Journal of Behavioral and Cognitive Therapy最新文献

Research supports the use of dialectical behavior therapy (DBT) for patients with eating disorders (EDs). The DBT skills deficit model suggests that individuals engage in maladaptive behaviors to reduce or avoid strong emotions due to lack of knowledge or mastery of more effective methods to regulate distress. A primary component of DBT is teaching patients skills to cope with emotional dysregulation. Building upon previous research, this study examined whether change in DBT skills use frequency mediated the relationship between emotion dysregulation and ED symptoms across ED diagnoses, in a sample of treatment-seeking adults with EDs (N = 454). Variables were measured at treatment admit, one-month post-admission, and discharge. Bootstrapped mediation analyses were used and biased-corrected 95% confidence intervals (CIs) were computed. Increases in DBT skills use mediated the association between emotion dysregulation and ED psychopathology (95% CI [−.0022, −.0002]), but not change in binge eating (95% CI [−.0034, .0001]) or self-induced vomiting (95% CI [−.0032, .0006]). The index of moderated mediation for all outcomes indicated the simple mediation model did not significantly differ as a function of diagnosis type. Results provide support for the DBT skills deficit model in an ED sample and suggest that DBT improves ED psychopathology by increasing frequency of using effective coping skills.

It is commonly assumed that women blush more strongly than men, but sex differences in blushing have been identified in only a few studies and what underlies these differences has not been explored. Hence, the aim of this study was to investigate factors that might underlie sex differences in blushing. To monitor blushing, changes in pulse amplitude in the forehead skin were measured in 40 male and 40 female participants during stressful laboratory tasks (serial subtractions and singing). A male or female experimenter interacted with participants during these tasks in a critical or friendly manner. In addition to blushing, the effect of these manipulations on gaze aversion (a nonverbal cue of embarrassment) was explored. Blushing was greater in women than men and was greater in participants tested by a male than female experimenter. However, neither the sex-composition of experimenter-participant dyads nor the interpersonal style of the experimenter modified blushing intensity, despite effects on eye contact. These findings suggest that sex-linked influences on autonomic reactivity rather than embarrassment moderate blushing during social interactions. These sex-linked influences may be important during cognitive-behavioural treatments for social anxiety associated with fear of blushing.

Given the high prevalence of emotional disorders among college students, its high social, emotional and economic costs, and a large treatment gap, we designed and evaluated a preventive group intervention based on the Unified Protocol for the transdiagnostic treatment of emotional disorders (UP; Barlow et al., 2011). A total sample of 128 college students in a state university in Bogotá (Colombia) was recruited for this quasi-experimental study with three assessment points: pre-treatment, post-treatment, and three-month follow-up. Participants were included in the control or intervention conditions based on non-random assignement. At the end of the intervention, group analysis suggested significant declines in transdiagnostic risk factors and neurotic temperament and gains in mindfulness, perceived control, and emotional dysregulation. Significant declines were found also for emotional variables such as stress, anxiety, and depression. These results suggest that a preventive intervention based on the Unified Protocol may have a significant impact on several transdiagnostic risk factors and emotional variables making it a promising prevention and mental health promotion program for college students. Since this is the first Colombian study on the matter, its replication and the use of larger and more diverse samples are recommended for future research.

This study reports findings from an open trial of a two-session intervention for veterans with symptoms of PTSD and hazardous drinking. Rooted behavioral economic theory, this intervention aimed to decrease alcohol use and increase alcohol-free activities through personalized and normative feedback. This trial assessed the feasibility and acceptability of the intervention in a sample of 15 veterans. Participants completed assessments at baseline and post-intervention (1-month and 3-months). Thirteen participants (86.6%) were retained between the baseline assessment and second intervention session. Acceptability data indicated that veterans overwhelmingly viewed the intervention positively with little dropout between the two sessions. Further, participants in our study reduced alcohol consumption from 37.30 (SD = 17.30) drinks per week at baseline to 22.50 (SD = 27.75) drinks per week at the 1-month assessment and then to 14.60 (SD = 18.64) at the 3-months assessment, representing medium to large effects. PTSD severity also decreased from 57.20 (SD = 16.72) at baseline to 48.90 (SD = 18.99) at the 1-month assessment, representing a small effect. Though effect sizes from pilot trials should be interpreted with caution, findings suggest that this intervention was well-received, feasible to deliver, and may have resulted in improvements in intervention targets.

Approach and avoidance motivational changes over the course of Emotion Regulation Therapy (ERT) were assessed at pre-, mid-, and post-treatment using an Approach-Avoidance variant of the Implicit Association Test (AAIAT) that specifically targeted implicitly-held action tendencies about approach/avoidance in the context of positively and negatively valenced word stimuli. We expected implicit associations would be demonstrated by reduced AAIAT Total scores from mid- to post-treatment potentially reflecting increased approaching of contexts regardless of valence. We hypothesized that: (1) AAIAT performance would be responsive to ERT during the second half of treatment when the intervention is specifically focused on exposure to approach-avoidance conflict; (2) changes in AAIAT performance during this period would be associated with changes in clinical outcomes; (3) changes in clinical outcomes during the first half of treatment would not be associated with changes in AAIAT performance occurring in the second half. As expected, AAIAT performance significantly changed from mid- to post-treatment, reflecting an increased likelihood of approaching contexts regardless of valence. These changes were related to improvements in quality of life, functional impairment, and negative emotional intensity. ERT shows promise in changing maladaptive approach/avoidance motivational tendencies for individuals with distress disorders, particularly during the second half, when treatment is focused on approach-avoidance content. This study underscores the value of implementing behavioral tasks as complementary tools to self-report measures in furthering our understanding of core mechanisms (e.g., motivation) implicated in the psychopathology and treatment of distress disorders.

Executive functions are a broad term used to describe the cognitive functions necessary to help individuals complete tasks and achieve goals. Executive functioning weaknesses are a hallmark feature of psychopathology, particularly in youth. These weaknesses are associated with chronic impairment across academic, social and family domains and do not typically improve into adulthood. Despite these negative outcomes, few behavioral interventions have been successfully developed to target executive functioning outside of ADHD, particularly in adolescents with various types of psychopathology. The thinkSMART® program was created to target the broad heterogeneity of adolescents with executive function weakness. We discuss the rationale for the development of the program, as well as outline the primary skill areas addressed. We also present an open-trial pilot study using the program in adolescents ages 12–17 who identify as having executive functioning weaknesses. Preliminary findings highlight the acceptability and feasibility of the program, as well as the initial efficacy in improving adolescents’ day-to-day executive functioning. We discuss the limitations and benefits of providing broad skills and compensatory strategies to improve adolescent executive functioning.

Recent evidence from well-controlled efficacy studies suggests that diffusing treatment focus across multiple concerns is associated with poorer clinical outcomes. However, research regarding treatment focus diffusion (TFD) in public mental health care (PMHC) settings, broadly or in implemented evidence-based treatments (EBT), is scarce, despite therapists in such settings often reporting more complex cases. Using multilevel modeling, this study examined TFD differences between two in-home PMHC services: (a) Multisystemic Therapy (MST; n = 911 youths, 109 therapists), an implemented EBT, and (b) a less structured service more characteristic of treatment as usual (n = 2362 youth, 457 therapists). The relationship between TFD and monthly therapeutic progress within and across these two service formats was also examined. Treatment focus diffusion occurred less in the implemented EBT. Overall, receiving services through the less structured service format and more diffused treatment focus predicted less and slower progress over the course of treatment. The relationship between TFD and less clinical progress was stronger in the MST format. These findings held when accounting for indicators of case complexity including initial level of impairment and number of diagnoses. EBTs appear to maintain a narrower treatment focus even when implemented in a public mental health system. However, even in EBTs, TFD predicts poorer clinical progress. Maintaining a narrow treatment focus, even in complex cases typical of PMHC, might improve clinical outcomes.

This study focused on sexual aversion (SA) – namely the experience of fear, disgust, and avoidance when exposed to sexual contexts or cues – and aimed to validate a virtual environment's ability to progressively trigger the typical emotional responses of SA. Thirty-nine participants (16 low-SA and 23 high-SA individuals) were immersed in a virtual room and then successively exposed to six scenarios in which a synthetic character showed erotic behaviors of increasing sexual intensity. Throughout immersion, subjective measures of anxiety and disgust (Subjective Units of Discomfort Scale; SUDS), skin conductance, heart rate, cardiac output, and eye movements were recorded. The changes in SUDS and physiological variables were examined through repeated measures analyses of variance. SUDS scores significantly increased as the levels of exposure progressed among the high-SA participants, who also reported significantly more anxiety and disgust than the low-SA group. Significant large time effects were found for cardiac output and eye fixation (on face, chest, and genitals), but no significant group*time interactions were found for physiological variables. Results show that this virtual environment may be a promising tool for research and practice, and its efficacy as part of a virtual reality exposure-based treatment for SA should be tested.