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1
Merrett, Charles, and Simon Easton. "The Cognitive Behavioural Approach: CBT’s Big Brother." Counselling Psychology Review 23, no. 1 (February 2008): 21–32. http://dx.doi.org/10.53841/bpscpr.2008.23.1.21.
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Cognitive Behavioural Therapy (CBT) is increasingly promoted as the treatment of choice in the UK. The Layard Report (2006) recommended a massive expansion in the provision of CBT. We discuss what we believe to be a fundamental contradiction in the thinking behind the Layard Report. After briefly reviewing the evidence for CBT, we suggest it suffers from a similar philosophical contradiction in the way it is practised. In particular, we argue that CBT is often associated with a pathological, disempowering model of psychological distress. Whilst recognising the current pressure to be seen to be practising CBT, we argue that a broader Cognitive Behavioural Approach (CBA), based on fundamental cognitive principles avoids the contradictions inherent in the provision of rigid, manualised CBT. CBA is proposed as a basis for understanding psychological experience and distress, and identifies the cognitions that are fundamental as causes of ‘mental health problems’ regardless of traditional diagnostic categories. The implications of CBA for prevention and therapy are discussed.
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Evans, Ceri. "Cognitive–behavioural therapy with older people." Advances in Psychiatric Treatment 13, no. 2 (March 2007): 111–18. http://dx.doi.org/10.1192/apt.bp.106.003020.
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Cognitive–behavioural therapy (CBT) is an effective treatment for a number of psychiatric disorders in adults of all ages. With the proportion of the population aged 65 or over increasing steadily, it is important to be aware of how the CBT needs of this age group can be best met. This article provides an overview of CBT and the historical context of using it with older people. Although an understanding of the individual, irrespective of age, is at the core of CBT, potential modifications to the procedure and content aimed at optimising its effectiveness for older people are discussed.
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Naeem, Farooq, Peter Phiri, Shanaya Rathod, and Muhammad Ayub. "Cultural adaptation of cognitive–behavioural therapy." BJPsych Advances 25, no. 6 (April 10, 2019): 387–95. http://dx.doi.org/10.1192/bja.2019.15.
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SUMMARYThe study of cultural factors in the application of psychotherapy across cultures – ethnopsychotherapy – is an emerging field. It has been argued that Western cultural values underpin cognitive–behavioural therapy (CBT) as they do other modern psychosocial interventions developed in the West. Therefore, attempts have been made to culturally adapt CBT for ethnic minority patients in the West and local populations outside the West. Some frameworks have been proposed based on therapists’ individual experiences, but this article describes a framework that evolved from a series of qualitative studies to culturally adapt CBT and that was field tested in randomised controlled trials. We describe the process of adaptation, details of methods used and the areas that need to be focused on to adapt CBT to a given culture. Further research is required to move the field forward, but cultural adaptation alone cannot improve outcomes. Access to evidence-based psychosocial interventions, including CBT, needs to be improved for culturally adapted interventions to achieve their full potential.LEARNING OBJECTIVESAfter reading this article you will be able to: •recognise the link between cultural factors and the need to adapt psychosocial interventions•identify the necessary steps to culturally adapt CBT•understand the modifications required to deliver therapy to individuals from diverse cultural backgrounds.
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Głuszek-Osuch, Martyna. "Cognitive behavioural therapy (CBT) – case studies." Medical Studies 1 (2016): 49–55. http://dx.doi.org/10.5114/ms.2016.58806.
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Ekberg, Katie, and Amanda Lecouteur. "Negotiating behavioural change: Therapists’ proposal turns in Cognitive Behavioural Therapy." Communication and Medicine 9, no. 3 (September 17, 2013): 229–39. http://dx.doi.org/10.1558/cam.v9i3.229.
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Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists’ proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed.
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Manjula, M., P. S. D. V. Prasadarao, V. Kumaraiah, and R. Raguram. "Temporal Patterns of Change in Panic Disorder during Cognitive Behaviour Therapy: An Indian Study." Behavioural and Cognitive Psychotherapy 42, no. 5 (August 2, 2013): 513–25. http://dx.doi.org/10.1017/s1352465813000635.
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Background: CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. Aim: The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. Method: Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. Results: Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4–5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. Conclusion: CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.
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Keen, Andrew J. A., and Mark H. Freeston. "Assessing competence in cognitive-behavioural therapy." British Journal of Psychiatry 193, no. 1 (July 2008): 60–64. http://dx.doi.org/10.1192/bjp.bp.107.038588.
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BackgroundPostgraduate courses on cognitive-behavioural therapy (CBT) assess various competencies using essays, case studies and audiotapes or videotapes of clinical workAimsTo evaluate how reliably a well-established postgraduate course assesses CBT competenciesMethodData were collected on two cohorts of trainees (n=52). Two examiners marked trainees on: (a) two videotapes of clinical practice; (b) two case studies; and (c) three essaysResultsEssay examinations were more reliable than case studies, which in turn were more reliable than videotaped assessments. The reliability of the latter two assessments was considerably lower than that commonly expected of high-stakes examinations. To assess reliably standard CBT competencies, postgraduate courses would need to examine about 5 essays, 12 case studies and 19 videotapesConclusionsReliable assessment of standard competencies is complex and resource intensive. There would need to be a marked increase in the number of samples of clinical work assessed to be able to make reliable judgements about proficiency
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Cosgrave, Elizabeth, and Vanessa Keating. "After the Assessment: Introducing Adolescents to Cognitive–Behavioural Therapy." Australian Journal of Guidance and Counselling 16, no. 2 (December 1, 2006): 149–57. http://dx.doi.org/10.1375/ajgc.16.2.149.
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AbstractThe objective of this article is to describe the practical aspects involved in adapting cognitive–behavioural therapy (CBT) to an adolescent population in Australia. Some effective ways to use CBT with adolescents include preparing them for CBT by providing a thorough cognitive–behavioural formulation, describing the cognitive–behavioural approach to therapy in an adolescent-friendly manner, and adapting language and treatment conditions to suit young people's needs.
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Addington, Jean, and John Gleeson. "Implementing cognitive-behavioural therapy for first-episode psychosis." British Journal of Psychiatry 187, S48 (August 2005): s72—s76. http://dx.doi.org/10.1192/bjp.187.48.s72.
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SummarySignificant symptomatic improvement after a first episode of psychosis is not matched by a similar improvement in functional outcome. Thus, increased attention has been given to psychological intervention, in particular cognitive-behavioural therapy (CBT), with the hope of enhancing functional recovery. Outcome trials of CBT for schizophrenia are few, in particular for the first episode, and have been occasionally criticised for their lack of significance compared with supportive therapies. We describe a modular CBT approach for those with a first episode of psychosis that addresses adaptation as well as both functional and symptomatic outcome and one that parallels the theoretical shift in CBT that has occurred in the last decade. Guidelines for integrating CBT into an early psychosis service are presented.
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Whitfield, Graeme. "Group cognitive–behavioural therapy for anxiety and depression." Advances in Psychiatric Treatment 16, no. 3 (May 2010): 219–27. http://dx.doi.org/10.1192/apt.bp.108.005744.
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SummaryCognitive–behavioural therapy (CBT) is a psychological treatment approach that can be delivered not only on a one-to-one basis but also to groups and in self-help formats. However, the evidence base supporting individual CBT is more extensive than the research regarding group CBT. This is likely to influence the choice of services that develop in the Improving Access to Psychological Therapies (IAPT) programme for the treatment of depression and anxiety disorders in primary care in England. This article outlines the different forms that group CBT takes, the way in which it may benefit people and the current evidence base supporting its use for anxiety and depression. It also outlines the advantages of group or individual CBT and describes those patients who appear to be best suited to a specific delivery.
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Brittlebank, Andrew, and Julie Owens. "Cognitive-behavioural therapy training for junior psychiatric trainees." Psychiatric Bulletin 21, no. 3 (March 1997): 169–70. http://dx.doi.org/10.1192/pb.21.3.169.
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There is an identified need for more psychiatrists who have been trained in cognitive-behavioural therapy (CBT). The Royal College of Psychiatrists' guidelines for psychotherapy training recommend that all psychiatric trainees receive CBT training. This paper describes a brief programme of CBT training for psychiatric senior house officers (SHO) which demonstrates a viable model achieving limited training objectives.
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Whitfield, Graeme, Moira Connolly, Alan Davidson, and Chris Williams. "Use of cognitive–behavioural therapy skills among trained psychiatrists." Psychiatric Bulletin 30, no. 2 (February 2006): 58–60. http://dx.doi.org/10.1192/pb.30.2.58.
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Aims and MethodPrevious studies have suggested that despite the cost of attendance at postgraduate cognitive–behavioural therapy (CBT) courses, psychiatrists are unable to engage in CBT after qualification. A postal survey of psychiatrists with postgraduate CBT training currently practising in Scotland was performed to assess the levels of training and supervision that they provide, therapeutic CBT activity, and supervision and continued professional development that they receive.ResultsOf the 58 psychiatrists, 51 replied to the survey (88%). Less than half of the respondents supervised other staff. Although 43 (84%) engaged in some therapeutic CBT activity, only 25 (49%) received supervision for their own practice. The main reasons given for not engaging in CBT therapeutic activity were that there was inadequate ‘protected time’ and that CBT had not been included in ‘job plans'.Clinical ImplicationsPsychiatrists can help to disseminate CBT skills. To do this, they require personal supervision, and time for the development and maintenance of therapeutic skills as well as for the training and supervision of others. This survey builds on the results of others and indicates that these requirements are currently being inadequately met.
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Cooper, Zafra, and Roz Shafran. "Cognitive Behaviour Therapy for Eating Disorders." Behavioural and Cognitive Psychotherapy 36, no. 6 (November 2008): 713–22. http://dx.doi.org/10.1017/s1352465808004736.
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AbstractThe eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.
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Quigley, Leanne, David J. A. Dozois, R. Michael Bagby, Daniela S. S. Lobo, Lakshmi Ravindran, and Lena C. Quilty. "Cognitive change in cognitive-behavioural therapy v. pharmacotherapy for adult depression: a longitudinal mediation analysis." Psychological Medicine 49, no. 15 (December 18, 2018): 2626–34. http://dx.doi.org/10.1017/s0033291718003653.
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AbstractBackgroundAlthough cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model.MethodsThe present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models.ResultsBoth CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant.ConclusionsThe results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.
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Yeo, Lay See, and Pui Meng Choi. "Cognitive-behavioural therapy for children with behavioural difficulties in the Singapore mainstream school setting." School Psychology International 32, no. 6 (July 6, 2011): 616–31. http://dx.doi.org/10.1177/0143034311406820.
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The present study investigated the effectiveness of a cognitive-behavioural therapy (CBT) programme delivered by a school psychologist for children with behavioural difficulties in Singapore elementary school classrooms. It examined the impact of a 12-session, psychoeducational group intervention in helping misbehaving pupils to control their school and home behaviours, maintain peer relationships, and improve self-esteem. Ninety-five pupils, aged between 8- and 12-years-old ( M = 10.08, SD = 1.10) were randomly assigned to CBT (experimental) groups and control groups. The CBTgroups learned and practised skills in self-monitoring, problem-solving, and self-management. The control groups discussed rule compliance and role-played behaviours that conformed to school rules. CBT groups improved significantly in school and home behaviours, self-control, social skills, and self-esteem compared to control groups. Effect sizes ranged from moderate (0.50) to large (2.94). Gains in self-esteem were maintained at follow-up for experimental groups only. The feasibility ofimplementing group CBT was discussed in light of competing demands on school psychologists to deliver diverse psychological services to children.
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Nordahl, Hans M., Thomas D. Borkovec, Roger Hagen, Leif E. O. Kennair, Odin Hjemdal, Stian Solem, Bjarne Hansen, Svein Haseth, and Adrian Wells. "Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder." BJPsych Open 4, no. 5 (September 2018): 393–400. http://dx.doi.org/10.1192/bjo.2018.54.
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BackgroundCognitive–behavioural therapy (CBT) is the treatment of choice for generalised anxiety disorder (GAD), yielding significant improvements in approximately 50% of patients. There is significant room for improvement in the outcomes of treatment, especially in recovery.AimsWe aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).MethodA total of 246 patients with long-term GAD were assessed and 81 were randomised into three conditions: CBT (n = 28), MCT (n = 32) and a wait-list control (n = 21). Assessments were made at pre-treatment, post-treatment and at 2 year follow-up.ResultsBoth CBT and MCT were effective treatments, but MCT was more effective (mean difference 9.762, 95% CI 2.679–16.845, P = 0.004) and led to significantly higher recovery rates (65% v. 38%). These differences were maintained at 2 year follow-up.ConclusionsMCT seems to produce recovery rates that exceed those of CBT. These results demonstrate that the effects of treatment cannot be attributed to non-specific therapy factors.Declaration of interestA.W. wrote the treatment protocol in MCT and several books on CBT and MCT, and receives royalties from these. T.D.B. wrote the protocol in CBT and has published several articles and chapters on CBT and receives royalties from these. All other authors declare no competing interests.
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Pinho, M., D. Martins, and S. Carvalho. "Cognitive-behavioural therapy role in the prevention of psychosis." European Psychiatry 64, S1 (April 2021): S498. http://dx.doi.org/10.1192/j.eurpsy.2021.1333.
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IntroductionAbout 30% of individuals in ultra-high risk (UHR) of psychosis develop overt psychosis within 3 years, and about 40% of those who don’t will keep experiencing ongoing attenuated psychotic symptoms and persistent functional disability. During this prodromal period, it’s possible to prevent the transition to a first-episode psychosis.ObjectivesTo conduct a short review of literature on the role of cognitive-behavioural therapy (CBT) in preventing psychosis in ultra-high risk patients.MethodsWe performed a literature search on PUBMED, using the query: “Cognitive Behavioral Therapy” [Mesh] AND “psychosis” AND “prevention”. We focused on data from systematic reviews, clinical trials and meta-analysis published on last 5 years, either in English or Portuguese.ResultsSome authors claim cognitive-behavioural therapy (CBT) as first-choice treatment in clients with ultra-high risk (UHR) for psychosis. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. On a Japanese study, the total score of Positive and Negative Syndrome Scale (PANSS) significantly improved on post-intervention and follow-up assessments, with large effect sizes observed. Teaching families to apply CBT with their offspring may bolster therapeutic gains made in time-limited treatment. CBT showed an 83% probability of being more effective and less costly than routine care.ConclusionsPatients with UHR for psychosis can be treated successfully with CBT to postpone and prevent the transition to a first-episode psychosis. CBT for UHR has been included in the European guidelines and awaits dissemination and implementation in mental health services.
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Quilty, L. C., C. McBride, and R. M. Bagby. "Evidence for the cognitive mediational model of cognitive behavioural therapy for depression." Psychological Medicine 38, no. 11 (June 26, 2008): 1531–41. http://dx.doi.org/10.1017/s0033291708003772.
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BackgroundAlthough empirical support for the efficacy of cognitive behavioural therapy (CBT) as a treatment for major depressive disorder (MDD) is well established, its mechanism of action is uncertain. In this investigation, we examined evidence for the cognitive mediational model in a randomized control trial involving CBT, interpersonal therapy (IPT) and pharmacotherapy (PHT) in patients with MDD.MethodOne hundred and thirty participants diagnosed with MDD were treated with CBT, IPT or PHT. Participants completed the Hamilton Depression Rating Scale, Beck Depression Inventory – II and Dysfunctional Attitudes Scale prior to and following treatment.ResultsThe cognitive mediational model, in which dysfunctional attitudes are proposed to mediate depressive symptom reduction in response to treatment, provided a good fit to the data when contrasting CBT v. IPT, with results supporting a mediational role for dysfunctional attitude change in depressive symptom reduction. The complication model, in which dysfunctional attitudes are proposed to be a consequence of depressive symptom reduction, provided a good fit to the data when contrasting CBT v. PHT, with results supporting a mediational role for depressive symptom reduction in dysfunctional attitude change.ConclusionsThere was no evidence for a mediational role for dysfunctional attitude change in IPT. Changes in dysfunctional attitudes accompanied both CBT and PHT; however, empirical evidence suggests that the role of attitudes in treatment outcome may differ between these two treatments.
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Shelley-Ummenhofer, Jill, and Peter D. MacMillan. "Cognitive-Behavioural Treatment For Women Who Binge Eat." Canadian Journal of Dietetic Practice and Research 68, no. 3 (September 2007): 139–42. http://dx.doi.org/10.3148/68.3.2007.139.
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Purpose: A dietitian-administered, shortened form of the Apple and Agras cognitive-behavioural therapy (CBT) method was evaluated in a group setting to determine its effect on improving obese women's self-esteem and reducing binge-eating behaviours, depression, and negative body image. Methods: Participants were recruited through newspaper and radio advertisements. Respondents who met study selection criteria were randomly assigned to either a CBT group (n=13) or a delayed group (D-CBT) (n=9). The treatment was administered over six weekly sessions to the CBT group, and then twice weekly over three weeks to the D-CBT group. Two measures of bingeing behaviour (severity and frequency), three measures of mood (depression, body image, and self-esteem), and body weight were assessed. Results: The intervention did not result in any changes in body weight. There were statistically significant and clinically important changes after treatment (p<0.05) for all five measures. Binge-eating severity and frequency decreased, depression decreased, body image improved, and self-esteem improved. All changes were greater in the six-week treatment group. Conclusions: The dietitian-administered, group setting CBT program is effective for reducing binge eating and improving emotional state in obese women.
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Maric, Marija, David A. Heyne, David P. MacKinnon, Brigit M. van Widenfelt, and P. Michiel Westenberg. "Cognitive Mediation of Cognitive-Behavioural Therapy Outcomes for Anxiety-Based School Refusal." Behavioural and Cognitive Psychotherapy 41, no. 5 (September 28, 2012): 549–64. http://dx.doi.org/10.1017/s1352465812000756.
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Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.
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Tarrier, Nicholas, Shôn Lewis, Gillian Haddock, Richard Bentall, Richard Drake, Peter Kinderman, David Kingdon, et al. "Cognitive–behavioural therapy in first-episode and early schizophrenia." British Journal of Psychiatry 184, no. 3 (March 2004): 231–39. http://dx.doi.org/10.1192/bjp.184.3.231.
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BackgroundThe initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.AimsTo test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.MethodThis was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.ResultsThere were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences.ConclusionsAdjunctive psychological treatments can have a beneficial longterm effect on symptom reduction.
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Carvalho, S., C. P. Martins, H. S. Almeida, and F. Silva. "The Evolution of Cognitive Behavioural Therapy – The Third Generation and Its Effectiveness." European Psychiatry 41, S1 (April 2017): s773—s774. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1461.
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Introduction.First wave cognitive behavioural therapy (CBT) focuses essentially on classical conditioning and operant learning and second wave on information processing. They are based on the premise that certain cognitions, emotions and physiological states lead to dysfunctional behaviour and so, by eliminating the first ones, changes in behaviour will take place. Third wave CBT appeared in an attempt to increase the effectiveness of first and second wave by emphasizing contextual and experiential change strategies.Objectives/Aims.To make a review on the actual state of the art of third wave CBT, focusing on MBSR (Mindfulness-Based Stress Reduction), MCBT (Mindfulness-based Cognitive Behavioural Therapy), DBT (Dialectical Behaviour Therapy), ACT (Acceptance and Commitment Therapy) and CFT (Compassion Focused Therapy).Methods.Research on PubMed using the terms “third wave cognitive behavioural therapy”.Results.Methods and targets differ between MBSR, MCBT, DBT, ACT and CFT. Depression, anxiety and borderline personality disorders are some of those targets. However, a transdiagnostic approach is the hallmark of all third wave therapies: mental processes or emotions transversal to many psychiatric disorders such as shame, self-criticism, experiential avoidance or cognitive fusion are the main focus, emphasizing the context and human experience over any categorical diagnosis.Conclusions.Third wave cognitive behavioural therapy is an emerging approach born from the need to improve and complement first and second waves. Although very promising, it is still a recent approach and data to support its superiority over the conventional therapies is missing.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Franklin, George, Alan J. Carson, and Killian A. Welch. "Cognitive behavioural therapy for depression: systematic review of imaging studies." Acta Neuropsychiatrica 28, no. 2 (June 30, 2015): 61–74. http://dx.doi.org/10.1017/neu.2015.41.
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ObjectiveAlthough cognitive behavioural therapy (CBT) has been shown to be an effective treatment for depression, the biological mechanisms underpinning it are less clear. This review examines if it is associated with changes identifiable with current brain imaging technologies.MethodsTo better understand the mechanisms by which CBT exerts its effects, we undertook a systematic review of studies examining brain imaging changes associated with CBT treatment of depression.ResultsTen studies were identified, five applying functional magnetic resonance imaging, three positron emission tomography, one single photon emission computer tomography, and one magnetic resonance spectroscopy. No studies used structural MRI. Eight studies included a comparator group; in only one of these studies was there randomised allocation to another treatment. CBT-associated changes were most commonly observed in the anterior cingulate cortex (ACC), posterior cingulate, ventromedial prefrontal cortex/orbitofrontal cortex (VMPFC/OFC) and amygdala/hippocampus.DiscussionThe evidence, such as it is, suggests resting state activity in the dorsal ACC is decreased by CBT. It has previously been suggested that treatment with CBT may result in increased efficiency of a putative ‘dorsal cognitive circuit’, important in cognitive control and effortful regulation of emotion. It is speculated this results in an increased capacity for ‘top-down’ emotion regulation, which is employed when skills taught in CBT are engaged. Though changes in activity of the dorsal ACC could be seen as in-keeping with this model, the data are currently insufficient to make definitive statements about how CBT exerts its effects. Data do support the contention that CBT is associated with biological brain changes detectable with current imaging technologies.
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Bailey, Veira. "Cognitive–behavioural therapies for children and adolescents." Advances in Psychiatric Treatment 7, no. 3 (May 2001): 224–32. http://dx.doi.org/10.1192/apt.7.3.224.
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The merging of behaviour and cognitive therapy into cognitive–behavioural therapy (CBT) occurred in the 1980s in both Europe and North America, particularly on the basis of the successful treatment of panic disorder by Clark (1986) in the UK and Barlow (1988) in the USA. The behavioural emphasis on empiricism with good-quality research design was combined with the cognitive focus on content and meaning.
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Ayres, Helen, and Claudia Koch. "Cognitive-behavioural therapy in a prison setting." Clinical Psychology Forum 1, no. 193 (January 2009): 43–47. http://dx.doi.org/10.53841/bpscpf.2009.1.193.43.
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This paper discusses the experiences of a community psychiatric nurse (CPN) and a clinical psychologist using cognitive-behavioural therapy (CBT) as part of an adult mental health team within a prison setting.
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Smith, Patrick, Sean Perrin, and William Yule. "Cognitive Behaviour Therapy for Post Traumatic Stress Disorder." Child Psychology and Psychiatry Review 4, no. 4 (February 1999): 177–82. http://dx.doi.org/10.1017/s1360641799002087.
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It is only relatively recently that Post Traumatic Stress Disorder (PTSD) has been recognised in children. Controlled treatment outcome studies of childhood PTSD are scarce, but those that exist indicate that Cognitive Behaviour Therapy (CBT) is an effective intervention. In this article, we briefly describe PTSD in children and outline some behavioural and cognitive models of the disorder. Derived from these models, prolonged therapeutic exposure and cognitive restructuring as part of a CBT package are then described. In practice, effective therapy will include more than exposure-based work, and additional procedures, including work with parents, are highlighted. While CBT is the treatment of choice of PTSD in childhood, there is an urgent need for further treatment outcome studies.
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Turner, Jarrod S., and David J. Leach. "Behavioural Activation Therapy: Philosophy, Concepts, and Techniques." Behaviour Change 29, no. 2 (June 2012): 77–96. http://dx.doi.org/10.1017/bec.2012.3.
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Behavioural Activation (BA) therapy is a stand-alone evidence-based treatment for depression and also is being applied to anxiety with promising outcomes. Essentially, BA involves structured therapy aimed at increasing the amount of activity in a person's daily life, so that he or she comes into contact with sources of positive reinforcement for clinically healthy behaviours. Originally, contemporary BA was developed as a behaviour therapy treatment condition in a study that compared BA to Cognitive Behavioural Therapy (CBT). Over time, many variants of BA have appeared in the published literature, which included techniques that might be viewed as being incompatible with the original intended treatment model and more similar to generic forms of CBT. The purpose of this article is to provide researchers and practitioners with a description of what we consider to be the distinctive and essential elements of BA therapy.
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Nurkowski, Joshua, Habiba Elshorbagy, Katelyn Halpape, Karen Jensen, Darcy Lamb, Eric Landry, Alfred Remillard, and Derek Jorgenson. "Impact of Pharmacist-Led Cognitive Behavioural Therapy for Chronic Insomnia." INNOVATIONS in pharmacy 11, no. 3 (August 3, 2020): 2. http://dx.doi.org/10.24926/iip.v11i3.3378.
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Background: Chronic insomnia is a common medical condition that negatively impacts quality of life and daytime function. Access to the first-line treatment for insomnia, cognitive behavioural therapy (CBT-i), is limited. Pharmacists are well positioned to provide this service, but evidence regarding pharmacist delivered CBT-i is sparse. The aim of this study was to evaluate the effectiveness of CBT-i delivered by pharmacists practicing in an outpatient clinic setting.
Methods: This study was a retrospective chart audit of adult patients with chronic insomnia who received CBT-i from a pharmacist at one of two outpatient clinics in Canada. The primary endpoints were the differences between patient self-reported sleep diary parameters and utilization of hypnotic medications before and after CBT-i was delivered. The differences in patient reported sleep parameters were compared using Wilcoxon Signed Rank test and paired samples t-test and changes in hypnotic utilization was compared using McNemar Chi-square test.
Results: 183 patients were referred for CBT-i and attended an initial appointment with a pharmacist. Of these, 105 did not receive the CBT-i. This resulted in 78 patients who met the inclusion criteria. Changes in sleep diary parameters were all statistically significantly improved after patients received CBT-i, except for total sleep time. Hypnotic medication use was also reduced. At baseline, 71.8% (n=56/78) of patients were taking one or more hypnotic medications compared to 52.6% (n=41/78) after CBT-i (p=0.0003).
Discussion: The results of this study provide preliminary evidence that pharmacists working in an outpatient clinic setting may be able to effectively deliver CBT-i for patients with chronic insomnia. The external validity of these results is limited by the observational study design and the inclusion of pharmacists practicing in outpatient clinics, which is not the setting where most pharmacists currently practice.
Conclusion: This observational study found improvements in sleep quality and efficiency, as well as, a reduction in hypnotic medication use, in patients who received CBT-i from pharmacists practicing in an outpatient clinic setting. Future randomized, controlled trials should evaluate the impact of CBT-i in a larger sample of patients, provided by pharmacists practicing in both outpatient clinics and community pharmacies.
Original Research
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Heslop-Marshall, Karen, Christine Baker, Debbie Carrick-Sen, Julia Newton, Carlos Echevarria, Chris Stenton, Michelle Jambon, et al. "Randomised controlled trial of cognitive behavioural therapy in COPD." ERJ Open Research 4, no. 4 (October 2018): 00094–2018. http://dx.doi.org/10.1183/23120541.00094-2018.
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Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective.Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire.In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62–4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19–2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49–2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.
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Rutter, Sarah, and Cathy Atkinson. "Educational psychologists’ use of cognitive behavioural therapy in professional practice." Educational and Child Psychology 39, no. 3 (December 2022): 113–28. http://dx.doi.org/10.53841/bpsecp.2022.39.3.113.
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AimThere is increasing recognition of the centrality schools have in supporting children and young people’s mental health and wellbeing, and the role of educational psychologists (EPs) in supporting this. Cognitive behavioural therapy (CBT) is a frequently-used, evidence-based approach for supporting a range of outcomes. The purpose of this study is to explore how EPs are operationalising CBT in their practice, and which therapeutic competencies are demonstrated.MethodSemi-structured interviews were completed with a self-selecting sample of eight EPs reporting to be knowledgeable about CBT and to regularly use it in their practice. Transcribed data were analysed using inductive and deductive thematic analysis.FindingsKey themes related to CBT in applied practice, the EP role, drawing on other psychological approaches, ethical practice, external influences and having a holistic view of the child. EPs were using CBT across a continuum of formality in therapeutic work and multi-faceted casework. A range of CBT competencies was demonstrated in practice with children and young people, and adults.LimitationsAs an exploratory research study the sample size was very small. The self-selecting sample does not claim to be representative of the wider EP population. The extent to which findings enable an understanding of the effectiveness of CBT within wider EP practice is extremely limited.ConclusionsThe flexibility of CBT as a therapeutic modality gives insight into its potential wider contribution across EP practice. Potential implications for EP professional training and practice are considered.
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Conradi, Henk Jan, Peter de Jonge, and Johan Ormel. "Cognitive–behavioural therapy v. usual care in recurrent depression." British Journal of Psychiatry 193, no. 6 (December 2008): 505–6. http://dx.doi.org/10.1192/bjp.bp.107.042937.
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SummaryWe examined in a primary care sample whether acute-phase cognitive–behavioural therapy (CBT) would be more effective than usual care for patients with multiple prior episodes of depression. Depression outcome was based on a 3-monthly administered Beck Depression Inventory (BDI) during a 2-year follow-up. We confirmed that in patients with four or more prior episodes, CBT outperformed usual care by four points on the BDI, but not in patients with three or fewer prior episodes. Subsequent analyses suggested that CBT may be able to tackle cognitive problems related to rumination in patients with recurrent depression.
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Totterdell, Peter, Stephen Kellett, and Warren Mansell. "Cognitive Behavioural Therapy for Cyclothymia: Cognitive Regulatory Control as a Mediator of Mood Change." Behavioural and Cognitive Psychotherapy 40, no. 4 (February 22, 2012): 412–24. http://dx.doi.org/10.1017/s1352465812000070.
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Background: Regulatory control of cognition is implicated in the amplification of mood variability in cyclothymia. Aims: This study examined whether cognitive behavioural therapy (CBT) directed at enhanced awareness and mood change could change global functioning, mood variability and regulatory control. Method: Using a prospective single case experimental design, mood and cognitive control ratings were recorded every 4 hours for 51 weeks by a patient diagnosed with cyclothymia, including a 5-week baseline, a 35-week (19 session) CBT intervention period and an 11-week follow-up period. Results: Findings indicated that the patient experienced reduced mood variability and greater regulatory control, became happier and less anxious but felt less energetic. Following CBT, high energy became negatively associated with positive mood, and this change was mediated by an increase in control over thoughts. Conclusions: The results suggest that CBT directed at cognitive control and mindfulness skills may help in the treatment of cyclothymia.
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Turkington, Douglas, and Peter J. McKenna. "Is cognitive-behavioural therapy a worthwhile treatment for psychosis?" British Journal of Psychiatry 182, no. 6 (June 2003): 477–79. http://dx.doi.org/10.1192/bjp.182.6.477.
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Cognitive-behavioural therapy (CBT) is of proven benefit for treatment of depression and has, over the past 5 years, been increasingly advocated as a treatment modality for schizophrenia. There has been considerable enthusiasm for the use of CBT in schizophrenia from psychiatrists, psychologists, psychiatric nurses and users alike. However, this enthusiasm may have precluded dispassionate evaluation of the effectiveness of this treatment. Even though an intervention is popular and is thought to be generally a ‘good thing’, we should not then take short-cuts through the evidence. In an era of limited resources every hour spent with a patient or training staff in a new technique must be justified. Is CBT really a worthwhile and effective treatment for patients with psychosis? This issue is debated by Dr Douglas Turkington, Senior Lecturer in Psychiatry in Newcastle upon Tyne and author of one of the leading texts on CBT for schizophrenia, and Dr Peter McKenna, consultant psychiatrist with the Cambridge Psychiatric Rehabilitation Service.
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McHugh, Patrick, Michael Gordon, and Michael Byrne. "Evaluating brief cognitive behavioural therapy within primary care." Mental Health Review Journal 19, no. 3 (September 2, 2014): 196–206. http://dx.doi.org/10.1108/mhrj-02-2014-0004.
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Purpose – The purpose of this paper is to evaluate the clinical effectiveness of a brief CBT intervention within a primary care adult mental health service. Design/methodology/approach – In total, 92 participants with mild to moderate mental health difficulties were provided with five sessions of brief CBT. Clinical improvement was measured using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, mid-treatment and post-treatment, and on the Beck Depression Inventory-II (BDI-II) at pre-treatment and post-treatment. Findings – The planned five sessions of CBT were completed by 48.9 percent (n=45) of participants. Treatment completers with full clinical data (n=31) showed large statistically significant improvements on the CORE-OM and BDI-II from pre-therapy to post-therapy. Of treatment completers and non-completers with post-therapy and mid-therapy CORE-OM data, respectively (n=34), 61.8 percent showed reliable and clinically significant change. No statistically significant differences were found between treatment completers (n=45) and non-completers (n=47) in their pre-therapy clinical scores or socio-demographic characteristics. Practical implications – Brief CBT can be a clinically effective primary care intervention but needs to be implemented in a way that ensures high treatment engagement across a range of service users. Originality/value – This paper contributes to the evidence base of a primary care psychological intervention and demonstrates the importance of assessing treatment completion when evaluating clinical effectiveness.
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Cowdrey, Felicity A., and Jennifer Davis. "Response to Enhanced Cognitive Behavioural Therapy in an Adolescent with Anorexia Nervosa." Behavioural and Cognitive Psychotherapy 44, no. 6 (March 9, 2016): 717–22. http://dx.doi.org/10.1017/s1352465815000740.
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Background: Few studies have examined the acceptability and usefulness of enhanced cognitive behavioural therapy (CBT-E) for adolescents with eating disorders (EDs). Aim: To investigate whether CBT-E was an acceptable and efficacious treatment for an adolescent presenting to a routine clinical service with an ED. Method: Daily self-monitoring records were completed during a baseline (A) and intervention (B) phase in addition to routine outcome measures. Results: There were reductions in both ED behaviours and “feeling fat”, and increases in weight after 11 CBT-E sessions. Progress was only partially maintained at 8-month follow-up. Conclusion: CBT-E may be an acceptable and useful intervention for adolescents with EDs.
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Beck, Judith S., Francine Broder, and Robert Hindman. "Frontiers in Cognitive Behaviour Therapy for Personality Disorders." Behaviour Change 33, no. 2 (April 14, 2016): 80–93. http://dx.doi.org/10.1017/bec.2016.3.
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Clinicians generally find individuals with personality disorders to be challenging to treat, especially compared to clients who have only a straightforward depression or anxiety disorder. In this article we will summarise research on the efficacy of cognitive behaviour therapy (CBT) for personality disorders. Then we will focus on the conceptualisation and treatment of CBT for personality disorders that is based on the work of Aaron Beck and colleagues; that is, it is predicated upon the cognitive model of psychopathology. Next, we will describe two other forms of treatment with cognitive behavioural roots: schema therapy and dialectical behaviour therapy. A final section will suggest future directions.
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Blackwell, Simon E., and Thomas Heidenreich. "Cognitive Behavior Therapy at the Crossroads." International Journal of Cognitive Therapy 14, no. 1 (February 8, 2021): 1–22. http://dx.doi.org/10.1007/s41811-021-00104-y.
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AbstractThe early development of cognitive behavior therapy (CBT) can be characterized by the coming together of behavioral and cognitive traditions. However, the past decades have arguably seen more divergences than convergences within the field. The 9th World Congress of Behavioural and Cognitive Therapies was held in Berlin in July 2019 with the congress theme “CBT at the Crossroads.” This title reflected in part the coming together of people from all over the world, but also the fact that recent developments raise important questions about the future of CBT, including whether we can in fact treat it as a unified field. In this paper, we briefly trace the history of CBT, then introduce a special issue featuring a series of articles exploring different aspects of the past, present, and future of CBT. Finally, we reflect on the possible routes ahead.
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Durham, Robert C., Moyra Guthrie, R. Victor Morton, David A. Reid, Linda R. Treliving, David Fowler, and Ranald R. MacDonald. "Tayside–Fife clinical trial of cognitive–behavioural therapy for medication-resistant psychotic symptoms." British Journal of Psychiatry 182, no. 4 (April 2003): 303–11. http://dx.doi.org/10.1192/bjp.182.4.303.
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BackgroundEvidence for the efficacy of cognitive–behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.AimsTo test the effectiveness of cognitive–behavioural therapy delivered by clinical nurse specialists in routine practice.MethodOf 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive–behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.ResultsTreatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).ConclusionsCognitive–behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.
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Scott, Jan, Eugene Paykel, Richard Morriss, Richard Bentall, Peter Kinderman, Tony Johnson, Rosemary Abbott, and Hazel Hayhurst. "Cognitive–behavioural therapy for severe and recurrent bipolar disorders." British Journal of Psychiatry 188, no. 4 (April 2006): 313–20. http://dx.doi.org/10.1192/bjp.188.4.313.
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BackgroundEfficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.AimsTo compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).MethodWe undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months.ResultsMore than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.ConclusionsPeople with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.
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Ajasllari, Jeta. "Cognitive Behavioural Therapy (CBT) and Treatment of Paediatric Patients with Chronic Renal Disease." Global Journal of Psychology Research: New Trends and Issues 6, no. 2 (November 18, 2016): 53–62. http://dx.doi.org/10.18844/gjpr.v6i2.560.
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The aim of this study was to evaluate the effectiveness of an intervention with CBT in patients with chronic renal disease. The study findings are in the context of previous researches and existing theories. Searches were done in the professional literature related to different chronic diseases and respectively with Chronic Kidney Disease in children and adolescents. Many paediatric chronic diseases are difficult to be managed because of the limitations caused by the disease itself; consequently, some of them need to be subjected to painful and difficult medical procedures as well. Respectively, for children diagnosed with CKD life changes completely because of limitations, mainly physical ones, due to the characteristics of the disease which require constant adaption as well as development of strategies to face the disease. Their behaviours must change accordingly as part of a new life of self-care. Cognitive-Behavioural Therapy is a psychological therapy, which has been investigated extensively and has been found as very effective to reduce psychological symptoms caused by the disease. This therapy integrates the modification of behaviour with the cognitive restructuring, the aim of which is to change the patient’s unhealthy behaviours through cognitive and behaviour techniques. Keywords: children; chronic kidney disease; cognitive behavioural therapy
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Feehan, Catherine J., and Panos Vostanis. "Cognitive-Behavioural Therapy for Depressed Children: Children's and Therapists' Impressions." Behavioural and Cognitive Psychotherapy 24, no. 2 (April 1996): 171–83. http://dx.doi.org/10.1017/s1352465800017422.
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A randomized trial was conducted of cognitive-behavioural therapy and a non-focused intervention for children and adolescents aged 8–16 years with depression (N = 57) referred to four child and adolescent psychiatry units. Children in both groups showed similar rates of recovery from depression at the end of treatment (cognitive-behavioural therapy: 87% recovery rate; non-focused intervention: 75% recovery rate). This paper addresses the question of how cognitive-behavioural therapy was perceived and used by depressed young sters in clinical settings (N=29). Only seven children (24%) kept a diary for all nine sessions of the CBT programme. Children who had been rated as compliant with CBT tasks were more likely to recover at the end of treatment. Analysis of the content of each cognitive-behavioural session has shown that all children received advice on self-monitoring, positive self-statementing, and social problem-solving, but only 50% actually received advice on cognitive restructuring, since this was scheduled late in the treatment package and most children had recovered by this stage. Children, parents and therapists had a high degree of agreement on the helpfulness of CBT. Children identified several helpful CBT elements, the majority being related to social problem-solving. The treatment programme was explained to parents, who did not actively participate in treatment, but they helped to plan suitable rewards for their children. Recommendations are made for the future use of CBT with referred young people with depressive disorders.
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Wilkinson, Philip. "Cognitive behavioural therapy with older adults: enthusiasm without the evidence?" Cognitive Behaviour Therapist 2, no. 2 (June 2009): 75–82. http://dx.doi.org/10.1017/s1754470x09000191.
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AbstractCognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.
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Pilgrim, David. "Rhetorical Aspects of the Contention about Cognitive Behavioural Therapy." History & Philosophy of Psychology 11, no. 2 (2009): 37–54. http://dx.doi.org/10.53841/bpshpp.2009.11.2.37.
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Cognitive behavioural therapy (CBT) has been promoted, in recent years, as the treatment of choice for mental health problems. However, its ascendency has also met with opposition, especially from clinical psychologists unconvinced by its merits. In this article, an explicit link is offered between the history of British empiricism and the emergence of CBT as a professional orthodoxy. After this link is made then a form of rhetorical inquiry is used to explore why that orthodoxy is currently controversial in the context of the professionalization of British clinical psychology. The rhetorical credibility of CBT rests upon notions of simplicity, objectivity and scientific evidence. However, its critics draw attention to its naivety, its lack of respect for diverse needs and its theoretical confusion and inadequacy. This contention is exemplified by the proposals from, and criticisms of, a multi-disciplinary report on ‘depression’, which has underpinned a policy shift involving increased access to psychological therapy in Britain.
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Hedman, Erik, Gerhard Andersson, Erik Andersson, Brjánn Ljótsson, Christian Rück, Gordon J. G. Asmundson, and Nils Lindefors. "Internet-based cognitive–behavioural therapy for severe health anxiety: randomised controlled trial." British Journal of Psychiatry 198, no. 3 (March 2011): 230–36. http://dx.doi.org/10.1192/bjp.bp.110.086843.
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BackgroundHypochondriasis, characterised by severe health anxiety, is a common condition associated with functional disability. Cognitive–behavioural therapy (CBT) is an effective but not widely disseminated treatment for hypochondriasis. Internet-based CBT, including guidance in the form of minimal therapist contact via email, could be a more accessible treatment, but no study has investigated internet-based CBT for hypochondriasis.AimsTo investigate the efficacy of internet-based CBT for hypochondriasis.MethodA randomised controlled superiority trial with masked assessment comparing internet-based CBT (n= 40) over 12 weeks with an attention control condition (n= 41) for people with hypochondriasis. The primary outcome measure was the Health Anxiety Inventory. This trial is registrated with ClinicalTrials.gov (NCT00828152).ResultsParticipants receiving internet-based CBT made large and superior improvements compared with the control group on measures of health anxiety (between-group Cohen'sdrange 1.52–1.62).ConclusionsInternet-based CBT is an efficacious treatment for hypochondriasis that has the potential to increase accessibility and availability of CBT for hypochodriasis.
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Oei, Tian P. S., and Alice E. O. Yeoh. "Pre-Existing Antidepressant Medication and the Outcome of Group Cognitive-Behavioural Therapy." Australian & New Zealand Journal of Psychiatry 33, no. 1 (February 1999): 70–76. http://dx.doi.org/10.1046/j.1440-1614.1999.00520.x.
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Objective: This study aimed to investigate the impact of pre-existing medication on the outcome of group cognitive-behavioural therapy (CBT) in the treatment of patients with depression. Method: Of the 71 patients diagnosed with major depression who participated in group CBT, 25 were on medication (CBT-M) and 46 were unmedicated (CBT). The patients received 12 sessions of group CBT over a 3-month period. The dependent measures used were the Beck Depression Inventory, Zung Self-Rating Depression Scale, Automatic Thoughts Questionnaire, Hopelessness Scale, Dysfunctional Attitude Scale, Daily Activity Rating Scale and Daily Mood Rating Scale. Results: Both the CBT and CBT-M groups showed statistically significant improvement in depression scores and cognitive process measures. However, the rate of improvement for both groups on these measures did not differ. Conclusion: The study indicated that pre-existing antidepressant medication did not enhance or detract from the positive treatment outcome of depressed patients receiving a group CBT treatment.
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Neal, Rachael L., and Adam S. Radomsky. "What do you really need? Self- and partner-reported intervention preferences within cognitive behavioural therapy for reassurance seeking behaviour." Behavioural and Cognitive Psychotherapy 48, no. 1 (September 9, 2019): 25–37. http://dx.doi.org/10.1017/s135246581900050x.
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AbstractBackground:Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.Aims:This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.Method:Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.Results:Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.Conclusions:Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.
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Onur, O., D. H. Ertem, D. Uludüz, and Ç. Karşıdağ. "Cognitive behavioral therapy for chronic migraine." European Psychiatry 41, S1 (April 2017): s500. http://dx.doi.org/10.1016/j.eurpsy.2017.01.626.
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AimAlthough current standard treatment for migraine headache is medication, high levels of psychological comorbidity has led to migraine influencing by cognitive, emotional and environmental factors, as well as biological. Viewing migraine in a biopsychosocial framework introduces the possible utilisation of psychological treatment options, such as cognitive behavioural therapy (CBT). The aim of this study was to evaluate the efficacy of CBT for chronic migraine.MethodologyThirty-five participants diagnosed as chronic migraine were recruited from Headache Clinic. According to inclusion criteria 14 participants, underwent bi-weekly lasting 30 minutes CBT sessions for 6 months, were administered Hamilton Anxiety Scale, Hamilton Depression Scale, Visual Analog Scale (VAS) and the Migraine Disability Assessment Scale (MİDAS) before and after CBT.FindingsNine of the participants were female and 5 male. Mean age of group was 34.35 ± 8.17. Duration of illness was 13.07 ± 7.18 and 12 of participants had the history of a psychiatry illness whose diagnoses were depression (7), anxiety disorder (4) and post-traumatic stress disorder (1). Nine of the patients had prophylactic migraine treatment. There were statistically significant difference in Hamilton Depression scores between before CBT (29.07 ± 7.74) and after CBT (14.21 ± 7.7); in Hamilton Anxiety scores before CBT (26.8 ± 11.7) and after CBT (11.7 ± 2.6); in VAS scores before CBT (8.07± 0.91) and after CBT (3.71 ± 1.32); in frequency of migraine attacks between before CBT (10.85 ± 3.50 day) and after CBT (4.92 ± 2.70 day) and in MİDAS before CBT (55.5 ± 20.4) and after CBT (20.12 ± 16.6) (P < 0.05).ConclusionCBT might reduce the severity of symptoms in migraine patients especially with the comorbidity of psychiatric illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Morrison, Anthony P., Melissa Pyle, Andrew Gumley, Matthias Schwannauer, Douglas Turkington, Graeme MacLennan, John Norrie, et al. "Cognitive–behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT." Health Technology Assessment 23, no. 7 (February 2019): 1–144. http://dx.doi.org/10.3310/hta23070.
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BackgroundClozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of cognitive–behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome.DesignThe Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU).SettingSecondary care mental health services in five cities in the UK.ParticipantsPeople with CRS aged ≥ 16 years, with anInternational Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms.InterventionsIndividual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services.Main outcome measuresThe primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs.ResultsParticipants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) –3.32 to 1.55 points;p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (–2.40 points, 95% CI –4.79 to –0.02 points;p = 0.049). CBT was associated with a net cost of £5378 (95% CI –£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46;p = 0.58).ConclusionsCognitive–behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained.Trial registrationCurrent Controlled Trials ISRCTN99672552.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Baile, José I., and María F. Rabito-Alcón. "Cognitive Behavioural Therapy for an Adolescent with Anorexia Nervosa." Children 9, no. 1 (January 10, 2022): 92. http://dx.doi.org/10.3390/children9010092.
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Introduction: The treatment of anorexia nervosa remains a matter of much debate. Though cognitive behavioural therapy would seem to offer good results, there is still no resounding evidence pointing to a single treatment of choice. The case presented in this paper examines the treatment with CBT of a patient presenting anorexia nervosa. Evaluation/diagnosis: An adolescent girl, 17 years of age, voluntarily attends psychological therapy to address eating behaviour problems. After administering the EAT-26, EDI-2, and BSQ standardised screening tests, as well as a clinical interview for assessment, a psychopathological profile is obtained, providing a diagnosis of anorexia nervosa, restricting subtype. Therapeutic goals: The therapeutic goals set were to reach a healthy weight for the patient’s age and height (specified as a minimum BMI of 18.5) and change the structure of thoughts, feelings, and behaviour that was justifying and maintaining the disorder. Treatment: Treatment lasted for 33 sessions and used cognitive behavioural techniques, such as cognitive restructuring, response cost, and positive reinforcement, in addition to family intervention techniques. Nutrition therapy was also carried out in parallel to the treatment sessions. Results: Following eight months of weekly sessions, the patient reached the target weight and changed attitudes towards food and body image, replacing them with healthy thoughts and behaviours. Follow-up made one and two years after the end of the treatment saw that these results were maintained. Discussion and conclusions: In this case, CBT proved effective in achieving the patient’s physical and psychological recovery. Therefore, this case contributes to the evidence of the efficacy of this therapeutic approach in certain cases of ED.
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Spector, Aimee, Georgina Charlesworth, Michael King, Miles Lattimer, Susan Sadek, Louise Marston, Amritpal Rehill, et al. "Cognitive–behavioural therapy for anxiety in dementia: pilot randomised controlled trial." British Journal of Psychiatry 206, no. 6 (June 2015): 509–16. http://dx.doi.org/10.1192/bjp.bp.113.140087.
Full textAbstract:
BackgroundAnxiety is common and problematic in dementia, yet there is a lack of effective treatments.AimsTo develop a cognitive–behavioural therapy (CBT) manual for anxiety in dementia and determine its feasibility through a randomised controlled trial.MethodA ten-session CBT manual was developed. Participants with dementia and anxiety (and their carers) were randomly allocated to CBT plus treatment as usual (TAU) (n= 25) or TAU (n= 25). Outcome and cost measures were administered at baseline, 15 weeks and 6 months.ResultsAt 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (–3.10, 95% CI −6.55 to 0.34) for CBT compared with TAU, which just fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (–5.37, 95% CI −9.50 to −1.25). Improvements remained significant at 6 months. CBT was cost neutral.ConclusionsCBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now required.