Telephone-Administered CBT is Effective for Depressed MS Patients with High Social Support

A study published in the Journal of Behavioral Medicine demonstrates that individuals with multiple sclerosis (MS) who have high levels of social support receive significant benefits from telephone-administrated cognitive behavioral therapy (T-CBT). The current study compared T-CBT to telephone-administered emotion-focused therapy (T-EFT) among depressed MS patients with both high and low levels of social support.

Participants (n=127) were randomized to receive either T-CBT (n=62) or T-EFT (n=65).  Both treatments were delivered over 16 weekly, 50-minute sessions. The T-CBT group participated in a manualized treatment approach, including 5 chapters focused on identifying and modifying depressogenic thoughts, increasing the number of pleasant activities, enhancing problem solving and managing interpersonal difficulties. The T-EFT group emphasized the development of a genuine, supportive and validating therapeutic relationship, in order to maximize exploration of emotional experiences; therapists in the T-EFT group were not permitted to use interventions for modifying cognitions, behaviors, or skills. Both groups were assessed at baseline and at 16 weeks post-treatment.

Results showed that MS patients with high levels of social support had greater reductions in depressive symptoms following T-CBT, compared to T-EFT. Among patients with low social support, similar reductions were noted for both treatments. For patients with high social support, CBT may, therefore, be a more beneficial treatment approach than EFT.

Beckner, V., Howard, I., Vella, L., & Mohr, D. C. (2010). Telephone-administered psychotherapy for depression in MS patients: moderating role of social support. Journal of Behavioral Medicine, 33, 1, 47-59.

Preventive Antenatal Group CBT for Chinese Women with Depression

According to the World Health Organization (WHO), major depression, including postnatal depression (PND), will be the second highest worldwide cause of disability and death by 2020. A recent study published in the International Journal of Nursing Practice, suggests that cognitive behavior therapy may be a promising treatment for women, worldwide, who suffer with PND.

Participants in the current study (n = 97) included pregnant Chinese women with mild to moderate depressive symptoms, recruited at the antenatal clinic in Hong Kong via convenience sampling. The trial program was conducted using quasi-experimental design.
Participants who received the intervention (n = 47) attended six, 2-hour, weekly group therapy sessions. Sessions focused on the core components of the cognitive behavior model, identifying patterns of irrational thoughts, strategies for managing unpleasant and stressful situations, identifying dysfunctional beliefs, relaxation exercises and engaging in pleasurable activities, and using CBT to handle future, stressful events.

Post-intervention evaluation showed highly positive feedback from participants. In fact, all of the participants agreed that content was easy to comprehend and reported that they found the intervention to be useful. This brief-antenatal CBT intervention was found to be both feasible for Hong Kong women and acceptable. This study provides helpful information for the future development and replication of the preventive, antenatal group CBT intervention.

Leung SSK, Lee AM, Chiang VCL, Lam SK, Yung C, Wong DFK. International Journal of Nursing Practice 2013; 19 (Suppl. 1): 28–37 Culturally sensitive, preventive antenatal group cognitive–behavioural therapy for Chinese women with depression, 19:1, 28–37.

The Importance of Diagnosis in CBT

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses the importance of diagnosis in effective cognitive behavior therapy. Dr. Beck explains that the patient’s diagnosis can be used, in part, as a guide for sessions, even when the focus of sessions shifts across treatment.

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

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Internet-based Cognitive Behavioral Therapy for Severe Health Anxiety

According to a new study published in The British Journal of Psychiatry, internet-based cognitive behavior therapy (CBT) may be an effective treatment for individuals with health anxiety. Participants (n=81) in the current study were randomly assigned to either an internet-based CBT group (n=40) or to a control group (an online discussion forum) (n=41). Participants in the CBT group received a 12-week treatment intervention that incorporated mindfulness training (teaching participants to observe their bodily sensations without trying to control them), a 12-module self-help text, and a discussion forum (in which participants could anonymously communicate with other members of the same group.) Participants in the CBT group also had access to a therapist through a secure online system, however there were neither face-to-face nor telephone contacts during the study. Participants in the control condition were encouraged to utilize the discussion forum to discuss their health anxiety and ways of coping with it. At post treatment, results showed that the internet-based CBT group displayed superior improvements over the control group. In fact, two-thirds of participants in the CBT group no longer met criteria for health anxiety. Further, large treatment effects were also maintained at the 6-month follow up. These findings suggest that internet-based CBT for health anxiety may be a promising alternative treatment for individuals without access to face-to-face therapy.

Erik Hedman, Gerhard Andersson, Erik Andersson, Brjann Ljotsson, Christian Ruck, Gordon J. G. Asmundson and Nils Lindefors (2011). “Internet-based cognitive-behavioral therapy for severe health anxiety: randomized controlled trial”. The British Journal of Psychiatry.

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.

Group CBT is Effective for Generalized Social Anxiety Disorder in Japan

According to a recent study published in Neuropsychiatric Disease and Treatment, cognitive behavior therapy (CBT) effectively reduces symptoms of generalized social anxiety disorder (SAD) and improves quality of life among Japanese patients for up to a year post-treatment. The present study aimed to identify the long-term efficacy and predictors of group CBT among patients diagnosed with SAD in a naturalistic setting in Japan. From July 2003 to August 2010, outpatient participants (n=113) received 12-20 group-based CBT sessions and were assessed at 1-year follow up points. The researchers then compared treatment completers to those who had dropped out. According to results, group-based CBT significantly reduced symptoms of SAD among patients, and these improvements were maintained for up to one year post-treatment.

Kawaguchi, A, Watanabe, N, Nakano, Y, et al. (2013). Group cognitive behavioral therapy for patients with generalized social anxiety disorder in japan: Outcomes at 1-year follow up and outcome predictors. Neuropsychiatric Disease and Treatment, 9, 267-275.

CBT for People with Disabilities

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses how to use cognitive therapy with people who have disabilities. He discusses how an individual’s specific negative beliefs about his or her disability can lead to other disorders, including depression and suicidality. Dr. Beck then outlines three main objectives for therapists working with patients with disabilities.

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