Acceptance-Oriented CBT with Highly Distressed Rheumatic Disease Patients

CBT studyOBJECTIVE: To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases.

METHODS: An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen’s effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters.

RESULTS: Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ? 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients.

CONCLUSION: The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment.

PRACTICE IMPLICATIONS: A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented

Vriezekolk, J. E., Eijsbouts, A. M., van, L. W. G., Beenackers, H., Geenen, R., & van, . E. C. H. (2013). An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases. Patient Education and Counseling, 91, 3, 357-63.

Using CBT and Smart Phones for the Self-Management of Chronic Pain

In this age of technology, internet interventions are becoming more common in the practice of Cognitive Behavioral Therapy (CBT).  Chronic Widespread Pain (CWP) causes patients to live in constant pain, as well as fear of that pain, which can lead to avoidant behavior and depression.  Kristjansdottir et al (2011) hope to develop an intervention program that will help patients with CWP to self-manage their pain.  Using CBT with a focus on mindfulness and the acceptance of pain, researchers developed a four week intervention that is administered to the patients via Web-enabled smart phones.  In the present study, the researchers look into the feasibility of the intervention.

Six women with CWP were recruited to participate in the intervention.  Each participant first met one-on-one with a therapist where she was asked about her condition, informed of the intervention, and lent a web-enabled phone.  For the next four weeks, the participants received an SMS text message three times a day (morning, evening, and a random time between 11:30 am and 2 pm) reminding the participants to fill out an online diary.  This diary included a set of questions asking about current thoughts and pain awareness.  Within 90 minutes, each participant received online feedback from a therapist, who was supervised by two other professionals of mindfulness meditation and CBT.

Each online diary included questions regarding the usefulness of the previous diary’s feedback.  The effects of the intervention were quantified by use of the Chronic Pain Acceptance Questionnaire (CPAQ) and the Pain Catastrophizing Scale (PSC), given to participants before and after the intervention.  Half-way through the intervention, and after completion, researchers met with participants to ask them about their experiences and opinions.

Kristjansdottir et al found that the participants were responsive to the intervention and saw it as supportive and useful.  Despite minimal technical difficulties, the program was found to be user-friendly and feasible.  Future randomized studies can adapt the program and explore its effects on CWP.

Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., van Dulmen, S., Wigers, S. H., & Eide, H. (2011).  Written online situational feedback via mobile phone to support self-management of chronic widespread pain: A usability study of web-based intervention.  BMC Musculosketital Disorders, 12(51).

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.

Cognitive Behavior Therapy of Anxiety for Terminal Cancer Patients

Patients suffering from terminal cancer are often plagued by anxiety over disease progression, pain, decreased functioning, and death. Cognitive Behavior Therapy (CBT) interventions for anxiety are designed to help clients test the reality and functionality of undue worrying. Geer, Park, Prigerson, and Safren (2010) indicate that excessive anxiety may lead to treatment non-adherence, and further diminish quality of life for these patients. The authors propose tailoring CBT to better serve this population.

Three case studies of patients, with incurable lung cancer, were presented in this article.  The patients showed decreased anxiety, improvement in quality of life, ability to manage stress more effectively, and improved communication with family and friends. The authors concluded, “Our tailored treatment approach helped patient gain a sense of personal control and improve quality of life in the face of an uncertain future and unpredictable disease course;” they also added that further research for treating this population of patients with CBT is needed.

The CBT treatment, described by these authors, for terminal cancer patients with anxiety was divided into four modules: “1) psychoeducation and goal setting; 2) relaxation training; 3) coping with cancer fears; and 4) activity planning and pacing.”  Treatment was aimed towards helping patients learn coping skills that reduce anxiety, as well as develop skills in managing symptoms of cancer and the side effects of chemotherapy. This protocol recommends a total of 6 to 7 intensive sessions.

Geer, J.A., Park E.R., Prigerson,H.G., and Safren, S.A. (2010). Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer. Journal of Cognitive Psychotherapy. 1; 24(4): 294-313. doi:10.1891/0889-8391.24.4.294.

CBT Relieves Chronic Back Pain

NewStudy-Graphic-72x72_edited-3In a recent study, published in the February 26, 2010 issue of The Lancet, 701 patients with chronic back pain were treated with either standard treatment alone or standard treatment supplemented with Cognitive Behavior Therapy (CBT). The intervention helped participants identify cycles of negative thinking that lead to their inactivity and thus perpetuated their pain. Specifically, CBT played an important role in helping patients to resume activities they had been avoiding based on distorted thoughts and beliefs about the pain they experienced (e.g., “I should avoid all activities that cause me pain.”). At one year follow-up, the participants who received CBT showed greater improvement on disability tests than their non-CBT counterparts.

Because CBT is cost-effective and does not expose patients to additional risks like so many other treatment options, the researchers hope that this study will raise awareness, among health insurance providers and physicians, of the important role CBT may play in clinical practice.



Lamb, S.E., Hansen, Z., Lall, R., Castelnuovo, E., Withers, E.J., Nichols, V., et al. (2010). Group cognitive behavioural treatment for low-back pain in primary care: A randomised controlled trial and cost-effectiveness analysis. The Lancet, 375(9718), 916-923.

PTSD Symptoms Benefited by Early Intervention CBT

NewStudy-Graphic-72x72_edited-3 A recent meta-analysis published in the American Journal of Psychiatry found trauma-focused Cognitive Behavioral Therapy (CBT) delivered within a 3-month period of traumatic events to be effective in the treatment of trauma-induced stress symptoms for patients with PTSD or acute stress disorder.

Research has demonstrated the effectiveness of “multiple-session trauma-focused psychological interventions to treat chronic PTSD,” but little had been done to evaluate the efficacy of early interventions. The present study analyzed randomized controlled trials of early interventions, assessing efficacy, the population receiving the greatest benefit, the best modalities of treatment, and the optimal timing of treatment.

The researchers performed a meta-analysis and systematic review of 25 studies whose interventions were designed to treat or prevent PTSD within 3 months of a traumatic event. The authors found that trauma-focused CBT was significantly more effective for patients than usual care or being on waiting lists in terms of reducing stress symptoms of trauma. The magnitude of the effects varied for this finding; CBT was found to be most effective for individuals diagnosed with acute PTSD or acute stress disorder. Participants who did not meet the diagnostic criteria of a psychological stress disorder gained only minimal benefits from trauma-focused CBT.

The authors concluded that trauma-focused CBT should be offered to patients suffering from acute PTSD or acute stress disorder. They also noted that further investigation could determine whether trauma-focused CBT should become part of initial screening programs for patients who have experienced major traumatic events.

Study authors: N. P. Roberts, N. J. Kitchiner, J. Kenardy, J. I. Bisson

Severe eating disorders helped by CBT

In a recent study in the American Journal of Psychiatry, investigators reported that people with severe eating disorders can be effectively treated by cognitive behavioral therapy (CBT) that focuses on perfectionism, binge eating, and other related issues.

Two types of CBT were employed in the protocol (in addition to a wait-list control group). One CBT protocol focused exclusively on eating-disorder psychopathology and the other was a broader, more complex form that included treatment of mood intolerance, perfectionism, and low self-esteem.

The two CBT groups experienced significant improvement whereas the wait-list group experienced little change in symptoms. The authors noted that in addition to the direct benefit to people with eating disorders, another important implication of this finding is that hospital stays can be avoided for the majority of these patients.

Study authors: C. G. Fairburn, Z. Cooper, H. A. Doll, et al.

Role of therapist competence in CBT for Depression

The role of therapist competence in cognitive behavioral therapy (CBT) outcomes was the subject of a naturalistic process-outcome study conducted at the Center for Cognitive Therapy, an outpatient clinic at the University of Pennsylvania. Sixty-nine clients presenting with depression, some with comorbid presenting problems, were treated by one of eighteen CBT therapists at the Center. Therapist competence was measured by clients and experts. The findings, published in Psychotherapy and Psychosomatics, were that more competent therapists achieved better outcomes with depression patients, regardless of degree of morbidity. The clinical implication of this finding is that “initial selection of therapists will enhance treatment outcomes,” and this contradicts the idea that more competent therapists should focus on more complex cases.

Study authors: W. Kuyken, D. Tsivrikos

CT reduces cerebral atrophy in Chronic Fatigue Syndrome

Researchers from Raboud University Nijmegen investigated whether Cognitive Therapy (CT) affected the cerebral atrophy of patients suffering from Chronic Fatigue Syndrome (CFS).

The study appeared in BRAIN: A Journal of Neurology.

The study included twenty-two CFS patients and twenty-two control subjects, all of whom underwent a two-step program of CBT. The initial focus of treatment is a “rehabilitative approach of a graded increase in physical activity,” while the second part emphasizes a “psychological approach that addresses thoughts and beliefs about CFS which may impair recovery.”

Upon completion of the CBT treatment, the CFS patients experienced significant improvement in their physical status as well as their cognitive performance. Furthermore, the CFS patients, who had initially shown significantly lower grey matter volume than the control subjects, showed a significant increase in grey matter volume through the work of CBT.

The results of this study, which included the partially reversed cerebral atrophy after effective CBT, are an “example of macroscopic cortical plasticity in the adult human brain, demonstrating a surprisingly dynamic relation between behavioural state and cerebral anatomy. Furthermore, (their) results reveal a possible neurobiological substrate of psychotherapeutic treatment.”

Study authors: F. P. de Lange, A. Koers, J. S. Kalkman, et al.

Cognitive-Behavioral Therapy Shows Promise for Children with Mental Illness – JAMA Article


The numbers are astonishing:

20% of children in the U.S. have some form of mental illness.

Only 1 in 5 receives treatment. Read more