Cognitive Behaviour Therapy最新文献

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.

Excoriation, or skin picking disorder (SPD), is a common and impairing condition, yet many individuals face barriers to accessing evidence-based care. Digital interventions offer a scalable option, but few have been evaluated in real-world settings. This study examined naturalistic outcomes among 2063 adult users of StopPicking, a self-guided online intervention for SPD. The program includes three modules: Module 1 focuses on self-monitoring and assessment, Module 2 delivers personalized behavioral strategies, and Module 3 supports maintenance and relapse prevention. Symptom severity was assessed at baseline, post-Module 1, and at final program use. Using an intent-to-treat approach, multilevel modeling showed a medium-sized reduction in symptom severity over time (Hedges' g = 0.71). Greater engagement, measured by self-monitoring frequency and number of weeks active in the program, was associated with lower final severity scores. Baseline severity, age of SPD onset, and age group were linked to usage patterns: users with higher severity or earlier onset tended to self-monitor more consistently, while older adults had higher rates of early discontinuation. Findings support StopPicking as a viable self-help option and highlight the importance of promoting meaningful engagement. Results also suggest that self-monitoring may function both as an indicator of engagement and a potential mechanism of change.

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.

Apps can reduce symptoms of depression and anxiety, yet their impact on broader functional outcomes remains less understood. This meta-analysis examined the efficacy of mental health apps for depression and anxiety on quality of life, general wellbeing, and disability outcomes. Twenty-five RCTs were included. Most trials targeted depression (k = 14), while other trials targeted generalized anxiety (k = 3), mixed depression/anxiety (k = 5), social anxiety (k = 2) and panic (k = 1). Small, significant post-test pooled effect sizes were observed for quality of life (n = 17; g = 0.18; 95% CI = 0.07, 0.28; I² = 43%), general wellbeing (n = 14; g = 0.34; 95% CI = 0.18, 0.50; I² = 63%), and disability (n = 3; g = 0.20; 95% CI = 0.03, 0.37; I² = 46%) in favor of apps over controls. Effects remained significant when adjusting for various sources of biases and were primarily applicable to samples with depression. Meta-regression showed that the effect size of primary symptoms was related to the effect size for quality of life. At follow-up, the pooled effect size for wellbeing nearly doubled (n = 10; g = 0.57; 95% CI = 0.39, 0.74; I² = 56%), but became non-significant for quality of life (n = 7; g = 0.08; 95% CI = -0.08, 0.25; I² = 65%). Apps designed for depression and anxiety may lead to acute improvements in broader functional outcomes.

Previous research has demonstrated that post-traumatic stress disorder (PTSD) symptoms and exposure to potentially morally injurious events (PMIEs) frequently co-occur in military veterans and share similar adverse mental and behavioral health outcomes. While studies have established a robust association between PTSD and dissociative symptoms in veterans, evidence supporting a direct link between exposure to PMIEs and dissociative symptoms has largely been anecdotal. In this cross-sectional study, a volunteer sample of 189 Israeli male combat veterans completed validated self-report questionnaires assessing PTSD symptoms, exposure to PMIEs, and dissociative symptoms. The results show cooccurrence of PTSD symptoms and depersonalization and/or derealization symptoms, hereby suggesting the existence of a dissociative subtype of PTSD, characterized by elevated PTSD symptoms alongside persistent or recurrent symptoms of depersonalization and/or derealization. Moreover, PTSD symptoms were found to mediate the relationship between PMIE exposure and dissociative symptoms. Notably, one of the facets of exposure to PMIEs, the commission of moral transgressions, was significantly associated with depersonalization/derealization symptoms, suggesting a dissociative subtype of PMIE exposure. These findings provide empirical support for the trauma model, which conceptualizes dissociative symptoms as resulting from severe trauma, and underscore the importance of offering specialized treatments for veterans who report having committed moral transgressions.