CBT Affects Automatic Threat Processing in Patients with Panic Disorder

According to a recent study published in Biological Psychiatry, cognitive behavior therapy (CBT) impacts automatic threat processing early on in treatment for patients with panic disorder. Research suggests that biased processing of emotional information is an underlying mechanism of affective disorders and influences the effectiveness of interventions used to treat them. For example, when simultaneously shown a face with a negative expression and a face with a neutral expression, patients with anxiety will automatically direct their attention to the face with the negative expression. This is believed to increase the likelihood of anxiety attacks.

Pharmacological treatment methods have been shown to reduce the automatic threat processing bias after an acute, short-term dose, before changes in anxiety and mood become evident. These changes have been shown to be predictive of later changes in therapeutic effects measured 6 weeks later, suggesting that the early changes in automatic biases drive recovery. While CBT has been shown to reduce the automatic threat processing bias as well, it is usually assumed that CBT functions primarily as a top-down treatment approach, primarily targeting more explicit cognitive beliefs and control processes rather than automatic processes. By this view, CBT would only reduce the automatic threat processing bias over time with repeated practice and learning. The current study sought to examine the effects of an acute-dose CBT administration on the automatic threat processing bias.

Participants (n=28) satisfied DSM-IV criteria for panic disorder and were randomly assigned to either the treatment group (n=14), which received a single session of CBT, or the control group (n=14), which received no intervention. Participants completed a faces dot probe task the day after treatment, which measured reaction times to the presentation of negative, neutral, and happy expression faces. Additionally, participants’ general clinical symptoms were measured at baseline, the day after treatment, and at a 4-week follow-up. Participants’ responses to a stress test, which placed them in situations designed to elicit anxious reactions, were also measured at all three test times to provide evidence for the efficacy of the single CBT session.

Results showed that the treatment group showed significantly reduced vigilance for the negative expression faces one day following treatment, while the control group showed no reduction. The two groups did not differ in measures of clinical symptoms at baseline or the day after treatment. However, the treatment group showed significant reductions in fear of physical symptoms and agoraphobia severity at the 4-week follow-up, while the control group showed no changes. In fact, 35.7% of patients in the treatment group fulfilled criteria for agoraphobia recovery at the follow-up, with their scores falling within the range of healthy individuals. The treatment group also reported lower stress in response to the stress tests both the day after treatment and at the 4-week follow-up. The reduction in fear bias was also attributed to 22% of the variance in symptom improvement over time.

These results indicate that a single session of CBT rapidly reduces the automatic threat processing bias, before the more explicit cognitive changes occur. This finding contradicts the generally assumed model of CBT, suggesting that it is more similar to pharmacological models, at least for anxiety and panic disorders, than previously thought. The results also provide evidence for the predictive effects of automatic threat processing bias reduction on overall symptom improvement over time, suggesting that this is a key component to the effective treatment of panic disorders. Additionally, these results imply that a subset of roughly one-third of panic disorder patients may only require a single session of CBT in order to recover from co-morbid agoraphobia.

Reinecke, A., Waldenmaier, L., Cooper, M. J., & Harmer, C. J. (2013). Changes in Automatic Threat Processing Precede and Predict Clinical Changes with Exposure-Based Cognitive-Behavior Therapy for Panic Disorder. Biological Psychiatry.

Identifying Suicide Risk

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck describes ways to identify a person at risk for suicide. He discusses immediate risk factors (such as those shown through the use of predictive scales), peripheral risk factors, and demographic risk factors. Dr. Beck also discusses his previous research involving the post-attempt suicide ideation scale and important findings from that research.

Beck Institute’s next CBT for Depression and Suicidality Workshop will take place July 15-17, 2013. For more information, visit our website.

CBT Improves Memory Functioning in Patients with Bipolar I Disorder

According to a recent study published in the Journal of Behavior Therapy and Experimental Psychiatry, cognitive behavior therapy (CBT) improves explicit memory recall and reduces explicit memory bias for negative words in patients with bipolar type I disorder.  Both mania and depression are associated with impaired memory.  In tests in which participants learn words and are then asked to recall them, bipolar patients, both manic and depressive, have been shown to recall less words overall but more words with negative emotional valence than non-bipolar or depressed people.  This suggests that bipolar disorder affects global memory performance and introduces a negative memory bias.  The present study sought to examine if a CBT intervention would improve global memory performance and reduce the negative memory bias in bipolar I patients using a randomized, wait-list controlled design.

Participants (n=73) were bipolar I patients aged 18-65 on a treatment waiting list.  The experimental group (N=53) was given CBT in addition to medication, and the control group (N=20) was treated with just medication.  Participants were assessed for memory at baseline and at a 6-month follow up.  In this procedure, they were given 30 words that had either positive, neutral, or negative affective valence (10 words for each category).  They were first asked to rate the emotional valence of each word on a one to five scale.  Then, they were told to write down as many words as they could recall.  Participants were also assessed for disorder levels with the Hamilton Depression Rating Scale (HDRS), Mania Rating Scale (MRS), and the Hamilton Anxiety Rating Scale (HARS), and completed the Dysfunctional Attitudes Scale (DAS).

Before treatment, there were no significant differences between the two groups in the number of words recalled in any affective valence category or in the severity of bipolar symptoms.   At the follow-up, 11 patients from the experimental group had dropped out.  Of the remaining 42, significant improvements on the HDRS, HARS, and DAS were observed.  No such improvements were observed in the control group.  The primary effect of interest, explicit memory recall, was also improved in the CBT group.  Futher, recall for positive and neutral words was significantly improved, and recall for negative words significantly decreased in this group.  No memory effects were observed in the control group.

These results indicate that CBT is not only effective in improving the general dysfunctional symptoms of bipolar I disorder, but also in improving explicit memory functioning and reducing negative memory bias in patients.  By reducing negative memory bias, CBT may help modify bipolar patients’ cognitive schemas and can contribute to decreased cognitive vulnerabilities such as the negative memory bias. Further, CBT techniques for regulating both positive and negative thoughts and emotions can allow patients to modify unhelpful and intrusive past memories.

Docteur, A., Mirabel-Sarron, C., Guelfi, J.-D., Rouillon, F., & Gorwood, P. (2013). The role of CBT in explicit memory bias in bipolar I patients. Journal of Behavior Therapy and Experimental Psychiatry, 44, 3, 307-311.

The Importance of Beliefs in CBT

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses his development of Cognitive Therapy. Dr. Beck discusses his early work in Psychodynamic Therapy, and he takes us through his key realization that people are motivated by their beliefs.

Beck Institute holds a number of CBT workshops throughout the year. For more information, visit our website.