Behavioural and Cognitive Psychotherapy最新文献

Background: The manner in which heuristics and biases influence clinical decision-making has not been fully investigated and the methods previously used have been rudimentary.

Aims: Two studies were conducted to design and test a trial-based methodology to assess the influence of heuristics and biases; specifically, with a focus on how practitioners make decisions about suitability for therapy, treatment fidelity and treatment continuation in psychological services.

Method: Study 1 (N=12) used a qualitative design to develop two clinical vignette-based tasks that had the aim of triggering heuristics and biases during clinical decision making. Study 2 (N=133) then used a randomized crossover experimental design and involved psychological wellbeing practitioners (PWPs) working in the Improving Access to Psychological Therapies (IAPT) programme in England. Vignettes evoked heuristics (anchoring and halo effects) and biased responses away from normative decisions. Participants completed validated measures of decision-making style. The two decision-making tasks from the vignettes yielded a clinical decision score (CDS; higher scores being more consistent with normative/unbiased decisions).

Results: Experimental manipulations used to evoke heuristics did not significantly bias CDS. Decision-making style was not consistently associated with CDS. Clinical decisions were generally normative, although with some variability.

Conclusions: Clinical decision-making can be 'noisy' (i.e. variable across practitioners and occasions), but there was little evidence that this variability was systematically influenced by anchoring and halo effects in a stepped-care context.

Background: Randomised controlled trials (RCTs) have provided considerable evidence for the short-term efficacy of cognitive behavioural therapy (CBT) in children and adolescents with depressive and anxiety disorders. However, the effectiveness and long-term stability of treatment effects under routine care conditions remain unproven.

Aims: This observational study investigates the effectiveness and stability of CBT under routine care conditions within a large sample of clinically referred youth with depressive and anxiety disorders.

Method: Two hundred and twenty former patients (age 6-18 years at start of treatment) underwent a follow-up assessment (follow-up interval: M=5.3 years, SD=2.47). Parent and self-ratings of behavioural and emotional problems were obtained at the beginning and end of treatment and at follow-up. Additionally, at follow-up, a telephone interview and questionnaires exploring other mental symptoms and life satisfaction were administered.

Results: A repeated measures ANOVA yielded statistically significant, medium to large pre- post symptom reductions (η_p²=.15 to η_p²=.47) and small to medium post-follow-up symptom reductions (η_p²=.03 to η_p²=.19). At follow-up, between 57 and 70% of the sample reported a decrease in different emotional symptoms since the end of treatment, and 80% reported improved life satisfaction.

Conclusions: These findings provide evidence for the effectiveness and stability of treatment effects of CBT in youth with depressive and anxiety disorders under routine care conditions. Due to the lack of a direct control condition and a substantial proportion of missing data, the results must be interpreted with caution.

Background: Dialectical behaviour therapy (DBT) skills groups have shown promise as an effective treatment for clients with emotional dysregulation, especially when combined with individual DBT. However, their efficacy is not well established as an online therapy, or in the Latinx population.

Aims: This study aimed to explore satisfaction, retention and effects of an internet-based DBT group added to individual online sessions.

Method: An ABAB withdrawal experimental single-case design was conducted to evaluate the effect of a brief online DBT skills group on emotional dysregulation, anxiety and depression for five Latinx participants. DBT skills group (phase B) were compared with placebo group sessions (phase A) and fortnightly individual DBT sessions were offered throughout to manage risk.

Results: Visual inspection showed a decrease in level of emotional dysregulation and a large effect size according to the Nonoverlap of All Pairs when comparing group DBT and placebo phases. Although depression symptoms decreased after introducing group DBT, anxiety indicators decreased most during the second round of group placebo sessions.

Discussion: Whilst only a pilot, this study suggests that online group DBT in Latinx populations is feasible and effective for changing emotional regulation processes but may not effectively target anxiety. Future research might increase the number of DBT sessions in order to enhance learning opportunities and generalization. Replication with larger sample sizes and diverse modalities is needed.

Background: Anxiety is common during the perinatal period and despite effective treatments being available, many women with perinatal anxiety disorders experience barriers when accessing treatment.

Aims: The aims of the current study were to explore women's perceived barriers to treatment uptake; cognitive behavioural therapy (CBT) treatment delivery preferences; and the utility of the Health Belief Model (HBM) in predicting intention to seek psychological help for women with perinatal anxiety symptoms.

Method: This study employed a cross-sectional design consisting of women with self-reported anxiety in the perinatal period. A total of 216 women (M_age=28.53 years; SD=4.97) participated in the study by completing a battery of online self-report measures.

Results: The results indicated that the most salient barriers to accessing care were: (1) the cost of treatment, (2) wanting to solve the problem on their own, and (3) thinking the problem would go away without treatment. Group-delivered CBT was the least acceptable treatment method, while face-to-face individual CBT was the most acceptable treatment method. The HBM variables predicted approximately 35% of the variance in help-seeking intention.

Discussion: This study has important implications for the delivery of psychological care in the perinatal period and may be used to improve treatment uptake.

Introduction: Dissociation is a recurrent symptom of post-traumatic stress disorder (PTSD) and is associated with emotional dysregulation. Beliefs about emotions seem to be involved in emotional dysregulation but have not been studied in relation to dissociation. Likewise, there is currently little empirical evidence of beliefs about dissociation. The aims of the study were to validate psychometric tools assessing these beliefs, to assess their role in dissociation, and to explore the mediating role of emotional dysregulation and beliefs about dissociation in the relationship between beliefs about emotion and dissociation.

Method: We recruited a sample from the general population (n=1009) and a sample of patients with PTSD (n=90). All participants completed self-report questionnaires to evaluate symptoms of PTSD (PTSD Checklist/Impact of Event Scale, PCL-5/IES-6), dissociation (Dissociative Experiences Scale, DES), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), beliefs about dissociation (Dissociation Beliefs Scale, DBS), and beliefs about emotion (Emotion and Regulation Beliefs Scale, ERBS).

Results: The questionnaires used to assess the beliefs about emotion (ERBS) and dissociation (DBS) had good psychometric properties. Dissociation was positively associated with positive and negative beliefs about dissociation and with negative beliefs about emotions in both the clinical and non-clinical groups. The relationship between beliefs about emotions and dissociation was mediated by emotional dysregulation and positive beliefs about dissociation in both groups.

Conclusion: The ERBS and DBS are effective tools to assess beliefs. Beliefs about emotion and dissociation seem to be involved in dissociative manifestations in both clinical and non-clinical individuals.

Background: Growing research indicates that death anxiety is implicated in many mental health conditions. This increasing evidence highlights a need for scalable, accessible and cost-effective psychological interventions to reduce death anxiety.

Aims: The present study outlines the results of a phase I trial for one such treatment: Overcome Death Anxiety (ODA). ODA is the first CBT-based online intervention for fears of death, and is an individualised program requiring no therapist guidance.

Method: A sample of 20 individuals with various mental health diagnoses commenced the ODA program. Death anxiety was assessed at baseline and at post-intervention. Depression, anxiety and stress were also measured.

Results: In total, 50% (10/20) reached the end of the program and completed post-treatment questionnaires. Of these, 60% (6/10) showed a clinically reliable reduction in their overall death anxiety, and 90% (9/10) showed a reduction on at least one facet of death anxiety. There were no adverse events noted.

Conclusions: ODA appears to be a safe and potentially effective treatment for death anxiety. The findings have provided initial evidence to support a randomised controlled trial using a larger sample, to further examine the efficacy of ODA.

Background: The diagnosis of obsessive compulsive disorder (OCD) is characterised by intrusive thoughts leading to compulsions to alleviate anxiety. However, research is lacking on impact post-diagnosis. Some research suggests diagnosis may benefit treatment access, but potentially leads to higher levels of stigma and altered self-identity.

Aims: The present study assessed the utility (treatment access and problem identification) and impact (stigma, personal wellbeing or social identity) of receiving a diagnosis of OCD.

Method: Semi-structured interviews with 12 individuals who had received a diagnosis of OCD were conducted between February and April 2020, then transcribed and analysed using theoretical thematic analysis.

Results: Participants reported positive impacts of diagnosis on both 'utility' and 'impact'.

Conclusions: The diagnosis of OCD was helpful for participants in making their symptoms tangible, providing relief and hope for recovery. Non-diagnostic or alternative frameworks should aim to meet this need. Future research may wish to identify how this understanding of disorders vary between different diagnoses, especially in terms of stigma and personal wellbeing.

Background: Despite evidence for its efficacy, exposure therapy for anxiety is rarely used in routine care settings. Efforts to address one major barrier to its use - therapists' negative beliefs about exposure - have included therapist-level implementation strategies, such as training and consultation. Experiential training, in which therapists themselves undergo exposures, has recently demonstrated feasibility, acceptability and preliminary effectiveness for increasing exposure use.

Aims: This study aimed to assess: (1) therapists' perceptions of experiential training and (2) barriers and facilitators to implementing exposure following training.

Method: Therapists who underwent experiential training (n=12) completed qualitative interviews and quantitative questionnaires. Interviews were coded using an integrated approach, combining both inductive and deductive approaches. Mixed methods analyses examined how themes varied by practice setting (community mental health versus private practice) and exposure use.

Results: Results highlight how therapist-level factors, such as clinician self-efficacy, interact with inner- and outer-setting factors. Participants reported positive perceptions of exposure after training; they noted that directly addressing myths about exposure and experiencing exposures themselves improved their attitudes toward exposure. Consistent with prior literature, issues such as insufficient supervisory support, organizational constraints, and client characteristics made it challenging to implement exposures.

Discussion: Results highlight the benefits of experiential training, while also highlighting the need to consider contextual determinants. Differences in responses across practice settings highlight areas for intervention and the importance of tailoring implementation strategies. Barriers that were specific to therapists who did not use exposure (e.g. hesitancy about its appropriateness for most clients) point to directions for future implementation efforts.