Journal of Behavioral and Cognitive Therapy最新文献

Accelerated models of care may be one solution to the problem of underutilization of mental health treatment in veterans. We report on a novel implementation of prolonged exposure (PE) therapy in a four-day, weekend-based intensive outpatient treatment program. Seventeen military veterans and service members (M_age = 45.23, SD_age = 10.18; 76.47% male) completed the program. Symptoms of posttraumatic stress disorder (PTSD) and depression were targeted in five separate cohorts. Given that this was an uncontrolled pilot study, we assessed patient satisfaction and treatment completion. In a completers analysis, PTSD and depression symptoms decreased significantly from pre- to posttreatment (p's < .05), with effect sizes of 1.22 and 0.85, respectively. Using recommended treatment response categories for the PCL-5, 76.47% were reliably changed at posttreatment. The dropout rate was 5.55%. Preliminary findings indicated that PTSD symptoms reductions were maintained from baseline to 1-month (Cohen's d = 1.19) and 3-month (Cohen's d = 1.46) follow-up. Delivering PE in a 4-day, intensive format was associated with clinically significant reductions in self-reported PTSD and depression symptoms. Additionally, completion rates and patient satisfaction were high, suggesting feasibility for patients.

The reliability of gold standard symptom assessments of post-traumatic stress disorder (PTSD) can be compromised by memory, emotional or cultural bias. The use of psychophysiological measures may complement psychometrics in tracking changes during treatment in physiological response and emotion regulation. In this systematic review, we integrate knowledge about the correlation between psychometric and psychophysiological measures in 22 prospective studies with trauma-focused cognitive, exposure, pharmacological and other interventions. Our objective was to determine how physiological resting states and reactivity pre- vs. post-intervention correspond to the effect of intervention on PTSD symptoms. Trends towards normalizing physiological resting states and arousal, as measured before and after treatment, were seen to correlate with a psychometric recovery. In patients with significant changes in trauma symptoms, pre- vs. post-treatment resting heart rate, heart rate reactivity to trauma cues and skin conductance decreased, and heart rate variability increased. Electromyography could measure adaptive decreases in startle responses to exposure content. Both blood pressure raw values and reactivity decreased post-treatment following cognitive therapy. Additional longitudinal studies are needed to explore standard testing paradigms that can be used for psychophysiological measures, and the corresponding cut-off levels that can indicate healthy and abnormal treatment response levels. The current findings stress a need for the development of a psychophysiological methodology that is feasible and reliable during experimental and clinical procedures to elucidate the effects of trauma intervention on emotional processing. Systematic review PROSPERO registration ID:CRD42021227774.

Alliance and adherence to therapeutic techniques are key elements of Cognitive Behavioural Therapy (CBT). Therapists’ beliefs about how important alliance and technique adherence are throughout CBT might impact how they deliver therapy. Furthermore, these beliefs might or might not be congruent with patients’ therapy-related beliefs. This research investigated whether therapists hold similar beliefs to patients regarding the importance of alliance and technique adherence throughout CBT and whether therapists could accurately predict patients’ beliefs. CBT therapists (n = 103) and CBT patients (n = 181) rated the importance of alliance and technique adherence to CBT outcomes in early, mid and late therapy. Therapists also predicted patients’ responses. Mann-Whitney U tests compared therapists’ responses and therapists’ predictions with patients’ responses at each stage of therapy. Therapists rated alliance and technique adherence as more important than patients did throughout therapy, with the largest discrepancy for alliance in early therapy. Therapists accurately predicted patients’ alliance importance ratings but underestimated patients’ technique adherence importance ratings for early and mid-therapy. Therapists are encouraged to challenge their assumptions about patients’ therapy-related beliefs by having open discussions with patients. Therapists are encouraged to prioritise technique adherence as well as alliance in early CBT.

Patients with multiple sclerosis (MS) often experience reduced health-related quality of life and mental health comorbidity. The prevalence of insomnia disorder and sleep quality impairments in MS patients ranges from 47% to 62%. Nevertheless, these problems often remain underdiagnosed and undertreated. This review systematically and critically assesses evidence from randomized clinical trials which evaluated the efficacy of different clinical interventions targeting mental and general health in patients with MS on insomnia symptoms and sleep quality. Pubmed, PsycINFO and Medline databases were systematically searched. Eligible studies included adults ≥ 18 years with MS diagnosis; were randomized clinical trials; and reported pre and post-treatment data for primary or secondary outcomes. Nine studies were selected including 755 adults with an MS diagnosis. Studies evaluated the efficacy of various treatments: psychological interventions (5); pharmacotherapy, including medications for fatigue, cannabis extract and melatonin (3); energy conservation therapy (1). Preliminary support was found for psychological interventions and cannabis extract. This work highlights the important need for more high-quality randomized controlled trials for interventions targeting insomnia in MS patients.

Various formats to deliver exposure stimuli have been developed, including video-based stimuli. Virtual reality-based exposure often utilizes a first-person perspective, which is associated with greater presence (e.g., feeling integrated in a virtual world) than third-person perspective. Yet, few have compared exposure stimuli presented in first-person versus third-person perspective. Thus, this study examined presence and anxiety levels associated with exposure video perspective. Participants (N = 18) completed a two-week video-based exposure treatment (i.e., watched one week of first-person perspective film and one week of third-person perspective film, counterbalanced). Participants reported anxiety and presence felt during the exposures. Results indicated greater presence was experienced during first-person videos than third-person ones. Anxiety levels did not differ between video perspective. An interaction between perspective and video order was found; those who watched third-person videos during week one reported more anxiety when presented first-person videos than those who watched the reverse order. Results support previous findings that more presence is reported with first-person than third-person perspective. More importantly, this study suggests an innovative way to sequence exposure stimuli so as to maximally sustain therapeutic levels of arousal over the course of treatment.

There is a lack of information in the literature on patients with borderline personality disorder (BPD) who do not respond sufficiently to the standard one-year dialectical behavior therapy (DBT). In this naturalistic, observational study, we compared 43 patients completing and responding to one year of DBT (m = 34.5 years, 83.7% women; first-year responders, R1) with 12 patients (m = 34.4 years, 91.7% women) with BPD who completed but did not respond clinically to the standard one-year DBT (first-year non-responders, NR1). We also followed the NR1's progress in treatment during a second consecutive year of DBT. Despite a lack of difference in clinical characteristics at baseline, progress of R1 and NR1 patients differed substantially and significantly during the first year of DBT. Over two years, the NR1 patients significantly improved on all outcome measures. However, most of the changes became significant only after 18 months of therapy. The proportion of NR1 patients attaining a Global Assessment of Functioning score > 60 after their second year of treatment was close to that of R1 patients (58.3% and 62.8%, respectively). Despite improvements in BPD symptomatology and an increased use of DBT skills, rates of reliable clinical change indicated that these NR1 patients remained vulnerable to depression and emotion regulation difficulties.

Attentional biases have been overlooked as a treatment focus in CBT practice. This pilot study examined patterns of attentional bias in an OCD clinical sample with a view to understanding the key mechanisms in order to inform assessment and intervention. It was hypothesised that individuals with OCD would demonstrate vigilance, delayed disengagement, and maintenance attentional biases towards OCD-related stimuli relative to a matched control group. Participants with OCD (n = 16) were compared with healthy controls (n = 16) matched by age and gender. Vigilance, disengagement and maintenance biases were measured by recording eye-movements during a free gaze task in which pairs of neutral-OCD and neutral-aversive images were presented. The OCD group demonstrated no evidence of vigilance or delayed disengagement biases toward OCD stimuli but did exhibit a maintenance bias towards OCD and, to a lesser extent, general aversive images. Clinical implications include the assessment of patient attentional biases to aid CBT interventions.

The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n = 30), ABBT (n = 30), or treatment as usual (TAU) (n = 30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.

The purpose of this study is to evaluate the evidence that cognitive behavioral therapy improves exaggerated appraisals of threat among people with a primary anxiety disorder. The current meta-analysis of 19 randomized clinical trials (1594 participants) tests whether cognitive behavioral treatments for anxiety disorders improve threat reappraisal to a greater extent than wait-list control conditions, non-cognitive behavioral treatments, and active control conditions. A statistically significant and large cumulative effect (g = 0.76, 95% CI: [0.51–1.01], p < 0.01) indicated that cognitive behavioral therapy produces greater improvements in threat reappraisal relative to a comparison condition. Heterogeneity of the effect was high (I² = 80.92%). A moderator analyses showed this effect was significant when compared to waitlist control conditions (g = 1.08) non-cognitive behavioral treatments (g = 0.37), and active control conditions (g = 0.29). The effect of cognitive behavioral treatment on threat reappraisal was greater for studies on panic disorder (g = 1.06) relative to social anxiety disorder (g = 0.60) and generalized anxiety disorder (g = 0.35). Findings from this meta-analysis support cognitive models of anxiety, which assert that cognitive behavioral therapy improves people's ability to make more realistic appraisals of threat.

Standard CBT programs for childhood anxiety are costly. Low-intensity self-help treatments may increase access to evidence-based interventions. These interventions are generally promising. We tested the effectiveness of a therapist-guided parent-delivered self-help group intervention based on the “Cool Kids” program at mid-treatment, post-treatment and 6-months follow-up. We enrolled 117 families with children aged 6–12 years. Effect sizes were calculated for mother, father and child reports. Reliable change and change in clinical status were based on mother and child report. We found a significant decrease in both anxiety and depression symptoms. Effect sizes were medium to large for anxiety symptoms following treatment. Mothers reported that 53.8% of the children obtained a reliable change in anxiety symptoms from pre- to post-treatment, and 66.7% from pre- to follow-up. Out of 72.6% children who were classified as having clinical anxiety prior to treatment, 52.9% and 58.8% changed their status to non-clinical at post-treatment and follow-up, respectively. Clinical significant change, involving having achieved both a reliable change and change of status from clinical to non-clinical, was obtained for 49.4% at post-treatment, and 58.8% at follow-up based on mother reports. Our findings indicate that parent-delivered self-help CBT groups may be a valuable asset in improving access to psychological cost-effective evidence-based treatments for anxious children.