Efficacy of a Danish version of the Cool Kids program: a randomized wait-list controlled trial.

OBJECTIVE: The purpose of the study was to evaluate the efficacy of a Danish version of the Cool Kids program, a generic manualized group cognitive-behavioural therapy (CBT) program for anxiety disorders among children and adolescents. METHOD: Children and adolescents (age 7-16) with a primary anxiety disorder diagnosis (n = 109) were randomly allocated to group CBT or a wait-list (WL) control condition at a Danish university clinic. RESULTS: Results showed that the Danish version of the Cool Kids program was efficacious with 48.2% free of all anxiety diagnoses at post-treatment, compared with 5.7% in the WL condition, and large effect sizes on self-report measures of child anxiety symptoms rated by child, mother, and father (ηp2 range = 0.18-0.24). Children and adolescents improved further from post-treatment to 3-month follow-up, and this improvement was maintained at 12-month follow-up. Participants with a primary diagnosis of social phobia (SoP) showed less improvement compared with other anxiety diagnoses. CONCLUSION: The study contributes to the evidence base for the Cool Kids program, previously only evaluated by its developers in Australia. Generic group CBT programs may not be the most appropriate treatment for children and adolescents with primary SoP.

Social anxiety and emotion knowledge: a meta-analysis.

It has been proposed that social anxiety is associated with poor emotion knowledge (EK), although studies have revealed mixed results. The aim of the present paper was to systematically investigate the association between EK and both non-clinical and clinical social anxiety by means of meta-analyses. Systematic, electronic database literature searches were performed, and meta-analyses were conducted on 43 included studies. Results showed that social anxiety was negatively associated with EK. The strongest association was found between clinical levels of social anxiety and the ability to understand one's own emotions (intrapersonal EK). Regarding interpersonal EK, a subgroup analysis showed that social anxiety was more strongly associated with a decreased ability to understand complex emotions than to recognize basic emotions. No differences were found between patients with social anxiety disorder (SAD) and patients with other anxiety disorders. Although a large between study heterogeneity and differing methodologies may prevent any firm conclusions from being reached, the results indicate that poor EK may play an important role in SAD, and that it could be beneficial to target EK in the treatment of SAD.

Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder.

OBJECTIVE: The primary aim of the study was to compare the effectiveness of group and individual cognitive behaviour therapy (CBT) for obsessive compulsive disorder (OCD). METHOD: One hundred and ten out-patients with OCD were randomly assigned to 15 sessions of either group CBT or individual CBT. Outcome measures were administered before and after treatment, as well as at 6- and 12-month follow-ups. The study was supplemented by a meta-analysis of accomplished comparative studies of group vs. individual CBT for OCD. RESULTS: Large and stable pre-post effect sizes were found for both treatment conditions in the study (d = 1.06-1.24 on the Yale-Brown Obsessive Compulsive Scale). There were no significant between-group differences in outcome at any data point (ds= -0.13 to 0.15). The meta-analysis of four accomplished comparative studies (including the present one) found a between-group mean effect size of (d= 0.15 favouring individual over group CBT at posttreatment (95% confidence interval, -0.12, 0.42). CONCLUSION: The results of this study suggest that OCD can be treated effectively with a group format of CBT, thus sparing some therapist resources, although the four accomplished comparative studies do not rule out the possibility of a small superiority of individually conducted CBT.

A randomized study of massed three-week cognitive behavioural therapy schedule for panic disorder.

OBJECTIVE: To compare the efficacy of massed vs. spaced group cognitive behavioural therapy (CBT) for patients with panic disorder with or without agoraphobia (PD). METHOD: Thirty-nine PD patients were randomly assigned to massed group CBT (daily 4-h sessions in week 1, two 2-h sessions in week 2 and one 2-h session in week 3) or traditional spaced weekly group CBT (13 consecutive, weekly 2-h sessions). The content and number of hours in the two treatment schedules were identical. Outcome was assessed after treatment, and at 3, 6 and 18 months of follow-up. RESULTS: Both treatment groups achieved significant improvement on all measures with large pre- to post-treatment and pre-treatment to follow-up effect sizes. No between-group differences were registered. Adherence and patient satisfaction did not differ between groups. CONCLUSION: The massed, 3-week group CBT schedule proved to be effective and feasible for PD patients with outcomes comparable with that of standard, spaced group CBT.

Group cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis.

OBJECTIVE: Behaviour therapy with exposure and response prevention (ERP) or cognitive behavioural therapy (CBT) including ERP are considered the psychological treatments of choice for obsessive-compulsive disorder (OCD), but group CBT/ERP has received relatively little research attention in the treatment of OCD. The aim of this study was to provide a meta-analysis of the effectiveness of group CBT/ERP for OCD. METHOD: A systematic literature search was conducted and studies were meta-analysed by means of the Cochrane Review Manager Program with measures of i) pre- to post-effect sizes (ES) and ii) between-group ES in comparison with different control conditions. Outcome was primarily measured on the Y-BOCS and ES was calculated in the form of Cohens d. RESULTS: Thirteen trials were included in the meta-analysis. The overall pre-post-ES of these trials of 1.18 and a between-group ES of 1.12 compared with waiting list control in three randomized controlled studies indicate that group CBT/ERP is an effective treatment for OCD. Group CBT achieved better results than pharmacological treatment in two studies. One study found no significant differences between individual and group CBT. CONCLUSION: Group CBT is an effective treatment for OCD, but more studies are needed to compare the effectiveness of group and individual treatment formats.

Suitability for psychoanalytic psychotherapy: validation of the Dynamic Assessment Interview (DAI).

OBJECTIVE: To examine the predictive validity of a particular interview and rating scale of patient suitability for psychoanalytic psychotherapy: The Dynamic Assessment Interview (DAI) scale. METHOD: Seventy-four psychiatric out-patients were interviewed with the DAI and the associations between DAI-scores and measures of outcome and of therapeutic alliance were investigated. RESULTS: Small to moderate correlations were found between the DAI suitability score and outcome (0.06-0.46) and between DAI suitability score and early rated alliance (0.14-0.45). The predictive value of the DAI-score was limited although on a par with the alliance measures used in the study. No other pretherapy predictor variable investigated was found significantly to predict outcome. CONCLUSION: The predictive power of the DAI measure was limited, a result, which is in agreement with results from former studies on suitability.

[Placebo effect in the drug therapy of depression]. / Placebovirkningen i medicinsk behandling af depression.

This paper estimates the effect sizes of placebo treatment of depression from meta-analyses of antidepressive medicine, and examines methodological artifacts in antidepressive research. It is concluded that between one-half and two-thirds of the effects of antidepressive medicine are explained by placebo response with a mean difference between treatment and placebo groups around 25 percent. This modest effect size should probably be adjusted for methodological bias due to incomplete blindness and other sources of error favouring the medicine group. Some practical consequences of the fact that depression is a placebo sensitive disorder are outlined.

The dynamic assessment interview (DAI), interpersonal process measured by structural analysis of social behavior (SASB) and therapeutic outcome.

In this study we investigated the interrelationships between the Dynamic Assessment Interview (DAI), the interpersonal process of the assessment interview analyzed with Structural analysis of Social Behavior (SASB), and treatment outcome. The DAI is a semistructured interview and rating procedure designed to evaluate patient suitability for psychodynamic psychotherapy based on the patient's immediate interaction with the assessment interviewer. In the selected sample (n = 20) the DAI ratings showed no significant correlations with the SASB-coded interpersonal process of the assessment interview nor with treatment outcome. The SASB-coded interpersonal process in the assessment interview correlated significantly with interpersonal process early in therapy and was able to predict treatment outcome. It is concluded that the abstract ''inner'' patient characteristics assumed to be of major prognostic importance for psychodynamic psychotherapy might be of limited validity, whereas the patient offered interpersonal process is worth further consideration as a predictor of treatment outcome. Finally, the relatively stressful structure of the DAI interview might have facilitated the prediction of treatment outcome from the interpersonal process in the assessment interview.

The Dynamic Assessment Interview: testing the psychodynamic assessment variables.

The Dynamic Assessment Interview (DAI) is a semi-structured interview with anchored scales to rate patients; suitability for psychodynamic psychotherapy. The DAI was inspired by the Personality Assessment Interview developed by Selzer et al. in 1987 and it introduces from the beginning of the assessment interview an explicit focus on the patient's immediate interactions with the interviewer. Seven theoretical derived variables are assessed, namely psychological mindedness, capacity for self-observation, capacity for empathy, tolerance of frustration, motivation, response to confrontation, and ability to contain and work with affect. In addition, the patient's attractiveness as a psychotherapy patient and his or her assumed confidence in the forthcoming treatment are assessed. The patient's personality organization ad modum Kernberg is measured from a global assessment of the interview. The present paper describes the DAI and presents its psychometric properties. An acceptable level of inter-rater agreement was found for the theoretically derived variables and for the personality organization diagnosis, with intra-class correlations or kappa coefficients ranging from 0.68 to 0.80.

The therapeutic alliance--a conceptual analysis.

The role and function of the therapeutic alliance in psychotherapy has increasingly been the focus of clinicians' and researchers' interests over the last decade. Alliance concepts have, however, been criticized for lack of conceptual clarity. The paper presents a generic model as a heuristic means for clarifying the conceptual meaning of the therapeutic alliance. The model distinguishes between the personal relationship aspect, and the collaborative, task-related aspect of the alliance, with therapist, patient, and common contributions to each of these aspects. The model is compared to other alliance conceptualizations, and its implications for alliance theory and research are discussed. A content analysis of four widely used alliance scales in relation to the model shows the scales to represent conceptually different, yet overlapping constructs. It is argued that the componential nature of the therapeutic alliance will render difficult any interpretation of findings regarding the relationship between alliance and outcome in traditional process-outcome research. More complex research strategies guided by theory are called for, if the therapeutic alliance should remain a vital field of research.