Journal of Behavioral and Cognitive Therapy最新文献

Cognitive reappraisal is an emotion regulation strategy based in cognitive behavioral therapy and can be associated with positive outcomes for individuals with and at risk for psychosis. However, the literature is mixed regarding whether this population uses cognitive reappraisal effectively. The current study examined cognitive reappraisal effectiveness in individuals at clinical high risk for psychosis and healthy control participants (N = 66; 34 clinical high risk, 32 healthy controls). The experimental task instructed participants to engage in reappraisal in real-time to regulate distress. We hypothesized that control participants would be more effective at using cognitive reappraisal compared to psychosis-risk participants, resulting in greater distress reduction post-reappraisal. Results demonstrated the opposite: the psychosis-risk group reported a greater change in distress level than the healthy control group after reappraisal was employed (Cohen’s d = 0.52). Exploratory analyses revealed that the clinical high risk group reported higher pre-task distress, but reported post-reappraisal distress levels equivalent to the healthy control group. These results contribute to emerging evidence that suggests individuals on the psychosis spectrum can implement reappraisal effectively. Therefore, complex training to improve cognitive reappraisal may not be needed. Instead, future research should examine the potential clinical utility of using simple reminders and/or guided prompts to promote cognitive reappraisal in individuals on the psychosis spectrum.

Previous studies have revealed that attentional bias toward aversive stimuli may play a causal role in the development and maintenance of anxiety disorders. This pilot study designed an experiment, using eye tracking, to capture gaze patterns individuals may display during a fear habituation trial. Three trials were conducted with twenty-eight subjects who reported aversion to insects. Pictures of cockroaches were used as aversive stimuli. The time proportion of the total visit duration and average visit duration toward aversive stimuli were analyzed using a mixed ANOVA, with three habituation trials and four self-report on fear level scores as within-participants factors. Across trials, the time proportion of total visit duration was relatively low when fear levels were high, and increased when fear levels decreased. Across trials, the average visit duration was short when fear levels were relatively high, and the average visit duration became relatively long as fear levels decreased. The results indicated that higher fear levels during exposure are likely to lead to attentional avoidance which might be a strategic effortful coping process (Eysenck, et al. 2007). This study is an crucial first step toward understanding the gaze patterns that fearful individuals may display during exposure trials. Using eye tracking technology, we objectively identified these gaze patterns and opened avenues to enhance the efficacy of exposure-based interventions tailored to address phobias.

Objective

The current study examined the efficacy of an online Acceptance and Commitment Therapy (ACT) intervention at addressing chronic pain in individuals with Chiari Malformation (CM) with the hope of informing adjunctive treatment options.

Method

52 adults (aged 18–65) with CM were randomized into either the treatment or a waitlist control group. Both groups completed baseline assessments followed by 8 weekly assessments of pain interference, anxiety, depression, sleep dysfunction, chronic pain acceptance, and psychological flexibility; the treatment group also completed 8 weekly online self-guided intervention modules. All participants were assessed at 8 weeks and 1-month post-intervention.

Results

Using hierarchical linear modeling, significant group differences were identified in the trajectories of psychological flexibility and chronic pain acceptance such that the treatment group improved at a faster rate. The curve in the trajectory of sleep dysfunction differed between groups but outcomes did not differ. There were no significant group differences in pain interference, depression, or anxiety symptoms, and psychological flexibility did not mediate any of the significant findings.

Conclusion

ACT processes of change were effectively engaged, as demonstrated by significant improvements in psychological flexibility and chronic pain acceptance within the treatment group. Possible modifications to the intervention may be necessary to improve treatment of non-responsive symptoms.

Trial Registration. This study was registered with Clinical Trials.gov (Identifier NCT04089670, 19–17).

Introduction

Depression is a top prevalent mental illness but has low care access globally. Community-based interventions were considered to be effective for depression with scarce resources.

Purpose

This study evaluated depression after group psychotherapy in primary settings in Vietnam for up to 12 months.

Method

A quasiexperimental study including a single-arm, pre- and post intervention assessment was conducted among 359 people aged 18–65 (PHQ-9 score ≥ 10) from August 2020 to January 2022 in 10 communes of Thai Nguyen Province, Vietnam. The PHQ-9 scores were collected at baseline and after 3, 6, and 12 months. The trained nonspecialists delivered 8 sessions of group therapy under supervision.

Result

Three hundred fifty-nine eligible people participated in the intervention, and three and two people dropped out after three months and six months, respectively. The mean PHQ-9 score decreased from 13.29 preintervention to 2.83 after 12 months. The difference in depression severity between the three points of follow-up was statistically significant (p < 0.001). Ninety percent of participants achieved reliable improvement, and 96% recovered at 12 months.

Conclusion

Community-based psychotherapy can be a promising approach to depression management in limited settings in the long term, which needs further study to evaluate its acceptance and feasibility in a specific context.

Introduction

Benzodiazepines (BDZs) are often inappropriately prescribed to manage anxiety and insomnia for longer-term use, despite guidelines recommending short-term use (i.e., <4 weeks). A range of harms can occur rapidly with regular use, and dependence can make stopping BDZs challenging. Evidence shows that a combination of BDZ tapering and psychological support are effective interventions, yet are not widely accessible.

Methods

This was a one-group pilot trial of a 6-week fully automated self-help BDZ digital intervention (‘BDZ digital health’), providing guidance on how to safely taper BDZs as well as psychological support. The trial was undertaken with Australian adults considering a reduction and/or withdrawal from their BDZ (N = 43). Participants were assessed at pre-intervention (Week 0), during intervention (Week 3), post-intervention (Week 6), and at a 3- and 6-month follow-up (Week 18 and 30 respectively).

Results

Reductions in BDZ use and self-reported dependency were observed over the course of the intervention. Significant symptom reductions in anxiety, insomnia, depression, psychological distress, and emotional dysregulation, as well as improvements in mental wellbeing and quality of life were observed when looking across all timepoints. However, the specific assessment timepoint changes for depression and psychological distress did not reach significance from the pre- to post-intervention timepoint. The intervention acceptability ratings were in the moderately high to high range.

Discussion

The preliminary results of the pilot trial suggest that BDZ digital health is an acceptable and promising self-help digital intervention to assist adults reducing and withdrawing from their BDZs, and to improve their mental health and wellbeing.

Trial registration: ACTRN12617000574347 (24/04/2017).

Pre-, peri-, and post-deployment factors, including demographic factor, psychological traits, and previous trauma experience, have been hypothesized to influence severity of combat-related posttraumatic stress disorder (PTSD) and whether an individual completes a treatment trial. Here we report on the roles of these factors on pretreatment PTSD symptom severity and how these factors affected treatment drop-out in 103 participants enrolled in a previously conducted treatment trial for PTSD for these individuals. We found that comorbid depression, IQ, breadth of combat experiences, and psychosocial functioning play significant roles in accounting for PTSD severity, with those five variables accounting for ∼51% of the variance, with depressive symptoms (∼38% of the variance in CAPS total score), extent of trauma exposure (∼5%), IQ (∼3%), the index trauma being related to witnessing a threat (∼3%), and psychosocial functioning (∼2%) contributing significantly. The same factors were investigated to assess their influence on completion of treatment protocols, where higher IQs and less diversity of trauma exposures were associated with a higher completion rate. Thus, the factors contributing to PTSD symptoms and treatment completion are diverse, encompass pre-, peri-, and post-trauma conditions, and span the breadth of neurobiological, combat, and psychosocial factors.

ClinicalTrials.gov identifier: NCT01391832.

Objectives

High levels of stress are associated with suicide ideation among college students. The interpersonal theory of suicide provides a framework for conceptualizing the association between stress and suicide. This study will examine the associations between multiple types of stress (daily life hassles vs. negative life events) on suicidal ideation and the role of adaptive/maladaptive coping skills as potential moderators of the relationship between stress, thwarted belongingness, perceived burdensomeness, and suicidal ideation.

Design

The current study is a secondary analysis of data gathered from South-eastern university students in the U.S.

Method

College students (N = 218) with elevated depressive symptoms completed cross-sectional surveys. Participants were predominantly (78%) women and (72.8%) Hispanic, with a mean age of 20.81 years (SD = 3.96).

Results

Daily life hassles and negative life events were indirectly associated with suicidal ideation via perceived burdensomeness and thwarted belongingness. Only maladaptive coping behaviors significantly moderated the indirect effect of daily life hassles and negative life events on suicide ideation via perceived burdensomeness, but not thwarted belongingness. Thus, reliance on maladaptive coping behaviors increased the strength of the association between daily life hassles/negative life events and suicidal ideation.

Limitations

This study utilized cross-sectional data from a sample of college students with elevated depressive symptoms and may not generalize to other college student populations. Additionally, the use of cross-sectional data precludes causal interpretations of the findings.

Conclusion

An improved understanding of potential buffers against the effects of stress can help identify opportunities for targeted prevention efforts to reduce rates of suicide-related behaviors in college students. Findings suggest that efforts to reduce student use of maladaptive coping behaviors may help to negate the negative impacts of stress on suicidal ideation.

As college counseling centers struggle to meet the growing demands of behavioral health services, digital mental health tools like smartphone apps offer a scalable solution to increase access to care. However, clinicians report greater time demands and uncertainty over how to act upon digital data. In this paper, by using established statistical techniques, we condense complex smartphone data into results that are quickly understood and clinically meaningful. Specifically, we show how smartphone digital phenotyping data collected by college students can be used to predict an individual’s anxiety and depression level on a daily or weekly basis with an error of less than 10%. These predictions are then condensed into a 1 to 5 scale with a 1 representing patients with the lowest risk of presenting high anxiety or depression, and a 5 representing the patients with the highest risk. If used in a clinical setting, these risk scores have the potential to help college counseling centers monitor symptom severity in real-time via students’ own smartphones, allocate resources more efficiently, and ensure that students are receiving the appropriate level of treatment.

There is a lack of evidence-based models and treatment for dissociation. This article aims to fill this gap by providing a comprehensive evidence-based model for dissociation using a cognitive behavioral conceptualization. We postulate that, following an initial experience of dissociation, associative conditioning will increase the frequency and intensity of dissociative symptoms. Various mechanisms could facilitate dissociation: negative beliefs about emotion, beliefs about dissociation, emotional dysregulation, low attentional control and poor mindfulness skills. Based on this model, a range of clinical interventions can be proposed to reduce dissociation, including cognitive restructuring through reality testing, decisional balance and Socratic questioning, emotion regulation and attentional training, and mindfulness-based programs. The impact of these interventions on dissociation needs to be appraised using experimental methodologies (randomized controlled trials and intervention studies with outcome measures).

This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.