***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for generalized social phobia were assigned to cognitive therapy ( CT ) , fluoxetine plus self-exposure ( FLU + SE ) , or placebo plus self-exposure ( PLA + SE ) . At posttreatment ( 16 weeks ) , the medication blind was broken . CT and FLU + SE patients then entered a 3-month booster phase . Assessment s were at pretreatment , midtreatment , posttreatment , end of booster phase , and 12-month follow-up . Significant improvements were observed on most measures in all 3 treatments . On measures of social phobia , CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment . FLU + SE and PLA + SE  did not differ . CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up . On general mood measures , there were few differences between the Few r and omized controlled trials have included panic disorder patients with moderate to severe agoraphobia . Therefore , this population was studied using pharmacotherapy as well as psychotherapy . At the time of the study , imipramine was widely used as a pharmacological treatment . Also , current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy . Therefore , the main objective of this study is to compare four psychosocial treatments — cognitive and grade d in vivo exposure treatments , grade d in vivo exposure , cognitive treatment , and supportive therapy — to evaluate the benefits of combining cognitive therapy with exposure in vivo . These treatments were combined with imipramine or placebo for a total of eight experimental conditions . Participants presented moderate to severe agoraphobia . The method involved a r and omized , double‐blind , placebo‐controlled trial with 137 participants who completed a 14‐session protocol involving the treatments just mentioned . Measures were taken at baseline and posttreatment and at 3‐ , 6‐ , and 12‐month follow‐up . All treatment conditions were statistically and clinical ly effective in reducing self‐reported panic – agoraphobia symptoms over the 1‐year follow‐up . No statistical differences were observed between imipramine and placebo conditions . This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1‐year follow‐up period . These surprising results support the need to document the relations among the various components of an intervention . This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole Background : The study was design ed to compare cognitive therapy ( CT ) with intensive behavior therapy ( BT ) in obsessive-compulsive disorder ( OCD ) and to study their change process . Methods : Sixty-five out patients with DSM-4 OCD were r and omized into 2 groups for 16 weeks of individual treatment in 3 centers . Group 1 received 20 sessions of CT . Group 2 received a BT program of 20 h in two phases : 4 weeks of intensive treatment ( 16 h ) , and 12 weeks of maintenance sessions ( 4 h ) . No medication was prescribed . Results : Sixty-two patients were evaluated at week 4 , 60 at week 16 ( post-test ) , 53 at week 26 and 48 at week 52 ( follow-up ) . The response rate was similar in the 2 groups . The Beck Depression Inventory ( BDI ) was significantly more improved by CT ( p = 0.001 ) at week 16 . The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT , while the baseline BDI score predicted a response in BT . At week 16 , only the changes in Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and a scale measuring the interpretation of intrusive thoughts correlated in CT , while the changes in Y-BOCS , BDI , and interpretation of intrusive thoughts correlated in BT . Improvement was retained at follow-up without a between-group difference . The intent-to-treat analysis ( last observation carried forward ) found no between-group differences on obsessions , rituals and depression . Conclusions : CT and BT were equally effective on OCD , but at post-test CT had specific effects on depression which were stronger than those of BT . Pathways to improvement may be different in CT and BT . The outcomes are discussed in the light of an effect size analysis Objective To determine whether Therapeutic Assessment ( TA ) versus assessment as usual ( AAU ) improves engagement with follow-up in adolescents presenting with self-harm . Design R and omised controlled trial with 3 months naturalistic follow-up . Setting Child and adolescent mental health services in two London National Health Service Trusts . Participants 26 clinicians r and omised into TA and AAU groups recruited 70 newly referred adolescents with self-harm . Interventions TA , a manualised procedure including a basic psychosocial assessment and a 30 min therapeutic intervention ; AAU , st and ard psychosocial assessment . Main outcome measures Attendance at the first follow-up session ; number of the follow-up sessions attended and changes in Strengths and Difficulties Question naire and Children 's Global Assessment Scale scores . All measures were adjusted for clustering , social class , changes of therapist and previous contact with services . Results Using the data on all participants ( n=70 ) , those in the TA group were significantly more likely to attend the first follow-up appointment : 29 ( 83 % ) versus 17 ( 49 % ) , OR 5.12 , 95 % CI ( 1.49 to 17.55 ) and more likely to attend four or more treatment sessions : 14 ( 40 % ) versus 4 ( 11 % ) , OR 5.19 , 95 % CI ( 2.22 to 12.10 ) . Three months after the initial assessment there were no statistically significant differences between the groups on Strengths and Difficulties Question naire scores : 15.6 versus 16.0 , mean difference −0.37 , 95 % CI ( −3.28 to 2.53 ) or Children 's Global Assessment Scale scores : 64.6 versus 60.1 , mean difference 4.49 , 95 % CI ( −0.98 to 9.96 ) . Conclusions TA was associated with statistically significant improvement in engagement . TA could be usefully applied at the point of initial assessment for adolescents with self-harm . Trial registration IS RCT N 81605131 http://www.controlled-trials.com/IS RCT Recent studies have shown that cognitive therapy is an effective treatment for panic disorder . However , little is known about how cognitive therapy compares with other psychological and pharmacological treatments . To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy , applied relaxation , imipramine ( mean 233 mg/day ) , or a 3-month wait followed by allocation to treatment . During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months . Imipramine was gradually withdrawn after 6 months . Each treatment included self-exposure homework assignments . Cognitive therapy and applied relaxation sessions lasted one hour . Imipramine sessions lasted 25 minutes . Assessment s were before treatment/wait and at 3 , 6 , and 15 months . Comparisons with waiting-list showed all three treatments were effective . Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures . At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures . Between 6 and 15 months a number of imipramine patients relapsed . At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months . Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up This study examined the effects of cognitive-behavior therapy ( CBT ) compared with traditional behavior therapy ( exposure and response prevention [ ERP ] ) in the group treatment of obsessive-compulsive disorder . Of the 76 participants who started treatment , 38 were wait-listed for 3 months before treatment to assess possible course effects . Both treatments were superior to the control condition in symptom reduction , with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up . In terms of clinical ly significant improvement , treatment groups were equivalent on the conclusion of treatment , but 3 months later significantly more ERP participants met criteria for recovered status . Only 1 of 7 belief measures changed with treatment improvement , and the extent of this cognitive change was similar between CBT and ERP groups . Discussion includes consideration of optimal formats for the delivery of different types of treatment Exposure therapy and cognitive behaviour therapy ( CBT ) are both effective in the treatment of panic disorder with agoraphobia . Cognitive theories suggest that the way in which exposure to avoided situations is implemented in either treatment may be crucial . In particular , it is suggested that clinical improvement will be greatest if opportunities for disconfirmation of feared catastrophes are maximized . In a small pilot study , 16 patients with panic disorder and ( moderate or severe ) agoraphobia were r and omly allocated to either habituation based exposure therapy ( HBET ) or exposure planned as a belief disconfirmation strategy and accompanied by dropping of safety-seeking behaviours . Both treatments were brief ( total of 3.25 h of exposure ) and were similar in terms of expectancy of change . Patients in the CBT condition showed significantly greater improvements in self-report measures of anxiety , panic and situational avoidance . They also completed significantly more steps in a st and ardized behavioural walk , during which they experienced significantly less anxiety . The controlled effect sizes for CBT were substantial ( range 1.7 - 2.7 ) , which suggests it may be a particularly efficient way of managing therapeutic exposure to feared situations in panic disorder with agoraphobia . Further research is needed to clarify the mechanism of change involved Cognitive therapy ( CT ) and interoceptive exposure ( IE ) as treatments of panic disorder without agoraphobia were compared in a sample of 69 patients , r and omly allocated to condition . There were no significant differences between treatments as to reductions in panic frequency , daily anxiety levels and a composite question naire score , at posttest after the 12-session treatment , and at both follow-ups ( 4 weeks , 6 months ) . In both conditions , high percentages of patients were panic free at post and follow-up tests ( range 75 - 92 % ) . Although the reduction in idiosyncratic beliefs about the catastrophic nature of bodily sensations was equally strong in both conditions , post-treatment beliefs correlated strongly with symptoms at post and follow-up tests in the CT condition , but not in the IE condition . Reduction of beliefs may be essential in CT , but not in IE . This suggests that the two treatments utilize different change mechanisms Ninety-six female assault victims with chronic posttraumatic stress disorder ( PTSD ) were r and omly assigned to 4 treatment conditions : prolonged exposure ( PE ) , stress inoculation training ( SIT ) , combined treatment ( PE-SIT ) , or wait-list control ( WL ) . Treatment consisted of 9 twice-weekly , individual sessions . Independent evaluations were conducted at pretreatment ; posttreatment ; and 3- , 6- , and 12-month follow-ups . All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other , and these gains were maintained throughout the follow-up period . However , in the intent-to-treat sample , PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity , depression , and anxiety . SIT and PE-SIT did not differ significantly from each other on any outcome measure Compared the effectiveness of cognitive therapy and performance-based exposure as treatments for panic attacks . Subjects were 48 panicky individuals selected without regard to agoraphobic disability , and who varied widely in that respect . Subjects were assigned r and omly to either cognitive treatment , performance-based exposure treatment , a combined cognitive/performance treatment , or a no-treatment control condition . All three treatments led to marked and enduring improvements in panic , and did not differ from one another in effectiveness , whereas the control condition produced little benefit . However , on several measures of phobia and panic-related cognitions , performance exposure was significantly more effective than cognitive therapy . Degree of agoraphobic disability had a significant bearing on panic treatment effectiveness . Whereas 94 % of the low agoraphobia Ss were free of panic after treatment , only 52 % of the high agoraphobia Ss became panic-free . The findings suggest that when panic treatment research excludes people with serious phobias , as it has routinely done in recent years , an overly positive estimate of panic treatment effectiveness can result Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder ( OCD ) and contemporary cognitive treatments . The current study investigated the 2-year follow-up results for participants who completed r and omized trials of group or individual treatment  and received either cognitive therapy ( CT ) or exposure plus response prevention ( ERP ) .  Yale-Brown Obsessive Compulsive Scale ( YBOCS ) scores for individual ERP and CT were not significantly different over 2 years . However , YBOCS scores were consistently lower over time for group ERP participants than for group CT participants . With a single exception in the group treatment study , secondary cognitive and de 
    Output:
    
Conclusions On the basis of extant literature , there appears to be no evidence of differential efficacy between cognitive therapy and exposure in PD , PTSD and OCD and strong evidence of superior efficacy of cognitive therapy in social