Benzodiazepines (BZs) are often used for the treatment of anxiety disorders and many clients presenting for Cognitive Behavioral Therapy (CBT) are already using them. Research suggests several good reasons for clients to consider discontinuation, including dampening benefit from CBT for anxiety, and the preference of many clients for nonmedical strategies for managing anxiety. Most clients require assistance in successfully discontinuing BZs, and this paper offers a brief step-by-step self-help handout for doing so. The handout helps clients decide whether they are ready to attempt BZ discontinuation, helps them plan the discontinuation effort, and suggests specific coping strategies for dealing with common discontinuation symptoms, including how to manage typical thoughts surrounding BZ discontinuation. The handout is especially useful after the client has experienced some success in reducing anxiety with CBT. The clinical use of the handout is discussed and suggestions offered for integrating it effectively into CBT for anxiety.

Ahmed, M., Westra, H.A., & Stewart, S.H. (2008). A self-help handout for benzodiazepine discontinuation using cognitive behavioral therapy. Cognitive and Behavioral Practice, 15, 317-324.

Sleep disruption is highly common in the United States and this difficulty can have a powerful effect on our well-being. We are currently aware of numerous behaviors, termed sleep hygiene factors, which are shown to disturb sleep. What is unclear is the extent to which these behaviors are problematic in the community. To answer this question we used a nationwide internet-based sample, and asked good and poor sleepers how frequently they performed these sleep-related behaviors. Although sleep hygiene behaviors were generally good, individuals reporting an uncomfortable nighttime temperature and those sleeping in a noisy environment were more than twice as likely to report poor sleep. Poor sleepers were also significantly more likely to engage in activating or arousing behaviors near bedtime. In particular, poor sleepers were prone to 'worry, plan, or think about important matters' in the bed. This investigation did not find increased usage of nighttime caffeine, alcohol or nicotine among poor sleepers.

Gellis, L.A., & Lichstein, K.L. (2009). Sleep hygiene practices of good of good and poor sleepers in the United States : An Internet-based study. Behavior Therapy, 40, 1-9.

Sleep disruption is highly common in the United States and this difficulty can have a powerful effect on our well-being. We are currently aware of numerous behaviors, termed sleep hygiene factors, which are shown to disturb sleep. What is unclear is the extent to which these behaviors are problematic in the community. To answer this question we used a nationwide internet-based sample, and asked good and poor sleepers how frequently they performed these sleep-related behaviors. Although sleep hygiene behaviors were generally good, individuals reporting an uncomfortable nighttime temperature and those sleeping in a noisy environment were more than twice as likely to report poor sleep. Poor sleepers were also significantly more likely to engage in activating or arousing behaviors near bedtime. In particular, poor sleepers were prone to 'worry, plan, or think about important matters' in the bed. This investigation did not find increased usage of nighttime caffeine, alcohol or nicotine among poor sleepers.

Gellis, L.A., & Lichstein, K.L. (2009). Sleep hygiene practices of good of good and poor sleepers in the United States : An Internet-based study. Behavior Therapy, 40, 1-9.

Exposure therapy helps to reduce behavioral avoidance that strengthens anxiety symptoms through systematic contact with a feared situation, object, thought, or memory. Although this treatment is very effective for many disorders, few therapists use it. This is partially due to concerns that exposure therapy is ‘cruel’ and unethical. However, a review of the literature suggests that exposure therapy is safe, tolerable, and even preferred by many patients. Despite such attributes, exposure therapy may place patients at greater risk than other forms of psychotherapy. Therefore, exposure therapy must be conducted by a competent clinician. Among other things, competency requires a comprehensive evaluation of whether the risk associated with exposure is acceptable. Acceptable risks of doing exposure may require some traditional therapy boundaries to be crossed but not violated. For example, exposure therapy may require sessions that are conducted outside of the office, but only if this is in the patient’s best interest. Consideration of this and other ethical concerns will allow for a safe context in which exposure therapy can be successfully utilized.

Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16, 172-180.

April is ABCT's election month. New this year is electronic voting. Only full and new professional members in good standing whose email is listed as the primary address on their ABCT record can vote. Not sure? Check your ABCT membership listing today to make sure you are "good to go" in April!

Not sure, log on and look on the membership directory to view your profile.

Or contact Lisa Yarde, ABCT's Membership Services Manager at lyarde@abct.org or 212-647-1890 x. 212.

ABCT launches web casts:
Watch presidential address, purchase training sessions.

Anger is little understood by researchers and clinicians; and it’s not happy about it at all. Some highlights from a talk given at ABCT’s annual convention in Philadelphia include:

• Anger: An overview.
• Anger: Is it learned?
• Anger: Is it linked to Aggression?
• Anger: Its relationship to fear.
• Anger: Anger and anxiety are tied to perceived safety and threat.
• Anger: As a function of revenge.
• Anger: How forgiveness helps, its limitations.

Or, to see the complete presentation, download the full address here:

Download:
Presidential Address: Anger as a Clinical Problem

Raymond DiGiuseppe

Despite the prevalence of anger and the problems it causes, anger is still not considered a primary clinical problem, with little research and less understanding. Models of the relationship between anger and aggression are confused and unclear. This has led to inadequate assessment strategies and diagnostic models and few effective treatments. Anger, like sadness or fear, serves a purpose, but can be dysfunctional in excess, impairing all aspects of life. Dr. DiGiuseppe proposes a model to understand anger as a clinical problem that can guide research, assessment, diagnosis, and treatment.

Web Cast: Invited Address: Advances in Psychiatric Rehabilitation

Kim T. Mueser

There have been tremendous advances in psychiatric rehabilitation. Recovery, once narrowly defined along medical terms, has been redefined with personal meaning and functional adaptation. Yet most with SMI still receive inadequate care. Dr. Mueser reviews state of the art treatment for SMI, highlighting emerging practices to address unmet needs, and obstacles – and solutions – to better care for this population.

Please click links to watch:

• Advances in Psychiatric Rehabilitation
• Advances in Psychiatric Rehabilitation: Q&A

For a full list of all ABCT podcasts, click here

ABCT launches web casts:
Watch presidential address, purchase training sessions.

ABCT offers web casts captured at the annual meeting. There will be invited addresses, clinical grand rounds, case conferences, even Anne Marie Albano’s Presidential address. Some of these are fee-based, and members get substantial discounts, many others are free. Please watch this space as we continue to add to our offerings.

Here are two, the first a Clinical Case Conference, the second a Clinical Grand Round. Both are approximately 90 minutes long, both are available at as streaming video. Please note that for web casts offered for purchase, you’ll need to make your payment and, within 2 business days, you’ll be sent an email with URL giving you access to that web cast for the next 9 months.

Web Cast: Clinical Child Case Conference: Clinical Practice in the Real World

Mary A. Fristad, Betsy D. Kennard, M. D. Rapport, and Eric Youngstrom

Four CBT therapists look at a child whose initial diagnosis is ADHD; is it. Our panel explores bipolar disorder, OCD, social phobias, borderline personality disorder, and more. The panel explores the symptoms and their meanings, and even give some explanations of how they’d deal with the family in this case. The video of a real client is not shown, but heard.

Please note that upon purchasing, you will be sent an email that unlocks the web site for viewing for the next 9 months. Email typically follows in 2 business days (sorry, no immediate gratification).

$20 member

$40 nonmember

Web Cast: Clinical Grand Round: Trauma-Focused CBT for Youth and their Parents

Esther Deblinger

Dr. Deblinger demonstrates the implementation of CBT interventions specifically designed to help youth and their non-offending parents cope in the aftermath of trauma, in this case child sexual abuse. She highlights methods to enhance clients’ understanding and engagement in the therapy process, and encourages open communication and assists clients in overcoming trauma-related distress and dysfunction.

Purchasing this gives the buyer web access for 90 days from date of purchase. Purchaser may use it for personal viewing or class room use. Detailed instructions will be sent to the purchaser within 2 business days of purchase (sorry it’s not an automatic launch).

$20 members

$40 nonmembers

Web Cast: Presidential Address: Cognitive Behavioral Therapy for Child Anxiety Comes of Age

Anne Marie Albano

From its roots in Mary Cover Jones’ study in the early 20s to just-completed multimodal studies, Dr. Albano addresses emerging trends and recent expansion of CBT treatment into community-based practice. The 50 minute presidential address is free.

Please click the link to watch...

Call for Candidates for Editor of the Behavior Therapist

Candidates are sought for Editor-Elect of the Behavior Therapist, volumes 34 - 36. The official term for the Editor is January 1, 2011 to December 31, 2013, but the Editor-Elect should be prepared to begin handling manuscripts approximately 1 year prior.

Candidates should send a letter of intent and a copy of their CV to Philip C. Kendall, Ph.D., Publications Coordinator, ABCT, 305 Seventh Avenue, 16th Floor, New York, NY 10001-6008 or via email to teisler@abct.org

Candidates will be asked to prepare a vision letter in support of their candidacy. David Teisler, ABCT's Director of Communications, will provide you with more details on the selection process as well duties and responsibilities of the Editor. Letters of support or recommendation are discouraged. However, candidates should have secured the support of their institution.

Questions about the responsibilities and duties of the Editor or about the selection process can be directed to David Teisler at the above email address or, by phone, at (212) 647.1890.

Letters of intent MUST BE RECEIVED BY August 3, 2009. Vision letters will be required by September 1, 2009.

STATEMENT REGARDING THE PROPOSED APA MODEL LICENSING ACT

We are the board of directors of the Association for Behavioral and Cognitive Therapies, which includes a large number of practicing psychologists among its members. We are writing to object to the inclusion of prescription authority in the proposed model licensing act currently under consideration.

As pointed out in an earlier post by a sister organization, the proposed preamble states, "The existing model act did not reflect the developments in professional practice that had occurred over the preceding 20 years. Specific developments included some psychologists obtaining prescriptive authority ..." We join SSCP in challenging the implication that "prescriptive authority" is a common activity of psychologists. After 20 years of intense activity, millions of dollars in support, and a huge amount of time and effort pressing for prescriptive authority, only two states and Guam have granted psychologists prescription privileges. The total number of psychologists who had sought and gained prescriptive authority in the two states mentioned was 65 as of early 2009. We believe that this indicates that there is little support for psychologists having prescription privileges. We invite APA to acknowledge this fact, give up on this issue, and join us in our focus on what psychologists do best - assess, predict, and treat behavioral and psychological problems using behavioral and methods strongly rooted in psychological science. We recommend removal of the phrase "some psychologists obtaining prescriptive authority" from the preamble.

By including this language in the model licensing act, APA is supporting a small, vocal, well - funded minority in a cause which is controversial both within and outside of the profession of psychology. Those who take up the cause of modernizing their state's licensing laws based on this model act are begging other professions to see that position as a self-serving turf issue, thus inviting opposition to both that authorization as well as others that, in contrast, are appropriate to the majority of practicing psychologists, and comfortably ensconced in current licensing laws in virtually every state in the nation. APA's position in the world of psychological practice requires that the organization consider carefully the impact of its actions on the profession as a whole, and not just a vocal minority of its membership.

Robert Leahy, Ph.D.
President

Anne Marie Albano, Ph.D.
Past President

Frank Andrasik, Ph.D.
President Elect

George Ronan, Ph.D.
Treasurer

Robert K. Klepac, Ph.D.
Representative at Large

Stefan Hofmann, Ph.D.
Representative at Large

Cheryl Carmin, Ph.D.
Representative at Large

Candidacy Communication Policy Statement

ABCT members who are running for elected office in other professional organizations may request to have their information included in the Behavior Therapist, on ABCT’s website, and/or sent to the ABCT listserv.

Information will be published in print and/or the internet for a period extending from three months prior to the election until after the election has occurred.

As a policy, ABCT does not endorse candidates; as such, the following disclaimer will accompany candidate information in print and/or online: For informational purposes only. The Association for Behavioral and Cognitive Therapies does not endorse the candidacy of any individual.

Members who wish to have their candidacy information included should email their name, their ABCT member number, the name of the professional organization in which they are running, the name of the office for which they are running, and the election date to David Teisler, Director of Communications, at teisler@abct.org.