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.
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- Go to article: Cognitive-Behavior Therapy With Eating Disorders: The Role of Medications in Treatment
Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia nervosa, but there is less empirical data on its usefulness with anorexia nervosa or binge-eating disorder. The use of cognitive-behavioral therapy (CBT) is recommended as the first line of treatment for bulimia nervosa and strongly recommended in combination when medications alone have not been effective. Combined treatment also improves symptoms such as anxiety, depression, and dietary restriction. Empirical studies support the usefulness of CBT with binge-eating disorder and suggest higher remission rates with combined treatment. No single psychotherapy or medicine alone is effective in treating anorexia nervosa. CBT is typically used as part of a comprehensive treatment program with nutritional rehabilitation and prudent use of medication. Both CBT and medication may have benefits in maintaining gains for anorexia nervosa patients after inpatient treatment. More research on CBT alone and in combination with medication is needed to adequately understand the respective roles of these therapies in a comprehensive treatment of eating disorders.
- Go to article: Blending the Good With the Bad: Integrating Positive Psychology and Cognitive Psychotherapy
The deficit model in clinical psychology is important, but has missed critical opportunities that have been brought to light by the emergence of positive psychology. By focusing on sources of strength and resilience, positive psychology can add new perspectives to ideas about dysfunctional behavior, and has important implications for the theory and practice of cognitive therapies. This special issue of the Journal of Cognitive Psychotherapy reflects the growing recognition of the importance of positive psychology. The articles in this special issue present an array of topics that blend positive psychology with cognitive therapy in ways that are articulate and insightful. Taken together, these articles suggest that the yield of positive psychology and cognitive therapies may well exceed that of either alone.
Cognitive therapy (CT) is now recognized as an effective intervention for schizophrenia in clinical guidelines developed in the United States (APA, 2006; Lehman et al., 2004) and Europe (e.g., National Institute of Clinical Excellence, 2002). However, empirical studies of CT for schizophrenia, cited as the evidence base for these recommendations, have been conducted solely with patients treated with concurrent medication. It has been a priority in some studies to enhance collaboration with the use of medication and insight into the illness for the individual patient (Kemp, Hayward, Applewhaite, Everitt, & David, 1996); and in most studies, such collaboration has been an integral part of the CT intervention. This article discusses potential interactions between medication and therapy, briefly outlines commonly used medication regimens for schizophrenia, details possible methods to improve adherence to pharmacotherapy, and explores issues encountered in collaboration in combined pharmacotherapy and CT. Finally, we discuss strategies for managing situations in which clients do not want to take medication.
- Go to article: Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy
Aaron T. Beck’s Cognitive Therapy (CT) and Albert Ellis’ Rational Emotive Behavior Therapy (REBT) are compared. A major difference between these therapies is that CT is an empirically based therapy and REBT is philosophically based. The origins and subsequent development of the therapies are reviewed with this difference highlighted. Comparisons between CT and REBT practice are made regarding attitudes toward client beliefs, use of guided discovery, types of cognition addressed, and the nature of the client-therapist relationship. The scientific foundations of CT are summarized in terms of the specificity of its conceptual models, the construction of targeted treatment protocols, and empirical findings that support both CT conceptualizations and treatments.
- Go to article: Similarities and Differences Between Rational Emotive Behavior Therapy and Cognitive Therapy
The main theoretical and practical applications of Rational Emotive Behavior Therapy (REBT) and Cognitive Therapy (CT) are examined and found to be similar to each other in most respects, but REBT bases its concepts of improved treatment of neurotic disorders and of severe personality dysfunctioning largely on philosophical, existential, and humanistic bases, while CT tends to align them with empirical results of outcome studies. Both REBT and CT, however, use philosophic and empirical outcome studies to construct and validate their theories.
With the emergence of manualized treatments in the 1980s, research protocols have focused increasing attention on documenting the integrity of treatment delivery. Two constructs have guided the conceptualization of assessing treatment integrity. The first, adherence, concerns the extent to which therapists adhere to the interventions of a therapy being tested, and measuring which particular interventions are performed. The second, competence, concerns the quality or skill in therapists’ execution of the therapy being tested. This article reviews the development of treatment integrity research for cognitive therapy in depression, and discusses salient issues that have arisen in its assessment. Recommendations for further refining the considerations of adherence and competence in the delivery of cognitive therapy are provided.
- Go to article: Assessing the Development of Competence During Postgraduate Cognitive-Behavioral Therapy Training
This article investigates the development of competency in cognitive-behavioral therapy (CBT) as a result of a postgraduate training course in CBT in Wellington, New Zealand. Thirteen experienced mental health professionals attended the half-time 30-week-long course. Preliminary data are presented on the development of knowledge as assessed at the beginning and end of the course by a modified version of the Behaviour Therapy Scale (Freiheit & Overholser, 1997), other-rated competence as measured by the Cognitive Therapy Scale—Revised (Blackburn, Milne, & James, 1997), and supervisor and student evaluations of competence in particular skill areas. All students improved in specific CBT skills as a result of training. The extent that students improved and variations around the other outcome measures, together with the limitations of this pilot study and suggestions for improvements for future investigations, are discussed.
- Go to article: Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
Response to Ellis’ Discussion of “Science and Philosophy: Comparison of Cognitive Therapy and Rational Emotive Behavior Therapy”
These authors appreciate Ellis’ clarification that he encourages REBT therapists to use many of the same principles and methods used by CT therapists. His assertions that many of these elements are done more frequently or thoroughly in REBT than in CT are best evaluated by objective observers via empirical analysis of therapy transcripts, session videotapes, and treatment manuals. Such research would have particular value if it linked therapy methods with treatment outcome and relapse prevention for particular problems. In this regard, Ellis’ recommendation that REBT become more empirical is welcome. Also, these authors clarify the distinction they make between the terms philosophical and philosophically-based; empirically responsive and empirically-based. Finally, the authors applaud Ellis’ major contributions to the field.
- Go to article: Changing Interpretation and Judgmental Bias in Social Phobia: A Pilot Study of a Short, Highly Structured Cognitive Treatment
Changing Interpretation and Judgmental Bias in Social Phobia: A Pilot Study of a Short, Highly Structured Cognitive Treatment
Interpretation and judgmental biases concerning negative evaluation are considered important maintaining factors in social phobia. Cognitive models imply that solely changing these core cognitions reduces social anxiety. Standardizing such an intervention in these core biases may simplify and shorten treatment and therefore increase its accessibility. We present pilot data (n =13) of a short (9 sessions), standardized cognitive therapy developed to intervene directly and solely in interpretation and judgmental biases in social phobia. Described are the design of this therapy and the cognitive techniques. This short therapy was effective in reducing social phobic complaints (effect size of 1.4) and interpretation and judgmental biases. In addition, we have indications that this treatment has high accessibility because of its short duration and standardization.