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May 23 – 25, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

May 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 16 states and 8 countries (including Brazil, Cayman  Islands, Denmark, Peru, Romania, Sweden, Switzerland, and Turkey) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects, such as Positive Psychology and CBT, and CBT with depressed patients in chronic pain. Dr. Judith Beck (pictured right) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.  Dr. Leslie Sokol (pictured below) spoke about the need for anxiety and the need to learn how to control it, rather than mask it with medication.  She emphasized the use of Socratic questioning and interoseptive exposure experiments in treatment.  Dr. Norman Cotterell (pictured below) spoke about suicidality.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

Group cognitive behavioral therapy for depressive and anxious symptoms in patients with epilepsy

A recent study published in Epilepsy & Behavior examined the effectiveness of a group cognitive behavioral therapy (GCBT) intervention for reducing symptoms of anxiety and depression in patients with epilepsy. Previous research has shown that individuals with epilepsy have higher rates of anxiety and depression symptomology than the general population; and while CBT has been shown to be effective in treating these conditions, the authors cite that such interventions are often not available to those with epilepsy.

The study sought to examine: 1) the effectiveness of GCBT for reducing symptoms of depression, anxiety, and negative automatic thoughts in patients with epilepsy, 2) whether a 10-session GCBT program can increase knowledge of CBT concepts and skills in patients with epilepsy, 3) the acceptability of GCBT to patients with epilepsy, as measured by recruitment attrition rate, number of overall sessions attended, and patient satisfaction with treatment.

Clinical psychologists and social workers were responsible for screening participants for inclusion via telephone, conducting the group sessions, and follow-up sessions with each participant. To measure symptoms and CBT knowledge the pre and post groups screening measures included: the Beck Depression Inventory II, the Beck Anxiety Inventory, the Automatic Thoughts Questionnaire, and the Cognitive Therapy Awareness Scale.

Results showed a significant improvement in patients’ mood, an increase in learned CBT skills and a high level of satisfaction with treatment. These findings indicate GCBT as a promising treatment for those with epilepsy, who suffer from symptoms of depression and/or anxiety. Some limitations were the small sample size, the lack of a control group, and the lack of data about  patients’ seizure disorders. The authors’ future research goals include assessing patients’ diagnoses, and obtaining follow up information to see the long-term effects of treatment.

Macrodimitris, S., Wershler, J., Hatfield, M., Hamilton, K., Backs-Dermott, B., Mothersill, K., Baxter, C., & Wiebe, S. (2011). Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety. Epilepsy and Behavior, 20, 1, 83-88.

Combination of Exercise and CBT Improves Outcomes in Depressed Patients with Heart Failure

newstudy-graphic-66x60.jpg A recent study appearing in the Journal of Psychosomatic Research aimed to examine the effectiveness of exercise combined with Cognitive Behavioral Therapy (CBT) as a treatment for heart failure. Participants were divided into four groups: 18 patients were assigned to complete a 12-week home-based exercise program in addition to 12 weeks of CBT, 19 patients were assigned to complete 12 weeks of CBT alone, 20 patients were assigned to complete only a 12-week home-based exercise program, and 17 patients were assigned to receive usual care. All of the participants were stable New York Heart Association Class II (mild) to III (moderate) heart failure patients that had been diagnosed with depression.  Patients with Class II heart failure experience fatigue, palpitations or dyspnea when undergoing ordinary physical activity.  Patients with Class III heart failure experience those same symptoms when undergoing less than ordinary physical activity. The patients were evaluated before treatment, after 12 weeks of treatment, and 3 months after the end of treatment. To evaluate the participants, the researchers used the Hamilton Rating Scale for Depression (HAM-D) to determine depressive symptom severity, a 6-minute walk test (6MWT) to determine physical function, and the Minnesota Living with Heart Failure Questionnaire to determine health-related quality of life (HRQOL). The combination group showed the greatest decrease in HAM-D scores (-10.4), while the usual care group showed the least decrease (-6.2), though none of the groups showed a statistically significant decrease. The combination group also showed a large improvement in the 6MWT at the three-month follow-up. Within the cross-section of moderately-to-severely depressed participants across all groups, only those in the combination group sustained lower HAM-D scores, showed significant improvement in the 6MWT, and showed the greatest increase in HRQOL.

Combination of CBT and Exercise May Ease Fibromyalgia

newstudy-graphic-66x60.jpgA new study conducted by researchers at Radboud University Nijmegen Medical Center in the Netherlands tested the effectiveness of Cognitive Behavioral Therapy (CBT) combined with exercise to treat fibromyalgia. This syndrome, that affects about 5 million adults in the U.S., causes widespread aches and pains, specific “tender points”, fatigue, and sleep problems. Though the cause of Fibromyalgia is unknown and it is difficult to treat, research has proven combinations of treatments more effective than a single treatment alone. Types of treatments for this syndrome include painkillers, antidepressants, CBT, and exercise therapy.

The study participants were “high-risk” fibromyalgia patients, those whose symptoms were judged to cause significant distress. First the participants were divided into two groups, based on how they handled their pain–those who avoided activities they feared would increase their pain and those who maintained their usual activities despite their pain. Both groups were then further divided into two randomly assigned groups–one group underwent 16 sessions of CBT-plus-exercise therapy and the other were placed on a wait-list for treatment. The CBT was specifically tailored as follows: For the patients who avoided activities, the CBT focused on dealing with the fear of pain and setting goals for increasing their daily activity. For the patients who maintained their activities, the CBT focused on setting more realistic goals and pacing daily activity to avoid overdoing it. After each CBT session, all of the patients had an exercise session with a physical therapist.

Immediately following the treatment period, and six months later, both the avoidant and the overactive therapy groups were faring better than those on the wait-list. After six months, 2/3 of the patients in the therapy groups had experienced noticeable changes in their daily lives, as compared to 1/3 of the wait-list patients. These improvements were in measures of physical well-being, such as pain, fatigue, and disability. They manifested themselves in the patients’ comparative ease in walking, climbing stairs, and doing household chores. Additionally, 62% of patients in the therapy groups experienced improvements in anxiety or depression symptoms, compared to 33% of patients on the wait-list.

CBT Found to Be Clinically Effective for Depressed Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3A new study published in the Archives of General Psychiatry investigated the clinical effectiveness of cognitive behavior therapy (CBT) for older adults in primary care. A total of 204 men and women aged 65 years or older with geriatric depression were randomly assigned to one of three groups: treatment as usual (TAU), TAU plus a talking control (TC), and TAU plus CBT. The CBT and TC treatments were offered over a period of four months and participants were followed up at 10 months. Depressive levels were measured with the Beck Depression Inventory-II (BDI-II) at baseline, at four months (the end of therapy), and again at 10 months. Based on BDI-II scores per session, a significant benefit of CBT versus the TAU and TC was observed, pointing to CBT as an effective treatment for depression in older adults.

This study was the largest CBT study conducted by general practitioner of their patients.

Cognitive Behavior Therapy Versus Light Therapy in the Treatment of SAD

NewStudy-Graphic-72x72_edited-3 According to a study published in the September issue of Behavior Therapy, researchers at the University of Vermont demonstrated that cognitive behavior therapy (CBT) was more effective than light therapy (LT) in the long-term treatment of seasonal affective disorder (SAD). Rohan and colleagues first randomized 69 participants into one of four groups: a light therapy treatment, a cognitive behavior therapy treatment, a combination of LT and CBT treatments, and a waist-list control. They then surveyed participants one year later. The results of that survey indicate that the CBT group (7.0%) and combination group (5.5%) had significantly less recurrence of winter depression during the following season, than the light therapy group (36.7%). These results persisted even after adjustments for ongoing treatment with light therapy, medication, and psychotherapy were made. A $2 million, 5-year grant from the National Institute of Mental Health (NIMH) will advance the next phase of this study, which is already underway.

Reference:

Rohan, K.J., Roecklein, K.A., Lacy, T.J., Vacek, P.M. (2009) Winter depression one year after cognitive-behavioral therapy, light therapy, or combination treatment. Behavior Therapy, 40, 225-238.

CBT Meta-Analysis Review is Most Downloaded Article in CPR

It looks as if the research efficacy of Cognitive Therapy is becoming more well-known. Clinical Psychology Review is a peer-reviewed journal that publishes substantive reviews of topics relevant to clinical psychology. The most downloaded article from this important journal is The empirical status of cognitive-behavioral therapy: A review of meta-analyses (Volume 26, Issue 1, January 2006, Pages 17-31), authored by Andrew C. Butler, Jason E. Chapman, Evan M. Forman and Aaron T. Beck.

This 2006 review summarizes CBT treatment outcomes for a wide array of psychiatric disorders and includes sixteen methodologically rigorous meta-analyses. Findings are consistent with previous review methodologies and demonstrate the efficacy of CBT for many disorders. Specifically, unipolar depression, generalized anxiety disorder, panic disorder (with or without agoraphobia), social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders all showed large effect sizes. Marital distress, anger, childhood somatic disorders, and chronic pain showed moderate effect sizes.

CBT was also shown to be somewhat superior to antidepressants in the treatment of adult depression and as effective as behavior therapy in the treatment of both adult depression and obsessive-compulsive disorder. Bulimia nervosa and schizophrenia showed large, uncontrolled effect sizes.

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.

Mood Disorders: Effects of Intensive CBT

NewStudy-Graphic-72x72_edited-3A recent study in the Journal of Psychiatric Practice found that Cognitive Behavioral Therapy (CBT) interventions used in an intensive partial-hospital (PH) setting are effective in treating severe mood disorders.

PH settings differ from inpatient treatment in that they are more flexible and less expensive. In this study, with CBT as the primary treatment, the length of stay was only 2 weeks. The researchers’ aims were to find the specific aspects of CBT that were successful in the treatment of mood disorders in a short-term PH setting.

The treatment included group and individual psychotherapy. Patients attended 12-20 group sessions per week. A written treatment contract was used and reviewed weekly to set specific goals and promote collaboration between patients and staff.

Group therapy was primarily CBT-oriented. The goals of therapy included teaching self-assessment (such as challenging maladaptive thoughts), behavioral coping (such as behavioral scheduling and behavioral activation), and developing better and more effective communication strategies.

The two-week treatment was divided into two stages. In the first, patients learned to identify triggers and utilize cognitive restructuring, among other interventions. The second stage included relapse prevention plans for a crisis situation and future plans (such as returning to work or school).

The researchers showed that both behavioral activation and a decrease in negative cognitions are associated with a decrease in depressive symptomatology at discharge. Additionally a decrease in negative thinking is associated with reduced general psychological distress at discharge.

Study Authors: M. S. Christopher, K. L. Jacob, E. C. Neuhaus, T. J. Neary, L. A. Fiola

Generalized Anxiety Disorder — CBT Benefits Older Adults in Primary Care

NewStudy-Graphic-72x72_edited-3 The results of a randomized clinical trial published in JAMA indicate that cognitive behavior therapy (CBT) can be effective for older adults with symptoms of worry and depression.

The 3-month CBT protocol was conducted in primary care clinics and included education, cognitive therapy, and problem-solving skills. Measures included the Beck Anxiety Inventory and Beck Depression Inventory II. Post-treatment assessments were conducted every three months over fifteen months.

Compared with the control group, patients who received treatment showed improvement in worry severity, depressive symptoms, and general mental health. A measure of GAD severity, however, did not indicate greater improvement with CBT.

The authors concluded that CBT is useful for this population especially in primary care settings, “where older adults most often seek treatment.”

Study authors: M. A. Stanley, N. L. Wilson, D. M. Novy, H. M. Rhoades, et al.