Background: Efficacy studies on treatment in adolescent victims of single rape are lacking, even though sexual victimization is most likely to occur during adolescence and despite the fact that adolescents are at risk to develop subsequent posttraumatic stress disorder.
Aim: The aim of this prospective observational study was to evaluate the short- and long-term outcomes of a nine-session cognitive behavior group therapy (STEPS), including a parallel six-session parents’ group on rape-related symptomatology in female adolescents (13-18 years). STEPS includes psychoeducation, exposure in sensu as well as in vivo, cognitive restructuring, and relapse prevention.
Methods: Fifty-five female adolescents with mental health problems due to single rape, but without prior sexual trauma, received STEPS while their parents participated in a support group. Subjects were assessed on posttraumatic stress (PTS) and comorbid symptoms using self-report questionnaires prior to and directly after treatment, and at 6 and 12 months follow-up.
Results: Repeated measures analysis showed a significant and large decrease in symptoms of PTS, anxiety, depression, anger, dissociation, sexual concerns, and behavior problems directly after treatment, which maintained at 12 months follow-up. Time since trauma did not influence the results. Dropout during STEPS was 1.8%.
Conclusions: The results potentially suggest that the positive treatment outcomes at short- and long-term may be caused by STEPS. The encouraging findings need confirmation in future controlled studies on the effectiveness of STEPS because it may be possible that the treatment works especially well for more chronic symptoms, while the less chronic part of the sample showed considerable improvement on its own.
Bicanic, I., de Roos, C., van Wesel, F., Sinnema, G., & van, d. P. (2014). Rape-related symptoms in adolescents: Short- and long-term outcome after cognitive behavior group therapy. European Journal of Psychotraumatology, 5.
Anxiety and related disorders are highly prevalent and costly to society. Fortunately, a large number of randomized controlled trials have demonstrated the efficacy of cognitive behavioral therapy (CBT) in the treatment of anxiety and related disorders. A smaller number of effectiveness studies have also demonstrated that similar outcomes to randomized controlled trials can be obtained in “real-world” settings. There is minimal research, however, into long-term outcomes in effectiveness research. This study describes the outcomes of 98 individuals with anxiety and related disorders treated in an outpatient, fee-for-service setting using a case formulation CBT approach. Participants were followed up each year after their discharge, for a period of 3 years. The results indicate that patients maintained their treatment gains, with large effect sizes obtained from pre-treatment to each follow-up time point (d = 1.11–1.60). The results provide preliminary evidence to suggest that individuals treated with CBT in “real world” settings maintain their treatment gains in the long-term.
Wootton, B. M., Bragdon, L. B., Steinman, S. A., &; Tolin, D. F. (2015). Three-year outcomes of adults with anxiety and related disorders following cognitive-behavioral therapy in a non-research clinical setting. Journal of Anxiety Disorders. Advance online publication. doi:10.1016/j.janxdis.2015.01.007.
In this video from a recent Beck Institute Workshop, Dr. Aaron Beck gives advice on how a clinician can keep a client presently focused in order to achieve the most effective results from therapy.
Objectives: There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach.
Method: Patients attended six sessions of a manualized cognitive-behavioral group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorized according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression.
Results: Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time.
Conclusion: The intervention evaluated shows clinical and organizational promise. The group approach needs to be further developed and tested in research with greater methodological control.
Bains, M. K., Scott, S., Kellett, S., & Saxon, D. (2014). Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults. Aging & Mental Health, 18, 8, 1057-1065.
Anger is related to violence prior to hospitalization, during hospitalization, and after discharge. Meta-analyses have established treatment efficacy in reducing anger, but few studies have addressed whether reduced anger leads to lowered aggressive behavior. This study concerns individually-delivered anger treatment, specialized for offenders with intellectual disabilities, delivered twice weekly for 18 sessions to 50 forensic hospital patients. Assessments involved patient self-report of anger, staff ratings of anger and aggression, and case records of assaultive incidents. Physical assault data were obtained from records 12 months pre-treatment and 12 months post-treatment. Significant reductions in assaults following treatment were found by GEE analyses, controlling for age, gender, length of stay, IQ, and pre-hospital violence. Following treatment, physical attacks reduced by more than half, dropping from approximately 3.5 attacks per patient 6 months prior to treatment, versus approximately 1 attack per patient in the 6-12 month interval post-treatment. In hierarchical regressions, controlling for IQ, reduction in physical assaults was associated with pre-to post-treatment change in anger level. These findings buttress the efficacy of anger treatment for patients having histories of violence and have significance for patient mental health, hospital staff well-being, therapeutic milieu, hospital management, and service delivery costs.
Novaco, R. W., & Taylor, J. L. (2015). Reduction of assaultive behavior following anger treatment of forensic hospital patients with intellectual disabilities. Behaviour Research and Therapy, 65, 52-59.
Clinicians who become overly enamored with techniques may fall into traps when conducting CT with youth (or patients of any age). A sure-fire way to minimize these missteps into therapeutic black holes is to base interventions on a sound formulation.
Beck Institute for Cognitive Behavior Therapy is a leading international source for training, therapy, and resources in CBT.
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