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Background: Little is known about which personality traits determine the effectiveness of various types of cognitive-behavioral therapy (CBT) on animal phobia. The objective of the present study was to investigate a possible association between personality traits and the outcome of single- and multi-session CBT., Methods: The present randomized clinical trial was conducted from November 2018 to May 2019 in Shiraz, Iran. Forty female students with rat phobia, who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria, were systematically allocated into a single- and a multi-session therapy group (odd numbers one-session treatment, even numbers multi-session treatment). In both groups, the students were gradually exposed to rats as part of the treatment. Psychological measures (state-anxiety, rat phobia, and disgust questionnaires) were used to compare pre- and post-intervention outcomes. Multivariate analysis of covariance was used to assess which personality traits influenced the intervention outcome. The statistical analysis was performed using SPSS (version 20.0) and P values<0.05 were considered statistically significant., Results: Rat phobia was positively and significantly affected by conscientiousness (P=0.001) and agreeableness (P=0.003). Of these personality traits, only a higher degree of conscientiousness resulted in a further reduction of state anxiety after the intervention (P=0.005). There were no significant differences between the pre- and post-intervention outcomes., Conclusion: The outcome of single- and multi-session rat phobia therapies was associated with specific personality traits of the participants, namely conscientiousness and agreeableness. Both intervention methods had an equal effect on reducing rat phobia., (Copyright: © Iranian Journal of Medical Sciences.)

Mindfulness-based cognitive therapy (MBCT) is an innovative evidence-based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet-based versus group-based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group-based MBCT out of 120 patients who were randomized to group-based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT., (© 2019 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

The aim of this study was to examine the effects of cognitive behavior group therapy (CBGT) and family psychoeducation (FPE) in promoting and maintaining adolescent mental health. This quantitative study used a quasi-experiment method, pre- and post-testing with a control group design. A total of 86 adolescents were selected using the purposive sampling method and allocated into two groups that were administered different types of intervention. The first intervention group was provided with mental health education and adolescent developmental stimulation only, which was carried out with individual exercises of stimulation. The second intervention group was provided with mental health education and adolescent developmental stimulation in addition to CBGT and FPE. A mental health continuum short-form questionnaire was used to determine mental health scores. The results showed that most of the adolescents received flourishing mental health scores. These scores significantly increased after receiving mental health education and developmental stimulation, as well as CBGT and FPE. Our results indicate that mental health education and developmental stimulation can be used to promote and maintain good mental health. CBGT and FPE can be used not only to treat mental health problems but also to promote flourishing mental health.

Prior research suggests that under some conditions, interventions that aggregate high-risk youth may be less effective, or at worse, iatrogenic. However, group formats have considerable practical utility for delivery of preventive interventions, and thus it is crucial to understand child and therapist factors that predict which aggressive children can profit from group intervention and which do not. To address these questions we video-recorded group Coping Power intervention sessions (938 sessions), coded both leader and participant behavior, and analyzed both leader and children's behaviors in the sessions that predicted changes in teacher and parent, reports of problem behavior at 1-year follow up. The sample included 180 high-risk children (69% male) who received intervention in 30 separate Coping Power intervention groups (six children assigned per group). The evidence-based Coping Power prevention program consists of 32 sessions delivered during the 4th and 5th grade years; only the child component was used in this study. The behavioral coding system used in the analyses included two clusters of behaviors for children (positive; negative) and two for the primary group leaders (group management; clinical skills). Growth spline models suggest that high levels of children's negative behaviors predicted increases in teacher and parent rated aggressive and conduct problem behaviors during the follow-up period in the three of the four models. Therapist use of clinical skills (e.g., warmth, nonreactive) predicted less increase in children's teacher-rated conduct problems. These findings suggest the importance of clinical training in the effective delivery of evidence-based practices, particularly when working with high-risk youth in groups.

A high proportion of patients presenting at epilepsy clinics experience functional non-epileptic attacks (FNEA), and while psychological treatment is generally thought to be the required intervention, evidence regarding psychological treatment of FNEA is limited. A small number of psychoeducation treatments have been evaluated, with promising results. As part of routine care within a neuropsychiatry service, a 3-session cognitive-behavior therapy- (CBT-) informed psychoeducation group was developed. Patients with comorbid epilepsy were included. The group's effectiveness was evaluated in terms of attack frequency, mood, illness perception, dissociative experiences, and patient feedback. Pre- and post-treatment data were obtained for 19 patients. The proportion of patients experiencing attacks significantly decreased, with almost 40% of treatment completers reporting being attack-free at the end of treatment. Significant improvements were also found on level of psychological distress, illness beliefs, and understanding of the condition. No significant changes in mood or general functioning were observed. High satisfaction was reported by almost all patients. Treatment outcome was not significantly affected by the level of dissociative experiences. The results suggest that CBT-based psychoeducation group treatment can be a beneficial part of treatment for those with FNEA, even for those experiencing high levels of dissociation. Further controlled studies with larger sample sizes are required., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate the feasibility and acceptability of "Cascade": an online, group-based, cognitive behavioral therapy intervention, delivered "live" by a psychologist, to assist parents of children who have completed cancer treatment., Methods: Forty-seven parents were randomized to Cascade (n = 25) or a 6-month waitlist (n = 22). Parents completed questionnaires at baseline, 1-2 weeks and 6 months post-intervention. Thirty parents completed full evaluations of the Cascade program (n = 21 randomized to Cascade, n = 9 completed Cascade post-waitlist)., Results: Ninety-six percent of Cascade participants completed the intervention (n = 24/25). Eighty percent of parents completed every questionnaire (mean completion time 25 min (SD = 12)). Cascade was described as at least "somewhat" helpful by all parents. None rated Cascade as "very/quite" burdensome. Parents reported that the "online format was easy to use" (n = 28, 93.3 %), "I learnt new skills" (n = 28, 93.3 %), and "I enjoyed talking to others" (n = 29, 96.7 %). Peer-to-peer benefits were highlighted by good group cohesion scores., Conclusions: Cascade is highly acceptable and feasible. Its online delivery mechanism may address inequities in post-treatment support for parents, a particularly acute concern for rural/remote families. Future research needs to establish the efficacy of the intervention., Trial Registration: ACTRN12613000270718, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613000270718.

Background: Breast cancer can be perceived as a traumatic event with disturbing effects on psychological domains such as depression, anxiety, and Posttraumatic Stress Disorder. In contrast, growing evidence has shown that posttraumatic growth can occur as a result of coping with breast cancer. Challenging the assumptive world, deliberate rumination, and emotional disclosure are recognized as strong predictors of posttraumatic growth. Group interventions may also increase social support, distress disclosure, and posttraumatic growth. The aim of this study is to evaluate how group-based interventions can facilitate posttraumatic growth and promote improved psychosocial adjustment to breast cancer. This article describes the study protocol and the applied research methods., Methods: To measure the impact of a group-based intervention on posttraumatic growth, a multi-center randomized control trial was developed for Portuguese breast cancer patients. 205 women with nonmetastatic breast cancer (stages 1 to 3) were recruited for the study and were randomly assigned either to the experimental group, which participated in an 8-session group intervention, or to the control group. Psychosocial variables, which consisted of posttraumatic growth, illness perception, stressfulness of the event, Posttraumatic Stress Disorder, core beliefs, rumination, social support, and distress disclosure were measured at three time points. The designated points in time for the assessments were baseline, 6 months post-intervention, and follow-up (12 months after baseline)., Discussion: This study is the first trial to assess the efficacy of a group-based intervention designed to facilitate posttraumatic growth following a breast cancer diagnosis. If proven to be effective, group-based intervention could be recommended as a complementary program to be included in hospital health-care and clinical practice., Trial Registration: The trial was registered on 28/10/2013 at the Current Controlled Trials ( ISRCTN02221709 ).

Objective: To compare clinical and process outcomes of cognitive processing therapy-cognitive only version (CPT-C) delivered via videoteleconferencing (VTC) to in-person in a rural, ethnically diverse sample of veterans with posttraumatic stress disorder (PTSD)., Method: A randomized clinical trial with a noninferiority design was used to determine if providing CPT-C via VTC is effective and "as good as" in-person delivery. The study took place between March 2009 and June 2013. PTSD was diagnosed per DSM-IV. Participants received 12 sessions of CPT-C via VTC (n = 61) or in-person (n = 64). Assessments were administered at baseline, midtreatment, immediately posttreatment, and 3 and 6 months posttreatment. The primary clinical outcome was posttreatment PTSD severity, as measured by the Clinician-Administered PTSD Scale., Results: Clinical and process outcomes found VTC to be noninferior to in-person treatment. Significant reductions in PTSD symptoms were identified at posttreatment (Cohen d = 0.78, P < .05) and maintained at 3- and 6-month follow-up (d = 0.73, P < .05 and d = 0.76, P < .05, respectively). High levels of therapeutic alliance, treatment compliance, and satisfaction and moderate levels of treatment expectancies were reported, with no differences between groups (for all comparisons, F < 1.9, P > .17)., Conclusions: Providing CPT-C to rural residents with PTSD via VTC produced outcomes that were "as good as" in-person treatment. All participants demonstrated significant reductions in PTSD symptoms posttreatment and at follow-up. Results indicate that VTC can offer increased access to specialty mental health care for residents of rural or remote areas., Trial Registration: ClinicalTrials.gov identifier: NCT00879255., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.

The context for the present study was a cluster-randomized controlled trial of a group-based anger-management intervention, delivered by day-service staff. We aimed to develop a scale to measure the fidelity of manualized cognitive-behavioural therapy (CBT) delivered to adults with intellectual disabilities in group-based settings. A 30-item monitoring instrument (the MAnualized Group Intervention Check: MAGIC) was adapted from an existing fidelity-monitor instrument for individual CBT. Two sessions for 27 groups were observed by pairs of monitors who had no other contact with the intervention. 16 observers participated, in 15 unique pairings. Observers recorded high levels of inter-rater reliability and the scale had good internal consistency. Fidelity ratings predicted two key outcomes of the intervention, and were themselves predicted by the therapists' clinical supervisors., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective(s): Treatment credibility and client satisfaction have received relatively little research attention, but extant findings indicate that some clients and therapists differ in their perceptions of what is helpful about therapy, with greater divergence related to poorer outcomes. This study examined relationships between treatment credibility, perceptions of therapy helpfulness, and treatment response., Method: Participants were 48 individuals (60.4% female; 53.2% Caucasian; mean age 32.79 years) with an anxiety disorder diagnosis. Participants completed a 12-week transdiagnostic treatment protocol; treatment credibility was rated after session 2, and treatment component helpfulness was rated posttreatment., Results: Treatment response was significantly correlated with perceived helpfulness of cognitive restructuring and exposure techniques, but not treatment credibility. Treatment responders recognized the helpfulness of factors considered to be important therapeutic processes., Conclusions: Findings emphasize the importance of client perceptions of cognitive and behavioral techniques in treatment and suggest the need to monitor client perceptions throughout the treatment process., (© 2012 Wiley Periodicals, Inc.)

Objective: The aim of this study was to prepare a group-based cognitive-behavioral therapy program for patients with schizophrenia and other psychotic disorders coping with auditory hallucinations, and to evaluate the effectiveness of the program., Method: The study included 12 male inpatients aged between 18 and 55 years from the Manisa Mental Health and Illnesses Hospital that were diagnosed with schizophrenia or schizoaffective disorder according to DSM-IV diagnostic criteria (SCID-I). The inclusion criteria were the diagnosis of schizophrenia or schizoaffective disorder, at least 1 hospitalization, the presence of auditory hallucinations, and the absence of alcohol/drug abuse/dependence, organic deficit, and mental/physical disability. In all, 7 patients received routine care plus group CBT and 5 patients received routine care alone. The group treatment program was conducted for 9-10 sessions twice a week. The patients were assessed using SAPS, SANS, the Problem/Symptom Checklist, and the Knowledge of Schizophrenia Questionnaire pre-treatment, post-treatment, and at the 1-year follow-up. The outcomes were analyzed using the Wilcoxon signed rank test., Results: There was a significant reduction in the severity and frequency of hallucinations, delusions, distress and occupation with auditory hallucinations, negative symptoms, and anxiety in the CBT group after treatment. Additionally, post-treatment outcome in the treatment group didn't change at 1 year follow-up. In the control group, there was no difference between pre-treatment and post-treatment outcome (P<0.05)., Conclusion: The therapy program was considered to be effective in increasing the ability to cope with auditory hallucinations and reducing their frequency for the patients with schizophrenia and schizoaffective disorder.

Previous research has established efficacy of cognitive behavioral therapy (CBT) for anxiety disorders, yet it has not been widely assessed in routine community clinic practices. Efficacy research sacrifices external validity to achieve maximum internal validity. Recently, effectiveness research has been advocated as more ecologically valid for assessing routine clinical work in community clinics. Furthermore, there is a lack of effectiveness research in group CBT. This study aims to extend existing research on the effectiveness of CBT from individual therapy into group therapy delivery. It aimed also to examine outcome using not only symptom measures, but also measures of related symptoms, cognitions, and life quality and satisfaction. Results from a cohort of patients with various anxiety disorders demonstrated that treatment was effective in reducing anxiety symptoms to an extent comparable with other effectiveness studies. Despite this, only 43% of individuals showed reliable change, and 17% were 'recovered' from their anxiety symptoms, and the post-treatment measures were still significantly different from the level of anxiety symptoms observed in the general population.

Objective: To test the effectiveness at 6 and 12 months' follow-up of group cognitive behavioural therapy (CBT) compared with blood glucose awareness training (BGAT) in poorly controlled Type 1 diabetic patients and to explore the moderating effect of baseline depression., Research Design and Methods: Adults with Type 1 diabetes (n = 86) with glycated haemoglobin (HbA(1c)) >or= 8% were randomized to CBT or BGAT. Primary outcome was HbA(1c) control. Secondary outcomes were: self-care, diabetes-related distress (Problem Areas in Diabetes scale; PAID), diabetes self-efficacy (Confidence in Diabetes Self-care scale; CIDS) and depressive symptoms (Centre for Epidemiological Studies--Depression scale; CES-D). Measurements were scheduled before CBT and BGAT, and at 3, 6 and 12 months after. Differential effects were analysed for the subgroup of patients reporting low vs. high baseline levels of depression., Results: Neither CBT nor BGAT had a significant impact on HbA(1c) at 6 and 12 months' follow-up. Both interventions resulted in lower depressive symptoms (CES-D 15.7-13.3, P = 0.01) up to 12 months, but only CBT was effective in lowering HbA(1c) in patients with high baseline depression scores (HbA(1c) 9.5-8.8%) up to 1 year of follow-up (P = 0.03)., Conclusions: Our findings suggest that group CBT can effectively help Type 1 diabetic patients with co-morbid depression achieve and maintain better glycaemic outcomes.

Introduction: Psychotherapy of depressive conditions is more and more in demand by patients. The effect of individual cognitive behavioral therapy (CBT) on depression is well-documented, and foreign studies indicate that group CBT also works well. There was no Danish manual on group CBT for the purpose of clinical implementation. The aim of the present project was to develop such a manual and complete a preliminary evaluation of the outcome., Materials and Methods: A therapy manual consisting of 12 group sessions of 2 hours duration was developed. A constituent part of the evaluation of the clinical effect was 10 group courses with a total of 51 consecutively referred patients with a non-psychotic depression requiring treatment., Results: On the basis of clinical experience, the manual has been revised and is now ready for publication. 80% of the patients completed the therapy course with a large Effect Size (ES) on psychiatric/depression symptoms (SCL-90R) and function level (GAF), as well as moderate ES on the degree of hopelessness (BHS)., Conclusion: The development and clinical implementation of a manual in cognitive behavioral group therapy has resulted in this treatment now being offered as permanent treatment for depressive patients throughout the cooperating centers. The existing manual can relatively easily be implemented in other treatment centers and clinics. The preliminary results are positive, but the design does not permit further conclusions.

This descriptive and comparative study employed a Q-sort process to describe common factors of therapy in two group therapies for inpatients with chronic mental illness. While pharmacological treatments for chronic mental illness are prominent, there is growing evidence that cognitive therapy is also efficacious. Groups examined were part of a larger study comparing the added benefits of cognitive versus supportive group therapy to the treatment milieu. In general, items described the therapist's attitudes and behaviors, the participants' attitudes and behaviors, or the group interactions. Results present items that were most and least characteristic of each therapy and items that discriminate between the two modalities. Therapists in both groups demonstrated good therapy skills. However, the cognitive group was described as being more motivated and active than the supportive group, indicating that the groups differed in terms of common as well as specific factors of treatment.

Aims: To assess the effects of cognitive behavioural group training (CBGT) on glycaemic control, diabetes self-efficacy and well-being in Type 1 diabetes patients in persistent poor glycaemic control., Methods: In a randomized controlled trial, a total of 107 patients with Type 1 diabetes in poor glycaemic control (HbA(1c) > or = 8%) were assigned to a 6-week CBGT or blood glucose awareness training (BGAT) as control condition. The intervention was preceded by a 3-month run-in period. Glycaemic control (HbA(1c)), diabetes-specific self-efficacy (CIDS), diabetes-related distress (PAID) and depressive symptoms (CES-D), were assessed at baseline (T1), directly before (T2) and 3 months after (T3) the intervention., Results: No significant changes in HbA(1c) were found after CBGT, whilst diabetes self-efficacy increased (mean CIDS score 71.6 +/- 14.0 to 74.3 +/- 12.2) and diabetes-related distress (mean PAID score 47.0 +/- 21.6 to 42.6 +/- 20.8) and depressive symptoms decreased (mean CES-D score 16.9 +/- 12.8 to 13.5 +/- 12.6). Changes in psychological outcomes were similar for both treatment groups. Diabetes self-care behaviours improved equally. Drop-out rate, which was higher among CBGT participants, was relatively low overall (total n = 15, 17.05%), and both interventions were well-appreciated by the participants., Conclusions: CBGT was successful in improving self-efficacy, diabetes-related distress and mood at 3 months' follow-up, but not in improving glycaemic control.

Juvenile sexual offending is increasingly being recognized as a serious crime among youth. The prevalence of sexual offending and sexual reoffending suggests that many juvenile sex offenders (JSOs) may repeat their offending behaviors if not treated. However, clinical trials evaluating specific interventions are virtually nonexistent. Instead, the literature on the treatment of JSOs is marked by discussions of strategies that are hypothesized to be beneficial, as well as descriptions of treatment programs that exist across the country. Further, while existing literature suggests that treatment for JSOs may deter future sexual offending behaviors, it is unclear which, if any, aspects of these treatments promote the development of positive behaviors. A discussion of existing treatment approaches, effectiveness, and treatment considerations follows.

Background: An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based., Aims and Objectives: The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach., Methods: A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component., Conclusions and Relevance to Clinical Practice: The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.

A substantial group of patients with type 1 diabetes has difficulty adhering to the treatment regimen, and as a consequence is at increased risk of developing microvascular complications. Cognitive behavioural interventions may help these patients to cope more effectively with their diabetes. We developed a 4 weeks cognitive behavioural group training (CBGT) for patients with type 1 (insulin-dependent) diabetes in persistent poor glycaemic control, to help them overcome negative beliefs and attitudes towards diabetes and improve their self-care behaviours. Feasibility and efficacy of CBGT were tested in a non-randomised prospective study in 24 poorly-controlled type 1 diabetes patients (mean age 35.2+/-11.1years; 15 female; mean HbA(1c) 9.3% (+/-1.2)), with assessments at 3 and 6 months follow-up. The programme was delivered in small groups (n=6-8), by a team of a diabetes nurse specialist and a psychologist. Primary outcome measures were glycosylated haemoglobin (HbA(1c)), diabetes-related emotional distress (PAID) and psychological well-being (WBQ-12). Changes in diabetes self-care activities (DSCI) were documented, along with perceived barriers in diabetes questionniare (BDQ) and fear of hypoglycaemia survey (HFS). Data were analysed using repeated measures analysis of variance. The CBGT proved to be feasible in this selected group of patients and was well appreciated. Following CBGT, mean HbA(1c) dropped by 0.8% at 6 months from baseline, while emotional well-being was preserved. It is concluded that CBGT is a promising intervention that deserves further evaluation in randomised controlled trials.

Geriatric depression is a disabling illness that is associated with increased morbidity and mortality and deserves aggressive and early intervention. Cognitive-behavioral group therapy is an effective intervention for the treatment of geriatric depression and can be used with residents in an assisted living facility to manage and prevent depression. Cognitive-behavioral group therapy protocol modifications for residents in assisted-living facilities aids their participation and learning.

The state of the art for treatment efficacy studies now requires manual guided treatments and tests of therapist adherence. This report provides findings regarding adherence assessment of therapists participating in an investigation of treatment matching in adolescent substance abusers. The Group Sessions Rating Scale (GSRS), a group-therapy process measure, was studied to determine its appropriateness for assessing group treatment of adolescents with a) substance use disorders (SUD), b) interrater reliability, c) internal consistency, and d) ability to discriminate the active ingredients of cognitive-behavioral therapy (CBT) from interactional therapy (IT). Interrater reliabilities were moderate to high, with those for CBT generally higher than those for IT. Internal consistency of CBT items was moderate, whereas those of IT were moderately high. Discriminability between the two treatment modalities was high. The frequency of active ingredients was generally therapy-specific: high for the relevant and low for the nonrelevant therapeutic modality items. The GSRS was found to be effective in the measurement of treatment process in adolescents with SUD.

This paper describes a cognitive therapy for men with a learning disability convicted of sex offences against children. Methods are described which focus the session, emphasize confidentiality, ensure that the patient accepts responsibility for the offence, and deal with issues of intent, harm done to the victim and sequences of offending behaviour. Methods for producing cognitive change are described. Patients were assessed regularly and data are presented in detail. While all six men showed improvement, there were several variables which interfered with the course of treatment. The study attempts to address two major problems in work with sex offenders: the difficulty of employing a controlled treatment design and the importance of a long follow-up period.

The present study investigated the impact of pre-existing pharmacotherapy regimes on the long-term outcome of brief intensive group cognitive-behavioural therapy (BIGCBT) in the treatment of panic disorder with or without agoraphobia in 106 patients (74 females). Forty patients were allocated to BIGCBT without medication, 40 to BIGCBT plus anti-anxiety medication, 10 to BIGCBT plus anti-depressant medication and 16 to BIGCBT plus combined anti-anxiety and anti-depressant medications. The mean follow-up period was 3.2 yr and ranged from 1.1 to 6.2 yr. The results demonstrated that patients who received BIGCBT concurrent with pre-existing medication regimes did not differ significantly (P > 0.001) from each other or from patients who underwent BIGCBT without medication on any of the dependent measures either at pre-treatment assessment or long-term follow-up. However, BIGCBT (with or without pharmacotherapy) was associated with significant (P < 0.001) long-term improvements in frequency of panic attacks, avoidance behaviour and questionnaire measures of anxiety, depression and agoraphobia. Furthermore, the large majority (80%) of patients in the BIGCBT without medication group remained medication-free at long-term follow-up. Of those patients who underwent BIGCBT concurrent with pre-existing pharmacotherapy, a large percentage (44%) reported no longer taking medication for their condition at long-term follow-up. Overall, it is concluded that pre-existing medication regimes (anti-anxiety, anti-depressant or combinations of these) do not significantly enhance or detract from the long-term outcome of a BIGCBT program used in the treatment of panic disorder and agoraphobia.

African American men are at increasingly high risk for HIV infection, but there have been few studies of HIV risk reduction interventions for heterosexual ethnic minority men. The present study randomly assigned 81 African American men to one of two HIV prevention interventions: a four-session cognitive-behavioral skills training HIV risk reduction intervention that has been successful with other populations or a four-session HIV risk education and sensitization control condition. Men were assessed at baseline, at immediate postintervention, and at a 3-month follow-up. Forty-five percent of participants dropped out of the intervention; dropouts were younger, more likely to have used condoms, and less likely to have been tested for HIV antibodies than men who completed the study. Outcome analyses showed that both interventions significantly increased AIDS-related knowledge, initial intentions to change HIV risk behaviors, and reduced unprotected vaginal intercourse. However, there were no significant differences between groups on any of the measures at postintervention or follow-up assessments. Recognizing the limitations of our small sample size, the results of this initial study caution against generalizing skills training HIV prevention interventions that have been successful with other populations to African American heterosexual men.

The objective of this study was to evaluate the effect of a short cognitive behavioural group therapy programme for somatization disorder in primary care. The treatment model was focused on patient education and stress relaxation. A controlled and prospective study design was used with repeated assessments of the patients' perception of their psychosocial problems, psychological distress and medication usage. The results were analysed up to 6 months after treatment and showed the treated patients to be moderately but significantly improved with respect to physical illness and somatic preoccupation, hypochondriasis, and medication usage. In a control group of untreated patients no such improvements were observed. In summary, the short group treatment programme used in this study may be beneficial for patients with somatization disorders. With some modifications it might be useful to practitioners in primary care for the management of psychosomatic disorders.

Objective: Many approaches have been tried in order to tackle the problem of obesity in children, but most of them have failed to achieve long-term weight loss. Cognitive behaviour therapy tends to predict good prospects. So far, no studies have investigated the surplus value of introducing a "healthy-eating" lifestyle program instead of a strict diet prescription, in combination with the principles of cognitive behaviour therapy. Therefore, a new program was designed. The second aim of the study was to evaluate the impact of different forms of therapeutic contact., Subjects and Methods: The obese group consisted of 205 children seeking treatment, and a control group of 54 obese school children. The effects of the program were evaluated by means of a pre-test/post-test design with a 1-y follow-up. Subjects were assigned to different therapeutic conditions: group therapy, individual therapy, summer camp or "advice in one session"., Results: A progressive and significant loss of weight for all therapeutic conditions was noticeable. The reduction continued at least 6 months after completing therapy. The control group, however, showed weight evolution in the opposite sense., Conclusions: A replication of the positive effect of CBT was found in a broad sample of clinically obese children, even without strict diet prescription. Our hypothesis that group approach will result in a better outcome is borne out.

Little is known about the effectiveness of cognitive behavioral treatment for patients with irritable bowel syndrome on a group basis. Previous studies have used only small samples, and studies with long term follow-up are lacking. The arm of the present study was to investigate: a) the effectiveness of a cognitive-behavioral group treatment compared with a waiting list control condition in alleviating abdominal complaints and b) the long term effectiveness of cognitive-behavioral group treatment. In study 1, we performed a controlled study with 25 patients in the group treatment condition and 20 patients in the waiting list control condition. Treatment consisted of eight 2-hour group sessions over a period of 3 months. In study 2, all patients were treated and followed up for an average of 2.25 years (range 6 months-4 years) after the completion of the group treatment. The abdominal complaints of the patients who underwent treatment were found to improve significantly more than the complaints of the patients awaiting treatment. Moreover, in agreement with the purpose of the therapy, the number of successful coping strategies was found to increase more and patients' avoidance behavior was found to decrease more in the treatment group than in the waiting list control group. The positive changes appeared to persist during follow-up. Cognitive-behavioral group treatment is effective in alleviating irritable bowel syndrome, in stimulating coping strategies, and in reducing avoidance behavior. At long term follow-up, the abdominal complaints, the number of successful coping strategies, and the avoidance behavior were still improved compared with the pretreatment assessment.

This report describes a brief, 15-session couples group therapy format developed by a university-affiliated human sexuality clinic for the simultaneous treatment of marital and sexual dysfunctions. The major marital and sexual themes addressed in this group treatment design, an overview and description of the structure of the cognitive-behavioral approach, and a case illustration are presented.

1. Depression affects an estimated 50% of the population over age 65. With the current expansion of the elderly in this country, the problem will continue to increase. 2. Depressed individuals view situations negatively when more positive interpretations are equally valid. The thrust of cognitive therapy is to replace the faulty and negative perceptions with more valid and positive ones. 3. Cognitive therapy was found to be effective in the elderly. Residents attended sessions regularly, and the change in the depression level for group participants was highly significant statistically and clinically noticeable.