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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2010.08.002 Byline: Freda McManus (a)(b), David Westbrook (a), Maria Vazquez-Montes (c), Melanie Fennell (b), Helen Kennerley (a) Abstract: As part of the UK government's initiative to Increase Access to Psychological Therapies (see http://www.iapt.nhs.uk/for full details of the IAPT programme) there has been an expansion in the provision of post-graduate Diploma training in cognitive behaviour therapy (CBT). Previous evaluations of such training programmes have yielded mixed results but have been limited by small sample sizes and/or limited assessment measures. Author Affiliation: (a) Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford OX3 7JX, UK (b) University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK (c) University of Oxford, Department of Public Health, Old Road Campus, Oxford OX3 7LF, UK Article History: Received 31 January 2010; Revised 4 August 2010; Accepted 4 August 2010

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2009.07.011 Byline: Linda A. Dimeff (a), Kelly Koerner (b), Eric A. Woodcock (a), Blair Beadnell (c), Milton Z. Brown (d), Julie M. Skutch (a), Andrew P. Paves (a), Alissa Bazinet (a), Melanie S. Harned (a) Abstract: This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods. Author Affiliation: (a) Behavioral Tech Research, Inc., Seattle, WA, USA (b) Evidence-Based Practice Institute, Seattle, WA, USA (c) University of Washington, Seattle, WA, USA (d) California School of Professional Psychology at Alliant International University, San Diego, CA, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2009.06.009 Byline: Souraya Sidani (a), Joyal Miranda (b), Dana R. Epstein (c), Richard R. Bootzin (d), Jennifer Cousins (e), Patricia Moritz (f) Abstract: The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia. Author Affiliation: (a) School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, Canada M5B 2K3 (b) Faculty of Nursing, University of Toronto, Toronto, ON, Canada (c) Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA (d) Department of Psychology, University of Arizona, Tucson, AZ, USA (e) Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA (f) School of Nursing, University of Colorado Health Sciences Center, Denver, CO, USA Article History: Received 26 March 2009; Revised 16 June 2009; Accepted 17 June 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2009.02.010 Byline: Stefan G. Hofmann, Sanna Heering, Alice T. Sawyer, Anu Asnaani Abstract: It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression group reported more anxiety than the Reappraisal group. However, the Acceptance and Suppression groups did not differ in their subjective anxiety response. These results suggest that both reappraising and accepting anxiety is more effective for moderating the physiological arousal than suppressing anxiety. However, reappraising is more effective for moderating the subjective feeling of anxiety than attempts to suppress or accept it. Author Affiliation: Boston University, USA Article History: Received 22 June 2008; Revised 2 February 2009; Accepted 16 February 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2006.03.013 Byline: Moniek M. ter Kuile (a), Jacques J.D.M. van Lankveld (b), Ellen de Groot (a), Reinhilde Melles (b), Janneke Neffs (a), Maartje Zandbergen (b) Keywords: Lifelong vaginismus; Cognitive behavior treatment; Sexual dysfunction Abstract: Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus. Author Affiliation: (a) Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands (b) Department of Medical, Clinical, and Experimental Psychology, Academic Hospital Maastricht, The Netherlands Article History: Received 20 October 2005; Revised 18 March 2006; Accepted 27 March 2006

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.12.009 Byline: James E. Mitchell (a), Melissa Burgard (a), Ron Faber (b), Ross D. Crosby (a), Martina de Zwaan (c) Keywords: Compulsive buying; Cognitive behavioral therapy Abstract: To our knowledge, no psychotherapy treatment studies for compulsive buying have been published. The authors conducted a pilot trial comparing the efficacy of a group cognitive behavioral intervention designed for the treatment of compulsive buying to a waiting list control. Twenty-eight subjects were assigned to receive active treatment and 11 to the waiting list control group. The results at the end of treatment showed significant advantages for cognitive behavioral therapy (CBT) over the waiting list in reductions in the number of compulsive buying episodes and time spent buying, as well as scores on the Yale-Brown Obsessive Compulsive Scale -- Shopping Version and the Compulsive Buying Scale. Improvement was well-maintained at 6-month follow-up. The pilot data suggests that a cognitive behavioral intervention can be quite effective in the treatment of compulsive buying disorder. This model requires further testing. Author Affiliation: (a) Department of Clinical Neuroscience University of North Dakota School of Medicine and Health Sciences, Neuropsychiatric Research Institute, 700 1st Avenue South, Fargo, North Dakota 58102, USA (b) Department of Journalism, University of Minnesota, Minneapolis, MN, USA (c) Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nuremberg, Germany Article History: Received 14 October 2005; Revised 8 December 2005; Accepted 14 December 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2006.01.004 Byline: Rosemery O. Nelson-Gray, Susan P. Keane, Ruth M. Hurst, John T. Mitchell, John B. Warburton, James T. Chok, Amanda R. Cobb Keywords: Dialectical behavior therapy (DBT); DBT skills training; Oppositional defiant disorder; Adolescent group therapy Abstract: A modified skills training component of dialectical behavior therapy (DBT) was implemented in a group therapy format for non-suicidal outpatient young adolescents who met criteria for oppositional defiant disorder (ODD). Thirty-two youths completed the 16-week program, as well as pre- and post-treatment measures. The treatment was effective not only in decreasing negative behaviors, but also in increasing positive behaviors, per caregiver report. The youths reported a significant reduction in externalizing and internalizing symptoms and in depression. Reliable change indices indicated that far more participants were in the improved category than in the deteriorated category on the measures of interest. Despite the absence of control groups but consistent with the treatment outcome research literature for DBT-based treatments for other disorders, this study demonstrated that DBT skills training is feasible and shows promise in improving the behavior of ODD young adolescents. Author Affiliation: Psychology Department, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC, 27402-6170, USA Article History: Received 13 September 2005; Revised 10 January 2006; Accepted 10 January 2006

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.10.014 Byline: Debora Vansteenwegen, Bram Vervliet, Dirk Hermans, Tom Beckers, Frank Baeyens, Paul Eelen Keywords: Return of fear; Human fear conditioning; Retrieval cues; Renewal; Cuing; Context-effects Abstract: It was previously demonstrated in our laboratory that conditioned fear in humans can renew after extinction, when this procedure took place in a different context (ABA-renewal [Vansteenwegen et al. (2005). Return of fear in a human differential conditioning paradigm caused by a return to the original acquisition context. Behaviour Research and Therapy, 43(3), 323-336]). Using the same experimental design, we now tested the power of retrieval cues to interact with this contextual renewal phenomenon. Two groups went through acquisition and extinction (in a different context). They were then tested in the original acquisition context and in the presence of a retrieval cue. In the acquisition-cue group, this cue previously featured during the acquisition procedure; in the extinction-cue group, the cue previously featured during the extinction procedure. As expected, renewal of conditioned electro-dermal responding and retrospective expectancy ratings was strongest in the acquisition-cue group. Theoretical and clinical implications of this finding are discussed. Author Affiliation: Centre for the Psychology of Learning and Behaviour Therapy, Department of Psychology, University of Leuven, Tiensestraat 102, B-3000 Leuven, Belgium Article History: Received 7 June 2005; Revised 5 October 2005; Accepted 25 October 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.10.012 Byline: Megan M. Kelly, John P. Forsyth, Maria Karekla Keywords: Panic; Sex differences; Biological challenge; Emotion regulation Abstract: Epidemiological studies show that women are twice as likely as men to develop panic disorder (PD) during their lifetimes. Data from retrospective studies also suggest that women are more distressed by panic and other negative emotional states than men, and that this tendency may precede the development of PD. The present prospective study sought to expand this work by evaluating sex differences in the predisposition to panic in individuals without PD or other forms of psychopathology. Participants (N=96; 52 women) were exposed to 12 panicogenic inhalations of 20% CO.sub.2-enriched air while physiological (e.g., heart rate, electrodermal response, Frontalis EMG) and self-report (e.g., subject distress, fear, frequency and severity of DSM-IV panic symptoms) response domains were monitored. As expected, magnitude of autonomic responding failed to reliably discriminate between women and men. Yet, women reported more fear and panic immediately following the challenge procedure relative to men, and this sex difference persisted when assessed again 30min post-challenge. Implications of these results are discussed broadly in the context of biopsychosocial accounts of sex differences in the clinical presentation of PD. Author Affiliation: Department of Psychology, University at Albany, State University of New York, SS369, 1400 Washington Ave., Albany, NY 12222, USA Article History: Received 1 November 2004; Revised 20 September 2005; Accepted 25 October 2005 Article Note: (footnote) [star] Portions of this paper were presented at the annual meeting of the World Congress of Cognitive and Behavioral Therapies, Vancouver, BC.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.07.005 Byline: Pernilla Asenlof (a), Eva Denison (a)(b), Per Lindberg (a) Keywords: Treatment outcome; Pain; Clinical significance; Behavioral medicine Abstract: This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinically meaningful change. The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain, applying an idiographic outcome measure, The Patient Goal Priority Questionnaire, in combination with the Jacobson and Truax methodology [(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67 (3), 300-307] for determination of clinical significance. The concurrent validity of the outcome variables behavioral performance, satisfaction with behavioral performance, and fulfilled pre-treatment expectations was also studied. Eighty-two patients, randomized to either individually tailored behavioral medicine treatment (experimental group) or physical exercise therapy (control group) were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals. The experimental intervention had high impact on participants' performance of their highest ranked everyday life activities, and resulted in larger proportions of clinically significant outcomes compared with controls. The concurrent validity of the outcomes was high for those reporting clinically significant changes, but more generally, there was a moderate agreement across outcome categories. The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct. Further development of idiographic outcome measures is necessary, as is the inclusion in pain intervention research. Author Affiliation: (a) Department of Public Health and Caring Sciences/Section of Caring Sciences, Uppsala University, Uppsala Science Park, S-751 83 Uppsala, Sweden (b) Department of Caring and Public Health Sciences, Malardalen University, VasterA[yen]s, Sweden Article History: Received 27 January 2004; Revised 20 June 2005; Accepted 6 July 2005

This study adopted a perspective of the individual to define domains of everyday life for the analysis of clinically meaningful change. The purpose was to compare the clinical significance of two interventions for patients with musculoskeletal pain, applying an idiographic outcome measure, The Patient Goal Priority Questionnaire, in combination with the Jacobson and Truax methodology [(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67 (3), 300-307] for determination of clinical significance. The concurrent validity of the outcome variables behavioral performance, satisfaction with behavioral performance, and fulfilled pretreatment expectations was also studied. Eighty-two patients, randomized to either individually tailored behavioral medicine treatment (experimental group) or physical exercise therapy (control group) were evaluated at baseline and 3 months post-treatment regarding behavioral treatment goals. The experimental intervention had high impact on participants' performance of their highest ranked everyday life activities, and resulted in larger proportions of clinically significant outcomes compared with controls. The concurrent validity of the outcomes was high for those reporting clinically significant changes, but more generally, there was a moderate agreement across outcome categories. The individual should be the unit for analyses of clinical significance to enhance the ecological validity of the construct. Further development of idiographic outcome measures is necessary, as is the inclusion in pain intervention research. Keywords: Treatment outcome; Pain; Clinical significance; Behavioral medicine

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.06.006 Byline: Steven C. Hayes (a), Jason B. Luoma (a), Frank W. Bond (b), Akihiko Masuda (a), Jason Lillis (a) Keywords: Acceptance and Commitment Therapy; Relational Frame Theory; Mindfulness; Acceptance; Mediational analysis; Third generation CBT; Clinical behavior analysis; Contextualism Abstract: The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising. Author Affiliation: (a) Department of Psychology, University of Nevada, Reno, NV 89557-0062, USA (b) Goldsmiths College, University of London, UK Article History: Received 4 June 2005; Accepted 30 June 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2004.11.007 Byline: Peter L. Fisher, Adrian Wells Keywords: Obsessive-compulsive disorder; Clinical significance; Efficacy Abstract: Controlled outcome studies investigating the efficacy of psychological treatments for obsessive-compulsive disorder (OCD) have employed different methods of determining the clinical significance of treatment effects. This makes it difficult to draw conclusions regarding the absolute and relative efficacy of psychological treatments for OCD. To address this issue, standardized Jacobson methodology for defining clinically significant change was applied to recent psychological outcome trials for OCD. The proportion of asymptomatic patients following treatment was also calculated. When recovery is defined by Jacobson methodology, exposure and response prevention (ERP) appears the most effective treatment currently available (50-60% recovered). However, when the asymptomatic criterion is used as the index of outcome, ERP and cognitive therapy have low and equivalent recovery rates (approximately 25%). Author Affiliation: Department of Clinical Psychology, Rawnsley Building, Manchester Royal Infirmary, University of Manchester, Oxford Road, Manchester M13 9WL, UK Article History: Received 22 June 2004; Revised 15 November 2004; Accepted 19 November 2004

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2004.11.012 Byline: Maureen L. Whittal, Dana S. Thordarson, Peter D. McLean Abstract: The efficacy of contemporary cognitive therapy for obsessive-compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature. Author Affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada V6T 2B5

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2004.10.005 Byline: Sue Ferrier, Chris R. Brewin Keywords: Obsessions; Compulsions; Cognition; Self; Identity Abstract: We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits. Author Affiliation: Subdepartment of Clinical Health Psychology, University College London, Gower Street, London WC1E 6BT, UK Article History: Received 24 May 2004; Revised 12 October 2004; Accepted 25 October 2004

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2004.09.006 Byline: David Westbrook, Joan Kirk Keywords: Cognitive therapy; Treatment outcome; Effectiveness; Benchmarking; Evaluation studies Abstract: There is increasing interest in questions about how far the demonstrated efficacy of psychological therapies in research trials can be translated into clinical effectiveness in routine practice. This paper summarises outcome data from several hundred patients treated with CBT in routine clinical practice in a National Health Service psychology service, and compares their outcomes with some of the published research. Although the data have flaws common in ordinary clinical practice (no untreated controls, missing data, uncontrolled pharmacotherapy, etc.), the analyses suggest that CBT in this context is an effective treatment, albeit with probably not quite such good results as it achieves in research trials. Using clinical significance statistics on standardised measures, about half of the sample reliably improved over a course of therapy, including about a third who recovered to normal range. Author Affiliation: Adult Psychology Service, Warneford Hospital, Oxford OX3 7JX, UK Article History: Received 18 March 2004; Revised 31 August 2004; Accepted 13 September 2004

Nineteen of 27 patients suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy and IBS education were located and evaluated 4 yr posttreatment. Seventeen of 19 (89.5, or 63% of the total original sample) rated themselves as more than 50% improved. Six of the 12 patients (50%) who submitted symptom monitoring diaries met our criteria for clinical improvement, i.e. achieving at least a 50% reduction in primary IBS symptom scores. The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant (P < 0.05) reductions were obtained abdominal pain/tenderness, diarrhea, nausea, and flatulence.