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- Go to article: Facilitating the Dissemination and Application of Cognitive-Behavioral Therapy for Anxiety in Youth
- Go to article: Anger Control in Men: Barb Exposure With Rational, Irrational, and Irrelevant Self-Statements
Anger can be frequent, intense and enduring, and is associated with intrapersonal and interpersonal distress as well as medical disorders. It is, therefore, important that effective treatments be developed. Based on the rational-emotive behavior therapy hypothesis that situational anger experiences are related to irrational thinking, we evaluated the therapeutic effects of practice with rational self-statements. Angry adult men (n = 45) from the community received 12 individual treatment sessions which consisted of repeated exposure to anger-provoking verbal barbs while they rehearsed rational, irrational or irrelevant self-statements. Results were generally supportive of the rational-emotive based intervention. In response to imaginal and face-to-face provocations, men who practiced rational self-statements were less angry on measures of state anger, anger-out, dynamometer intensity, and dynamometer frequency. Reactions to the barb technique were good, as indicated by a positive therapeutic alliance. Further exploration of this technique as part of a full spectrum treatment strategy for anger is recommended.
Bipolar disorder (BPD) is a severe, recurrent psychiatric illness characterized by a chronic course of vacillating episodes of major depression and mania that impair functioning across many psychosocial domains (DSM–IV; DSM–IV-TR). Within each type of episode, changes occur in mood, cognitive processing, and regulation of vegetative functioning. Typical mood shifts include sadness (in depression) or euphoria (in mania). Either state can produce irritability, anxiety, and anger. In addition, both the process and the content of cognitive functioning are altered. Typical changes in process include decreased speed of thought in depression and increased speed of thought in mania. Content changes include negativity in depression and in mixed states, and grandiosity or paranoia in manic states. According to the cognitive-behavioral model of BPD (Basco & Rush, 2005), these changes in mood and cognition are accompanied by behavioral changes, typically increases in activity in mania and decreases in activity in depression. These behavioral changes, in turn, generally have a negative impact on the individual’s psychosocial functioning, such as slowed work productivity, neglect of household or family responsibilities, and reduced involvement in social activities, bring negative consequences to patients as well as those in their primary support groups. In mania, risk taking, disorganized behavior, sleep loss, and reduced medication adherence quickly exacerbate symptoms, reduce quality of functioning, and create significant psychosocial problems. BPD is sensitive to stress (Goodwin & Jamison, 1990). As symptoms alter functioning, new stressors are created as a consequence. Added stress exacerbates symptoms, and functioning may decline further.
- Go to article: Is It True That Men Are From Mars and Women Are From Venus? A Test of Gender Differences in Dependency and Perfectionism
Is It True That Men Are From Mars and Women Are From Venus? A Test of Gender Differences in Dependency and Perfectionism
Several theorists have proposed that dependency and perfectionism differentially characterize depression in women and men. Structural equation modeling was conducted on a sample of 427 patients with mood disorders to test the hypotheses that: (1) depressed women exhibit greater dependency than depressed men, (2) depressed men exhibit greater perfectionism than depressed women, (3) dependency is more related to depression in women, (4) perfectionism is more related to depression in men, (5) reductions in dependency during treatment are more associated with recovery in women, and (6) reductions in perfectionism during treatment are more associated with recovery in men. No support was found for any of the hypothesized gender differences. Women and men did not differ in the level of dependency or perfectionism, or in the correlation between these variables and depression. In addition, changes in dependency and perfectionism during treatment were not differentially associated with changes in depression in women and men.
- Go to article: Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth
Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth
Background: Many youth with tic disorders experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than the tics themselves and negatively impact self-concept, psychosocial functioning, and quality of life. Objective: Although there exist pharmacological and behavioral treatments that target the frequency and severity of tics, no intervention has been developed specifically to help youth with tics cope with their condition and limit associated functional impairment and distress. With this in mind, we report an intervention case series of eight youth (ages 8–16 years) supporting the initial efficacy of a cognitive-behavioral therapy program entitled “Living with Tics” that promotes coping and resiliency among youth with tics. Method: Eight youth with a principal diagnosis of a tic disorder (i.e., Tourette syndrome [N = 6]; Chronic Tic Disorder [N = 2]) and associated psychosocial impairment participated. Assessments were conducted at screening, pretreatment, and posttreatment by trained raters. Treatment consisted of 10 weekly individual psychotherapy session focused on improving coping with having tics. Results: Six of eight youth were considered treatment responders. On average, participants exhibited meaningful reductions in tic-related impairment, anxiety, and overall tic severity as well as improvements in self-concept and quality of life. Conclusions: These data provide preliminary evidence for conducting a larger controlled trial to examine the utility of the Living with Tics psychosocial intervention for promoting adaptive functioning among youth with tics.
This article offers a brief review and comment on the three articles by Robert Leahy, Michael Tompkins, and John Riskind and Nathan Williams on case conceptualization and treatment resistance. It focuses on how each of the authors understands treatment failure as a by-product of inaccurate case conceptualization and their proposal for overcoming resistance to change through improved case formulation. I conclude with some general comments on the similarities and differences between the three articles, and propose a number of questions that remain unanswered about the nature of treatment resistance in psychotherapy.
Blatt, Beck, and others theorize the existence of two depressive states (labeled anaclitic/sociotropic and introjective/autonomous) as well as corresponding personality types vulnerable to these forms of depressive affect. This study tested two hypotheses. First, we hypothesized that there would be a significant degree of convergence between the two most popular measures of these depressive states in the categorization of inpatient subjects. Second, we predicted distinctive cognitive vulnerabilities underlying these two clinical subtypes. Sixty-three diagnosed inpatient depressives were administered the Depressive Experiences Questionnaire (DEQ) and the Sociotropy-Autonomy Scale (SAS). The Implication grid (Impgrid) technique was then used to assess presumed cognitive vulnerabilities. Results provided little support for the proposed convergent validity between subscales of the DEQ and SAS, perhaps resulting from the unreliability of the former measure. As predicted, however, hypothetical shifts on achievement constructs oh the Impgrid precipitated more cognitive change for autonomous individuals as identified by the SAS than did shifts on dependency constructs. In contrast, for sociotropic subjects shifts in both the dependency and achievement domains carried similarly substantial implications for their self-construing.
- Go to article: Cognitive Therapy for Delusions in Schizophrenia: Models, Benefits, and New Approaches
The main purpose of the review is to demonstrate how cognitive models of psychosis translate into cognitive-behavioral approaches for intervening with psychotic symptoms in schizophrenia. Several cognitive-behavioral factors which play a role in the maintenance and possibly formation of delusional beliefs are discussed, including attentional bias to threat, “data gathering” deficits, dysfunctional metacognition, and safety behaviors. Strategies for engagement, problem formulation, and psychoeducation with deluded patients are described. Cognitive-behavioral interventions are presented, specifically, cognitive restructuring, behavioral experiments, and coping skills training. Challenges to conducting cognitive-behavioral therapy (CBT) with delusions in schizophrenia are reviewed. Novel cognitive therapies, which address these challenges, are presented.