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CBT plus Medication is Effective for Treatment Resistant Depression

According to a new study published online in The Lancet (December 7, 2012) and Contemporary Clinical Trials, cognitive behavior therapy (CBT) as an adjunct to usual care has shown to be an effective treatment for reducing depression and improving quality of life in patients with treatment resistant depression. Although pharmacotherapy is often used as a first-line treatment for depression, only one-third of patients fully respond to anti-depressants and only half receive up to a fifty percent decrease in symptoms. The current study employed a large-scale CoBalT (two parallel-group) randomized controlled trial to investigate the effectiveness of combining CBT and usual care (including pharmacotherapy) versus usual care, alone, for treatment resistant depression. Participants (n=469) ranged from age 18 to 75 and were already taking anti-depressants. They were randomly assigned to receive either CBT plus usual care (n=234) or usual care alone (n=235).

At the 6 month follow up, 46% of  participants (n=95) in the CBT plus usual care group met criteria for response to treatment, as compared to only 22% of participants (n=46)  in the usual care group. Those who received CBT were more likely to experience remission, received lower scores on the Beck Depression Inventory (BDI), and experienced fewer symptoms of anxiety and panic. At the 12-month follow up, these improvements were maintained.

This study is the first large-scale randomized control trial investigating CBT treatment as an adjunct to usual care in patients showing treatment resistance to anti-depressants.  Findings suggest that CBT in combination with usual care can be extremely effective for treating depressive symptoms and improving the quality of life of patients suffering from depression.

Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Garland, A, Hollinghurst, S., Jerrom, B., Kessler, D., Kuyken, W., Morrison, J., Turner, K., Williams, C., Peters, T., & Lewis, G. (2012). Cognitivebehavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. Published online 7th December 2012.

Neurobiology and Cognitive Behavior Therapy

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses  correlates between neurobiology and the cognitive model of depression. Dr. Beck explains the reflexive and reflective systems of cognitive processing and how these systems are impacted by depression. He then summarizes the effects of cognitive behavior therapy on the brain, highlighting the corrective nature of CBT.

For more information on CBT workshops and training, visit our website.

CBT is Effective for Trait Anxiety and Worry

According to a study published in the Canadian Journal of Psychiatry, both cognitive behavior therapy (CBT) and short term psychodynamic psychotherapy (STPP), help reduce symptoms of anxiety and depression in patients with generalized anxiety disorder (GAD).  In the long-term however, CBT has demonstrated superiority in measures of trait anxiety and worry.

Participants (n=57) in the current study were treated with either CBT (n=29) or STPP (n=28) for up to 30 sessions. Both groups yielded large improvements concerning symptoms of depression and anxiety which remained stable at a 6 month follow-up.  At the 12 month follow-up, CBT treatment was shown to provide greater reductions in anxiety symptoms, as measured by the State-Trait Anxiety Inventory (STAI) and the Penn State Worry Questionnaire (PSWQ).  These results are consistent with several other previous trials demonstrating the long-term benefits of CBT for GAD.

Salzer, S., Winkelbach, C., Leibing, E., Leweke, F., & Leichsenring, F. (2011). Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-Month follow-up. Canadian Journal of Psychiatry, 56, 8, 503-508.

Long-Term Comparison of Traditional CBT and Acceptance and Commitment Therapy

According to a recent study published in Behavior Therapy, traditional cognitive behavior therapy (CT) may be more effective for treating anxiety and depression in the long-term than Acceptance and Commitment Therapy (ACT). The current study is a follow up comparison of the long-term outcomes of CT and ACT. The original study measured symptoms of students seeking treatment, (n=132) age 18-52 (M=26.7) before and after receiving CT and ACT. At post treatment, both groups improved on measures of depression, anxiety, and general functioning, and the results did not yield a significant difference in effectiveness between the two samples receiving treatment.

This long-term follow up study, conducted 18 months later included a majority (n=91) of the original sample who received either CT (n=45) or ACT (n=46). Although participants in both treatment groups benefitted initially from the different therapies, participants from the CT treatment group gained significant and lasting improvement in their symptoms and functioning:

 

  • 81.8% of CT patients versus 60.7% of ACT patients remained reliably recovered on measures of depression (Beck Depression Inventory-II);
  • 72.7% of CT patients versus 56.0% ACT patients remained in the recovered range for anxiety (Beck Anxiety Inventory);
  • 46.4% of CT patients versus 22.6% ACT patients maintained improvements in interpersonal and occupational functioning (Outcome Questionnaire); and
  • 37.8% of CT patients versus 22.9% of ACT patients remained in the normative range on measures of quality of life (Quality of Life Inventory).

This is the first known comparison of the long-term efficiency of CT versus ACT. While research and replication studies are necessary, these preliminary findings suggest that traditional CT has long-term advantages over ACT in treating depression and anxiety, and in increasing general functioning and overall quality of life.

Forman, E.M., Shaw, J.A., Goetter E.M., Herbert, J.D., Park, J.A., & Yuen, E.K, (2012). Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behavior     Therapy, 43(4) 801-811

Individualized Internet-CBT Reduces Symptoms in Adults with Panic Attacks

According to a recent study published in the Journal of Medical Internet Research, individually tailored, internet-based cognitive behavior therapy (iCBT) may help alleviate panic symptoms and comorbid anxiety and depression. The current study examined the efficacy of iCBT for adults with reoccurring panic attacks. Participants (n=57) were randomly assigned to either receive treatment immediately (n=29), or to a waitlist control group (n=28).  Treatment included eight weeks of therapist-guided and individually-tailored, modular CBT designed to target participants’ comorbid symptoms. At post-treatment, 67% of participants in the experimental group showed significant improvements in symptoms, as compared to 11% in the control group. At a 12-month follow up, 70% of participants interviewed had maintained improvements. These results suggest that tailored iCBT may be a valuable, short- and long-term treatment option for individuals with panic and comorbid anxiety and depressive symptoms.

Silfvernagel, K., Carlbring, P., Kabo, J., Edström, S., Eriksson, J., Månson, L., & Andersson, G. (2012). Individually tailored internet-based treatment for young adults and adults with panic attacks: Randomized controlled trial. Journal of Medical Internet Research, 14(3) e65.

Group CBT Helps Women with Low Self-Esteem

A recent study published in Behavioural and Cognitive Psychotherapy indicates that cognitive behavioral therapy (CBT) group intervention may be helpful for women with low self-esteem, and co-morbid depression and anxiety. In the current study, researchers used a set of CBT-based self-help workbooks, Overcoming Low Self-Esteem Self-Help Course (Fennell, 2006), to implement group therapy in a recruited sample of 37 women with low self-esteem (as indicated by the Robson Self Concept Questionnaire (RSCQ)). The group met once per week for two hours, for a total of eight sessions. Final results revealed clinically significant improvements in self-esteem and mood, including decreased depression and anxiety scores at post-intervention. While the mechanism for change is not yet clear, the researchers hypothesize that the group experience, combined with their learning adaptive skills and gaining new perspectives via CBT treatment, enhanced participants’ overall feelings of acceptance and increased confidence, both of which contribute to healthy self-esteem.

Morton, L., Roach, L., Reid, H., & Stewart, S. H. (2012). An evaluation of a CBT group for women with low self-esteem. Behavioural and Cognitive Psychotherapy, 40, 2, 221-5.

Systems of Psychotherapy (Part 2)

In this video from Beck Institute’s recent CBT Workshop for Students and Faculty, Dr. Aaron Beck discusses cognitive behavior therapy within the context of systems of psychotherapy. Dr. Beck explains that CBT is rooted in a broad theoretical framework and refined and reformulated for each disorder. Therapeutic strategies are selected based on the individual conceptualization of the patient. According to Dr. Beck, basic methods of CBT, such as cognitive reframing, can be adapted for more complex cases. He refers to his recent research on schizophrenia to demonstrate how to adapt CBT strategies within the theoretical framework.

To view part 1 of this video, visit the Beck Institute YouTube page: www.youtube.com/beckinstitute.

National Dissemination and Implementation of CBT for Depression in the Department of Veterans Affairs Health Care System Improves Patient Outcomes

According to a recent study published in the Journal of Consulting and Clinical Psychology, the implementation of CBT training for depression (CBT-D) significantly improves patient outcomes in the Veterans Affairs (VA) health care system. In the current study, 211 therapists participated in a VA CBT-D Training Program and delivered therapy to 356 patients. Therapist training included a 3-day CBT workshop followed by a 6-month consultation phase (weekly, 90-minute telephone-based consultation sessions led by an expert CBT-D clinician). Therapist competencies were assessed using the Cognitive Therapy Rating Scale (CTRS) and patient outcomes were assessed using the Beck Depression Inventory-II and World Health Organization Quality of Life-BREF. At the conclusion of the program, all of the therapists who completed training (82%) demonstrated competency in administering CBT-D, as well as higher levels of confidence, self-efficacy, and positive attitudes toward treatment. Furthermore, the implementation of CBT-D resulted in highly significant reductions in depressive symptoms and improvements in quality of life among patients treated. In fact, patient assessments revealed a 40% average decline in mean BDI-II scores recorded during the initial and later phases of treatment. This study has important implications for both therapists and veterans suffering from depression: A comprehensive CBT training program, when implemented in a realistic time-frame with follow-up consultation, significantly increases therapists’ ability to deliver effective treatment to depressed VA patients.

Karlin, B.E., Brown, G.K., Trockel, M., Cunning, D., Zeiss, A.M., & Taylor, C.B. (2012, July23). National dissemination of cognitive behavioral therapy for depression in the department of veteran affairs health care system: therapist and patient-level outcomes. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029328

Beck Institute’s Level I CBT Workshop for Students and Faculty

Click the picture to see all group photos with Dr. Judith Beck

AUGUST 13-15, 2012: 173 post-doctoral fellows, psychiatry residents, other graduate students, and faculty from mental health, medical, and related fields traveled from 27 states and 10 foreign countries, including: Australia, Brazil, Canada, Costa Rica, Dominican Republic, Mexico, Philippines, Slovenia, South Africa and Thailand, to Philadelphia, PA for Beck Institute’s 3rd Annual Cognitive Behavior Therapy Workshop for Graduate Students and Faculty. The diversity of attendees was remarkable. Students and faculty came from all over the world, demonstrating a tremendous commitment to the study and practice of cognitive behavior therapy.

Cognitive Behavior Therapy Training with Dr. Judith BeckOn the first two days of training, Dr. Judith Beck covered the fundamentals of cognitive behavior therapy and CBT for depression. On the third day of training, Dr. Randy Fingerhut , Assistant Professor of Psychology at LaSalle University, covered CBT for anxiety disorders.

In addition to didactic instruction, our attendees participated in case discussions, dyadic role plays, and other experiential exercises to practice newly learned CBT strategies and techniques with their peers and colleagues.

Father of Cognitive TherapyDr. Judith Beck conducted several role plays with workshop participants to demonstrate a variety of CBT techniques for treating depression, and Dr. Aaron Beck participated in a special question and answer and role play session with workshop participants. He answered clinical questions and questions about CBT history, research, and theory, and role played with a workshop participant on how to divert a client’s attention from distress.

Afterward, both Drs. Beck met with the Beck Institute scholarship winners for an intimate discussion about current CBT research.

Cognitive Behavior Therapy Scholarship Winners

Next year’s CBT Workshop for Graduate Students and Faculty will be held on August 12-14, 2013.  Click here for more information.  For more pictures from our Student and Faculty Workshop visit our Facebook page.

Online CBT Course Shows Promise in Treating Depression among Adolescents and Young Adults

According to a recent study published in the Journal of Medical Internet Research, internet-based cognitive behavior therapy (CBT) may help reduce depressive symptoms among adolescents and young adults. The current study aimed to determine the effectiveness of Master Your Mood (MYM), an internet based CBT intervention, for depressive symptoms among young people. Participants (244; ages 16-25) were randomly assigned to the online MYM course or to a wait-list control. The online MYM group focused on cognitive restructuring—participants were taught and encouraged to identify and respond to their own unhelpful and inaccurate thoughts; to engage in pleasant activities every day; and to measure their mood every day to help them understand the connection between pleasant activities and mood level. At a 3-month follow up, the MYM group showed significant improvements in depressive and anxiety symptoms. These promising results suggest that internet-based interventions may help reach adolescents and young adults who might otherwise remain untreated.

Van der Zanden, R., Kramer, J., Gerrits, R., & Cuijpers, P. (2012). Effectiveness of an online group course for depression in adolescents and young adults: a randomized trial. Journal of Medical Internet Research 14(3).