CBT is Effective for Adherence and Depression in HIV-Infected Injection Drug Users

A recent study in the Journal of Consulting and Clinical Psychology suggests that cognitive behavioral therapy for adherence and depression (CBT-AD) can be an effective treatment for decreasing depression and increasing adherence to medication in HIV-infected injection drug users. The present study examined the effects of time-limited CBT-AD on participants with HIV and depression, and currently receiving treatment for their injection drug use.  Participants (n=89) ranged from age 18 to 65 and were randomly assigned to receive either CBT-AD (n=44) or enhanced treatment as usual (ETAU) (n=45). Participants in the intervention group received 9 treatment sessions over a period of 3 months, involving 11 informational, problem-solving, and cognitive behavioral steps. At each step, the participants and the therapist collaboratively defined the problem, generated alternative solutions, made decisions about the solutions, and developed a plan for implementing them.

At post-treatment, the intervention group showed significant improvements.  The Beck Depression Inventory showed a significant reduction in symptoms of depression in the CBT-AD group (M=5.1 points) compared to the ETAU group (M= <1 point). A 40% decrease in symptoms of depression was shown from baseline to post treatment with CBT-AD. These clinically significant improvements were maintained at the 12 month follow up. The Medication Event Monitoring System (MEMS) showed that during the CBT-AD intervention, adherence improved 11.8% from baseline and 11.3% more than the ETAU condition. However adherence gains were not maintained at follow-up. It is proposed that continued adherence counseling may be necessary to maintain adherence gains, even when depression symptoms improve.

Depression and substance abuse are the most comorbid disorders associated with HIV-infection, and it is suggested that even a small change in adherence can result in improved outcomes for HIV patients. The results of this study suggest that the integration of CBT-AD into substance abuse counseling may be useful for decreasing depression and improving adherence to medication (with continued sessions) in HIV-infected patients with a history of injection drug use.

Safren, S.A., O’Cleirigh, C.M., Bullis, J.R., Otto, M.W., Stein, M.D., & Pollack, M.H. (2012) Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Injection Drug Users: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 80(3), 404-415.

Ways for Therapists to Stay Motivated

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses techniques for therapists to remain motivated in their practice. He discusses the importance of distancing oneself from concerns and worries. Dr. Beck gives examples of how therapists can distance themselves, including meditation as well as monitoring and responding to their own cognitions.

Beck Institute provides several training opportunities for CBT therapists. For more information visit our website.

Combined Therapy is Effective for Patients with Refractory Bipolar Disorder in the Long-Term

According to a recent study published in European Psychiatry, a combined treatment, including cognitive behavior therapy (CBT), psycho-education, and pharmacology results in greater long-term efficacy in patients with refractory bipolar disorder than standard pharmacological treatment.

The current study is a 5-year follow-up to a previous trial which examined the differences in efficacy for patients (n=40) with treatment resistant bipolar disorder who were randomly assigned to an experimental group that used a combined therapy, or control group that used pharmacology alone.  There were multiple evaluation points (6-months, 12-months, and 5-years) and at each follow-up, the between-group differences remained significant.

At all follow-up points, the combined therapy group had lower depression and anxiety scores. They also showed significant differences in mania and maladjustment at post-treatment, which were sustained through the 6-month, 12-month, and 5-year evaluation points. Further, the experimental group had fewer hospitalizations at the 12-month evaluation point. At the 5-year follow-up, 88.9% of patients who received pharmacological treatment alone continued to show persistent affective symptoms and/or difficulties in social-occupational functioning, compared to just 20% of patients who received the combined therapy treatment.

These findings suggest that a combined therapy, including CBT, psycho-education, and pharmacology may be quite helpful for patients with refractory bipolar disorder in the long term and superior to pharmacological treatment, alone.

González, I. A., Echeburúa, E., Limiñana, J. M., & González-Pinto, A. (2012) Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial. European Psychiatry. In Press

CBT for Chronic Schizophrenia

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck describes his early work with treating chronic schizophrenia as quite “memorable.” Dr. Beck’s early work, which he documented in a paper published 1952, helped pave the way for treating schizophrenia with evidence-based CBT. CBT for schizophrenia is commonly practiced in the United Kingdom and gaining momentum in the United States.

Beck Institute’s next CBT for Schizophrenia Workshop will take place May 6-8, 2013. For more information, visit our website.

CBT Reduces Tinnitus Severity

According to a recent study published in Hearing Research, cognitive behavior therapy (CBT) is effective in reducing tinnitus severity. Tinnitus is an auditory disorder that affects 5-15% of adults in industrialized nations. Though tinnitus has physical origins, it also has heavy emotional and cognitive components.

This study aimed to evaluate the effectiveness of CBT for patients suffering from tinnitus using a parallel group-controlled trial. Participants (n=286) consisted of patients who had been suffering from tinnitus for at least 4 months. These patients were randomly assigned to either the experimental group (n=166) to receive a standardized tinnitus-specific CBT treatment, or a wait-list control group (n=120). The primary outcome measure used in this study was the tinnitus change score. Secondary outcome measures were the tinnitus severity score, tinnitus loudness score, and tinnitus annoyance score.

According to results, 84% of participants in the treatment group showed an improvement in tinnitus scores, compared to only 22% in the control group. All three secondary outcome measures (tinnitus severity score, tinnitus loudness score, and tinnitus annoyance score) also indicated significant improvement among participants in the CBT group compared to the control group. In fact, the treatment group showed a reduction of 50% in tinnitus severity; no change was observed in the control group.

These results suggest that structured tinnitus-specific CBT can be an effective treatment for patients suffering from chronic tinnitus. Although more research is necessary, these findings are promising for patients with tinnitus, as pharmacological and other treatments for the disorder are not well established or evidence-based.

Zenner, H.-P., Vonthein, R., Zenner, B., Leuchtweis, R., Plontke, S. K., Torka, W., Pogge, S.,Birbaumer, N. (2012). Standardized tinnitus-specific individual cognitive-behavioral therapy: A controlled outcome study with 286 tinnitus patients. Hearing Research.

CBT for Substance Abuse

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses his academic and clinical history in the treatment of substance abuse. He speaks of his early clinical trials involving cognitive therapy for substance abuse. 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.

CBT Shows Long-Term Efficacy in Treating Children and their Parents with Functional Abdominal Pain

A recent study published in the Archives of Pediatrics & Adolescent Medicine demonstrates that a brief cognitive behavior therapy (CBT) intervention effectively treats, in the long-term, children with functional abdominal pain and improves parent’s responses to the child’s pain. This recent study investigates a randomized sample of children with functional abdominal pain (n=200) and their parents at a follow up occurring 12 months after the initial treatment. The experimental group had received a social learning and CBT intervention (SLCBT) while the control group received an education and support (ES) treatment, both lasting three sessions. The children’s symptoms and pain-coping responses were examined using standard instruments. Initial baseline measurements were collected prior to treatment.

The results from the parent study were maintained at the 12-month follow-up. Children in the SLCBT intervention group showed greater baseline to 12 month reductions in symptom severity and greater improvements in pain-coping responses as compared to those in the ES group.  Moreover, parents of the children in the SLCBT group showed greater baseline to 12 month decreases in their solicitous responses to their child’s symptoms and in their maladaptive beliefs regarding their child’s pain compared to parents with children in the control group.

These results indicate that a brief CBT intervention can provide significant improvements for children with functional abdominal pain and their parents in several areas including symptom severity, coping mechanisms, and parental response. The researchers suggest that future studies test whether a longer intervention would increase efficacy of symptom reduction and coping, or if perhaps a group intervention setting would be as effective, thus reducing cost and time.

Levy, R. L., Langer, S.L., Walker, L.S., Romano, J.M., Christie, D.L., Youssef, N., DuPen, M.M., Ballard, S.A., Labus, J., Welsh, E., Feld, L.D., & Whitehead, W.E. (2012). Twelve-Month Follow-up of Cognitive Behavioral Therapy for Children With Functional Abdominal Pain. Archives of Pediatrics & Adolescent Medicine.

How To Achieve Mastery in CBT

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses the process by which therapists develop confidence and achieve mastery in CBT. Dr. Beck explains that with training and experience, therapists begin to approach sessions confidently, with the skills they require to adapt CBT methods according to the client’s individual case conceptualization. Dr. Beck also discusses the Cognitive Therapy Rating Scale (CTRS), which is designed to measure competency in CBT.

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

Click here for CBT resources including the CTRS and CTRS Manual.

How to Become Highly Skilled in CBT

In this video from a recent Beck Institute Workshop, Drs. Aaron and Judith Beck discuss the process of improving as a therapist. Like most skills, excellent therapy skills are achieved over time with good training and experience. Dr. Aaron Beck emphasizes the importance of utilizing patient feedback, as well as learning from colleagues and supervisors. Dr. Judith Beck discusses the importance of keeping an open mind in one’s progression as a therapist, including incorporating new techniques from other fields of therapy within the CBT framework.

Beck Institute provides several training opportunities for CBT therapists. For more information visit our website.

CBT Demonstrates Long-Term Effectiveness for Adults with Anxiety

According to a new study published in Behaviour Research and Therapy, research has demonstrated that cognitive behavior therapy (CBT) has long-term effectiveness for adults with anxiety disorders. The current study sought to examine the immediate and long-term effectiveness of CBT treatment within a naturalistic, outpatient setting. Participants (n=181) included individuals with the primary diagnoses of OCD, GAD, social phobia, panic disorder with agoraphobia, and specific phobia who had received at least 3 (and on average 14) CBT sessions with a therapist, using CBT interventions exclusively, in an outpatient, fee-for-service setting. At post-treatment, 113 participants (62%) were identified as “responders” or “remitters” (i.e., much or very much improved). Of these, 87 participants (77%) maintained their status as “responders” or” remitters” at one-year follow up. These findings suggest CBT outcomes for anxiety disorders among clinic patients are effective in both the short- and long-term.

DiMauro, J., Tolin, D. F., Domingues, J., & Fernandez, G. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour Research and Therapy, 51, 2, 82-86.