Beck Institute Blog

A recent meta-analysis published in the American Journal of Psychiatry found trauma-focused Cognitive Behavioral Therapy (CBT) delivered within a 3-month period of traumatic events to be effective in the treatment of trauma-induced stress symptoms for patients with PTSD or acute stress disorder.

Research has demonstrated the effectiveness of “multiple-session trauma-focused psychological interventions to treat chronic PTSD,” but little had been done to evaluate the efficacy of early interventions. The present study analyzed randomized controlled trials of early interventions, assessing efficacy, the population receiving the greatest benefit, the best modalities of treatment, and the optimal timing of treatment.

The researchers performed a meta-analysis and systematic review of 25 studies whose interventions were designed to treat or prevent PTSD within 3 months of a traumatic event. The authors found that trauma-focused CBT was significantly more effective for patients than usual care or being on waiting lists in terms of reducing stress symptoms of trauma. The magnitude of the effects varied for this finding; CBT was found to be most effective for individuals diagnosed with acute PTSD or acute stress disorder. Participants who did not meet the diagnostic criteria of a psychological stress disorder gained only minimal benefits from trauma-focused CBT.

The authors concluded that trauma-focused CBT should be offered to patients suffering from acute PTSD or acute stress disorder. They also noted that further investigation could determine whether trauma-focused CBT should become part of initial screening programs for patients who have experienced major traumatic events.

Study authors: N. P. Roberts, N. J. Kitchiner, J. Kenardy, J. I. Bisson

A recent study in the Journal of Attention Disorders discovered that brief Cognitive Behavioral Therapy (CBT) group sessions help to significantly decrease ADHD patients’ psychological consequences of the disorder.

Adults diagnosed with ADHD are more likely to suffer from a range of social and emotional consequences including comorbid disorders. These comorbid disorders include: anxiety, personality disorder, depression, academic underachievement, substance abuse, social interaction difficulties, relationship difficulties, occupational problems, low self-esteem, and poor self-identity. These additional symptoms are in large part due to adult patients’ late diagnosis and the adverse reactions their behavior prior to diagnosis aroused from others. Keep reading »

JUNE 09: Psychologists, psychiatrists, social workers, graduate students, family therapists, professors,  counselors, and other professionals from mental health, medical, and related fields traveled from Barbados, Canada, Saudi Arabia, United Kingdom, and ten U.S. states to participate in the Beck Institute Cognitive Therapy training workshop. Pictured left, Drs. Aaron and Judith Beck conduct a case review after participants observed (via closed-circuit television) Dr. Aaron T. Beck’s live patient-session.

Participants received professional training in Cognitive Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.

TRAINEE FEEDBACK

Teerakiat Jareonsettasin, MD, Psychiatrist (UK): “It’s been the best workshop I have ever attended. I’ve learned so much that it’s worth every penny and second invested in it.”

Yihong Zhu, PhD, Visiting Scholar (New York): “The workshop is really good and helpful for my work.”

Lisa Bander, LCSW, Psychotherapist, Supervisor (New York): “This has been such an incredible experience.”

Christine Bates, MSW candidate, Graduate Student (Virginia): “This was a wonderful experience. Everyone was wonderful and I learned so much. It was an honor to be able to be here. I can not wait to convince my friends to come here! Thanks for everything!”

Muhammad Majeed, MD, Psychiatrist (New York): “It is great. I got to know myself better.”

Learn more about Cognitive Therapy workshops at Beck Institute.

Circulation: The American Heart Association issued an advisory regarding the need for screening, referral, and treatment of depression in people with coronary heart disease (CHD). Depression is more prevalent in CHD patients and can contribute to a number of negative outcomes for the disease. Major depression that is comorbid with CHD is associated with more ambulatory and emergency care visits, days spent in bed because of illness, and functional disability; it is also associated with worse coronary prognoses. Additionally, depression is associated with decreased adherence to medications, medical treatment regimens, successful modifications of other cardiac risk factors, and participation in cardiac rehabilitation. Regardless of whether “depression affects cardiac outcomes directly or indirectly, the need to screen and treat depression is imperative.”

The advisory included the use of the Patient Health Questionnaire as part of the assessment of depression and depressive symptoms. Once depression is diagnosed, the three recommendations for treatment are antidepressant drugs, physical activity, and cognitive behavioral therapy (CBT), alone and/or in combination. At least 12 to 16 sessions of cognitive behavioral therapy over 12 weeks were advocated to achieve remission of moderate to severe depression.

Advisory authors: J. H. Lichtman, J. T. Bigger, J. A. Blumenthal, N. Frasure-Smith, et al.

MAY 2009 Extramural Training Workshop: (Left) Dr. Aaron Beck conducts a roleplay with trainee Robert Dudley, Ph.D., a research tutor at the University of Newcastle, U.K. The workshop was attended by psychiatrists, psychologists, social workers, counselors, physicians, nurse practitioners, post-doctoral fellows, researchers, and professors. Participants traveled from Canada, Ireland, Russia, Thailand, United Kingdom, and twelve U.S. states. The Extramural Training program provides intensive, one-on-one supervision to professionals seeking to enhance their clinical Cognitive Therapy skills.

Professional training in Cognitive Therapy was provided by Beck Institute faculty members Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., Norman Cotterell, Ph.D., and Cory F. Newman, Ph.D. Guest lecturers were Beck Institute Scholars Robert Dudley, Ph.D., and George Slavich, Ph.D. 

Learn more about the Extramural Training program.

Like everyone else, we are alarmed by the reports of rising suicide rates among American soldiers and veterans. We have started the Soldiers Suicide Prevention (SSP) project to provide state-of-the-art cognitive therapy training scholarships and other resources to mental health professionals who treat our heroes. Beck Institute has already trained—and currently trains—many mental health professionals within the Veterans Administration (VA) and various branches of the U.S. military. We hope to expand our training—and save more lives.

“More soldiers committed suicide in January than [were] killed by Al Qaeda”—New York Daily News, 2/09

One of our former trainees, John Milwee, Psy.D., is currently a VA therapist and sees the problem first hand. In his blog on the Soldiers Suicide Prevention website, Dr. Milwee says, “Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide.”

Soon after we started SSP, a donation came in from the father of a young woman who had recently entered the Navy. He wanted “to support her and her fellow service men and women even more.” This donation will enable us expand the number of partial scholarships we can offer.

“As the number of new providers being trained in CT increases we can be more confident that our Veterans will be given state-of-the-art treatment.”—Dr. John Milwee

To learn more about the problem of soldier suicide, apply for a partial scholarship, or donate to a scholarship fund, please visit www.SoldiersSuicidePrevention.org

Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide. Keep reading »

A recent study in the Journal of Psychiatric Practice found that Cognitive Behavioral Therapy (CBT) interventions used in an intensive partial-hospital (PH) setting are effective in treating severe mood disorders.

PH settings differ from inpatient treatment in that they are more flexible and less expensive. In this study, with CBT as the primary treatment, the length of stay was only 2 weeks. The researchers’ aims were to find the specific aspects of CBT that were successful in the treatment of mood disorders in a short-term PH setting.

The treatment included group and individual psychotherapy. Patients attended 12-20 group sessions per week. A written treatment contract was used and reviewed weekly to set specific goals and promote collaboration between patients and staff.

Group therapy was primarily CBT-oriented. The goals of therapy included teaching self-assessment (such as challenging maladaptive thoughts), behavioral coping (such as behavioral scheduling and behavioral activation), and developing better and more effective communication strategies.

The two-week treatment was divided into two stages. In the first, patients learned to identify triggers and utilize cognitive restructuring, among other interventions. The second stage included relapse prevention plans for a crisis situation and future plans (such as returning to work or school).

The researchers showed that both behavioral activation and a decrease in negative cognitions are associated with a decrease in depressive symptomatology at discharge. Additionally a decrease in negative thinking is associated with reduced general psychological distress at discharge.

Study Authors: M. S. Christopher, K. L. Jacob, E. C. Neuhaus, T. J. Neary, L. A. Fiola

The results of a randomized clinical trial published in JAMA indicate that cognitive behavior therapy (CBT) can be effective for older adults with symptoms of worry and depression.

The 3-month CBT protocol was conducted in primary care clinics and included education, cognitive therapy, and problem-solving skills. Measures included the Beck Anxiety Inventory and Beck Depression Inventory II. Post-treatment assessments were conducted every three months over fifteen months.

Compared with the control group, patients who received treatment showed improvement in worry severity, depressive symptoms, and general mental health. A measure of GAD severity, however, did not indicate greater improvement with CBT.

The authors concluded that CBT is useful for this population especially in primary care settings, “where older adults most often seek treatment.”

Study authors: M. A. Stanley, N. L. Wilson, D. M. Novy, H. M. Rhoades, et al.

In a study published in the Journal of Psychiatric Practice, researchers investigated the effectiveness of Cognitive Behavioral Group Therapy (CBGT) incorporated into the typical routine treatment of an inpatient psychiatric unit. Typically the aim of inpatient treatment is to stabilize patients and prevent crises. The goals of CBGT in this study were to decrease violent and aggressive behavior, to improve relations among patients and between patients and professionals, to normalize patients’ experience of their disorder, to improve self-esteem, and to decrease patients’ feelings of isolation.

Typical goals of CBGT, which also applied to this study, are stress management, setting of specific goals (including plans for when patients are discharged from the unit), and homework assignments.

In this study, patients took part in CBGT for approximately 2 hours a day, 5 days a week. The structure of the therapy included setting goals, a review of previous homework assignments, a discussion about the topic of the day, and a new homework assignment. The therapy attempted to improve communication, help patients understand how their cognitions, emotions, and behaviors interact, and teach patients skills through strategies such as modeling, role playing, and structured problem solving.

The researchers measured efficacy based on readmission to the hospital, patient satisfaction, use of physical restraint, ward atmosphere, length of stay, and the number of beds needed. They compared years 1, 2, 3, and 4 with the control (year 0, where CBGT was not used). Results of the study included a significant reduction in readmission, especially for those suffering from schizophrenia and bipolar disorder. Additionally there was a significant increase in patient satisfaction at discharge. There was an overall decrease in the use of physical restraint, length of stay, and beds needed. The results suggest that the use of CBGT was an effective method in the achievement of the goals (listed above) for inpatients.

CBGT elicited the active participation of patients in therapy, helped normalize their illness, and helped them with problem solving. Interestingly, having patients teach other patients how to manage their problems was especially helpful. All these factors had a “large and immediate impact on patients.”

Study authors: F. Veltro, N. Vendittelli, I. Oricchio, F. Addona, et al.