CPT is Effective for Military-Related PTSD

According to a recent study published in the Journal of Anxiety Disorders, cognitive processing therapy (CPT) may have a greater effect on military-related PTSD than other usual treatments. CPT is a form of trauma-focused cognitive behavior therapy (CBT) that focuses on key themes such as safety, control, power, self-esteem, and intimacy. The present study examines the efficacy of CPT for PTSD among treatment seeking veterans (n=59) within a naturalistic setting compared to other treatments typically used for PTSD (a variety of non-trauma focused symptom management intervention, psycho-education, supportive counseling, and CBT with elements of exposure.) At post-treatment and 3 month follow up, participants in the CPT condition (n=30) showed significantly lower levels of PTSD symptoms than those who received other treatments (n=29) according to self -reporting and clinical ratings.  Additionally, there were larger reductions in comorbid depression and anxiety for participants receiving CPT than treatment as usual. These results suggest that CPT is an effective, evidence based treatment for military-related PTSD in real world environments and situations.

Forbes, D., Llyod, D., Nixon, R. D. V., Elliot, P., Varker, T., Perry, D., Bryant, R. A., & Creamer, M. (2012). A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(3), 442-452.

CBT plus Medication is Effective for Treatment Resistant Depression

According to a new study published online in The Lancet (December 7, 2012) and Contemporary Clinical Trials, cognitive behavior therapy (CBT) as an adjunct to usual care has shown to be an effective treatment for reducing depression and improving quality of life in patients with treatment resistant depression. Although pharmacotherapy is often used as a first-line treatment for depression, only one-third of patients fully respond to anti-depressants and only half receive up to a fifty percent decrease in symptoms. The current study employed a large-scale CoBalT (two parallel-group) randomized controlled trial to investigate the effectiveness of combining CBT and usual care (including pharmacotherapy) versus usual care, alone, for treatment resistant depression. Participants (n=469) ranged from age 18 to 75 and were already taking anti-depressants. They were randomly assigned to receive either CBT plus usual care (n=234) or usual care alone (n=235).

At the 6 month follow up, 46% of  participants (n=95) in the CBT plus usual care group met criteria for response to treatment, as compared to only 22% of participants (n=46)  in the usual care group. Those who received CBT were more likely to experience remission, received lower scores on the Beck Depression Inventory (BDI), and experienced fewer symptoms of anxiety and panic. At the 12-month follow up, these improvements were maintained.

This study is the first large-scale randomized control trial investigating CBT treatment as an adjunct to usual care in patients showing treatment resistance to anti-depressants.  Findings suggest that CBT in combination with usual care can be extremely effective for treating depressive symptoms and improving the quality of life of patients suffering from depression.

Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Garland, A, Hollinghurst, S., Jerrom, B., Kessler, D., Kuyken, W., Morrison, J., Turner, K., Williams, C., Peters, T., & Lewis, G. (2012). Cognitivebehavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. Published online 7th December 2012.

Symptom Change in CBT for Generalized Anxiety Disorder

According to a recent study published in the Journal of Consulting and Clinical Psychology, cognitive behavior therapy (CBT) may have a greater effect on symptom change in generalized anxiety disorder (GAD) than applied relaxation (AR). The current study sought to determine if change in worry accounts for change over time in somatic anxiety to the same degree in CBT and AR. Participants (treatment-seeking adults with GAD) were assigned to receive 12 weeks of either CBT (n=31) or AR (n=26).

At post-treatment, participants in both treatment groups experienced significant reductions in somatic anxiety and time spent worrying. On average, worrying was reduced from 5-6 hours per day to 3 hours per day. However, change in worry accounted for subsequent change in somatic anxiety to a much greater extent in the CBT group than the AR group. When treatment focused on reducing worry, 49.95% of somatic anxiety was also reduced among participants in the CBT Group, and just 25.87% among participants in the AR group. These results suggest that although two treatments may have similar efficacies at post treatment, the mechanisms of change may differ. Further, these results demonstrate that CBT produces symptom change in a manner that is consistent with the theoretical underpinnings on which treatment is based.

Donegan, E., and Dugas, M. (2012) Generalized anxiety disorder: A comparison of adults receiving cognitive behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology, 80(3), 490-496.

Neurobiology and Cognitive Behavior Therapy

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses  correlates between neurobiology and the cognitive model of depression. Dr. Beck explains the reflexive and reflective systems of cognitive processing and how these systems are impacted by depression. He then summarizes the effects of cognitive behavior therapy on the brain, highlighting the corrective nature of CBT.

For more information on CBT workshops and training, visit our website.

CBT is Effective for Trait Anxiety and Worry

According to a study published in the Canadian Journal of Psychiatry, both cognitive behavior therapy (CBT) and short term psychodynamic psychotherapy (STPP), help reduce symptoms of anxiety and depression in patients with generalized anxiety disorder (GAD).  In the long-term however, CBT has demonstrated superiority in measures of trait anxiety and worry.

Participants (n=57) in the current study were treated with either CBT (n=29) or STPP (n=28) for up to 30 sessions. Both groups yielded large improvements concerning symptoms of depression and anxiety which remained stable at a 6 month follow-up.  At the 12 month follow-up, CBT treatment was shown to provide greater reductions in anxiety symptoms, as measured by the State-Trait Anxiety Inventory (STAI) and the Penn State Worry Questionnaire (PSWQ).  These results are consistent with several other previous trials demonstrating the long-term benefits of CBT for GAD.

Salzer, S., Winkelbach, C., Leibing, E., Leweke, F., & Leichsenring, F. (2011). Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-Month follow-up. Canadian Journal of Psychiatry, 56, 8, 503-508.

Long-Term Comparison of Traditional CBT and Acceptance and Commitment Therapy

According to a recent study published in Behavior Therapy, traditional cognitive behavior therapy (CT) may be more effective for treating anxiety and depression in the long-term than Acceptance and Commitment Therapy (ACT). The current study is a follow up comparison of the long-term outcomes of CT and ACT. The original study measured symptoms of students seeking treatment, (n=132) age 18-52 (M=26.7) before and after receiving CT and ACT. At post treatment, both groups improved on measures of depression, anxiety, and general functioning, and the results did not yield a significant difference in effectiveness between the two samples receiving treatment.

This long-term follow up study, conducted 18 months later included a majority (n=91) of the original sample who received either CT (n=45) or ACT (n=46). Although participants in both treatment groups benefitted initially from the different therapies, participants from the CT treatment group gained significant and lasting improvement in their symptoms and functioning:

 

  • 81.8% of CT patients versus 60.7% of ACT patients remained reliably recovered on measures of depression (Beck Depression Inventory-II);
  • 72.7% of CT patients versus 56.0% ACT patients remained in the recovered range for anxiety (Beck Anxiety Inventory);
  • 46.4% of CT patients versus 22.6% ACT patients maintained improvements in interpersonal and occupational functioning (Outcome Questionnaire); and
  • 37.8% of CT patients versus 22.9% of ACT patients remained in the normative range on measures of quality of life (Quality of Life Inventory).

This is the first known comparison of the long-term efficiency of CT versus ACT. While research and replication studies are necessary, these preliminary findings suggest that traditional CT has long-term advantages over ACT in treating depression and anxiety, and in increasing general functioning and overall quality of life.

Forman, E.M., Shaw, J.A., Goetter E.M., Herbert, J.D., Park, J.A., & Yuen, E.K, (2012). Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behavior     Therapy, 43(4) 801-811

CBT for Substance Abuse

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses cognitive behavior therapy for addictions and explains the methodology and effectiveness of in-office desensitization with substance use disorder patients. Dr. Beck also references a recent book, Group Cognitive Therapy for Addictions, which he co-authored with Amy Wenzel, Ph.D., Bruce Liese, Ph.D., and Dara Friedman-Wheeler, Ph.D.

For CBT resources, visit Beck Institute’s CBT Store:

Beck Institute’s next CBT for Substance Abuse Workshop will take place April 15-17, 2013. For more information, or to sign-up, visit our website.

Group Cognitive Behavioral Interventions for Low Back Pain among Primary Care Patients

According to a recent study published in PAIN, group cognitive behavioral intervention (CBI) is effective in reducing low back pain (LBI) and disability over a 12-month period. The results indicate that the effects of CBI are maintained for up to an average of 34 months.

Participants (701, ages 18 and older), recruited from primary care settings in England who were experiencing at least moderately troublesome lower back pain for at least six weeks, participated in a randomized control trial. They received either 10-15 minute sessions of best-practice advice from a trained health professional or a cognitive behavioral intervention (one-hour individual assessment and six 90-minutes sessions of group therapy.)  At 20-50 month follow ups, returning participants (395 participants) noted less disability and pain than the original sample. The effects of CBI are reported to reduce lower back pain and sustain reductions over a length of time ranging from an average of 34 months up to 50 months.  Improvements do occur when using best-practice advice, however they are slower and often less substantial, leading to minimal impact on disability. The sustainability of CBI may be attributed to the acquisition of skills needed to challenge negative thoughts and beliefs and become more physically active.

Lamb, S. E., Mistry, D., Lall, R., Hansen, Z., Evans, D., Withers, E. J., & Underwood, M. R. (February 01, 2012). Group cognitive behavioural interventions for low back pain in primary care: Extended follow-up of the Back Skills Training Trial (ISRCTN54717854). Pain, 153, 2, 494-501.

Tips for Cognitive Behavior Therapists

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck explains that effective therapists often incorporate cleverness and creativity into guiding their patients toward correcting erroneous beliefs. Dr. Beck also discusses mistakes that inexperienced therapists sometimes make, such as jumping from misinterpretation to misinterpretation. Dr. Beck advises therapists to work through erroneous cognitions, one at a time; however, he also cautions against focusing too long on a particular cognition.

To learn more about cognitive behavior therapy training, visit our website.

From our Archives: Coping with Depression

Newsweek, January 8, 1973

This article (below), published in Newsweek in early 1973, takes us back almost 40 years into the history of depression, exemplifying just how far we’ve progressed in understanding and treating depression. Early research findings in the causes and treatment of depression, which remain significant and valuable today, are noted and credited to several scientists including Dr. Aaron Beck. Dr. Beck is referenced and quoted on pages 53-54.

The story was written by Newsweek’s Medicine Editor at the time, Matt Clark and included reports from Mariana Gosnell, Evert Clark, Jerome Gram and others.

(Click on the pages to enlarge them)