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A wide range of technological approaches has been adopted in assessment and intervention using cognitive-behavior therapy (CBT). The articles that comprise this special issue cover a diversity of areas, including motion-tracking devices, ecological momentary assessment, facial recognition software to provide rapid feedback, audio and tablet-based CBT-administered procedures, web-based acceptance program for stress reduction, and videoconferencing for delivery of anxiety treatment in youth. It is expected that technological advances will continue to lead to additional advances in CBT delivery., (Copyright © 2018. Published by Elsevier Ltd.)

Background: All trials conducted to date on BRAVE-ONLINE for youth anxiety disorders have excluded children with High Functioning Autism Spectrum Disorder (HFASD) and therefore it is unknown whether these programs might be beneficial to HFASD children. The aim of this study was to evaluate the efficacy of BRAVE-ONLINE in HFASD children with an anxiety disorder., Methods: Forty-two HFASD children, aged 8-12 years, with an anxiety disorder, and their parents, were randomly assigned to either the BRAVE-ONLINE condition (NET) or a waitlist control (WLC). Diagnostic interviews and parent/child questionnaires were completed at pre-treatment, post-treatment and 3-month follow-up., Results: At post- assessment, compared to children in the WLC condition, children in the NET condition demonstrated a significantly greater reduction in number of anxiety diagnoses, clinical severity of diagnosis, and self and parent reported anxiety symptoms, as well as significantly greater increases in overall functioning. However, loss of primary diagnosis in this sample was lower than in previous studies., Limitations: The small sample size, coupled with attrition rates, makes it difficult to generalise the findings of the study to HFASD population and to conduct analyses regarding mediators, moderators and predictors of outcomes., Conclusions: The BRAVE-ONLINE program may be useful in reducing anxiety symptoms in HFASD children, although the effects are less strong than those found in neurotypical children for a variety of reasons., (Copyright © 2017. Published by Elsevier B.V.)

Background: Anxiety is a common and impairing problem in children and adolescents with autism spectrum disorder (ASD). There is emerging evidence that cognitive-behavioral therapy (CBT) could reduce anxiety in children with high-functioning ASD., Objective: To systematically review the evidence of using CBT to treat anxiety in children and adolescents with ASD. Methods for this review were registered with PROSPERO (CRD42012002722)., Methods: We included randomized controlled trials published in English in peer-reviewed journals comparing CBT with another treatment, no treatment control, or waitlist control. Two authors independently screened 396 records obtained from database searches and hand searched relevant journals. Two authors independently extracted and reconciled all data used in analyses from study reports., Results: Eight studies involving 469 participants (252 treatment, 217 comparison) met our inclusion criteria and were included in meta-analyses. Overall effect sizes for clinician- and parent-rated outcome measures of anxiety across all studies were d = 1.19 and d = 1.21, respectively. Five studies that included child self-report yielded an average d = 0.68 across self-reported anxiety., Conclusions: Parent ratings and clinician ratings of anxiety are sensitive to detecting treatment change with CBT for anxiety relative to waitlist and treatment-as-usual control conditions in children with high-functioning ASD. Clinical studies are needed to evaluate CBT for anxiety against attention control conditions in samples of children with ASD that are well characterized with regard to ASD diagnosis and co-occurring anxiety symptoms.

• A brief telemental health intervention (iCOPE with COVID-19) was developed for youth. • The intervention was delivered at the outset of the COVID-19 pandemic. • Child and adolescent anxiety decreased post-intervention compared to pre-intervention. • Results suggest acceptance of iCOPE with COVID-19 with children and adolescents. The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time. [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]

Research on the psychosocial impact of COVID-19 has found significant levels of distress among the general population, and among those especially vulnerable due to chronic social or health challenges. Among these are individuals aging with HIV infection, who are encountering COVID-19 as a new infectious threat to their health and wellbeing. In a longitudinal observational study of the psychosocial impact of COVID-19 in middle-aged and older people living with HIV, we identified a subset of participants who expressed heightened levels of distress and were referred for clinical intervention. This paper describes the supportive and contemporary cognitive-behavioral interventions that were provided and presents data on changes in distress in this case series. This work provides a model for identifying people in at-risk groups in acute need of psychological intervention and for implementing an individualized clinical response that can be safely delivered in the context of COVID-19 and future crisis situations. [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]

Dana Kamaradova,1 Martin Brunovsky,2 Jan Prasko,1 Jiri Horacek,2 Miroslav Hajda,1 Ales Grambal,1 Klara Latalova1 1Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic; 2National Institute of Mental Health, Klecany, Czech Republic 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. Keywords: anxiety, obsessive–compulsive disorder, autobiographical script, electroencephalography, cognitive-behavior therapy

Although depression and anxiety affect approximately 20% of children and adolescents, many of those affected do not receive treatment because, in large part to the shortage of mental health providers across the United States. As an alternative to traditional mental health counseling, the Creating Opportunities for Personal Empowerment (COPE) program is an evidence-based manualized 7-session cognitive behavioral therapy–based program that is being effectively delivered to children and teens with depression and anxiety by pediatric and family healthcare providers in primary care practices with reimbursement from insurers. The purpose of this study was to perform a cost analysis of delivering COPE and compare it to the cost of hospitalization for primary mental health diagnosis. Findings indicated a cost savings of $14,262 for every hospitalization that is prevented. Implementation of COPE can improve outcomes for children and teens with depression and anxiety, and could potentially result in millions of dollars of cost savings for the U.S. healthcare system. [ABSTRACT FROM AUTHOR]

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]

Objective: To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive-behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events.Method: Data were from 319 youths (age range 10.9-25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview Schedule and completed questionnaires (eg, about family functioning, life events, and mental health service use).Results: Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers. Acute treatment responders were less likely to be in the chronically ill group (odds ratio = 2.73; confidence interval = 1.14-6.54; p < .02); treatment type was not associated with remission status across the follow-up. Several variables (eg, male gender) predicted stable remission from anxiety disorders.Conclusion: Findings suggest that acute positive response to anxiety treatment may reduce risk for chronic anxiety disability; identified predictors can help tailor treatments to youth at greatest risk for chronic illness.Clinical Trial Registration Information: Child and Adolescent Anxiety Disorders (CAMS). http://clinicaltrials.gov/; NCT00052078. [ABSTRACT FROM AUTHOR]

Background: The Research Domain Criteria (RDoC) has been developed as an alternative approach to studying psychiatric disorders. The RDoC constructs and units of analysis, from genes up through paradigms, are intended to describe a hierarchy of priority measurements. Several of these have been investigated in the context of empirically-supported treatments, as either moderators or mediators of outcome.Method: This review considers the available research on the moderating and mediating role of genes, molecules, circuits and physiology in cognitive-behavior therapy (CBT) outcome studies for negative valence system conditions.Findings: Based on the review, research has aspired to identify candidate genes, molecules, circuits and physiological moderators or mediators of treatment, but no definitive tests have been conducted. Instead, several candidate variables have been found that deserve further investigation.Limitations: The available research is based on diagnoses from the DSM, whereas the RDoC initiative endeavors to determine empirically valid taxonomic signs.Conclusions: The results of this review are discussed in the joint context of developments in empirically-supported psychological therapy and the specific aims of the RDoC initiative, and conclude with recommendations for future research. [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]

OBJETIVO: verificar a resposta dos pacientes com transtorno de pânico com agorafobia à modelo proposto de terapia cognitivo-comportamental (TCC) nos dois subtipos respiratórios de transtorno de pânico: o subtipo respiratório (SR) e subtipo não respiratório (SNR) Amostra randomizada por sorteio com 50 pacientes diagnosticados segundo o Manual Diagnóstico e Estatístico dos Transtornos Mentais. A medicação: antidepressivos tricíclicos ou inibidores seletivos de recaptação da serotonina. Setenta e sete ponto seis porcento da amostra de pacientes de ambos os grupos apresentaram o SR e 22,4 % o SNR. Os pacientes do SR, responderam satisfatoriamente ao tratamento com técnicas da TCC, reduzindo ansiedade, sintomas respiratórios e os ataques de pânico. Os pacientes do SR melhoraram, segundo a escala de avaliação global do funcionamento, de 55,8 para 70,9 em comparação com o SNR.The objective of the present study was to verify the response of patients with panic disorder (agoraphobia) to existing cognitive-behavior therapy models (CBT) of two respiratory subtypes of panic disorder (PD): respiratory subtype (RS) and non respiratory subtype (NRS). We randomly selected a sample of 50 patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The medication used was tricycle or selective serotonin reuptake inhibitor antidepressants. Seventy-seven point six percent of the patients from both groups showed RS and 22.4% the NRS. The RS patients responded satisfactorily to the treatment with techniques of CBT decreasing anxiety, breathing symptoms and panic attacks. According to the global functioning assessment scale, RS patients improved from 55.8 to 70.9 in comparison with NRS ones.

O transtorno de pânico (TP) caracteriza -se por ataques agudos de ansiedade frequentes e recorrentes. A actual concepção para o TP realça o medo das sensações corporais a partir do momento em que o indivíduo associa de forma equivocada as sensações físicas que se apresentam como sendo prenúncio de uma doença grave e/ou morte iminente, não conseguindo interpretá -las como mecanismos fisiológicos naturais. Relatamos três casos graves de TP do subtipo respiratório, com agorafobia, cujos sintomas de hiperventilação predominavam sobre os demais. O tratamento consistiu na prescrição de antidepressivos tricíclicos e no encaminhamento para sessões de terapia cognitivo -comportamental (TCC). O objectivo do relato dos casos é demonstrar a evolução satisfatória do tratamento com a técnica dos exercícios de indução de sintomas (EIS) em ambiente de laboratório para a redução e/ou extinção dos sintomas hiperventilatórios, entre outros. Esse procedimento foi considerado fundamental na evolução do tratamento e permitiu preparar os doentes para enfrentarem situações agorafóbicas subsequentes.Panic disorder (PD) is characterized by frequent and recurrent acute panic attacks. The current cognitive conception for PD enhances the fear of corporal sensations, when the individual define his physical sensations as being related to a serious disease or imminent death, not interpreting them as natural physiologic mechanisms. We reported three severe cases of PD of the respiratory subtype, with agoraphobia, whose symptoms of hyperventilation predominated on clinical picture. The treatment consisted on tricycles antidepressant and cognitive-behavior therapy (CBT) sessions. The objective of reporting the cases is to demonstrate the satisfactory evolution of the treatment with the technique of panic symptoms induction exercises (SIE) in controlled laboratory environment. On that way, reducing or extinguishing hyperventilation symptoms. This procedure was considered very important in the evolution of the treatment and allowed us to prepare the patients to face subsequent agoraphobic situations.

Objective To explore the efficacy of cognitive-behavior therapy (CBT) for patients with comorbid generalized anxiety disorder (GAD) and insomnia using 2 sequential treatments. Method Using a single-case methodology, 10 women (mean age = 45) with chronic insomnia and GAD were randomly assigned to CBT for GAD followed by CBT for insomnia, or to CBT for insomnia followed by CBT for GAD. Sleep and anxiety were measured via diagnostic interviews, daily diaries, and self-report questionnaires. Results Time series analyses, group effect sizes, and indications of clinically significant change revealed improvements on anxiety, worry, and sleep after CBT for GAD. Following CBT for insomnia, positive changes were observed on sleep and, to a lesser extent, anxiety and worry. Conclusions In the presence of comorbid GAD and insomnia, initiating treatment for GAD first produced superior clinical benefits in anxiety and sleep. The addition of insomnia-specific treatment led to additional improvements in worry and sleep quality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of comorbid anxiety or depressive disorders on treatment response to cognitive-behavior therapy (CBT) for insomnia, behavior therapy (BT), or cognitive therapy (CT). Method: Participants were 188 adults (117 women; Mage = 47.4 years) with chronic insomnia, including 45 also presenting a comorbid anxiety or mild to moderate depressive disorder. They were randomized to BT (n = 63), CT (n = 65), or CBT (n = 60). Outcome measures were the proportion of treatment responders (decrease of ≥8 points on the Insomnia Severity Index; ISI) and remissions (ISI score < 8) and depression and anxiety symptoms. Results: Proportion of treatment responders and remitters in the CBT condition was not significantly different between the subgroups with and without comorbidity. However, the proportion of responders was lower in the comorbidity subgroup compared to those without comorbidity in both the BT (34.4% vs. 81.6%; p = .007) and CT (23.6% vs. 57.6%; p = .02) alone conditions, although remission rates and prepost ISI change scores were not. Pre to post change scores on the depression (–10.6 vs. –3.9; p < .001) and anxiety measures (–9.2 vs. –2.5; p = .01) were significantly greater in the comorbidity subgroup relative to the subgroup without comorbidity but only for those treated with the full CBT; no difference was found for those treated with either BT or CT alone. Conclusions: The presence of a comorbid anxiety or mild to moderate depressive disorder did not reduce the efficacy of CBT for insomnia, but it did for its single BT and CT components when used alone. [ABSTRACT FROM AUTHOR]

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Cognitive models of social anxiety disorder propose self-focused attention as a key maintenance factor of the disorder. However, whether this holds true for different cultural contexts has not been investigated. The present experiment investigated the influence of self-construal (interdependent versus independent) on self-focused attention in high and low socially anxious individuals. Eighty-seven participants, divided into high versus low socially anxious and interdependent versus independent self-construal, performed a self-focused attention probe detection paradigm. A reaction time metric relating to attention deployment on the self versus the other served as an index of self-focused attention. In individuals with an interdependent self-construal those who are highly socially anxious showed decreased self-focused attention compared to those who are low socially anxious. In individuals with an independent self-construal the effect of social anxiety was less strong and in the opposite direction (but congruent with cognitive models). These results indicate that self-focused attention in social anxiety depends on self-construal. These findings implicate different therapies for people with social anxiety disorder, depending on their self-construal. [ABSTRACT FROM AUTHOR]

Anxiety and related disorders are highly prevalent and costly to society. Fortunately, a large number of randomized controlled trials have demonstrated the efficacy of cognitive behavioral therapy (CBT) in the treatment of anxiety and related disorders. A smaller number of effectiveness studies have also demonstrated that similar outcomes to randomized controlled trials can be obtained in “real-world” settings. There is minimal research, however, into long-term outcomes in effectiveness research. This study describes the outcomes of 98 individuals with anxiety and related disorders treated in an outpatient, fee-for-service setting using a case formulation CBT approach. Participants were followed up each year after their discharge, for a period of 3 years. The results indicate that patients maintained their treatment gains, with large effect sizes obtained from pre-treatment to each follow-up time point ( d = 1.11–1.60). The results provide preliminary evidence to suggest that individuals treated with CBT in “real-world” settings maintain their treatment gains in the long-term. [ABSTRACT FROM AUTHOR]

Background: Transdiagnostic cognitive-behavioral treatments for emotional disorders are a new approach that empirically supported. Despite this most of the researches in this field have no control group and so there is a little information about comparing of the effect of transdiagnostic approach to others. The current study was compared transdiagnostic with cognitive-behavior therapy on patients with depression and anxiety disorders. Materials and Methods: This study was a pretest-post test randomized control trial. A diagnostically heterogeneous clinical sample of 23 patients with a principal depression and anxiety disorders that randomly assigned in two groups and participated in eight sessions. Participants were recruited from clinical psychology and psychiatry clinics of Taleghani hospital, Tehran, Iran. Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and Quality of life Scale (IRQL) were completed pre and post intervention by participants. The results were analyzed by dependent sample f-test and analyses of covariance (ANCOVA). Results: Data analyses showed that transdiagnostic therapy was effective for decreasing anxiety and depression symptoms, and have more effect for anxiety in comparing to cognitive-behavior therapy. Conclusion: Transdiagnostic therapy was confirmed in decreasing depressive and anxiety symptoms and improving quality of life in patients with depression and anxiety disorders and transdiagnostic therapy was more effective than cognitive-behavior therapy for decrease anxiety symptoms. [ABSTRACT FROM AUTHOR]

Individuals with Panic Disorder With Agoraphobia (PD/A) experience recurrent unexpected panic attacks and anxiety about the attacks along with significant anxiety about being in places or situations in which it would be difficult to escape or receive assistance if a panic attack were to occur. Feared situations are endured with extreme distress or avoided entirely. Cognitive-behavioral therapy (CBT) is the treatment of choice for PD and PD/A. In this case study, interoceptive exposure (IE) therapy and in vivo exposure therapy were used to treat a 30-year-old housebound woman. Following in-home assessment, psychoeducation, and a limited number of exposure sessions, clinical services were transitioned from in-home to using videoconferencing until in vivo exposure sessions began outside the home. The client was able to meet all behavioral goals by the end of treatment and no longer met criteria for PD/A. This case demonstrates the treatment effectiveness in an individual. Future research should seek to conduct randomized control trials to determine whether videoconference is an efficacious method of delivery for PD/A. This case demonstrates evidence for videoconferencing as an effective tool in treatment delivery for PD/A. [ABSTRACT FROM AUTHOR]

Research documents the application of cognitive-behavioral therapy (CBT) with technology either as therapeutic adjuncts or stand-alone interventions. The literature evaluating the feasibility and efficacy of using technology with CBT for youth experiencing internalizing disorders is small though steadily emerging. Technological approaches offer cost-effective and efficient service to an increased number of anxious youth for whom a CBT treatment would be otherwise unavailable. The present article aims to review the use of two broad types of technology in CBT for anxious children and adolescents: computer- and internet-based CBT and mobile mental health applications (i.e., mobile phone, smartphone, and tablet technology). Within each section, we provide an overview of the advantages and general principles of each type of technology, and review evidence for the use of each type of technology along with examples of current applications. Finally, we discuss ethical issues, barriers, and future directions for the use of technology in facilitating dissemination of effective treatments. [ABSTRACT FROM AUTHOR]

Background: Cannabis is the most frequently used illegal substance in the United States and Europe. There is a dramatic increase in the demand for treatment for cannabis dependence. Cannabis users frequently have co-morbid mood symptoms, especially depression and anxiety, and regular cannabis users may self-medicate for such symptoms. Objectives: We report a double-blind, placebo-controlled treatment study, for the prevention of cannabis use in cannabis-dependent individuals. Method: Regular cannabis-dependent users ( n = 52) were treated for 9 weeks with weekly cognitive-behavior and motivation-enhancement therapy sessions together with escitalopram 10 mg/day. Urine samples were collected to monitor delta-9 tetrahydrocannabinol (THC) during treatment and questionnaires were administered to assess anxiety and depression. Results: We observed a high rate of dropout (50%) during the 9-week treatment program. Fifty-two patients were included in the intention-to-treat analysis. Of these, ten (19%) remained abstinent after 9 weeks of treatment as indicated by negative urine samples for THC. Escitalopram provided no advantage over placebo in either abstinence rates from cannabis or anxiety and depression scores during the withdrawal and abstinent periods. Conclusions: Escitalopram treatment does not provide an additional benefit either for achieving abstinence, or for the treatment of the cannabis withdrawal syndrome. Due to limitations of our study, namely, a high dropout rate and effects of low abstinence rates on measures of anxiety, depression and withdrawal, it is premature to conclude that selective serotonin reuptake inhibitors are not effective for treatment of the cannabis withdrawal syndrome. [ABSTRACT FROM AUTHOR]

The paper is a response to a commentary by Rogojanski and Rego (2013) on our case study of Sara (Jensen, Hougaard, & Fishman, 2013). Sara was a client who achieved a remarkable and durable change in her longstanding social phobia (SP) after short-term group cognitive-behavior therapy (CBT). Our response deals with the following topics: (1) safety behavior; (2) the idiographic arrangement of exposure as behavioral experiments; (3) acceptance as a mechanism of action in CBT; (4) the specific format of the Aarhus treatment program; and (5) recent advances in quantitative research on change mechanisms in CBT for anxiety disorders. We conclude that Rogojanski and Rego's commentary and our further reflections underline the original conclusion from our case study: that generally, change mechanisms in psychotherapy are highly complex, and that specifically, the data from Sara's case could be consistent with several disparate theories of change mechanisms in CBT, revealing a high degree of overlap and intertwining among the theories. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy (CBT) is an effective treatment for emotional disorders such as anxiety or depression, but the mechanisms underlying successful intervention are far from understood. Although it has been a long-held view that psychopharmacological approaches work by directly targeting automatic emotional information processing in the brain, it is usually postulated that psychological treatments affect these processes only over time, through changes in more conscious thought cycles. This study explored the role of early changes in emotional information processing in CBT action. Methods: Twenty-eight untreated patients with panic disorder were randomized to a single session of exposure-based CBT or waiting group. Emotional information processing was measured on the day after intervention with an attentional visual probe task, and clinical symptoms were assessed on the day after intervention and at 4-week follow-up. Results: Vigilance for threat information was decreased in the treated group, compared with the waiting group, the day after intervention, before reductions in clinical symptoms. The magnitude of this early effect on threat vigilance predicted therapeutic response after 4 weeks. Conclusions: Cognitive behavioral therapy rapidly affects automatic processing, and these early effects are predictive of later therapeutic change. Such results suggest very fast action on automatic processes mediating threat sensitivity, and they provide an early marker of treatment response. Furthermore, these findings challenge the notion that psychological treatments work directly on conscious thought processes before automatic information processing and imply a greater similarity between early effects of pharmacological and psychological treatments for anxiety than previously thought. [ABSTRACT FROM AUTHOR]

Complex behavior patterns may underlie symptoms of obsessive-compulsive disorder (OCD), which, in turn, seem to contribute to the maintenance of symptoms, hinder its management, and interfere with the client's compliance with treatment. Although the evidence-based choice for treating OCD is cognitive-behavior therapy (CBT), such treatment might prove ineffective if it is not accompanied by a careful and thorough investigation of the contingencies involved in the onset and maintenance of symptoms; and this might take longer than predicted by treatment manuals. We present a case study of the treatment of "Angela," a client with OCD who suffered from sub-clinical symptoms for 20 years and did not obtain relief with antidepressant medication. Angela underwent cognitive-behavioral therapy for three and a half years and was treated by the first author in weekly sessions. The difficult management of symptoms, the contingencies involved in them, and the development of the therapeutic relationship are discussed. Treatment results indicated a significant decrease in symptoms, anxiety, and discomfort. We believe this case illustrates limitations associated with a strict, manual-driven treatment with a pre-determined number of sessions. [ABSTRACT FROM AUTHOR]

Recently, transdiagnostic has received considerable interest from psychopathology and cognitive-behavior therapy (CBT), especially with regard to anxiety and depressive disorders. This article provides a review on transdiagnostic as a new perspective in the field of clinical psychology. The conceptual psychopathological fundamentals and their implications for research and clinical interventions are described. Based on concepts emerging from cognitive, emotional and learning data, we identified the main transdiagnostic factors, processes and/or mechanisms across emotional and other mental disorders, which provide a framework for implementing the basic therapeutic principles of transdiagnostic CBT. The article concludes highlighting the theoretical and applied relevance of the transdiagnostic approach and its potential contribution to developments in clinical psychology. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Premature ejaculation (PE) is quite common. Although effective treatments do exist, only a few affected people consult a practitioner in order to overcome their problem. At the same time, studies have shown that reading didactical documents about their PE problem (bibliotherapy) can be useful to men. Aim. The aim of this study was to improve the bibliotherapy approach using up-to-date knowledge and techniques. The expected benefits were the following: (i) an effective manual shorter than previous ones; (ii) easier to assimilate therapeutic principles; and (iii) a method thereby made accessible to a broad population most of whom usually do not consult for this type of sexual problem. Method. A short bibliotherapy titled The Practical Guide of PE[in French] was tested among PE subjects who were diagnosed with PE according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria. Assessments were made at baseline (N = 421), at 4-8 months (N = 120), and at 10-14 months (N = 79) after they read The Practical Guide. A control group of 66 subjects was left on a waiting list and was assessed 2 months after baseline. Main Outcome Measures. The main outcome measures are self-reported ejaculatory latency time, feeling of control upon ejaculation, sexual satisfaction, distress related to PE, anxiety experienced during sexual intercourse, and sexual cognitions (Sexual Irrationality Questionnaire). Results. Significant improvements were found for all the self-reported parameters, both at 4-8 and at 10-14 months after the bibliotherapy. The improvements were associated with an adjustment of sexual cognitions. The response to treatment seemed better for those subjects with moderate PE. Although the severity criteria used in this study did not precisely meet the International Society for Sexual Medicine criteria for lifelong PE, they were likely related. The response did not seem to be affected by variables such as age, education, or personality. Conclusion. Its cost/benefit ratio makes The Practical Guide a valuable therapeutic tool. Kempeneers P, Andrianne R, Bauwens S, Georis I, Pairoux J-F, and Blairy S. Clinical outcomes of a new self-help booklet for premature ejaculation. J Sex Med 2012;9:2417-2428. [ABSTRACT FROM AUTHOR]

The objective of the present study was to verify the response of patients with panic disorder (agoraphobia) to existing cognitive-behavior therapy models (CBT) of two respiratory subtypes of panic disorder (PD): respiratory subtype (RS) and non respiratory subtype (NRS). We randomly selected a sample of 50 patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The medication used was tricycle or selective serotonin reuptake inhibitor antidepressants. Seventy-seven point six percent of the patients from both groups showed RS and 22.4% the NRS. The RS patients responded satisfactorily to the treatment with techniques of CBT decreasing anxiety, breathing symptoms and panic attacks. According to the global functioning assessment scale, RS patients improved from 55.8 to 70.9 in comparison with NRS ones. [ABSTRACT FROM AUTHOR]

We compared the effects of a 16-week Cognitive-Behavioral Therapy (CBT) program and a Social Recreational (SR) program on anxiety in children with Autism Spectrum Disorders (ASD). Seventy children (9-16 years old) were randomly assigned to either of the programs ( n = 36; n = 34). Measures on child's anxiety using the Spence Child Anxiety Scale-Child (SCAS-C) and the Clinical Global Impression-Severity scale (CGI-S) were administered at pre-, post-treatment, and follow-ups (3- and 6-month). Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as 'Normal' and 'Borderline' for both programs. Findings from the present study suggest factors such as regular sessions in a structured setting, consistent therapists, social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to determine the efficacy of cognitive behavioral therapy and religious cognitive therapy on anxiety in Tehranian high school students. Method: In an experimental study, Forty-five students with high anxiety levels were randomly assigned to a cognitive behavioral therapy (CBT), religious cognitive therapy (RCT), or control groups. CBT and RCT were applied to the experimental groups during eight sessions once per week, whereas the control group did not receive any therapy. Cattle's Anxiety Scale was used as the pretest, post-test, and follow-up for each of the three groups. Analysis of covariance was applied to analyze the data. Results: The analysis of data showed that mean anxiety scores in the experimental groups were significantly lower than those in the control group on the post test and follow-up. However, no significant difference was observed between the effectiveness of CBT and RCT for decreasing anxiety in students. Conclusion: CBT and RCT were remarkably effective for reducing anxiety in students. These results have implications for future research in the field of multidimensional psychotherapy for psychological disorders. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals. Primary objective: To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety. Method: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. Results: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318–0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies. Conclusions: CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research. [Copyright &y& Elsevier]

Abstract: Objectives: The objectives of the present study were (1) to assess the impact of cognitive-behavior therapy (CBT) for posttraumatic stress disorder (PTSD) on associated sleep disturbances and (2) to explore the correlates of persistent sleep difficulties in terms of anxiety and depression symptoms and perceived health. Method: Fifty-five individuals with PTSD were administered a series of assessments designed to evaluate sleep, PTSD symptoms, symptoms of anxiety and depression, and perceived health before and after individual CBT for PTSD and at 6-month follow-up. Results: Significant improvements were observed on sleep quality, sleep onset latency, sleep efficiency, and sleep disturbances. These changes were not fully maintained after 6 months, and 70% of people who reported baseline sleep difficulties (Pittsburgh Sleep Quality Index >5) still reported significant problems with sleep after treatment. Persistent sleep difficulties were associated with more severe posttraumatic, anxious, and depressive symptoms as well as poorer health. Conclusion: Although CBT for PTSD had a favorable impact on sleep, the majority of participants suffered from residual sleep difficulties. Individuals with persistent sleep difficulties posttreatment may experience more residual posttraumatic, depression, and anxiety symptoms and poorer mental and physical health than those who do not report sleep problems posttreatment. Further research in this area will allow clinicians to treat sleep problems in these individuals more effectively. [Copyright &y& Elsevier]

Abstract: We examined the therapeutic efficacy of a culturally adapted form of CBT (CA-CBT) for PTSD as compared to applied muscle relaxation (AMR) for female Latino patients with treatment-resistant PTSD. Participants were randomized to receive either CA-CBT (n = 12) or AMR (n = 12), and were assessed before treatment, after treatment, and at a 12-week follow-up. The treatments were manualized and delivered in the form of group therapy across 14 weekly sessions. Assessments included a measure of PTSD, anxiety, culturally relevant idioms of distress (nervios and ataque de nervios), and emotion regulation ability. Patients receiving CA-CBT improved significantly more than in the AMR condition. Effect size estimates showed very large reductions in PTSD symptoms from pretreatment to posttreatment in the CA-CBT group (Cohen’s d = 2.6) but only modest improvements in the AMR group (0.8). These results suggest that CA-CBT can be beneficial for previously treatment-resistant PTSD in Latino women. [Copyright &y& Elsevier]

Objective: Anorexia nervosa (AN) is a life threatening and difficult to treat illness with a high relapse rate. Current treatments are inadequate and new approaches to treatment are needed. Method: We review the data on anxiety in AN, the relationship between anxiety disorders and AN, and the use of Exposure and Response Prevention in treatment. Results: The overlap between AN and anxiety disorders suggest a model of AN in which baseline anxiety features yield eating related fears, avoidance behaviors, and ritualized safety behaviors that promote the underweight state and the perpetuation of the disorder. We propose an Exposure and Response Prevention treatment to prevent relapse in AN. Discussion: Overlap between AN and anxiety disorders suggests that Exposure and Response Prevention may be a new and beneficial approach to preventing relapse in individuals with AN. [ABSTRACT FROM AUTHOR]

Remoralization as an outcome measure for psychological treatments was compared with symptom reduction (agoraphobic avoidance and cognitions). Twenty-four patients with panic disorder and agoraphobia received empirically supported treatment and were monitored across multiple time points for 28 weeks. Treatment resulted in reduced symptoms and enhanced remoralization (Cohen's d=1.19-1.45). Slopes of symptoms and remoralization were obtained from latent growth model analyses. The slopes correlated highly (r=- .50 to -.55), which indicates similar patterns of change over time. The slope of remoralization also correlated with a number of aspects of health-related quality of life, while the slope of symptom reduction did not. Although strongly related to symptom reduction, the measurement of remoralization is expected to provide unique information for treatment efficacy research. [ABSTRACT FROM AUTHOR]