Child- and Family-Focused CBT for Pediatric Bipolar Disorder

OBJECTIVE: Previous studies have found that family-based psychosocial treatments are effective adjuncts to pharmacotherapy among adults and adolescents with bipolar disorder (BD). The objective of this study was to compare the efficacy of adjunctive child- and family-focused cognitive-behavioral therapy (CFF-CBT) to psychotherapy as usual (control) for mood symptom severity and global functioning in children with BD.

METHOD: Sixty-nine youth, aged 7 to 13 years (mean = 9.19, SD = 1.61) with DSM-IV-TR bipolar I, II, or not otherwise specified (NOS) disorder were randomly assigned to CFF-CBT or control groups. Both treatments consisted of 12 weekly sessions followed by 6 monthly booster sessions delivered over a total of 9 months. Independent evaluators assessed participants at baseline, week 4, week 8, week 12 (posttreatment), and week 39 (6-month follow-up).

RESULTS: Participants in CFF-CBT attended more sessions, were less likely to drop out, and reported greater satisfaction with treatment than controls. CFF-CBT demonstrated efficacy compared to the control treatment in reducing parent-reported mania at posttreatment and depression symptoms at posttreatment and follow-up. Global functioning did not differ at posttreatment but was higher among CFF-CBT participants at follow-up.

CONCLUSION: CFF-CBT may be efficacious in reducing acute mood symptoms and improving long-term psychosocial functioning among children with BD.

West, A. E., Weinstein, S. M., Peters, A. T., Katz, A. C., Henry, D. B., Cruz, R. A., & Pavuluri, M. N. ( 2014). Child- and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorder: A Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 11, 1168.

Beyond the Label: Relationship between Community Therapists’ Self-Report of a CBT Orientation and Observed Skills

Policy-makers, payers, and consumers often make decisions based on therapists’ reported theoretical orientations, but little is known about whether these labels represent actual or potential skills. Prior to CBT training, therapists (n = 321) reported theoretical orientations. Experts rated CBT competency using the Cognitive Therapy Rating Scale Therapy at pre-, mid-, and post-training. CBT- and non-CBT identified therapists showed equivalent, non-competent baseline CBT skills. CBT-identified therapists showed greater CBT skills at mid-training, but by end of training, groups evidenced equivalent achieved competency. Baseline CBT orientations were neither valid, nor useful markers of later competency. Policy, clinical and research implications are discussed.

Creed, T.A., Wolk, C.B., Feinberg, B., Evans, A.C., & Beck. A.T. (2014). Beyond the label: Relationship between community therapists’ self-report of a cognitive behavioral therapy orientation and observed skills. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-014-0618-5.

CBT Treatment for Insomnia Improves Patient Outcomes while Reducing Healthcare Costs and Utilization

Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi).

Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005-2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ? 1 session of bCBTi. Those who attended ? 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32).

Results: For completers and responders, all HCU and cost variables, except number of medications, significantly decreased (ps < 0.05) or trended towards decrease at post-treatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No significant decreases occurred for non-completers.

Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the findings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in significant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia.

McCrae, C. S., Bramoweth, A. D., Williams, J., Roth, A., & Mosti, C. (2014). Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. Journal of Clinical Sleep Medicine, 10, 2, 127-35.

Dr. Aaron Beck Receives Changing Minds Award

Congratulations to Dr. Aaron Beck who received the Changing Minds Award at the Minding Your Mind Annual Blue Gene Gala, in Wyndmoor, Pennsylvania on October 19, 2014. Dr. Beck received this award for his lifetime achievement in psychiatry. During his acceptance speech, Dr. Beck discussed the influence of catastrophizing across all of the psychological disorders. He described how catastrophizing was adaptive in the wild, and that individuals with the “catastrophizing gene” were at the top of the evolutionary ladder. His message was to de-stigmatize mental illness and to show the positive aspects of some symptoms in an evolutionary sense.

Dr. Judith Beck, a featured speaker for this event, provided the Keynote address. Dr. Beck talked about ways to reduce stigma, first, by providing a rationale for labeling both mental illness and physical illness as just “illness. ” Second, she discussed how people with mental illness need help to de-stigmatize themselves by evaluating their self-critical thoughts, especially those that interfere with seeking treatment. Dr. Beck also talked about Cognitive Behavior Therapy and noted the overwhelming amount of research that demonstrates its effectiveness for a large number of problems. Dr. Beck described what a typical therapy session is like and how it leads to improvement. She concluded with why we should all have hope for people with mental illness—because good therapy can help them get better and stay better. Dr. Judith Beck was also presented with a plaque in recognition of her advances in the field.

Cognitive Therapy plus Medication is More Effective than Medication Alone in the Treatment of Depression

OBJECTIVE: To determine the effects of combining cognitive therapy (CT) with ADM vs ADM alone on remission and recovery in major depressive disorder (MDD).

METHOD: A total of 452 adult outpatients with chronic or recurrent MDD participated in a trial conducted in research clinics at 3 university medical centers in the United States. The patients were randomly assigned to ADM treatment alone or CT combined with ADM treatment. Treatment was continued for up to 42 months until recovery was achieved.

RESULTS: Combined treatment enhanced the rate of recovery vs treatment with ADM alone (72.6% vs 62.5%; t451?=?2.45; P?=?.01; hazard ratio [HR], 1.33; 95% CI, 1.06-1.68; number needed to treat [NNT], 10; 95% CI, 5-72). This effect was conditioned on interactions with severity (t451?=?1.97; P?=?.05; NNT,?5) and chronicity (?2?=?7.46; P?=?.02; NNT,?6) such that the advantage for combined treatment was limited to patients with severe, nonchronic MDD (81.3% vs 51.7%; n?=?146; t145 = 3.96; P?=?.001; HR, 2.34; 95% CI, 1.54-3.57; NNT, 3; 95% CI, 2-5). Fewer patients dropped out of combined treatment vs ADM treatment alone (18.9% vs 26.8%; t451?=?-2.04; P?=?.04; HR, 0.66; 95% CI, 0.45-0.98). Remission rates did not differ significantly either as a main effect of treatment or as an interaction with severity or chronicity. Patients with comorbid Axis II disorders took longer to recover than did patients without comorbid Axis II disorders regardless of the condition (P?=?.01). Patients who received combined treatment reported fewer serious adverse events than did patients who received ADMs alone (49 vs 71; P?=?.02), largely because they experienced less time in an MDD episode.

CONCLUSIONS: Cognitive therapy combined with ADM treatment enhances the rates of recovery from MDD relative to ADMs alone, with the effect limited to patients with severe, nonchronic depression.

Hollon S.D., DeRubeis R.J., Fawcett J., et al. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online August 20, 2014. doi:10.1001/jamapsychiatry.2014.1054.

CBT Methods with Unassimilated Immigrants

During a recent Beck Institute Workshop, Dr. Aaron Beck comments on the challenges unassimilated immigrants and their second generation offspring may face, as well as their susceptibility to mental illness. Dr. Beck cites research conducted in Great Britain and discusses the effectiveness of Cognitive Behavior Therapy (CBT) among this population.

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Origins of Dr. Aaron Beck’s Theory of Depression

During a recent Beck Institute Workshop, Dr. Aaron Beck discusses the origins of his theory of depression. He then describes several research techniques he employed to test the psychoanalytic hypothesis that depression is caused by inverted hostility.

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Integrating New Wave Therapies and CBT

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses how new wave therapies can be integrated into the cognitive therapy (CT) framework. Dr. Beck describes when it is helpful to utilize newer strategies that encompass for example, acceptance and commitment therapy, mindfulness, and dialectical behavior therapy. Dr. Beck emphasizes the importance of using these strategies within the general theoretical model of CT and specific case formulation of the disorder in order to address patients’ specific needs based on their individual case conceptualization.

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Validation for Patients with Borderline Personality Disorder

During a recent Beck Institute Workshop, Dr. Aaron Beck explains that in recent years eastern philosophies and religions have had an increased influence on CBT and which have been incorporated into mindfulness based cognitive therapy, acceptance and commitment therapy, and dialectic behavior therapy. In discussing DBT, he emphasizes the importance of validation with borderline personality disorder patients.

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Practical Solutions for CBT Training and Certification

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck and Dr. Judith Beck discuss CBT training and certification in countries with vigorous, and often impracticable standards for CBT certification. As a practical solution, Dr. Judith Beck proposes a step wise training program for basic to advanced levels of certification and a corresponding triage system for patients.

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