Cognitive Behaviour Therapy最新文献

Providing new psychological treatments in clinical settings requires implementation strategies adapted to the organizational context. This study explored how licensed psychologists experienced their context when providing a new transdiagnostic psychological treatment, "the hybrid treatment", to treat comorbid pain and emotional problems in a clinical setting. We aimed to identify which contextual factors the therapists experienced as facilitating or hindering, to gain a better understanding of important considerations when planning a future implementation strategy. Contextual factors were identified using the Consolidated Framework of Implementation Research (CFIR) in data collection and analysis. Data were collected through semi-structured interviews (N = 9). Thematic analysis resulted in the identification of five main influencing factors: Perception of the intervention's adaptability, prioritization of the patient's needs, leadership engagement, structure for collaboration, and therapists' professional engagement. The results highlight the importance of ensuring a clearly stated mandate for the key individuals involved. The findings may guide future implementation of new psychological treatments into regular care, to enhance facilitators and overcome barriers.

Behavioural experiments are experiential exercises used in Cognitive Behavioural Therapy to drive cognitive change by testing patients' idiosyncratic, emotionally linked beliefs. In this paper, we provide clinical guidance on how to deliver effective behavioural experiments that maximise cognitive change based on lessons learnt over the last 30 years from our work using Cognitive Therapy to treat Panic Disorder (CT-PD), Social Anxiety Disorder (CT-SAD) and Post-Traumatic Stress Disorder (CT-PTSD). We describe key steps for setting up and carrying out powerful experiments, including common blocks and barriers patients and therapists come across when using them.

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.

Despite a wealth of research demonstrating the efficacy of exposure therapy for the anxiety and related disorders, research shows that few therapists use this technique in clinical practice. Negative beliefs about exposure therapy have been shown to be the most significant barrier to use or optimal use. A richer and more nuanced understanding of the relationship between negative beliefs and exposure use, and its implications for training and practice, is warranted. This research aimed to identify the specific negative beliefs about exposure held by Australian psychologists, and the association of these beliefs with the use of therapist-assisted and self-guided exposure (i.e. between-session exposure homework) of exposure therapy for anxiety, obsessive-compulsive, and post-traumatic stress disorders. One hundred registered psychologists participated in an online study. Results suggest that the most frequently endorsed negative belief is the need for arousal reduction techniques to tolerate distress associated with exposure therapy. Negative beliefs about exposure were negatively correlated with both therapist-supported and self-guided exposure of exposure therapy across all disorders, though largest correlations were found for therapist-supported techniques. Training implications of these findings are discussed.

Among those with borderline personality disorder (BPD), dialectical behavior therapy (DBT) is considered a frontline treatment for reducing impulsivity and suicidality and improving emotion regulation. DBT has been proven effective when delivered within Veterans Health Administration. Much of the research supporting the use of DBT was conducted on patients with relatively clean diagnostic profiles (e.g. excluding bipolar disorder). However, Veterans are diagnostically complex and are especially likely to have comorbid posttraumatic stress disorder (PTSD). We sought to understand how a PTSD diagnosis affected treatment outcomes among Veterans who presented for full-model DBT treatment. In a sample of 62 Veterans, half of whom had probable (N = 24) or confirmed (N = 7) PTSD, we tested whether comorbid PTSD and BPD affected baseline severity, treatment engagement, or treatment outcomes. Compared to those without PTSD, BPD-PTSD did not hamper treatment engagement and was unrelated to BPD symptom severity at baseline. BPD-PTSD was associated with noninferior and indeed sharper reductions in BPD symptoms throughout treatment. That is, relative to Veterans without PTSD, Veterans with co-occurring PTSD and BPD symptoms reported steeper symptom reductions. Altogether, our findings support the use of DBT in Veterans who present with both BPD symptoms and PTSD.

Anxiety and depressive disorders are the most prevalent disorders worldwide and significantly impair quality of life (QoL). Transdiagnostic cognitive behavioural therapy (TD-CBT) is effective in treating these disorders and improving QoL, but its long-term mechanisms of change are poorly understood. Rumination and worry are key processes addressed by TD-CBT. In this study, we analysed the sequential effect of TD-CBT on post-treatment rumination and worry, anxiety/depression symptoms at 6-months and psychological and physical QoL at 12-months. We use data from PsicAP, a randomised clinical trial in the Primary Care (PC) setting, with 1061 participants randomised to TAU (treatment as usual) or TD-CBT+TAU. Path analyses using SEM were employed to test serial mediation models. Analyses indicated that TD-CBT exerts its long-term beneficial effects on QoL through a cascade of effects, whereby first the maladaptive cognitive processes of rumination and worry are reduced (post-treatment), then anxiety and depressive symptoms (6-months) and finally QoL is improved (12-months). This study provides longitudinal evidence on the mechanisms of change of TD-CBT in patients with anxiety and depression. It also highlights the importance of targeting transdiagnostic interventions towards early modification of negative repetitive thought processes as a critical pathway to long-term symptomatic and functional recovery.

Whilst there is evidence supporting the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of Binge Eating Disorder (BED), it remains unclear whether this can be delivered virtually without loss of clinical effect. This study aims to explore the acceptability and preliminary clinical effectiveness of a virtual therapist-led DBT group for BED. Of 108 adults with BED who were offered a virtual 10-week DBT group between 2020 and 2022, 51 commenced treatment; 8 groups were conducted. Patients completed measures of eating disorder pathology, mood and anxiety at start, end of treatment, and 1-month follow-up. Binge abstinence rates were recorded weekly. Forty-seven percent of those offered the group began treatment; of that group 71% completed treatment. Binge abstinence rates of 64.71% were achieved by end of treatment. Generalized Linear Mixed Models showed significant reductions in eating and mood pathology, with generally strong effect sizes. All changes were maintained at 1-month follow-up. Preliminary findings suggest that a virtual 10-week DBT group for BED is clinically effective. Further research is required to replicate these findings in an appropriately powered sample. The significant number of patients not opting-in suggests barriers to treatment uptake that would be helpful to explore to further inform treatment acceptability.

Cognitive-Behavioral Therapy (CBT) and Mindfulness-Based Therapy (MBT) are efficacious treatments for Sexual Interest/Arousal Disorder (SIAD) in women. Many women with SIAD have a history of sexual assault (SA), but the degree to which SA history predicts engagement in treatment of SIAD, or its efficacy, is generally unknown. It is also possible that treatment of SIAD may improve Posttraumatic Stress Disorder (PTSD) symptoms related to SA. We engaged in secondary analysis of a trial assessing an online intervention for SIAD (called eSense) to explore whether SA history predicted treatment engagement or outcomes, and whether PTSD symptoms improved. Women with SIAD were randomized to online CBT (n = 43), online MBT (n = 43), or a waitlist control (n = 43). Participants completed self-report measures of engagement, SIAD symptoms, and PTSD symptoms at baseline, mid-treatment, posttreatment, and 6-month posttreatment. SA history did not predict treatment engagement or changes in SIAD symptoms. Overall PTSD symptoms decreased in MBT over and above waitlist. Exploratory analyses including follow-up assessment suggested that, among SA survivors, PTSD symptoms improved most in CBT whereas, for those without SA history, improvement was greater in MBT. SA survivors can use and benefit from evidence-based online therapies, like eSense, for SIAD.