CBT is Effective for Pediatric OCD

OBJECTIVE: The purpose of this study was to examine the acute effectiveness of manualized exposure-based CBT with a family-based treatment, as an initial treatment for pediatric OCD delivered in regular community child and adolescents outpatient clinics. The report summarizes outcome of the first treatment step in the NordLOTS, which was conducted in Denmark, Sweden and Norway.

METHOD: 269 participants, age 7-17, with OCD, received treatment for 14 weekly sessions. Treatment response was defined as CY-BOCS score of ?15 at post treatment.

RESULTS: 241 participants (89.6%) completed all 14 weeks of treatment. Treatment response among the completers was 72.6% (95% CI 66.7%-77.9%). Mixed effects model revealed a statistically significant effect of time F(1,479) = 130.434. Mean symptom reduction on the CY-BOCS was 52.9% (SD = 30.9). The estimated within-group effect size between baseline and post treatment was 1.58 (95% CI: 1.37-1.80).

CONCLUSION: This study found that manualized CBT can be applied effectively in community mental health clinics. These findings underscore the feasibility of implementing exposure-based CBT for pediatric OCD in a regular child and adolescent mental health setting.

Torp, N. C., Dahl, K., Skarphedinsson, G., Thomsen, P. H., Valderhaug, R., Weidle, B., Melin, K. H., … Ivarsson, T. (January 01, 2015). Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS). Behaviour Research and Therapy, 64, 1, 15-23.

Beyond the Label: Relationship between Community Therapists’ Self-Report of a CBT Orientation and Observed Skills

Policy-makers, payers, and consumers often make decisions based on therapists’ reported theoretical orientations, but little is known about whether these labels represent actual or potential skills. Prior to CBT training, therapists (n = 321) reported theoretical orientations. Experts rated CBT competency using the Cognitive Therapy Rating Scale Therapy at pre-, mid-, and post-training. CBT- and non-CBT identified therapists showed equivalent, non-competent baseline CBT skills. CBT-identified therapists showed greater CBT skills at mid-training, but by end of training, groups evidenced equivalent achieved competency. Baseline CBT orientations were neither valid, nor useful markers of later competency. Policy, clinical and research implications are discussed.

Creed, T.A., Wolk, C.B., Feinberg, B., Evans, A.C., & Beck. A.T. (2014). Beyond the label: Relationship between community therapists’ self-report of a cognitive behavioral therapy orientation and observed skills. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-014-0618-5.

A Randomized Pilot Study of CBT Anger Treatment for Iraq and Afghanistan Veterans

OBJECTIVE: Anger and aggression are serious problems for a significant proportion of veterans who have served in combat. While prior research has suggested that cognitive behavioral treatments may be effective for anger problems, there are few controlled studies of anger treatment in veterans and no studies of anger treatment focusing exclusively on veterans from the Iraq and Afghanistan wars. This randomized pilot study compared an adapted cognitive behavioral intervention (CBI) to a supportive intervention (SI) control condition for the treatment of anger problems in veterans returning from deployment in Iraq or Afghanistan.

METHODS: 25 veterans with warzone trauma, problems with anger, and one or more additional hyperarousal symptoms were randomized and 23 started treatment (CBI, n = 12; SI, n = 11). Outcome measures were administered at pre- and post- treatment and at 3 months post-treatment.

RESULTS: CBI was associated with significantly more improvement than SI on measures of anger and interpersonal functioning. Gains were maintained at follow-up.

CONCLUSIONS: Findings suggest that CBI may be more effective than an active control providing psychoeducation, relaxation, and supportive therapy for treating anger problems in returning veterans. The findings need to be replicated in an adequately powered and more diverse sample.

Shea, M. T., Lambert, J., & Reddy, M. K. (2013). A randomized pilot study of anger treatment for Iraq and Afghanistan veterans. Behaviour Research and Therapy, 51, 10, 607-13.

The Beck Scale for Suicide Ideation (BSS) is a useful tool designed to help clinicians detect and measure the severity of suicidal ideation. For more information on the BSS, visit www.beckscales.com.

CBT improves Memory of Veterans Suffering from PTSD

Posttraumatic stress disorder (PTSD) is characterized by hyperarousal, flashbacks, avoidance, and memory dysfunctions. Although psychotherapy improves the clinical symptoms, its effect on memory has not been explored. In addition, there is no information about gene expression changes related to hippocampal functions. We assessed PTSD patients (n = 20) using the Wechsler Memory Scale-Revised (WAIS-R) and a paired associates learning (PAL) test, as well as changes in blood FK506 binding protein (FKBP5) mRNA expression before and after cognitive behavioral therapy (CBT). Results revealed that before CBT PTSD patients were impaired on WAIS-R delayed recall, attention/concentration, and PAL compared with trauma-exposed control subjects (n = 20). These memory dysfunctions showed a significant improvement after CBT. Better performance on the PAL test correlated with enhanced blood FKBP5 mRNA expression. These results suggest that elevated FKBP5 expression during CBT is related to improved associative memory linked to the hippocampal formation.

Szabó, C., Kelemen, O., & Kéri, S. (2014). Changes in FKBP5 expression and memory functions during cognitive–behavioral therapy in posttraumatic stress disorder: A preliminary study. Neuroscience Letters, 569, 116-120.

The Beck Scale for Suicide Ideation (BSS) is a useful tool designed to help clinicians detect and measure the severity of suicidal ideation. For more information on the BSS, visit www.beckscales.com.