral therapy as a preventative therapy for suicide, by performing a randomized control study adequate in power to detect treatment differences.

Participants consisted of patients who had attempted suicide and received a medical or psychological evaluation within 48 hours of the attempt. Participants were randomly assigned to follow-up care of either CBT or usual care (UC). Those placed in the CBT group received outpatient CBT sessions that were specifically designed for preventing future suicide attempts. The CBT aimed to address and identify the thoughts, images, and core beliefs that activated the previous suicide attempt, and to teach cognitive and behavioral strategies as better ways of coping with these thoughts and stressors.

The authors found that participants in the CBT group were 50% less likely to reattempt suicide than the participants in the UC group. In addition, the CBT group measured significantly lower for depression as well as hopelessness than the UC group. The authors concluded that “the short-term feature of cognitive therapy would make it particularly applicable for the treatment of suicide attempters at community mental health centers, which typically provide relatively short-term therapy.”

Reference: Brown, G. K, Have, T. T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. Journal of the American Medical Association, 294, 563-570

CBT Meta-Analysis Review is Most Downloaded Article in CPR

It looks as if the research efficacy of Cognitive Therapy is becoming more well-known. Clinical Psychology Review is a peer-reviewed journal that publishes substantive reviews of topics relevant to clinical psychology. The most downloaded article from this important journal is The empirical status of cognitive-behavioral therapy: A review of meta-analyses (Volume 26, Issue 1, January 2006, Pages 17-31), authored by Andrew C. Butler, Jason E. Chapman, Evan M. Forman and Aaron T. Beck.

This 2006 review summarizes CBT treatment outcomes for a wide array of psychiatric disorders and includes sixteen methodologically rigorous meta-analyses. Findings are consistent with previous review methodologies and demonstrate the efficacy of CBT for many disorders. Specifically, unipolar depression, generalized anxiety disorder, panic disorder (with or without agoraphobia), social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders all showed large effect sizes. Marital distress, anger, childhood somatic disorders, and chronic pain showed moderate effect sizes.

CBT was also shown to be somewhat superior to antidepressants in the treatment of adult depression and as effective as behavior therapy in the treatment of both adult depression and obsessive-compulsive disorder. Bulimia nervosa and schizophrenia showed large, uncontrolled effect sizes.

Beliefs Can Interfere with Treatment Adherence

judith-beck_1024w.jpgI recently read an interesting case description on a professional listserv about a “difficult” client who was not fully adherent with treatment. Apparently he argued with his therapist and did little homework outside of the session. It was apparent to me that the therapist had made a mistake. She was continuing to try to deliver “standard” CBT treatment, without attending to the therapeutic relationship sufficiently. I hypothesized that the client had an interfering belief:

“If I refrain from arguing with my therapist and comply fully with treatment……[something bad will happen or it will mean something bad about me.” ].

I don’t have enough details about the case to understand how the client would finish this assumption, but some clients might answer:

“I’ll feel so distressed that I won’t be able to stand it,” or “it will mean she’s in control, and I’m not.”

Until such interfering beliefs are elicited, evaluated, and effectively responded to, this client is unlikely to make much progress.

–Posted by Judith S. Beck, Ph.D., Director, Beck Institute

Empirically Validated Treatments

There have been very interesting posts on the listserv this week, about the necessity (1) to validate the theory underpinning a particular treatment approach, (2) to insure that treatment is based on this validated formulation, and (3) to validate the efficacy of the treatment itself. A particular technique or strategy, devoid of a coherent and tested underlying theory, should not be labeled as an “empirically validated treatment,” much less a “system of psychotherapy,” as many are.

Here’s how Dr. Aaron Beck described cognitive therapy on the listserv:

There is no generic cognitive therapy that fits all cases. From the very beginning, we have focused on a specific conceptualization of each of the disorders. The treatment approach then is derived from the disorder-specific formulation. Thus, in obsessions and compulsions, the theoretical formulation followed by the British group and others centers on modifying the beliefs about the obsession and compulsions. These beliefs can then be modified through behavioral experiments (often referred to as “exposure therapy”) and explicit restructuring of the beliefs about the obsessions and compulsions. I’m afraid of using an artificial dichotomy in separating “cognitive” and “behavioral” techniques. Experience (facilitated by actual in vivo behavior) is one of the most powerful ways of achieving cognitive change. Behavior therapy does not have a monopoly on the behavioral techniques, but what does differentiate behavior therapy and cognitive therapy is the theoretical formulation.

—Posted by Dr. Judith Beck, Director, Beck Institute