Behavioural and Cognitive Psychotherapy最新文献

Background: Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies. Little is known on their effectiveness when severe fatigue and insomnia co-occur.

Aims: This observational study investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of CBT-F and CBT-I. Furthermore, it was determined if changes in fatigue and insomnia symptoms are associated, and how often the co-occurring symptom persists after CBT.

Method: Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, n = 241) received CBT-F and patients with insomnia disorder (n = 162) received CBT-I. Outcomes were fatigue severity assessed with the subscale of the Checklist Individual Strength (CIS-fat) and insomnia severity assessed with the Insomnia Severity Index (ISI). In each cohort, treatment outcomes of the subgroups with and without co-occurring symptoms were compared using ANCOVA. The association between changes in insomnia and fatigue severity were determined using Pearson's correlation coefficient.

Results: There were no differences in treatment outcomes between patients with and without co-occurring fatigue and insomnia (CBT-F: mean difference (95% CI) in CIS-fat-score 0.80 (-2.50-4.11), p = 0.63, d = 0.06; CBT-I: mean difference (95% CI) in ISI-score 0.26 (-1.83-2.34), p = 0.80, d = 0.05). Changes in severity of both symptoms were associated (CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001). Among patients no longer severely fatigued after CBT-F, 31% still reported insomnia; of those without clinical insomnia after CBT-I, 24% remained severely fatigued.

Conclusion: CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.

Background: Parent depression is a well-established prospective risk factor for adverse offspring mental health. Multiple lines of evidence suggest that improvements in parent depression predicts improved offspring mental health. However, no systematic review has examined the impact on offspring of psychological treatment of purely parent depression after the postnatal period.

Aims: To systematically review the literature of randomised controlled trials examining the impact on offspring mental health outcomes of psychological interventions for parental depression after the postnatal period.

Method: We pre-registered our systematic review on PROSPERO (CRD42023408953), and searched the METAPSY database in April 2023 and October 2024, for randomised controlled trials of psychological interventions for adults with depression, which also included a child mental health or wellbeing outcome. We double screened 938 studies for inclusion using the 'Paper in a Day' approach. All included studies would be rated using the Cochrane Risk of Bias tool.

Results: We found no studies that met our inclusion criteria.

Conclusions: Robust research into psychological therapy for depression in adults outside the postnatal period has failed to consider the potential benefits for the children of those adults. This is a missed clinical opportunity to evaluate the potential preventive benefits for those children at risk of adverse psychological outcomes, and a missed scientific opportunity to test mechanisms of intergenerational transmission of risk for psychopathology. Seizing the clinical and scientific opportunities would require adult-focused mental health researchers to make inexpensive additions of child mental health outcomes measures to their evaluation projects.

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: Specific phobia of vomiting (SPOV), also called emetophobia, is a debilitating condition that shares features with several other anxiety disorders and obsessive-compulsive disorder (OCD). Approximately half of sufferers from SPOV do not fully benefit from current treatment modalities.

Aims: Bergen 4-day treatment (B4DT) is a highly concentrated form of exposure and response prevention developed for OCD. This case series reports on the first participants undertaking the treatment for SPOV.

Method: Five female participants underwent the B4DT adapted to SPOV. The Specific Phobia of Vomiting Scale (SPOVI) and Emetophobia Questionnaire (EmetQ-13) were administered pre-treatment, post-treatment, and at 3- and 6-month follow-up. Participants were also shown a 27-minute video portraying vomit-related stimuli of increasing intensity at pre- and post-treatment. The time participants managed to watch the video and their subjective anxiety and nausea were assessed at regular intervals. Reliable and clinically significant change were calculated on SPOVI post-treatment and at 6-month follow-up.

Results: Four of the participants achieved clinically significant change and the fifth reliable improvement, and these results were maintained at 6-month follow-up. The participants watched the vomit-related stimuli video for an average of 10 minutes pre-treatment whereas all completed it post-treatment, experiencing considerably less anxiety. These results were maintained at 6-month follow-up.

Conclusion: The B4DT may be a robust and time-effective treatment format for SPOV with low attrition rates, but further research is needed to verify this.

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: The COVID-19 pandemic has had a negative impact on the population's mental health, particularly for individuals with health anxiety (HA) and obsessive compulsive disorder (OCD). This is in conjunction with a significant change in accessibility of face-to-face psychological services which have had to rapidly adapt to the remote delivery of therapy.

Aims: Using a single-arm open trial design, the study aimed to evaluate the effectiveness of evidence-based CBT interventions for HA and OCD delivered via a blend of online therapist consultations interspersed with self-study reading materials. A secondary aim was to evaluate remote training workshops provided to therapists.

Method: Therapists attended three half-day remote workshops after which consecutive participants with HA or OCD were assigned to therapists for treatment. Monthly expert supervision was provided. Patients completed routine outcome measures at each session and an idiosyncratic measure of pre-occupation with COVID-19 at pre- and post-treatment.

Results: Significant and comparable improvements were observed on measures of anxiety, depression and social adjustment from pre- to post-treatment in both the HA (n=14) and OCD (n=20) groups. Disorder-specific measures also showed significant improvements after treatment. The HA group showed greater levels of change on the COVID-19-specific questionnaire. The training workshops were well received by therapists, who valued the monthly supervision sessions.

Conclusions: The study provides support for the effectiveness of the online delivery of CBT for HA and OCD supported by the inclusion of additional self-study booklets.

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.

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: Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.

Aims: We investigated whether the processes outlined in Clark's (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.

Method: We recruited three groups of adolescents (12-17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD ('clinical control'), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms ('community control'). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.

Results: The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.

Conclusions: We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark's cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.

Background: Although research has highlighted that suicidal imagery (SuiMI) and experiential avoidance (EA) are important in understanding suicidality, there is a need to understand how they potentially interact. Previous research has highlighted that EA potentially leads to increased cognitive intrusions, but it not known whether EA leads to increased SuiMI.

Aims: The purpose of this study was to explore the influence of SuiMI and EA on suicidality (i.e. encompassing thoughts, behaviour and suicide attempts). It was hypothesised that greater frequency of SuiMI would be associated with greater EA. It was also hypothesised that greater SuiMI would be associated with greater suicidality, and that EA would moderate this relationship.

Method: Hypotheses were tested by surveying 197 general university students who completed self-report measures that assessed suicide-related mental imagery (i.e. Suicidal Imagery Questionnaire, SIQ), experiential avoidance (i.e. Multi-dimensional Experiential Avoidance Questionnaire, MEAQ) and suicidality (i.e. Suicidal Behaviours Questionnaire-Revised, SBQ-R).

Results: Frequency of SuiMI was positively correlated with the tendency to engage in EA. SuiMI was a significant predictor of both suicidality and EA. Exploratory analysis found that voluntary SuiMI explained greater variance in suicidality than intrusive, involuntary SuiMI, and that SuiMI only predicted EA in low-risk participants and not for those at high risk of suicide. EA did not predict suicidality and it also did not show any moderating effect on the relationship between SuiMI and suicidality.

Conclusion: There is evidence to suggest that suicide-related mental imagery may play an important role in suicide risk and more specifically imagery that is voluntarily engaged with. Future research is needed to explore the different types of imagery in relation to suicidal ideation in populations at higher risk of suicide.