Cognitive Behaviour Therapy最新文献

This study investigates the feasibility and preliminary evidence for the efficacy of a single-session online metacognitive training (MCT-ED) among a population considered to be at-risk of developing an eating disorder. A total of N = 95 participants with high weight concerns were randomised to an MCT-ED condition (n = 43) or a waitlist control condition (n = 52). Participants completed measures of body image flexibility, perfectionism, weight and shape concerns and mood at baseline, post-treatment (one-week post-baseline), and 3-months post-treatment. The MCT-ED intervention consisted of content targeting cognitive flexibility and perfectionism. Treatment completion for MCT-ED was 93.62%, indicating that the intervention was feasible and acceptable. Participants also provided positive ratings on a feedback questionnaire indicating preliminary feasibility. At 1-week post-treatment, relative to the waitlist condition, the MCT-ED group had significantly lower personal standards (d = 0.64) and experienced a significantly greater decrease in concern over mistakes (d = 0.57). These improvements were not sustained at 3-month follow-up. Findings suggested that MCT-ED is a feasible brief intervention format for those with elevated weight concerns, but more research is required to produce longer, more meaningful effects that may impact weight and shape concerns.

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.

Negative posttraumatic cognitions (NPCs) and cognitive emotion regulation (CER) strategies have both been proposed as predictors of change in evidence-based cognitive behavioral therapies for posttraumatic stress disorder (PTSD). However, they are rarely studied simultaneously, with only one study examining these predictors in a randomized clinical trial of prolonged exposure therapy. It remains to be tested how these variables predict improvements in PTSD severity in real world clinical settings or different delivery formats. Data from 487 military service members and veterans that participated in a 2-week nonrandomized, uncontrolled cognitive processing therapy-based intensive treatment program (ITP) for PTSD were used to evaluate NPCs and CER strategies as predictors of improvements in PTSD severity. Results showed that, in a model with both predictors, decreases in self-focused NPCs, world-focused NPCs, and catastrophizing (CER strategy) were associated with reductions in PTSD severity during treatment and at follow-up. However, these effects were small (R² ranging from .005 to.04) relative to reductions in depression severity (R2 = .40). Although NPCs and CER strategies significantly predicted reductions in PTSD severity, their overall impact was relatively small in this nonrandomized, uncontrolled ITP. Future research should continue to investigate these and other predictors in a variety of treatment settings.

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.

Three decades of research indicate that intolerance of uncertainty (IU) plays a role in the maintenance of mental health conditions. In particular, the relationship between IU and worry is especially strong. The current study aimed to conduct a partial examination of the Intolerance of Uncertainty Model (IUM) of GAD as well as the Transdiagnostic Model of Intolerance of Uncertainty (TMIU), in a clinical sample of adults with GAD using path analysis. Participants with a primary diagnosis of GAD (N = 112) completed a range of measures that assessed IU, cognitive avoidance (CA), positive beliefs about worry (PBW), threat estimates, worry, and anxiety, with two path analysis models constructed for the IUM and TMIU. In a preliminary analysis of the IUM, path analysis found that CA and PBW did not have an indirect effect the relationship between IU and worry, however, CA (and not PBW) had an indirect effect on the relationship between IU and anxiety. For the TMIU, the first model demonstrated a poor fit. In an alternative model, threat estimates were found to indirect effect the relationship between IU and worry as well as anxiety. This suggests that threat appraisals do play a role in the relationship between IU, worry and anxiety in individuals with GAD.

With the rising number of dementia cases, supporting family caregivers to maintain their well-being is crucial. Acceptance and Commitment Therapy (ACT) shows promise in promoting psychological flexibility and positive behaviour change. However, it is still developing in caregiving contexts. This study evaluated the preliminary efficacy of a fully online ACT intervention for caregivers of people with dementia. This study employed a pre-post design with two follow-up assessments at 3 and 6 months. A 9-week web-based self-help ACT program, including individual goal setting prior to the intervention, and minimal contact motivational coaching, was provided to 30 family caregivers in the Netherlands. Linear mixed-effect models based on a complete-case analysis showed significant changes in depressive symptoms (mean difference: -3.34, d = -0.78). Significant and sustained improvements were observed in stress (mean difference: -6, d = -1.13) and anxiety (mean difference: -5.55, d = -1.38), both of which were clinically significant. Sense of competence increased (mean difference: 1.1, d = 0.45). ACT-specific measures, including psychological flexibility, engaged living, and inflexibility, also showed significant improvements with medium-to-large effect sizes. This online intervention demonstrated promising preliminary evidence of ACT's potential efficacy on caregivers' well-being, warranting further research in larger-scale controlled trials.

Loneliness has detrimental effects on physical and mental well-being, making relevant any systematic means of inhibiting its impact. Whereas interventions based on cognitive behavior therapies have shown efficacy, interventions based on Ellis's rational emotive behavior therapy (REBT) have not been systematically assessed. In 2019, Hyland et al. demonstrated that the REBT theoretic principles of psychopathology and psychological health significantly predict loneliness scores, providing an empirical justification for later intervention efforts. The Hyland et al. sample was small, with limited demographic and geographic diversity. This paper replicates the Hyland et al. analyses using a larger (N = 3,064) sample drawn from the United States, United Kingdom, Canada, Australia, and South Africa. The present results replicate Hyland et al.'s results for both the psychopathology and psychological health models, with minimal variation in model fit from country to country. Implications for the development of an REBT-based intervention to treat loneliness are discussed.

Low-intensity interventions, designed as accessible, scalable, and cost-effective, are increasingly adopted globally to address common mental health problems. Typically, based on Cognitive Behavioural Therapy (CBT), low-intensity interventions emphasise patient self-management techniques, practiced outside of sessions as between-session work (BSW). Although crucial for symptom improvement, task completion remains a challenge, and research on predictors of BSW engagement in low-intensity contexts is limited. This qualitative study employed interpretive description methodology and framework analysis to interview 24 patients from UK NHS Talking Therapies services, exploring barriers and facilitators to between-session engagement in low-intensity CBT-based interventions. Themes constructed emphasised the importance of prioritising BSW, where between-session activities are endorsed during sessions to cultivate favourable patient attitudes. Specific, tailored task planning, continuous practitioner review and proactive responses to non-completion were key to secure engagement. External support from patients' social networks also reinforced engagement and mitigated barriers such as time constraints. Findings highlight the need for targeted provider training to ensure consistent application of engagement-enhancing techniques, as well as adjustments to intervention delivery to better incorporate patient preferences and leverage social support. This study provides critical insights and actionable guidance that can enhance the global delivery and effectiveness of low-intensity interventions.

Major depressive disorder (MDD) is a leading contributor to disease burden. Although research shows that patients with MDD generally prefer psychotherapy, less than half achieve remission after psychotherapy. This highlights the need to understand which factors improve psychotherapy effectiveness for MDD. Therefore, this study explores the association between treatment integrity, defined by adherence to and competence in cognitive behavioural therapy (CBT), and treatment outcome for MDD within a pragmatic randomized controlled (non-inferiority) trial comparing CBT and short-term psychodynamic supportive psychotherapy (SPSP). Out of 77 cases (50% of the included CBT cases), two sessions per case (one from each half of treatment) were randomly selected and rated by two independent raters for adherence and competence using the Cognitive Therapy Adherence and Competence Scale (CTACS). Results showed competence, but not adherence, to be significantly associated with treatment outcome with a small effect size (ƒ² = 0.059) similar to common factors such as goal consensus. Therapist competence in applying CBT appeared to be more important for treatment outcome than adherence to protocol. Prioritizing training therapists' skills in applying CBT-specific techniques over adherence to protocol could possibly enhance treatment outcomes in the future. Additional research to further unravel the treatment integrity-outcome relation is suggested.