Identical symptomology but different diagnoses: Treatment implications of an OCD versus schizophrenia diagnosis

New Study (1)Abstract
Background: Individuals with identical symptomatology may receive conflicting diagnoses, potentially leading to different treatments. The aims of this study were to assess diagnostic impressions and treatment recommendations for obsessive–compulsive disorder (OCD) versus schizophrenia-spectrum disorders (SSD).
Methods: Participants (N = 82) were recruited from accredited doctoral programs. All participants were randomized to assess diagnostic impressions and treatment recommendations for 15 vignettes. These were measured across three separate testing sessions.
Results: Large discrepancies in treatment recommendations were found. All participants who selected OCD recommended psychotherapy while only 15.4% of participants who identified the same vignette as schizophrenia suggested psychotherapy. More than half the participants who reported schizophrenia selected antipsychotics as the primary response; medication was not a primary recommendation when the vignette was identified as OCD.
Conclusion: Symptoms conceptualized as SSDs were recommended medication; those same symptoms conceptualized as OCD were recommended psychotherapy. Greater awareness regarding the efficacy of psychosocial treatments for SSDs is needed.

Hunter, N., Glazier, K., & McGinn, L. K. (2015). Identical symptomology but different diagnoses: Treatment implications of an OCD versus schizophrenia diagnosis. Psychosis: Psychological, Social and Integrative Approaches. doi:10.1080/17522439.2015.1044462

Implementing a web-based intervention to train community clinicians in an evidence-based psychotherapy: A pilot study

New Study (1)Abstract:

Objective: The authors conducted a feasibility assessment of online training plus an online learning collaborative to support implementation of an evidence-based psychosocial treatment in a community mental health systems.

Methods: Two mental health centers were randomly allocated to in-person training with local supervision, and three were assigned to online training plus an online learning collaborative supported by expert clinicians. Participants (N=36) were clinicians interested in interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for bipolar disorder. After training, 136 patients reported monthly on the extent to which clinicians used 19 IPSRT techniques.

Results: Clinicians from both training groups increased use of IPSRT techniques. Patients of clinicians receiving Internet-supported e-learning and of those receiving in-person training reported comparable clinician use of IPSRT techniques.

Conclusions: Internet-supported e-learning by community clinicians was found to be feasible and led to uptake of an evidence-based psychotherapy comparable to that by clinicians who received face-to-face training.

Stein, D. B., Celedonia, K.L.,  Swartz, A. H., DeRosier, E. M., Sorbero, J. M., Brindley, A. R., Burns, M. R., Dick, W. A.,  & Frank, E. (2015) Implementing a Web-Based Intervention to Train Community Clinicians in an Evidence-Based Psychotherapy: A Pilot Study. Psychiatric Services, 66(9).

Ethical considerations in exposure therapy with children

New Study (1)Abstract:

Despite the abundance of research that supports the efficacy of exposure therapy for childhood anxiety disorders and OCD, negative views and myths about the harmfulness of this treatment are prevalent. These beliefs contribute to the underutilization of this treatment and less robust effectiveness in community settings compared to randomized clinical trials. Although research confirms that exposure therapy is efficacious, safe, tolerable, and bears minimal risk when implemented correctly, there are unique ethical considerations in exposure therapy, especially with children. Developing ethical parameters around exposure therapy for youth is an important and highly relevant area that may assist with the effective generalization of these principles. The current paper reviews ethical issues and considerations relevant to exposure therapy for children and provides suggestions for the ethical use of this treatment.

Gola, A. J., Beidas, S. R., Antinoro-Burke, D., Kratz, E. H. & Fingerhut, R. (2015). Ethical considerations in exposure therapy with children.  Cognitive and Behavioral Practice. doi:10.1016/j.cbpra.2015.04.003

Workshop Participant Spotlight – Deborah Zwick, PhD

Meet Deborah Zwick, PhD, a clinical psychologist who traveled to Beck Institute from Vail, Colorado. She, along with 41 other mental health professionals, attended our workshop,DSC_0389 CBT for Children and Adolescents taught by Torrey Creed, PhD.

She decided this workshop would be a great fit for her career, as she consults with private schools and is now seeing more children in her practice. After working for 25 years in Chicago with adolescents and adults, adding knowledge on working specifically with children will help to expand her practice.

Her biggest takeaway from this training? CBT is malleable. It can be used in a variety of ways with all types of clients.

Dr. Creed is “fantastic; her combination of enthusiasm, warmth and evidence-based, sound material” made this “one of the better workshops I’ve attended in many years.” Dr. Zwick also appreciated how this workshop drew professionals from around the world, with participants from 6 countries and 16 states.

Coming to Beck Institute is like “going to the mountaintop for learning CBT.” 



Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: A randomized controlled trial

New Study (1)Abstract:

Major depressive disorder (MDD) is prevalent after traumatic brain injury (TBI); however, there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T) (n = 40) or in-person (CBT-IP) (n = 18), compared with usual care (UC) (n = 42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated, 17-item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (treatment effect = 1.2, 95% CI: -1.5-4.0; p = 0.37) and a nonsignificant trend favoring CBT on the SCL-20 (treatment effect = 0.28, 95% CI: -0.03-0.59; p = 0.074). In follow-up comparisons, the CBT-T group had significantly more improvement on the SCL-20 than the UC group (treatment effect = 0.36, 95% CI: 0.01-0.70; p = 0.043) and completers of eight or more CBT sessions had significantly improved SCL-20 scores compared with the UC group (treatment effect = 0.43, 95% CI: 0.10-0.76; p = 0.011). CBT participants reported significantly more symptom improvement (p = 0.010) and greater satisfaction with depression care (p < 0.001), than did the UC group. In-person and telephone-administered CBT are acceptable and feasible in persons with TBI. Although further research is warranted, telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment.

Fann, J.R., Bombardier, C.H., Vannoy, S., Dyer, J., Ludman, E., Dikmen, S., Marshall, K., Barber, J. & Temkin, N. (2015). Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: A randomized controlled trial. J Neurotrauma. 2015 Jan 1;32(1):45-57. doi: 10.1089/neu.2014.3423.