Group cognitive behavioral therapy for depressive and anxious symptoms in patients with epilepsy

A recent study published in Epilepsy & Behavior examined the effectiveness of a group cognitive behavioral therapy (GCBT) intervention for reducing symptoms of anxiety and depression in patients with epilepsy. Previous research has shown that individuals with epilepsy have higher rates of anxiety and depression symptomology than the general population; and while CBT has been shown to be effective in treating these conditions, the authors cite that such interventions are often not available to those with epilepsy.

The study sought to examine: 1) the effectiveness of GCBT for reducing symptoms of depression, anxiety, and negative automatic thoughts in patients with epilepsy, 2) whether a 10-session GCBT program can increase knowledge of CBT concepts and skills in patients with epilepsy, 3) the acceptability of GCBT to patients with epilepsy, as measured by recruitment attrition rate, number of overall sessions attended, and patient satisfaction with treatment.

Clinical psychologists and social workers were responsible for screening participants for inclusion via telephone, conducting the group sessions, and follow-up sessions with each participant. To measure symptoms and CBT knowledge the pre and post groups screening measures included: the Beck Depression Inventory II, the Beck Anxiety Inventory, the Automatic Thoughts Questionnaire, and the Cognitive Therapy Awareness Scale.

Results showed a significant improvement in patients’ mood, an increase in learned CBT skills and a high level of satisfaction with treatment. These findings indicate GCBT as a promising treatment for those with epilepsy, who suffer from symptoms of depression and/or anxiety. Some limitations were the small sample size, the lack of a control group, and the lack of data about  patients’ seizure disorders. The authors’ future research goals include assessing patients’ diagnoses, and obtaining follow up information to see the long-term effects of treatment.

Macrodimitris, S., Wershler, J., Hatfield, M., Hamilton, K., Backs-Dermott, B., Mothersill, K., Baxter, C., & Wiebe, S. (2011). Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety. Epilepsy and Behavior, 20, 1, 83-88.

April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I

April 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, and other professionals from mental health, medical, and related fields traveled from 18 states and 8 countries, including Australia, Brazil, Canada, France, Ireland, New Zealand, Peru, and United Arab Emirates. Pictured above-left, Dr. Aaron T. Beck conducts a roleplay with Ricardo Luiz Malina Losso, a psychiatrist from Brazil, to demonstrate useful techniques to use for challenging problems when working with patients. Dr. Beck also conducted a live patient session that was viewed (via closed-circuit television) by participants in the April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I at Beck Institute.

Cognitive Behavioral Therapy Treatment Plan

Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured below), during which he explained what the next session should include (see video clip here). 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.

(Right) Dr. Judith Beck conducts a roleplay with David Black, a psychologist from Missouri.  Dr. Beck discussed how to differentiate between practical and psychological problems, and how to use a cognitive framework to understand why psychological problems arise. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed

and engaged in demonstration roleplays among other activities. More event highlights:

Current State of Cognitive Behavior Therapy in Japan

A recent report by Yutaka Ono, M.D. and colleagues (2011) described the current status of research on cognitive behavior therapy (CBT) in Japan. CBT ranked first as the treatment method that medical facilities would most like to provide. On the basis of this information, the study group developed an individual CBT program for treating Japanese patients with depression. The program was based on the model developed by Aaron T. Beck, M.D., with some adaptation to address the cultural characteristics of Japanese patients. The Japanese government has made the treatment manual available on the Japanese Ministry of Health, Labor and Welfare’s website.

Since its introduction to Japanese psychiatrists in the late 1980s, CBT has greatly expanded in Japan, including the development of the Japanese Association for Cognitive Therapy (JACT). JACT, an organization of mental health professionals committed to the advancement of CBT, has grown to more than 1500 members. The Japanese government has been a strong proponent of the cognitive therapy movement. In addition to funding studies, the National Center of Neurology and Psychiatry decided to establish a new Center for Cognitive Behavior Therapy. Dr. Ono was named as a founding chief of the Center, which is set to open next month. In an effort to increase clinical expertise and standardize supervision of CBT, Dr. Judith Beck will be conducting workshops in May, 2011, in Tokyo.

Ono, Y., Furukawa T.A., Shimizu, E., Okamoto, Y., Nakagawa, A., Fujisawa, D., Nakagawa, A., Ishii, T., & Nakajima, S. (2011).  Current status of research on cognitive therapy/cognitive behavior therapy in Japan. Psychiatry and Clinical Neurosciences 65, (2): 121–129. doi: 10.1111/j.1440-1819.2010.02182.x.