Neurocognitive Change in Schizophrenia

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses neurocognitive change among schizophrenic patients who receive CBT treatment. Dr. Beck references a study in which a sample of highly regressed patients with schizophrenia received between six and eighteen months of Cognitive Therapy. Dr. Beck first explains that at the end of the study patients improved on both psychological tests (e.g., quality of life measures) and neurocognitive tests. He then provides a hypothesis for this outcome.

For more information on Beck Institute’s workshops, visit our website.

Evidence-Based Treatment Approaches for Troops with PTSD

Nearly 20% of the 2.6 million troops deployed to Afghanistan and Iraq report symptoms of posttraumatic stress disorder (PTSD). PTSD is associated with hyperarousal, avoidance, and disturbing or reoccurring flashbacks, all of which affect mental and physical health.

The Department of Defense (DoD) and Veterans Affairs (VA) have recommend four treatment approaches for PTSD: Prolonged Exposure (PE) Therapy, Cognitive Processing Therapy (CPT), Stress Inoculation Therapy (SIT), and Eye-Movement Desensitization and Reprocessing (EMDR) Therapy. While there has been little empirical research indicating that EMDR and SIT are effective for PTSD, there is considerable research supporting the effectiveness of both PE and CPT. As a result, the VA has mandated that PE and CPT be available to all patients with PTSD. PE uses imagined and in vivo exposure to help patients confront trauma-related stimuli and extinguish fear responses. CPT targets trauma-related maladaptive cognitions by exposing patients to their own thoughts as they write about their traumas. According to the current review, four randomized control trials (RCTs) support the efficacy of PE for military-related PTSD and one RCT and one uncontrolled effectiveness study provide initial support for the efficacy of CPT in treating military-related PTSD.

Even though the VA has mandated PE and CPT for veterans and military service men and women with PTSD, it is important for clinicians who work with this population (both within and outside the VA) to educate their clients about evidenced based treatment to promote retention and recovery.

Steenkamp, M. M., & Litz, B. T. (February 01, 2013). Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence. Clinical Psychology Review, 33, 1, 45-53.

CBT for Suicidality

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses CBT for suicidal ideation. Dr. Beck references the suicide intent scale which is used to determine an individual’s level of suicidality. Dr. Beck explains that suicidal patients typically experience high levels of hopelessness. It is key to address and decrease hopelessness to reduce suicidality.

For more information on Beck Institute’s CBT for Depression and Suicidality Workshop, visit our website.

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CBT Shows Promise for Anxious Youth with Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) is an umbrella term representing a range of persistent cognitive deficits and impairments in communication and social interaction, often diagnosed by age two, and includes autistic disorder, Asperger’s syndrome, and pervasive developmental disorders. Children with ASD are at an elevated risk for developing anxiety disorders, which can become highly debilitating across environmental contexts (home, school, and social contexts). The results of previous research (case studies, small group studies, and randomized clinical trials) have provided evidence and support for the efficacy of modified CBT for youth with ASD and anxiety.

In a 2012 study published in Autism Research and Treatment, researchers developed a modified version of a CBT intervention (“Facing Your Fears”) for adolescents with ASD, titled “Facing Your Fears: Group Therapy for Managing Anxiety in Children with High Functioning ASD” (FYF-A). They then assessed the feasibility and acceptability of the FYF-A intervention program.

Participants included 24 adolescents and their families, age 13-18, with ASD and anxiety. They attended 14, 90-minute sessions, plus 1 booster session, which included large group activities with teens and parents, small-group activities with teens and parents alone, and dyadic work with parent and teen pairs. The program focused on core CBT components (including an introduction to anxiety symptoms and implementation of CBT strategies) and several modifications for teens with ASD. These modifications included: (1) a social skills module to address areas of social challenge; (2) parent-teen dyadic work focused on achieving a mutual understanding and shared goals; (3) the use of technology to both monitor symptoms of anxiety and remind participants to utilize CBT strategies; and (4) a parent curriculum.

At post-treatment, participants showed significant reductions in anxiety severity and intrusiveness. These reductions were maintained at the 3-month follow up. Further, nearly half of the participants met criteria for a positive treatment response on primary diagnosis following the intervention. These finding are encouraging, as they add further evidence that modified CBT for adolescents with ASD is effective in decreasing anxiety symptoms among this group.

Reaven, J., Blakeley-Smith, A., Leuthe, E., Moody, E., & Hepburn, S. (January 01, 2012). Facing Your Fears in Adolescence: Cognitive-Behavioral Therapy for High-Functioning Autism Spectrum Disorders and Anxiety. Autism Research and Treatment, 2012, 2, 1-13.

Increasing Clients’ Readiness for Change

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses initial steps to increase a client’s readiness for change. Using examples from his own work, Dr. Beck addresses the importance of first conceptualizing and uncovering the specific beliefs and fears that interfere with the client’s readiness for change.

To attend a workshop at the Beck Institute, visit our website.

CBT Helps Prevent Soldiers from Developing Symptoms of PTSD

Research indicates that 4.3% of troops develop PTSD upon returning from combat. A recent epidemiological study published by the Digital Access to Scholarship At Harvard describes a program launched by the Department of Veterans Affairs (VA) in an effort to reduce the risk for post-traumatic stress disorder (PTSD) in post-war veterans. This initiative ensures that all combat veterans, regardless of occupational rank, will receive evidence-based cognitive behavior therapy (CBT) upon returning from war.

In the current study, American, British, and Dutch authorities administered a number of epidemiological surveys to post-war veterans. These surveys were designed to evaluate the mental health status of veterans upon returning from the wars in Iraq and Afghanistan. Results of these surveys showed tense, irritable, and depressive-like symptoms among these soldiers, therefore making many of them candidates for CBT treatment. Participants in the study received either prolonged exposure (PE) treatment, which requires patients to recount traumatic memories repeatedly within a structured, supportive therapeutic context until distress declines, or cognitive processing therapy (CPT) which requires patients to write continuously about their traumatic experience. Of the 66% of veterans who completed the PE program, 74% had post-treatment scores that fell below the cutoff for PTSD.

Since this study, the Army has also developed a number of methods to prevent soldiers from developing symptoms for PTSD. One post-deployment early intervention program, Battlemind Debriefing, focuses on preparing soldiers with the specific skills they need to transition from combat zone to home. The Army has also developed similar training programs for larger groups transitioning from home to combat units. These programs teach soldiers “emotional bonding skills” that are useful to their specific combat unit. Rather than having soldiers focus on the traumatic events they have experienced, these programs focus on strengthening their family relationships and coping skills. According to the author, the prospects for resiliency and recovery from PTSD are at their current highest, as VA is ensuring evidence based treatment. Still, the “surest route to preventing PTSD in the world is to further the global decline in violence” (McNally, 13).

McNally, Richard J. (2013). Are we Winning the War Against Posttraumatic Stress Disorder? Digital Access to Scholarship at Harvard. Science 336 (6083). 1-16.