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CONTENTS For a full PDF version of the issue, click here.
The growth of managed health care in the United States has placed a high premium on the goal of efficiency in the treatment of psychopathology, but without sacrificing treatment efficacy in the process. A preliminary evaluation of a brief, 6-week version of cognitive behavioral group therapy (CBGT) for generalized social anxiety disorder was conducted. Various self-report and behavioral assessment measures were collected at pre- and posttreatment, and self-report assessments were again conducted at 6- and 12-week follow-ups. The results suggest improvement during the acute 6-week treatment phase, and further improvement during the 6 weeks following treatment termination. These gains were maintained at the 3-month follow-up assessment. Effect-size comparisons with prior studies revealed that the present treatment produced comparable treatment gains at the 6-week follow-up assessment to those produced by prior studies using the standard 12-week CBGT protocol. Clinical and research implications are discussed.
Parent-Child Interaction Therapy (PCIT) is a short-term, evidence-based parent training program for families with 2- to 6-year-old children experiencing behavioral, emotional, or family problems. Based on both attachment theory and social learning theory, PCIT research has provided evidence of efficacy, generalization, and maintenance. The new directions in PCIT research are highlighted in this article.
The scientist-practitioner model depends on the interplay of research and clinical work. Just as research informs and improves clinical practice, clinical practice leads to the generation of important and practical research questions. The purpose of this article is to describe the clinical application of Parent-Child Interaction Therapy (PCIT), detailing its essential clinical components and presenting a case example that illustrates the application of PCIT to the treatment of child physical abuse. Recommendations for common implementation difficulties are presented through the case example.
Many behaviorally trained scientist-practitioners have noted the poor utilization of behavioral interventions in psychiatric treatment settings. However, few have applied their behavior change skills to improve the organizational systems that are failing. This study first reviews the additive impact of a three-phase organizational change program, grounded in behavioral science, to reduce seclusion/restraint reliance in a public psychiatric hospital. It then describes a variation of the procedure that was subsequently applied to the problem of psychotropic prn medication reliance, both within the hospital and to a specific ward that evinces relatively high reliance. Significant reductions were realized in reliance on these procedures for the management of difficult cases. The results supplement previous evidence of the value of behavioral methods for individualized and ward-level program interventions by demonstrating that they also hold value for identifying relevant organizational problems and for instigating, strengthening, and maintaining organizational system changes to improve the quality of care. The advantages of a grounding in behavioral science and intervention methods for the provision of health care in management of public systems, as well as guidelines for behavioral clinicians who wish to enhance their impact on such systems, are discussed. SPECIAL SERIES—Integrating Buddhist Philosophy With Cognitive and Behavioral Practice
This series provides one of the first articulations of Buddhism by empirically trained therapists and theorists with varying degrees of interest and personal involvement in Buddhist practice. It is meant as a guide to open dialogue between empirically trained mental health practitioners and Buddhist scholars, and as an initial attempt to appreciate what this 2,500-year-old school of philosophy has to offer to contemporary scientific approaches to human behavior and suffering. Included among the references cited in this introduction, are many excellent sources of further information about Buddhism. There are as many viewpoints about Buddhism, its tenets, and its application as there are Western schools of therapy and theories of behavior. This list is brief by necessity of space, and readers are encouraged to form their own personal libraries of relevance from this beginning.
Basic concepts in Buddhism are presented for cognitive-behavioral therapists. Buddhist theoretical causes of suffering are presented as extensions of cognitive assumptions of selfhood. The essentialist position is contrasted to the Buddhist perspectives of dialectics and interdependence. The focus on impermanence in Buddhist thought is presented. The synergistic relationship between compassion and mindfulness is examined. Compassion as both behavioral alternative to essentialism as well as precursor to mindfulness is discussed. Additionally, mindfulness meditation from the Buddhist perspective is presented.
The purpose of this paper is to provide an overview of how Buddhist philosophy can be applied in the treatment of individuals with substance abuse problems (alcohol, smoking, and illicit drug use) and other addictive behaviors (e.g., compulsive eating and gambling). First I describe the background of my own interest in meditation and Buddhist psychology, followed by a brief summary of my prior research on the effects of meditation on alcohol consumption in heavy drinkers. In the second section, I outline some of the basic principles of Buddhist philosophy that provide a theoretical underpinning for defining addiction, how it develops, and how it can be alleviated. The third and final section presents four principles within Buddhist psychology that have direct implications for the cognitive-behavioral treatment of addictive behavior: mindfulness meditation, the Middle Way philosophy, the Doctrine of Impermanence, and compassion and the Eightfold Noble Path. Clinical interventions and case examples are described for each of these four principles, based on my research and clinical practice with clients seeking help for resolving addictive behavior problems.
Dialectical behavior therapy (DBT; Linehan, 1993a) was developed as a treatment for borderline personality disorder (BPD). It involves a dialectical synthesis of the change-oriented strategies of cognitive-behavioral therapy with more acceptance-oriented principles and strategies adapted primarily from client-centered therapy and from Zen. In this paper, I note both similarities and contrasts between cognitive-behavioral therapy and Zen. I then highlight the role of Zen principles in DBT’s assumptions about patients, theory of BPD, selection of treatment targets, and treatment strategies. Finally, the article describes the value of mindfulness practice for patients with BPD, how mindfulness skills are taught to patients in DBT, and benefits of mindfulness practice for therapists.
The philosophy, basic theory, applied theory, and technology of Acceptance and Commitment Therapy (ACT) are briefly described. Several issues relevant to Buddhist teachings—the ubiquity of human suffering, the role of attachment in suffering, mindfulness, wholesome actions, and self—are examined in relation to ACT. In each case there are clear parallels. Given that a major focus in the development of ACT has been on the identification of basic behavioral processes that make sense of acceptance and defusion-based treatments, these parallels suggest that the basic account may also provide a scientific grounding within the behavioral tradition for a range of Buddhist concepts and practices.
There is clearly a need for effective stress management programs for individuals with HIV/AIDS given their increased susceptibility to illness and disease progression as a result of the immunosuppressive effect of stress. Mindfulness meditation is a relatively new holistic approach to health promotion and is associated with improved stress management along with reductions in negative affect and improvements in well-being. Surprisingly, empirical studies or theoretical discussions of the usefulness of mindfulness meditation with HIV-positive individuals are limited. After briefly reviewing existing data, a rationale for incorporating mindfulness meditation into treatment programs for individuals with HIV/AIDS is presented.
Buddhist psychology and philosophy have the potential of contributing to the cognitive behavioral conceptualization and treatment of psychopathology. In this article, the relevance of Buddhism to the treatment of clinical anxiety is presented. Metacognition is viewed as a concept that can bridge Buddhist and cognitive behavioral psychology. In addition to delineating Buddhist conceptions of cognition and cognitive functioning, practical applications, in the form of mindful attention, are outlined. |
