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Beliefs Can Interfere with Treatment Adherence

judith-beck_1024w.jpgI recently read an interesting case description on a professional listserv about a “difficult” client who was not fully adherent with treatment. Apparently he argued with his therapist and did little homework outside of the session. It was apparent to me that the therapist had made a mistake. She was continuing to try to deliver “standard” CBT treatment, without attending to the therapeutic relationship sufficiently. I hypothesized that the client had an interfering belief:

“If I refrain from arguing with my therapist and comply fully with treatment……[something bad will happen or it will mean something bad about me.” ].

I don’t have enough details about the case to understand how the client would finish this assumption, but some clients might answer:

“I’ll feel so distressed that I won’t be able to stand it,” or “it will mean she’s in control, and I’m not.”

Until such interfering beliefs are elicited, evaluated, and effectively responded to, this client is unlikely to make much progress.

–Posted by Judith S. Beck, Ph.D., Director, Beck Institute

American Heart Association Advisory Regarding Depression, Coronary Heart Disease, and CBT

NewStudy-Graphic-72x72_edited-3 Circulation: The American Heart Association issued an advisory regarding the need for screening, referral, and treatment of depression in people with coronary heart disease (CHD). Depression is more prevalent in CHD patients and can contribute to a number of negative outcomes for the disease. Major depression that is comorbid with CHD is associated with more ambulatory and emergency care visits, days spent in bed because of illness, and functional disability; it is also associated with worse coronary prognoses. Additionally, depression is associated with decreased adherence to medications, medical treatment regimens, successful modifications of other cardiac risk factors, and participation in cardiac rehabilitation. Regardless of whether “depression affects cardiac outcomes directly or indirectly, the need to screen and treat depression is imperative.”

The advisory included the use of the Patient Health Questionnaire as part of the assessment of depression and depressive symptoms. Once depression is diagnosed, the three recommendations for treatment are antidepressant drugs, physical activity, and cognitive behavioral therapy (CBT), alone and/or in combination. At least 12 to 16 sessions of cognitive behavioral therapy over 12 weeks were advocated to achieve remission of moderate to severe depression.

Advisory authors: J. H. Lichtman, J. T. Bigger, J. A. Blumenthal, N. Frasure-Smith, et al.

Internet-based CBT helps service members with post-traumatic stress

A recent study in the American Journal of Psychiatry reviews therapist-assisted, Internet-based, self-management cognitive behavior therapy (CBT) for service members with post-traumatic stress disorder (PTSD). This protocol was compared with Internet-based supportive counseling for PTSD. Both groups used websites, homework assignments, and educational information concerning PTSD. The authors found that the CBT protocol led to “sharper declines in daily log-on ratings of PTSD symptoms and global depression” in addition to other symptom reduction; these improvements were also noted at 6 months. The authors state that this protocol “may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care.”

Study authors: B. T. Litz, C. C. Engel, R. A. Bryant, A. Papa  

 

All-male CBT workshops effective for men with insomnia

CBT has been successfully used to treat insomnia in both men and women, but according to a recent article men tend to seek treatment less often than women. Even when they consult their primary care providers, those providers are often unaware of CBT’s effectiveness and may have limited CBT resources to offer their patients.

To address this, researchers offered group CBT in the form of 1-day, all-male CBT workshops. The study ran six months, and drew 111 inquiries, some of them self-referred. The researchers noted that roughly half of the participants had not mentioned their insomnia to their primary care providers. In a six-week follow-up, the men “reported significant improvements in their sleep, as well as reductions in their depression.”

–Read more about CBT for insomnia.

Cognitive Behavior Therapy helps prevent spread of HIV

The National Institute of Mental Health (NIMH) recently launched a Healthy Living Project to promote healthful behaviors among those who have HIV. The Healthy Living Project had two phases: 1) to qualitatively investigate and understand the living contexts of those with HIV and 2) to offer an intervention – Cognitive Behavior Therapy (CBT). Read more

Unemployed? Cognitive Behavior Therapy may be able to help

Usually we write in about recent studies — and this unemployment study is actually from 1997, but we thought it was interesting enough to warrant highlighting. People often ask us about using Cognitive Behavior Therapy (CBT) techniques for everyday life issues (as opposed to using CBT for specific psychiatric disorders), and this unemployment study, conducted in the UK, is a great example of how CBT can be applied to other areas.

Here’s the overview: researchers recruited 289 people who had been unemployed for more than one year (but who did not have psychiatric disorders). They were randomly assigned to either group CBT or a control group that focused on social support. Read more

CBT for Smoking Cessation among Cancer Patients

Smoking, alcohol use and depression often co-exist at high rates among patients with head and neck cancer. Researchers recently designed a randomized, controlled study to see whether patients with head and neck cancer and at least one of the above traits improved with integrated Cognitive Behavior Therapy (CBT) that addressed all of the above factors.

184 patients were randomly assigned to either usual care or 9-11 CBT phone sessions plus optional medications over a period of six months. At the end of the trial, those in the CBT group had significantly improved their smoking cessation rate as compare to those in the usual care group (47% compared to 31%).

The study suggests that an integrated CBT approach, which treats smoking cessation, alcohol and depression simultaneously, may improve smoking cessation rates and provide a more practical means of addressing these co-morbid factors.

Cognitive Behavior Therapist – How to Find One

Two days ago, we received a great comment that said, “This is *not* what I experienced when I saw a cognitive-behavioral therapist… I wish cognitive-behavioral therapy as described on this site was available. Too many CBT therapists are not well-trained and refuse to think!” (you can read Sam’s full comments about the kind of ‘CBT’ that he and his friend received on this post – his is the fourth comment down).

We thought it was important to highlight his experience because we think many consumers may not know about the vast differences in training and approach among people who call themselves Cognitive Therapists or Cognitive Behavior Therapists. Read more

HBO Film on Cognitive Behavior Therapy for Addiction

HBO is launching a new addiction project, and one of its films features Cognitive Behavior Therapy (CBT) as the “most effective treatment for stimulant addiction.” The film follows a group of individuals undergoing CBT treatment for addiction at the Matrix Institute in California.   Read more

Women War Vets with PTSD improve through CBT

In the U.S., post-traumatic stress disorder (PTSD) is more prevalent among women than men, and is especially prevalent among women in the military. This February 28th JAMA study is the first to examine PTSD treatment for this population – female veterans and women in active duty. Read more