Behavioural and Cognitive Psychotherapy最新文献

Background: There can be heterogeneity in outcomes for individuals receiving targeted CBT for voices (CBTv), and rates of drop-out require investigation. To promote the directed provision of interventions to those most likely to benefit, it is necessary to elucidate the relationship between the factors driving the variability in engagement and response to these interventions.

Aims: This study aimed to explore the possible predictors of engagement and outcome for a transdiagnostic cohort of service users receiving Guided self-help cognitive behaviour intervention for VoicEs (GiVE), a brief, manualised CBTv intervention.

Method: This study utilised a quasi-experimental approach to explore and analyse potential predictors of engagement and outcome for service users offered a course of GiVE within routine clinical practice. The sample consisted of 142 service users who were assessed between January 2017 and September 2019 and were offered the GiVE intervention.

Results: The offer of the intervention was accepted by 108 (76%) service users and completed by 74 (52%). Clinically meaningful benefits on the primary outcomes of voice-related distress and recovery were reported by 54% and 48% of the service users who completed the intervention, respectively. For the prediction of engagement, only higher age was found to be associated with increased engagement, particularly for those aged 45-54 and 55-64. For the prediction of outcome, the only clinical measure found to be associated with poorer outcome was an increased anxiety score at baseline.

Conclusions: Engagement with and outcomes from the GiVE intervention may be enhanced with a pre-intervention consideration of age and the reduction of anxiety, respectively.

Background: Individuals with hoarding disorder exhibit heightened attachment to objects, but little is known about possible drivers of object attachment and associated object saving behaviors. Theory and preliminary evidence posit that the heightened object attachment characteristic of hoarding disorder may be partially explained by the experience of vivid, 'Proustian' memories related to objects.

Aims: The current study piloted a novel Proustian Memory Task to examine whether self-reported vividness of memories associated with cherished objects, mundane objects, and non-objects was associated with greater urge to save objects and greater hoarding symptoms.

Method: Participants (N=443) included a non-selected community sample recruited from the crowd-sourcing platform Prolific. Participants were asked to identify and describe a memory associated with their most cherished belonging, a mundane belonging, and a recent vacation (i.e. non-object control). Participants also reported their urge to save the identified objects and completed a self-report measure of hoarding symptoms.

Results: Hoarding symptoms were not associated with vividness of memories of cherished objects, or with non-objects, but were associated with greater vividness of memories of mundane objects. Greater vividness of memories associated with objects was associated with a greater urge to save both cherished and mundane objects; however, this relationship was stronger for mundane compared with cherished objects. The relationship between memory vividness and urge to save objects was not impacted by hoarding symptoms.

Conclusions: Findings provide preliminary evidence that the experience of Proustian memories, particularly those related to mundane objects, may play a role in object attachment and hoarding symptoms.

Background: Community crime against older people is of increasing concern but the relationship between safety-seeking behaviours and continued psychological distress has not been examined. As existing assessment tools have limited validity, we aimed to investigate this by designing a novel person-reported safety-seeking behaviour measure (PRSBM) and conducting preliminary evaluation of its wider applicability.

Method: We collected mixed-methods data from n=100 initially distressed older victims at 3 months post-crime, using the PRSBM. This asked older victims how often they engaged in six behaviours (checking, reassurance-seeking, rumination, avoidance, rituals, hypervigilance), what these were, how often, and how much they had changed since the crime. We measured continued distress using the two-item General Anxiety Disorder and Patient Health Questionnaires. We analysed qualitative behaviour data using codebook thematic analysis, quantitative data on behaviour frequency and change using logistic regression adjusted for gender, age and crime type, and explored the PRSBM psychometric structure using unique variable analysis.

Results: Older victims reported a wide range of safety-seeking behaviours conceptually consistent with their experiences. Some were highly restrictive; others may help maintain independence. The frequency of checking, avoidance, and hypervigilance, and a change in avoidance, were most strongly associated with continued distress. The PRSBM was acceptable, comprehensive, and captured differences and commonalities in safety-seeking.

Conclusions: As older victims identified as avoidant appear at risk of losing their independence, referral for treatment is recommended. The PRSBM appears promising as a research and clinical tool in a range of settings, suggesting further testing in different populations would be worthwhile.

Background: Low educational literacy is associated with high rates of mental health problems. In Pakistan, only 60% of the population is literate. Traditional CBT requires literacy skills. Interventions to address the literacy barriers need to be developed.

Aims: To evaluate the feasibility, acceptability, and preliminary efficacy of a culturally adapted CBT-based animated 'Shorts' series for depression and anxiety in individuals with no or low educational literacy.

Method: This randomized, rater-blind randomized controlled trial (RCT) compared an animated Shorts series and treatment as usual (TAU) with TAU alone in Pakistan. The primary outcomes were feasibility (recruitment, retention, adherence to treatment and trial processes) and acceptability (drop-outs and participants' feedback). The secondary outcomes included the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Thirty consenting participants were randomly allocated to one of the groups in a 1:1 ratio and were assessed at baseline and the end of the intervention at 12 weeks.

Results: The intervention was feasible and acceptable and was successful in reducing the symptoms of depression and anxiety. However, these findings need to be further confirmed in a larger RCT.

Conclusions: These preliminary findings are encouraging, and if future studies confirm that this approach can work, we should be able to overcome the literacy barrier in low- and middle-income countries.

Background: Perinatal obsessive-compulsive disorder (PNOCD) can impact up to one in five individuals in the perinatal period. Whilst effective treatment for PNOCD is available, parents experience barriers accessing this evidence-based psychological therapy. Healthcare professionals' perspectives on barriers to accessing support are valuable to develop targeted interventions to increase access to support for PNOCD.

Aim: This study aimed to prioritise a list of barriers to accessing therapy for PNOCD, in terms of importance and amenability to change, from the perspective of healthcare professionals.

Method: 203 healthcare professionals from across primary, community and secondary care services completed a survey where they ranked barriers in terms of importance and amenability to change. Barriers were ranked within clusters and across cluster names; 47 barriers were organised into seven clusters. Rankings were analysed using descriptive statistics and the non-parametric Friedman's test.

Results: Professionals ranked healthcare professionals' knowledge and training on PNOCD as the barrier which was most important and amenable to change. Parents' knowledge and awareness of PNOCD and services, their attitudes to mental health problems, and their attitudes towards healthcare professionals and services were ranked as the second most important and amenable to change.

Conclusion: Professionals view their colleagues' knowledge and training on PNOCD as the most important barrier impacting parents access to evidence-based therapy for PNOCD. Training for professionals could be targeted to increase access. Parents' awareness and attitudes surrounding PNOCD, mental health and services were also identified by professionals as an important barrier and is recommended to be targeted to increase access.

Background: Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress ('hotspots') during a trauma.

Aims: A data-only study was undertaken of cognitive therapy for PTSD 'hotspot' charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic 'imagination-based hotspots' in this sample.

Method: Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of 'imagination-based hotspots', defined as 'a peak of emotion during a traumatic event that is related to something imagined "in the mind's eye" as opposed to directly perceived with the senses'.

Results: 81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the 'shoes' of a tower resident.

Conclusions: Imagination-based mental imagery appears to be linked to the 'hotspots' of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of 'hotspots' in PTSD treatment.

Background: Approximately 24% of stroke survivors develop post-stroke depression (PSD), which is associated with poor psychological recovery, identity disruption, and reduced self-esteem. Psychological interventions often fail to address these broader challenges. The Wisdom Enhancement Timeline technique, which facilitates autobiographical reflection, has shown promise for depression in older adults. It has not yet been studied in a post-stroke population.

Aims: This study evaluated the effectiveness of the Wisdom Enhancement Timeline technique in stroke. It was hypothesised that wisdom would improve first, followed by identity/self-esteem and mood.

Method: A multiple-baseline single-case experimental design (SCED) was used across three stroke survivors. Daily visual analogue scale (VAS) ratings measured mood, identity, self-esteem, and wisdom during the trial. The Patient Health Questionnaire-9 (PHQ-9) measured depressive symptoms at pre- and post-intervention. Visual analysis, Tau-U, generalised least squares regression (adjusting for autocorrelation), and piecewise regression evaluated intervention effects.

Results: Improvements were observed across all participants and outcomes. Tau-U analysis indicated small-to-large effect sizes across outcomes (effect size range: 0.30-0.92). Breakpoints confirmed wisdom improved first, followed by identity/self-esteem and mood last. Regression confirmed significant level shifts across all outcomes. All participants showed clinically meaningful reductions in PHQ-9 scores, operationalised as a shift from pre-intervention scores above 10 to post-intervention scores below 10.

Conclusions: Wisdom-based interventions could be beneficial in a stroke population, promoting improvements in mood, identity coherence, self-esteem and wisdom. The Wisdom Enhancement Timeline technique shows promise for PSD treatment, although further research is needed to validate these effects.

Background: People experiencing psychosis in acute crisis should be offered cognitive behavioural therapy for psychosis (CBTp); however, there are few crisis-focused CBTp-informed models to underpin formulation development for people experiencing psychosis and receiving inpatient mental health care.

Aims: This paper draws on existing CBTp and crisis theories to conceptualise a psychotic crisis from a cognitive behavioural perspective to inform the delivery of therapy in inpatient settings.

Method: Previous literature is reviewed, critiqued, and synthesised. It draws upon relevant crisis and CBTp theories to outline how to best formulate a psychotic crisis.

Discussion: Drawing on existing research and theory, this paper outlines how a psychotic crisis can develop and be maintained. It highlights the importance of the person's context including the social, political, and cultural context, interpersonal context and trauma, and previous and current inpatient experience. It then outlines the key triggers, cognitive, behavioural, and emotional components of the crisis, and personal strenghts, values and resources. A crisis-focused CBTp-informed approach is outlined, which can be used to underpin formulation and brief therapy strategies for people experiencing a psychotic crisis. More research is required to explore the efficacy of such therapies.

Background: While around one-fifth of UK secondary school pupils exhibit clinically significant eating pathology, in-school mental health provision does not include interventions to address such eating pathology.

Aims: This preliminary qualitative study aimed to explore the views of staff, parents and pupils, on the idea of introducing a school-based brief cognitive behavioural therapy programme for non-underweight eating disorders.

Method: 31 pupils, 22 parents and 27 staff participated in 12 focus groups across four schools. The semi-structured interview guide covered topics around the practicalities of a potential eating disorders treatment programme, the acceptability of the intervention, and likelihood of future uptake.

Results: Five over-arching themes and 12 subthemes emerged, reflecting the scale of eating and body image concerns, management limitations, and the importance of prioritising mental health over education. Advantages, challenges, considerations, and solutions were proposed for an in-school eating disorders treatment programme.

Conclusions: These qualitative data show that there is support for an appropriately implemented in-school delivery of brief, evidence-based treatment, demonstrating the potential scope of such an approach to support children and adolescents to receive early help with their eating problems and body image concerns.

Objective: This experimental study investigated whether the trait factors of world assumptions and cognitive flexibility were predictive of levels of attentional bias to threat stimuli, memory integration, and data-driven processing.

Methods: An opportunity sample of 74 participants took part in the investigation. Participants viewed a virtual reality film to induce mild distress to mimic processes that can occur in individuals when experiencing a traumatic event. A prospective experimental design was conducted involving measurements at pre-trauma exposure (Time 1), post-exposure (Time 2) and one-week follow-up (Time 3). Self-report measures of world assumptions, cognitive flexibility, and cognitive processing were administered. Eye-tracking equipment was used to assess attentional bias towards threat images, and a free recall task to assess memory integration.

Results: A mixed effects linear model found increased cognitive bias towards trauma-related threat images pre/post-exposure, specifically for a maintenance attentional bias. Significantly greater data-driven processing was observed post-exposure, with greater conceptually driven processing observed at one-week follow-up. No significant findings were observed for memory integration. World assumptions were predictive of increased data-driven processing; the relative use of data-driven to conceptually driven processing; and trait anxiety. Cognitive flexibility was predictive of state anxiety.

Conclusion: These results provide additional support for the role of maintained attention, data-driven processing, and conceptually driven processing in post-trauma reactions as per established cognitive theories of post-traumatic stress disorder. More research is required to fully explore the roles of core beliefs, assumptions and cognitive flexibility in this area.