Cognitive Behaviour Therapy最新文献

Internalizing disorders are common in lesbian, gay, bisexual, transgender, queer, questioning, and otherwise non-heterosexual or non-cisgender (LGBTQ+) people. Few studies have evaluated the efficacy of cognitive behavior therapy (CBT), a well-established treatment for internalizing disorders, in LGBTQ+ people. The current study quantitatively synthesized outcomes from existing trials of CBT for internalizing disorders in LGBTQ+ people. Seven databases were searched, identifying 14 relevant studies with a total of 414 participants. A medium within-group effect size was found for depressive symptoms from pre-treatment to post-treatment (k = 14; g = 0.60; 95% CI: 0.44-0.76; I² = 71.59) and pre-treatment to 2-6-month follow-up (k = 7; g = 0.63; 95% CI: 0.40-0.86; I² = 71.59). For anxiety and related disorder symptoms, a medium within-group effect size was found from both pre-treatment to post-treatment (k = 10; g = 0.73; 95% CI: 0.47-0.99; I² = 71.59) and to 3-9-month follow-up (k = 5; g = 0.70; 95% CI: 0.54-0.87; I² = 36.04). Exploratory analyses indicated small between-group effects at post-treatment between intervention and control groups. Effect sizes were comparable to those in the general population, indicating preliminary support for treating internalizing disorders in LGBTQ+ people with CBT.

Qualitative investigations that openly explore changes and facilitators of changes from the patient's perspective might offer valuable insights on impacts of therapy and helpful and hindering aspects. Our aim for this study was to explore the perspective of patients on a transdiagnostic Internet-based intervention to understand (1) which changes (positive as well as negative effects) responders and non-responders experienced, and (2) which aspects of the intervention they found helpful or hindering in facilitating those changes. We interviewed 21 patients that showed response or non-response to treatment using the Change Interview Schedule following a 10-week Internet-based intervention based on the Unified Protocol. Interviews were analyzed using qualitative content analysis. Both responders and non-responders reported positive changes, with few negative changes mentioned. Across both groups, increased positive affect was reported most frequently (81%). Both groups reported helpful factors, with guidance mentioned most frequently across both responders and non-responders (85.7%). Mainly, aspects of the specific framework were perceived as hindering (e.g. lack of personalization) (66.7%). Overall, patients reported mostly positive impacts, even if they did not respond to treatment. Results highlighted that what patients find helpful or hindering is individual.

The Bergen Four Day Treatment (B4DT) is a concentrated treatment for OCD that has demonstrated promising effectiveness in Nordic country samples. The B4DT is delivered over four days and provides individual treatment in a group context. The effectiveness of the B4DT for OCD has not been tested outside Nordic countries. The current pilot study evaluated the feasibility and the potential effectiveness of B4DT in a different culture and health-care system in the United States. Findings from 48 adults with OCD who completed the B4DT indicated that OCD, anxiety, and depression symptom severity significantly decreased from pre- to post-treatment, and gains were maintained at six month follow-up. The Yale-Brown Obsessive Compulsive Scale scores were reduced from moderate to subclinical; specifically, the average scores of 27.0 (pre-treatment) fell to 11.7 (post-treatment), 12.7 (3-month follow-up), and 13.7 (6-month follow-up). The B4DT was rated as highly acceptable by the US patients. Over 95% of the patients stated that they would recommend the treatment to a friend. These findings provide the first preliminary evidence for the generalizability of the B4DT to patients outside Nordic countries. Cultural and context-dependent issues that affected this dissemination pilot study are discussed in addition to future clinical and research directions.

Metacognitive interventions have received increasing interest the last decade and there is a need to synthesize the evidence of these type of interventions. The current study is an updated systematic review and meta-analysis where we investigated the efficacy of metacognitive interventions for adults with psychiatric disorders. We included randomized controlled trials that investigated either metacognitive therapy (MCT; developed by Wells) or metacognitive training (MCTraining; developed by Moritz). Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until May 2024. The final analyses included 21 MCT- and 28 MCTraining studies (in total 3239 individuals). Results showed that MCT was more efficacious than both waiting-list control conditions (g = 1.84) as well as other forms of cognitive behavior therapies (g = 0.43). MCTraining was superior to treatment as usual (g = 0.45), other psychological treatments (g = 0.46) and placebo conditions (g = 0.15). Many of the included studies lacked data on blinding procedures, reporting of inter-rater reliability, treatment adherence, competence, treatment expectancy and pre-registration procedures. We conclude that both MCT and MCTraining are probably efficacious treatments but that future studies need to incorporate more quality aspects in their trial designs.

Researchers and clinicians are becoming increasingly aware of the importance of assessing positive functioning to inform clinical outcomes. This paper evaluates the Questionnaire on Well-Being (QWB, available for free https://doi.org/10.17605/OSF.IO/GSC3R), a clinically informed instrument that assesses subjective well-being, across two studies. Study One, consisting of treatment-seeking individuals in an assertiveness training sample (n = 495), explored the factorial structure of the QWB, assessed the four-week test-retest reliability, criterion-related validity, and identified a preliminary cutoff point for the QWB with clinical significance. Study Two, including participants from the general public (n = 1561), confirmed the factorial structure of the QWB and further evaluated criterion-related validity. The results provided support for a unidimensional structure for the QWB. Furthermore, the QWB exhibited excellent internal reliability (Cronbach's alpha = 0.93 and 0.94 in Study One and Two, respectively), high test-retest reliability (ICC₃ = .50 at a four-week follow-up in Study One), and appropriate criterion-related validity demonstrating positive correlations with positive affect and negative correlations with psychopathology. Finally, a cutoff point on the QWB below 50 was associated with marked psychopathology. These findings provide preliminary support for the usage of the QWB in clinical and non-clinical settings, establishing the QWB as a reliable indicator of subjective well-being.

The Mini Social Phobia Inventory (Mini-SPIN) is a short 3-item measure of social anxiety disorder (SAD). Using existing data, the current study examined the psychometric properties of the Mini-SPIN using a large, treatment seeking sample of children aged 6-16 years with data available for youth (n = 695, 170) and their caregivers (n = 703, 177) at pre-treatment and follow-up, respectively. The ability of the Mini-SPIN to discriminate between those with and without SAD was examined at pre-treatment and 6-month follow-up, across caregiver and child report. The criterion group validity, internal consistency and construct validity of the measure was also examined. Results revealed that at pre-treatment the Mini-SPIN demonstrated good discriminant validity in detecting cases of SAD from non-SAD (with cut-off of 4 on child report, and 6 on caregiver report). At 6-month follow-up, the discriminant ability of the Mini-SPIN was found to be less than acceptable for child reported scores, but acceptable for caregiver reported scores. The Mini-SPIN further demonstrated good criterion group validity, internal consistency and construct validity across caregiver and child report. Overall, the findings from the current study lend further support for the use of the Mini-SPIN as a screening tool for SAD.

The network approach to psychopathology postulates that it is more helpful to think of psychiatric problems to be caused by each other, rather than by underlying diseases. Personalized networks can be created using questionnaires asking participants about their perceptions of the causal links between symptoms, which is time-efficient but has shown low test-retest reliability. The present study explores whether perceptions of causal links can instead be assessed using interviews. The study investigates the feasibility, acceptability and test-retest reliability of such an interview format. 21 adolescents were interviewed twice within one week. Results showed an average test-retest reliability for node centrality of r_s = .703 (SD = .148), and for causal links r_s = .533 (SD = .198). A majority of participating adolescents rated the interview as easy to understand. On a group level, the node both most central and frequent was negative emotions. Future studies should evaluate the clinical utility of networks created in interviews, both in terms of face-validity and to guide clinicians in treatment choices.

Perfectionism is a transdiagnostic process associated with multiple mental health disorders. Perfectionism can moderate the effectiveness of Cognitive Behavioural Therapy (CBT) for depression, but it remains unclear whether perfectionism is associated with CBT outcomes for anxiety disorders. This study investigated the relationship between perfectionism, treatment outcomes and adherence for individuals seeking internet-based CBT (iCBT) for Generalised Anxiety Disorder (GAD). A total of 1,904 adults from the general Australian community commenced an iCBT GAD program and completed measures of perfectionism, generalised anxiety, depression and psychological distress at baseline, mid-treatment, and post-treatment. Regression analyses were used to examine relationships between baseline perfectionism, post-treatment symptom reductions and treatment completion. Baseline perfectionism was significantly associated with pre-treatment GAD symptom severity, but not treatment completion or reductions in GAD severity post-iCBT. Significant reductions in generalised anxiety symptom severity (Hedges' g = 1.32), depression symptoms (g = 0.97), distress (g = 1.34) and perfectionism (both striving and evaluative concerns, g = 0.49 and g = 0.37, respectively) were observed with treatment. These findings suggest that iCBT for GAD is effective in reducing perfectionism, despite not directly targeting this process. Given there was no significant relationship between baseline perfectionism and treatment outcomes, it may not be necessary to specifically target perfectionism when delivering iCBT for GAD.

While most psychotherapy methods are about equally effective, it is unclear if (1) different methods of psychotherapy differ in the severity of negative effects, (2) negative effects impact outcome and (3) this impact is moderated by psychotherapy method. We analyzed data from an observational study of 141 patients from a day treatment program for depression. Based on shared decision-making, patients were treated with either Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Metacognitive Therapy (MCT). Negative effects were assessed with the Negative Effects Questionnaire (NEQ), severity of depressive symptoms with the Quick Inventory of Depressive Symptomatology (QIDS-SR). Treatment groups were propensity score matched to account for baseline differences. Severity of negative effects did not differ between CBASP and MCT. The association between negative effects and outcome was moderated by treatment method. For patients treated with CBASP, negative effects were associated with outcome: those experiencing the lowest severity of negative effects had the greatest improvement in symptoms during treatment. Treatments were equally tolerated but differed in their association between negative effects and outcome. Results need to be considered with caution due to the considerable drop-out rate during the follow-up period and the non-controlled nature of our study.