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CONTENTS
REGULAR ARTICLES
ISSUES IN DIVERSITY • Steve Safran, Ph.D., Section Editor BOOK REVIEW • James Herbert, Ph.D., Section Editor ABSTRACTS EDITOR’S INVITATION: Getting Back to Basics: Primers in Cognitive and Behavioral Therapy This editorial is an invitation to submit papers to a new recurring series, “Primers in Cognitive and Behavioral Practice.” CB Primers will be concise papers focused on specific concepts, principles, and procedures that form the foundations of cognitive and behavioral practice. Papers should begin with an introduction and definition of the concept, principle, or procedure, and, whenever possible, include several examples from clinical cases or applied scenarios. Space permitting, a short summary of relevant empirical studies should be included or a brief bibliography of key papers or review texts. This is an open invitation to submit papers on the concepts identified in the questions above in addition to any relevant construct or issue in CBT. Interested authors may discuss potential paper ideas with me by e-mail (annemarie.albano@med.nyu.edu). All papers will go through a peer review process. One more thing to consider— CB Primers may be an excellent vehicle for papers authored by students and trainees. If you are spending time answering essay questions regarding the assumptions of behavior therapy, the mechanisms underlying interoceptive exposure, or the reasons for why punishment is considered an ineffective method for inducing lasting positive behavioral change, a bit of tweaking and a critical read by a mentor could turn the paper into a publication. Not only does this serve the author well but it also serves the broader field of cognitive and behavioral therapists who have little time to dust off the old textbooks and get back to the basics.
Consistent with the goal of providing reviews of core strategies and principles used in cognitive-behavior therapy (Albano, 2003), this article is devoted to a discussion of the philosophy, elements, and potential benefits of treatment contracting. Treatment contracting is discussed as a way of formalizing the goals, responsibilities, and strategies to be employed in treatment by therapists, patients, and the patient’s support network. In particular, we discuss the potential value of contracts for enhancing motivation and eliciting adaptive behaviors from patients, particularly at moments of high stress or high risk when these behaviors are most needed. In addition, we comment on how contracts can serve as an agreement of advocacy for patients who may fail to take appropriate action for themselves during acute distress. We provide an example of a treatment contract for use with adults with posttraumatic stress disorder (PTSD). This contract most directly focuses on enhancing motivation for treatment and engendering self-care, and is embedded in the context of an informational worksheet detailing common patterns in PTSD.
This paper describes a multimodality trauma treatment protocol (MMTT) for children and adolescents with PTSD. Based upon empirically validated cognitive-behavioral methods of treating PTSD in adults and anxiety and aggression in children, MMTT was developed as a group intervention administered in schools to treat children and adolescents exposed to single-incident trauma resulting in PTSD. In this paper, the protocol development and outcome data is described, followed by a detailed overview of the protocol. Attention is given to clinical implications for both school and community mental health center application of the protocol.
Dramatic changes over the past 3 decades have significantly affected the way clinical services for alcohol problems are conceptualized and provided. An important trend is toward delivering services outside of specialized alcohol programs. Expansion of services to primary health care and mental health settings is likely to reach greater numbers of individuals than can be reached in specialized alcohol treatment programs. An important aspect of the change has been the introduction of motivational interviewing (MI) techniques. Although motivation was once viewed as a trait to explain both poor outcomes as well as why people drop out of treatment, today motivation is conceptualized as a state that can be influenced by therapists. MI is a nonconfrontational way of talking and interacting with clients that involves delivering messages in a manner that avoids eliciting resistance (e.g., not using labels such as “alcoholic”). MI has been shown to increase compliance, reduce resistance, decrease dropouts, and result in better treatment outcomes with all types of alcohol abusers, from those who are mildly dependent to those who are severely dependent on alcohol. This article also provides a table of major MI do’s and don’ts and examples of what to say and what not to say to clients.
Generalized anxiety disorder (GAD) is a chronic, pervasive disorder associated with significant impairment in functioning. While cognitive-behavioral interventions appear to be relatively efficacious in reducing GAD symptoms, the proportion of treated individuals who reach desired levels of end-state functioning is less than ideal. A number of recent theoretical and empirical advances in the field have led to the development of novel, experimental treatments for GAD. The current paper describes the integration of acceptance and mindfulness techniques into an existing cognitive-behavioral group treatment for GAD. Data from 4 clients suggest that further refinement of acceptance and mindfulness methods may facilitate improvement in the quality of life and psychosocial functioning of individuals diagnosed with GAD.
This article describes a three-stage model that can be used to guide the cognitive-behavioral treatment of depression. During the first stage, the therapist establishes a sound therapeutic alliance, conducts a thorough assessment of depression, and uses differential diagnosis to guide the preliminary treatment plan. During the second stage, a series of modules are used to match the treatment plan with the particular needs of each client. The modules target different areas that are often related to depression: reduced activity, social impairment, ineffective coping, cognitive biases, problem-solving deficits, and inadequate self-esteem. During the third stage, depressed clients can learn specific strategies to reduce the risk of relapse and manage the possible recurrence of depressive feelings. The three-stage model promotes an integration of treatment strategies and allows the therapist to provide a structured treatment plan that remains responsive to the needs of each particular client.
Virtual reality as a medium for exposure therapy in the treatment of social anxiety was utilized in a private-practice setting for two different courses of individual treatment: weekly psychotherapy and a 3-day intensive course of therapy. Participants met diagnostic criteria for social phobia with prominent public speaking fears, and completed self-report questionnaires at pretreatment and posttreatment. During exposure therapy, participants were presented with a virtual audience, consisting of video of actual people embedded within a virtual classroom environment. Results indicated that treatment was successful as measured by completion of a behavioral avoidance test at the end of treatment, decreases in self-reported measures of public speaking anxiety comparable to controlled clinical outcome trials for social phobia, and qualitative feedback. Follow-up data, obtained from 1 participant, showed continued improvement after therapy was completed. These preliminary findings suggest that virtual reality may be a useful tool for exposure therapy within a comprehensive treatment of social anxiety.
Cognitive behavior therapy (CBT) has been demonstrated to be a useful adjunct to medication and other standard treatments for schizophrenia patients. Although the cognitive approach to schizophrenia has become popular in the United Kingdom, it has received relatively little attention in the United States. The present paper serves as on overview of CBT for schizophrenia, with an emphasis on delusions. We discuss the purpose and enumerate the challenges of conducting CBT with schizophrenia patients, providing specific case examples and strategies—such as normalizing, collaboration, behavioral experiments, understanding the meaning of patients’ delusions, role-plays, and imagery exercises—for handling such challenges. It is concluded that CBT can lead to decreased distress associated with patients’ symptoms.
Practicing psychologists frequently are asked to provide services to individuals whose backgrounds may differ from their own. Education in multicultural issues increasingly is being considered an important component of doctoral training programs. This article discusses the results of a survey of behavioral doctoral students concerning their graduate training on gay, lesbian, and bisexual (GLB) issues. The results indicate that participants (a) have received minimal training in GLB issues, (b) feel inadequate in working with GLB individuals, and (c) express significantly more favorable attitudes toward gay men than a sample from the general population. Included are recommendations for improving training in sexual orientation issues in behavioral clinical psychology programs. |
Getting Back to the Basics: Primers in Cognitive and Behavioral Therapy