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Psychotherapy as an epigenetic ‘drug’: psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs

Psychotherapy may be just as effective as psychopharmacology in treating psychiatric disorders. Psychotherapy focuses on psychodynamic and psychoanalytic prinicples while psychopharmacology is based on neurobiology. In the past, more emphasis was placed on psychopharmacology to treat psychiatric disorders. This article suggest that a psychotherapy could change the brain chemistry, eliciting the same results as drug therapy. Circuits in the brain are affected by efficiency of information processing. Many different disorders, that have various symptoms, are marked by inefficiency to process information, this could be too high or too low. By stimulating brain activity, symptoms of the disorder should be alleviated.

Psychotherapy can now be defined by its psychodynamic aspects and its capability of inducing epigenetic changes in the brain. The best approach is to combine psychotherapy and drug therapy. A study found that using cognitive behavior therapy and SSRIs to treat SSRI resistant depression was more effective than just medication treatment. This combination of treatments was also found more effective in treating adults with depression. The article states the best therapies to use in this combined approach are cognitive behavior therapy and interpersonal therapy.

Psychotherapy can activate epigenetic changes in the brain, or change brain circuits. This is the effect that psychopathic medications can also elicit. Given the limitations of both psychotherapy and pharmaceuticals, a combination of the two is best for therapies.

Stahl, S.M. (2011). Psychotherapy as an epigenetic ‘drug’: Psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs. Journal of Clinical Pharmacy and Therapeutics. doi:10.1111/j.1365-2710.2011.01301.x

CBT/MET Therapy Helps Improve Symptoms in Comorbid MDD/AUD Adolescents

A recent, two-year acute phase trial published in Addictive Behaviors found both manual-based cognitive behavior therapy (CBT) and motivation enhancement therapy (MET) to be beneficial treatments for adolescents suffering from both major depressive disorder (MDD) and alcohol use disorder (AUD). This was the first controlled study to compare CBT/MET with fluoxetine or placebo versus naturalistic care (control group), among adolescents with comorbid MDD/AUD.

Participants included 50 adolescents (ages 15-20) who met DSM-IV criteria for AUD and MDD. Qualified and trained masters level staff delivered nine sessions of manual-based CBT/MET, coupled with either fluoxetine (SSRI) or a placebo pill, to participants in the experimental condition. The Hamilton Rating Scale for Depression (HAM-D-27) and the Beck Depression Inventory (BDI) were used to assess depressive symptoms. The timeline follow-back method (TLFB), a tool used to measure controlled drinking, assessed drinking behavior.

Participants in the experimental condition who received CBT/MET demonstrated superior outcomes to the control group who did not receive any psychological intervention. Furthermore, no differences were noted between participants who received CBT/MET and fluoxetine versus CBT/MET and a placebo. These findings suggest that CBT/MET may be most efficacious for the treatment of comorbid MDD/AUD.

Cornelius, J.R., et al. (2011). Evaluation of cognitive behavioral therapy/motivational enhancement therapy (CBT/MET) in a treatment trial of comorbid MDD/AUD adolescents. Addictive Behaviors, 36(8), 843-848.

November 14 – 16, 2011, Cognitive Behavior Therapy Workshop Level ll: Personality Disorders and Challenging Problems

Dr. Judith Beck demonstrates a how to conceptualize a challenging case.

Last week at Beck Institute we held our Level 2 CBT Workshop on Personality Disorders and Challenging Problems. Psychologists, psychiatrists, social workers, counselors, and other health and mental health professionals traveled from all over the world, including Canada, India, Peru and nine U.S. states, to receive training in Cognitive Behavior Therapy.

Participants received professional training from Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.  Lectures and role-plays emphasized the need for the therapeutic alliance in order to establish rapport.  Dr. Sokol

Level 2 participants watched multiple live patient sessions while at Beck Institute

discussed patient collaboration and made it clear that a therapist should always be there for the client.  The use of mood checks was discussed and participants were told that a patient will often start with negative emotions and it is critical to probe them for positives to counter the negatives.

CBT Worksheet Demonstration

Dr. Judith Beck (above) demonstrated how to use a variety of CBT worksheets for therapists to use, such as the Cognitive Conceptualization Diagram. Dr. Beck encouraged workshop participants to roleplay (left and below) with one another to practice cognitive therapy techniques for personality disorders and challenging problems. Click here to learn more about our CBT workshops and how to register for our next Level 2 in February 2012. See below for more workshop highlights:

 

CBT for Depression

Dr. Aaron Beck explains the history of biological and psychological research on depression. He also discusses studies that looked at the likelihood of depression in people who experienced trauma during childhood. This video was taken at Beck Institute’s CBT for Children and Adolescents workshop, for more information, or to register for our next workshop visit: www.beckinstitute.org/cbt-workshops/

Evaluation of a DVD-Based Self-Help Program in Highly Socially Anxious Individuals – Pilot Study

A recent study published in Behavior Therapy found a CBT-oriented DVD-based self-help program (SHP), to be a potential treatment option for those with nonclinical degrees of social anxiety. Social anxiety disorder is described as a constant fear of particular social or performance situations coupled with acting in an embarrassing manner in those situations. The current study sought to evaluate the effectiveness of CBT-oriented DVD-based SHP supplemented by therapeutic assistance. The participants in the current study suffered from subthreshold social anxiety, which if not treated could evolve into social anxiety disorder as diagnosed in the DSM-IV. Participants had access to therapists via phone, email, or in-person sessions, in addition to the SHP.

Following several self-report questionnaires and an interview, twenty-four participants were selected to participate in the study. Twelve participants were assigned to the control group and were placed on a wait-list while the remaining twelve were given the SHP. Both groups completed self-report measures before and after the intervention. The experimental group underwent an eight-week trial program during which time they viewed guided lessons and were subsequently given homework assignments (e.g., approaching a stranger and asking for the time.) Participants then emailed their therapist a summary of their homework assignment. This helped researchers ensure that participants were truly completing the program and understanding the material presented to them.

Results demonstrated that participants in the experimental group showed improvement in their scores on the self-report assessments. Out of the twelve participants in the experimental group, only one withdrew during the eight-week session for unknown reasons. This low attrition rate may suggest that the program was well-received. The researchers concluded that CBT-oriented DVD-based SHPs supplemented by therapeutic assistance could benefit those with social anxiety symptoms.

Mall, A.K., et al. (2011). Evaluation of a DVD-based self-help program in highly socially anxious individuals—Pilot study. Behavior Therapy, 42, 439-448.

CBT for Bipolar I Patients (Students Ask Dr. Beck – Part TEN)

Dr.  Aaron Beck describes how cognitive behavior therapy  has been applied to Bipolar I Patients. He begins by explaining the development of scales for measuring symptoms, and then discusses techniques which therapist’s can implement when approaching mania, insomnia, and maladaptive behaviors.

First Comparative Study of Early and Delayed CBT Interventions for PTSD

A recent and first comparative study of early and delayed cognitive behavior therapy (CBT) interventions for PTSD found that prolonged exposure (PE), cognitive therapy (CT), and delayed PE prevent chronic PTSD in recent survivors. This study published in the Archives of General Psychiatry used equipoise-stratified randomization with trauma survivors who were recruited from Hadassah Hospital in Jerusalem. Adult trauma survivors were initially screened via telephone to ensure that they met DSM-IV criteria for PTSD. Adults (516) who met criteria were randomly assigned to receive treatment in a prolonged exposure (PE) group, a cognitive therapy (CT) group, double blind comparison of treatment with escitalopram (SSRI) or placebo groups, and a control wait-list group. Of the 756 adults who did not meet DSM-IV criteria, 296 of them accepted an invitation to receive clinical assessment.

The participants were evaluated following early interventions at 5 months and assessed again at 9 months. PE and CT treatment sessions were recorded and evaluated by CT experts. The Clinician-Administered PTSD Scale (CAPS) was used to measure the presence of PTSD at 5 and 9 months following treatment. Results showed that PE, CT, and delayed PE treatments were effective in lowering the rates and symptoms of PTSD in participants. Furthermore, there was no significant difference between the presence of PTSD in participants who received PE or CT and delayed PE treatment. This suggests that delaying PTSD interventions may not pose a threat to treatment outcomes. There was also no difference in improvement between the groups who received the SSRI versus placebo pills.

Since this was the first comparative study of early and delayed PTSD interventions, the researchers recommend replication studies to test for reliability. They also propose that future research focus on more simple CBT techniques to determine how those methods play a role in preventing PTSD. Finally, the lack of improvement from pharmacological treatment with escitalopram necessitates further evaluation and replication with larger samples.

Shalev, A.Y., Ankri, Y., Israeli-Shalev, Y., Peleg, T., Adessky, R., & Freedman, S. (2011). Prevention of posttraumatic stress disorder by early treatment. Arch Gen Psychiatry.

October 31 – November, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

November 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 11 states and 5 countries (including Brazil, Singapore, Canada, India, and the Dominican Republic) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., and Amy Cunningham, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects (video will be posted on our YouTube Channel).

Cognitive Behavior Therapy for Depression

Dr. Judith Beck (pictured left) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.

Cognitive Behavior Therapy for Anxiety

Dr. Amy Cunningham (pictured below) spoke about the need for anxiety and the need to learn how to cope with it.  She emphasized the use of teaching problem-solving skills and building self-efficacy.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

Cognitive Therapy in the Future (Students Ask Dr. Beck – Part NINE)

Dr. Beck discusses the growing nature of cognitive therapy. Based on the building blocks of an empirically validated theory, cognitive therapy, is continually evolving through numerous trials, moving towards inclusion of biological aspects.

Therapist adherence to manualized cognitive-behavioral therapy for anger management delivered to veterans with PTSD via videoconferencing

It is important that veterans with Posttraumatic Stress Disorder (PTSD) have access to evidence-based treatment (EBT). A significant number (40%) of military service members leaving active duty return to rural or remote areas where access to EBT and specialized PTSD treatment is often limited or unavailable. To overcome this obstacle, the use of video conferencing is becoming a more widespread and acceptable method of providing therapy to those living in areas with limited access to EBT.

While research indicates that cognitive behavior therapy (CBT) is an effective treatment for PTSD, there are few studies that examine outcomes of group CBT with veterans.  In the current study, Morland et al. compared therapist adherence to manualized cognitive-behavioral anger management group treatment (AMT) between therapy delivered via video conference (VC) and the traditional in-person modality. The researchers also compared the equivalency of cognitive-behavioral anger management group therapy delivered via VC and the same therapy delivered in-person.

The results of this study indicate that utilizing video conferencing did not affect therapists’ adherence to CBT anger management group therapy. This study provides support for the utility of video conferencing as a method for delivering effective therapy to veterans. It also identifies video-conferencing as a potential gateway to evidence-based CBT for veterans and service members returning to remote areas following deployment. These findings encourage future research on the effectiveness of video conferencing among different populations and EBTs.

Morland, L.A., Greene, C.J., Grubbs, K., Kloezeman, K., Mackintosh, M., Rosen, C., et al. (2011). Therapist Adherence to Manualized Cognitive-Behavioral Therapy for Anger Management Delivered to Veterans with PTSD via Videoconferencing. Journal of Clinical Psychology, 67, 629-638.