Search

More than 35 years ago, fetal alcohol syndrome (FAS) was first identified in the United States as a major birth defect resulting from prenatal alcohol exposure (Jones and Smith 1973; [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.chb.2010.04.020 Byline: Shannon L. Currie (a), Patrick J. McGrath (b), Victor Day (c) Keywords: Mental health; Cognitive behavioral therapy; Computer-assisted therapy; Students; Selfhelp approaches Abstract: Internet-based intervention programs can improve mental health outcomes, and may offer a novel medium for reducing emotional distress in post-secondary students. This paper describes the development and usability testing of a new cognitive behavioral therapy-based program, 'Feeling Better' designed to reduce symptoms of emotional distress in post-secondary students. An iterative qualitative usability testing approach was used to assess the program's usability (i.e., ease of navigation, clarity, efficiency and acceptability). Three cycles of participant feedback and feedback from counselling centre staff was coded and used to iteratively modify the interface. Changes were both structural (e.g., shortening sections) and stylistic (e.g., aesthetic features), remodeling 'Feeling Better' into a user-friendly platform ready to be used and its effects evaluated in further studies. Author Affiliation: (a) Psychology Department, Dalhousie University, Life Sciences Centre, Halifax, Nova Scotia, Canada B3H 4J1 (b) IWK Health Centre, Dalhousie University, Canada B3H 4J1 (c) Counselling and Psychological Services, Dalhousie University, Canada B3H 4J1

Despite the documented efficacy of cognitive-behavioral therapy (CBT) for many psychological disorders, the vast majority of suffering people do not receive treatment. Treatment underutilization may prove at least partially due to ambivalence about seeking treatment. Ambivalence could result if, for example, people with social anxiety disorder (SAD) want to decrease their anxiety symptoms but are worried they will be judged negatively should they seek treatment. Motivation enhancement therapy (MET) can be a useful tool to help non-treatment seekers explore and resolve ambivalence regarding seeking treatment. A case study illustrates the application of MET to encourage the utilization of CBT for a non-treatment seeker with SAD. This case study includes outcome data regarding the client's experience with post-MET CBT for her social anxiety. [c] 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1195-1206, 2009. Keywords: motivational interviewing; motivation enhancement therapy; social anxiety disorder; social phobia; cognitive-behavior therapy DOI: 10.1002/jclp.20641

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH). Keywords: alcohol use disorders, women, couple therapy, behavior therapy, comorbidity

Cognitive--behavioral treatments for insomnia are as effective as medications and have longer lasting effects. The current study used a clinical case series design to evaluate the effectiveness of a brief behavioral intervention for insomnia delivered in a nonresearch, real-world family medicine clinical setting. Participants included 29 sleep-impaired patients who were seen regardless of their comorbid conditions. The treatment included three brief visits with a behavioral health consultant (BHC), plus the provision of a self-help insomnia-treatment book. At posttreatment 83% of participants achieved a mean sleep efficiency >85%, as compared to only 14% at baseline. Limited-contact behavioral treatment of insomnia delivered by BHCs within a collaborative care family medicine clinic effectively reduced symptoms of insomnia, regardless of comorbid medical diagnoses. Keywords: insomnia; primary care; integrated care

Cost-effectiveness and cost-utility of cognitive therapy (CT), rational emotive behavioral therapy (REBT), and fluoxetine (Prozac) for major depressive disorder (MDD) were compared in a randomized clinical trial with a Romanian sample of 170 clients. Each intervention was offered for 14 weeks, plus three booster sessions. Beck Depression Inventory (BDI) scores were obtained prior to intervention, 7 and 14 weeks following the start of intervention, and 6 months following completion of intervention. CT, REBT, and fluoxetine did not differ significantly in changes in the BDI, depression-free days (DFDs), or Quality-Adjusted Life Years (QALYs). Average BDI scores decreased from 31.1 before treatment to 9.7 six months following completion of treatment. Due to lower costs, both psychotherapies were more cost-effective, and had better cost-utility, than pharmacotherapy: median $26.44/DFD gained/month for CT and $23.77/DFD gained/month for REBT versus $34.93/DFD gained/month for pharmacotherapy, median $/QALYs=$1,638, $1,734, and $2,287 for CT, REBT, and fluoxetine (Prozac), respectively. Keywords: depression; cost-effectiveness; cost-utility; pharmacotherapy; CBT; REBT; fluoxetine; DFD; QALY; psychotherapy

A randomized clinical trial was undertaken to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic major depressive disorder. The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory. No differences among treatment conditions at posttest were observed. A larger effect of REBT (significant) and CT (nonsignificant) over pharmacotherapy at 6 months follow-up was noted on the Hamilton Rating Scale for Depression only. Keywords: major depressive disorder; rational emotive behavior therapy; cognitive therapy; selective serotonin reuptake inhibitors; efficacy/outcome study

Dialectical behavior therapy (DBT) was originally designed as a treatment of emotionally dysregulated, impulsive, and dramatic disorders (e.g., borderline personality disorder) and populations (e.g., parasuicidal women). However, a number of complex disorders represent the dialectical opposite of BPD and related disorders; these disorders are characterized by being overcontrolled, emotionally constricted, perfectionistic, and highly risk-averse. In this article, the authors introduce a recent adaptation of DBT that targets cognitivebehavioral rigidity and emotional constriction and illustrates its application through the case of a man suffering from both paranoid personality disorder and obsessive-compulsive personality disorder. Keywords: comorbidity; personality disorders; dialectical behavior therapy; emotional constriction; risk aversion

Research suggests that experiential avoidance may play an important role in generalized anxiety disorder (GAD; see Roemer, L., & Orsillo, S.M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54-68, for a review). Therefore, a treatment that emphasizes experiential acceptance, as well as intentional action, may lead to both reduced symptomatology and improved quality of life and functioning for individuals with this chronic disorder. In an open trial of a newly developed acceptance-based behavior therapy for GAD, 16 treated clients demonstrated significant reductions in clinician-rated severity of GAD and reports of anxiety and depressive symptoms and fear and avoidance of their internal experience, as well as significant improvements in reports of quality of life, at both posttreatment and 3-month follow-up. Directions for future treatment development and research are discussed.

In this randomized controlled trial, group behavior therapy (BT; n = 12) was compared to group supportive therapy (ST; n=12) in the treatment of trichotillomania (TTM). Both treatments were also compared to a naturally occurring waiting period, the time period that participants waited for groups to form. Participants completing group BT experienced significantly greater decreases in self-reported hair-pulling symptoms and clinician-rated hair loss severity than did those in group ST. Decreases were significantly greater after treatment than after the naturalistic waiting period. In addition, a significantly higher percentage of those in the BT than ST condition were rated as much improved or very much improved on the Clinical Global Impression scale at posttreatment. However, despite substantial symptom improvement, TTM severity remained problematic at posttreatment. Specifically, few participants in either treatment met criteria for clinically significant change at posttreatment. In addition, relapse of symptoms occurred over the 6-month follow-up period. Results provided partial support for the short-term efficacy of group BT. However, the group format may not maximize the efficacy of BT for TTM. Thus, it is recommended that future BT research test either individual therapy or a combination of group and individual formats for TTM.

Abstract: Limited access to positive reinforcers is a central feature in behavioral formulations of substance use and depression, and evidence suggests both disorders share similar environmental contexts. The Behavioral Therapy for Depression in Drug Dependence (BTDD) was developed to target the density of potential reinforcers in a patient's environment to reduce both depression and illicit substance use using therapeutic techniques from three operant based treatment programs, Community Reinforcement Approach, Changing Reinforcement Events, and Treatment-plan Contingency Management. Results of an uncontrolled Stage Ia trial (n = 29), indicated 48% of the participants demonstrated at least a 50% reduction in baseline depression scores during the 16-session treatment program. Those designated as treatment responders completed more out-of-session behavioral activities, attended more treatment sessions, and demonstrated less benzodiazepine use during the program than non-responders. There were no changes in opiate and cocaine use. BTDD may be a useful adjunct to methadone maintenance for treating comorbid depressive disorders. Keywords: Behavioral therapy, comorbidity, depression, drug use, methadone maintenance, INTRODUCTION Methadone maintenance is an effective agonist treatment for opiate dependence. However, psychiatric comorbidity, particularly depression, is prevalent (1, 2), associated with more severe dependence (3), and poor prognosis (4). [...]

The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates. Behavioral Naltrexone Therapy (BNT) was developed to improve retention on oral naltrexone by integrating voucher incentives, Motivational and Cognitive Behavioral therapies, and a significant other for monitoring medication adherence. In a 6-month, randomized, controlled trial in heroin dependent patients, BNT (N = 36) improved retention in treatment compared to a standard treatment control (Compliance Enhancement (CE); N = 33) (log rank = 4.28; p = .04). Most patients retained beyond 3 months achieved abstinence from opioids, but retention at 6 months was only 22% on BNT and 9% on CE. A systematic review of related controlled trials revealed similar effect sizes in the small to medium range, and substantial dropout. There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone. Future research should consider combinations of behavioral methods with new long-acting injectable or implantable naltrexone formulations. Keywords: Antagonist, behavior therapy, heroin, naltrexone, opioid dependence, treatment, INTRODUCTION The opioid antagonist naltrexone is a theoretically promising treatment for opioid dependence that has never lived up to its potential. A recent meta-analysis (1) and accompanying editorial (2) support [...]