Behavioural and Cognitive Psychotherapy最新文献

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.

Background: Despite their considerable public health impact, most people with depressive disorders do not receive treatment due to barriers that limit access to high-quality care. Since the onset of the COVID-19 pandemic, depressive symptoms have sharply increased, and access-to-care barriers were magnified by physical distancing requirements. Videoconferencing is a virtual care modality that reduces access-to-care barriers and can be used to deliver cognitive behavioural therapy (CBT), an evidence-based treatment for depressive disorders. However, it is unclear whether videoconference CBT effectively decreases depressive symptoms, particularly in a group therapy format.

Aim: This non-randomized study compared outcomes of group CBT for depressive disorders delivered via videoconference versus in-person.

Method: Data on clinical outcomes (pre- and post-treatment depression, anxiety, and stress symptoms), treatment attendance, drop-out, and patient satisfaction were collected from adult outpatients of a mood disorders clinic who attended 14 weekly group CBT sessions either in-person (pre-pandemic; n=255) or via videoconference (during the pandemic; n=113).

Results: Pre- to post-treatment decreases in depression, anxiety and stress symptoms did not differ between treatment modalities (β=-.01-.06, p>.05). These effects were robust to patient-level factors (i.e. age, sex, co-morbidities, medication use). Moreover, videoconference group CBT was associated with higher attendance (d=0.33) and lower drop-out (53% vs 70% of participants) compared with in-person group CBT.

Conclusions: Videoconference group CBT for depressive disorders appears to be a promising and effective alternative to in-person CBT. However, these findings should be interpreted in light of the study's non-randomized design and the potential confounding effects of the COVID-19 pandemic.

Background: Dissociative experiences are common transdiagnostically, and particularly prevalent in psychosis. Such experiences have long been under-recognised in routine clinical practice, despite evidence that dissociation is related to clinical complexity and increased risk of self-harm and suicidality. Adopting a symptom-specific, targeted approach to conceptualisation and intervention for dissociation may help improve outcomes.

Aims: The evidence base for psychological treatments targeting dissociation is building, but training and guidance for clinicians remains sparse. This review outlines a preliminary approach to the treatment of a subtype of dissociative experience (felt sense of anomaly dissociation), based on emerging research evidence and clinical practice. The guidance is tailored to the context of psychosis, and may also have broader clinical relevance.

Method: We present symptom-specific guidance for clinicians, including factors to consider in the assessment, formulation, and intervention for felt sense of anomaly dissociation in the context of psychosis, and reflections on process issues. We present a cognitive behavioural model, where affect-related changes are interpreted as an internal threat, driving a maintenance cycle of catastrophic appraisals and safety behaviours. Using this formulation, evidence-based therapy techniques familiar to most readers can then be applied.

Conclusions: It is important for clinicians to consider dissociation. As well as generating new avenues for translational intervention research, we anticipate that the novel insights and specific advice outlined here will be of use to professionals working with dissociation in psychosis (and beyond). Encouragingly, we demonstrate that widely used, evidence-based skills and techniques can be employed to address distress arising from dissociation.

Background: Severe fatigue following COVID-19 is a debilitating symptom in adolescents for which no treatment exists currently.

Aims: The aim of this study was to determine the effectiveness and feasibility of cognitive behavioural therapy (CBT) for severe fatigue following COVID-19 in adolescents.

Method: A serial single-case observational design was used. Eligible patients were ≥12 and <18 years old, severely fatigued and ≥6 months post-COVID-19. Five patients, consecutively referred by a paediatrician, were included. The primary outcome was a change in fatigue severity, assessed with the fatigue severity subscale of the Checklist Individual Strength, 12 weeks after the start of CBT, tested with a permutation distancing two-phase A-B test. Secondary outcomes were the presence of severe fatigue, difficulty concentrating and impaired physical functioning directly post-CBT as determined with questionnaires using validated cut-off scores. Also, the frequency of post-exertional malaise (PEM) and absence from school directly post-CBT determined with self-report items were evaluated.

Results: All five included patients completed CBT. Twelve weeks after starting CBT for severe post-COVID-19 fatigue, three out of five patients showed a significant reduction in fatigue severity. After CBT, all five patients were no longer severely fatigued. Also, four out of five patients were no longer physically impaired and improved regarding PEM following CBT. All five patients reported no school absence post-CBT and no difficulties concentrating.

Conclusion: This study provides a first indication for the effectiveness and feasibility of CBT among adolescents with post-COVID-19 fatigue.

Background: People with intellectual disability often face barriers accessing mainstream psychological services due to a lack of reasonable adjustments, including the absence of adapted versions of routine outcome measures. Adapted versions of the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) have been created for adults with ID.

Aims: This study aims to evaluate the psychometric properties of the adapted PHQ-9 and GAD-7.

Method: The adapted PHQ-9 and GAD-7 and the Glasgow Depression and Anxiety Scales (GDS-ID, GAS-ID) were administered to 47 adults (n=21 clinical group; n=26 community group) with ID. Cross-sectional design and between-group analyses tested for discriminant validity. Concurrent and divergent validity was tested using correlational designs. Reliability was investigated by internal consistency and test-retest analysis.

Results: The clinical group scored significantly higher on the adapted PHQ-9 (t₄₅=-2.28, p=.03, 95% CI [-7.09, -.45]) and GAD-7 (t₄₅=-3.52, p=.001, 95% CI [-7.44, -2.02]) than the community group, evidencing discriminant validity. The adapted PHQ-9 correlated with the GDS-ID (r₄₇=.86, p<.001) and the adapted GAD-7 correlated with the GAS-ID (r₄₆=.77, p<.001). The adapted PHQ-9 (Cronbach's α=.84, ICC=.91) and GAD-7 (Cronbach's α=.86, ICC=.77) had good internal consistency and test-retest reliability.

Conclusions: Preliminary research suggests the adapted PHQ-9 and GAD-7 are valid and reliable measures. They could provide a reasonable adjustment for the minimum dataset used in NHS Talking Therapies and can be easily administered in routine clinical practice. Further work to establish additional psychometric properties is now required.

Background: Fear of childbirth (FoB) is a common experience during pregnancy which can cause clinically significant distress and impairment. To date, a number of investigations of FoB have assumed that clinically significant FoB is best understood as a type of specific phobia. However, preliminary evidence suggests that specific phobia may not be the only diagnostic category under which clinically significant symptoms of FoB are best described.

Aim: The current study is the first to investigate which DSM-5 diagnostic categories best describe clinically significant symptoms of FoB.

Method: Pregnant people reporting high levels of FoB (n=18) were administered diagnostic interviews related to their experience of FoB.

Results: Participants (n=18) were predominantly nulliparous (73.3%), cisgender women (83.3%). Of these, 14 (77.8%) met criteria for one or more DSM-5 anxiety-related disorders. Preliminary findings suggest that primary FoB may align with specific phobia criteria, whereas secondary FoB (following a traumatic birth) may be better classified under post-traumatic stress disorder (PTSD). FoB also featured in other anxiety-related disorders but was not the primary focus (e.g. obsessive-compulsive disorder). Four participants did not meet criteria for any DSM-5 disorder.

Conclusions: Findings provide preliminary evidence that clinically significant FoB fits within existing DSM-5 categories, in particular specific phobia and PTSD. Although FoB-related concerns appears in other anxiety-related disorder categories, it does not appear as the primary focus. Although informative, due to the small sample employed in this research, replication in larger and more diverse samples is needed.

Background: Hallucinations and other unusual sensory experiences (USE) are common in people with psychosis. Yet access to effective psychological therapies remains limited. We evaluated if we can increase access to psychological therapy by using a brief treatment, focused only on understanding and dealing with hallucinations (Managing Unusual Sensory Experiences; MUSE), delivered by a less trained but more widely available workforce that harnessed the benefits (engaging content, standardisation) afforded by digital technology. The delivery of this in a real-world setting was considered within the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework.

Method: Thirty-eight people with psychosis and distressing hallucinatory experiences were offered sessions of MUSE, delivered by trained and supervised assistant psychologists. MUSE was evaluated within an uncontrolled study conducted in routine clinical practice. Assessments pre- and post-treatment enabled consideration of the impact of the real-world intervention.

Results: There was good uptake (88.4%), and receipt of MUSE (89% received four or more sessions). On average participants received 8.69 sessions. The participants reported significant reductions in voice hearing, paranoia, as well as improved quality of life. The feedback from the participants indicated that MUSE delivered by a less trained workforce was acceptable and beneficial.

Conclusions: In a real-world setting we were able to offer and deliver sessions of a brief psychological psycho-education and coping skills enhancement package to people with distressing USE in the context of psychosis. The delivery of MUSE when considered against the NASSS framework appears to be a good candidate for adoption in services.

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: Defence behaviours - actions carried out to reduce perceived threat - are an important maintenance factor for persecutory delusions. Avoidance of feared situations and subtle in-situation behaviours reduce opportunities for new learning and are erroneously credited for the non-occurrence of harm; hence inaccurate fears are maintained. In contrast, exposure to feared situations whilst dropping defence behaviours - a key technique of cognitive therapy for paranoia - allows the discovery of new information concerning safety, thereby reducing persecutory delusions.

Aim: We aimed to develop for use in research and clinical practice a self-report assessment of paranoia-related defence behaviours.

Method: A 64-item pool was developed from interviews with 106 patients with persecutory delusions, and completed by 53 patients with persecutory delusions, 592 people with elevated paranoia, and 2108 people with low paranoia. Exploratory and confirmatory factor analyses were used to derive the measure. Reliability and validity were assessed.

Results: Two scales were developed: a 12-item avoidance scale and a 20-item in-situation defences scale. The avoidance scale had three factors (indoor spaces, outdoor spaces, and interactions) with an excellent model fit (CFI=0.98, TLI=0.97, RMSEA=0.04, SRMR=0.027). The in-situation defences scale had a 5-factor model (maintaining safety at home, mitigating risk, staying vigilant, preparing for escape, and keeping a low profile) with a good fit (CFI=0.95, TLI=0.94, RMSEA=0.046, SRMR=0.039). Both scales demonstrated good internal reliability, test-retest reliability, and construct validity.

Conclusions: The Oxford Paranoia Defence Behaviours Questionnaire is a psychometrically robust scale that can assess a key factor in the maintenance of persecutory delusions.

Background: Motivational Interviewing (MI) has demonstrated significant effects in diverse areas of practice, with over 2,000 controlled clinical trials published. Some criticisms of MI have emerged along the way.

Aims: We examine theoretical and methodological critiques of MI.

Method: We discuss three significant theoretical and methodological criticisms of MI: (1) that MI lacks conceptual stability; (2) that MI lacks a theoretical foundation; and (3) that MI is just common factors in psychotherapy.

Results: It is true that definitions and descriptions of MI have evolved over the years. Mastery of MI clearly varies across providers, and when the quality of an intervention is unmeasured, it is unclear what has been trained or delivered. Reliable and valid tools to assess MI fidelity are available but often unused in outcome studies. It remains unclear what levels of proficiency are necessary to improve client outcomes. Some attempts to minimize variability in the delivery of MI appear to have reduced its effectiveness. In respect of the second critique is that MI lacks a theoretical foundation. It is unclear whether and how this is a disadvantage in research and practice. Various theories have been proposed and specific causal chain predictions have been tested. A third critique is that MI is merely common factors found among psychotherapists. The contribution of such relational skills is testable. There are specific aspects of MI related to client language that influence client outcomes above and beyond its relational components.

Conclusions: The critiques reflect important factors to consider when delivering, training, and evaluating MI research.