How CBT can change your brain waves

A lot of coverage of science concentrates on how what goes on in the brain affects the way we feel and think but the relationship can, of course, work both ways with treatments and good and bad events in people's lives having an effect on what happens between our ears. Researchers from McMaster University in Hamilton, Ontario looked into this in a study of 25 people who were having psychotherapy for social anxiety. The participants had 12 once-a-week sessions of cognitive behaviour therapy and were compared to two control groups; one control group had very high social anxiety, one very low social anxiety and neither group received any psychotherapy. The participants had a series of electroencephalograms (EEGs) and the researchers measured their levels of delta-beta-coupling (DBC) which is associated with anxiety. Before treatment the participants DBC levels were similar to the high-anxiety control group and much higher than the low-anxiety one. However, as their treatment went on their DBC levels fell, matching the improvement recorded both by themselves and their doctors. Once they had finished their psychotherapy the participants' DBC levels were similar to those of the low-anxiety group.

Executive dysfunction, problem-solving and depression

People with executive dysfunction have problems setting goals, planning, initiating and sequencing behaviour. Executive dysfunction is often a symptom of depression and a team of researchers from Weill Cornell Medical College in New York studied the effectiveness of two different kinds of therapy in combating it in a study of 221 older adults with depression. Problem-solving therapy (PST) helps patients identify the most important problems in their lives, select solutions and make concrete plans for dealing with them while supportive therapy (ST) is more like counselling being based on 'active listening' and offering support in a non-judgemental environment. The participants were divided into two groups, each having either PST or ST, and received 12 weekly sessions of therapy. After six weeks both groups had shown comparable levels of improvement, however, the group receiving PST showed greater improvements after nine and 12 weeks and this difference was still there 24 weeks after the end of treatment. PST was particularly helpful for people who had cognitive problems and who had had more previous episodes of depression.

Alexopoulos, George S. ... [et al] - Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction: effect on disability Archives of General Psychiatry January 2011, 68(1): 33-41

Acceptance and anxiety

When James Dean's character in Rebel Without a Cause is asked 'What are you rebelling against?' he replies 'What have you got?' and people with generalized anxiety disorder (GAD) feel much the same about worry. Acceptance-based behavioural therapy (ABBT) promotes the acceptance rather than the avoidance of uncomfortable emotions, persuades people that they can usefully channel these emotions and gets them to confront the situations that make them fearful. A team of researchers from the University of Massachusetts studied 31 people, half of whom were put on a waiting list and half of whom received ABBT. The people who received ABBT had significantly fewer difficulties in regulating their emotions and felt less fear about their emotional responses as well as being less bothered by uncertainty; improvements that were maintained when they were followed up after three and nine months.

Treanor, Michael ... [et al] - Acceptance-based behavioral therapy for GAD: effects on outcomes from three theoretical models Depression and anxiety doi: 10.1002/da.20766

CBT shows long-term gains for childhood phobias and anxiety

Phobias and anxiety disorders in childhood do not always go away over time and can increase the risk of worsening mental-health problems, teenage pregnancy, dropping out of high school and not going on to college and university. There is now quite a lot of evidence that exposure-based cognitive behaviour therapy (CBT) which aims to gradually get people used to what they are frightened of and change their thinking about it is effective at treating these problems but little research has been done into its long-term effectiveness. A team of researchers led by Lissette M. Saavedra from RTI International in North Carolina studied 67 people who had received exposure-based CBT as children and followed them up between eight and 13 years later to see how they were getting on. The study found that the participants' problems were still under control a long time after treatment.

Saavedra, Lissette ... [et al] - Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood Journal of Child Psychology and Psychiatry August 2010, 51(8), 924-934

Therapist competence and patient improvement

Many studies have shown that cognitive therapy is an effective treatment for depression but it can be hard to tell how much of this is down to the effectiveness of the therapy per se and how much of it is down to the competence of the individual therapist. Researchers from Ohio State University studied videotapes of therapy sessions involving 60 adults with moderate-severe depression and their six therapists. The researchers rated the therapists' skills and the patients completed a questionnaire after each session to measure their depression; the researchers didn't know how the patients were getting on when they assessed the therapists' skills. Patients with high levels of anxiety and early-onset depression benefitted most from the highly-rated therapy sessions. Higher levels of therapist competence were related to more symptom improvement during the first four sessions. After 16 weeks the association between therapists' competence and patients' improvement was still there although it was not quite as strong.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/07/100706161803.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

CBT for depressed ill people

Depression occurs in 6-14% of people in hospital and is even more prevalent in people with diabetes and cancer. Whatever people's physical health problems depression always dramatically reduces quality of life and is associated with longer hospital stays, higher rates of rehospitalization and increased hospital use. Psychotherapy is thought to be more effective for people with other health complaints as psychiatric drugs can interfere with other medicines. Researchers from Radboud University in the Netherlands reviewed 29 studies into the effectiveness of cognitive behaviour therapy for depression in people with physical disease. They found that it 'significantly reduces depressive symptoms.'

Beltman, Matthijs W., Oude, Richard C. and Speckens, Anne E. - Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. British Journal of Psychiatry, July 2010, 197(1), 11-19

Fighting self stigma

People with mental-health problems often suffer from stigma from the rest of society which can take a negative view of mental illness. In some cases people internalize this stigma - so-called 'self-stigma' - and lose their self-esteem and self-confidence. A team of researchers led by Professor Roe from the University of Haifa studied the effectiveness of a treatment called Narrative Enhancement Cognitive Behavioural Therapy which aims to give people with mental illness the necessary 'tools' to deal with self-stigma. They compared 21 people who completed the treatment with 22 who were placed on a waiting list. Those who participated in the treatment showed reduced self-stigma and an increase in their quality of life and self-esteem.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/05/100513093731.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

CBT and IBS

A significant minority of people with irritable bowel syndrome (IBS) respond rapidly to cognitive behaviour therapy and these benefits seem to be long-lasting. Researchers from the University at Buffalo, in New York, studied 71 people with IBS who received smaller or larger 'doses' of cognitive behaviour therapy (CBT). 30% of the sample could be classified as 'rapid responders' of whom 90-95% were still better after three months. Although the rapid responders had more symptoms at the start of the study they achieved a more substantial and sustained symptom reduction than non-rapid responders. Both 'doses' of CBT had comparable rates of rapid responders.

You can find out more about this research at

http://www.sciencedaily.com/releases/2010/04/100427070846.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Drinking women do better in couples therapy

Women being treated for alcohol problems with cognitive behaviour therapy (CBT) might respond better to couples therapy than individual therapy. Barbara McCrady from the University of New Mexico and Elizabeth Epstein from the Center of Alcohol Studies at Rutgers University in New Jersey studied 102 women with a steady partner or husband. Some received couples therapy while others received individual therapy. For each woman the researchers calculated the percentages of days abstinent and the percentage of days of heavy (more than three drinks in a day) drinking. For the first month of treatment the abstinence rate rose sharply. During the year following treatment the women in couples therapy reported fewer heavy-drinking days than the women in individual treatment.

http://www.sciencedaily.com/releases/2010/04/100420142037.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

CBT and learning disabilities

People with learning disabilities suffer from mental-health problems as much as, if not more than, other people. Cognitive behaviour therapy has been found to be effective for a number of different mental-health problems but it is unclear whether people with learning disabilities are able to grasp the links between thoughts, feelings and behaviour that they need to understand in order for the therapy to be effective. Researchers from the University of East Anglia and Norfolk Primary Care NHS Trust looked into this issue in a study of 34 adults with learning disabilities. 18 of them were given training in distinguishing between thoughts, feelings and behaviours and in linking thoughts and feelings while the rest of the participants went to a relaxation class. The study found that the training led to significant improvements in the particpants' abilities to link thoughts and feelings, skills that could then be applied to new situations. However, the training had no effect on the participants' ability to distinguish between thoughts, feelings and behaviour.

Bruce, Melanie ... [et al] - Does training improve understanding of core concepts in cognitive behaviour therapy by people with intellectual disabilities? A randomized experiment British Journal of Clinical Psychology March 2010, 49(1), 1-13

Cognitive insight and psychosis

Cognitive insight is the ability to self-reflect, realise that beliefs may be mistaken and consider feedback from other people. Lack of it is thought to play an important role in the development and continuation of psychosis, and a team of researchers from the University of Pennsylvania and the Institute of Psychology, King's College London looked into the influence of cognitive insight on the progress of 78 outpatients being treated for psychosis with cognitive behaviour therapy. They found that people with more cognitive insight had less severe delusions after treatment and that people whose cognitive insight improved over the course of their treatment had 'clinically significant reductions' in the severity of both delusions and auditory hallucinations by the end of their therapy.

Perivoliotis, Dimitri ... [et al] - Cognitive insight predicts favourable outcome in cognitive behavioral therapy for psychosis Psychosis February 2010, 2(1), 23-33

CBT may not be a miracle cure for major mental illness

Cognitive behavioural therapy (CBT) is now the dominant form of psychotherapy and is being used in severe mental illnesses such as schizophrenia, major depression and bipolar disorder that have traditionally been treated primarily with drugs. A team of researchers from the U.K. and Spain - none of whom declared any connections to the drug industry - reviewed a number of studies into the effectiveness of using CBT to treat schizophrenia, major depression and bipolar disorder. They found that CBT was not effective in reducing symptoms in schizophrenia or preventing relapse. It had a small effect in treating major depression but was not effective at preventing relapse in bipolar disorder.

Lynch, D., Laws, K.R. and McKenna, P.J. - Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials Psychological Medicine January 2010, 40(1), 9-24

CBT for depression in older people

Older people's depression problems are sometimes put down to loneliness and old age but new research suggests that they can benefit from cognitive behaviour therapy in the same way as younger people. Researchers from University College London studied 204 people over 65 who had been diagnosed with depression. Some of them carried on with their regular treatment while others received CBT. The participants answered questions about their depression at the start of the study and after four and ten months of treatment. The study found that after around seven sessions of CBT people had less depression than those in the other group.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=124318&cn=5

Online CBT for depression

Computerised CBT has shown promise as a way of offering treatment to people who are unable or unwilling to receive face-to-face treatment and for those in areas where it is difficult to travel to get treatment. It is also significantly cheaper than face-to-face therapy and could be a good way of delivering this service to more people. Researchers from the University of Bristol studied 297 people suffering from depression. Half of them used online CBT while the other half received 'care-as-usual' from their GP. After four months almost two-fifths of those who received the online CBT got better compared to one in four of those receiving treatment as usual. After eight months people were still feeling the benefits of the online CBT.

http://www.telegraph.co.uk/health/healthnews/6062089/Depressed-people-should-get-online-counselling-study-says.html

Internet CBT for insomnia

One third of people report symptoms of insomnia and around one in ten actually meet the clinical criteria for the condition. Cognitive behaviour therapy is one of the most effective treatments for the condition but its availability is limited by a shortage of clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessability to treatment and clinicians. One way round this could be by using Internet CBT. Researchers at the University of Virginia in the U.S. and the University of Laval in Quebec studied 45 people with sleep problems comparing 22 people using an Internet CBT programme with 23 on a waiting list who formed a control group. The Internet programme was based on face-to-face CBT approaches and used the techniques of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring and relapse prevention. The participants who received the Internet intervention significantly improved their sleep leading the researchers to conclude that Internet CBT has 'considerable potential in delivering a structured behavioural programme for insomnia'

Ritterband, Lee M. ... [et al] - Efficacy of an Internet-based behavioural intervention for adults with insomnia Archives of General Psychiatry July 2009, 66(7), 692-698

CBT for insomnia

Most people with insomnia can be treated effectively with cognitive behaviour therapy (CBT). Researchers from Kentucky studied the effectiveness of CBT on 64 participants who all completed five or more treatment sessions. The CBT teaches strategies to 'reset' the bodily systems that regulate sleep. Specific strategies included education on sleep-regulating systems, sleep-scheduling recommendations, sleep-hygiene education, relaxation training, cognitive therapy and mindfulness training. The results of the study showed that 50-60% of the participants experienced remission of their main sleep problem. The participants also showed improvements in sleep efficiency, average nightly awakenings, total sleep time and average nights of sleep medication use per week.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/06/090609072709.htm

Computerized CBT helps with insomnia

Computerized cognitive behaviour therapy (CBT) is effective in treating sleep problems. Researchers from the University of Manitoba in Canada studied 118 adults with chronic insomnia. Half of them used a computerized CBT programme and half were placed on a waiting list for treatment. The programme was made up of information about insomnia and sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy. The cognitive therapy part of the programme was designed to help individuals develop realistic expectations about sleep and the impact of sleep on their functioning the next day while teaching them a variety of strategies for coping with worries and an over-active mind. The results showed that 81% of the people using the programme showed at least mild improvement in their sleep and 35% rated themselves as much, or very much, improved. 30% of people who finished the programme managed to get an extra hour's worth of sleep. They also developed healthier attitudes about sleep and were less likely to have an over-active mind at bedtime. However, there was a 33% drop-out rate for the programme, compared to only 22% for 'in person' psychotherapy.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/06/090601091916.htm

Treating depression after bypass surgery

About one in every five patients suffers a major bout of depression following heart bypass surgery and at least that many again develop milder forms of depression. Researchers from the University of St Louis divided 123 depressed bypass patients into three groups. A third received cognitive behaviour therapy (CBT), a third received supportive stress management and a third received 'usual care.' Within each group about half the participants were taking antidepressants. After three months 71% of the people in the CBT group and 57% in the supportive stress management group saw their depression symptoms lift compared to just 33% in the 'usual care' group; figures which remained about the same after nine months. Whether or not the participants were taking antidepressants seemed to have little effect on what happened to their depression.

http://uk.reuters.com/article/healthNews/idUKTRE53565H20090406?feedType=RSS&feedName=healthNews

CBT for anxiety in autistic youngsters

Anxiety disorders are common in children with autism and are associated with more difficulties in getting on with other people. The characteristics of autism can make conventional treatments difficult but several studies have suggested that cognitive behaviour therapy (CBT) might be helpful. A study by researchers at the University of California, Los Angeles, looked at the effectiveness of the Building Confidence* CBT programme, modified for use with children with autism. They studied 36 children between the ages of seven and eleven, half of whom were treated with CBT and half of whom went onto a waiting list. After 16 sessions of CBT both groups were assessed by independent experts none of whom knew whether the participants had used CBT or not. 78.5% of the children receiving CBT were judged to have improved compared to only 8.7% on the waiting list. Those parents whose children had had CBT were more likely to say they had improved although the children themselves felt no different. The improvements observed by the independent evaluators were still there three months after the treatment had finished.

Wood, Jeffrey J. ... [et al] - Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial Journal of Child Psychology and Psychiatry March 2009, 50(3), 224-234

*The lead author of the study was also the author of the Building Confidence programme

CBT for PTSD

Traumatic experiences can cause significant pyschological problems for large numbers of people. Not everyone is affected but it is estimated that 13% of people involved in car crashes and 19% of people who are victims of violent crime go on to suffer from acute stress disorder. Rates of acute post-traumatic stress disorder (PTSD), which is defined as PTSD symptoms for less than three months, vary from 23% of those involved in car crashes to 47% in rape victims. A third of people who develop acute PTSD go on to develop chronic PTSD, suffering symptoms for 6 years or longer. People have tried to develop interventions to prevent the development of chronic PTSD. One such intervention was psychological debriefing but this began to be questioned in the 1990s, little evidence was found for its effectiveness and many experts now advise against it. A review of 25 studies by researchers at Cardiff University found that trauma-focused cognitive-behaviour therapy (CBT) was more effective than doing nothing or supportive counselling for acute stress disorder and acute PTSD.

Roberts, Neil P. ... [et al] - Systematic review and meta-analysis of multiple-session early interventions following traumatic events American Journal of Psychiatry March 2009, 166(3), 293-301