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Internet-based Cognitive Behavioral Therapy for Severe Health Anxiety

According to a new study published in The British Journal of Psychiatry, internet-based cognitive behavior therapy (CBT) may be an effective treatment for individuals with health anxiety. Participants (n=81) in the current study were randomly assigned to either an internet-based CBT group (n=40) or to a control group (an online discussion forum) (n=41). Participants in the CBT group received a 12-week treatment intervention that incorporated mindfulness training (teaching participants to observe their bodily sensations without trying to control them), a 12-module self-help text, and a discussion forum (in which participants could anonymously communicate with other members of the same group.) Participants in the CBT group also had access to a therapist through a secure online system, however there were neither face-to-face nor telephone contacts during the study. Participants in the control condition were encouraged to utilize the discussion forum to discuss their health anxiety and ways of coping with it. At post treatment, results showed that the internet-based CBT group displayed superior improvements over the control group. In fact, two-thirds of participants in the CBT group no longer met criteria for health anxiety. Further, large treatment effects were also maintained at the 6-month follow up. These findings suggest that internet-based CBT for health anxiety may be a promising alternative treatment for individuals without access to face-to-face therapy.

Erik Hedman, Gerhard Andersson, Erik Andersson, Brjann Ljotsson, Christian Ruck, Gordon J. G. Asmundson and Nils Lindefors (2011). “Internet-based cognitive-behavioral therapy for severe health anxiety: randomized controlled trial”. The British Journal of Psychiatry.

Identifying Suicide Risk

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck describes ways to identify a person at risk for suicide. He discusses immediate risk factors (such as those shown through the use of predictive scales), peripheral risk factors, and demographic risk factors. Dr. Beck also discusses his previous research involving the post-attempt suicide ideation scale and important findings from that research.

Beck Institute’s next CBT for Depression and Suicidality Workshop will take place July 15-17, 2013. For more information, visit our website.

CPT is Effective for Military-Related PTSD

According to a recent study published in the Journal of Anxiety Disorders, cognitive processing therapy (CPT) may have a greater effect on military-related PTSD than other usual treatments. CPT is a form of trauma-focused cognitive behavior therapy (CBT) that focuses on key themes such as safety, control, power, self-esteem, and intimacy. The present study examines the efficacy of CPT for PTSD among treatment seeking veterans (n=59) within a naturalistic setting compared to other treatments typically used for PTSD (a variety of non-trauma focused symptom management intervention, psycho-education, supportive counseling, and CBT with elements of exposure.) At post-treatment and 3 month follow up, participants in the CPT condition (n=30) showed significantly lower levels of PTSD symptoms than those who received other treatments (n=29) according to self -reporting and clinical ratings.  Additionally, there were larger reductions in comorbid depression and anxiety for participants receiving CPT than treatment as usual. These results suggest that CPT is an effective, evidence based treatment for military-related PTSD in real world environments and situations.

Forbes, D., Llyod, D., Nixon, R. D. V., Elliot, P., Varker, T., Perry, D., Bryant, R. A., & Creamer, M. (2012). A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(3), 442-452.

Long Term Effects of CBT for PTSD

According to a recent study published in the Journal of Consulting and Clinical Psychology, cognitive-behavior treatments (CBT) may provide long-term improvements for PTSD and related symptoms. CBTs such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) have already been shown to be effective and are considered some of the “first line treatments” for PTSD. However, the important question of CBT’s long term efficacy for PTSD has not been explored as deeply, as follow ups typically occur only three to six months after treatment.

The current study compares the long term outcomes of CPT and PE for PTSD in female rape survivors. The original study measured symptoms of women suffering from PTSD (n=171), before and after receiving either CPT or PE. This long term follow up, from 4.5 to 10 years later (M = 6.15), includes 73.7% of the original sample following initial treatments (n= 126) of CPT (n= 63) or PE (n=63). Researchers used the PTSD Symptom Scale (PSS), the Beck Depression Inventory (BDI), and the Clinician-Administered PTSD Scale (CAPS) to measure PTSD symptoms. Of those allocated to CPT, 46 completed the therapy, 10 received some therapy, and 7 did not start. Of those allocated to PE, 44 completed the therapy, 13 received some therapy, and 6 did not start.

Participants who received both cognitive therapies (CPT and PE) showed significant improvements in PTSD and related symptoms from pre- to post-treatment. There was no marked significance in the difference between the two samples receiving treatment. During the long term follow up, there was an impressive amount of maintenance of these improvements in symptoms. At pre-treatment assessment, 100% of participants had met criteria for PTSD; however, at the long term follow up only 22.2% of participants in the CPT group and 17.5% in the PE group met criteria for PTSD. In addition, there was no further psychotherapy or medication use reported which could have otherwise accounted for the long term efficacy of these treatments.

Female rape survivors in this study benefitted significantly from a lasting improvement in PTSD symptoms. Although further research and replication studies are needed, these findings suggest that CBT may be effective for years following initial treatment.

Resick, Patricia A., Williams, Lauren F., Suvak, Michael K., Monson, Candice M., & Gradus, Jaimie L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80(2) 201-210.

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Beck Institute will offer a 3-day workshop on CBT for PTSD on September 10-12, 2012, in Philadelphia. A limited number of spaces remain.

Cognitive Behavior Therapy is Effective for Sleep Disturbances in US Military Vets

According to a recent study published in the Journal of Psychosomatic Research, cognitive behavior therapy (CBT) may improve sleep and reduce daytime PTSD symptoms among military veterans. The current study compared Prazosin (a pharmacological treatment for sleep disturbance) versus a CBT sleep intervention against a placebo control. Fifty US military veterans were randomly assigned to either the Prazosin group (n = 18), the CBT group (n = 17), or the placebo group (n = 15). Both active groups (Prazosin and CBT) showed greater reductions in insomnia and daytime PTSD symptom severity. Overall sleep improvements were noted in 61.9% of those who completed the active treatments and 25% of those in the placebo group. These results suggest that both pharmacological and CBT interventions may improve sleep and reduce PTSD symptoms among military veterans.

Germain, A., Richardson, R., Moul, D. E., Mammen, O., Haas, G., Forman, S. D., Rode, N., … Nofzinger, E. A. (2012). Placebo-controlled comparison of prazosin and cognitive-behavioral treatments for sleep disturbances in US Military Veterans. Journal of Psychosomatic Research, 72, 2, 89-96.

Culturally Adaptive CBT for Traumatized Refugees and Ethnic Minority Patients

An article in the current issue of Transcultural Psychiatry (April 2012) describes how cognitive behavior therapy (CBT) can be adapted for treating PTSD among traumatized refugees and ethnic minority patients. Culturally adaptive CBT (CA-CBT) is a promising, culturally sensitive therapy technique that promotes emotional and psychological flexibility. In the current article, the authors describe 12 key components of culturally sensitive treatment for traumatized refugees and ethnic minorities. This treatment model which provides patients with new, adaptive processing modes may improve care among specific cultural groups.

Hinton, D.E, Rivera, E.I. Hofmann, S.G., Barlow, D.H., & Otto, M.W. (2012) Adapting CBT for traumatized refugees and ethnic minority patients: Examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry, 49(2) 340-365. Doi: 10.1177/1363461512441595

CBT Via Video Teleconferencing is Effective for PTSD in Vets

According to a recent pilot study published in the Journal of Traumatic Stress, group cognitive behavior therapy (CBT) delivered via video teleconferencing is a safe, feasible, and effective treatment for veterans with posttraumatic stress disorder (PTSD). Participants in the current study included 13 veterans diagnosed with PTSD at VA clinics in the Hawaiian Islands; each was randomly assigned to receive group cognitive processing therapy (a form of cognitive behavior therapy originally developed by Patricia Resick, Ph.D.) in an in-person therapy group or video teleconferencing therapy group. According to results, both groups displayed reductions in PTSD symptoms, without between-group differences on process outcome variables. In addition, participants in each group expressed high levels of treatment credibility, satisfaction with treatment, and homework adherence. A full randomized control trial (RCT) is currently underway to more rigorously evaluate the clinical effectiveness of cognitive processing therapy delivered via video teleconferencing.

To find out more about Beck Institute’s Soldier Suicide Prevention initiative visit www.cbtforsoldiers.org.

Morland, L. A., Hynes, A. K., Mackintosh, M., Resick, P. A., & Chard, K. M. (2011). Group cognitive processing therapy delivered to veterans via telehealth: A pilot cohort. Journal Of Traumatic Stress, 24(4), 465-469. doi:10.1002/jts.20661

CBT for Drug Addiction and PTSD via Wearable Sensor Platform and Mobile Application

Researchers from the Engineering in Medicine and Biology Society (EMBS) are currently examining the effects of cognitive behavior therapy (CBT) delivered via mobile device to patients suffering from drug-addiction and post-traumatic stress disorder (PTSD). The delivery system involves an ankle sensor (to monitor electrodermal activity, 3-axis acceleration, and temperature) and an ECG heart monitor. The monitors contain bluetooths which are connected to patients’ cell phones. When certain arousal levels are detected via the monitoring system, therapeutic messages are delivered by text to patients’ cell phones. The effectiveness of this system is being evaluated.

Fletcher RR, Tam S, Omojola O, Redemske R, Kwan J.(2011). Wearable sensor platform and mobile application for use in cognitive behavioral therapy for drug addiction and PTSD. Conf Proc IEEE Eng Med Biol Soc., 1802-5.

CBT for Disaster-Exposed Youth with PTSD

A recent study published in Behavior Therapy provides initial evidence for the efficacy of manualized Cognitive Behavior Therapy (CBT) for disaster-exposed youth with posttraumatic stress disorder (PTSD). Previous research suggests that group-based CBT is effective in decreasing post-traumatic stress levels in youth. Treatment is often difficult to obtain for this population, however, due to lack of resources. The current study eliminated this obstacle by providing treatment within a school setting.

The current research was conducted on six youth exposed to Hurricane Katrina. The participants ranged from ages 8 to 13 from neighborhoods that experienced significant destruction following the disaster. Master’s level graduate students administered pre and post-tests to participants, and treatment was conducted by a doctoral level therapist using the StArT intervention— a trauma-focused CBT program designed specifically for hurricane-exposed youth. Treatment consisted of 10 sessions which included psychoeducation, cognitive restructuring, exposure, problem solving, and relapse prevention.

Following the intervention, participants showed a decline in PTSD symptoms and no longer met criteria for PTSD at post-treatment. Half of the participants reported no other anxiety disorder diagnoses following treatment, and there was an overall reduction in the incidence of other anxiety problems common in this population.  While replication studies and further assessments are needed, the StArT manual shows promising potential as an effective CBT manual for disaster-exposed youth.

Taylor, L.K & Weems, C.F. (2011). Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: Results from a multiple-baseline examination. Behavior Therapy, 42, 349-363.

CBT for Soldiers: A personal message to professionals from Drs. Aaron and Judith Beck

Dear Colleagues,

We are trying to address a very serious problem: military personnel who need effective psychological/psychiatric treatment but who are not receiving it. To address this urgent problem, we have embarked upon a new initiative to offer partial scholarships to our Cognitive Behavior Therapy training programs for mental health professionals who treat soldiers, veterans, and their families (www.cbtforsoldiers.org).

Cognitive ehavior therapy (CBT) has been demonstrated in hundreds of controlled trials worldwide to be effective for a wide range of problems, including depression, suicide, post traumatic stress disorder, anxiety disorders, substance abuse, and many more.

The non-profit Beck Institute in suburban Philadelphia is recognized as one of the premiere training sites for this kind of psychotherapy. The application of cognitive therapy to the needs of our military veterans is clear. The RAND Corporation conducted a study for the military on Predicting the Consequences of PTSD, Depression and Traumatic Brain Injury. One of the study’s summary conclusions is that the capacity to provide evidence-based psychotherapies for PTSD and major depression (for example, CBT) would be important in closing the treatment gap.

We would like to bring our expertise to mental health professionals who treat soldiers, veterans, and their families. Please visit www.cbtforsoldiers.org.