Sequential Treatment: A New Way of Integrating Pharmacotherapy and Psychotherapy

Background: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. Method: The aim of the trial was to study the effectiveness of CBT versus ST carried out ‘as usual’. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 reached weeks 48 and 72 (endpoint). Results: At week 6, after CT, group 1 was better than group 2 on the main social phobia measure. At week 12, after SST, group 1 was better than group 2 on most of the measures and demonstrated a significantly higher rate of responders. This finding was replicated after switching group 2 to CBT. Sustained improvement was observed in both groups at follow-up. Compliance with abstinence from medication increased over time. Conclusions: CBT was more effective than ST and demonstrated long-lasting effects. This may suggest that social phobia management requires more than a simple and inexpensive psychological intervention.

Section: Methodsmentioning

confidence: 99%

Cognitive Behavior Therapy versus Supportive Therapy in Social Phobia: A Randomized Controlled Trial

Cottraux

Note²,

Albuisson³

et al. 2000

“…It is conceivable that application of psychotherapeutic techniques may follow these stages and be specifically geared for them [159]. …”

Section: Application Of Psychological Therapies To Medical Diseasesmentioning

confidence: 99%

Psychosomatic Medicine: Emerging Trends and Perspectives

Fava

Sonino

2000

Self Cite

130

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.

“…Hooley and Richters [70]highlight the value of focusing on the identification of more powerful predictors of relapse rather than on the development of alternative measures of EE. Other authors [71, 72]emphasize the importance of identifying psychological well-being (encompassing family relationship) as a protective factor against relapse in mood disorders.…”

Section: Future Directionsmentioning

confidence: 99%

Therapeutic Interventions Focused on the Family of Bipolar Patients

Reinares¹,

Colom²,

Martínez‐Arán³

et al. 2001

Background: Although genetic and biological factors are crucial in the pathophysiology of bipolar disorder, the importance of psychosocial and familial factors in triggering or mitigating relapses warrants the implementation of psychotherapeutic interventions. The authors review and criticize the role of family intervention in bipolar disorder. Methods: The main computerized databases (Medline, Psychological Abstracts, Current Contents) have been searched for the terms ‘family intervention’, ‘family management’, ‘family therapy’, ‘psychotherapy’, ‘psychoeducation’ and ‘bipolar disorder’. Results: Some studies have associated high expressed emotion in relatives and poorer outcome in bipolar disorder. Studies on families of bipolar patients seem to support that family intervention as adjunctive therapy to pharmacological treatment may reduce the number of relapses and hospitalizations, improving familial, occupational and social functioning. However, controlled studies are scarce and most of them have a great number of methodological pitfalls such as small sample size, uncontrolled pharmacological treatment, absence of long follow-up and biased populations, among others. Conclusions: Both bipolar patients and their relatives could benefit from family intervention as adjunctive treatment to pharmacotherapy. Nevertheless, it would be necessary to design further investigations avoiding some of the limitations listed above, and controlling additionally for psychopathology in family members, and the influence of life events. It would be important to distinguish between causes and effects, studying which factors are involved in family attitudes and determining whether the interactive patterns are variable or stable according to the clinical state of the patient. Finally, it would be useful to design viable, effective and measurable interventions for the accurate delimitation of the role of family intervention in the treatment of bipolar disorder.