Cognitive Behaviour Therapy最新文献

Mental contamination refers to feelings of dirtiness and/or urges to wash that arise without direct contact with a contaminant. Cognitive models propose that this results from "serious, negative misappraisals of perceived violations". However, the specific violation misappraisals most relevant to mental contamination have yet to be established empirically, in part due to the lack of a comprehensive validated inventory of violation appraisals. Therefore, this study's aim was to develop and validate such a measure. Items for the new Violation Appraisal Measure (VAM) were developed from qualitative interviews, theoretical models, and previous empirical work. An Exploratory Factor Analysis was conducted in a sample of (n = 300) undergraduate participants, which revealed a four-factor structure: Responsibility/Self-Blame, Permanence, Mistrust, and Self-Worth. The VAM showed excellent internal consistency ($\alpha$ = 0.90), good convergent (r = .50 to .64) and adequate divergent (r = -.01 to .46) validity and was predictive of mental contamination symptoms over and above existing related appraisal measures, $\Delta$F(1,289) = 29.35, p < .001, $\Delta$R² = 0.06. A Confirmatory Factor Analysis in a second sample of (n = 300) undergraduate students confirmed strong model fit for the four-factor structure of the VAM. The development of the VAM is an important contribution to the search for empirically based cognitive mechanisms in mental contamination and other violation-related sequelae.

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R² = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

Knowledge about how to enhance group cognitive behavioral therapy (GCBT) outcomes is needed. In a randomized controlled effectiveness trial, we examined group cohesion (the bond between group members) and the alliance (the client-clinician bond) as predictors of GCBT outcomes. The sample was 88 youth (M age 11.7 years, SD = 2.1; 54.5% girls; 90.7% White) with anxiety disorders. Observers rated group cohesion and alliance in 32 sessions from 16 groups. We examined early group cohesion and alliance (r = .50, p < .001) and group cohesion and alliance change from early to late in treatment in relation to outcomes using generalized estimation equations accounting for nesting within groups (ICCs .31 to .55). The outcomes were diagnostic recovery, clinical severity, and parent- and youth-reported anxiety symptoms, each at post-treatment, 12-months, and 4-years follow-up. There were more significant associations with 4-years follow-up than earlier outcomes. Clinical severity and parent-reported anxiety symptoms were more frequently predicted than diagnostic recovery. Clinician- and parent-reported outcomes were far more frequently significantly predicted by cohesion and alliance than youth-rated outcomes. We conclude that group cohesion and alliance are related but distinct variables, both associated with some GCBT outcomes for as long as 4 years after treatment.

Between-session work (BSW) acts as the vehicle to translate skills learnt in therapy sessions into adaptive changes in everyday life, a key goal in Cognitive Behavioural Therapies (CBT). Despite a well-established relationship between engagement with BSW and enhanced treatment outcomes, difficulties completing between-session tasks are common and factors affecting patient engagement with BSW are poorly understood. This mixed-methods systematic review and "best fit" framework synthesis explored predictors of engagement with BSW in CBT-based interventions. Comprehensive searches were conducted across five databases, identifying 59 eligible studies. This combined theory and empirical evidence approach depicted ten predictor themes related to between-session engagement, spanning individual, relational and contextual concepts. While ambiguous findings were generated by existing evidence, several factors emerged as relatively consistent predictors of engagement with BSW: positive patient beliefs regarding BSW and treatment such as perceived helpfulness, and practitioner competency in planning and reviewing BSW, including providing a rationale and addressing difficulties were associated with greater engagement. Conversely, patient in-session resistance, including counter change talk, was an indicator of disengagement between-sessions. The impact of patient symptomology, sociocultural environment, practitioner beliefs and the therapeutic relationship is unclear. The conceptual model presented offers a testable framework for researchers and a guideline for practitioners.

Clinical supervision is considered important in psychotherapy training, but little is known about the efficacy of specific supervision methods. We investigate two such methods (video-based vs. verbal report-based supervision) in a randomized controlled trial. Seventy-three supervisees were trained in common cognitive-behavioral therapy methods (i.e. behavioral activation and cognitive restructuring) by means of written information and a modelling video demonstrating the techniques. Supervisees had to apply the techniques in role plays with standardized patients (presenting depressive patients). Subsequently, supervisees were randomized to supervision, based on the video, or supervision based on the verbal report of the supervisees. Subsequently and after a three-month follow-up period, supervisees had to demonstrate the therapeutic techniques again. Therapist competence, therapeutic alliance, empathy, and anxiety were assessed through various different perspectives (i.e. independent raters, standardized patients, and supervisees' self-evaluation). Both supervision conditions lead to a significant improvement of therapeutic competences, therapeutic alliance, and empathy. No significant differences were found between the two supervision conditions. At three-month follow-up, training effects decreased on all perspectives except standardized patients. A training condition without supervision would be necessary to demonstrate that improvements are specific effects of the supervision conditions. Moreover, further supervision seems necessary to maintain training effects over time.

Black persons who smoke are recognized as a smoking health disparity group and face higher rates of tobacco-related disease and morbidity. These disparities result from, in part, exposure to minority-related stress, which results in lower rates of quit success. Anxiety sensitivity (AS), which refers to the fear of stress, is associated with lower rates of cessation and impedes quit success among Black adults who smoke. The current study evaluated the feasibility, utilization, acceptability, and initial efficacy of a smoking cessation and AS reduction smartphone application for Black adults with elevated AS who smoke (The Mobile Anxiety Sensitivity Program for Smoking [MASP]). Participants (N = 24; 62.50% female; M_age = 47.83 years, SD = 9.32) participated in a 6-week trial of MASP. Retention was 83.33% at the 6-week follow-up and MASP utilization was high, with all features used by most participants. Participants reported that MASP was acceptable and 25% of participants reported 7-day point-prevalence abstinence, demonstrating strong utility and impact potential. Results also indicated a statistically significant reduction in AS from baseline to follow-up (p = .003, Cohen's d=.76). Black persons who smoke with AS may benefit from an accessible, adaptive app with culturally tailored treatment that addressed AS in the context of smoking cessation.

A minority of bereaved adults experiences prolonged grief disorder, depression, and/or posttraumatic stress disorder, with heightened risks observed among bereaved parents. Cognitive-behavioural therapies, both face-to-face and online, have demonstrated efficacy in treating post-loss mental health problems. Mobile phone applications potentially offer an efficient and cost-effective way to deliver self-help to bereaved adults, yet controlled effectiveness studies are lacking. Therefore, we examined the short-term efficacy of the My Grief app, based on cognitive-behavioural therapy, in 248 bereaved parents, in a randomised controlled trial (Clinicaltrials.gov, identifier: NCT04552717). Participants were randomly allocated to access to the My Grief app (n = 126) or a waitlist (n = 122). At baseline and post-assessment, symptoms of prolonged grief, posttraumatic stress, and depression, negative grief cognitions, rumination, and avoidance were assessed. Reductions in prolonged grief and posttraumatic stress symptoms and negative cognitions in the intervention group were larger than in the control group, albeit with small effect sizes. Fifteen app users reported negative experiences with the app; for example, some mentioned that it elicited painful memories and emotions related to their loss. My Grief appears to achieve modest improvements in mental health in bereaved parents. Given that it is accessible and low-cost, it is an important addition to the suite of prolonged grief interventions.

Mental health disorders are particularly prevalent among public safety personnel (PSP). Emotional Resilience Skills Training (ERST) is a cognitive behavioural training program for PSP based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (i.e. Unified Protocol). The current study was designed to assess whether ERST is associated with reduced putative risk factors for mental disorders and increased individual resilience. The PSP-PTSI Study used a longitudinal prospective sequential experimental cohort design that engaged each participant for approximately 16 months. PSP from diverse sectors (i.e. firefighters, municipal police, paramedics, public safety communicators) completed self-report measures of several putative risk variables (i.e. anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, state anger) and resilience at three time points: pre-training (n = 191), post-training (n = 103), and 1-year follow-up (n = 41). Participant scores were statistically compared across time points. Participants reported statistically significantly lower scores on all putative risk variables except pain anxiety, and statistically significantly higher resilience from pre- to post-training. Changes were sustained at 1-year follow-up. The results indicate that ERST is associated with reductions in several putative risk variables and improvement in resilience among PSP.

The goal of this study was to understand how mindful awareness, acceptance, and values-consistent action change across acceptance-based behavioral therapy (ABBT) for generalized anxiety disorder (GAD) and determine their effect on symptoms. We examined weekly data from 31 individuals who received ABBT as part of a randomized control trial for individuals with GAD (Hayes-Skelton, Roemer, & Orsillo, 2013). Participants answered questions weekly about three components of ABBT, including the percentages of time they spent over their past week: 1) aware of the present moment, 2) accepting of their internal experiences, and 3) engaging in values. GAD symptoms were examined using two self-report measures (DASS-21 Stress subscale and PSWQ) and two clinician-rated interview measures (CSR and SIGH-A) at pre- and post-treatment.¹ Mindful awareness, acceptance, and values-consistent action increased linearly across ABBT. All three change trajectories were positively correlated (Z's 2.99 to 8.74, p's < .001). Mindful awareness, acceptance, and values-consistent action across treatment predicted decreases in GAD symptoms above and beyond baseline for most outcome measures (Z's -1.95 to -3.03, p's < .05), with the exception that mindfulness did not predict DASS-stress (Z = -1.39, p = .17). These findings are consistent with the structure and model of ABBT.

Panic disorder is costly, and while evidence-based interventions for panic disorder are effective, obtaining a diagnosis often precludes access to such treatments. This is problematic because the categorical diagnosis of panic disorder (i.e. "you have it, or you don't") supported by modern diagnostic manuals contradicts empirically supported dimensional models of panic disorder. Taxometric analyses, which test the dimensional or categorical latent structure of constructs, have consistently revealed dimensional latent structures when applied to other anxiety disorders and panic-related processes, but taxometric analyses have never been applied to panic disorder. To address this gap in the literature, three nonredundant taxometric procedures were applied to seven theoretically-relevant indicators of panic disorder derived from Panic Disorder Severity Scale data collected from 663 participants recruited via Amazon Mechanical Turk. Simulated comparison plots and objective fit indices were also evaluated. The collective results provided consistent empirical support for a dimensional model of panic disorder, with an overall mean CCFI score of .39. The implications of the present findings for the measurement, assessment, diagnosis, and treatment of panic disorder are discussed.