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Online Newsletter Committed to Excellence in the Fields of Mental Health, Addiction, Counseling, Social Work, and Nursing
February 13, 2010
Cognitive Behavioral Therapy CBT and PTSD
CMHS Consumer Affairs E-News
November 27, Vol. 07-187
Internet-Based PTSD Therapy May Help Overcome Barriers to Care
for more on PTSD and CBT,click link below
PTSD CEUs CBT CEUs
NIMH-funded researchers recently completed a pilot study showing that an Internet-based, self-managed cognitive behavioral therapy (CBT) can help reduce symptoms of post-traumatic stress disorder (PTSD) and depression, with effects that last after treatment has ended. This study supports further development of PTSD therapies that focus on self-management and innovative methods of providing care to large numbers of people who do not have access to mental health care or who may be reluctant to seek care due to stigma. The researchers published their study in the November 2007 issue of the American Journal of Psychiatry.
Brett Litz, Ph.D., of the National Center for PTSD at the VA Boston Healthcare System and Boston University, and colleagues recruited service members from the Department of Defense who had developed PTSD following the September 11, 2001, attack on the Pentagon or from recent combat exposure. Forty-five participants first met with a therapist to determine their baseline PTSD and depression symptoms, and then were randomly assigned to one of two 8-week long, therapist-assisted, Internet-based treatments.
One treatment used strategies from CBT, which previous research has shown to be effective in relieving symptoms of PTSD. This CBT-based therapy aimed to first help participants identify situations that triggered their PTSD symptoms by working with a therapist and then improve their ability to manage those symptoms through on-line homework assignments. The other therapy, called supportive counseling, asked participants to monitor their own current, non-trauma-related problems, and then write about those experiences online. These participants also received periodic phone calls or emails from their therapist, who provided supportive but non-directed counseling. Participants in both groups were asked to log on daily to a Web site specific to their assigned treatment. After rating their PTSD and depression symptoms using a checklist, participants were allowed access to the Web site where they could find information about PTSD, stress, trauma, and other related health topics; communicate with their therapist; or complete treatment-specific activities.
After eight weeks of treatment, participants in both groups had fewer or less severe PTSD and depression symptoms, but those in CBT-based therapy showed greater improvements than those in supportive counseling therapy. Six months after their first meeting with a study therapist, participants who received CBT-based therapy showed continued improvements, while those in the supportive therapy group experienced an increase in PTSD and depression symptoms.
These findings suggest the CBT-based online therapy may be an efficient, effective, and low-cost method of providing PTSD treatment following a traumatic event to a large number of people. The researchers noted that fewer people completed the CBT-based therapy than the supportive counseling therapy. However, regardless of therapy group, the discontinuation rate among study participants was similar to the 30 percent discontinuation rate reported in studies of face-to-face treatment. Further study is needed to improve treatment use and completion and to test Internet-based PTSD therapies in a larger study population.
Reference
Litz BT, Engel CC, Bryant R, Papa A. A Randomized Controlled Proof-of-Concept Trial of an Internet-Based, Therapist-Assisted Self-Management Treatment for Posttraumatic Stress Disorder. Am J Psychiatry. 2007 Nov;164(11):1676-84.
November 27, Vol. 07-187
Internet-Based PTSD Therapy May Help Overcome Barriers to Care
for more on PTSD and CBT,click link below
PTSD CEUs CBT CEUs
NIMH-funded researchers recently completed a pilot study showing that an Internet-based, self-managed cognitive behavioral therapy (CBT) can help reduce symptoms of post-traumatic stress disorder (PTSD) and depression, with effects that last after treatment has ended. This study supports further development of PTSD therapies that focus on self-management and innovative methods of providing care to large numbers of people who do not have access to mental health care or who may be reluctant to seek care due to stigma. The researchers published their study in the November 2007 issue of the American Journal of Psychiatry.
Brett Litz, Ph.D., of the National Center for PTSD at the VA Boston Healthcare System and Boston University, and colleagues recruited service members from the Department of Defense who had developed PTSD following the September 11, 2001, attack on the Pentagon or from recent combat exposure. Forty-five participants first met with a therapist to determine their baseline PTSD and depression symptoms, and then were randomly assigned to one of two 8-week long, therapist-assisted, Internet-based treatments.
One treatment used strategies from CBT, which previous research has shown to be effective in relieving symptoms of PTSD. This CBT-based therapy aimed to first help participants identify situations that triggered their PTSD symptoms by working with a therapist and then improve their ability to manage those symptoms through on-line homework assignments. The other therapy, called supportive counseling, asked participants to monitor their own current, non-trauma-related problems, and then write about those experiences online. These participants also received periodic phone calls or emails from their therapist, who provided supportive but non-directed counseling. Participants in both groups were asked to log on daily to a Web site specific to their assigned treatment. After rating their PTSD and depression symptoms using a checklist, participants were allowed access to the Web site where they could find information about PTSD, stress, trauma, and other related health topics; communicate with their therapist; or complete treatment-specific activities.
After eight weeks of treatment, participants in both groups had fewer or less severe PTSD and depression symptoms, but those in CBT-based therapy showed greater improvements than those in supportive counseling therapy. Six months after their first meeting with a study therapist, participants who received CBT-based therapy showed continued improvements, while those in the supportive therapy group experienced an increase in PTSD and depression symptoms.
These findings suggest the CBT-based online therapy may be an efficient, effective, and low-cost method of providing PTSD treatment following a traumatic event to a large number of people. The researchers noted that fewer people completed the CBT-based therapy than the supportive counseling therapy. However, regardless of therapy group, the discontinuation rate among study participants was similar to the 30 percent discontinuation rate reported in studies of face-to-face treatment. Further study is needed to improve treatment use and completion and to test Internet-based PTSD therapies in a larger study population.
Reference
Litz BT, Engel CC, Bryant R, Papa A. A Randomized Controlled Proof-of-Concept Trial of an Internet-Based, Therapist-Assisted Self-Management Treatment for Posttraumatic Stress Disorder. Am J Psychiatry. 2007 Nov;164(11):1676-84.
Anxiety Disorders
What are anxiety disorders?
for more information and ceus on anxiety disorders ceus, click link below
Anxiety Disorders CEUs Panic Disorders CEUs BBS Approved MFT LCSW
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. This fact sheet briefly describes the different types of anxiety disorders. This fact sheet is not exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research can yield rapid and dramatic changes in our understanding of and approaches to mental disorders. If you believe you or a loved one has an anxiety disorder, seek competent, professional advice or another form of support.
Generalized Anxiety Disorder: Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.
Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms.
Formal diagnosis: When someone spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.
Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.
Panic Disorder: People with panic disorder experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment.
Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.
Formal Diagnosis: Either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep.
Treatment: Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards" for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms. Proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks.
Phobias: Most of us steer clear of certain, hazardous things. Phobias however, are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.
Symptoms: Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias.
Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.
Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.
Post-traumatic Stress Disorder: Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person's ability to hold a job or to develop intimate relationships with others.
Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. People with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks.
Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.
Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti-anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.
For more information, as well as referrals to specialists and self-help groups in your State, contact:
Anxiety Disorders Association of America
8730 Georgia Avenue - Suite 600
Silver Spring, MD 20910
Telephone: 240-485-1001
Fax: 240-485-1035
www.adaa.org
Mental Help Net
CenterSite, LLC
570 Metro Place
Dublin, OH 43017
http://mentalhelp.net/poc/center_index.php?id=1
National Mental Health Association
2001 Beauregard Street, 12th Floor
Alexandria, VA 22311
Telephone: 800-969-6642
Fax: 703-684-5968
(TDD): 800-433-5959
www.nmha.org/infoctr/factsheets/index.cfm
The National Institute of Mental Health's toll-free information line is
1-866-615-6464; their web address is www.nimh.nih.gov/healthinformation/anxietymenu.cfm.
for more information and ceus on anxiety disorders ceus, click link below
Anxiety Disorders CEUs Panic Disorders CEUs BBS Approved MFT LCSW
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. This fact sheet briefly describes the different types of anxiety disorders. This fact sheet is not exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research can yield rapid and dramatic changes in our understanding of and approaches to mental disorders. If you believe you or a loved one has an anxiety disorder, seek competent, professional advice or another form of support.
Generalized Anxiety Disorder: Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.
Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms.
Formal diagnosis: When someone spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.
Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.
Panic Disorder: People with panic disorder experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment.
Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.
Formal Diagnosis: Either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep.
Treatment: Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards" for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms. Proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks.
Phobias: Most of us steer clear of certain, hazardous things. Phobias however, are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.
Symptoms: Many of the physical symptoms that accompany panic attacks - such as sweating, racing heart, and trembling - also occur with phobias.
Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.
Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.
Post-traumatic Stress Disorder: Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person's ability to hold a job or to develop intimate relationships with others.
Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. People with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks.
Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.
Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti-anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.
For more information, as well as referrals to specialists and self-help groups in your State, contact:
Anxiety Disorders Association of America
8730 Georgia Avenue - Suite 600
Silver Spring, MD 20910
Telephone: 240-485-1001
Fax: 240-485-1035
www.adaa.org
Mental Help Net
CenterSite, LLC
570 Metro Place
Dublin, OH 43017
http://mentalhelp.net/poc/center_index.php?id=1
National Mental Health Association
2001 Beauregard Street, 12th Floor
Alexandria, VA 22311
Telephone: 800-969-6642
Fax: 703-684-5968
(TDD): 800-433-5959
www.nmha.org/infoctr/factsheets/index.cfm
The National Institute of Mental Health's toll-free information line is
1-866-615-6464; their web address is www.nimh.nih.gov/healthinformation/anxietymenu.cfm.
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