Journal of Cognitive Psychotherapy最新文献

While cognitive behavioral therapy (CBT) is a first-line treatment for anxiety, it is not typically offered to those with intellectual disability (ID). In this article, we provide a historical perspective on the treatment of mental health concerns in adults with ID, describe an adapted CBT treatment for anxiety in adults with Williams syndrome (WS) and mild to moderate ID, and discuss general modifications to CBT for adults with ID. Strategies used to successfully adapt CBT for adults with WS that may generalize for adults with ID more broadly include: (a) using child-based CBT manuals as a framework; (b) involving a caregiver as a therapy partner; (c) incorporating a high level of repetition; (d) simplifying language; (e) slowing the pace of instruction; and (f) incorporating specific examples and adaptations for WS.

Cognitive fusion (CF) and experiential avoidance (EA) are two constructs of acceptance and commitment therapy that contribute to psychological distress. The current study aimed to examine whether CF and EA accounted for variance in the relationships between key cognitive maintaining factors of social anxiety and indicators of social anxiety. This issue was investigated using a longitudinal design in a nonclinical sample. Participants (N = 361) completed baseline measures of CF, EA, cognitive maintaining factors, and indicators of social anxiety, and the measures of indicators of social anxiety were recompleted 6 weeks later (N = 262). Results showed that baseline postevent processing had significant indirect effects on fear of negative evaluation at follow-up: (a) via CF, (b) via EA, and (c) via a serial pathway of CF → EA. Interventions that aim to reduce CF, in particular, may be a priority in reducing fear of negative evaluation associated with postevent processing.

The metacognitive model of generalized anxiety disorder (GAD) considers Type II worry, which represents one's tendency to negatively appraise worry, as a defining feature of GAD, and negative metacognitive beliefs are central to eliciting Type II worry during worry episodes. Extant research has found that individuals experiencing GAD report elevated Type II worry, and that negative metacognitive beliefs correlate with Type II worry. However, because of how Type II worry was assessed in existing studies, it remains unclear if negative metacognitive beliefs relate to state Type II worry specifically during a worry episode. This study sought to fill that gap in the existing literature among a sample of individuals experiencing elevated GAD symptom severity (N = 106). Participants completed an assessment of GAD symptom severity and metacognitive beliefs, while later attending an in-person study session where they completed a worry induction and state Type II worry, as conceptualized as the strength of negative appraisals of worry, which was then assessed. Metacognitive beliefs generally positively correlated with state Type II worry, with negative metacognitive beliefs being the only metacognitive belief domain that correlated with state Type II worry in multivariate analyses. Implications for how these results support the metacognitive model of GAD and treatment implications are discussed.

This de-identified case study seeks to increase the understanding of the process and impact of modifying exposure and response prevention (ERP) to address obsessions associated with COVID-19. The case study presents the assessment, diagnosis, and treatment of obsessive-compulsive disorder via televideo utilizing ERP for a woman who presented with difficulty with contamination and harm obsessions related to COVID-19. Over the course of 7 months, including an initial evaluation, this client attended 24 treatment sessions via synchronous video telehealth. Psychoeducation, self-monitoring, in vivo and imaginal exposures, response prevention, and behavioral activation strategies were utilized. Following treatment, this client was successfully managing symptoms and her scores on the Yale Brown Obsessive-Compulsive Scale and Sheehan Disability Scale had decreased significantly.

Heeding calls to examine multiple protective factors within single studies, this study tested whether resilience uniquely predicted higher life satisfaction and lower depression over the predictive ability of generalized self-efficacy (GSE) and mindfulness among 332 university students. A second purpose was to test whether resilience uniquely buffered the relationship between two forms of stress-cumulative stress from particular negative life events and general perceived stress-and both life satisfaction and depression over the buffering ability of GSE and mindfulness. In hierarchical multiple regressions, resilience uniquely predicted 3% of the variance in satisfaction with life and 1% of the variance in depression. GSE and mindfulness buffered the relationship between cumulative negative life event stress and depression. At higher levels of GSE and mindfulness, the relationship between cumulative negative life event stress and depression was weaker.

A prior open trial of acceptance and commitment therapy (ACT) for comorbid social anxiety disorder (SAD) and depression showed clinically significant improvement over the course of 16 sessions. The aim of the current study was to test the feasibility and acceptability of ACT for this population in a pilot randomized trial within a routine practice setting. Patients (n = 26) were randomly assigned to 16 weeks of medication treatment as usual (mTAU) versus mTAU plus ACT (mTAU + ACT). Results showed that a significantly greater percentage of patients in mTAU not only dropped out of the study but also dropped out of treatment at the practice altogether, compared to patients in mTAU + ACT. Overall, results from this study suggest that having a comparison condition of mTAU alone in a randomized trial in a routine practice setting is not feasible and that patients with comorbid forms of SAD may require psychotherapy to remain engaged in treatment in standard clinical practice. Preliminary results for patients within the mTAU + ACT condition on treatment satisfaction and outcomes were comparable to results from the prior open trial, suggesting that ACT itself is worthy of further investigation. Further modifications to the study design may be needed to develop a feasible and acceptable comparison condition against which to test ACT for comorbid SAD in a routine practice setting.

A mental health treatment gap exists in which individuals who would benefit from evidence-based psychotherapies (EBPs) do not receive them. It is critical to take effective actions so that individuals with unmet mental health needs feel empowered to seek treatment. Direct-to-consumer (DTC) marketing meets this objective. DTC marketing is an effective, patient-centered approach that creates patient demand for a product or service by influencing patient behaviors, attitudes, and preferences. While primarily used in the United States and New Zealand to promote prescription drugs, uses and practices for DTC marketing with nonpharmaceutical EBPs are less established. This article highlights the value of leveraging this marketing approach to increase awareness and use of EBPs. Additionally, an illustrative example is presented that describes the use of social marketing and marketing mix principles to develop effective DTC marketing campaigns in psychotherapy practice.

The application of cognitive behavioral therapy (CBT) for hoarding disorder (HD) is described. We describe the components of CBT for HD and provide examples of how this treatment was implemented with two individuals at our clinic, one in group treatment and the other in individual therapy. These case examples are used to highlight a process of troubleshooting common barriers to treatment, enhancing motivation, creating structure, and assessing treatment progress. We compare the group and individual treatment for HD and discuss the pros and cons of each approach. Furthermore, we emphasize the importance of in-session practice, accountability and clear expectations, and realistic goal-setting across individual and group treatment. Finally, based on the cases included here, we highlight the need for additional research to extend CBT for HD (e.g., additional modules to help family members support a loved one in treatment for HD).

Mental health clinicians frequently experience hate speech during patient care, resulting in an ethical dilemma. This study evaluated a 1-hour webinar discussing the ethics of working with Veterans who use hate speech, motivations and intentions of hate speech, and guidance on how to respond. The webinar was offered through the virtual Community-Based Outpatient Clinic Mental Health Grand Rounds session at the Veterans Health Administration (VHA). Rural mental health clinicians were the target audience; however, all VHA clinicians could attend. Participants were VHA clinicians who completed the evaluation for the training and received one continuing education unit for this training (n = 668). They were highly satisfied with the training and would recommend it to others. They also reported the intention to talk with coworkers and trainees about responding to hate speech and requested additional training. The recorded training can be viewed for free at https://www.mirecc.va.gov/visn16/working-with-patients-who-use-hate-speech.asp.