Month: iulie 2008

A “Platform for Advanced Imaging – fMRI/EEG – in Clinical Cognitive Sciences/Psychotherapy” will be developed at the Babes-Bolyai University, Department of Clinical Psychology and Psychotherapy/International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, based on a grant from the European Union through the Romanian Government – National Authority for Research. The Platform will be composed of a Center for Advanced Imaging – fMRI/EEG – in Clinical Cognitive Sciences, which has two Laboratories: (1) Advanced fMRI Lab.; and (2) Advanced EEG Lab. Thus, the Platform will make use of an advanced technology, consisting of fMRI (3T) and EEG technologies, and it will be fully operational in 2009.

 

Building on our international expertise in evidence based assessment and psychotherapy (see our Web of Science indexed publications), this new development will help us complement our advanced research at the computational and algorithmic-representational levels (e.g., large randomized clinical trials comparing psychotherapy and medication for various clinical conditions by outcome, mechanism of change and cost-effectiveness, virtual reality therapy) with research at the implementational level (brain level) to facilitate the understanding and integration of  the mechanisms and processes of psychotherapy and other psychological interventions intended for the treatment of various clinical conditions and/or for health promotion.

(R) GAD CLINICAL TRIAL – A BRIEF DESCRIPTION

TO START: FALL 2008

I. TITLE

·     Cognitive Therapy vs. Rational Emotive Behavior Therapy vs. Acceptance & Commitment Therapy in the Treatment of Generalized Anxiety Disorder. A Randomized Clinical Trial: Outcomes, Theory of Change, and Cost-Effectiveness.

 

II. LOCATION

·     The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health at  Babes-Bolyai University, Cluj-Napoca, Romania (see for details and for the expertise of the Institute in running large scale randomized clinical trials: www.psychotherapy.ro). The trial is funded internationally.

 

III. OBJECTIVES

·     To investigate, in a randomized clinical trial, the efficacy, the mechanisms of change, and the cost-effectiveness of Cognitive Therapy (reference treatment) vs. Rational Emotive Behavior Therapy vs. Acceptance & Commitment Therapy in the treatment of generalized anxiety disorder (GAD).

o    Theoretical implications: (1) a better understanding of the mechanisms involved in GAD and (2) a better integration of the diverse cognitive pathogenetic mechanisms of GAD into (a) a coherent cognitive-behavior theory and (b) a rigorous and integrative psychological assessment strategy (measures/scales).

o    Practical Implications: New clinical protocols and guidelines for the evidence-based assessment and therapy of GAD.

 

IV. INTERNATIONAL COORDINATING TEAM

·     Principal Investigator (PI): Dr. Daniel David, Professor, Ph.D., Babes-Bolyai University, Romania, Director of the International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health (see his expertise at: www.psychotherapy.ro) & Co-PI: Dr. Aurora Szentagotai, Associate Professor, Ph.D., Babes-Bolyai University.

·     External Research Consultant:  Dr. Douglas Mennin, Ph.D., Associate Professor, Yale University, USA, Director of Yale Anxiety & Mood Services at Yale University.

·     Psychiatric Components Consultants: Dr. Doina Cosman, MD, Professor, Ph.D., and Dr. Viorel Lupu, MD, Professor, Ph.D., “Iuliu Haţieganu” University of Medicine and Pharmacy, Romania.

 

1. Cognitive Therapy (CT) Coordinating Group

·     Coordinator: Ramona Moldovan, Assistant Professor, MA, Babes-Bolyai University, Clinical Psychologist (trained in CT by the Romanian Association of Cognitive and Behavioral Psychotherapies with international CT supervisors).

·     Clinical Consultant: Dr. Robert Leahy, Clinical Professor, Ph.D., Department of Psychiatry, Weill-Cornell University Medical College, USA (President of the Academy of Cognitive Therapy (ACT); President of the Association for Behavioral and Cognitive Therapies (ABCT)).

·     Research Consultant: Dr. Stefan G. Hoffman, Professor, Ph.D., Boston University, USA, Director of the Psychotherapy and Emotion Research Laboratory at Boston University.

2. Rational Emotive Behavior Therapy (REBT) Coordinating Group

·     Coordinator: Bianca Macavei, Assistant Professor, MA, Babes-Bolyai University, Clinical Psychologist (trained in REBT by the Romanian Association of Cognitive and Behavioral Psychotherapies with international REBT supervisors; supervisor in REBT at the Albert Ellis Institute, USA).

·     Clinical Consultant: Dr. Windy Dryden, Professor, Ph.D., University of London, UK, Supervisor in REBT at the Albert Ellis Institute.

·     Research Consultant: Dr. Raymond DiGiuseppe, Professor, Ph.D., St. John University, USA, Director of Professional Education at the Albert Ellis Institute (Past President of the ABCT).

3. Acceptance & Commitment Therapy (ACT) Coordinating Group

·     Coordinator: Ioana Cristea, Assistant Professor, MA, Babes-Bolyai University, Clinical Psychologist (trained in ACT by the Romanian Association of Cognitive and Behavioral Psychotherapies with international ACT supervisors).

·     Clinical Consultant: Dr. Kelly G. Wilson, Associate Professor, Ph.D., University of Mississippi, USA, ACT Supervisor.

·     Research Consultant: Dr. Steven Hayes, Professor, Ph.D., University of Nevada, USA; Founder of ACT (Past president of ABCT).

 

V. DESIGN

A rigorous randomized clinical trial, following the model implemented in one of our previous studies on major depressive disorder (MDD) (see the below cited study), will be designed for this study.

·          David, D., Szentagotai, A., Lupu, V., & Cosman, D. (2008). Rational emotive behavior therapy, Cognitive therapy and Medication in the treatment of major depressive disorder: A randomized clinical trial, post-treatment outcomes, and six month follow-up. Journal of Clinical Psychology, 64, 728-746.

All the methodological components (e.g., treatment integrity, allegiance effect, missing data analysis, attrition/power calculation etc.) of this trial on GAD will be implemented similar to the ones in the MDD trial (mentioned above). Each treatment will consist of about 20 sessions, delivered over a 14-week period.

 

1. Outcome measures

a. General:

·     OQR 45.2 – (Adult outcome measure; age 18+)

·     POMS (Profile of Mood States; includes: (a) functional and dysfunctional negative feelings scores and (b) positive affect)

·     SF-37 (Quality of Life)

b. Specific:

·         HRSA (Hamilton Rating Scale for Anxiety)

·         BAI (Beck Anxiety Inventory)

·         GAD-Q-IV (the Generalized Anxiety Disorders Questionnaire 4th Edition)

SCID-RV will be used for categorical diagnoses (based on DSM-IV)

Note: All outcome measures will be administered pre- mid- and post-treatment. The BAI will be administered each session.

 

2. Hypothesized mediating (i.e., mechanisms of change) variables

·             ATQ (Automatic Thoughts Questionnaire) (related to CT)

·         DAS (Dysfunctional Attitudes Scale) (related to CT)

·         ABS-II (Attitudes and Beliefs Scale – II) (related to REBT)

·         USA (Unconditional Self-Acceptance) (related to REBT)

·         AAQ (Acceptance and Action Questionnaire) (related to ACT)

·         EAS (Experiential Avoidance Scale) (related to ACT)

·         RE (Response Expectancies for Non-volitional Outcomes [i.e., anxiety, relaxation]; VAS type      scales) (not specifically related to any of the investigated forms of therapy)

·         PSWQ (Penn State Worry Questionnaire) (not specifically related to any of the forms of therapy)

·         DERS (Difficulties in Emotional Regulation Scale) (not specifically related to any of the investigated forms of therapy)

·         AIM (Affect Intensity Measure) (not specifically related to any of the investigated forms of therapy)

Note: All mediating variable measures will be administered pre-, mid-, and post-treatment. The ATQ and RE will be administered each session.

 

3. Hypothesized moderator variables

·         LOT (Level of Optimism and Pessimism)

·         Brief-Cope (Coping Mechanisms)

Note: All hypothesized moderating variables measures will be administered pre-, mid-, and post-treatment.

 

Other measures will include demographics and relevant medical data. Some cognitive tasks (e.g., cognitive inhibition/interference) and psychophysiological measures will be also employed (to be established) to complement the self-report measures.

 

 

În perioada 17-19 Septembrie, 2008, la Bucureşti, Ministerul Educaţiei şi Cercetării – Autoritatea Naţională pentru Cercetare Ştiintifică, în colaborare cu Academia Română, va organiza Conferinţa: „Diaspora Ştiinţifică Românească„. Ideea este de a-i reuni pe cei mai prestigioşi cercetători români din ţară şi din diasporă, pentru a gândi împreună cercetări şi activităţi de impact internaţional.

Domeniul „Psihologie„ va fi reprezentat la această Conferinţă prin Simpozionul/Workshop-ul invitat: „Stiinte Cognitive Clinice” (Invited Chair: Prof. univ. dr. Daniel David, Universitatea Babeş-Bolyai; Co-chairs: Prof. univ. dr. Şerban Ionescu, Franţa; Prof. univ. dr. Puiu Vasilescu, SUA).  Simpozionul/Workshop-ul se va desfăşura la Institutul de Filosofie şi Psihologie „C. Rădulescu Motru” al Academiei Române.

Participarea la Simpozion/Workshop se face pe bază de invitaţie nominală, numărul de invitaţi fiind limitat de bugetul Simpozionului/Workshop-ului. Alţi colegi interesaţi de lucrări şi de rezultatele întâlnirii pot însă lua legatura cu Asist univ. drd. Ramona Moldovan (ramonamoldovan@psychology.ro), şi, în limita locurilor disponibile în sală, vor putea participa la lucrările Simpozionului/Workshop-ului în calitate de audienţi. Sinteza şi concluziile Simpozionului/Workshop-ului vor fi făcute public.

Pentru lista participanţilor invitaţi din ţară şi străinătate şi pentru mai multe informaţii vezi Site-ul Conferinţei la: http://www.diaspora-stiintifica.ro (secţiunea Psihologie).

În anul 2002/2003 profesorul Daniel David a fost desemnat de un Consorţiu format din oameni de știință de top de la Institute de cercetare şi Universităţi americane de prestigiu (ex. Albert Ellis Institute, Albert Einstein College of Medicine, Mount Sinai School of Medicine, etc.) să formeze şi să conducă o echipă de cercetare internaţională al cărei rol major a fost „…să elaboreze şi să implementeze un Program de Cercetare Programatică – „CBT in the Context of Cognitive Science”, pe o perioadă de 5 ani, – care să integreze domeniul clinic, reprezentat de psihoterapiile cognitive şi comportamentale (CBT), cu cel al ştiinţele cognitive, în aşa numitul domeniu al – „Clinical Cognitive Sciences” -…(aşa cum se prezentau ele la acea dată)”. Cercetarea Programatică este descrisă succint în:

• David, D. (2003). Rational Emotive Behavior Therapy (REBT); The view of a cognitive psychologist. In W. Dryden (Ed.), Theoretical developments in REBT. Brunner/Routledge: London.

 

Anul acesta (2008) s-a încheiat formal Programul – „CBT in the Context of Cognitive Science” – , printr-un Raport prezentat (Iulie, 2008, la New-York) de profesorul David instituţiilor din SUA care au susţinut financiar demersul. Prezentăm în continuare succint, ideile principale ale Raportului:

 

1. Rezultatele obţinute s-au exprimat în contribuţii semnificative la cunoaşterea internaţională. Astfel, au fost introduse şi testate în domeniul ştiinţelor cognitive clinice noi constructe şi/sau tehnici psihoterapeutice inovative, cu valenţe euristice remarcabile, precum: „binary model of distress”, „mental contamination in cognitive restructuring”, „response hope”, „the expanded ABC cognitive model of psychopathology”,  „rational anticipation technique„, „global restructuring technique„, „incompatible information technique„, etc.. De asemenea au fost testate concurenţial în experimente cruciale (vezi Karl Popper pentru detalii privind acest concept), şi în consecinţă au fost validate sau invalidate, o serie de teorii și modele, clarificându-se astfel tematici care au generat „debate-uri” ani în şir în literatura de specialitate (ex. „qualitative versus quantitative distinction between functional and dysfunctional negative feelings”; „the primacy of demandignes”; „hot versus cold cognition distinction”; „the role of unconscious information processing (cognitive unconscious) in the cognitive model of psychopathology” etc.). Aceste constructe şi rezultate au pătruns deja în limbajul de specialitate, fiind citate în lucrările altor grupuri de cercetare independente (ex. din China, Europa, SUA, etc.).

 

2. Principalele publicaţii care exprimă activitatea acestui Program – „CBT in the Context of Cognitive Science” – sunt descrise în continuare (alte contribuţii pe baza datelor obținute în acest Program sunt în curs de publicare/elaborare, urmând să apară în următorii 1-2 ani):

 

• David, D., Szentagotai, A., Lupu, V., & Cosman, D. (2008). Rational emotive behavior therapy, Cognitive therapy, and Medication in the treatment of major depressive disorder: A randomized clinical trial, posttreatment outcomes, and six month follow-up. Journal of Clinical Psychology, 64, 728-746.
• DiLorenzo, T.A., David, D., & Montgomery, G.H. (2007). The interrelations between irrational cognitive processes and distress in stressful academic settings. Personality and Individual Differences, 42, 765-776.

• Szentagotai, A., & Freeman, A. (2007). An analysis of the relationship between irrational beliefs and automatic thought in predicting distress. Journal of Cognitive and Behavioral Psychotherapies, 7, 1-9.

• Montgomery, G.H, David, D., DiLorenzo, T.A., & Schnur, J.B. (2007). Response expectancies and irrational beliefs predict exam-related distress. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 25, 17-34.
• David, D., Montgomery, G., & DiLorenzo, T.A. (2006). Response expectancy versus response hope in predicting distress. A brief research report. Erdelyi Pszichologiai Szemle, 1, 1-13.
• David, D., & Szentagotai, A. (2006). Cognition in cognitive-behavioral psychotherapies; Toward an integrative model. Clinical Psychology Review, 26, 284-298.
• David, D., David, A., Ghinea, C., Macavei, B., & Kallay, E. (2006). A Search for the „Hot” cognitions in a clinical and a non-clinical context: Appraisal, attributions, core relation theme, irrational beliefs, and their relation to emotion. Advances in Psychology Research, 40, 1-37.
• Szentagotai, A., & Kallay, E. (2006). The faster you move the longer you live – A test of rational emotive behavior therapy? Journal of Cognitive and Behavioral Psychotherapies, 6, 69-80.
• David, D., Montgomery, G.H., Macavei, B., & Bovbjerg, D. (2005). An empirical investigation of Albert Ellis’ binary model of distress. Journal of Clinical Psychology, 61, 499-516.
• David, D., Schnur, J., & Birk, J. (2004). Functional and dysfunctional emotions in Ellis’ cognitive theory; An empirical analysis. Cognition and Emotion, 18, 869-880.
• David, D., Szentagotai, A., Kallay, E., & Macavei, B. (2005). A synopsis of rational-emotive behaviour therapy; Fundamental and applied research. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23, 175-221.
• David, D., McMahon, J., & Macavei, B. (2005). Cognitive restructuring and mental contamination: An empirical re-conceptualization. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23, 21-56.
• David, D., Schnur, J., & Belloiu, A. (2002). Another search for the ”hot” cognition: Appraisal irrational beliefs, attribution, and their relation to emotion. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 20, 93-131.
• David, D. (2003). Rational Emotive Behavior Therapy (REBT); The view of a cognitive psychologist. In W. Dryden (Ed.), Theoretical developments in REBT. Brunner/Routledge: London.

3. De asemenea, în urma Programului a rămas o echipă de cercetare performantă, care funcţionează într-o reţea internaţională, cu ”noduri/unități” (puncte de lucru) în Europa, SUA şi România, un actor major și influent în cunoaşterea ştiinţifică internaţională în domeniu.