Individual versus Group Cognitive Behavior Therapy for Insomnia

Cognitive behavior therapy for insomnia (CBT-I) has been identified as an effective treatment for primary insomnia, and according to a recent study published in Sleep and Biological Rhythms, individual CBT-I may be a superior treatment approach to group CBT-I.

In the current study, researchers compared the short-term effectiveness of both individual and group CBT-I, in individuals who met DSM-IV-TR criteria for primary insomnia (i.e., a fear of insomnia, increased somatic tension, and mental arousal in bed).  In addition to primary diagnoses of insomnia, all participants in the study also reported chronic use of hypnotics and engaged in either individual CBT-I (n=20) or group CBT-I (n=25).  Both groups were exposed to the same major treatment components, including education concerning sleep hygiene, as well as stimulus control, sleep restriction, and cognitive therapies.  Pre and post-treatment evaluations utilized sleep logs, the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), the Pittsburgh Sleep Quality Index (PSQI) and actigraphy (a non-invasive method of monitoring human rest/activity cycles) to assess sleep outcomes between participant groups.

Findings revealed that overall, both individual and group CBT-I produced positive sleep outcomes.  However, across multiple objective and subjective sleep measurements, individual CBT-I resulted in significantly greater participant gains over group CBT-I.  These results support the use of individual CBT-I above group CBT-I when treating primary insomnia.

Yamadera, W., Sato, M., Harada, D., Iwashita, M., Aoki, R., Obuchi, K., Ozone, M., … Nakayama, K. (July 07, 2013). Comparisons of short-term efficacy between individual and group cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms, 11, 3, 176-184.

For professional trainings and seminars in CBT for insomnia, visit: www.med.upenn.edu/cbti.

CBT Case Formulation

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses how identifying patients’ beliefs, behaviors, and points of focus is an integral part of cognitive behavioral case formulation. Dr. Beck then provides an example to illustrate how beliefs, behaviors, and points of focus are interrelated and can lead to the activation of core beliefs.

For CBT resources, visit our website.

Ways to Elicit Automatic Thoughts

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses ways to elicit relevant automatic thoughts from clients. He gives examples of using imagery and in-vivo role-plays to teach clients how to identify automatic thoughts in session. Once clients learn how, they can begin to identify and modify interfering automatic thoughts throughout life.

For CBT resources, visit our website.

CBT Helps Prevent Depression in At-Risk Adolescents

Research from a randomized clinical trial recently published in JAMA Psychiatry indicates that group cognitive-behavioral prevention (CBP) may help prevent depression in at-risk adolescents. Participants included 316 adolescents with current or past elevated depressive symptoms and whose parents experienced current and/or prior depression. They were randomly assigned to either the CBP group or care as usual (CU). The CBP intervention consisted of eight weeks of weekly 90-minute group sessions, as well as six monthly 90-minute booster sessions. Cognitive restructuring and problem solving were emphasized throughout the course of treatment.

Participants were assessed pre-intervention, after the acute intervention, after the booster sessions, and at one year (21 months) and 2 years (33 months) post intervention. Results showed that adolescents in the CBP group had significantly fewer onsets of depressive episodes than the care as usual group. However, parental depression significantly moderated the effect of the intervention. That is, when parents were depressed at baseline, average onset of depression between the CBP group and usual care did not differ. These results indicate that CBPs may be an evidence-based alternative to preventing depression, and that improvements are needed to strengthen the CBP intervention particularly when active parental depression is involved.

Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., … & Garber, J. (2013). Prevention of Depression in At-Risk Adolescents: Longer-term Effects. doi:10.1001/jamapsychiatry.2013.295

CBT Relapse Prevention

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck describes examples of the  application of techniques such as mindfulness, acceptance, and validation. He also explains how these and other important techniques can be used to enhance relapse prevention.

For CBT resources, visit our website.

Dissemination of Evidence-Based Treatments for PTSD: Barriers and Accomplishments

Posttraumatic stress disorder (PTSD) presents as a significant public health challenge because of its pervasive effects on mental health, physical health, and psychosocial problems. A recent review published in Psychological Science in the Public Interest, evaluates the effectiveness of prolonged exposure (PE) and cognitive behavior therapy (CBT) for individuals with PTSD. Although studies indicate that these treatments are efficacious for various populations, many individuals with PTSD do not receive evidence-based treatments (EBTs). The present review investigates barriers to be addressed in order to promote dissemination of EBTs for PTSD in developed and developing countries. Specifically, the authors review examples of dissemination models, discuss possible solutions, and suggest future steps in disseminating EBTs for PTSD. Improved dissemination of EBTs for PTSD is necessary in order to increase accessibility of successful treatments.

Foa, E. B., Gillihan, S. J., & Bryant, R. A. (2013). Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest, Supplement, 14(2), 65-111.

The Cognitive Model and Case Formulation

In this video from Beck Institute’s 4th Annual Student Workshop, Dr. Aaron Beck discusses how the cognitive model can be applied to various psychiatric disorders and psychological problems. Dr. Beck provides an example of a client with several problems including back pain, panic attacks, generalized anxiety, and depression to illustrate how the cognitive model is used to inform case formulation.

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

A Monthly Summary of Beck Institute Updates [September 2013]

In its efforts to encourage the growth and dissemination of CBT throughout the world, Beck Institute has expanded its online presence across social media and other platforms. To keep you (our readers) informed of our most recent updates, we’ve decided to implement a monthly summary including: blogs, CBT articles, CBT trainings, and other updates for our readers. We’re very excited about some of the new developments at Beck Institute, including our new Core Curriculum. Please use the following links to go back and read what you may have missed from September 2013:

Click here for a complete schedule of Beck Institute workshops

See what you missed in August 2013

Child Perfectionism May Impact CBT Anxiety Treatment Outcomes

A recent study published in Behavior Research and Therapy investigated the effect of child perfectionism before treatment on the outcome of cognitive behavior therapy (CBT) for anxiety.  Perfectionism is typically defined as a trait involving personally demanding standards for performance.  Although a link has been found between perfectionism and adult anxiety treatment outcomes, there is a paucity of research on how perfectionism impacts CBT anxiety treatment in children.  Participants included 67 children ages 6-13 who were attending a group-based CBT program for their primary diagnoses of anxiety as part of a larger randomized controlled trial.  While perfectionism reduced following CBT anxiety treatment, higher levels of pre-treatment self-oriented perfectionism predicted higher levels of anxiety symptoms (self-reported) following treatment and at the 6-month follow up. Thus, some features of perfectionism may present as an obstacle for desirable treatment outcomes in children with anxiety.  Research is warranted to further understand the link between perfectionism and anxiety in children and how to enhance the ability to identify children at risk for anxiety and improve CBT interventions for anxious children.

Mitchell, J. H., Newall, C., Broeren, S., & Hudson, J. L. (September 01, 2013). The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children. Behaviour Research and Therapy, 51, 9, 547-554.

Pretreatment Predictors of Dropout in War Veterans Receiving CBT for PTSD

Although research suggests that cognitive behavior therapy (CBT) is rather efficacious in the treatment of posttraumatic stress disorder (PTSD) symptoms, CBT also appears to be limited by high rates of treatment attrition. A recent retrospective study published in Psychological Services examined differences between war veterans (Iraq and Afghanistan) who completed treatment versus those who dropped out of treatment.

Participants (N = 117) in the present study received outpatient CBT treatment for PTSD at a PTSD specialty clinic. Their clinical data was evaluated, and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was utilized to predict treatment dropout. Dropout was defined as ending treatment before attaining the predetermined treatment goals set by the client and clinician.

According to results, approximately 68% of participants dropped out of treatment. Younger war Veterans were more likely to drop out from treatment than older veterans. Additionally, patients with high scores on MMPI-2 TRT scale, which measure discomfort with discussing problems and negative attitudes toward mental health treatment, were also more likely to drop out of treatment. Notably, war veterans who completed treatment showed reductions in PTSD symptom severity. These results suggest that age and negative attitudes toward mental health services can help predict treatment adherence in war veterans seeking treatment for PTSD.

Garcia, H. A., Kelley, L. P., Rentz, T. O., & Lee, S. (February 01, 2011). Pretreatment Predictors of Dropout From Cognitive Behavioral Therapy for PTSD in Iraq and Afghanistan War Veterans. Psychological Services, 8, 1, 1-11.