The Need for Web-Based Cognitive Behavior Therapy Among University Students

ABSTRACT

This study investigates students' need for a web-based cognitive-behavior therapy (CBT) intervention program for preventing depression, the mental health status of those who felt a need for such a program, and underlying factors of the intention to use web-based self-help. A conceptual model for explaining intention to use web-based self-help is proposed. Nearly half of the participants reported a need for help with psychological problems, but only a third of these actually sought help from traditional mental health services. In conclusion, there is a need for web-based self-help, and web-based CBT has the potential to attract a group of students who, so far, have not been reached by traditional mental health services.     

Evaluating a Web-Based Cognitive-Behavioral Therapy for Maladaptive Perfectionism in University Students

Abstract

Objective: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress. Participants: Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban university. The data were collected from July 2009 to August 2010. Methods: Forty-seven maladaptive perfectionists were randomly assigned to a 12-week CBT or a wait-list control group and assessed via questionnaires at pre- and postintervention. Statistical procedures included t tests, Pearson correlations, and analysis of covariance. Results: At the postintervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and automatic thoughts. Conclusions: The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.     

Client Personality,Working Alliance and Outcome

Abstract

The relationship of the five-factor model of personality to working alliance, symptoms and well-being was examined in a diverse community mental health sample (N = 103). Agreeableness, openness, extraversion and conscientiousness were associated with alliance. Neuroticism was strongly associated with symptoms, and negatively associated with well-being. Extraversion was moderately associated with well-being. Personality is deserving of further study as a potentially important influence on therapy process and outcome. Part of the much-replicated association of alliance with outcome may be accounted for by personality. Implications for social work practice and research are discussed.     

The effectiveness of creative bibliotherapy for internalizing,externalizing, and prosocial behaviors in children: A systematic review

IntroductionCreative bibliotherapy is the guided reading of fiction and poetry relevant to therapeutic needs. Experiencing stories is hypothesized to act on the same mechanisms as cognitive behavioral therapy (CBT). This systematic review assesses the efficacy and effectiveness of creative bibliotherapy for the prevention and treatment of internalizing and externalizing behaviors, and the strengthening of prosocial behaviors in children (aged 5–16).MethodAn electronic search in seven major databases was conducted along with hand searches of key journals and bibliographies. Only randomized or cluster-randomized trials were included. Primary outcomes: internalizing behavior (e.g., anxiety and depression), externalizing behavior (e.g., aggression), and prosocial behavior (e.g., behavioral intentions and attitudes towards others). Secondary outcomes: parent–child relationship, peer relationship, educational attainment and reading ability.Results9180 records were located after removing duplicates. 9134 were excluded prior to screening. Of the 46 full-text articles assessed for eligibility, eight met the inclusion criteria and 38 were excluded. Meta-analysis was inappropriate due to study heterogeneity. Overall results suggest that creative bibliotherapy has small to moderate effect for internalizing behavior (δ range: 0.48–1.28), externalizing behavior (δ range: 0.53–1.09), and prosocial behavior (δ range: 0–1.2).ConclusionCreative bibliotherapy can have a small to moderate positive effect on child behavior. Although no definitive model of creative bibliotherapy emerges from the included studies, to some extent all interventions reflected CBT mechanisms. Further research is required to: 1) model the change processes taking place when children experience stories; 2) develop and pilot an intervention; 3) assess subgroup effects by gender, age, modality and literacy.     

Internet-based Cognitive Behavioral Therapy for DSM-IV Sexual Dysfunctions in Breast Cancer Survivors: Predictors of Treatment Response

Abstract

Objectives: We evaluated factors predictive of the effect of internet-based cognitive behavioral therapy (CBT) in breast cancer survivors with a sexual dysfunction. Methods: Fifty-five women completed questionnaires assessing sexual functioning and distress at baseline and post-CBT. Results: Higher therapy compliance and better partner baseline sexual functioning predicted better post-CBT sexual functioning. Higher therapy compliance and higher partner relationship satisfaction predicted lower sexual distress. Therapy compliance, in turn, was predicted by active partner involvement in therapy and a stronger therapeutic relationship. Conclusions: To increase the effect of internet-based CBT, we recommend partner involvement in therapy and establishing a strong therapeutic relationship.     

Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.     

Three perspectives on clients' experiences of the therapeutic alliance: a discovery-oriented investigation

To deepen our understanding of the therapeutic alliance in conjoint treatment, we interviewed clients in four families about their individual, private experience of the alliance after an early session. These qualitative data were triangulated with family members' scores on Pinsof's Family Therapy Alliance Scale-Revised and observational ratings of their behavior on the System for Observing Family Therapy Alliances. This discovery-oriented investigation focused on three interrelated aspects of the alliance: the family's shared sense of purpose about the needs, goals, and value of therapy (i.e., within-system alliance), split alliances with the therapist, and felt sense of safety within the therapeutic context. Results were highly consistent across the three perspectives and congruent with idiographic, therapist-rated outcomes.     

Motivational interviewing as a pregroup intervention for partner-violent men

This study investigated the effects of a pregroup motivational intervention for domestic abuse perpetrators. Men presenting for treatment at a community domestic violence agency (N = 108) were assigned to receive either a two-session intake using the techniques of motivational interviewing (MI) or a structured intake (SI) control. All participants were then referred to a cognitive behavioral treatment (CBT) program in groups homogeneous with respect to intake condition. The motivational intake led to more constructive in-session behavior during the early phase of group CBT, greater compliance with group CBT homework assignments, higher late session therapist ratings of the working alliance, and more help seeking outside of the domestic violence program. No significant effects of intake condition were found on session attendance, self-reports of readiness to change abusive behavior, or client reports of the working alliance. Partner reports of abusive behavior outcomes during the 6 months after group CBT revealed a marginal effect favoring the MI condition on physical assault. The findings suggest that motivational interviewing can increase receptivity to partner violence interventions.     

Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study

ABSTRACT

In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients’ development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners’ specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.     

Use of Self in Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has not traditionally utilized “use of self” to describe the clinician’s role in counseling but much attention has been given to the importance of the therapeutic relationship and the components necessary and appropriate for a strong working alliance. The CBT approach is discussed within the framework of previously articulated five uses of selves. A case example is presented.

Surviving the swamp: Using cognitive behavioural therapy in a social work setting

This paper explores the attempts of an adolescent support team working for South Gloucestershire Social Services, to integrate Cognitive Behavioural Therapy (CBT) into its practice. We explain how we, as a team, undertook a year-long course of study in CBT and discuss the advantages and difficulties we encountered. Then, beginning with a case study, we draw out the limitations of trying to use CBT in a social work setting. We focus specifically on how the complications of wider family systems will often compromise individual therapeutic work with young people and conclude that a more pragmatic approach to CBT is required in social work, rather than attempts to replicate work carried out in the clinical setting.     

Paining Out: An Integrative Pain Therapy Model

This article describes and evaluates an integrative pain therapy model as a beneficial form of pain-management for chronic pain. The author based his model on cognitive-behavioral modalities, progressive relaxation combined with art therapy, sensory awareness combined with indirect clinical hypnosis, formal clinical hypnosis and self-hypnosis. Those techniques were applied in small group settings to systematically alter pain perception, pain interpretations and response to pain for the group participants’ benefit. As a result, the group participants gained a greater sense of control over the pain, eased or abolished the pain, and decreased the stress, anxiety and depression associated with chronic pain. The techniques used were synthesized into ten group therapy sessions. A small data sample suggests that the model has clinical utility and maintained its benefits in a 6- to12-month follow-up.

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Abstract

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants’ randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.     

Family Discussion Groups for Patients with Chronic Pain: A Pilot Study

This pilot study investigated the benefits of discussion groups for patients with chronic pain and their family members. Nineteen patients with chronic pain and 41 relatives participated in four consecutive groups. Most patients and family members found their participation clearly helpful for themselves and for the family. The group helped them to improve communication, support and mutual relationships, and to better cope with the pain. Reported beneficial factors were experiencing communality, having a place to discuss things with each other, gaining insights, and learning from fellow‐sufferers and their own family. Post treatment, patients also felt less distressed by the pain, less depressed, less insufficient and showed an increase in life‐control and social activities. Moreover, some aspects of the family climate improved, but only in the perception of the family members. The present study points to the value of a multifamily format in chronic pain therapy and suggests the appropriateness of further controlled investigation.     

Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

ABSTRACT

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.     

A pilot study of CBT versus escitalopram combined with CBT in the treatment of pathological gamblers

We conducted a randomised controlled trial pilot study (N = 30) with two treatment groups: (1) Manualised cognitive behavioural therapy (CBT) (n = 15) and (2) escitalopram combined with CBT (n = 15). Treatment was administered individually and the CBT included weekly sessions for eight consecutive weeks. The treatment with escitalopram lasted for a minimum of 16 weeks (20 mg/day), with an optional continuation for a 6-month follow-up period. Repeated measures ANOVA with modified intent-to-treat analyses were conducted. Results showed significant time effects on all measures for both treatment conditions, although no significant group or time × group effects. The results indicated that both treatments were effective in the short term (effect sizes (ES) ranging from 0.45 to 0.91 for the CBT group and 0.27 to 0.72 for the escitalopram+CBT group), and that adding CBT to escitalopram had no additional statistically significant effect (between-group ES of 0.11 and 0.29 for primary outcome measures at 16-weeks post-treatment).     

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.     

Female Sexual Pain Disorders and Cognitive Behavioral Therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive–behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.     

Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience

ABSTRACT

This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.     

One Woman's Experience of Living with Chronic Pain

ABSTRACT

Emphasis within chronic pain literature is placed upon lost productivity of patients, escalating health care costs, and denunciation of compensation/disability claims, with exiguous recognition of the personal costs of chronic pain. Sufferers, particularly women, are vulnerable to being pathologized and labeled through the psychologizing of their pain and subsequently silenced in the pursuit of health care services. By means of an illness narrative, this article illustrates the invaluable contribution the chronic pain sufferer can make towards the understanding of her pain. Social work, as a health profession, will be challenged to listen to women's stories and to empower sufferers in the proclamation of their own voices, in an efficient movement towards participatory service delivery.