Arthur Freeman and Roya McCluskey

Keywords control, impediments, lack of motivation The concept of resistance was first introduced to the psychological literature in the classic volume Studies in Hysteria in the 1890s (Breuer & Freud, 1893-1895 1955). Resistance was conceptualized as the patient's avoidance of thoughts, ideas, verbalizations, and behaviors as a way of coping against unbearable ideas that created anxiety which, by definition, signaled danger. The resistance manifested itself in the therapy by the patient's...

Combining Cbt With Religious Beliefs And Practices

Cognitive-behavioral approaches are based on the notion that reduction in emotional and behavioral dysfunction can be accomplished if clients relinquish certain beliefs and adopt others. Most religious traditions with a large number of adherents have an articulated set of beliefs and practices. Thus, it is a relatively straightforward process to identify those religious beliefs and practices that are consistent with, or are otherwise supportive of, a change from disturbance-associated beliefs...

Alan S Bellack and Wendy N Tenhula

Keywords schizophrenia, cognitive-behavior therapy, psychosis, hallucinations, delusions Although antipsychotic medications are generally effective at reducing the positive symptoms of schizophrenia (e.g., hallucinations, delusions), moderate to high levels of symptoms continue to persist among a large number of schizophrenia patients. As many as 20 of patients may not be responsive to medication, and many others are only partially responsive. Residual symptoms are a source of considerable...

Interacting Elements Of

The cognitive therapy literature recommends including the following elements in CCFs (Needleman, 1999 Persons, 1989) Stressors that precipitated the client's chief complaint Core beliefs or schemas longstanding, deeply held, emotionally laden beliefs about self, others, and the world that have a profound influence on behavior (e.g., I'm a loser People are only out for themselves) Other salient beliefs (e.g., conditional assumptions If I work extremely hard at all times, I might not fail...

Carrie Winterowd Aaron Beck and Dan Gruener

Everyone has been in pain at some point in his or her life. However, unrelieved chronic pain is perhaps one of the most challenging problems faced by health care consumers as well as practitioners and providers. It is estimated that 75-80 million people in the United States suffer from some sort of chronic pain, at an annual cost of 65-70 billion (Tollison, 1993). There are a number of personal, social, and environmental consequences of having unrelieved, chronic pain (see Gatchel & Turk,...

Cognitivebehavioral Therapy For Anxiety Disorders

Cognitive-behavioral therapy is the most empirically supported psychosocial treatment for anxiety disorders. The cognitive-behavioral understanding of anxiety disorders is largely based on learning theory. Mowrer's two-factor theory suggests that anxiety disorders are created initially via classical conditioning, and then maintained via operant conditioning. According to this theory, anxiety develops when a neutral stimulus becomes paired with an aversive response. For example, someone who was...

Future Directions

The discussion up to this point has focused on the clinical modification of CBT interventions for individuals with ASD. Specific outcome research for such modification is lacking, although there are encouraging case reports of success. Perhaps the most neglected but potentially useful CBT intervention procedures involve the use of relaxation techniques in concert with cognitive structuring. It is not uncommon that the comorbidity of ASD and Anxiety Disorder is not detected addressed, given the...

The Emergence of Behavioral Medicine 1950s1970s

Despite physicians' resistance to incorporate behavioral training into medical school curriculums in the early 1900s, the importance of the role of psychology in medicine had becomes evident in the 1950s (Stone, 1979). For example, a lecture series was presented at the University of Pittsburgh on The Relationship of Psychology to Medicine (Dennis, 1950 as cited in Stone, 1979). During this time, physicians began to acquire behavioral training and psychologists increasingly became employed by...

Review Of The Research Literature On Cbt And Chronic Pain

There is firm evidence in the research literature that both cognitive-behavioral and behavioral treatments are superior to no-treatment control conditions on a variety of outcomes (e.g., reducing pain levels, use of pain medications, negative thoughts, extent of physical disability as well as enhancing pain control, psychological adjustment, physical functioning and health status and psychosocial functioning) and these effects are maintained at follow-up for a variety of chronic pain clients...

Empirical Support Of Cbt For Addictive Behaviors

While clinicians are presently using CBT interventions for the treatment of addictive behaviors, few treatment programs exist and controlled studies are scarce. This is particularly true of sexual addictions and pathological Internet use, as no controlled studies were available as of this writing. Despite the lack of literature on a number of addictive behaviors, research on pathological gambling is emerging. Sharpe and Tarrier (1992) offered a case study of a 23-year-old self-referred gambler....

Elizabeth A Gosch and Aaron Pollock

Keywords depression, children, parenting, treatment, self-control A number of cognitive and behavioral models of depression have influenced treatment approaches with children. Most notably, Beck's model of depression emphasizes that mal-adaptive schemas cause negative distortions in perceiving and processing information that lead to depressive symptoms. Negative cognitions about the self, world, and future (the cognitive triad) characterize and maintain depressive symptoms. Also influential,...

Child And Adolescent Therapy

Research on treatment of child and adolescent depression is increasing. Curry (2001) reviewed the six controlled CBT studies with children (< 12 years old), employing highly structured cognitive or behavioral interventions in a school-based setting, and found five of the six studies supported the efficacy of acute-phase CBT relative to control or alternative treatment conditions in reducing depressive symptoms, with no difference between behavioral and cognitive treatment approaches (studies...

Recommended Readings

M., & Roemer, L. (2001). Practitioner's guide to empirically based measures of anxiety. New York Kluwer Academic Plenum. Barlow, D. H. (2004). Anxiety and its disorders (2nd ed.). New York Guilford Press. Morris, T. L. & March, J. S. (2004). Anxiety disorders in children and adolescents (2nd ed.). New York Guilford Press. Anxiety Anger Management Training (AMT) Richard M. Suinn and Jerry L. Deffenbacher Both anxiety and anger conditions can impair performance,...

Contemporary Uses Of Biofeedback

Biofeedback encompasses any physiological process that can be measured. The most common modes used in contemporary clinical practice assess autonomic nervous system functioning and are summarized in the following table Electromyogram biofeedback involves sensors that measure skeletal muscle tension, particularly in the frontalis (forehead), masseter ( jaw), and trapezius (upper back). Increased electrical firings indicate increased tension (Basmajian, 1989). The goal of EMG biofeedback is to...

Treatment

CBT treatment for anger (Kassinove & Tafrate, 2002) consists of four stages (1) preparing the patient for intervention, (2) working toward anger reduction through behavior change, (3) reducing anger by developing acceptance skills, and (4) preparing the patient for relapse. Preparation. Angry patients are often resistant to treatment. As compared to anxious or depressed patients, who often seek help on their own, angry patients are typically referred by others. Moreover, when they do come...

Individual Based Approaches

Individual cognitive-behavioral approaches have been used to reduce depression and other forms of psychosocial distress in caregivers of impaired and disabled older family members. For example, in a randomized clinical trial, Gallagher-Thompson and Steffen (1994) assigned depressed family caregivers of physically and cognitively impaired older adults (N 66) to time-limited (i.e., 16-20 sessions) cognitive-behavioral or brief psychodynamic individual psychotherapy. They found that participants...

Therapy

Therapy sessions focus on helping the client learn (1) cognitive restructuring skills (i.e., identifying, evaluating, and modifying negative automatic thoughts and beliefs) related to pain and emotional distress, (2) relaxation techniques (i.e., deep abdominal breathing, progressive muscle relaxation, hypnosis, and or biofeedback) and other behavioral strategies (e.g., pain and activity monitoring, distraction, assertiveness training), and (3) problem-solving skills to cope with pain and other...

Deborah Slalom and E Thomas Dowd

Keywords gambling, pathological gambling, high-risk behavior Gambling has always existed in one form or another however, since 1980, it has taken on a life of its own. It can be found in almost every area of life ranging from charitable bingo games to state lotteries to casinos and, now, online gambling. In fact, gross gambling revenues have increased from 10.4 billion in 1982 to 47.6 billion in 1996. This is greater than the combined revenue from movies, recorded music, cruise ships, sports,...

Behavioral Interventions

Behavioral approaches to pain management refer to skills such as relaxation training, pain monitoring, activity scheduling and monitoring, distraction techniques, assertiveness training, and problem solving. To provide some immediate relief from pain, the client can be taught a series of relaxation techniques early in therapy, including deep breathing, progressive muscle relaxation (tensing and relaxing different muscle groups in the body), guided imagery (e.g., imagining a safe place, a place...

References

J., & van Dyck, R. (2000). Selective serotonin reuptake inhibitors in the treatment of panic disorder and agoraphobia. International Clinical Psychopharmacology, 15(Suppl. 2), 25-30. Baxter, L. R., Jr., Schwartz, J. M., Bergman, K. S. et al. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry, 49, 681-689. Blackburn, I. M., & Bishop, S. (1983). Changes in cognition...

Treatment Procedures And Formats

Child-based CBT interventions have been increasingly used to try to decrease children's aggressive, antisocial behavior and assume that children engage in aggressive behavior as a result of (a) learned cognitive distortions, such as biased attention to aggressive cues and the attribution of hostile intent to the action of others (b) cognitive deficiencies, such as poor problem-solving and verbal mediation skills and (c) a related tendency to respond impulsively to both external and internal...

Etiology Of Phobias

The development of phobias has been understood in various ways. It has been proposed that individuals who experience panic attacks or panic-like symptoms have high levels of anxiety sensitivity, or the tendency to perceive anxiety as harmful (Reiss, Peterson, Gursky, & McNally, 1986). Studies have found that individuals with panic disorder with agoraphobia have high scores on a measure of anxiety sensitivity, indicating their aversion to the experience of anxiety itself (Antony et al.,...

The Nature Of Cognitivebehavioral Interventions

A number of varied interventions have been employed with individuals with anger-control problems including relaxation-based interventions, systematic desensitization, behavioral skills training, adjudicated psychoeducational counseling programs, rational-emotive behavioral therapy, and cognitive-behavioral programs, such as self-instructional training, stress inoculation training, problem-solving interventions, and exposure-based procedures. The CBT interventions are usually short-term (8 to 22...

Cognitivebehavioral Therapy Interventions For Anger Problems

Deffenbacher (1999) suggests that the first goal of treatment should be to establish good rapport. Good rapport provides a foundation of trust that is essential for the success of treatment. In addition, Deffenbacher describes why it is important to build a common understanding of the presenting problem and to reach agreement as to what the goals of therapy should be for angry clients. Basic counseling skills such as empathy and positive regard are important for building this rapport. In...

Psychology in Medicine in the 1800s

Stone (1990) reflects on his review of the historical literature as long as there have been psychologists there have been efforts to apply psychology to phenomena of health, illness, and health care (p. 7). It is well known that the efforts of Wilhelm Wundt and Emil Kraepelin (1800s) demonstrated and shaped the integration of psychology in the medical setting. Briefly, Wundt was the founder of experimental psychology. He had the first lab, wrote the first book, started the first journal, taught...

Summary And Future Considerations

Behavioral strategies and lifestyle modifications are paramount to managing sleep disorders and their sequelae. In addition to sleep hygiene, utilizing a cognitive-behavioral approach and conceptualization may produce additive benefit. Similar to helping patients with medical conditions, such as chronic pain or cardiovascular disease, examining the beliefs, attitudes, thoughts, and emotional responses of patients with sleep disorders is likely to provide an even greater understanding and...

Fit Between Cognitivebehavioral Therapy And Primary Care

There are many reasons that cognitive-behavioral approaches fit well within the primary care model. First, cognitive-behavioral approaches are evidence-based, an approach that fits current thinking in primary care. Given the recent emphasis on evidence-based treatments in primary care, the climate is quite receptive to approaches that are empirically supported. Second, many of the problems seen in primary care are those for which cognitive-behavioral approaches have already been shown to be...

Factors Influencing The Emergence And Expression Of Ptsd In Children And Adolescents

Research shows that characteristics of traumatic experiences, such as severity, duration, and proximity, impact the emergence and expression of PTSD symptoms. For example, there is evidence of a dose-response relationship between traumatic events and the development of PTSD such that events that are life-threatening are associated with greater and more severe symptoms than traumatic events that are less threatening or are experienced less directly (Davis & Siegel, 2000 Green et al., 1991)....

Comparisons Among Treatments

Key studies comparing the previously discussed efficacious treatments for PTSD have found few differences in outcome between CBTs. For instance, in a study comparing SIT, exposure therapy, and their combination in a female assault sample with PTSD, only general anxiety was significantly lower in exposure therapy compared to exposure therapy SIT (Foa et al., 1999). However, there was a trend for more clients in exposure therapy (52 ) to obtain good end-state functioning (a composite of PTSD,...

Application To Older Victims

These studies apply to older trauma victims with several caveats. Chiefly older victims find the modal exposure treatments distressing to tolerate. Intensive exposure methods with older adults may be counterproductive. It increases the level of autonomic arousal, with adverse effects on cognitive performance. There are many benefits to the use of prolonged exposure, but older patients do best with dosed exposure and coping techniques. The primary therapeutic task in PTSD treatment becomes the...

Selfreflection

In conventional CBT programs, the client is encouraged to self-reflect to improve insight into his or her thoughts and feelings, thereby ideally promoting a realistic and positive self-image as well as enhancing the ability to self-talk for greater self-control. However, the concept of self-awareness may be different for individuals with Asperger's disorder. There may be a qualitative impairment in the ability to engage in introspection. Research evidence, autobiographies, and clinical...

Contemporary Contributors And Empirical Research On Cognitive Vulnerability

Two current researchers, Lauren Alloy and Lyn Abramson, have played a major role in spearheading the use of behavioral high-risk designs of cognitive vulnerability. Their Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) Project is more advanced in testing prospective designs than any comparable program of vulnerability research in other disorders, and is an exemplary program of cognitive vulnerability research. In the case of other disorders (e.g., anxiety, eating disorders),...

Summary And Future Directions

Several CBTs have proven efficacy for the treatment of chronic PTSD, including exposure therapy, stress inoculation training, cognitive therapy, and cognitive processing therapy. Studies that have compared these efficacious treatments have not consistently demonstrated the superiority of one of these treatments over another. In addition, cognitive-behavioral treatment packages that combine elements of exposure therapy with stress inoculation training or cognitive therapy have also demonstrated...

Guidelines for Using Dreams

The following guidelines can assist the clinician in utilizing dreams within the context of CBT. 1. The dream needs to be understood in thematic rather than symbolic terms. The particular images and ideas scale the level of emotion. 2. The thematic content of the dream is idiosyncratic to the dreamer and must be viewed within the context of the dreamer's life. 3. The specific language and imagery of the dream are important to the meaning. 4. The affective responses to the dreams can be seen as...

Using The Socratic Dialogue

The following basic rules or instructions for implementing and using SD are recommended. 1. The techniques must be embedded in the therapeutic collaboration. The collaboration involves an acceptance of the therapist as having a goal and direction for the therapy. The therapeutic goal is the roadway on which the therapist and patient will travel, the SD is the means of conveyance. As the road dips and curves, the SD will need to be adjusted in its speed, direction, and content. Rather than the...

Grief And Loss

Unfortunately, there remains an inconsistent use of terms and definitions in the grief literature, leading to sometimes confusing conclusions. For the sake of clarity, grief is defined here as representing the particular reactions one experiences while in a state of bereavement. These reactions to the perception of loss can be psychological, social, and physical. Bereavement has been conceptualized as the experiential state one endures after realizing a loss. It refers to the emotions,...

Epidemiology Of Ptsd In Children And Adolescents

Data indicate that trauma exposure is highly prevalent among children. One study found that 25 of children aged 9-18 had experienced at least one potentially traumatic event in their lifetimes such as the death of a loved one, witnessing a traumatic event, or sexual abuse (Costello, Erkanli, Fairbank, & Angold, 2002). More specifically, as of 1995, epidemiological data indicate that 1.8 million adolescents from 12 to 18 had been sexually abused, 3.9 million had been severely assaulted, 2.1...

Cognitivebehavioral Interventions

Cognitive-behavioral interventions have been used with caregivers to improve time management, coping, problem-solving skills, assertiveness, relaxation, positive experiences, and self-care, and to decrease distorted thought processes regarding the caregiving experience. Regardless of the specific technique or modality utilized, the fundamental goal of these interventions is to decrease distress and to improve the caregiver's ability to cope with the multifac-eted caregiving challenges and role...

Summary And Conclusions

Phobias can be distressing and debilitating disorders. Individuals with agoraphobia, specific phobia, and social phobia experience fear in particular situations or around particular objects that often manifests itself in a panic attack or paniclike symptoms. The experience of panic leads to anticipatory anxiety about having future symptoms of panic, resulting in avoidance of the phobic situation. CBT has been found to be effective in treating these phobias through a combination of exposure,...

Interventions With Patients With Dementia

Medications are now available for Alzheimer's disease and other dementias that sometimes slow the progression of symptoms, but do not reverse the overall course of the disorder (Mendez & Cummings, 2003). Psychological interventions have focused on the early stages of the illness when people still have an awareness of their problems, and can actively participate in treatment. Early stage support groups for patients and their families have been very popular and can now be found in many...

Cognitivebehavioral Treatment Of Perfectionism

Although there are hundreds of studies examining the efficacy of cognitive-behavioral therapy (CBT) for psychological problems that are known to be associated with perfectionism (e.g., social phobia, depression, obsessive-compulsive disorder, eating disorders Nathan & Gorman, 2002), there are no controlled studies examining the use of CBT for treating perfectionism directly (Shafran & Mansell, 2001). Instead, there are a few case studies examining the effects of CBT on perfectionism, a...

Empirical Support for CBT for Childhood PTSD

Several important treatment outcome studies have examined the efficacy of CBT for PTSD in children. In the late 1980s, following the introduction of PTSD into DSM-III (APA, 1980), Saigh (1987a,b 1989) carried out a series of single-case trials of imaginal flooding therapy for traumatized children and adolescents in Lebanon. This treatment involved children identifying and describing their traumatic experiences over a multiple baseline with outcome, measured through self-reported ratings of...

Empirical Status Of Therapy For Bulimia Nervosa

The efficacy of CBT for BN has been evaluated in nearly 30 controlled studies. The percentage reduction in binge eating and purging across all clients receiving CBT is typically 80 or more compared to virtually 0 reduction in wait-list controls. Approximately 50 of those treated with CBT report complete cessation of all binge eating and purging at treatment termination. Large effect sizes for CBT are found for both behavioral symptoms (e.g., binge frequency 1.28) and cognitive symptoms (e.g.,...

Cbt For Obesity The Present

More than 150 studies have evaluated the effectiveness of CBT for obesity. Reviews of randomized trials show that comprehensive interventions, typically delivered in 15 to 24 weekly group sessions, produce average weight losses of approximately 8.5 kg (Wadden, Brownell, & Foster, 2002). This amount of weight loss commonly produces clinically significant improvements in selected risk factors for disease (e.g., blood pressure, blood glucose, blood lipids) and beneficial changes in mood and...

Cbt For Obesity The Past

Cognitive-behavioral therapy (CBT) constitutes the foundation of current lifestyle interventions for weight loss. Early behavioral theorists (e.g., Ferster, Nurnberger, & Levitt, 1962) invoked the principles of operant and classical conditioning to explain how learned patterns of overeating and sedentary behavior produce a positive energy balance and result in an excess accumulation of adipose tissue. From an operant conditioning perspective, overeating is viewed as a behavior largely...

Wayne A Bower

Keywords cognitive therapy, treatment, depression, inpatient, psychotherapy Cognitive therapy (CT) has become one of the most prominent treatment models in mental health and has been adapted for use with a wide range of medical patients. Initially designed as an outpatient treatment, CT has been adapted and used in an extensive variety of settings such as crisis intervention, day-treatment, partial hospital programs, and inpatient settings. Various authors have described the adaptation of CT to...

Cognitive Behavior Therapy

The major factors distinguishing CBT for children from other psychosocial interventions for youth are their focus on maladaptive learning histories and erroneous or overly rigid thought patterns as the cause for the development and maintenance of psychological symptoms and disorders. As such, CBT for children is focused on the here and now rather than oriented toward uncovering historical antecedents of mal-adaptive behavior or thought patterns. Treatment goals are clearly determined and...

Cbt And The Trauma Memory

There does not appear to be any superiority between cognitive therapy and exposure or between exposure and stress inoculation. There also does not appear to be any advantage of combining treatments so that exposure plus cognitive therapy or exposure plus stress inoculation are not superior to each intervention alone. There may be a slight advantage of individual therapy over group. That said, the exact components of care applied to older victims should be broadly considered and multiple in...

Explanatory Behavioral Models

Over the years several behavioral explanatory models of sexual aggression have been proposed. Early models were based on theories of conditioning and deviant arousal. This sexual motivational conditioning model proposed that deviant sexual behavior occurs because the offender's early deviant sexual fantasies are paired with masturbation (Maguire, Carlisle, & Young, 1965). Although many sex offenders may be diagnosed or identified as exhibiting deviant sexual interests, the presence of such...

Jonathan D Huppert and Edna B

Keywords OCD, obsessions, compulsions, exposure, insight Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by both obsessions and compulsions. Obsessions are intrusive thoughts, images, or impulses that come into one's mind for no apparent reason, are unwanted, and are distressing. Compulsions are characterized by repeated behaviors or thoughts that serve to decrease the obsessional distress. To meet criteria for OCD, obsessions and or compulsions must take up at least 1...

Andrea M Chronis

Keywords ADHD, parent training, behavior problems, oppositional defiant disorder, conduct disorder Behavioral parent training has been established as an empirically supported treatment for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). Parent training programs focus on teaching parents behavior modification techniques based on social learning principles. Parents are instructed to modify antecedents and consequences of child...

Anxiety Disorders

Anxiety has been demonstrated to be a very common mental health problem in people with DD. The complete spectrum of anxiety disorders is represented in this population as opposed to their noncognitively challenged counterparts. Relaxation training is a common component in a CBT approach to treating anxiety. Individuals with MR DD are reported to have better results learning relaxation training when modeling and physical guidance were used to teach the difference between tense and relaxed...

Acute Care And Rehabilitation Settings

It is generally accepted that what defines a treatment setting as acute is the medical status of the patients in it rather than some characteristic of the facility. Thus, patients in an acute care setting are medically unstable and likely to experience rapid changes in status. The NICU and medical stabilization floors are good examples of acute care settings. Patients at this level are not able to tolerate several hours of therapy. Rather, the patient takes part in bedside rehabilitative...

Empirical Basis

The empirical support for cognitive-behavioral therapy with terminally ill individuals is limited but growing. In a review of the grief literature, Malkinson (2001) found that the few studies that exist and have been cited as effective have utilized desensitization to avoided stimuli, cognitive restructuring, visualization, stress inoculation training, thought-stopping, relaxation exercises, and skill acquisition to assist individuals in coping with grief reactions. While these studies focused...

Anxiety Management Training AMT

AMT teaches the patient the cognitive and behavioral skills to more effectively manage the aversive emotions experienced in PTSD. Typically, the specific skills taught are relaxation training, breathing retraining, trauma education, guided self-dialogue, cognitive restructuring, and communication skills. Although frequently considered a palliative approach to treating PTSD, AMT appears to possess the capacity to influence the frequency and intensity of PTSD symptoms across different types of...

Victoria M Follette and Alethea A A Smith

Keywords exposure, cognitive processing therapy, PTSD, stress inoculation training Exposure therapy has increasingly been found efficacious with a variety of anxiety-related disorders including phobias, generalized anxiety disorder, and posttraumatic stress disorder. Originally developed using concepts from basic learning theory, concerns about enhancing the efficacy of exposure therapy have led to the enhancement of this technique with additional components. The primary augmentation has been...

Overview Of The Caregiving Literature

Historically, the study of caregiving has developed within the context of caring for persons with schizophrenia or dementia. Thus, until the rise in focus on clinical health psychology and behavioral medicine, little attention had been given to caregivers of medically ill persons, or differences between various caregiving populations. More recently, variables affecting the well-being of caregivers of patients with medical illnesses such as cancer, HIV AIDS, traumatic brain injury, spinal cord...

Outcome Studies Of Ct For Bp

Encouraging single case reports, case series, and open or nonrandomized studies (e.g., Scott, 1995b Zaretsky, Segal, & Gemar, 1999) suggested benefits from the use of CT as an adjunct to standard treatments, with individuals reporting improvements in medication adherence, reductions in manic and depressive symptoms, and, where measured, improvements in psychosocial functioning. There are five published RCTs of CT for individuals with BP (Cochran, 1984 Lam et al., 2000, 2003 Perry, Tarrier,...

Brief Overview Of Cognitive Therapy

An optimal course of CT begins with a cognitive formulation of the individual's unique problems related to BP, particularly emphasizing the role of core maladaptive beliefs (such as excessive perfectionism, unrealistic expectations for social approval) that underpin and dictate the content of dysfunctional automatic thoughts and drive patterns of behavior. This formulation dictates which interventions are employed with a particular individual and at what stage of therapy that approach is used....

Social Cost Outcomes and Benefitto Cost Ratio

Three BCT studies (two in alcoholism and one in drug abuse) have examined social costs for substance abuse-related health care, criminal justice system use for substance-related crimes, and income from illegal sources and public assistance. The average social costs per case decreased substantially in the 1-2 years after as compared to the year before BCT, with cost savings averaging 5000- 6500 per case. Reduced social costs after BCT saved more than 5 times the cost of delivering BCT, producing...

Cbt In The Treatment Spectrum

Though one of the most widely researched treatments for numerous Axis II and other Axis I disorders, CBT is not currently the most widely used in the treatment of SUDs, particularly alcohol. Fuller and Hiller-Sturmhofel (1999) reported that the 12-step programs, such as Alcoholics Anonymous, are most commonly used to treat alcoholism, with CBT a distant second, and pharmacological treatments such as disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia) an even more distant third....

Timothy J OFarrell and William Fals Stewart

Keywords alcoholism, drug abuse, couples therapy, behavioral contracts, communication skills training Although alcoholism and drug abuse have been historically viewed as individual problems best treated on an individual basis, there has been a growing recognition over the last three decades that couple and family relationship factors often play a crucial role in the maintenance of substance misuse. The relationship between substance abuse and couple relationship problems is not unidirectional,...

Katie M Castille and Maurice F Prout

Keywords phobia, fear, phobic response, anxiety disorders Anxiety disorders have been identified as the most prevalent mental health problem in the United States. According to the Epidemiologic Catchment Area (ECA) study sponsored by the National Institute of Mental Health, the 1-month prevalence rate for anxiety disorders is 7.3 (Regier et al., 1998). Among anxiety disorders, phobic disorders are the most common, with a prevalence rate of 6.2 . According to the Diagnostic and Statistical...

Stephanie H Felgoise and Holly Kricher

Keywords terminal illness, grief, coping, loss, quality of life The psychological sequelae to a terminal illness diagnosis, also termed life-threatening illness, are complex and ideographic. Terminal illness or life-threatening illness is operationally defined as any condition that shortens normative life expectancy, a condition that is not due to normative causes. Some examples of these types of illnesses include AIDS, COPD, cardiac conditions, and some forms of cancer. Individuals often...

Mervin R Smucker

Keywords child sexual abuse, imagery rescripting, schemata, CBT, PTSD The alarming prevalence of childhood sexual abuse (CSA) and its long-term deleterious effects on the lives of victims is well documented. A history of sexual abuse in childhood is frequently associated with a range of psychological disturbances in adulthood, including chronic depression and anxiety, suicidality and self-injurious behaviors, relationship disturbances, sexual difficulties, and chronic PTSD symptoms (e.g.,...

Types Of Sexual Dysfunction

The best data sample (Laumann et al., 1994) indicates that rates of sexual dysfunction and problems have remained relatively constant or have increased in the past 30 years. However, the types and causes of sexual dysfunction have changed. Traditionally, sexual dysfunction had been caused by lack of information, repressive attitudes and values, a rigid male-female double standard, and prevalence of primary dysfunction (i.e., the person has never been sexually functional). Now, causes of sexual...

Basic Tenets And Philosophy

The major factors distinguishing CBT for children from other psychosocial interventions for youth are their focus on maladaptive learning histories and erroneous or overly rigid thought patterns as the cause for the development and maintenance of psychological symptoms and disorders. However, several other central tenets differentiate CBT from other treatments for children. Not surprisingly, given CBT's foundations in experimental psychology, CBT has at its core a commitment to the scientific...

Cognitive Challenging

Cognitive challenging is another useful treatment for anxiety disorders. Cognitive challenging is based on the assumption that thoughts play a powerful role in producing and maintaining anxiety, as in the spider bite example discussed earlier. The theory behind cognitive challenging suggests that people develop automatic thoughts that are often inaccurate. These thoughts are called automatic because people are usually unaware of them. A common automatic thought may be If I have a panic attack...

Cognitive Developmental Hypnotherapy

The model is quite new on the therapeutic scene, having been presented explicitly in two book chapters (Dowd, 1993, 1997), one book (Dowd, 2000), and one article (Dowd, 2001). It retains the cognitive-developmental emphasis on modifying cognitive structures (or core cognitive schemas) which are laid down developmentally early in life and thereafter progressively elaborated on and differentiated but not substantially changed. As these schemas become more organized and differentiated, they...

John H Riskind and David Black

Keywords cognitive vulnerability, cognitive bias, beliefs, cognitive structures Cognitive vulnerabilities are faulty beliefs, cognitive biases, or structures that are hypothesized to set the stage for later psychological problems when they arise. They are in place long before the earliest signs or symptoms of disorder first appear. These vulnerabilities are typically purported to create specific liabilities to particular psychological disorder after individuals encounter stressful events, and...

Research On

Cognitive behavior therapies are among the most empirically supported of psychotherapies. Research is ongoing in the use of CBT in numerous disorders including substance use (Carroll, 1999). In a review of research into cognitive behavior therapies as stand-alone treatments for alcohol abuse, Longabaugh and Morgenstern (1999) found that CBST delivered as a stand-alone treatment does not differ in effectiveness from these other treatment approaches. This also was true when CBST was used for...

Jan Scott

Keywords cognitive therapy, bipolar disorders, manic depression Until recently, bipolar disorders (BP) were widely regarded as a biological illness that should be treated with medication (Scott, 1995a). This view is gradually changing for two reasons. First, in the past three decades, there has been a greater emphasis on stress-vulnerability models. This has led to the development of new etiological theories of severe mental disorders that emphasize psychosocial and particularly cognitive...

CBT for Noncardiac Chest Pain

Noncardiac chest pain (NCCP) refers to persistent chest pain without an identifiable cardiac (e.g., ischemic disease) or psychiatric (e.g., chest pain related to panic disorder) etiology. Over 50 of patients referred to cardiology clinics have chest pain with no positive medical findings or known medical problems (e.g., mitrovalve prolapse). Symptoms often endure with about 75 of NCCP patients reporting continued chest pain at a 1-year follow-up. Persons with NCCP are more likely to have...

Cbt For Emotional Distress

CBT approaches are increasingly being evaluated as a means to decrease psychological distress symptoms (e.g., depression, anxiety) among cancer patients, as well as to improve their overall quality of life. This trend began with a landmark study conducted by Worden and Weisman (1984) in which they found an intervention package that included training in problem-solving and relaxation skills to promote effective coping and adaptation among newly diagnosed cancer patients. Behavioral stress...

Description Of Cbt Model For Adhd In Adults

The core symptoms of ADHD are developmentally inappropriate levels of impulsivity, inattention, and or hyperactivity that have been present since childhood. To make the diagnosis in adulthood requires clear evidence that these symptoms have caused enduring difficulties throughout the individual's development, although there can be great variability in the intensity of symptoms and in the settings in which they occur. Finally, it must be determined that the symptoms are not better accounted for...

Empirical Evidence For Cbt For Adhd

Overall, the empirical literature on psychosocial treatments for adults with ADHD is sparse. CBT approaches have offered some encouraging preliminary results. Wilens et al. (1999) performed a chart review of 26 adults seeking treatment for ADHD. Clinical data were collected at baseline, at the point of medication stabilization, and at the end of CBT (introduced after medication stabilization). The findings indicated that CBT was associated with patient improvements on a measure of depression,...

Methodology Of Behavioral Assessment

There are many possible behavioral assessment tools available for use. The exact nature of these tools depends on the specific types of target problems being assessed. Methods of behavioral assessment include direct observation by another or self-observation in vivo, in vitro, or during performance on an analogue measure. Regardless of the specific tool selected or designed, a commonality across all tools is the monitoring of important and relevant aspects of the target response. For example, a...

Empirical Status Of Cbt For Older Adults With Depression And Personality Disorders

The efficacy of CBT for younger adults has a growing base of evidence. CBT has generally yielded effect sizes as large or larger than treatment with antidepressant medications or other forms of psychotherapy in the treatment of depression, and it may be more effective than other treatments for depressed individuals with personality disorders (APA, 2000). Presumably because of the emphasis on patient skill acquisition in CBT, patients are less likely to relapse after treatment to remission if...

Literature Review Of Cbt For Ptsd

These theoretical models led to the development of the three most widely used treatments for war-related PTSD today cognitive therapy, anxiety management therapy, and exposure therapy. Depending on individual differences and the ways in which people emotionally process traumatic experiences, a patient may respond differently to each type of treatment modality. However, new treatment alternatives are constantly being developed and their efficacy tested for example, eye movement desensitization...

Cbt For Obesity The Future

Does the CBT model of obesity require reformulation Cooper and Fairburn (2002) have agued for the need to reformulate the theory, aims, and procedures used in CBT for obesity. These authors maintain that the problem of poor long-term outcome following CBT for obesity may be attributed to two factors (a) inattention to the cognitive factors that contribute to weight regain and (b) ambiguity over treatment goals in long-term interventions. They note that long-term failure may be directly related...

Coping And Adjustment

In addition to dealing with the losses associated with the illness process, coping with the day-to-day problems that arise is important to individuals faced with this stressor. Many problems can present as a result of changing roles, financial status, medical treatment, and decreasing physical health. Lazurus and Folkman (1984) have proposed that there are two primary forms of coping emotion-focused and problem-focused coping. Although it may be tempting to view these forms of coping as...

Talia I Zaider and Richard G Heimberg

Keywords social anxiety disorder, social phobia, anxiety disorders, adults, children Social Anxiety Disorder (SAD), also known as social phobia, is characterized by an excessive and persistent fear of one or more social or performance situations. Individuals suffering from SAD endure these situations with acute discomfort, and a great many avoid them altogether. The anxiety and associated avoidance behavior can be crippling, making it difficult for those affected to sustain relationships or...

Thomas Dowd

Keywords hypnosis, hypnotherapy, imagery In its relatively short history, cognitive therapy has proved to be not only an efficacious treatment for a wide variety of psychological and behavior problems, but also an integrating theory of tremendous heuristic power (Afford & A. T. Beck, 1997). It originally began, independently by A. T. Beck (1976) and Ellis (1962), as a system of therapy based on changing maladaptive cognitions (automatic assumptions, irrational thoughts) in the here and now...

Directions For Anger Management Interventions With Youth

There is a general consensus that angry youth have parents who lack effective parenting skills and who evidence similar patterns of impulsive and aggressive responses to perceived provocations. Often there is an early use of extensive physical punishment and many aggressive youth have been victims of their parents' rage reactions. These youth develop in a home environment void of models of prosocial coping and with limited understanding of and communication about emotional expression. Their...

Criticisms Of Cbt

Literature specifically focusing on persons with AIDS, COPD, cardiac conditions, cancer, and others may offer support to cognitive-behavioral interventions for terminally ill persons. However, caution is warranted in generalizing across populations due to the inherent differences in disease processes, length of time from diagnosis to death, societal reactions to such illnesses, and medical technology and knowledge addressing such conditions. Cognitive-behavioral therapies have traditionally...

Stress Inoculation Training

Developed by Meichenbaum (1974), SIT is an anxiety management program that was modified for use with sexual assault survivors. SIT is made up of training in general anxiety management techniques to address the three channels of fear and anxiety (i.e., physical, behavioral, and cognitive). These techniques can then be applied in response to specific PTSD symptoms and in general. The rationale for SIT asserts that as clients are better able to use these techniques to manage their anxiety, their...

Negative Cognitive Styles As Vulnerabilities For Depression

Do negative cognitive styles actually increase people's vulnerability to depression Recent prospective studies have obtained considerable support for the cognitive vulnerability hypothesis (see Alloy et al., 1999). In the Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) Project (Alloy et al., 1999), nondepressed college freshmen, with no other mental disorders, were selected to be at hypothesized high risk (HR) or low risk (LR) for depression based on the presence versus absence of...

Brian Baucom

Keywords couples, relationship therapy, behavioral couples therapy Cognitive-behavioral couples therapy (CBCT) has been evolving since the late 1960s when the first study of a behav-iorally based treatment for couples was published. The first behavioral treatments for couples attempted to increase the frequency of discrete, desired behaviors by using direct reinforcement by partners. Since that time, CBCT has been refined as couples researchers have developed a better understanding of the ways...

Treating Low Selfesteem

The model forms a basis for an individually tailored cognitive conceptualization of the difficulties for which the patient has sought therapy. It is the foundation for an integrated program of cognitive-behavioral interventions, which draws on established protocols for treating depression and anxiety, as well as the clinical literature on changing schemas and core beliefs (e.g., Beck, Freeman, & Associates, l990 Young, Klosko, & Weishaar, 2003). The program is briefly summarized in Table...

Narcolepsy

Narcolepsy is a disorder characterized by four hallmark symptoms (1) excessive daytime sleepiness which is most prominent, (2) cataplexy, (3) sleep paralysis, and (4) hypna-gogic hallucinations. At times, the urge to sleep can be so irresistible that the individual experiences a sleep attack. It is primarily treated through the use of stimulants and antidepressants. Stimulants are the treatment of choice and are useful in keeping the individual awake but are not effective in relieving other...

Future Directions In Cbt For Bulimia Nervosa

Although CBT is currently the most effective form of treatment for BN with most clients exhibiting significant reductions in BN symptoms following treatment, only roughly 50 of clients treated with CBT are completely free of BN symptoms in the long term. Given this rate of full response, the need to improve the efficacy of CBT for BN is clear especially since administering an alternative therapy to those who do not initially respond to CBT for BN has, in most instances, not resulted in...

Empirical Support For Cbt With Children

Studies of treatment outcomes of CBT for youth, with both internalizing (e.g., anxiety disorders, depression) and externalizing difficulties (e.g., aggression), have provided some empirical support (i.e., the data document beneficial gains associated with CBT treatment). For example, randomized clinical trials of CBT for anxious youth (e.g., Kendall et al., 1997) have been reviewed and deemed as evidence that CBT is probably efficacious in treating anxiety disorders in youth (Kazdin & Weisz,...

Indications for and Limitations of CBT for Treating Childhood PTSD

Results from studies implementing cognitive-behavioral interventions for childhood PTSD demonstrate reduced symptomatology in all PTSD symptom clusters and suggest that intensive, short-term individual, parent, and group treatments are efficacious and safe in treating traumatized children across a range of developmental levels. In addition, while significantly reducing PTSD symptomatology in children, some trauma-focused CBTs also have proven equally effective at diminishing peripheral...

Social Avoidance And Anxiety

Beliefs about being defective and the importance of appearance to the self will drive varying degrees of social anxiety and avoidance. Thus, depending on the nature of their beliefs, patients will tend to avoid a range of public or social situations or intimate relationships because of the fear of negative evaluation of the imagined defects. Many patients endure social situations only if they use camouflage (for example, excessive makeup) and various safety behaviors. These are often...

Criticisms Of Cbt With Children

Despite the apparent effectiveness of combining education and graded exposure themes into one treatment package, it remains unclear which aspects of CBT are most active, and to what extent other factors (e.g., family dynamics, child demographics, order of treatment components) may influence treatment outcomes. With the exception of trials that have utilized structured manualized interventions, determining the efficacy of relative CBT components is difficult as the arrangement and emphasis on...

James D Herbert and Kristy Dalrymple

Keywords social anxiety, social phobia, cognitive-behavior therapy, social skills, group therapy Social Anxiety Disorder (SAD also known as Social Phobia) is defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a marked and persistent fear of social or performance situations in which embarrassment may occur. These situations may include public speaking, eating in public, writing in public, speaking with authority figures, conversations, dating,...

Mark J Williams and Robin B Jarrett

Keywords depression, treatment, bipolar disorder, chronic depression, childhood depression Cognitive-behavior therapy (CBT) is a general term for psychosocial interventions designed to change responding and to improve symptoms and quality of life. Historically, the distinctions among cognitive behavior therapies for depression concern what type of responding (cognition or behavior) is targeted to change mood. Behavioral conceptualizations emphasize changing mood by first altering overt...

Christine Maguth Nezu and Michelle A Peacock

Keywords cognitive-behavior therapy, behavior therapy, mental retardation, developmental disabilities, dual diagnosis Compared to the general population, individuals with mental retardation are at increased risk for developing behavioral, psychological, and emotional disorders. Characteristics associated with mental retardation such as deficits in social-cognitive processing ability and communication skills may negatively influence their ability to cope with stress and increase their...

The Cognitive Hypnotherapeutic Treatment Of Psychological Disorders

Cognitive hypnotherapy has been applied to many problems, including anxiety and phobias, stress-related disorders, depression, and habit disorders, as well as general life-enhancing interventions (Dowd, 2000). More recently, it has been applied to pain reduction (Dowd, 2001) and obsessive-compulsive disorders (Dowd, 2003). In treating all these (and other) disorders, the model is the same. First the therapist must identify (in collaboration with the client as much as possible) the cognitive...

Building Support for Abstinence with the Recovery Contract

The therapist, with extensive input from the partners, develops and has the partners enter into a daily Recovery Contract (also referred to as a Sobriety Contract). As part of the contract, partners agree to engage in a daily Sobriety Trust Discussion, in which the substance-abusing partner states his or her intent not to drink or use drugs that day (in the tradition of one day at a time from Alcoholics Anonymous). In turn, the nonsubstance-abusing partner verbally expresses positive support...