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The treatment or the resocialization is the most important part of the prison sentence which methods can be individual and group. Motivated inmates and less resistance for the treatment are the main precondition for effective treatment. Appropriate behavior of personnel is the main factor for that result. Cognitive-behavioral therapy (CBT) as the most effective evidence based psychotherapy approach for offender population is a type for inmate treatment. CBT is a result of Aaron Beck pioneering work in the 1960s. CBT model is based on the triangle relationships between cognition, emotions and behavior. The cognition is defined as a product of the three levels: cognitive schemas, negative automatic thoughts and dysfunctional thinking or thinking errors. The inventory of risk, need and strengths (IORNS), an risk assessment instrument, based on Risk, need and responsivity (RNR) model, was used for selection of (N=27) inmates and CBT treatment pilot program final evaluation, in Macedonian prison Bitola. The evaluation was done by comparing pre and post test measures in (N=12) male inmates, as optimal number for group psychotherapy treatment. According to the RNR model the treatment program needs to be oriented to the inmates needs. Implementing CBT treatment program for group psychotherapy and IORNS as short screening tool in Macedonian prisons was the aim of the project supported by the Council of Europe in this work. The results showed significant lower Procriminal attitudes but higher Aggression because of higher Aggressive behavior in the post measures. Results and instrument can be used in next CBT programs evaluations for better rehabilitation of prison inmates and reducing recidivism. [ABSTRACT FROM AUTHOR]

Copyright of Sucht is the property of Hogrefe AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children's functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP). Methods: PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL). Results: A total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment. Conclusions: We observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research. [ABSTRACT FROM AUTHOR]

Purpose: Body-focused repetitive behaviors (BFRBs), including skin picking and hair pulling, are common behavioral problems with a lifetime prevalence of up to 5.5%. Extant research indicates that the best treatment approach for BFRBs is Cognitive Behavioral Therapy (CBT), but many of those who struggle with BFRBs are either reluctant to seek treatment or lack access to a therapist with sufficient expertise and experience. Methods: This paper presents preliminary data on the efficacy of two internet-based, therapist-assisted programs designed to treat hair pulling (TrichStop) and skin picking (SkinPick). The programs consist of evidence-based CBT components, including psychoeducation, Habit Reversal Training (HRT) and Acceptance and Commitment Therapy (ACT). We examined changes in self-reported symptom severity of participants in the two programs between February 2019 and December 2022 who had completed at least two assessments (840 participants in SkinPick and 583 participants in TrichStop). Results: Both programs resulted in a considerable reduction in symptom severity, with large effect sizes according to the conventional interpretation of Cohen's d. Improvement in symptoms was progressive over time, and overall improvement correlated with the number of sessions each participant has completed. Conclusions: This preliminary study, which is based on a large sample of participants, indicates that the two programs significantly reduce the severity of skin picking and hair pulling. The study has several limitations, including the lack of a control group, reliance on self-report based on partial scales, and paucity of demographic data, which should be addressed in future controlled studies. [ABSTRACT FROM AUTHOR]

Objective: How are collaborative interactions associated with clients' progress in therapy? This study addressed this question, by assessing the quality of therapeutic collaboration and comparing it passage by passage with the clients' assimilation of problematic experiences in two cases of major depression treated with Cognitive Behavioral Therapy, one recovered and one improved-but-not-recovered. Method: We used the Therapeutic Collaboration Coding System to code collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate clients' progress. In both cases, for the distribution of specific collaborative therapeutic exchanges, we tested for the difference of empirical means between lower and higher APES levels. Results: Both cases progress in APES, but in contrast with Annie (Improved-but-not-recovered), Kate (Recovered) achieved higher levels of change in last sessions. In addition, we found significant differences in the types of collaborative therapeutic exchanges associated with lower and higher APES levels. Conclusion: Ambivalent therapeutic exchanges distinguished the recovered case from the not recovered case highlighting a source of difficulties in facilitating therapeutic change in CBT. In addition, observations in these cases supported the theoretical suggestion that supporting interventions would be better accepted at lower APES levels, whereas challenging interventions would be better accepted at higher APES levels. [ABSTRACT FROM AUTHOR]

This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the impact of Cognitive-Behavior Therapy (CBT) on resilience in old people with "empty nest syndrome." Three older adults with empty nest syndrome underwent CBT for 8 weeks in a single-case experimental design. Changes in resilience were tracked through measurements at baseline, intervention, and follow-up. Visual analysis as well as an effect size index of Percentage of Nonoverlapping Data (PND) were then analyzed. CBT resulted in a significant increase in psychological resilience for all three participants across the intervention phase. Follow-up data showed that all subjects were able to maintain their resiliency four weeks after the intervention. This single-case experimental study supports the hypothesis that CBT improves resiliency in old people with empty nest syndrome. Cognitive Behavior Therapy is effective in increasing resiliency in old people with empty nest syndrome. The culture dynamics is an important component in the emergence and persistence of empty nest syndrome. [ABSTRACT FROM AUTHOR]

Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction. [ABSTRACT FROM AUTHOR]

This study aimed to identify the effectiveness of CBT in reducing symptoms of anxiety in a sample of adolescents with learning disabilities. To achieve the objectives of the study, the tool was prepared, which was represented by the anxiety scale, and it was confirmed that the scale had validity and consistency indications appropriate for its application to the individuals of the study sample, and a training program based on CBT was built. Where the researcher applied the study tools to a sample consisting of (8) students, they were chosen intentionally. Data were statistically processed by extraction of mean and standard deviations, and the unscientific Wilcoxon Signed Ranks Test was used. The results showed that there were statistically significant differences on pre and post measurement in reducing symptoms in favor of post measurement, which indicates the effectiveness of the training program. In light of the results, I made some recommendations. [ABSTRACT FROM AUTHOR]

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the role of attachment insecurity in predicting a worse longitudinal trend of eating disorder (ED) psychopathology and body uneasiness in patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) treated with Enhanced Cognitive Behavior Therapy, considering the longitudinal interplay between these dimensions. Method: In total, 185 patients with AN or BN performed the baseline assessment, and 123 were re‐evaluated after 1 year of treatment. Participants completed questionnaires evaluating ED psychopathology (Eating Disorders Examination Questionnaire) and body uneasiness (body uneasiness test). For the assessment of adult attachment, the Experiences in Close Relationships‐Revised was administered at baseline. Bivariate latent change score analysis within the structural equation modeling framework was performed to investigate the evolution of ED psychopathology and body uneasiness, their longitudinal interplay, and the role of attachment style as an outcome predictor. Results: After treatment, all psychopathological features showed an overall improvement. Higher baseline levels of body uneasiness predicted a worse course of ED psychopathology. The change in body uneasiness over time depended on changes over time in ED psychopathology, but not vice versa. Insecure attachment predicted a worse longitudinal trend of ED psychopathology, and, through this impairment, it indirectly maintained higher levels of body uneasiness, as confirmed by mediation analyses. Discussion: The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive‐behavioral conceptualization of EDs with a developmental perspective that considers attachment‐related issues. Public significance statement: Considering the burden of EDs in terms of public health and the unsatisfactory response to standard treatments, the identification of outcome predictors is of considerable clinical interest. This study demonstrated that attachment insecurity was associated with worse longitudinal trends of ED psychopathology and body uneasiness in patients with AN and BN treated with CBT‐E, highlighting the importance of personalizing treatment programs taking into account a developmental perspective on these disorders. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases such as multiple sclerosis (MS) suffer more from psychiatric consequences than others, and their quality of life may be drastically affected, causing syndromes like depression and anxiety. Mindfulness-integrated cognitive behavioral therapy (Mi-CBT) seems to improve stress coping strategies in chronically ill patients, but its effectiveness has been little studied in MS. So, in this study, we aimed to assess its effectiveness on stress coping strategies in women suffering from MS in Mazandaran province, Iran. Methods: In this semi-experimental study, we selected 40 women with MS who had been referred to a neurologist in Mazandaran province, Iran during the year 2016 by convenient sampling and randomly assigned to the Mi-CBT and control group with a one-to-one ratio. Patients in the intervention group were under treatment for eight 120-minutes session, while the control group only stayed on the waiting list. After obtaining the ethics committee's approval (IR.IAU.CHALUS.REC.1397.018) and patient's informed consent, both groups underwent a pre-test assessment with a stress status questionnaire developed by Endler and Parker in 1988. The same assessment was done for both groups two times more, one after compilation of all sessions, and one 45 days later. Repeated measures analysis of variance was done using SPSS Version 24 software. Results: There was a difference between intervention and the control group for avoidanceoriented, and problem-oriented stress coping strategies (p<0.01), but there was not a significant difference for emotion-oriented strategy between groups (P=0.22). Conclusion: MiCBT is effective in improving stress coping strategies in women with MS, and overall mental health. [ABSTRACT FROM AUTHOR]

Objective To evaluate effects of the MINDSTRONG© cognitive-behavioral skills building program versus an attention control program on mental health outcomes and lifestyle behaviors of graduate health professional students. Participants: 201 entering graduate students from seven health sciences colleges at a public land grant University in the U.S. Midwest. Methods: A randomized controlled trial was conducted with three-month follow-up. Valid and reliable instruments measured depression, anxiety, stress, healthy lifestyle beliefs and healthy lifestyle behaviors. Results: Students receiving MINDSTRONG© reported less depression/anxiety and healthier lifestyle behaviors than those receiving the control program. Students with elevated levels of depression/anxiety at baseline demonstrated greater benefits from the program. Conclusions: MINDSTRONG© can be used as a preventive and early intervention for improving mental health outcomes and lifestyle behaviors in graduate students. Because the program can be delivered by trained non-mental health professionals, it has the potential to be widely scaled on campuses throughout the U.S. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The study aimed to investigate the complex relationship between eating disorder (ED) specific psychopathology, emotion dysregulation, and their longitudinal variations in patients with anorexia nervosa (AN) treated with a multidisciplinary approach including enhanced cognitive‐behavior therapy (CBT‐E), and to provide an integrated model which includes childhood trauma as a predictor of worse treatment outcomes. Method: In total, 120 female patients with AN were evaluated at admission (T0), and 105 were re‐evaluated after 1 year (T1) of treatment. At T0, patients underwent a clinical assessment and filled the Symptom Checklist 90‐Revised (SCL90‐R), the Eating Disorders Examination Questionnaire (EDE‐Q), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). SCL‐90‐R, EDE‐Q, and DERS were readministered at T1. Variations between T0 and T1 were evaluated, and the proposed model was investigated using bivariate latent change score analysis in a structural equation modeling (SEM) framework. Results: An overall significant clinical amelioration was observed after treatment. A unidirectional effect of DERS scores on EDE‐Q variations was outlined by SEM: patients with higher baseline DERS scores achieved less EDE‐Q improvements, and EDE‐Q latent change score was significantly predicted by longitudinal variations of DERS—but not vice versa. Higher CTQ scores predicted reduced treatment efficacy for ED‐specific psychopathology through the mediating effect of higher baseline DERS scores. Discussion: The present study sheds light on the mechanism by which early trauma compromises treatment outcome in patients with AN, underlining the crucial role of emotional dysregulation. [ABSTRACT FROM AUTHOR]

We compare the relative efficacy of virtual reality therapy exposure (VRET) versus in vivo therapy exposure among individuals suffering from phobias. A systematic search was completed up to 03 April 2020, using the following databases: ACM Digital Library, ResearchGate, IEEE, Science Direct, MIT PressJournals, Center for Direct Scientific Communication (CCSD) and Mary Ann Liebert Publishers. Five authors searched the databases using the following terms: Virtual Reality, Phobia, Mental health, Computing, Therapy, HMD, CAVE, Virtual ambient, in virtuo, Avoidance, Exposure, VRET, in vivo, Anxiety, Agoraphobia, Social Phobia, Stimuli, Cognitive–behaviour. All studies that evaluate the effect of in virtuo exposure towards phobia rehabilitation were selected. By reviewing the article, each author then applied the inclusion and exclusion criteria, and 30 articles were selected. Data extracted included the number of samples, amount of sessions, study variables that may affect the final outcome, therapy technology. The data provided was synthesized using a meta-analysis based on the results. The results demonstrated a positive outcome of Virtual Reality Exposure Treatment in the treatment of most phobias. In contrast, some of these treatments did not work for a few specific phobias in which the standard procedures were more effective. The findings suggest that for some specific phobias treatment, Virtual Reality Exposure Treatment does not reach the in vivo exposure level of immersion and presence. Further research is needed to perform studies with higher-dimension samples, since many papers report a low sample size and that is probably why many of them have inconclusive results. [ABSTRACT FROM AUTHOR]

This commentary describes the transition to remote delivery of cognitive-behavioral therapy (CBT) for anxiety in children with autism spectrum disorder (ASD) who participates in a clinical trial during the COVID-19 pandemic. The effects of COVID-19 on children's anxiety and on the family functioning are discussed. Modifications to CBT necessitated by telehealth delivery were aimed at maximizing engagement of children and their parents while maintaining treatment fidelity and adhering to the research protocol. Treatment targets were updated to address new sources of anxiety and CBT exposure exercises were modified to accommodate the new reality of quarantine restrictions. If the COVID-19 pandemic continues to affect treatment delivery it may require a widespread utilization of telehealth for treating anxiety in children with ASD. [ABSTRACT FROM AUTHOR]

This study reports on the results of a pilot study designed to evaluate the Resilience Education Program (REP): a brief Tier 2 intervention that includes small‐group cognitive‐behavioral instruction, paired with a modified check‐in/check‐out procedure. Three elementary school students demonstrating early indicators of internalizing behavior concerns participated in the current intervention. A multiple‐baseline single‐case design was used to evaluate intervention effects. Outcome data corresponded to teacher‐collected direct behavior rating data, which were specific to each student's particular internalizing concerns (e.g., negative affect, withdrawal) and were collected on a daily basis during times when these behaviors were most problematic. Visual analysis and effect size estimates were used in evaluating intervention effects relative to baseline conditions for each student. Results indicated REP yielded a moderate intervention effect for two out of three students (Tau‐U = 0.72 and 0.68, respectively), each of whom exhibited an immediate reduction in internalizing behavior. Both students also demonstrated an absence of negative behaviors in the maintenance phase. Findings for the third student were obfuscated by low behavioral rates during baseline. Following the intervention, educators rated REP as a socially valid intervention. Limitations of this study and future directions for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: Cognitive‐behavioral therapy (CBT)—therapist‐led (CBTth) and guided‐self‐help (CBTgsh)—has efficacy for binge‐eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. Method: Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge‐eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). Results: Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT‐type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. Discussion: Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect‐sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes. [ABSTRACT FROM AUTHOR]

Background: Dialectical Behavior Therapy (DBT) has shown evidence of its effectiveness in the treatment of borderline personality disorder (BPD) and eating disorders (EDs) separately, and there is preliminary evidence for co-occurrent BPD and EDs. However, the long-term effectiveness of DBT for this specific population is still unknown. The main goal of this study was to assess long-term treatment effectiveness in people diagnosed with BPD and ED. Methods: Participants (N = 109) had previously received a 6-month treatment during a clinical trial (DBT = 64 vs. Treatment as Usual, Cognitive Behavior Therapy; TAU CBT = 45). Outcome measures (emotional eating, depressive symptoms, anger, emotion regulation, impulsiveness, and resilience) were evaluated prospectively at 4- and 6-year follow-ups. Results: There was a statistically significant improvement in most study outcomes from pre-treatment to the follow-ups in the DBT condition, and in depression, resilience and trait anger in the TAU CBT. No statistically significant between-group differences were found. Nonetheless, a high percentage of participants showed a clinically significant improvement over time in the DBT condition. Conclusions: Findings of this study contribute to determinate the long-term treatment effectiveness of DBT for people with BPD and ED in routine psychotherapeutic practice. Longitudinal studies with larger sample sizes are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework. Method: We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates. Results: A two-class solution fit well, differentiating youth with high (n = 54) vs. low (n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT (n = 26) or CBT-Depression (n = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes. Conclusions: Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03153904. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to investigate using a superiority framework the efficacy of a combined treatment (cognitive-behavioral therapy based on behavioral components derived from classical behavioral therapy modifications and cognitive components mainly derived from rational emotive behavior therapy, plus an attention training component in a virtual environment (CBT/REBT + ATX, N = 20) as compared to psychotherapy alone (CBT/REBT, delivered over 16 weeks, N = 18—reference treatment) and non-stimulant medication alone (atomoxetine; ATX, N = 21—reference treatment) for children with Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: A three-arm pilot randomized controlled trial was conducted. Fifty-nine children (Mage = 8.46, SD = 1.57) were randomly allocated to one of the 3 conditions. Results: Our preliminary findings indicated a significant difference between the CBT/REBT + ATX and ATX group at post-treatment for the total ADHD symptoms rated by parent, d = 1.30, 95% CI [0.63, 1.98], p = 0.010. Conclusions: The combined treatment seems to be superior to the medication alone on parent ratings on ADHD symptoms, however, on clinical ratings on ADHD diagnosis and functioning there are no significant group differences between treatments. Future larger trials with follow-up assessments are needed to test the stability of the effects over time. [ABSTRACT FROM AUTHOR]

An individual with obsessive-compulsive disorder (OCD) and poor insight has a significant impact on the person, thinking clearly about his obsessive thought and compulsive behavior. Cognitive-behavior therapy is an evidence-based therapy for the treatment of OCD patients. However, the need felt to incorporate other therapeutic approaches such as supportive, mindfulness-based therapy to treat OCD. This case study tried to discuss the efficacy of a holistic intervention approach in an individual with OCD who had poor insight. The result showed that the holistic approach decreased distress, intrusive thought and reassurance-seeking behavior and improved his insight. At the end of the psychotherapy session, the Y-BOCS score decreased to 15. [ABSTRACT FROM AUTHOR]

Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive–Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia. [ABSTRACT FROM AUTHOR]

Background: Cognitive models of panic disorder (PD) highlight the role of panic-related associations and interpretations. However, results are mixed and rely on specific measures. This study examined panic-related associations and interpretations using established and new paradigms in individuals varying on anxiety sensitivity (AS). Methods: Associations were measured using a priming task and a novel Single Target Implicit Association Test (STIAT); interpretations were assessed using the Interpretation Bias Questionnaire (IBQ) and a novel Scrambled Sentences Task (SST). Symptoms were assessed via a provocation task (Straw Breathing Task, SBT). Results: Panic-related interpretations correlated with AS and other PD-related measures. Of the association tasks, only the priming task correlated with one of the other PD-related measures. Panic-related interpretations assessed via the SST, but not priming, STIAT, and IBQ, predicted SBT reactivity. The relationship between AS and SBT reactivity was mediated by panic-related interpretations. Conclusions: Our data provide support for panic-related interpretations as an important cognitive mechanism. [ABSTRACT FROM AUTHOR]

Copyright of Psychologica: Revista da Faculdade de Psicologia e de Ciencias da Educacao da Universidade de Coimbra is the property of Imprensa da Universidade de Coimbra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It is not uncommon for patients with obsessive-compulsive disorder (OCD) to present with symptoms that suggest possible risk. This can include apparent risk, which reflects the content of obsessional fears, and genuine risk arising as the unintended consequence of compulsive behaviors. In both situations, risk can cause confusion in relation to diagnosis and treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. Guidance is offered to support clinical decision making and treatment planning. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive-behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment. Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs. Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment. Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety. Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658. [ABSTRACT FROM AUTHOR]

Objective: Patients’ processing of psychotherapy between sessions (“inter-session process” (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. Methods: Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. Results: Patients receiving CBT-E reported more on “applying therapy” in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of “recreating the therapeutic dialogue between sessions,” “recreating the therapeutic dialogue with negative emotions” as well as “applying therapy with negative emotions” in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. Conclusions: In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change. [ABSTRACT FROM AUTHOR]

Exposure-based cognitive-behavior therapy (EBCBT) is the treatment of choice for panic disorder (PD). However, little is known about early treatment processes that facilitate retention in treatment and positive outcomes of PD treatment. We studied the development of early treatment process with semi-structured individual in-depth interviews with 12 patients with PD, conducted post session 3. Grounded theory was used to analyze the transcripts. The development of early treatment process was captured by four thematic categories: approaching the problem, easing in and opening up, building trust and bonding, and making sense of panic. The developmental scheme culminated to the core category: Jointly Engaging in PD Therapy versus Awaiting Relief, capturing early engagement or disengagement from PD therapy respectively. The emergent core category was cross-validated against distal treatment outcome. Emergent processes can be replicated and incorporated in early treatment procedures of EBCBT for PD. Clinical practice recommendations are discussed. [ABSTRACT FROM AUTHOR]

Behavioral and cognitive models--as well as complementary theories such as the inference-based, mood-as-input, and seeking proxies for internal states approaches--have been put forward to explain the development and maintenance of obsessive-compulsive disorder (OCD). Although theory is important to inform the conceptualization and treatment of OCD, experimental research is essential to provide empirical support for these different theoretical approaches. Experiments allow an increased understanding of the mechanisms (e.g., maladaptive beliefs) associated with the etiology and maintenance of OCD symptoms and, in this way, directly contribute to the expansion and creation of cognitive-behavioral treatment strategies. This selective review demonstrates how foundational and sometimes groundbreaking experiments pertaining to core OCD symptoms (i.e., checking/reassurance seeking, obsessions, contamination, and ordering/arranging) have informed the improvement of cognitive-behavior therapy for this debilitating mental illness. The relevance of experiments with both clinical and analog samples is discussed, and recommendations for future experimental work are provided. [ABSTRACT FROM AUTHOR]

Background: The underlying symptomatology of obsessive–compulsive disorder (OCD) can be viewed as an impairment in both cognitive and behavioral inhibition, regarding difficult inhibition of obsessions and behavioral compulsions. Converging results from neuroimaging and electroencephalographic (EEG) studies have identified changes in activities throughout the medial frontal and orbital cortex and subcortical structures supporting the cortico-striato-thalamo-cortical circuit model of OCD. This study aimed to elucidate the electrophysiological changes induced by autobiographical and general anxiety scenarios in patients with OCD.Methods: Resting-state eyes-closed EEG data were recorded in 19 OCD patients and 15 healthy controls. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography (sLORETA). The changes in the emotional state were induced by two different scenarios: the autobiographical script related to patient’s OCD symptoms and the script triggering general anxiety.Results: During the resting state, we proved increased delta activity in the frontal, limbic and temporal lobe and the sub-lobar area in OCD patients. In a comparison of neural activities during general anxiety in OCD patients and the control group, we proved an increase in delta (parietal, temporal, occipital, frontal and limbic lobes, and sub-lobal area), theta (temporal, parietal and occipital lobes) and alpha-1 activities (parietal lobe). Finally, we explored the neural activity of OCD patients during exposure to the autobiographic scenario. We proved an increase in beta-3 activity (left frontal lobe).Conclusion: Our study proved differences in neural activation in OCD patients and healthy controls during imagination of general anxiety. Exposure to the autobiographic OCD scenario leads to activation of left frontal brain areas. The results show the possibility of using specific scenarios in OCD therapy. [ABSTRACT FROM AUTHOR]

Objective: Clinical perfectionism has been found to be a risk and maintaining factor in eating disorders (EDs), compulsive exercise, and athlete burnout. This study investigated whether an unguided internet cognitive–behavioral treatment (ICBT) for perfectionism would reduce ED pathology, compulsive exercise, and burnout in individuals who engage in regular exercise. Method: Participants were randomly allocated to intervention (n = 38) or waitlist control (n =29). A generalized linear mixed model (GLMM) analysis was conducted pre and post treatment. A follow‐up analysis was conducted with the intervention group at 3 and 6 months. Results: The intervention group experienced a significant reduction in perfectionism (FMPS‐CM: F[1,117] = 17.53, p = < .001, Cohen's d = .82), ED symptomology (EDE‐Q: F[1,55] = 7.27, p = .009,Cohen's d = .53) and compulsive exercise (CET: F[1,116] = 10.33, p < .001,Cohen's d = .63). The changes attained post‐treatment were maintained within the intervention group at 3‐month (FMPS‐CM (t[1,100] = 3.67, p < . 001, Cohen's d = .85) (EDE‐Q (t[1,50] = 2.20, p = .03, Cohen's d = 1.26) and 6‐month follow‐up (FMPS (t[1,100] = 2.74, p = 007, Cohen's d = .70) (EDE‐Q (t[1,50] = 2.18, p = .03, Cohen's d = 1.26). Discussion: The results indicate unguided ICBT for perfectionism can have a significant impact on perfectionism, compulsive exercise, and ED symptomatology. [ABSTRACT FROM AUTHOR]

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The aims of this study were to examine the effects of group cognitive-behavior therapy (CBT) on improving anxiety symptoms and enhancing personal growth among adolescents at risk of developing anxiety disorders in school settings in Hong Kong. Method: A total of 26 participants received an eight-session CBT group and 20 received treatment as usual in the waitlist control condition. Instruments measuring anxiety symptoms, types of anxiety in children, dysfunctional thoughts, and personal growth were used to assess the changes in severity of anxiety symptoms, dysfunctional thoughts, and personal growth among the participants. Results: A 2 x 2 mixed model analyses of variance were employed, results demonstrated significantly greater improvements in overall anxiety symptoms, generalized anxiety symptoms, and personal growth--use of resources in the participants of the CBT group compared to the control group. Conclusion: Group CBT may potentially improve anxiety symptoms of adolescents in school settings in Hong Kong. [ABSTRACT FROM AUTHOR]

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform "one fits all" approach. [ABSTRACT FROM AUTHOR]

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Innovative approaches to the treatment of pathological gambling are required since the number of individuals who seek treatment tend to be fewer than the prevalence studies would indicate. In this study, an innovative approach to the treatment of pathological gambling was used in order to address the common hindrances to treatment-seeking these patients face. One such approach is to offer the option of manual-guided tele-counselling. This case study reports on the progress of one individual who was treated using this modality. For reasons of privacy and anonymity, the individual in this case report preferred to address her problem gambling with the assistance of a therapist whom she never met. The client was provided with 10 weeks of tele-counselling treatment during which six treatment modules were delivered. Problems of access, privacy and anonymity were overcome with this method and the client was able to reduce their gambling behavior significantly with the therapeutic gains being maintained at the 6-month follow-up. The implications for the treatment of problem gambling using a non-traditional approach are discussed. [ABSTRACT FROM AUTHOR]

The term accommodation has been used to refer to family responses specifically related to obsessive-compulsive (OC) symptoms: it encompasses behaviors such as directly participating in compulsions, assisting a relative with obsessive-compulsive disorder (OCD) when he/she is performing a ritual, or helping him/her to avoid triggers that may precipitate obsessions and compulsions. At the opposite side, family responses to OCD may also include interfering with the rituals or actively opposing them; stopping accommodating OC symptoms or actively interfering with their performance is usually associated with greater distress and sometimes even with aggressive behaviors from the patients. This article summarizes progress of the recent research concerning family accommodation in relatives of patients with OCD. Family accommodation is a prevalent phenomenon both among parents of children/adolescents with OCD and relatives/caregivers of adult patients. It can be measured with a specific instrument, the Family Accommodation Scale, of which there are several versions available for use in clinical practice. The vast majority of both parents of children/adolescents with OCD and family members of adult patients show at least some accommodation; providing reassurances to obsessive doubts, participating in rituals and assisting the patient in avoidance are the most frequent accommodating behaviors displayed by family members. Modification of routine and modification of activities specifically due to OC symptoms have been found to be equally prevalent. Specific characteristics of patients (such as contamination/washing symptoms) and of relatives (the presence of anxiety or depressive symptoms or a family history positive for another anxiety disorder) are associated with a higher degree of family accommodation; these family members may particularly benefit from family-based cognitive-behavioral interventions. In recent years, targeting family accommodation has been suggested as a fundamental component of treatment programs and several interventions have been tested. Clinicians should be aware that family-based cognitive-behavior therapy incorporating modules to target family accommodation is more effective in reducing OC symptoms. Targeting family accommodation may be as well relevant for patients treated pharmacologically. [ABSTRACT FROM AUTHOR]

Medically unexplained symptoms (MUS) commonly present across the board in medical specialties and are often challenging to treat. Our objective was to assess the efficacy for cognitive-behavior therapy (CBT) in MUS. Electronic search of databases was carried out for published controlled trials in English language peer-reviewed journals from inception till August 2016. Effect sizes for the trials were computed using standardized mean difference, and I2 test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using a random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool. A total of 11 trials involving 1235 subjects were included in the study. Ten trials used standard CBT techniques while one studied the efficacy of mindfulness-based CBT technique. The control arms were treatment as usual in five trials, augmented care in four and waitlisted controls in two trials. The pooled mean effect size for CBT was 0.388 (range 0.055-0.806, 95% confidence intervals 0.316-0.461). The I2 value was 0 using a random effects model indicating low heterogeneity among studies. Risk of bias was noted in many included studies. Egger plot intercept indicated potential publication bias. CBT was superior to the waiting list, treatment as usual or enhanced usual care with moderate effect sizes in the treatment of MUS. These findings are impacted by the limited number of studies in this area and questionable methodological rigor of included studies. [ABSTRACT FROM AUTHOR]

Background: Early dramatic treatment response suggests a subset of patients who respond to treatment before most of it has been offered. These early responders tend to be over represented among those who are well at termination and at follow-up. Early response patterns in psychotherapy have been investigated only for a few of mental disorders so far. The main aim of the current study was to examine early response after five therapypreparing sessions of a cognitive behavior therapy (CBT) for syndromes of medically unexplained symptoms (MUS). Methods: In the context of a randomized, waiting-list controlled trial 48 patients who suffered from ≥3 MUS over ≥6 months received 5 therapy-preparing sessions and 20 sessions of CBT for somatoform disorders. They completed self-report scales of somatic symptom severity (SOMS-7 T), depression (BDI-II), anxiety (BSI), illness anxiety and behavior (IAS) at pre-treatment, after 5 therapy-preparing sessions (FU-5P) and at therapy termination (FU-20 T). Results: The current analyses are based on data from the treatment arm only. Repeated measure ANOVAs revealed a significant decrease of depression (d = 0.34), anxiety (d = 0.60), illness anxiety (d = 0.38) and illness behavior (d = 0.42), but no change of somatic symptom severity (d = -0.03) between pre-treatment and FU-5P. Hierarchical linear multiple regression analyses showed that symptom improvements between pre-treatment and FU-5P predict a better outcome at therapy termination for depression and illness anxiety, after controlling for pre-treatment scores. Mixed-effect ANOVAs revealed significant group*time interaction effects indicating differences in the course of symptom improvement over the therapy between patients who fulfilled a reliable change (i.e., early response) during the 5 therapy-preparing sessions and patients who did not reach an early reliable change. Demographic or clinical variables at pre-treatment were not significantly correlated with differential scores between pre-treatment and FU-5P (-.23 ≤ r ≤ .23). Conclusions: Due to several limitations (e.g., small sample size, lack of a control group) the results of this study have to be interpreted cautiously. Our findings show that reliable changes in regard to affective-cognitive and behavioral variables can take place very early in CBT of patients with distressing MUS. These early changes seem to be predictive of the outcome at therapy termination. Future studies are needed in order to replicate our results, and to identify mechanisms of these early response patterns in somatoform patients. [ABSTRACT FROM AUTHOR]

Background: Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language barriers, and stigma. Cultural adaptations to existing evidence-based treatments have been encouraged to improve access. However, little is known about mental health treatments translated from English to Spanish targeting anxiety among this Hispanic age group. Objctive: This case study offers an example of how an established, manualized, cognitive-behavioral treatment for adults 55 years and older with generalized anxiety disorder (known as “Calmer Life”) was translated to Spanish (“Vida Calma”) and delivered to a monolingual, Hispanic 55-year-old woman. Results: Pre- and post-treatment measures showed improvements in symptoms of anxiety, depression, and life satisfaction. Conclusion: Findings suggest Vida Calma is a feasible treatment to use with a 55-year-old Spanish-speaking adult woman. Clinical Implications: Vida Calma, a Spanish language version of Calmer Life, was acceptable and feasible to deliver with a 55-year-old participant with GAD. Treatment outcomes demonstrate that Vida Calma improved the participant’s anxiety, depression, and life satisfaction. [ABSTRACT FROM PUBLISHER]

Objective. Individuals with the hepatitis C virus (HCV) have high rates of both chronic pain and substance use disorder (SUD). Despite high comorbidity, there are limited data available on effective methods of treatment for co-occurring chronic pain and SUD. In this study, we sought to develop and conduct preliminary testing of an integrated cognitive- behavior therapy (CBT) for chronic pain and SUD in patients with HCV. Design. Descriptive, including pretreatment, posttreatment, and follow-up testing. Setting and Patients. Outpatient clinic as part of one VA Medical Center. Participants. Veterans with chronic pain, SUD, and HCV. Intervention. Eight-session integrated group CBT for chronic pain and SUD in patients with HCV. Methods. Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up. Results. Generalized estimating equations identified improvements in pain interference, reducing cravings for alcohol and other substances, and decreasing past-month alcohol and substance use. The proportion of participants who met diagnostic criteria for current SUD demonstrated a four-fold decrease over the course of the study from 24% at baseline to 15% at post-treatment and 6% at 3-month follow-up. On response to a global impression of change, 94% of participants noted improvement from baseline. Conclusions. Results from this pilot study suggest that a customized CBT for patients with both chronic pain and SUD (CBT-cp.sud) may be beneficial in improving important pain and addiction-related outcomes in patients with HCV. Larger scale investigations of this intervention appear warranted. [ABSTRACT FROM AUTHOR]

Motivation is a key ingredient in the successful treatment of pediatric obsessive-compulsive disorder (OCD). As a first-line treatment, cognitive-behavior therapy (CBT) requires extensive client engagement, including participating in exposures and doing homework tasks. A lack of motivation to comply with these tasks may seriously affect treatment outcome. This case study identifies factors interfering with motivation and illustrates motivational strategies to enhance compliance of a child with OCD. The patient was an 11-year-old boy with severe OCD and symptoms of oppositional defiant disorder (ODD). He had extensive OCD-related avoidance behavior but denied the presence of symptoms or did not acknowledge them as a problem. In this article, we discuss the different techniques used to enhance motivation, which subsequently led to a favorable outcome. [ABSTRACT FROM AUTHOR]