Clinical and neural responses to cognitive behavioral therapy for functional tremor

ObjectivesTo evaluate changes in tremor severity and motor/emotion-processing circuits in response to cognitive behavioral therapy (CBT) delivered as treatment for functional tremor (FT), the most common functional movement disorder in adults.MethodsFifteen patients with FT underwent fMRI with motor, basic-emotion, and intense-emotion tasks before and after 12 weeks of CBT. Baseline fMRI was compared to those of 25 healthy controls (HCs). The main clinical endpoint was the tremor score (sum of severity, duration, and incapacitation subscores) adapted from the Rating Scale for Psychogenic Movement Disorders (PMDRS) assessed by a blinded clinician. CBT responders were defined as those with PMDRS score reduction >75%. Anatomic and functional brain images were obtained with a 4T MRI system. Generalized linear model and region-of-interest analyses were used to evaluate before-versus-after treatment-related changes in brain activation.ResultsCBT markedly reduced tremor severity (p < 0.01) with remission/near remission achieved in 73.3% of the cohort. Compared to HCs, in those with FT, a functionally defined fMRI region of interest in the anterior cingulate/paracingulate cortex showed increased activation at baseline and decreased activation after CBT during basic-emotion processing (p = 0.012 for CBT responders). Among CBT responders, the change in anterior cingulate/paracingulate was more significant in those with more severe baseline depression (r = 0.75, p < 0.01).ConclusionsTremor severity improved significantly after CBT. The improvement was associated with changes in the anterior cingulate/paracingulate activity, which may represent a marker of emotional dysregulation in FT and a predictor of treatment response.Classification of evidenceThis study provides Class III evidence that CBT significantly improves tremor severity in patients with functional tremor.

Download Full-text

Rostral Anterior Cingulate Cortex Morphology Predicts Treatment Response to Internet-Based Cognitive Behavioral Therapy for Depression

Biological Psychiatry Cognitive Neuroscience and Neuroimaging ◽

10.1016/j.bpsc.2017.08.005 ◽

2018 ◽

Vol 3 (3) ◽

pp. 255-262 ◽

Cited By ~ 8

Author(s):

Christian A. Webb ◽

Elizabeth A. Olson ◽

William D.S. Killgore ◽

Diego A. Pizzagalli ◽

Scott L. Rauch ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Anterior Cingulate Cortex ◽

Treatment Response ◽

Behavioral Therapy ◽

Cingulate Cortex ◽

Anterior Cingulate ◽

Cognitive Behavioral ◽

Rostral Anterior Cingulate Cortex

Download Full-text

Emotion-Abstraction Patterns and Cognitive Interventions in a Single Case of Standard Cognitive-Behavioral Therapy

Research in Psychotherapy Psychopathology Process and Outcome ◽

10.4081/ripppo.2014.146 ◽

2015 ◽

Vol 17 (2) ◽

Cited By ~ 2

Author(s):

Sandra Sassaroli ◽

Romina Brambilla ◽

Eva Cislaghi ◽

Roberta Colombo ◽

Eva Cislaghi ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Rating Scale ◽

Behavioral Therapy ◽

Therapeutic Process ◽

Therapeutic Change ◽

Cognitive Behavioral ◽

Therapeutic Interventions ◽

Abstract Thinking ◽

Cognitive Content ◽

Cognitive Interventions

Cognitive-behavioral therapy (CBT) assumes that therapeutic change de-pends mainly on change of cognitive content, while, from a theoretical viewpoint, other processes are excluded. This study aims to explore standard CBT interventions using a model of therapeutic change that includes both emotional and cognitive processes, i.e., the therapeutic cycle model (TCM; Mergenthaler, 1985; 1996), which describes the pro-cesses of therapeutic change in terms of cycles involving both emotional arousal and ab-stract thinking activation. We classified standard CBT interventions in three main are-as: assessing, disputing, and reframing biased beliefs. In 10 individual cognitive therapy sessions with a 30-year-old patient affected by a panic disorder with agoraphobia (PDA), this study aimed to explore whether cognitive interventions are not only related to abstract thinking but also to the emotional activation phases of TCM. Three inde-pendent judges assessed the presence of cognitive therapeutic interventions using the Comprehensive Psychotherapeutic Interventions Rating Scale (CPIRS; Trijsburg et al., 2002). A software program measured the TCM cognitive and emotional variables. The measures revealed significant correlations between cognitive therapeutic interventions and phases of abstract thinking activation during the therapeutic process. The results clarified the role of cognitive interventions in the therapeutic process as a useful instru-ment aimed to increase reality testing.

Download Full-text

The assessment of cognitive‐behavioral therapy skills in patients diagnosed with health anxiety: Development and pilot study on an observer‐based rating scale

Clinical Psychology & Psychotherapy ◽

10.1002/cpp.2387 ◽

2019 ◽

Vol 26 (6) ◽

pp. 639-649

Author(s):

Destina Sevde Ay ◽

Franziska Kühne ◽

Florian Weck

Keyword(s):

Pilot Study ◽

Cognitive Behavioral Therapy ◽

Rating Scale ◽

Behavioral Therapy ◽

Health Anxiety ◽

Cognitive Behavioral

Download Full-text

Suitability for Short-Term Cognitive-Behavioral Therapy

Journal of Cognitive Psychotherapy ◽

10.1891/088983907782638743 ◽

2007 ◽

Vol 21 (4) ◽

pp. 334-345 ◽

Cited By ~ 15

Author(s):

Gail Myhr ◽

Jeanne Talbot ◽

Lawrence Annable ◽

Gilbert Pinard

Keyword(s):

Anxiety Disorder ◽

Cognitive Behavioral Therapy ◽

Rating Scale ◽

Behavioral Therapy ◽

Linear Regression Analysis ◽

Cognitive Behavioral ◽

Reliable Change Index ◽

Short Term ◽

Variable Model ◽

Wide Range

The Suitability for Short-Term Cognitive Therapy Rating Scale (SRS) defines 10 criteria to assess suitability for short-term cognitive-behavioral therapy (CBT). This study examines the relationships between pretreatment SRS scores and outcome of 113 patients treated with short-term CBT for a wide range of disorders. Using the reliable change index (RCI) as a measure of outcome, 65 individuals (57.5%) of the sample experienced statistically reliable improvement. Married status, employed status, female gender, and anxiety disorder as a primary diagnosis were positively correlated with posttreatment RCI. Awareness of emotion and security operations were the SRS items most strongly correlated with outcome. Also correlated were the two alliance potential items (in-session and out-of-session evidence) and the acceptance of personal responsibility for change. Hierarchical multiple linear regression analysis resulted in a three-variable model where married status, primary anxiety disorder, and mean SRS score accounted for 20% of the variance in RCI scores. We conclude that the SRS adds predictive value to the assessment of potential to succeed in CBT.

Download Full-text

Predictors of outcome for telephone and face-to-face administered cognitive behavioral therapy for depression

Psychological Medicine ◽

10.1017/s0033291715001208 ◽

2015 ◽

Vol 45 (15) ◽

pp. 3205-3215 ◽

Cited By ~ 14

Author(s):

C. Stiles-Shields ◽

M. E. Corden ◽

M. J. Kwasny ◽

S. M. Schueller ◽

D. C. Mohr

Keyword(s):

Cognitive Behavioral Therapy ◽

Rating Scale ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Classification And Regression Tree ◽

Psychological Characteristics ◽

Treatment Modalities ◽

Depression Severity ◽

Predictors Of Outcome ◽

Face To Face

BackgroundCognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression.MethodA total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18).ResultsThe demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome.ConclusionsFindings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.

Download Full-text

Changes in Community Clinicians’ Attitudes and Competence following a Transdiagnostic Cognitive Behavioral Therapy Training

10.31234/osf.io/hw36g ◽

2020 ◽

Author(s):

Torrey A. Creed ◽

Margaret Ellen Crane ◽

Amber Calloway ◽

Thomas M Olino ◽

Philip C. Kendall ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Rating Scale ◽

Behavioral Therapy ◽

Change Score ◽

Attitude Scale ◽

Cognitive Behavioral ◽

Evidence Based ◽

Training Methods ◽

Change Models ◽

Intensive Training

Objective: Although data suggest that knowledge of evidence-based practices (EBPs) and attitudes towards EBPs may be related, the relation between attitudes and competence in delivering EBPs has not been examined. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training. Methods: Community clinicians (N=891) received intensive training in cognitive behavioral therapy skills followed by six months of consultation. Clinician attitudes were assessed using the Evidence Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data was analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase).Results: Latent change models identified significant improvement in attitudes (Mslatent change≥1.07, SEs≤ 0.19, zs≥6.85, ps< .001) and competence (Mslatent change≥13.13, SEs≤3.53, zs≥2.30, ps<.001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop phase and across the full training (bs≥1.58, SEs≤1.13, z≥1.89, p<.048, β≥0.09); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in the consultation phase (b=1.40, SE=1.07, z=1.31, p=.19, β=0.08). Change in attitudes and change in competence in the training period, the workshop phase, and the consultation phase were not significantly correlated. Conclusions: Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training.

Download Full-text

The Temporal Associations of Therapeutic Alliance and Manual Adherence With Depressive Symptom Change in Cognitive Behavioral Therapy for Adult Outpatient Major Depression

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.602294 ◽

2021 ◽

Vol 11 ◽

Author(s):

Frank J. Don ◽

Ellen Driessen ◽

Jaap Peen ◽

Jan Spijker ◽

Robert J. DeRubeis ◽

...

Keyword(s):

Depressive Symptom ◽

Cognitive Behavioral Therapy ◽

Therapeutic Alliance ◽

Linear Mixed Model ◽

Rating Scale ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Symptom Change ◽

Depression Change ◽

Perceived Helpfulness

Background: The therapeutic alliance is considered an important causal agent of psychotherapy efficacy. However, studies in cognitive behavioral therapy (CBT) for depression have suggested that alliance might be more of a consequence rather than a cause of depressive symptom change, while adherence to CBT specific techniques was found to be associated with subsequent depression change. We aimed to add to this body of literature by assessing the temporal associations of both therapeutic alliance and manual adherence with depressive symptom change in a relatively large sample of depressed adult outpatients over the full course of CBT.Methods: Adults with a major depressive episode (n = 98) participating in a randomized clinical trial were offered 22 weeks of CBT and rated the Penn Helping Alliance Questionnaire (HAq-I) at weeks 5 and 22. Therapists rated their adherence to the CBT manual after each session and observers assessed the Hamilton Depression Rating Scale scores at weeks 0, 5, 10, and 22. Linear mixed model analyses were used to assess the associations of alliance and adherence with prior and subsequent depression change.Results: HAq-I Relationship and manual adherence ratings were not significantly associated with prior nor with subsequent depression change (p > 0.14). Prior depression change was associated with the HAq-I subscale Perceived helpfulness at the end of treatment (r = 0.30, CI = 0.03–0.56, p = 0.03).Conclusion: We were not able to replicate prior depression change in CBT for depression to be associated with improved quality of the therapeutic alliance when using a more “pure” measure of the therapeutic relationship. Limitations of this study include the subjective alliance and adherence assessments. Our findings indicate the need to appropriately distinguish between the perceived helpfulness and the relationship factors when examining therapeutic alliance.

Download Full-text

Faculty Opinions recommendation of Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727593394.793572389 ◽

2020 ◽

Author(s):

Michiel Westenberg ◽

Janna Marie Bas-Hoogendam

Keyword(s):

Emotion Regulation ◽

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioral Therapy ◽

Anterior Cingulate Cortex ◽

Social Anxiety Disorder ◽

Behavioral Therapy ◽

Therapy Response ◽

Anterior Cingulate ◽

Cognitive Behavioral

Download Full-text

Depression-related anterior cingulate prefrontal resting state connectivity normalizes following cognitive behavioral therapy

European Psychiatry ◽

10.1192/j.eurpsy.2020.34 ◽

2020 ◽

Vol 63 (1) ◽

Cited By ~ 1

Author(s):

Spiro P. Pantazatos ◽

Ashley Yttredahl ◽

Harry Rubin-Falcone ◽

Ronit Kishon ◽

Maria A. Oquendo ◽

...

Keyword(s):

Prefrontal Cortex ◽

Cognitive Behavioral Therapy ◽

Resting State ◽

Behavioral Therapy ◽

Post Treatment ◽

Anterior Cingulate ◽

Cognitive Behavioral ◽

Symptom Improvement ◽

Whole Brain ◽

Before And After

Abstract Background. Aberrant activity of the subcallosal cingulate (SCC) is a common theme across pharmacologic treatment efficacy prediction studies. The functioning of the SCC in psychotherapeutic interventions is relatively understudied, as are functional differences among SCC subdivisions. We conducted functional connectivity analyses (rsFC) on resting-state functional magnetic resonance imaging (fMRI) data, collected before and after a course of cognitive behavioral therapy (CBT) in patients with major depressive disorder (MDD), using seeds from three SCC subdivisions. Methods. Resting-state data were collected from unmedicated patients with current MDD (Hamilton Depression Rating Scale-17 > 16) before and after 14-sessions of CBT monotherapy. Treatment outcome was assessed using the Beck Depression Inventory (BDI). Rostral anterior cingulate (rACC), anterior subcallosal cingulate (aSCC), and Brodmann’s area 25 (BA25) masks were used as seeds in connectivity analyses that assessed baseline rsFC and symptom severity, changes in connectivity related to symptom improvement after CBT, and prediction of treatment outcomes using whole-brain baseline connectivity. Results. Pretreatment BDI negatively correlated with pretreatment rACC ~ dorsolateral prefrontal cortex and aSCC ~ lateral prefrontal cortex rsFC. In a region-of-interest longitudinal analysis, rsFC between these regions increased post-treatment (p < 0.05FDR). In whole-brain analyses, BA25 ~ paracentral lobule and rACC ~ paracentral lobule connectivities decreased post-treatment. Whole-brain baseline rsFC with SCC did not predict clinical improvement. Conclusions. rsFC features of rACC and aSCC, but not BA25, correlated inversely with baseline depression severity, and increased following CBT. Subdivisions of SCC involved in top-down emotion regulation may be more involved in cognitive interventions, while BA25 may be more informative for interventions targeting bottom-up processing. Results emphasize the importance of subdividing the SCC in connectivity analyses.

Download Full-text