Cognitive-behavioral approaches

Rawson RA, Huber A, McCann M, et al A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry 59 817—824, 2002 Rohsenow DJ, Monti PM, Martin RA, et al Motivational enhancement and coping skills training for cocaine abusers effect on substance use outcomes. Addiction... 

Carroll KM (1998). A Cognitive-Behavioral Approach Treating Cocaine Addiction (NIH Publication No. 98-4308). National Institute on Drug Abuse, Rockville, MD. 

Cognitive psychotherapeutic techniques have further been developed since their introduction by Beck et al. (1979), who demonstrated their effectiveness in the treatment of depression. Several studies have extended Beck s cognitive therapy to adulthood schizophrenia with encouraging clinical results. The efficacy of cognitive-behavioral approaches could be demonstrated in several key areas in schizophrenia, especially therapy-resistant hallucinations and delusions. Several approaches have also addressed therapeutic efforts in the treatment of associated symptoms such as anxiety and depression. In addition, cognitive-behavioral techniques have been shown to be effective in treatment of chronic schizophrenia, resulting in reduction of distress and disruption due to hallucinations and delusions. In some studies anxiety and depression associated with schizophrenia could also be reduced to some extent. The value of these techniques in children and adolescents has yet to be demonstrated. 

Oordt, M.S. 2001. Managing severe gas mask anxiety with a cognitive-behavioral approach an illustrated case study and treatment protocol. Mil Psychol 13(3) 165-76. 

Daniel HC, van der Merwe JD. Cognitive behavioral approaches and neuropathic pain. Handbook Clin Neurol 2006 81 855-868. 

Deblinger, E., Heflin, A. H. (1996). Ti eating sexually abused children and their nonoffending parents A cognitive behavioral approach. Thousand Oaks, CA S e. 

Maintain a Developmental Focus. The nature of the intervention varies based on the developmental level of each child and his or her family. The child s maturity and ability to reason are considered throughout treatment planning. A developmental perspective consistent with literature on best practice is integrated with behavioral and cognitive-behavioral approaches. 

Several recent documents provide excellent reviews of empirically supported treatments for childhood depression, anxiety, adhd, and disruptive behavior (Kazdin, 2000 U.S. Department of Health and Human Services, 1999). One treatment for depression, self-control therapy (Stark, Reynolds, Kaslow, 1987 Stark, Rouse, Livingston, 1991), reduces symptoms of depression and anxiety. Self-control therapy utilizes a cognitive-behavioral approach to group treatment and includes twenty-four 45-minute sessions. Sessions focus on restructuring maladaptive cognitions (e.g., ITl never win at anything) and training in social skills, assertiveness, and relaxation. 

Botvin, G. J., Baker, E., Dusenbury, L., Tortu, S., Botvin, E. M. (1990). Preventing adolescent drug abuse through a multi-modal cognitive-behavioral approach Results of a 3-year study. Journal of Consulting and Clinical Psychology, 58,437-446. 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

Psychotherapy focused on reducing the influence of the CNS on the gut has been studied. Cognitive behavioral therapy (CBT), dynamic psychotherapy, relaxation therapy, and hypnotherapy have been reported to be effective in some patients. However, CBT and relaxation therapy do not appear to be better than standard approaches.18 Biofeedback may provide relief in cases of severe constipation, but definitive evidence is lacking.16 Psychotherapy interventions provide relief from pain and diarrhea but not constipation.19... 

While pharmacologic agents may help prevent relapse, psychotherapy should be the core therapeutic intervention. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), 12-step facilitation (TSF), behavioral couples therapy (BCT), community reinforcement approaches, and contingency management are the best-studied forms of psychotherapy in this group of patients. 

Glenn MB. A differential diagnostic approach to the pharmacological treatment of cognitive, behavioral, and affective disorders after traumatic brain injury. J Head Trauma Rehabil 2002 17(4) 273-283. 

Comorbid personality disorders have long been associated with TRD and a poor response to antidepressant treatment. For example, Pfohl et al. (1984) observed only a 16% response rate in inpatients with comorbid depression and personality disorder compared with a 50% response rate in patients with pure depression. Similar results were reported from a study by D. W. Black et al. (1987), in which, with the use of ECT in addition to a TCA, the response rate among those with a comorbid Axis II disorder was lower, 42% compared with a 60% recovery in those without Axis II pathology. The best approach for these patients may be a combination of psychotherapy and medication. This approach was recently borne out by the Treatment of Depression Collaborative Research Project (Shea et al. 1990), which found that cognitive-behavioral therapy yielded a better response than either imipra-... 

Westra, H.A., Stewart, S.H. Cognitive behavioral therapy and pharmacotherapy complementary or contradictory approaches to the treatment of anxiety Clin. Psychol. Rev. 18, 307-340, 1998. 

Avoiding drugs that lower the threshold for panic symptoms, such as caffeine or over-the-counter stimulants, may also help. Some phobic symptoms are managed by in vivo exposure or cognitive therapy. In general, the best approach is a combination of pharmacotherapy and psychotherapy, in particular, cognitive behavioral techniques. 

Nondrug approaches (e.g., cognitive-behavioral therapy) are always preferable when effective. 

Therapy and/or counseling is also very important. Different therapy approaches used in substance abuse treatment include individual psychotherapy, behavioral therapy, cognitive-behavioral therapy, group therapy, and family therapy. Often, more than one therapeutic approach is used during drug rehabilitation. 

Perhaps the role of cognitive-behavioral treatments ought to be tested, as both depression and chronic pain tend to be responsive to cognitive and behavioral interventions. To our knowledge, very few, if any, treatments have studied the combined effects of pharmacotherapy and behavioral or physical therapies. Given the complex nature of FM, a multifactorial approach may be the most effective (40) and an important area to explore with more scientific rigor. 

Both pharmacological and psychotherapeutic interventions have proven effective, to various degrees, in the treatment of anxiety disorders. Usually, a combination of both techniques seems to yield the best results. A number of factors (e.g., patient preference, availability of specially trained therapists, cost, and prior results) will determine whether medications, psychotherapy, or both are selected. Among the psychotherapies, the evidence shows cognitive-behavioral techniques as the preferred approach. 

---