Karen Jacob

Effectiveness of cognitive--behavioral treatment for panic disorder versus treatment as usual in a managed care setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings.

Development and Validation of the Cognitive-Behavioral Therapy Skills Questionnaire

Although several theories exist to describe why patients improve in cognitive-behavioral therapy (CBT), in only a limited number of studies has CBT skill acquisition been examined, particularly among patients with complex clinical profiles. Thus, the overarching aim of this research was to develop a tool to measure patients’ use of CBT skills, such that it would have clinical utility for patients and therapists during treatment. In Study 1, the authors developed an initial set of items for the Cognitive-Behavioral Therapy Skills Questionnaire (CBTSQ). They submitted these items to an exploratory factor analysis in an initial administration (n = 350) and to a confirmatory factor analysis in a second administration (n = 378). Results indicated that there were two factors (Behavioral Activation and Cognitive Restructuring) with good factor structure and internal consistency, and both the factors evidenced expected relationships with other constructs. In Study 2, the criterion validity of the CBTSQ was investigated on a patient sample in a CBT-oriented treatment setting. Results showed that CBTSQ scores increased following treatment, and Cognitive Restructuring and Behavioral Activation scores predicted reduction of overall psychiatric symptoms and depression. Thus, the CBTSQ appears to be a promising measure of CBT skill acquisition and treatment outcome as well as an instrument that can help patients and therapists monitor progress specifically related to a CBT skills training treatment approach.

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting : 2-year follow-up

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.

Short-Term Cognitive Behavioral Partial Hospital Treatment: A Pilot Study

Objective. Brief, cost-contained, and effective psychiatric treatments benefit patients and public health. This naturalistic pilot study examined the effectiveness of a 2-week, cognitive-behavioral therapy (CBT) oriented partial hospital program. Methods. Study participants were 57 patients with mood, anxiety, and/or personality disorders receiving treatment in a private psychiatric partial hospital (PH) setting. A flexible treatment model was used that adapts evidence-based CBT treatment interventions to the PH context with emphases on psychoeducation and skills training. Participants completed self-report measures at admission and after 1 and 2 weeks, to assess stabilization and functional improvements, with added attention to the acquisition of cognitive and behavioral skills. The data were analyzed using repeated measures analyses of variance and correlation. Results. Participants reported a decrease in symptoms and negative thought patterns, improved satisfaction with life, and acquisition and use of cognitive and behavioral skills. Skill acquisition was correlated with symptom reduction, reduced negative thought patterns, and improved satisfaction with life. Conclusions. Results of this pilot study suggest that a 2-week PH program can be effective for a heterogeneous patient population with mood, anxiety, and/or personality disorders. These findings are promising given the prevalence of treatments of such brief duration in private sector PH programs subject to the managed care marketplace. Future studies are planned to test this flexible PH treatment model, with particular attention to the effectiveness of the CBT approach for the treatment of different disorders and to whether effectiveness is sustained at follow-up. Further study should also examine whether skill acquisition is a mechanism of change for symptom reduction and functional improvements.

Cross-fertilization versus transmission: Recommendations for developing a bidirectional approach to psychotherapy dissemination research

Abstract Psychotherapy researchers are increasingly engaged in collaborations with clinical practitioners and mental health administrators. Each party brings its own perspectives, values, and agendas to bear in these encounters. Viable research—practice collaborations depend on understanding and negotiating some of the tensions in these relationships. In this article, we discuss the contexts that prevail for various participants in a psychotherapy dissemination study as well as the values, goals, costs, and benefits related to research participation. This article is a collaboration among the researchers, mental health administrators, therapists, and clients involved in an ongoing treatment dissemination study. Our recommendations for research—practice collaborations are based on our experiences and dialogues over the course of this study.