Journal of Behavioral and Cognitive Therapy最新文献

Obsessive-compulsive disorder (OCD) is associated with “emotional disconnections” (e.g., difficulty understanding your emotions), but very limited work has examined these links prospectively or in the context of OCD treatment. This study tested the hypotheses that emotional clarity and emotional awareness would predict improvement in OCD symptoms during Exposure and Response Prevention (ExRP) in a naturalistic treatment sample, based on the putative impact of these factors on emotional processing. We tested the effect of baseline levels of emotional clarity and awareness (measured using the Difficulties in Emotion Regulation Scale) on OCD symptoms at baseline, mid- and post-treatment (Obsessive-Compulsive Inventory, Revised) in a study of adults diagnosed with OCD and receiving ExRP in an open treatment clinic (N = 131) using multilevel modeling. Both lack of emotional clarity and lack of emotional awareness predicted OCD symptom severity at post-treatment. Lack of awareness also predicted greater improvement in OCD symptoms during treatment, while clarity did not. Consistent with previous research, individuals who reported being less clear about their emotions had more severe OCD symptoms at post-treatment. Extending previous findings, those who reported being more aware of their emotions before treatment showed less symptom improvement during treatment. Clinical and theoretical implications of these findings are discussed.

This meta-analysis examines the effects of mindfulness-informed and mindfulness-based interventions including acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT) on depressive and anxiety symptoms among college students. Three electronic databases (PubMed, PsycINFO, and Cochrane Central) were utilized and systematically searched. Effect estimates were reported as standardized mean differences (SMDs) and data were pooled using random-effects models. Twenty-two comparisons derived from 19 studies (2716 participants) were included in the meta-analysis. For studies employing passive control conditions (n = 17), post-intervention effect sizes were significant for depressive (0.47 [95% CI: 0. 32–0.63]) and anxiety symptoms (0.58 [95% CI: 0.34–0.82]). Effect sizes were significant at post-intervention among MBCT (0.76 [95% CI: 0.48–1.03] for depressive symptoms and 1.37 [95% CI: 0.70–2.04] for anxiety symptoms) and MBSR (0.58 [95% CI: 0.31–0.86] for depressive symptoms and 0.49 [95% CI: 0.24–0.73] for anxiety symptoms). The effect size of ACT for depressive symptoms at post-intervention was significant (0.28 [95% CI: 0.09–0.48]), but the post-intervention effect size of ACT for anxiety symptoms was not significant (0.23 [95% CI: −0.01 −0.47]). Our analyses showed no superiority for ACT, MBSR, and MBCT to active control conditions, either when they were combined or considered separately. This meta-analysis provides empirical evidence in support of ACT, MBSR, and MBCT for reducing depressive and anxiety symptoms among college students.

Despite established efficacy, there is low engagement in prolonged exposure (PE) therapy for PTSD among combat veterans. In preparation for a full-scale randomized trial, we sought to evaluate the feasibility, safety, and preliminary efficacy of quetiapine to enhance patient engagement in PE therapy. Open-label, randomized pilot trial of quetiapine monotherapy vs. Treatment as Usual (TAU) medications in 20 military veterans with combat related PTSD who were seeking care from the San Antonio Polytrauma Rehabilitation Center at the South Texas Veterans Healthcare System (STVHCS). Participants were randomized to receive either Quetiapine (n = 10) monotherapy or pharmacological TAU (n = 10) in patients who were receiving PE as a standard of care therapy. We collected information on (1) the number of potentially eligible veterans approached, the number screened, and the number randomized, (2) adverse events reported, (3) number of participants continuing PE treatment at least until session #4 (i.e., after first exposure session) and the total number of sessions of PE completed by the participants, and (4) change in PTSD severity and sleep quality measured by the PTSD Checklist for DSM-5 (PCL-5) and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed for 18 intent-to-treat participants with mean (SD) age, 53.5 (13.4) years; and baseline PCL-5 score, 57.6 (7.6). More veterans in the quetiapine group (n = 9; 100%) received at least the first exposure session of PE therapy compared to TAU ((n = 3; (37.5%), p = .006] and completed PE therapy (n = 8; (88.9%) vs (n = 3; (37.5%), p = .03). Both PCL-5 (p = .03) and PSQI (p = .02) scores decreased significantly more for participants in the quetiapine than the TAU group. Preliminary findings support the feasibility, safety, and possible efficacy of quetiapine as an adjunct to enhancing engagement in PE therapy. A full-scale randomized trial is required to determine the true efficacy of quetiapine to enhance engagement in PE treatment.

Emotional disorders, including depression, are associated with deficits in retrieving past and imagining future autobiographical events. Imagining future events requires accessing different types of information, from general conceptual knowledge to specific event details. Here, we tested the hypothesis that depression levels within a community sample are most strongly reflected in how conceptual information about the self (i.e., self-schemas) are accessed. In an online experiment, we collected ratings of depression as well as anxiety, which often presents alongside depression, in a group of participants who then completed a trait judgment task in which they judged whether positive and negative traits reflected the self or another person, followed by an event imagination task in which participants generated specific future events for the self or another person. A second experiment was run on a separate group of participants who performed these same tasks in reversed order. Across experiments, we found that depression but not anxiety levels were associated with greater endorsement of negative traits only for the self, was not related to the ability to imagine specific future events but did alter how these events were evaluated. An exploratory analysis revealed greater endorsement of negative traits for the self when the trait judgement task came before imagining events. These results provide new insights into how depression levels in a subclinical sample are associated with changes in autobiographical knowledge, enhancing negative self-schemas, when imagining future events.

The Online Remote Behavioural Intervention for Tics (ORBIT) trial found that an internet-delivered, therapist-supported, and parent-assisted Exposure and Response Prevention (ERP) intervention reduced tic severity and improved clinical outcomes. This process evaluation aimed to explore mechanisms of impact and factors influencing efficacy. Participants were 112 children with a tic disorder and their parents randomised to the active intervention arm of the ORBIT trial. Child engagement was assessed by usage metrics and parent engagement by chapter completion. Experiences of the digital intervention were explored by semi-structured interviews. Outcomes (3-months post randomisation) were change in tic severity and overall clinical improvement. Tic severity reduced from baseline to 3-month follow-up and 36% were rated as much improved clinically. Greater tic severity at baseline predicted reduction in tic severity. Parental engagement was the only independent predictor of clinical improvement. There were no statistically significant mediators or moderators of the relationship between level of child engagement and outcome. From the qualitative findings, child participants appreciated working together with parents on the intervention and participants found the intervention engaging. ORBIT may be an effective and acceptable intervention for children and young people with tic disorders, with parental engagement being a key factor in successful outcomes.

Non-suicidal self-injury is commonly explained using an emotion regulation framework. Increasingly, early maladaptive schemas (EMS) are also used to conceptualise self-injury. However, there is an absence of research examining the relationship between EMS, emotion regulation, and self-injury. The current study attempted to address this gap by comparing youth with and without a history of self-injury on measures of emotion regulation difficulties and EMS, specifically Abandonment/Instability and Defectiveness/Shame. Specifically, we were interested in assessing whether difficulties in emotion regulation mediated the relationship between EMS and self-injury. Four hundred and three Australian secondary and university students aged between 16 and 25 years, completed measures of self-injury, EMS, and difficulties in emotion regulation. We found significant and positive relationships between Abandonment/Instability, Defectiveness/Shame and six emotion regulation difficulties. Young people with a self-injury history reported more difficulties in emotion regulation compared to those who had never self-injured. For each of the EMS, there was a direct effect on self-injury status, as well as an indirect effect via total emotion regulation difficulties. There was a significant indirect effect of Abandonment/Instability on self-injury via limited access to emotion regulation strategies. Results contribute to our understanding of mechanisms underlying the association between EMS and self-injury, that is, through emotion regulation difficulties. Results are discussed with reference to clinical implications, suggesting that targeting both EMS and emotion regulation difficulties may be appropriate when working with young self-injurers.

Difficulty in regulating emotions is implicated in the severity and persistence of obsessive-compulsive disorder (OCD). While emotional regulation has recently been examined relative to certain clinical manifestations of this disorder, its association with symmetry, ordering, and arranging symptoms (SOAS) remains poorly understood. However, the heterogeneity of both OCD and emotional regulation difficulties has hindered the identification of specific associations that may permit the refinement of treatment strategies. The present study examines this issue in a sample of 237 participants who completed online questionnaires of OCD symptoms and difficulties in emotional regulation. Initial analyses demonstrated positive and significant correlations between SOAS and several forms of emotional difficulties when considered individually. However, multivariate analyses demonstrated the preponderant role of impulse control difficulties (β = 0.279, t = 4.363, p < 0.100) in explaining variance in SOAS. When experiencing negative emotions, difficulties in impulse control behaviors appear to play a salient role in the exacerbation of symptoms of symmetry, ordering, and arranging, and merit particular attention in the choice of clinical interventions for these patients.

The current study examined predictors of outcomes across two school clinician-delivered treatments (i.e., treatment as usual [TAU] or modular cognitive-behavioral therapy [M-CBT]) for youth with anxiety disorders. Predictors reflected two broad domains—therapist factors (i.e., education, years of experience, therapeutic orientation, work related stressors/barriers, self-efficacy, and attitudes towards evidence-based practices) and treatment-related factors (i.e., dosage, child compliance with treatment, therapeutic alliance, therapeutic nonspecifics, and proportion and quality of evidence-based structure elements). One hundred and ninety-five youth (mean age 10.98; 50.3% female, 53.5% non-Hispanic Caucasian) and 54 therapists (90.7% female, 72.2% non-Hispanic Caucasian) that were enrolled and randomized in a previous study (Ginsburg et al., 2020) participated. Results showed that incorporation of more evidence-based structure elements (e.g., agenda setting, assigning homework) and higher child compliance with treatment significantly increased odds of response to treatment. These findings provide important information about key ingredients to successful treatments, regardless of treatment condition/modality, and can be used to inform future training and implementation of school-based treatments for youth with anxiety disorders.

Suicide is an important public health issue in France, where the suicide rate is among the highest in Europe. While suicidal thoughts and behaviors are prevalent among young adults including college students, an important gap exists between the presence of psychological difficulties and the use of mental health services. Using data drawn from the French portion of the World Mental Health International College Student survey initiative (WMH-ICS), the current study investigates the use of mental health services among college students with 12-month suicidal ideation and examines the barriers identified by students who did not receive care, and include cohorts enrolled pre-pandemic and during the pandemic. Only one quarter received services and among those who did not, one half reported a perceived need. Prior services use, any anxiety disorder, depressive disorder, and suicide attempt were associated with the use of services in the past 12 months. The most frequently reported barriers were wanting to handle the problem on their own, being unsure of where to go or who to see, and being too embarrassed. The pandemic context was associated neither with services use nor with greater reported barriers. These findings underline the gap in mental health services use among college students despite the accessibility of mental health services in France. Identifying the barriers which restrict the use of mental health services among students could contribute to identifying specific targets for prevention, and facilitate access to appropriate services.

To provide a normative backdrop by which clinical-researchers and clinicians can consider the benefits of cognitive behavioral therapy (CBT) for major depressive disorder (MDD), we consider what is known and what can be extrapolated about the average patterns of remission and relapse for CBT-treated versus untreated individuals with MDD. To achieve this, a detailed analysis of the average monthly trajectories experienced by CBT-treated patients is performed: remission during the duration of acute-phase (three months) and continuation-phase CBT (nine months thereafter) as well as relapse during the year following remission are examined utilizing published clinical trial data. We contextualize these mean treatment trajectories with comparative trajectories of untreated individuals and provide both graphical (primary outcome) and textual information on the patterns of remission and relapse as judged by the current literature. Finally, through investigating these trajectories, we also present where the current literature is and is not well-informed on the longitudinal course of CBT-treated and untreated MDD.