Meet Deborah Zwick, PhD, a clinical psychologist who traveled to Beck Institute from Vail, Colorado. She, along with 41 other mental health professionals, attended our workshop CBT for Children and Adolescents taught by Torrey Creed, PhD.
She decided this workshop would be a great fit for her career, as she consults with private schools and is now seeing more children in her practice. After working for 25 years in Chicago with adolescents and adults, adding knowledge on working specifically with children will help to expand her practice.
Her biggest takeaway from this training? CBT is malleable, it can be used it a variety of ways with all types of clients.
Dr. Creed is “fantastic, her combination of enthusiasm, warmth and evidence-based sound material” made this “once of the better workshops I’ve attended in many years.” Dr. Zwick also appreciated how this workshop drew professionals from around the world, with participants from 6 countries and 16 states.
Coming to Beck Institute is like “Going to the mountain top for learning CBT.”
Major depressive disorder (MDD) is prevalent after traumatic brain injury (TBI); however, there is a lack of evidence regarding effective treatment approaches. We conducted a choice-stratified randomized controlled trial in 100 adults with MDD within 10 years of complicated mild to severe TBI to test the effectiveness of brief cognitive behavioral therapy administered over the telephone (CBT-T) (n = 40) or in-person (CBT-IP) (n = 18), compared with usual care (UC) (n = 42). Participants were recruited from clinical and community settings throughout the United States. The main outcomes were change in depression severity on the clinician-rated 17 item Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between the combined CBT and UC groups over 16 weeks on the HAMD-17 (treatment effect = 1.2, 95% CI: -1.5-4.0; p = 0.37) and a nonsignificant trend favoring CBT on the SCL-20 (treatment effect = 0.28, 95% CI: -0.03-0.59; p = 0.074). In follow-up comparisons, the CBT-T group had significantly more improvement on the SCL-20 than the UC group (treatment effect = 0.36, 95% CI: 0.01-0.70; p = 0.043) and completers of eight or more CBT sessions had significantly improved SCL-20 scores compared with the UC group (treatment effect = 0.43, 95% CI: 0.10-0.76; p = 0.011). CBT participants reported significantly more symptom improvement (p = 0.010) and greater satisfaction with depression care (p < 0.001), than did the UC group. In-person and telephone-administered CBT are acceptable and feasible in persons with TBI. Although further research is warranted, telephone CBT holds particular promise for enhancing access and adherence to effective depression treatment.
Fann, J.R., Bombardier, C.H., Vannoy, S., Dyer, J., Ludman, E., Dikmen, S., Marshall, K., Barber, J. & Temkin, N. (2015). Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: A randomized controlled trial. J Neurotrauma. 2015 Jan 1;32(1):45-57. doi: 10.1089/neu.2014.3423.
Deborah Beck Busis, LCSW
Diet Program Coordinator
Beck Institute for Cognitive Behavior Therapy
A recent article in the American Journal of Public Health (Fildes et al., 2015)
reiterates the disheartening statistics on weight loss. This study and many others have shown that most obese people who lose weight gain it back. In our experience, a major reason for this outcome is that dieters make changes that they are unable to sustain. For example, they reduce their calories too much, eliminate favorite foods, decline social events that include food, or set exercise goals that are too strenuous or time-consuming. When they inevitably return to previous eating, social, and exercise habits, they start to regain weight, feel helpless, become hopeless and stop their weight loss efforts altogether.
To reverse this trend, we ensure that every change we suggest is reasonable and maintainable. This means that dieters usually do not lose weight as quickly as they have in the past or lose as much weight as they would like. But they are much more likely to keep off the weight (plus about five pounds or so) that they do lose. Our philosophy is that successful weight loss entails figuring out the art of the possible.
One of our dieters, for example, had a very busy schedule and disliked cooking. Through a variety of standard cognitive therapy techniques, we helped her prioritize exercise and healthy eating and then did problem solving. She committed to exercise 30 minutes three to four times a week, which meant reducing (but not eliminating) the time she spent watching television and reading for pleasure. She also chose not to cook dinner at home, so we created a list of healthy take out and frozen options and planned when she could make the time to pick up her food. Could we have persuaded her to commit to several hours of shopping and cooking every Sunday to prepare healthy meals for the week? Probably. But as she disliked cooking, it seemed likely that at some point she would stop prioritizing and scheduling cooking and be left unprepared with no healthy food for the week.
Another dieter really loved pizza but believed, like many people, that he had to stop eating it altogether to lose weight. Dieters frequently try to eliminate certain foods or entire food groups, but they almost always revert at some point to eating their favorite foods again (which is fine, as long as it is in moderation). Once they begin eating the “forbidden” food again, though, they overdo it, because they haven’t learned to plan when and how much they’re going to eat nor how to stick to this plan. They interpret their abstinence violation as a sign that they are off track and then have difficulty regaining control over their eating overall.
We taught this dieter a combination of cognitive and behavioral skills so he could stay in control around pizza. First we made a plan. He would go to a pizza shop several times and order two large slices to take out. We identified likely thoughts that would interfere with this plan and created strong responses that he read before he went. He practiced this plan several times, bringing the pizza home so he wouldn’t have immediate access to more. Once he gained confidence in his ability to eat a reasonable amount of pizza in a controlled environment, he practiced eating pizza in more difficult circumstances–when he went out to dinner and to a party. Each time we predicted the thoughts he might have that could lead him off track and developed coping cards for him to read. He was able to gain the skills and confidence to control himself around pizza, which significantly increased the probability of his keeping weight off long-term.
It just doesn’t work for most dieters long term to make changes they can sustain only in the short term. We believe that reversing the dismal statistics on weight loss starts first with a focus on the art of the possible and is predicated on two words: reasonable and maintainable.
Cognitive behavioral therapy (CBT) has been shown to be highly effective in the treatment of health anxiety. However, little is known about the effectiveness of group CBT in the treatment of health anxiety. The current study is the largest study that has investigated the effectiveness of combined individual and group CBT for patients with the diagnosis of hypochondriasis (N=80). Therapy outcomes were evaluated by several questionnaires. Patients showed a large improvement on these primary outcome measures both post-treatment (Cohen’s d=0.82-1.08) and at a 12-month follow-up (Cohen’s d=1.09-1.41). Measures of general psychopathology and somatic symptoms showed significant improvements, with small to medium effect sizes. Patients with more elevated hypochondriacal characteristics at therapy intake showed a larger therapy improvement, accounting for 7-8% of the variance in therapy outcome. CBT group therapy has therefore been shown to be an appropriate and cost-effective treatment for health anxiety.
Weck F., Gropalis M., Hiller W. & Bleichhardt G. (2015) Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety). Journal of Anxiety Disorder, 30 (1). doi: 10.1016/j.janxdis.2014.12.012. Epub 2015 Jan 3.
Background: Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a clinical trial of smartphone-based CBT.
Methods/Design: We present a study protocol that describes a single-blind randomised controlled trial comparing a cognitive behaviour therapy-informed software application (Actissist) plus Treatment As Usual (TAU) with a symptom monitoring software application (ClinTouch) plus TAU in early psychosis. The study consists of a 12-week intervention period. We aim to recruit and randomly assign 36 participants registered with early intervention services (EIS) across the North West of England, UK in a 2:1 ratio to each arm of the trial. Our primary objective is to determine whether in people with early psychosis the Actissist app is feasible to deliver and acceptable to use. Secondary aims are to determine whether Actissist impacts on predictors of first episode psychosis (FEP) relapse and enhances user empowerment, functioning and quality of life. Assessments will take place at baseline, 12 weeks (post-treatment) and 22-weeks (10 weeks post-treatment) by assessors blind to treatment condition. The trial will report on the feasibility and acceptability of Actissist and compare outcomes between the randomised arms. The study also incorporates semi-structured interviews about the experience of participating in the Actissist trial that will be qualitatively analysed to inform future developments of the Actissist protocol and app.
Discussion:To our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake, attrition and potential efficacy of a CBT-informed smartphone app for early psychosis. Mobile applications designed to deliver a psychologically-informed intervention offer new possibilities to extend the reach of traditional mental health service delivery across a range of serious mental health problems and provide choice about available care.
Bucci, S., Barrowclough, c., Ainsworth, J., Morris, R., Berry, K., Machin, M., Emsley, R., Lewis, S., Edge, D., Buchan, L., & Haddock, G. (2015) Using mobile technology to deliver a cognitive behaviour therapy-informed intervention in early psychosis (Actissist): Study protocol for a randomised controlled trial. Trials Journal, 16 doi:10.1186/s13063-015-0943-3
While weight, beliefs about weight and weight changes are key issues in the pathology and treatment of eating disorders, there is substantial variation in whether and how psychological therapists weigh their patients. This review considers the reasons for that variability, highlighting the differences that exist in clinical protocols between therapies, as well as levels of reluctance on the part of some therapists and patients. It is noted that there have been substantial changes over time in the recommendations made within therapies, including cognitive-behavioral therapy (CBT). The review then makes the case for all CBT therapists needing to weigh their patients in session and for the patient to be aware of their weight, in order to give the best chance of cognitive, emotional and behavioral progress. Specific guidance is given as to how to weigh, stressing the importance of preparation of the patient and presentation, timing and execution of the task. Consideration is given to reasons that clinicians commonly report for not weighing patients routinely, and counter-arguments and solutions are presented. Finally, there is consideration of procedures to follow with some special groups of patients
Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why:Behaviour Research and Therapy, Volume 70, Issue null, Pages 1-10 Glenn Waller, Victoria A. Mountford
Amanda, a recent graduate of University of Michigan (but a Spartans fan!) attended the Beck Institute CBT for PTSD workshop, taught by Dr. Aaron Brinen. She traveled from Michigan with 8 other trainees from Henry Ford Health System. At HFHS, Amanda is a clinical therapist for adults and teenagers, where she also runs a substance abuse group.
The group from HFHS had the opportunity to travel to Philadelphia and attend training at Beck Institute, because their organization recently learned that they will be providing services to first responders in the Detroit area, and the CBT for PTSD workshop was the perfect fit.
When she learned she would have the opportunity to attend a workshop at Beck Institute, Amanda was thrilled because she learned and loved CBT in graduate school. “And let’s be honest, the Beck Institute is prestigious.” Other than meeting Dr. Aaron Beck, and learning more about prolonged exposure therapy, Amanda most appreciated that, “Dr. Brinen is amazing with talking about difficult topics and keeping us engaged.”