Cognitive Behaviour Therapy最新文献

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.

Internet-based interventions (IBIs) are effective for treating depression, but they can also lead to negative effects in some participants. There is no consensus on which specific characteristics of negative effects clinicians and researchers should focus on. Studies often combine distinct (sub)categories of negative effects, complicating interpretation. This study aimed to identify specific (sub)categories of negative effects related to depression and adherence and explore their predictors. In a sample of participants undergoing an IBI for depression (N = 1610; 61% female), 113 participants (7%) reported experiencing at least one negative effect. 110 participants qualitatively reported negative effects and were categorized into a framework consisting of two main categories (treatment-related vs. patient-related) of negative effects, divided into five subcategories (format, contact, implementation, symptoms, and insight). No differences in adherence were observed between any (sub)categories of negative effects; however, participants who reported treatment-related negative effects showed significantly lower symptom improvement than those reporting patient-related negative effects. No patient demographic characteristics predicted any negative effects. Differentiating treatment- and patient-related negative effects could enhance future research and intervention efforts.

Little is known about which transdiagnostic cognitive behavioural processes (precipitating or maintaining factors across different psychiatric disorders) are most critical to target to improve the outcomes of interventions for eating disorders (EDs). As a first step toward developing a better understanding of this issue, we conducted a modified Delphi study to reach consensus on processes for early intervention and augmenting evidence-based treatment. Across three rounds, four panels were included: people with lived experience (n = 38), significant others (n = 27), clinicians specialising in the treatment of EDs (n = 44), and ED researchers (n = 29). For early intervention, nine processes were endorsed: basing self-worth on one or two aspects of oneself; persistent and excessively high standards; poor distress tolerance skills; being self-critical; negative body image; difficulty coping with developmental life transitions; low self-compassion; low self-worth and self-acceptance; and negative social media use. For augmenting treatment, nine similar processes were endorsed, except life transitions and social media use, which were replaced by social isolation and unhelpful thinking habits. This information can inform a future research agenda for improving interventions for EDs. However, consensus only occurred for approximately one fifth of the 49 processes, with a disconnect between the lived experience and researcher panels that requires attention.

Chronic musculoskeletal pain (MSKP) is a common and challenging condition often occurring with generalized anxiety disorder (GAD). Cognitive behavior therapy (CBT) is a first-line treatment for GAD, but limitations on the potential availability or engagement in CBT have encouraged consideration of remote and autonomous treatment options. Yet, little is known about preferences for different modalities of CBT. This study evaluated relative preferences for in-person, telehealth, or digital CBT among individuals with comorbid MSKP and anxiety. Using local and national online advertising, we recruited a sample of 85 individuals with MSKP and self-reported clinical levels of anxiety (mean age: 40.3, 74.4% female, 67.1% White). Results indicated a significant preference for in-person therapy over digital treatment. Nonetheless, multiple indices of higher pain-related fear and distress were linked to a greater relative preference for digital therapy. Dissemination of scalable digital treatment for anxiety for adults with MSKP may find the best reception among individuals with these characteristics.

Sudden gains are rapid, substantial, and lasting symptom reductions between sessions which have been associated with better treatment outcomes. Frequent symptom measurements in treatment change research can be burdensome; ultra-brief scales can reduce this burden, increase completion rates, and enable the examination of a broader range of constructs. This study compared the timing, prevalence, and treatment outcomes associated with sudden gains during an internet-delivered treatment using standard and ultra-brief self-report measures of depression and anxiety. Existing data (N = 937) from a five-week internet-delivered treatment for depression and anxiety in university students was analysed. Anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and its brief version the GAD-2, and depression symptoms were measured using the Patient Health Questionnaire 9-item Scale (PHQ-9) and its brief version the PHQ-2. More sudden gains were identified by the PHQ-9 than the PHQ-2, and more by the GAD-2 than the GAD-7. Critically, the standard and ultra-brief measures identified different individuals as having experienced a sudden gain. Sudden gains were associated with higher baseline symptom severity. These results seem to raise important questions about the detection of sudden gains, and the comparability of findings across studies using different measures.

Hispanic emerging adult college students experience increased exposure to psychological distress associated with emerging adulthood and sociocultural pressures, which increases the risk for developing maladaptive eating cognitions and behaviors. Eating expectancies have been implicated as a maladaptive eating cognition associated with unhealthy eating, and there is a need to examine affective vulnerability processes that may drive such cognitions among this health-vulnerable population. One factor that has demonstrated relations to maladaptive eating expectancies is anxiety sensitivity. Therefore, the current study examined anxiety sensitivity in relation to eating expectancies among Hispanic emerging adult college students. Participants were 337 Hispanic emerging adult college students (81.9% female; M_age = 20.37, SD = 1.92; age range = 18-25) from an urban university. After controlling for age, sex, body mass index, and acculturative stress, the results indicated that greater levels of anxiety sensitivity were positively related to increased eating expectancies to alleviate boredom, lead to feeling out of control, and to help manage negative affect. Findings suggest that even after controlling for empirically relevant factors, Hispanic emerging adult college students with elevated anxiety sensitivity may be at increased risk for maladaptive eating expectancies to alleviate boredom, lead to feeling out of control, and to help manage negative affect.