Cognitive Behaviour Therapy最新文献

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.

Higher pretreatment estimated intelligence quotient (IQ) has been associated with higher treatment gains in adult patients treated with cognitive processing therapy (CPT). We assessed the association between IQ and PTSD treatment outcome in young patients (14-21 years) with childhood abuse-related PTSD treated with developmentally adapted CPT (D-CPT). Participants (N = 44) of a randomized controlled trial assessing the effectiveness of D-CPT were tested with the Culture-Fair Intelligence Test before treatment. PTSD symptomatology was assessed with the Clinician-administered PTSD Scale for Children and Adolescents at baseline, midtreatment, posttreatment, and at 3-, 6-, and 12 months after end of therapy. Multilevel modeling was used to assess the association of IQ and PTSD symptom reduction at all assessment points. Binary regression was used to assess if IQ predicted PTSD remission and dropout. Results showed no association between IQ and PTSD symptom reduction (β_{IQ x time} = .12, t = 1.33, p = .19). IQ did also not predict diagnostic status of PTSD at posttreatment (β_IQ = .05, z = 1.22, p = .22) nor dropout (β_IQ = -.04, z = -1.04, p = .29). Our results indicate that young patients with PTSD might profit from a D-CPT treatment independent of their IQ.

The network approach to psychopathology postulates that it is more helpful to think of psychiatric problems to be caused by each other, rather than by underlying diseases. Personalized networks can be created using questionnaires asking participants about their perceptions of the causal links between symptoms, which is time-efficient but has shown low test-retest reliability. The present study explores whether perceptions of causal links can instead be assessed using interviews. The study investigates the feasibility, acceptability and test-retest reliability of such an interview format. 21 adolescents were interviewed twice within one week. Results showed an average test-retest reliability for node centrality of r_s = .703 (SD = .148), and for causal links r_s = .533 (SD = .198). A majority of participating adolescents rated the interview as easy to understand. On a group level, the node both most central and frequent was negative emotions. Future studies should evaluate the clinical utility of networks created in interviews, both in terms of face-validity and to guide clinicians in treatment choices.

Perfectionism has been suggested as a risk factor relevant to multiple psychological disorders, including obsessive-compulsive disorder (OCD) and eating disorders (ED). However, it remains unclear how perfectionism contributes to general and specific psychopathology. Disorder-specific processes (e.g. body dissatisfaction, responsibility) between perfectionism and subsequent symptoms may offer an explanation. The current study examined longitudinal associations between perfectionism, body dissatisfaction or responsibility, and symptoms of ED or OCD. A community sample of 499 women (18-30) completed a three-wave online study, assessing perfectionism, ED and OCD symptoms, body dissatisfaction, and responsibility/threat overestimation. Temporal relations between perfectionism and symptoms were analyzed using a structural equation model. Effects of body dissatisfaction and responsibility/threat overestimation were analyzed using multiple hierarchical regressions. Results showed that perfectionism predicted subsequent OCD symptoms, but not ED symptoms. ED symptoms, but not OCD symptoms, predicted subsequent perfectionism. No interaction effects between perfectionism and the disorder-specific processes were found. Instead, body dissatisfaction independently contributed to both ED and OCD symptoms, whereas inflated responsibility/threat overestimation predicted specifically OCD symptoms. To conclude, perfectionism appears to increase the risk of psychological symptoms. However, in this sample this was specific to OCD symptoms. Given ED symptoms predicted later perfectionism, bidirectional effects need to be considered.

The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been evaluated and implemented nationwide in Norway. Its effectiveness has yet to be fully established in other countries. A total of 86 patients with OCD underwent the treatment at the Icelandic Anxiety Centre (KMS) from 2018 to 2023. Of these, 61.6% were classified as having severe symptoms, and 38.4% with moderate symptoms. Of the sample, 72.1% had previously received psychological treatment for OCD and 86.0% had at least one comorbid disorder, depression being the most common (50.0%). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered pre-treatment, posttreatment, and at 3-month follow-up, along with measures on general anxiety, depression, and occupational impairment. The mean score on Y-BOCS was 30.5 (SD = 3.6) pre-treatment, 10.6 (SD = 4.1) posttreatment and 10.9 (SD = 5.4) at 3-month follow-up. By the end of treatment, 94.9% of the patients had responded and 68.0% were in remission. At the 3-month follow-up, 92.5% were responders and 67.9% remitters. Participants were satisfied with the treatment and had improved in terms of occupational functioning, which was maintained at follow-up. These preliminary results suggest that the B4DT may be a swift and effective treatment format for OCD.

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.

Exposure therapy is an efficacious treatment for anxiety-related disorders. Yet, fear often returns after treatment. Occasional reinforcement, in which the feared stimulus is intermittently presented during extinction, increases safety learning and slows fear renewal in conditioning paradigms and analogue samples, but no studies to date have examined this strategy in clinical samples. The present study examined the effects of vicarious occasional reinforcement on fear renewal in a snake-phobic sample across multiple levels of analysis. Fear was intermittently reinforced by providing reminders of the feared outcome (a snake bite) throughout a two-session analogue video exposure manipulation. Snake-phobic adults were randomized to one of three conditions: a single-cue [S], multiple-cue [M], or multiple-cue+fear-outcome [M+FO] exposure group. Results showed the three groups did not significantly differ in threat expectancy or attentional bias for threat at follow-up. Despite sustained anxiety, however, the M+FO condition completed significantly more steps on a visual avoidance task at follow-up than the M and S conditions and heightened mean distress during exposure mediated this effect. The M and S groups did not significantly differ in visual avoidance at follow-up. These findings suggest incorporating reminders of the feared outcome into exposure may be an effective strategy for increasing inhibitory retrieval.

Interoceptive exposure (IE) exercises are underused, especially in people with chronic physical health problems. Secondary data analyses were conducted to examine the use of and acute responses to IE exercises in individuals with and without a history of chronic physical health problem(s). Participants (N = 413; Mage = 38.6, 56.1% with chronic physical health problems) enrolled in a 6-month randomized controlled trial that aimed to reduce anxiety and depression. Participants had access to a smartphone-based intervention that included on-demand access to IE exercises: head rush, straw breathing, chair spinning, fast breathing, and running in place. Utilization of the IE exercises and acute responses to the exercises were evaluated in the context of chronic physical health problem history. Participants with versus without a chronic physical health problem completed statistically significantly more IE exercises. Acute effects of IE exercises on distress and physical sensations were similar for those with and without a history of chronic physical health problems, as well as those who were versus were not taking medication. There is no evidence that chronic disease history influences the acute response to IE exercises. Continued research is needed to further assess the safety of IE exercises in people with various medical conditions.

Exercise directly improves mood and cognition. Providing exercise immediately before cognitive behavior therapy (CBT) sessions may therefore enhance the clinical responsiveness to CBT. The present pilot study examined the feasibility and direction of effect of exercise+CBT versus CBT in depressed outpatients using a stepped wedged design. Thirty-three patients received either group-based CBT (12-16 weeks) or group-based exercise+CBT within specialized mental healthcare settings. Weekly therapist-supervised exercise sessions (45 min, moderate intensity, running/indoor cycling) were provided directly before the CBT sessions, with encouragement for home-exercise. Feasibility was assessed through recruitment, retention, and safety, alongside treatment adherence and treatment effects on clinically relevant outcomes. Recruitment yielded 37% of eligible patients with similar retention rates across conditions. No adverse events were reported. The exercise+CBT condition attended 63% of supervised exercise sessions (72% at moderate/vigorous intensity) and fewer CBT sessions (42%) compared to the CBT condition (54%). The conditions showed similar improvements in depressive symptoms, rumination, and CBT skills over time. Our study shows in a specialized mental health care routine practice population that providing exercise before CBT sessions is feasible, warranting a future randomized controlled trial.