Direction of Cognitive Behavior Therapy

Dr. Aaron Beck discusses the past, present, and future of the field of cognitive behavior therapy. He explains his initial intentions were to build therapeutic alliance with patients, and develop theoretical understanding of depression – not start a new school or therapy. Dr. Beck notes that we presently have a cognitive model that encompasses all psychopathology, and there are specialized techniques to treat individual disorders. The future will involve a wide range of research, training and clinical practice to further modify and enhance the practice of cognitive behavior therapy. To find out more about our trainings or to register for a workshop in which you will learn directly from Drs. Judith and Aaron Beck please visit: www.beckinstitute.org/cbt-workshops.

CBT for Disaster-Exposed Youth with PTSD

A recent study published in Behavior Therapy provides initial evidence for the efficacy of manualized Cognitive Behavior Therapy (CBT) for disaster-exposed youth with posttraumatic stress disorder (PTSD). Previous research suggests that group-based CBT is effective in decreasing post-traumatic stress levels in youth. Treatment is often difficult to obtain for this population, however, due to lack of resources. The current study eliminated this obstacle by providing treatment within a school setting.

The current research was conducted on six youth exposed to Hurricane Katrina. The participants ranged from ages 8 to 13 from neighborhoods that experienced significant destruction following the disaster. Master’s level graduate students administered pre and post-tests to participants, and treatment was conducted by a doctoral level therapist using the StArT intervention— a trauma-focused CBT program designed specifically for hurricane-exposed youth. Treatment consisted of 10 sessions which included psychoeducation, cognitive restructuring, exposure, problem solving, and relapse prevention.

Following the intervention, participants showed a decline in PTSD symptoms and no longer met criteria for PTSD at post-treatment. Half of the participants reported no other anxiety disorder diagnoses following treatment, and there was an overall reduction in the incidence of other anxiety problems common in this population.  While replication studies and further assessments are needed, the StArT manual shows promising potential as an effective CBT manual for disaster-exposed youth.

Taylor, L.K & Weems, C.F. (2011). Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: Results from a multiple-baseline examination. Behavior Therapy, 42, 349-363.

Cognitive Conceptualization

At a recent workshop Dr. Aaron Beck described how to utilize cognitive case conceptualization in treatment of children with autism. This video was taken at Beck Institute’s Cognitive Behavior Therapy for Children and Adolescents Workshop. For more information visit www.beckinstitute.org/cbt-workshops/cbt-for-children-and-adolescents.

December 12 – 14, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

Dr. Beck conducting roleplay with a workshop participant.

December 2011: Last week at Beck Institute, psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 13 US states and 6 foreign countries (including Australia, Canada, China, Germany, Ireland, and Japan) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., and Amy Wenzel, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a roleplay session (pictured above), with one of the workshop participants. Following the roleplay interview Dr. Beck answered questions from participants in a case discussion, during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects (video will be posted on our YouTube Channel).

Cognitive Behavior Therapy for Depression

Dr. Judith Beck (pictured left) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.

In this picture (left) Dr. Beck is demonstrating how to use a cognitive conceptualization diagram in CBT treatment with depressed clients.

Cognitive Behavior Therapy for Anxiety

Dr. Amy Wenzel (pictured below) spoke about the need for anxiety and the need to learn how to cope with it.  She emphasized the use of teaching problem-solving skills and building self-efficacy.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

Modular CBT for Body Dysmorphic Disorder

A recent pilot study published in Behavior Therapy found that modular Cognitive Behavior Therapy (CBT) may help reduce symptom severity and depression in Body Dysmorphic Disorder (BDD). BDD is characterized by an often-delusional preoccupation with an imagined or slight defect in appearance that causes significant distress and impairment in daily functioning. The current study incorporates a broadly applicable CBT treatment manual with a specific focus on the BDD model and BDD symptoms.

Participants included twelve individuals, male and female, who met DSM-IV-TR criteria for BDD. Participants were randomly assigned to two treatment groups: one which received 18 therapy sessions and one which received 22 therapy sessions. Two licensed psychologists delivered manualized treatment via individual 60-minute sessions twice per week for the first four weeks, and once per week thereafter. CBT methods and techniques included psycho-education, cognitive restructuring, mindfulness/perceptual retraining, relapse prevention, as well as modular interventions tailored to each participant’s individual symptoms. Participants were encouraged to evaluate their negative and maladaptive thoughts and avoidance behaviors, identify adaptive and robust responses, and engage in homework assignments. Before and following treatment, participants were assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS), the Clinical Global Impression Scale (CGI), the Brown Assessment of Beliefs Scale (BABS), the Beck Depression Inventory-II (BDI-II), and the Client Satisfaction Inventory (CSI).

Results, which include a decrease in BDD symptom severity and delusionality, improvement in depressive symptoms, and high retention and satisfaction rates, suggest that modular manualized CBT treatment for BDD is a practical, well-received, and effective treatment for this disorder. This modular approach maintains the integrity of the core procedures of manualized treatment while incorporating flexible treatment tailored to meet individual patient’s needs.

Sabine Wilhelm, Ph.D., and Gail Stetekee Ph.D., two of the authors, were nominated for and participated in the Beck Institute Scholar Supervision program.

Fama, J.M., Greenberg, J.L., Phillips, K. A., Steketee, G., Wilhelm, S. (2011). Modular Cognitive-Behavioral Therapy for Body Dysmorphic Disorder. Behavior Therapy, 42(4), 624-633.

CBT for Psychosis

In this video Dr. Aaron T. Beck answers a question about CBT treatment for at-risk adolescents with psychosis. Dr. Beck explains past research and significant findings that have led to efficacious cognitive therapy treatment protocol for treating adolescents with psychosis. To find out how you can learn more about CBT for Children and Adolescents visit www.beckinstitute.org/cbt-workshops/cbt-for-children-and-adolescents and for treating psychosis using cognitive therapy for patients with schizophrenia visit www.beckinstitute.org/cbt-workshops/cbt-for-schizophrenia.

MRSI Correlates of CBT in Pediatric OCD

A recent study published in Progress in Neuro-Psychopharmacological & Biological Psychiatry found that Cognitive Behavior Therapy (CBT) is effective in altering metabolic hyperactivity of neurochemicals associated with OCD symptoms in pediatric obsessive-compulsive disorder (OCD) patients. OCD is an anxiety disorder in which individuals experience obsessive, anxiety producing thoughts and seek relief through engaging in repetitive, compulsive behaviors. The current study investigated effects of CBT on neurochemicals in pediatric OCD. A variation of magnetic resonance imaging (MRI) was used to study the effects of CBT on specific neurochemicals in specific areas of the brain that are associated with OCD.

The participants included five, medication-free patients with diagnosed OCD and no prior exposure to CBT. The average age of the participants was 13. Each participant underwent exposure-based CBT once a week for 12 weeks. OCD symptom severity was assessed before and after the 12-week intervention using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). MRIs were also conducted on each patient before and after the study to measure neurochemical levels.

Certain neurochemicals associated with OCD significantly contribute to the obsessive thoughts and ritualistic behaviors characteristic of the disorder. Normally, these chemicals work in tandem in a specific neural pathway to moderate the initiation, sustainability and eventual ending of behavioral routines. In individuals with OCD, however, there is increased activity in this pathway, creating an imbalance in activity. When patients adhere to exposure-based CBT techniques, the chemicals have a chance to correct the imbalance, allowing the brain, body and behaviors to synchronize. In this study, four of the five participants had significant post-CBT decreases in the chemicals known to negatively affect the behavioral routine cycle. Though not statistically significant, participants also had a 32.8% decline in symptom severity based on their post-CBT CY-BOCS score. It is evident that CBT, which is based on modifying maladaptive thoughts and behaviors, can actually alter abnormal brain chemistry in OCD patients which helps reduce symptoms of the disorder.

O’Neill, J., Piacentini, J.C., Chang, S., Levitt, G. J., Rozenman, M., Bergman, L.,…McCraken, J.T. (2011). MRSI correlates of cognitive-behavioral therapy in pediatric obsessive- compulsive disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 36 (2012) 161-168.

Cognitive Behavioral Therapy for Schizophrenia

In this video Dr. Aaron Beck discusses his efforts to develop treatment for patients with schizophrenia. Dr. Beck explains that brain deficits, which caused apathy, anhedonia, and significant problems in executive brain functioning, needed to be addressed. The findings from a study Dr. Beck collaborated on, this past year, suggest that patients with schizophrenia have far more capability to improve their lives than was previously assumed. Dr. Beck hopes these findings will change the way clinicians treat the more than one million patients for whom schizophrenia is profoundly limiting. To find out how you can learn more from Dr. Aaron Beck on CBT for Schizophrenia visit www.beckinstitute.org/cbt-workshops/cbt-for-schizophrenia.

Tourette Syndrome and CBT

A recent study published in the International Journal of Cognitive Therapy found that cognitive behavior therapy (CBT) may significantly improve motor functions and brain activity in individuals with Gilles de la Tourette syndrome (GTS).  GTS is a neuropsychiatric disorder characterized by simple or complex multiple motor tics and one or more vocal tics. GTS can hinder daily living, especially in adults and contributes to cognitive impairment (e.g., deficits in learning and fine motor coordination). The current study investigated the relationships between symptom expression, complex motor processing, and brain activity in GTS before and after a CBT intervention program. The researchers aimed to determine the impact of CBT on these parameters (symptom expression, complex motor processing, and brain activity) and how changes in brain processes relates to  corresponding changes in GTS symptoms.

Participants in the current study included 10 previously diagnosed GTS patients and 14 individuals without neurological or psychiatric problems. A CBT management program was implemented with participants.  Before and following the CBT program, participants were given the traffic light paradigm, a task which measures reaction time, to compare cortical events during automatic processing versus controlled processing. An electroencephalogram (EEG) recorded the electrophysiological signals emitted during the traffic light paradigm and symptom severity was assessed using the Tourette Syndrome Global Scale (TSGS) and the Yale Global Tourette Syndrome Scale (YGTSS).  These scales were administered during structured interviews conducted by a clinician.

GTS participants showed significant reductions in tic frequency as measured by the TSGS and YGTSS post-CBT intervention.  Fine motor dexterity improved and there were significant changes in electrophysiological measures. Participants also showed reduced cerebral activation post-CBT in central regions of the brain when inhibiting automatic motor responses during the traffic light paradigm. These findings suggest a new and exciting way to bridge neuroscience and cognitive behavior therapy.

Imbriglio, T.V.,  Lavoie, M. E., O’Connor, K. P., Stip, E. (2011). Neurocognitive Changes Following Cognitive-Behavior Treatment in Tourette Syndrome and Chronic Tic Disorder. International Journal of Cognitive Therapy, 4(1), 34-50.

Exercise and Depression

Dr. Aaron Beck discusses the effect of exercise on depressed patients. Some contributing factors include the importance of exercise and whether an individual has a genetic predisposition to depression. Dr. Beck encourages therapists to collaboratively work on activity scheduling with individual suffering from depression.