Cognitive Behaviour Therapy最新文献

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.

A systematic review and meta-analysis was conducted of different types of CBTs for ID in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until January 2025. The effectiveness of CBT, methodological quality, and moderators of treatment outcomes were examined and benchmarked by meta-analytically comparing them with efficacy studies for ID. Thirty-two studies were included, comprising 5231 participants. Very large within-group effect sizes (ES; Hedges' g) were obtained for ID-severity at post-treatment (1.87), and follow-up (1.68), on average 12 months post-treatment. Remission rates were 45% post-treatment and 51% at follow-up. Attrition rate was 13.9%. Risk of bias was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies (1.83) had almost exactly the same ES as efficacy studies (1.82) at post-treatment. Furthermore, there was no significant difference between effectiveness and efficacy studies on sleep diary measures, remission rates, and self-ratings of depression and anxiety. CBTs for ID are effective when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.Prospero registration id: CRD420251032141.

Gratitude and hope are established predictors of mental and physical health and well-being. Scarce literature investigates relevant mediators of these relationships in a single model and during the COVID-19 pandemic. The current study investigated the mediating role of health anxiety (measured three months after baseline) in the relationship of gratitude and hope at baseline with alcohol use, fatigue, pain, and well-being six months later. The sample was composed of 788 mostly male (58.1%), White (70.3%), middle-aged adults (M_age = 38.0, SD = 11.8). Structural equation models (SEM) were used to analyze the data. Gratitude at baseline's indirect effect of health anxiety three months later was both small and negative for alcohol use (ab = ‒.06, 95% CI [-.10, -.03]) and pain (ab = ‒3.01, 95% CI [-4.34, -1.68]). Health anxiety appears to be a robust mediator of the relationship between gratitude and mental and physical health outcomes. Hope was a stronger and more direct predictor of well-being compared to gratitude. The findings of this study may provide evidence for examining health anxiety levels as a risk factor when trying to promote resilience factors in individuals who report health issues, particularly during times of environmental contagion.