Journal of Cognitive Psychotherapy最新文献

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared to low-perfectionist controls, in specific cortical structures: the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), right inferior parietal lobule (IPL). Participants in the perfectionist condition (n = 43) were from a randomized controlled trial evaluating ACT for clinical perfectionism and low-perfectionist controls were undergraduate students (n = 12). Participants completed three tasks (editing a passage, mirror image tracing, circle tracing) using functional near-infrared spectroscopy (fNIRS) to measure neural activation. Results indicate that ḥin the DLPFC and MPFC of the perfectionists whereas activation in the other tasks were relatively similar. There were no differences were observed in the right DLPFC, MPFC, and right IPL between the posttreatment perfectionist and nonperfectionist control groups. Our findings suggest an unclear relationship between neural activation and perfectionism.

Nearly all patients interact with critical gatekeepers-insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

Prior research suggests that estradiol may moderate fear extinction in animal models and humans. Based on these findings, estradiol may also moderate cognitive reappraisal, which is theorized to be an important mechanism of change in extinction-based therapy (exposure therapy). We compared cognitive restructuring (CR) skills acquisition and outcome between women with primary anxiety disorders who had high versus low estradiol using a standardized CR task that closely resembles clinical practice. As a proxy of CR outcome, we assessed subjective distress ratings before and after the task and psychophysiological arousal (heart rate and electrodermal activity) throughout the task. Contrary to predictions, results showed that CR skills acquisition and outcome did not differ between the high and low estradiol groups. Although both groups demonstrated reductions in negative affect and skin conductance responses during the CR task, suggesting that participants were able to acquire CR skills and use them effectively to regulate distress, the groups did not differ with respect to CR ability or outcome. The findings suggest that estradiol may not moderate cognitive reappraisal, and may have more of an effect on basic habituation and extinction processes instead.

Misophonia, a condition marked by extreme intolerance to certain classes of sounds (e.g., respiratory or gustatory noises), has recently attracted increased research attention. As yet there are no evidence-based treatments, although some promising options are under empirical consideration. This paper presents a stress management and exposure therapy-based treatment protocol for adults with misophonia. The protocol details considerations specific to exposure therapy for misophonia, including unique considerations for developing hierarchies and example misophonia exposure exercises and exposure homework. Stress management approaches employed to facilitate engagement with exposure are also described. Two case examples are included, which illustrate the application of the misophonia treatment protocol. The first case describes treatment for a client whose misophonia symptoms are the primary focus and the second case describes treatment for a client whose misophonia symptoms are secondary to relationship difficulties. This protocol can be used to stimulate further treatment research for misophonia and guide treatment for individuals with misophonia.