Cognitive Restructuring in CBT

Dr. Aaron Beck reviews cognitive restructuring with a depressed client during a recent Beck Institute Workshop. Dr. Beck describes how he helped the client evaluate evidence for and against his thoughts and his belief that he was a failure. He also explains how cognitive restructuring helps depressed clients access rational thinking that is typically blocked by their cognitive distortions.

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CBT for Autism in School Settings

This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7-11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34-1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment, compared to 25 % of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted.

Wood, J. J., Fujii, C., Renno, P., & Dyke, M. (2014). Impact of cognitive behavioral therapy on observed autism symptom severity during school recess: a preliminary randomized, controlled trial. Journal Of Autism And Developmental Disorders. doi:10.1007/s10803-014-2097-7

The Influence of Behavior Therapy and Neo-Freudism on the Development of Cognitive Therapy

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses how early behavior therapists and neo-Freudians influenced his work in developing Cognitive Therapy. Dr. Beck refers to the work of Albert Ellis, George Kelly, and Karen Horney as particularly influential.

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CBT is Effective for Body Dysmorphic Disorder

There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking). Thirty-six adults with BDD were randomized to 22 sessions of immediate individual CBT-BDD over 24 weeks (n=17) or to a 12-week waitlist (n=19). The Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS), Brown Assessment of Beliefs Scale, and Beck Depression Inventory-II were completed pretreatment, monthly, posttreatment, and at 3- and 6-month follow-up. The Sheehan Disability Scale and Client Satisfaction Inventory (CSI) were also administered. Response to treatment was defined as ?30% reduction in BDD-YBOCS total from baseline. By week 12, 50% of participants receiving immediate CBT-BDD achieved response versus 12% of waitlisted participants (p=0.026). By posttreatment, 81% of all participants (immediate CBT-BDD plus waitlisted patients subsequently treated with CBT-BDD) met responder criteria. While no significant group differences in BDD symptom reduction emerged by Week 12, by posttreatment CBT-BDD resulted in significant decreases in BDD-YBOCS total over time (d=2.1, p

Wilhelm, S., Phillips, K. A., Didie, E., Buhlmann, U., Greenberg, J. L., Fama, J. M., & … Steketee, G. (2013). Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial. Behavior Therapy, doi:10.1016/j.beth.2013.12.007


Evaluating Unhelpful Automatic Thoughts in CBT

During a recent Beck Institute Workshop, Dr. Aaron Beck and Dr. Judith Beck discuss addressing clients’ automatic thoughts that may be true but unhelpful. They describe how therapists can help clients evaluate whether thoughts are productive in helping them reach their goals.

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CBT is Effective for Treatment-Resistant Depression in Community Mental Health

State mental health systems have been leaders in the implementation of evidence-based approaches to care for individuals with severe mental illness. Numerous case studies of the wide-scale implementation of research-supported models such as integrated dual diagnosis treatment and assertive community treatment are documented. However, relatively few dissemination efforts have focused on cognitive behavioral therapy (CBT) for individuals with major depression despite evidence indicating its efficacy with this population. A multi-site effectiveness trial of CBT was conducted within the Texas public mental health system. Eighty-three adults with major depression received CBT from community clinicians trained through a workshop and regular consultation with a master clinician. Outcomes were compared to a matched sample of individuals receiving pharmacotherapy. Outcome measures used included the quick inventory of depressive symptomatology and beck depression inventory. Individuals receiving CBT showed greater improvements in depression symptoms than those in the comparison group. Greater pre-treatment symptom severity predicted better treatment response, while the presence of comorbid personality disorders was associated with poorer outcomes.

Lopez, M. & Basco, M. (2014). Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression. Administration and Policy in Mental Health Service and Research.  DOI:10.1007/s10488-014-0546-4

Behavioral Experiments in Cognitive Therapy

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses the use of behavioral experiments in cognitive therapy. He explains that behavioral experiments are more than just “getting the patient active”. Instead, they are also used to help the client test and then modify inaccurate and unhelpful beliefs that impact healthy functioning.

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CT is as Effective as Fluoxetine in Preventing Depressive Relapses

A recent study published in JAMA Psychiatry showed Cognitive Therapy (CT) to be as effective as medication (Fluoxetine) in reducing the risk of major depressive disorder (MDD) relapse. Participants in the current study included 523 adults with a diagnosis of MDD and a score of 14 or higher on the Hamilton Rating Scale for Depression. They were recruited from clinical referrals and advertisements during 2000 to 2008. Researchers employed a sequential, 3-stage design with an acute phase in which all patients received 12 weeks of CT; an 8-month experimental phase in which responders at higher risk were randomized to receive either a continuation of CT, fluoxetine, or a pill placebo; and a 24-month longitudinal, posttreatment follow up. At the end of the 8-month experimental stage, participants were assessed without treatment at 4 month intervals, continuing for 32 months. Results showed that CT and fluoxetine had almost equal relapse rates during the 8-month experimental phase, which were maintained during the assessment following termination of treatment. While further research is needed to fully understand the differences between psychopharmacological treatment and CT for depression, these finding suggest that CT is a valid alternative to drug therapies.

Jarret, R. B., Minhajuddin, A., Gershenfeld, H., Friedman, E. S., & Thase, M. E. (2013). Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: A randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo. JAMA Psychiatry, 70(11), 1152-1160. doi:10.1001/jamapsychiatry.2013.1969

The Future of Psychotherapy

At a recent Beck Institute Workshop, Dr. Aaron Beck describes the evolution of CBT and its projected trajectory. He proposes that there will be one psychotherapy based on a basic validated theory, with specific formulations and techniques for each disorder. Dr. Beck also discusses a triage system in which specialists would be assigned to clients based on the severity of their symptoms and disorder(s).

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