Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia

OBJECTIVE: A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric setting. METHOD: Twelve adolescents with social phobia (ages 13-18), diagnosed by DSM-IV criteria and confirmed with Anxiety Disorders Interview Schedule for Children assessment, were randomly assigned to treatment (n=6) and waitlist (n=6) groups. The waitlist group was subsequently treated, and results were included in the data analysis. Assessments, including Anxiety Disorders Interview Schedule for Children interviews and self-report Social Phobia and Anxiety Inventory and Beck Depression Inventory II questionnaires, were performed at baseline and immediately after treatment or waitlist. RESULTS: All subjects completed the treatment program. Compared with the waitlist group, treated subjects showed significantly greater improvement in both examiner-evaluated (Anxiety Disorders Interview Schedule for Children) and self-reported (Social Phobia and Anxiety Inventory) symptoms of social anxiety (effect sizes [d], 1.63 and 0.85, respectively). No significant change was seen in Beck Depression Inventory II scores for treatment or waitlist groups. CONCLUSIONS: This study provides support for the use of simplified cognitive-behavioral interventions for adolescents with social phobia that are practical for community psychiatric settings.     

Improving mental health through community action

This article reviews briefly some of the theoretical ideas and empirical findings which support the notion that societal processes that produce stress may lead to psychiatric disorder. Based on this, a conceptual model for improving mental health through community action is outlined. A case report is then given describing one effort to apply the model in an urban mental health center. Characteristics of the model are thus clarified and illustrated. Next steps are then suggested whereby the effectiveness of this approach to mental health through community action can be further developed and evaluated.     

Improving medication compliance of a patient with schizophrenia through collaborative behavioral therapy

Introduction by the column editors: Numerous factors influence a patient's decision to accept or reject prescribed medications, including the patient's personal values, environmental conditions, and the quality of the patient-physician relationship (1). Guidelines for evaluating and managing noncompliance with medication regimens by patients with schizophrenia take this multidimensional perspective into account, emphasizing functional assessment of nonadherence behaviors and individualized behavior-change strategies to secure and maintain the patient's cooperation (2). Moreover, a collaborative approach to planning pharmacotherapy is required to ensure medication compliance, with a particular emphasis on linking the positive effects of medications with the patient's personal goals and desires for better functioning and quality of life (3).The following case study illustrates the application of principles for enhancing medication compliance in the treatment of a woman diagnosed as having schizophrenia, paranoid type. Strategies presented by Dr. Heinssen include collaborative treatment contracts, analysis of adherence behaviors, and techniques for boosting medication cues and reinforcers in the patient's home. The therapy described was provided in the Life Skills partial hospitalization and psychiatric rehabilitation program, a multidisciplinary, multilevel outpatient service of the now-closed Chestnut Lodge Hospital in Rockville, Maryland. The program integrated medical, social-learning, and cognitive-behavioral interventions for psychosis within a psychiatric rehabilitation framework.     

青少年认知偏差和心理健康的关系

目的探讨青少年认知偏差的特点及其与心理健康关系。方法以中小学生认知调查量表、中国中学生心理健康量表为工具,随机抽取广州市3所中学653例中学生进行研究。结果（1）认知偏差问题总体检出率为35．4％,严重认知偏差检出率为2．9％,“过度完美”、“苛求善待”是主要认知偏差问题;（2）中度以上心理健康问题检出率为4．3％,较严重的心理健康问题检出率为0．15％,“情绪不良”、“学习压力”、“适应不良”是主要心理健康问题;（3）认知偏差与心理健康相关显著,维护自我、获得关注、苛求善待、消极态度对心理健康有预测作用,联合解释率是16．7％。结论青少年认知偏差与心理健康之间存在显著负相关,本研究提示可利用认知调节来提高中学生的心理健康水平。     

认知行为治疗在精神科的价值

生物—心理—社会因素共同影响下的精神障碍在我国成年人群中的现患病率高达17.5%,其中主要是抑郁障碍、焦虑障碍、物质使用障碍等,但临床上对这些疾病的治疗依然以药物为主.虽然大量研究证实了认知行为治疗(CBT)在多种精神障碍治疗中的一线地位,有关CBT治疗各类精神障碍起效的神经生物学机制的医学影像学的研究已成为目前研究的热点之一,但国内精神科及心理学领域的专业人员对于规范的认知行为治疗理论与实践操作普遍缺乏深入的了解,也自然缺乏足够的合格CBT专业人员在临床工作中为患者提供其所需的CBT.现就CBT的起源、发展、理论模型及临床操作流程做简要介绍,并结合案例介绍其关键技术,以推动国内更多的同行关注并主动接受CBT培训,以此拓展与提升国内精神心理卫生服务的能力,更好地服务于患者.     

Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study

Background: Cognitive Behavioral Therapy (CBT) has demonstrated benefits for anxious school‐aged children and adolescents; however, treatment programs have not been developed to teach CBT strategies to children under the age of eight. This pilot study examined a novel treatment program for children aged 5–7 years with anxiety disorders. Methods: Thirty‐two children (19 females) aged 5–7 years (mean age=6.51 years) with DSM‐IV anxiety disorders and their families completed a 12‐week, manualized CBT group program. Parent and child groups (5–8 children per group) were held separately but concurrently. Multiple measures of anxiety (Screen for Child Anxiety Related Emotional Disorders, Anxiety Disorders Interview Schedule for DSM‐IV—Parent Version, and clinician Children's Global Assessment Scale ratings) were completed pre and post each treatment series. A subset of participants (n=11; 8 females; mean age=6.34 years) completed an initial assessment followed by a wait period of approximately 3.5 months (range 2.5–5 months) with a second assessment just before treatment start. No treatment was received during this wait time. Results: With treatment, 43.8% of children no longer met criteria for any Axis 1 anxiety disorders whereas 71.9% had at least one anxiety disorder resolve. A series of paired, two‐tailed t‐tests revealed significant reduction in anxiety symptoms on standardized measures. Children who waited for treatment showed no significant change in anxiety symptoms during nontreatment but demonstrated improvement after program attendance. Conclusions: This pilot study suggests that CBT can be used effectively to treat anxious children as young as 5 years of age. Further research is warranted. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Comparing cognitive behavioral therapy and integrated cognitive behavioral therapy/psychodynamic therapy in group treatment for partner violent men

This was a pilot study comparing the effectiveness of cognitive-behavioral therapy (CBT; n = 18) with integrated CBT and psychodynamic therapy (CBT/PT; n = 27) in reducing partner violence. The study examined differences between the two treatment groups at posttreatment with regard to attachment dimensions, interpersonal problems, psychological/behavioral functioning, and general symptom and relationship distress. Results indicated that the CBT/PT groups showed significantly more improvement than the CBT groups on measures of partner violence, attachment, and interpersonal problems at posttreatment. Conversely, the CBT groups showed significantly more improvement than the CBT/PT groups on measures of psychological/behavioral functioning and general symptom and relationship distress. Finally, there was a significant difference between the treatment groups on recidivism rate, with the CBT/PT groups having the lowest rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

A mental health consultation-education program with group service agencies in a disadvantaged community

The consultation-education program described here worked with about 20 community-based group service agencies in a severely deprived urban area. The agencies included: (a) traditional neighborhood houses, (b) recreational and character-building centers, (c) church-sponsored group programs, and (d) neighborhood service centers. The program involved: (a) a planning body of administrators of group service agencies, (b) a consultation service on problems of individuals or groups, and (c) training workshops for agency staff. The program was geared to both institutional changevia enhanced integration of services and promotion of new skills, and to attitude changeof individual psychosocial caretakers.The authors wish to acknowledge the help of Dr. Melvin S. Roman, Mr. Emanuel Hallowitz, and Mrs. Joan Margolis in the development of this program.     

Family cognitive behavioral therapy for children and adolescents with clinical anxiety disorders

OBJECTIVE: A family cognitive-behavioral therapy for children and adolescents ages 8 to 18 years with clinical anxiety disorders was developed and evaluated. METHOD: Seventeen families were measured before and after wait list, after treatment, and at 3-month and 1-year follow-up. RESULTS: No children changed their diagnostic status during wait list, whereas of the treated children, 41% were free of their primary anxiety disorder posttest, 57% at 3-month follow-up, and 71% at 1-year follow-up. Effect sizes of improvement were large for children's fears, dysfunctional beliefs, and interpretations of ambiguous situations and medium for children's internalizing and externalizing symptoms. Interestingly, fathers but not mothers reported less anxiety themselves after treatment. Large improvements were observed on parents' dysfunctional beliefs about their child's anxiety and their role as a parent. Finally, some improvements occurred in family and rearing variables. CONCLUSIONS: Family cognitive-behavioral therapy seems effective for clinically anxious children and their families.     

Improving mental health and substance abuse services for adolescents

This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families. Depending on the state of knowledge of each topic, the authors either highlight the importance of the area or offer a specific position statement. It is intended that these statements be reviewed for possible endorsement by the American College of Mental Health Administration (ACMHA) and for transmission to other professional organizations, federal and state governmental agencies and the field in general.     

Moderators of PTSD symptom change in group cognitive behavioral therapy and group present centered therapy

To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p = .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p = .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p = .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p = .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.     

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.     

Clinic-friendly screening for cognitive and mental health problems in school-aged youth with epilepsy

Cognitive, psychiatric, psychosocial, and behavioral difficulties are common in youth with epilepsy. Collectively, these comorbidities can be referred to as mental health problems as they reflect brain and behavioral function. Detection and treatment of mental health problems remain an unmet need in epilepsy care that can impact epilepsy, psychosocial, scholastic, and quality-of-life outcomes. Given limited resources in everyday pediatric epilepsy practice, this targeted review provides a stratified plan and suggested tools for screening school-aged youth with epilepsy for the presence of mental health problems. Comanagement of epilepsy and associated comorbidities is a newer concept that may help address the complex, long-term needs of patients by using a multidisciplinary team approach and by engaging primary care providers.     

Marketing a mental health program

Correspondence: Compeer, Inc., Monroe Square-Suite B-1, 259 Monroe Ave., Rochester, NY, 14607.     

Increasing the effectiveness of frontline workers through a model mental health training program

The Ontario Ministry of Housing provides permanent, affordable, independent housing for mental health consumers. This approach, not contingent on consumer participation in support service programs, is part of a continuum of housing options. To help integrate consumers into social housing communities, the ministry engaged a Senior Advisor, Mental Health, to develop alternate ways to maintain housing for this group. A province-wide mental health training initiative aimed at front-line housing staff, which uses unique techniques such as popular theatre, experiential exercises and partnership building/strategic alliance development will be described in this paper.Sheri Weisberg conducted this study as Senior Advisor, Mental Health for the Ontario Ministry of Housing.     

网络团体认知行为治疗在改善抑郁焦虑症状中的应用

本文目的是对网络团体认知行为治疗（IGCBT）改善抑郁焦虑症状方面的文献进行综述,分别从治疗形式、治疗方案、疗效及作用机制等方面进行阐述,并总结其局限性和未来研究方向。认知行为治疗（CBT）是一套结构化的、短程的、着眼于现在的心理治疗方法,网络和团体的开展形式使得CBT的应用更加广泛,其在缓解不同疾病引起的抑郁焦虑症状方面效果较好,但也存在一些弊端。本文通过回顾IGCBT的临床应用及其对改善患者抑郁焦虑症状的效果和作用机制,为其今后的应用提供参考。