Behavioural and Cognitive Psychotherapy最新文献

Background: Evidence suggests that death anxiety is a transdiagnostic construct underlying numerous anxiety-related conditions. A previous phase I trial of Overcome Death Anxiety (ODA), a novel online stand-alone psychological intervention to reduce death anxiety, demonstrated preliminary evidence of efficacy and acceptability in a clinical population. However, this trial was limited by a small sample size (n=20).

Aims: To further evaluate the efficacy of this intervention in reducing death anxiety in a clinical population, compared with a waitlist control.

Method: This paper describes the protocol of a phase II randomized controlled, unblinded trial of ODA. A total sample of 256 adults living in Australia, diagnosed with an anxiety-related condition, will be recruited. These participants will be randomised to ODA or a waitlist control. Primary outcomes will be measured as changes in scores on death anxiety questionnaires, reflecting treatment efficacy. The secondary outcomes to be measured are depression, anxiety, stress, suicidality, insomnia, and meaning of life, as well as feedback about treatment program acceptability. This trial will assess the efficacy of ODA for reducing death anxiety in a population diagnosed with various anxiety-related conditions, as well as the overall acceptability and tolerability of the intervention.

Conclusions: This study will provide evidence to evaluate the efficacy of ODA in people diagnosed with an anxiety-related condition.

Background: Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained.

Aim: The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program.

Method: A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression.

Results: The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up.

Conclusions: Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

Background: Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

Aims: To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre-post effect size.

Method: Nine children and adolescents (aged 8-17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

Results: No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

Conclusions: These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

Background: A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations.

Aims: The current study's aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents.

Method: The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors.

Results: Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η²p=0.047, p=0.005), Impaired Autonomy and Performance (η²p=0.074, p<0.001), and Impaired Limits (η²p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η²p=0.046, p=0.005) and Excessive Responsibility and Standards (η²p=0.054, p=0.002).

Conclusions: Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.

Background: Distressing mental images are common in people with psychosis. The central role of metacognitive difficulties in psychosis suggests that metacognitive interventions with imagery properties could play a central role in managing distressing mental imagery. A brief imagery-based metacognitive intervention was developed to target the control mechanism of distressing mental images in psychosis.

Aims: A fixed baseline case series was designed to investigate whether the intervention was acceptable, feasible and effective.

Method: Eight participants who met criteria for a schizophrenia spectrum diagnosis and experienced distressing future-oriented mental images took part in the case series, which consisted of three phases; baseline, intervention, and follow-up. Symptoms of anxiety, depression, persecutory delusions and schemas were assessed pre- and post-intervention, and qualitative feedback was collected at follow-up.

Results: The metacognitive intervention was feasible, acceptable, and rated as highly satisfactory. One participant dropped out at the baseline phase. No adverse events were reported. Positive change scores with a decrease in symptoms were reported for anxiety, depression, persecutory delusions, and schemas. Tau-U analysis showed positive trends and high effect sizes on mental imagery characteristics at follow-up.

Conclusion: Our findings suggest that it is acceptable and feasible to engage people with psychosis in a brief imagery-based metacognitive intervention and that positive change can be achieved. Further studies are needed to replicate and clarify the findings of our study and develop the evidence base for this intervention.

Introduction: Bipolar disorder (BD) has a significant impact on functioning in the absence of acute mood episodes. This has been associated with subsyndromal symptoms, co-morbidities, and emotional dysregulation. The present study aims to evaluate the acceptability and preliminary efficacy of imagery-based cognitive therapy (ImCT) in a French community setting. We were particularly interested in the link between mental imagery and emotional dysregulation as this may clarify the mechanisms involved in the potential efficacy of the therapy and ultimately improve its relevance.

Method: Ten participants underwent ImCT, with weekly assessments of mood fluctuations, anxiety, and emotional dysregulation conducted over 1 month (i.e. pre-therapy, post-therapy and 1-month follow-up). Recovery, post-traumatic stress symptoms and self-compassion were measured at baseline and post-therapy. Attrition rates and satisfaction were measured.

Results: All participants who completed therapy (n=8) reported high levels of satisfaction. Five of them showed reliable individual improvement on emotion dysregulation scores. At the group level, a significant decrease in mood fluctuation with a large effect size was found post-therapy.

Conclusion: ImCT showed good acceptability among participants who completed the study. Importantly, our study is the first to provide an indication that ImCT may alleviate subsyndromal mood symptoms but also emotional dysregulation in individuals with BD. This latter finding is particularly relevant given the scarcity of validated psychosocial interventions targeting emotional dysregulation in BD.

Background: Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms.

Aims: The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters.

Method: The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention.

Results and discussion: Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group (U=1644, p<0.001, Wilcoxon r=0.280). No significant change was observed in attention bias post-intervention (U=2460, p=0.737, Wilcoxon r=0.039), while a significant increase was observed in attention-bias variability (U=3172, p<0.001, Wilcoxon r=-0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.

Background and aims: Low-intensity psychological interventions are effective for children and young people (CYP) with mental health difficulties and can help bridge the demand-capacity gap. Despite increasing awareness, training and use of low-intensity psychological interventions, it is not yet understood what is being implemented in clinical practice in the UK and the associated evidence base.

Method: This paper presents two studies; first, a national survey (n=102) of practitioners to identify low-intensity psychological interventions currently delivered in practice and second, an exploration of the availability and the strength of empirical support (characterised as 'gold', 'silver' and 'bronze') of low-intensity CBT interventions for CYP.

Results: The first study found a wide variety of interventions being used across different services; 101/102 respondents reported using routine outcome measures. The second study identified 44 different low-intensity interventions, 28 of which were rated as having gold empirical support. However, only 13 of the gold interventions were considered accessible for practitioners and only two were reported being used in routine practice.

Conclusion: These findings highlight that these interventions have been developed and empirically tested, but many are not easily accessible, highlighting the 'research-practice' gap in the provision of low-intensity interventions. There is a need for an increase in standardisation of care and accessibility of gold interventions. This paper hopes to begin the process of creating a hub of low-intensity interventions that are accessible and empirically supported to improve equity of access and outcomes of low-intensity psychological interventions for CYP.

Intolerance of uncertainty (IU) is commonly defined as the tendency for one to interpret uncertainty as negative or threatening. Most general or non-specific measures of IU show a strong relationship with worry and generalized anxiety disorder symptoms; however, a specialized measure of intolerance of uncertainty in social situations could provide insight into the role of IU in social anxiety. The purpose of this study was the development and preliminary validation of the Intolerance of Uncertainty in Social Interactions Scale (IU-SIS), a comprehensive measure designed to assess intolerance of uncertainty in social situations. Participants consisted of a non-referred sample. Based on an exploratory factor analysis, a two-factor solution was retained, with factors labelled Social Ambiguity and Need to Reduce. Both subscales were found to have good reliability and validity. Both subscales of the IU-SIS predicted up variance on measures of social anxiety after controlling for variance explained by a well-established general/non-specific measure of IU. Overall, the IU-SIS shows promise as a tool to elucidate the association between intolerance of uncertainty and social anxiety.