¶ … Cognitive-behavior therapy (CBT) has become the treatment of choice for a wide range of psychological disorders and its efficacy has been demonstrated by numerous quantitative, qualitative and mixed methods studies (Spates & Pagoto, 2010). In order to develop a thorough understanding of CBT and its applications, this paper provides a review of a series of quantitative and qualitative research articles as well as a mixed methods study and a program evaluation. Finally, a summary of the research and important findings concerning CBT and its implications for practitioners are presented in the paper's conclusion. Quantitative research articles

A study by Shafiei and Hoseini (2016) evaluated the use of CBT-based treatment on the coping strategies used by young adults with substance abuse problems who subsequently relapsed. Using a descriptive cross-sectional study, the researchers developed a sample of 70 young adult addicts (aged 18-24 years) who were self-referred to substance abuse treatment centers in Iran (Shafiei & Hoseini, 2016). These researchers used the Adolescence Relapse Coping Questionnaire for their analysis of the respective efficacy of different relapse coping strategies and descriptive statistics were used to analyze the data that resulted (Shafiei & Hoseini, 2016). Based on their analysis, Shafiei and Hoseni (2016) determined the nearly three-quarters (71.2%) of the respondents suffered a total relapse and began substance abusing behaviors.

The coping skills that were employed by the respondents were shown to be effective in helping them overcome this setback and regain some control over their circumstances (Shafiei & Hoseni, 2016). In this regard, Shafiei and Hoseni (2016) conclude that, "Coping cognitive behavioral therapy helps individuals to recognize the difficult situation, avoid them in the right time and apply effective coping mechanisms. Teaching coping skills, changing reinforcement contingencies, and fostering motivation are the some of the basic tasks in this approach" (p. 46). In sum, CBT-based interventions have widespread application notwithstanding cross-cultural differences (Shafiei & Hoseni, 2016).

The overarching objective of a recent study by Zainal and Renwick (2016) was to evaluate the quantitative treatment acceptability and credibility ratings of outpatients in an eating disorder treatment program in at 12 months. Almost all of the 142 adult participants were women (98%) who were recruited during the period June 2010 through November 2012 from four UK-based treatment centers (Zainal & Renwick, 2016). The inclusion criteria for participants were a DSM-IV-TR diagnosis of anorexia nervosa (AN) or eating disorder not otherwise specified AN type (EDNOS-AN),. a body mass index (BMI) below 18.5 kg/m2 as well as having no major mental or physical co-morbidities that required separate treatment and no lower BMI limit provided the participants were otherwise healthy (Zainal & Renwick, 2016).

These researchers used the quantitative data generated by the Eating Disorders Examination (EDE) which is a semi-structured diagnostic interview that produces four subscale scores and the mean of these four subscales provides an overall global score with higher scores reflecting more severe eating disordered psychopathology (Zainal & Renwock, 2016). The EDE has demonstrated reliability and validity and the instruments were completed by trained clinicians and inter-rater reliability was established throughout the data analysis (Zainal & Renwock, 2016).

The credibility and acceptability of two CBT-based treatment programs were evaluated by participants using a visual analog scale based on the following questions: (a) how acceptable did you find the type of treatment you received from your therapist during this study? and 2) to what extent do you feel that the treatment you received has helped you to reduce your eating disorder behaviors?, with responses ranging from "not at all" and "completely unacceptable" to "very much so" and "completely acceptable" for their perception of the treatment program's credibility and acceptability, respectively (Zainal & Renwick, 2016). To help improve the consistent interpretation of these questions, the researcher provided participants with the definition of credibility as being "the reduction of eating disorder behaviors to assess how the treatment has been effective" (Zainal & Renwick, 2016, p. 37).

The results of this study showed that at 12 months post-randomization (i.e., following the completion of both weekly and follow-up treatment sessions), participants who received the Maudsley Anorexia Treatment for Adults (MANTRA) evaluated their treatment significantly higher in both credibility and acceptability compared to participants who received Specialist Supportive...

Based on the analysis of the data, Zainal and Renwick (2016) conclude that the MANTRA treatment can be recommended over the SSCM for the treatment of anorexia nervosa.
The purpose a study by Vannesi and Ninci (2015) was to provide a description concerning the application and interpretation of quantitative data for calculating effect size resulting from CBT interventions. According to Vannesi and Ninci (2015), effect size is a quantitative measure that provides useful estimates concerning the meaningfulness of any changes that are associated with a given intervention. An important point made by these researchers is that, "Determining that a functional relationship exists between the counseling treatment and the outcome variable is recommended prior to calculating an effect size" (p. 403). It is also important to note that in order to improve the validity and generalize the findings of time series data to determine if interventions are the source of the change or due to something else, more than a single patient must be studied (Vannesi & Ninci, 2015). For instance, Vannesi and Ninci point out that, "if a counselor investigates the effect of [CBT] on reported client anxiety, the counselor may begin by taking repeated measures during a baseline period. The counselor will then introduce the treatment and continue data collection" (p. 404). The aggregated time series data then allows clinicians to calculate an effect size, but it will remain unclear whether any change was caused by the CBT intervention or an unknown such as the patient taking medication without disclosing it (Vannesi & Ninci, 2015).

These researchers describes four indices (a) the percent of nonoverlapping data (PND), (b) percent of data exceeding the median (PEM), (c) nonoverlap of all pairs (NAP) and (d) Tau-U, as well as step-by-step guidelines concerning how to use these four indices in clinical settings (Vannesi & Ninci, 2015). The first step involves determining functional relationships, internal validity and experimental control; the second step involves actually calculating the effect size, and the third step is the interpretation of the resulting quantitative data. The authors conclude their study with considerations that must be taken into account when interpreting the data from each of these indices, and recommend graphing the data to identify patterns and including a confidence interval and p value if the results are intended for publication (Vannesi & Ninci, 2015).

Finally, a quantitative analysis by Dorrepaal and Thomaes (2010) identified a total of seven studies that satisfied their inclusion criteria which were treatments that specifically targeted child abuse-related post traumatic stress disorder (PTSD) or complex PTSD. These seven studies were then meta-analyzed based on effect size, drop-out, recovery, and improvement rates. Six of the selected studies involved CBT-based treatments while the seventh involved person centered therapy approach. The results of this study showed that subjects suffering from child abuse-related PTSD experienced modest recovery and improvement rates using exposure treatments but no such comparable outcomes were achieved for the child-abuse related complex PTSD (Dorrespaal & Thomaes, 2010). In addition, these researchers also concluded that, "Limited evidence suggests that predominantly CBT treatments are effective, but do not suffice to achieve satisfactory end states, especially in complex PTSD populations" (Dorrespaal & Thomaes, 2010, p. 37). Based on their results, Dorrespaal and Thomaes (2010) recommend additional research that examines the direct comparisons between types of treatment for patients with complex PTSD in order to improve the generalizability of these results.

Qualitative research articles

The purpose of a study by Hendry and Solman (2010) was to provide a qualitative analysis of women's perceptions of barriers to and facilitators of physical activity based on different interventions, including CBT. According to Hendry and Solman (2010), the research to date indicates that women who suffer from panic disorder report experiencing less depression when they are treated with CBT in combination with a home-based walking program compared to those who received CBT only. Using this research as their background, Hendry and Solman (2010) report the results of a case study design and semi-structured interviews to investigate perceived facilitators and barriers to physical activity among three African-American and 17 European-American middle-aged women living in Louisiana who were self-referred for physical fitness purposes. Most of the women were college educated and all were regarded as upper middle class (Hendry & Solman, 2010).

The results of this qualitative analysis identified three main themes: (a) negotiations of ideal weight with the conventional medical establishment; (b) perceptions of menopause as causing hormone deficiencies thereby functioning as a barrier to exercise; and (c) negotiations of the socially imposed self in relation to cultural…