Browsing by Subject "Cognitive Behavioral Therapy"
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Item Cognitive Processing Therapy and Trauma-Related Negative Cognitions: Relationship and Effect on Treatment(2017-07-27) Holliday, Ryan Phillip; Surís, Alina; Morris, E. Ellen; LePage, James; Jackson, Jamylah; Pai, AnushkaCognitive Processing Therapy (CPT) is based on the theory that posttraumatic stress disorder (PTSD) is a disorder of non-recovery after an exposure to a qualifying trauma. This non-recovery results in assimilated and overaccomodated trauma-related cognitions which negatively affects an individual's schema pertaining to self, the world, and self-blame. This post-trauma alteration in an individual's schema is typically expressed and reinforced in the form of trauma-related negative cognitions (NCs). Although the theoretical underpinnings of NCs as well as their effect on symptom severity in individuals with PTSD have been studied, the role of NCs in therapeutic outcome is less understood. In particular, although CPT specifically targets and addresses NCs, there is limited research regarding the role of NCs during and after CPT treatment. This dissertation consisted of two studies. The purpose of the first study was to examine the overall effectiveness of CPT in attenuating NCs from pre- to post-treatment. To address this study's aim, a meta-analysis of current peer-reviewed clinical trials that assessed NCs at pre- and post-CPT treatment was conducted. The purpose of the second study was to determine if NCs predict therapeutic outcome (i.e., decreases in PTSD and depression symptom severity) over the course of CPT treatment and at follow-up. To address this study's aim, a secondary analysis of a randomized clinical trial of CPT in women and men with military sexual trauma (MST)-related PTSD was performed. Specifically, cross-lagged panel analyses were conducted with NC scores entered as a predictor of subsequent reductions in PTSD and depression symptoms over the course of treatment and follow-up. The first study concluded that CPT had a large effect size in reducing NCs from pre- to post-treatment. Results from the second study were indicative that NCs about self-blame predict subsequent reductions in PTSD symptom severity over the course of CPT and follow-up in veterans with MST-related PTSD. These studies provide further information regarding the effectiveness of CPT in addressing NCs as well as the mediating role of NCs during and after treatment.Item Components Analysis of a Cognitive Behavioral Therapy Treatment Program for Children and Adolescents with Major Depressive Disorder(2017-07-12) Owen, Victoria Jane; Kennard, Beth D.; Emslie, Graham; Hughes, Jennifer L.; Mayes, Taryn; Nakonezny, PaulThis study examined whether the receipt of specific CBT components in a CBT treatment program, parent or family involvement, and dosage across four domains (i.e., frequency, duration, length, and intensity) were associated with risk of occurrence of relapse among children and adolescents with Major Depressive Disorder (MDD). Children and adolescents aged 8 to 17 with MDD (n=75) completed a continuation phase CBT- focused treatment program after responding to an acute phase pharmacotherapy intervention. Study therapists completed session checklists following each session to document which components were introduced during session, as well as documenting parent/family involvement, and dosage variables (e.g., length of session, etc.). Depression severity was also measured through the CDRS-R, which allowed for measurement of relapse status, which was the outcome variable for the current study. Cox Proportional Hazard Regression Models were utilized to investigate whether two primary components (i.e., Wellness, Relapse-Prevention), dosage, and parent/family involvement were related to hazard of relapse. Inclusion of Wellness and Relapse-Prevention components were not significantly related to risk of relapse. Similarly, parent/family involvement was not significantly related to hazard of relapse. Regarding dosage, however, results indicate that a higher frequency of sessions, as well as a longer period of time over which treatment is delivered (e.g., length) were significantly related to a reduced risk of relapse. However, there was no statistically significant finding regarding risk of relapse based on cumulative number of minutes spent in session. Further, when length of treatment was controlled, an increase in number of weeks that elapse between each session (e.g., intensity) was related to a higher risk of relapse, suggesting that sessions that occur closer to one another are related to a reduced risk of relapse. These findings are congruent with some of the existing research on this subject, and ultimately support the idea that treatment dosage should be measured across several domains (e.g., frequency, duration, length, intensity). Additional research with a larger sample size should be conducted regarding the influence of receipt of specific CBT components as well as parent/family involvement given the lack of statistically significant findings in the current study.Item Improving Understanding of Cognitive Processing Therapy: Patterns and Predictors of Symptom Change(2018-07-27) Holder, Nicholas Davis; Surís, Alina; Emmett, Gloria; LePage, James; Morris, E. Ellen; Pai, AnushkaSurvivors of military sexual trauma (MST) are more likely to develop posttraumatic stress disorder (PTSD) than survivors of combat and other sexual traumas. Cognitive processing therapy (CPT) has been identified as one of the most effective PTSD treatments, and is the only treatment validated for veterans with MST-related PTSD. Existing research has emphasized studying pre-post change in total PTSD symptom severity; however, PTSD symptoms may not respond equivalently to CPT. Specifically, re-experiencing symptoms may predict change in other symptom criteria, and sleep disturbance may remain even after successful treatment. Improved understanding of the patterns and predictors of symptom change may help optimize treatment outcome. The current dissertation investigated variability in symptom change during and after CPT using data from a randomized clinical trial of CPT for MST-related PTSD. In the first study, the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT was assessed using three cross-lagged panel analyses. Hyperarousal, avoidance, and re-experiencing symptoms were entered as a predictor of subsequent change in the PTSD symptom criteria. A logarithmic pattern of change was found for all symptom criteria. Hyperarousal symptoms predicted and temporally preceded change in avoidance symptoms. No criteria predicted or temporally preceded change in hyperarousal or re-experiencing symptoms. The aim of the second study was to describe the prevalence of sleep disturbance in veterans with MST-related PTSD and identify predictors of change in sleep disturbance following CPT using a multiple regression analysis. Sleep disturbance was prominent at baseline affecting 100% of the sample. Clinically significant sleep disturbance remained prevalent at posttreatment regardless of total symptom improvement. Results of the multiple regression analysis did not identify significant predictors of change in sleep disturbance following CPT. PTSD symptoms did not resolve uniformly during and after CPT in this sample. Focusing on pre-post change in total PTSD symptoms likely ignores important differences in symptom change. Describing variability in symptom change can provide patients more realistic treatment expectations, and can allow providers to look for a characteristic pattern of change during treatment. Further research is needed to link elements of CPT to these patterns of symptom change.Item Physical, Emotional, and Cognitive Mediators of Therapeutic Expectations for Treating PTSD Related to Military Sexual Trauma(2017-04-06) Raja, Annia Waheed; Surís, Alina; Businelle, Michael; Koehler, Heidi; Thoman, Lisa V.; Robinson, ReedPTSD due to military sexual trauma affects both male and female Veterans, and Veterans with MST-related PTSD contend with a host of physical, emotional, and cognitive sequelae. Evidence-based treatments for MST-related PTSD broadly focus on reducing symptoms by increased exposure and/or emotional processing of physical, emotional, and cognitive triggers. However, given the high treatment dropout rates for Veterans with PTSD and given that avoidance symptoms are most predictive of a PTSD diagnosis for Veterans with MST, research suggests that it may be important to understand the role of pretreatment symptoms and therapeutic expectations for Veterans seeking treatment for PTSD related to MST. This study investigated whether physical, emotional, and cognitive variables mediated the relationship between pre-treatment PTSD severity and therapeutic expectations for Veterans seeking Cognitive Processing Therapy or Present-Centered Therapy for PTSD due to MST. Additionally, this study examined whether the relationship between pre-treatment therapeutic expectations and change in PTSD severity (pre-post treatment) was moderated by treatment type. Results indicated that the relationship between pre-treatment PTSD severity and therapeutic expectations was significantly mediated, within separate models, by posttraumatic cognitions and suicide-related cognitions. Results did not indicate significant moderation by treatment type of the relationship between pre-treatment therapeutic expectations and change in PTSD severity. Clinical implications for significant findings include recommendations for assessing posttraumatic cognitions before, during, and after treatment, bolstering hopefulness and strengthening the therapeutic alliance prior to commencing treatment, and directly addressing interpersonal factors for Veterans with greater PTSD severity and/or lower therapeutic expectations prior to treatment.Item The Psychosocial Impact of a Social Interaction Skills Training (SIST) Workshop for Vitiligo Patients(2020-05-01T05:00:00.000Z) Tan, Andrea; Pandya, Amit; Schuster, Lisa; Glass, Donald A.BACKGROUND: Vitiligo may cause substantial psychosocial burden on affected individuals, particularly affecting social and interpersonal interactions. Psychosocial interventions remain scarce. OBJECTIVE: To develop and implement a Social Interaction Skills Training (SIST) workshop for vitiligo patients. METHODS: A workshop was developed and facilitated using Social Interaction Skills Training principles. The Social Avoidance and Distress Scale, Brief Fear of Negative Evaluation-II Scale, visual analog scales, and open-ended workshop questionnaire were administered to participants before and after the workshop to determine its impact. RESULTS: Of 17 participants, 11 completed all assessments; 6 completed at all but the penultimate and/or last assessment. Statistically significant improvement in the Social Avoidance and Distress Scale and visual analog scales were seen up to 8 weeks after the workshop. The Brief Fear of Negative Evaluation-II Scale showed a statistically significant decrease immediately after the workshop that was not maintained at follow up. Workshop questionnaires revealed themes regarding motivations to attend, impact on quality of life, and implementation of newly-learned strategies. LIMITATIONS: Single-arm pilot study with small sample size and lack of randomization to non-intervention group. CONCLUSION: Social Interaction Skills Training may potentially be a useful intervention for vitiligo patients to reduce psychosocial burden and warrants further study.Item [Southwestern News](2001-04-13) Harrell, AnnItem [Southwestern News](2004-08-17) Hansard, Donna StephItem Suicide Cognitions Among Veterans: A Construct for Assessment and Intervention(2019-07-09) Wiblin, Jessica Leigh; LePage, James; Surís, Alina; Hughes, Jennifer L.; Morris, E. Ellen; Richardson, ColleenMilitary veterans represent a population that is more likely to be exposed to traumatic events and therefore diagnosed with posttraumatic stress disorder (PTSD) compared to civilian men and women. Military sexual trauma (MST) is a traumatic event endorsed by approximately 28% of women veterans and 1.5% of male veterans. Not only are survivors of MST more likely to be diagnosed with PTSD than survivors of other traumas, they are also at risk for significant psychosocial consequences and comorbid psychiatric diagnoses. Of particular significance, veterans with MST-related PTSD report increased suicidal ideation and report higher incidences of suicidal self-directed violence (SDV). The Veterans Health Administration (VHA) has placed emphasis on both screening for MST and suicide prevention efforts. As a result, providers within the VHA have a greater opportunity to provide clinical care to a vulnerable population. However, research is mixed regarding whether veteran survivors of MST are more or less likely to utilize health care services within the VHA. Women veterans who have experienced MST in particular have been found to be less likely to utilize VHA health care services. This dissertation sought to increase understanding of suicide cognitions as a construct for assessment as well as potential treatment-seeking barriers and consists of two studies, each a secondary analysis of an RCT examining the efficacy of CPT in treating MST-related PTSD. The aim of the first study was to evaluate the psychometric properties of the SCS and identify the optimal factor structure. A four-factor structure was identified and the SCS was psychometrically valid in this sample. The purpose of the second study was to investigate whether suicide cognitions predict greater or lesser medical and mental health care utilization among female veterans with MST-related PTSD. Both logistic regression analyses and hierarchical multiple linear regression analyses were conducted to identify whether SCs predict medical (inpatient and outpatient) and mental health (inpatient and outpatient) care utilization. Decreased physical health concerns and unbearability predicted inpatient medical care utilization. These studies provide additional support for how SCs can be utilized to improve assessment of suicide risk, as well as inform clinical approaches.Item [UT News](1986-03-10) Harrell, AnnItem [UT Southwestern Medical Center News](2008-02-26) Ladson, LaKisha