Cognitive Behaviour Therapy最新文献

Practice assignments (i.e. homework) are a key component in cognitive behavioral therapies that predict treatment outcomes for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) separately. However, research has not explored these variables among individuals with comorbid PTSD and MDD. This study evaluated whether practice assignment adherence and helpfulness predicted PTSD (Clinician-Administered PTSD Scale for DSM-5; CAPS-5) and MDD (Montgomery-Åsberg Depression Rating Scale; MADRS) outcomes at posttreatment and 3-month follow-up. Data were derived from a randomized clinical trial comparing cognitive processing therapy (CPT) and behavioral activation-enhanced CPT (BA+CPT) among 83 U.S. active duty service members with comorbid PTSD and MDD. Participants reported greater assignment adherence in BA+CPT than CPT (p = .008), primarily due to higher adherence to BA assignments within BA+CPT. Multilevel models indicated helpfulness ratings were significantly related to decreased CAPS-5 scores (p = .044) but not MADRS scores (p = .074); service members with the highest helpfulness ratings achieved the best outcomes. Adherence was not significantly related to CAPS-5 (p = .494) or MADRS (p = .114) outcomes. Findings provide clinical insights regarding compliance in integrated treatments and highlight the value in assessing helpfulness of practice assignments during treatment.

Cognitive-behavioral therapy (CBT) patients with minoritized racial/ethnic backgrounds report similar outcomes as White patients but may report weaker alliances and less frequent CBT skill use. Given its transdiagnostic utility, we tested how racial/ethnic background impacted treatment outcomes, the alliance, and therapy skill use in the Unified Protocol (UP). Participants (N = 70, M_age = 33.7, 67% female, 74% White) with emotional disorders completed six sessions of core UP modules. Participants rated their past-week anxiety, depression, and skill use before each session and the strength of the alliance after each session. We tested whether racial/ethnic background moderated the slopes of symptom change, alliance, and skill use. White patients reported marginally steeper reductions in anxiety than patients with minoritized identities, B = .27, p = .08, but similar improvements in depression and overall alliance, ps > .10. However, White patients reported steeper increases in agreement on the tasks of therapy, B = -.31, p = .047, and skill use, B = .36, p = .02. Patients with minoritized identities may achieve similar reductions in anxiety and depression as White patients despite smaller increases in therapy task agreement and skill use. Clinicians working with patients with minoritized identities may prioritize these two constructs.

Although CBT has been found to be effective in the treatment of eating disorders, it is not clear if there are differences between treatment formats. We conducted a network meta-analysis (NMA) of randomized trials of broadly defined CBT comparing individual, group, guided self-help (GSH) and unguided self-help (USH) with each other or with a control condition. The NMA used a frequentist graph-theoretical approach and included 36 trials (53 comparisons; 3,136 participants). Only one trial was aimed at anorexia nervosa. All formats resulted in large, significant effects when compared to waitlists, with no significant difference between formats (group: g = 1.08, 95% CI: 0.84; 1.31; GSH: g = 0.94, 95% CI: 0.75; 1.13; individual: g = 1.06, 95% CI: 0.77; 1.36; USH: g = 0.62, 95% CI: 0.30; 0.93). No significant difference was found between any format and care-as-usual. Analyses limited to binge eating disorder supported the effects of individual, group and GSH formats, with no significant differences between them. Few trials with low risk of bias were available. CBT for eating disorders can probably be delivered effectively in any format, without significant differences between the formats. These results should be considered with caution because of the non-significant differences when compared to care-as-usual and the considerable risk of bias.

First responders are repeatedly exposed to trauma in the course of their work, increasing their vulnerability to posttraumatic stress disorder (PTSD). Efforts to reduce the risk of PTSD could focus on individual factors that increase the risk for PTSD. Although many of these factors are immutable, others, such as high anxiety sensitivity (AS), can theoretically be targeted and fortified through intervention. The current study investigated the effectiveness of a brief (single session) cognitive behavioural therapy for AS intervention vs. a waitlist control in reducing AS, and subsequently mitigating PTSD and related mental health symptoms. Participants were 179 first responders from eight workplaces in Canada. The intervention was delivered remotely to these workplaces in a group format. Workplaces were randomly assigned to the intervention or waitlist control. Participants completed a self-report questionnaire pre-intervention, one-week post-intervention, and 8 months later (and at comparable time points in the control condition). Hierarchical linear regressions revealed that intervention conditions did not predict (a) AS during one-week follow-up or (b) PTSD and related symptoms during eight-month follow-up. Theoretical and clinical implications, including recommendations specific to interventions involving first responders, are discussed in detail.

Many veterans do not initiate trauma-focused evidence-based psychotherapy (TF-EBP) to treat posttraumatic stress disorder (PTSD). Instead, veterans receive other treatments prior to TF-EBP and the process of transitioning to TF-EBP is poorly understood. The goal of the current study was to understand clinicians' beliefs about and approaches to transitioning veterans into TF-EBP. Clinicians (n = 20) with any experience providing TF-EBP from across the national VA healthcare system participated in semi-structured qualitative interviews. Rapid qualitative analysis procedures were used to identify themes: (1) TF-EBP is rarely contraindicated; (2) there is no consensus on treatment alternatives after veterans decline TF-EBP; (3) unstructured therapy can be a barrier to TF-EBP; (4) data from non-TF-EBP can be used to encourage TF-EBP engagement; (5) veterans are poorly informed about PTSD referrals; (6) culturally responsive PTSD care involves asking questions throughout the treatment process; (7) TF-EBP was delivered with attention to how identity may impact treatment; (8) TF-EBP was among the first treatment option offered by all clinicians; (9) veterans initiate TF-EBP when willing; and (10) clinicians developed resources socialize veterans to structured treatment. Since non-TF-EBP approaches may be indicated (or requested) for some veterans, strategies to facilitate transitions to TF-EBP are needed.

The Visual Social Anxiety Scale (VSAS) is a novel picture-based self-report measure of social anxiety that shown promising psychometric properties among non-selected participants. The present study aimed to validate the VSAS among individuals with clinically diagnosed social anxiety disorder (SAD) and establish clinical cutoff scores. One-hundred-and-three adults with SAD completed the VSAS with a battery of additional self-report measures of social anxiety, depression, and general anxiety. Internal consistency, convergent and discriminant validities, were assessed. Clinical cutoff scores were established via a Receiver Operating Characteristics (ROC) analysis using a control group of individuals without any past or present psychopathology (n = 34). An Exploratory Factor Analysis (EFA) was performed to explore underlying thematic factors. The VSAS exhibited high internal consistency and adequate convergent and discriminant validities. The ROC analysis showed the area under the curve to be 0.95 and yielded an optimal cutoff score of 23.40, providing high accuracy (0.90), sensitivity (0.89), and specificity (0.91) for distinguishing SAD from non-SAD individuals. The EFA revealed a 3-factor structure representing the following themes: social interpersonal situations, formal interpersonal situations, and being the center of attention. The psychometric properties of the VSAS support its utility in assessing and identifying individuals with clinical SAD.

Intolerance of uncertainty (IU) is a risk factor for posttraumatic stress symptoms (PTSS) following trauma, and attentional biases for uncertainty stimuli (ABU) may be as well. Evidence suggests that better attentional control protects individuals who are vulnerable to several forms of psychopathology from developing such pathology. However, to our knowledge, the potential buffering effect of attentional control in relations between IU, ABU, and PTSS has yet to be examined. In the present study, 125 trauma-exposed undergraduate participants completed a battery of self-report measures and an eye-tracking visual-search task to assess ABU. The sample was primarily White (88.80%) and female (83.2%) with an average age of 19.70 years (SD = 2.60). A series of hierarchical regressions demonstrated that elevated IU and difficulties disengaging from uncertainty stimuli were associated with higher PTSS, but only among participants with lower scores on a measure of attentional control. For participants with relatively better attentional control, the associations between IU, ABU, and PTSS were non-significant. The non-clinical nature and relative homogeny of the current sample may limit generalizability of results, which warrant replication. Attentional control may protect trauma-exposed individuals from the negative effects of IU and ABU on PTSS.

Anorexia nervosa is commonly treated using outpatient cognitive-behavioural therapy (CBT), but its effectiveness needs to be established. This systematic review and meta-analysis (PROSPERO CRD42023484924) assessed outpatient CBT's effectiveness for anorexia nervosa and explored potential moderators (pre-treatment Body Mass Index (BMI), age, illness duration, protocol duration of therapy, dropout). Searches (SCOPUS, PsycINFO, MEDLINE, grey literature) identified 26 studies reporting pre- to post-treatment outcomes for at least one primary measure (weight, eating disorder symptoms). Studies were medium to high quality. Secondary outcome data (depression, anxiety, quality of life) were also extracted. Meta-analyses (26 studies) found medium to large post-treatment effect sizes for weight (g = 0.87; 95% CI 0.67-1.08) and eating disorder symptoms (g = -0.74; 95% CI -0.93 - -0.54), with change starting early and increasing to follow-up. Effect sizes for secondary outcome measures were medium to large. Pre-treatment BMI moderated weight gain. This review was constrained by excluding non-English language papers and the limited number of papers reporting minimum data for inclusion. Overall, results suggest an optimistic picture for patients with anorexia nervosa treated with outpatient CBT. Clinicians can expect good outcomes using CBT, regardless of patients' starting weight, age, or illness duration.

Social Anxiety Disorder (SAD) is associated with significant interpersonal difficulties, yet little is known about how individuals with SAD experience sexual interactions. The current study examined the emotional consequences of sexual interactions among individuals with and without SAD, using a 21-day daily diary design. Participants were 108 single young adults (54 with SAD; 54 without), all of whom were not in a romantic relationship. Participants reported daily on their sexual interactions and emotional experiences. We found no significant differences in the number of sexual interactions between individuals with and without SAD as well as when social anxiety was examined as a continuum of severity. However, for individuals without SAD, sexual interactions were followed by higher levels positive emotions, whereas for individuals with SAD, no such emotional benefit was observed (and this remained when examining social anxiety as a continuum of severity). Finally, we found differences in the experience of negative emotions following sex between individuals with and without SAD, but those were not found when social anxiety was examined as a continuum. Implications for research and treatment of SAD are discussed.