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Posts Tagged ‘‍‍CBT’

Computer Program May Help Adolescents With Depression

Posted by Sun on April 29, 2012

WASHINGTON, April 27, 2012 – It was bound to happen sooner or later. There is a 3D computer fantasy game that teaches good thinking habits as effectively as biological therapist units can. The game, designed for children and adolescents, is called SPARX (not to be confused with SPANX which are women’s undergarments). SPARX stands for Smart, Positive, Active, Realistic, X-factor thoughts. The Study The game provides cognitive-behavioral therapy to the gamers. That means means it helps them replace Gloomy Negative Automatic Thoughts (GNATS) with positive SPARX thoughts. It was tested on adolescents and young adults from spring 2009 to mid-summer 2010. Participants had a single diagnosis (depression) but were not at risk for self-harm or suicide, and were not receiving other treatment. As already indicated, SPARX was successful in relieving (in some cases alleviating) the young players’ depressive symptoms. “It is at least as good as treatment as usual [with a therapist], would be cheaper and easier to disseminate, and could be used to increase access to therapy,” wrote Dr. Merry, one of the study’s authors. While some counselors may be miffed by this, I know one who thinks the program should be given to everyone that owns a computer, regardless of their age. She feels the world would benefit from a global increase in effective thought processing. The GameThe idea of the game is for SPARX to take over a virtual world that is inhabited by GNATS. There are seven levels, or modules, that lead players through the process of cognitive restructuring (thinking effectively) while on their mission to nick the GNATS. Levels:

  1. Introduces GNATS, the idea of hope, and relaxation through breathing
  2. Is about taking action, progressive muscle relaxation, and basic communication skills.
  3. Addresses anger, hurt feelings, assertiveness, listening, and negotiation
  4. Teaches problem solving, and introduces cognitive restructuring via SPARX
  5. Teaches players to recognize different species of GNATS (names not in Latin)
  6. How to exchange negative thoughts for effective ones, and negotiation skills
  7. Reviews all the skills, teaches mindfulness, relapse prevention, asking for help

Client/Gamer Satisfaction After the study, satisfaction questionnaires showed that SPARX participants liked being able to utilize the program at the clinic, school, or at home, and appreciated working through the seven modules at their own pace. Players also gave high marks for the look and feel of the game (like New Zealand, where it was created), and that it was designed specifically for young people. Those participants in the study that did not use the game (control group), but saw a living, breathing counselor instead, took the same satisfaction survey and reported they liked being able to go at their own pace. They felt good being supported and listened to, and learned things they didn’t know. Sounds like a draw. I’m sure all therapists are heartened to know they are as competent and appreciated as SPARX. What’s Good About SPARX

  • It can be an effective first step in treating depression.
  • It is easy to obtain and inexpensive to offer.
  • SPARX and other programs like it may provide help for young, depressed people that shy away from one-on-one therapy.
  • It may prevent some young people from going on antidepressants.
  • SPARX is fun so players stick with it.

Overall, the use of SPARX significantly reduced players’ anxiety, depression, sense of hopelessness, and improved their quality of life. This is remarkable for a self-help tool. A three month follow-up revealed the benefits of the game had continued. My counselor friend said, “Who doesn’t want to have fun while they’re learning. If playing a game like SPARX gives children a leg-up in life, I’m for it. I’m not going to worry about digital counselors until they have emotional sensitivity, insight, and intuition. If that happens, I’ll take down my shingle and go see one.” Resource: Abstract. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression. BMJ

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Posted in CBT and Hypnotherapy, Depression, Bipolar and Anxiety, Uncategorized | Tagged: , | Leave a Comment »

fMRI May Predict Response to Cognitive Behavioral Therapy

Posted by Sun on April 29, 2012

April 18, 2012 (Arlington, Virginia) — Baseline brain activation studies may predict treatment response in women undergoing cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) related to domestic violence, new research shows.

Using functional magnetic resonance imaging (fMRI) before and after cognitive trauma therapy for battered women (CTT-BW), researchers found that certain baseline patterns of brain activation predicted better response to treatment.

Specifically, the study showed that greater baseline anterior cingulate and less baseline posterior insula response to anticipation predicted treatment response.

“If we can find techniques to target these areas specifically to enhance CBT and future treatments, that is important,” said lead investigator Robin Aupperle, PhD, who collected the data at the Veterans Affairs Medical Center and the University of California, both in San Diego, before moving to her current position at the University of Missouri in Kansas City.

The study was presented here at the Anxiety Disorders Association of America (ADAA) 32nd Annual Conference.

Room for Improvement

Some studies show only a 50% response rate to CBT therapies in the domestic violence population, so “there is room for improvement,” said Dr. Aupperle.

“Given that we have developed these great behavioral treatments that are only currently effective for certain individuals, how do we push that forward…to actually enhance their effectiveness further?”

Work aimed at enhancing CBT was featured prominently at the meeting, but very few studies have explored the combination of fMRI with CBT, said Dr. Aupperle.

Pretreatment PTSD imaging studies have shown dysfunctional neurocircuitry involving the amygdala and insula regions as well as prefrontal regions, she noted.

“So the idea is that perhaps with PTSD, you’re seeing an inability to recruit the prefrontal regions to appropriately inhibit the amygdala and insula responses.”

The few studies exploring fMRI response to CBT treatment demonstrate decreased amygdala response and increased anterior cingulate response with treatment compared with baseline, she said.

However, very little is known about imaging predictors of treatment response.

The current study focused on the specific neural mechanisms involved in anticipatory processing because “anticipation lies at the center of our understanding of anxiety” and plays an important role in avoidance behavior, she said.

Fourteen women with domestic violence–related PTSD underwent fMRI at baseline and then again after a 10- to15-week CTT-BW treatment. Brain activation was measured during anticipatory processing of positive and negative emotional images.

The Clinician-Administered PTSD Scale (CAPS) was used to measure response to treatment and showed a significant decrease in mean scores — from 66 at baseline to 16 posttreatment (P < .001) — a response that was largely maintained at the 3-month follow-up, she said.

Hypothesis Confirmed

fMRI showed that treatment increased anterior cingulate and posterior cingulate responsivity and decreased anterior insular responsivity, “confirming our hypothesis,” she said.

Because only 2 women showed less than a 50% response to treatment, fMRI predictors could not be identified for response vs no response, so instead, the researchers examined predictors of level of response.

They noted that greater baseline activation within the dorsal anterior cingulate and the posterior cingulate predicted better posttreatment CAPS score.

“The more they recruited these regions during anticipation at baseline, the better they responded to treatment,” said Dr. Aupperle.

The findings help narrow the focus on specific neural targets in PTSD and underscore the role of imaging in both monitoring and predicting treatment response, she said.

“What will be important is using this knowledge for future interventions. If we know there are certain areas of the brain that are responding differently or abnormally…can we think of ways to specifically target those? And then could we perhaps use fMRI or other techniques to test those out to see which ones might have the potential to go forward with larger clinical trials?”

“Discouraging” Findings?

Asked to comment on the presentation for Medscape Medical News, Melissa Hunt, PhD, associate director of clinical training at the University of Pennsylvania’s Department of Psychology, in Philadelphia, said that in some ways, the research was “rather discouraging.”

“What it suggests is that a lot of damage has already been done, that it’s reflected in brain morphology and brain function, and that it predicts poor response to treatment,” she said.

However, the imaging documentation of treatment response was reassuring, she said.

“This [research] was focused on PTSD. There’s a lot of early imaging data in OCD [obsessive compulsive disorder] that suggests that effective exposure therapy for OCD actually normalizes brain function. So that makes me a little more optimistic that perhaps we can, through effective therapy, actually normalize some of these things.”

Dr. Aupperle and Dr. Hunt have disclosed no relevant financial relationships.

Anxiety Disorders Association of America (ADAA) 32nd Annual Conference. Session 316R, presented April 13, 2012.

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Applied Relaxation and Cognitive Behavioral Therapy Effectively Reduce Anxiety

Posted by Sun on April 29, 2012

Cognitive behavioral therapy (CBT) is a widely used approach to treat symptoms of general anxiety disorder (GAD). The goal of CBT is to help an individual be more tolerant of their worrying behaviors, thus decreasing the negative psychological and physical symptoms of GAD. Applied relaxation (AR) is an alternative approach that is used for various mental health problems, including GAD. It focuses on the somatic symptoms of tension and physical discomfort associated with anxiety, with the goal of reducing worry. Both CBT and AR have been shown to be effective at diminishing the symptoms of GAD in individuals who struggle with emotional and somatic symptoms. However, few studies have compared the dynamics that cause the symptom reduction in each of these treatment approaches.

Eleanor Donegan of the Department of Psychology at Concordia University in Montreal sought to identify the mechanisms by which AR and CBT worked and also to determine if one was more effective than the other at maintaining long-term symptom reduction. For her study, Donegan evaluated 57 individuals who underwent either AR or CBT over a period of 12 weeks. She found that for both groups, the amount of time they spent worrying each day decreased from approximately 36% of the time to 20%. Additionally, both AR and CBT reduced the amount of daily anxiety by nearly 50%.

Donegan noted that even though the participants were much less anxious as a result of their treatment, they still had significantly higher levels of worry and anxiety than non–clinically anxious individuals. When Donegan looked at how the effects were achieved, she found similarities and differences. Specifically, even though both AR and CBT decreased somatic anxiety, the effect on worry was more significant in the individuals who underwent CBT. However, Donegan believes that both of these techniques could be useful to address GAD. She added, “Change in worry occurs in part because of change in somatic anxiety, and vice versa, in both CBT and AR.”

Donegan, E., Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028132


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How to Overcome Obsessive Compulsive Disorder (OCD)

Posted by Sun on July 12, 2011

What is Obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted and repeated thoughts (obsessions) and repetitive behaviors (compulsions). OCD interferes with the person’s daily life, careers and relationships. OCD is ranked as the tenth most disabling illness by the World Health Organization (WHO), Because, OCD affects every part of a person’s life.


Obsessive-compulsive disorder symptoms include both obsessions and compulsions.

Obsession symptoms

Obsessions are thoughts, images, or impulses that repeatedly enter the person’s mind, and he or she can’t control them.

Some common obsessions

  • Fear of dirt or germs
  • Impulses to shout obscenities in inappropriate situations
  • Disgust with bodily waste or fluids
  • Fear of thinking evil or sinful thoughts
  • Fear of harming a family member or friend
  • Need for constant reassurance
  • Hair loss or bald spots because of hair pulling
  • Replaying pornographic images in your mind
  • Doubts that you’ve locked the door or turned off the stove

Compulsions symptoms

OCD compulsions are specific behaviors that people who have OCD try to get rid of distressing feelings by performing them.

Compulsion symptoms and signs may include:

  • Counting in certain patterns
  • Saving newspapers, mail or containers when they are no longer needed
  • Asking for reassurance over and over again
  • Hand washing until your skin becomes raw
  • Counting to a certain number, over and over
  • Checking the stove repeatedly to make sure it’s off


There are types of therapy specifically designed for OCD. Nowadays, therapists use the specific CBT technique for OCD is called exposure response prevention.

Cognitive behavioral therapy helps people recognize irrational, negative beliefs and behaviors and replace them with rational, positive ones. Goal of cognitive-behavioral therapy is replacing destructive thinking habits with healthy one. In exposure and response prevention (ERP) therapist exposes person repeatedly to an obsession such as touching a trash can, then he or she prevents from hand-washing by patient. This exercise is repeated from mildest issue to most severe. ERP cuts the link between person’s obsessive thoughts and behavior compulsive and reduce fears and anxieties.


Several medicines are available to treat OCD. Antidepressants help increase levels of serotonin, so may be helpful for OCD. These medicines include: clomipramine, fluoxetine, sertraline, paroxetine and fluvoxamine.

Living with OCD

  • Learn relaxation and stress management. Stress is a main trigger for the onset of your OCD symptoms. Learn stress management techniques such as relaxation, mediation, yoga and etc.
  • Overcoming guilt and shame. The guilt and shame often are associated with OCD. The first step for coping with OCD is overcoming the guilt and shame. In reality, the obsessive thoughts and compulsive behaviors are just a problem like any other problem.
  • Learn about obsessive-compulsive disorder. Education about your problem helps you deal better with it.
  • Be patient with yourself. Overcoming OCD takes time, effort, and patience
  • Redefine the obsessive thoughts: your obsessive thought is just symptom, it not reality.
  • Don’t fight with obsessive thoughts. Fighting with each thought reinforces that thought. Challenge your obsessive thoughts and replacing rational thoughts, but then gently turn your attention away.
  • Use mindfulness technique. Get outside yourself so observe your thoughts in a non-judgmental fashion.

If you have any questions, please feel free to ask


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