Journal of Cognitive Psychotherapy最新文献

One potential explanation for difficulty in treating trichotillomania despite increased research on evidence-based treatments is the heterogeneity in symptom presentation. An individualized treatment approach may help increase treatment response and recovery. Additionally, understanding which processes help improve treatment outcomes in psychosocial interventions may be particularly important. This study examined how changes in trichotillomania-specific psychological inflexibility related to week-to-week levels of hair-pulling severity and distress. We also explored a potential bidirectional relationship between hair-pulling severity and trichotillomania-specific psychological inflexibility. Results indicated that trichotillomania symptom severity predicted trichotillomania-specific psychological inflexibility and vice versa, suggesting a bidirectional relationship. Additionally, trichotillomania-specific psychological inflexibility may play a more central role in trichotillomania symptom changes. Moreover, distress was strongly predicted by current trichotillomania-specific psychological inflexibility. Trichotillomania-specific psychological inflexibility appears to be a process of change in treatment for trichotillomania. Clinical implications are discussed.

Obsessive-compulsive disorder (OCD) is a debilitating, often chronic condition with symptoms that are time-consuming and can cause distress or impairment. OCD can involve and have a significant impact on families. Although calls for family-inclusive treatment for OCD exist, results on its effectiveness are mixed. This case report presents Jane, a young adult with OCD in psychiatric residential treatment, and how her symptoms were profoundly affected and maintained in part by maladaptive family processes. Attachment-based family therapy is used in conjunction with exposure and response prevention to reduce Jane's symptoms, minimize family accommodations, address underlying family processes, and improve family dynamics. Treatment outcomes were assessed through standardized tools, clinician observations, and patient self-reports. By the conclusion of treatment, Jane saw reductions in OCD, anxiety, and depressive symptoms, an increase in well-being, and improved family communication. Implications and recommendations will be discussed.

Although exposure with response prevention (ERP) is the frontline treatment for obsessive-compulsive disorder (OCD), several challenges exist in its implementation. Emerging technologies, including mobile health (mHealth) apps and extended reality (XR), offer innovative solutions to overcome these challenges. In response, we surveyed OCD therapists to establish the utilization of emerging technologies in clinical practice and investigate accompanying barriers. A total of 223 therapists reported their use, interest, and perceived barriers regarding mHealth and XR tools in clinical practice. While 62.1% presently reported using mHealth apps-mostly mindfulness and mood tracking-fewer therapists used them for ERP-specific tasks. Despite high interest in XR by OCD therapists, only 9.1% had used XR in ERP. Barriers to technology utilization included lack of knowledge, limited training, and uncertainty about evidence to support use. Findings highlight a need for clinical resources, therapist training, and further research to determine how to optimize the implementation of ERP using novel technologies.

Telehealth has become a pillar for the delivery of psychotherapy, including exposure-based treatments for anxiety-related disorders. While research broadly supports the efficacy of telehealth-delivered anxiety treatments, clinicians and patients need to weigh the benefits and limitations to make informed decisions. This piece highlights the benefits of supporting continued use of telehealth exposure-based treatments, including access to specialized services, treatment efficiency, facilitation of naturalistic exposures, and family involvement. We also outline challenges related to building rapport, delivering psychoeducation, monitoring safety behaviors, and treating young children or individuals with complex presentations. Strengths and weaknesses are summarized in a checklist that can be used as a preliminary tool for clinicians and patients to assess the suitability of teletherapy. Additionally, we discuss gaps between efficacy and clinician perceptions of feasibility and identify future research directions, including examination of treatment moderators and development of triage frameworks to guide treatment format decisions. Teletherapy holds lasting promise for exposure-based care, but its implementation must be flexible, tailored, and informed by evidence and patient-specific factors.

The emergence of generative artificial intelligence (GenAI) presents new opportunities for enhancing exposure therapy for anxiety- and trauma-related disorders. GenAI is not a replacement for clinical expertise but a powerful ancillary tool. This article offers practical guidance for clinicians and patients on how to use GenAI to develop and conduct personalized exposure exercises. To help orient clinicians to these tools, we provide an overview of ethical considerations and describe the fundamentals of how to use GenAI between and within sessions. We discuss how GenAI tools can assist in generating exposure stimuli, such as images, videos, and scripts, as well as conversational agents. We also provide guidance on how these tools can assist in brainstorming and organizing exposure hierarchies. Finally, we discuss how exposure therapy can continue to flourish using GenAI through clinician training, the exchange of GenAI stimuli and procedures, and clear messaging from leadership and organizations.

Youth in foster care exhibit behavioral and emotional challenges, often linked to complex trauma exposure. There is a paucity of accessible evidence-based interventions to support foster caregivers in addressing youths' needs. Self-guided, digital single-session interventions (SSIs) represent a promising solution. As the first phase of an intervention mapping project, we conducted a systematic, qualitative needs assessment with foster caregivers (n = 13) and child welfare providers (n = 6) to inform the design of a trauma-informed SSI for foster caregivers. A team-based, multistage analytic coding strategy guided by grounded theory principles and consisting of inductive and deductive approaches was used. Thematic content analysis and axial coding identified resulting themes. Three areas of challenges and desired support were identified, including validating foster caregivers and addressing systemic challenges, supporting caregivers in navigating foster care transitions, and addressing trauma and developmental challenges in foster youth. Implications for the design of a community-informed SSI are discussed.

Cognitive behavioral therapies are the first-line psychotherapeutics for fear-based conditions, including anxiety, obsessive-compulsive (OCD), and trauma-related disorders. Despite documented efficaciousness and effectiveness, various factors limit the availability of these evidence-based treatments. Technologies may be used to circumvent treatment barriers, improving access to care and optimizing treatments to address symptoms among those with fear-based conditions. Original research articles in this Special Issue include a study on provider use of digital mental health and extended reality technologies for the treatment of OCD; a stepped-care treatment study on trichotillomania, a condition highly comorbid with fear-based conditions; and a qualitative needs assessment for the development of a digital, trauma-informed, single-session intervention for foster caregivers. The Special Issue also includes two review pieces: one presenting treatment recommendations on generative artificial intelligence for exposure therapies and the second on treatment considerations for telehealth-delivered treatment for OCD.

Cognitive impairment is a core feature of schizophrenia, significantly affecting patients' daily functioning and quality of life. Cognitive rehabilitation nursing (CRN) has emerged as a promising nonpharmacological approach to improve cognitive deficits. This systematic review and meta-analysis aimed to evaluate the efficacy of CRN in enhancing cognitive function in patients with schizophrenia. A systematic literature search was conducted in Web of Science, PubMed, and Scopus for studies published between 2020 and 2025, using a combination of controlled vocabulary and free-text terms. Eligible studies were original, peer-reviewed articles examining CRN interventions in individuals with schizophrenia, with cognitive or functional outcomes. Fifteen studies comprising 19 intervention arms met the inclusion criteria. Methodological quality was assessed using the Cochrane RoB-2 (Risk of Bias 2) tool for randomized trials and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) for nonrandomized studies. Standardized mean differences (SMDs) with Hedges' g correction were calculated under a random-effects model. Heterogeneity was examined using I² statistics, and publication bias was evaluated through funnel plots and Egger's test. A total of 19 intervention arms from 15 studies were included. Overall, cognitive rehabilitation yielded a small but favorable effect across cognitive domains (SMD = .35, p = .084), with a significant moderate-to-large effect observed for executive function (SMD = 0.63, p = .035), particularly in studies employing computerized, individualized, or virtual reality-based interventions. Effects on global cognition, memory, and functional outcomes were smaller and nonsignificant, while social cognition, assessed in one study, showed a small negative effect (SMD = -0.34, p = .046). Pharmacological and game-based interventions showed inconsistent efficacy. Substantial heterogeneity was present (I² = 85.3%), with outcome domain emerging as a significant moderator (p < .001). Publication bias analysis indicated potential small-study effects, although no missing studies were identified via the trim-and-fill method. This meta-analysis supports the effectiveness of CRN in improving cognitive outcomes in schizophrenia, with the strongest effects on executive function. Targeted, multimodal, and tech-enhanced interventions showed the greatest promise. Despite heterogeneity, the findings were consistent, reinforcing CRN's role in multidisciplinary psychiatric care.

Existential obsessions-persistent, intrusive doubts about unanswerable questions such as the nature of reality, identity, free will, and death-are an understudied and underrecognized presentation of obsessive-compulsive disorder (OCD). Although these symptoms align with core OCD features, their abstract and philosophical content distinguishes them from more commonly studied presentations. This article provides a conceptualization of existential obsessions, outlining their phenomenology, cognitive-behavioral underpinnings, and implications for assessment and treatment. We identify four primary content domains, namely, metaphysical, thanatological, ontological, and deterministic obsessions, and draw on established OCD models to explain their development and maintenance. Sociocultural and developmental influences are also highlighted. We then outline treatment recommendations based on the conceptual model and present a research agenda to address gaps in the literature, including the need for targeted assessment tools, empirical tests of proposed mechanisms, and treatment trials. Just as other manifestations of OCD have gained clarity through empirical study, existential obsessions merit scientific attention to enhance recognition and improve outcomes.