Behavioural and Cognitive Psychotherapy最新文献

Background: One of the most effective treatments for social anxiety disorder (SAD) is cognitive behavioural therapy (CBT). Prior research indicates group cohesion is connected to treatment success in group CBT for SAD (CBGT). Videoconference CBGT delivery is now common following the COVID-19 pandemic; however, research investigating treatment outcomes and group cohesion in videoconference CBGT for SAD is limited.

Aims: The present study aimed to compare group cohesion in videoconference CBGT for SAD to group cohesion in both in-person CBGT for SAD and videoconference CBGT for other anxiety and related disorders. A secondary aim was to compare symptom reduction across all three groups.

Method: Patients completed a 12-week CBGT program for SAD in-person (n=28), SAD via videoconference (n=46), or for another anxiety or related disorder via videoconference (n=100). At mid- and post-treatment patients completed the Group Cohesion Scale Revised (GCS-R), and at pre- and post-treatment patients completed the Social Phobia Inventory (SPIN, only in the SAD groups) and the Depression Anxiety Stress Scales (DASS-21).

Results: Over the course of treatment, all three groups showed a significant increase in cohesion and a significant decrease in symptoms (η_p² ranged from .156 to .562, all p<.001). Furthermore, analyses revealed no significant difference in cohesion scores between groups at both mid- and post-treatment.

Conclusions: These results suggest that videoconference CBGT for SAD is similarly effective in facilitating cohesion and reducing symptoms compared with in-person delivery. Limitations of the study and implications for treatment are discussed.

Background: Moral injury is a potentially deleterious mental health outcome that can follow exposure to events that challenge one's moral code. Theoretical models suggest a multi-faceted self-concept may support adaptation following such events. However, little is known about the relationship between self-concept complexity and outcomes following potentially morally injurious events.

Aims: This cross-sectional study investigated hypothesized relationships between self-concept complexity and outcomes in adults (n=172) exposed to potentially morally injurious events.

Method: Participants completed validated measures of event-related distress, traumatic stress, depression and anxiety, and a self-complexity task in which they provided multiple descriptors of their self-concept. Responses were coded for overall diversity, defined as number of categories of self-descriptors, and role diversity, defined as number of social and activity-based roles.

Results: Multiple regression analyses found greater role diversity independently predicted lower event-related distress, while overall self-diversity and total number of self-descriptors did not.

Conclusion: Findings indicate diversity in active facets of the self (e.g. relational or activity-based roles) may buffer the effects of a potentially morally injurious event.

Background: Preliminary evidence suggests that mental imagery may be an important clinical feature in hoarding. Individuals who hoard use objects as receptacles for memories, and experience more frequent, intrusive and distressing images compared with the general community. However, the specific nature of these associations remains poorly understood.

Aims: We aimed to investigate whether hoarding traits were related to the ability to voluntarily generate imagery in different sensory modalities, and uniquely with the tendency to experience negative intrusive imagery. We also aimed to understand the mechanism by which mental imagery experiences may confer vulnerability to hoarding problems.

Method: Undergraduates (n=328) completed questionnaires assessing hoarding, beliefs about objects, imagining ability across the senses, and negative intrusive imagery, as well as symptom measures of depression, obsessive-compulsive disorder and post-traumatic stress. We conducted Pearson's correlations, hierarchical regressions, and mediational analyses.

Results: Hoarding tendencies were associated with reduced visualising ability, but not with the capacity to deliberately generate imagery in other senses. Hoarding was also uniquely associated with the tendency to experience negative involuntary imagery when controlling for symptoms of depression, obsessive-compulsive disorder, and post-traumatic stress. Object-memory beliefs partially mediated the relationship between hoarding and reduced visualising ability. Object attachment partially mediated the relationship between hoarding and negative intrusive imagery.

Conclusions: Results suggest that visualisation difficulties may promote a reliance on objects to facilitate recall, and experiencing negative intrusive imagery may strengthen object attachment. Findings may inform imagery-based conceptualisations and treatments of hoarding problems, such as imagery training or modification interventions.

Background: Several psychological models of bipolar disorder propose that certain types of appraisals can lead to increases in manic symptoms.

Aims: We tested whether the belief that being 'high' is a natural part of one's personality and correlates with manic symptoms 4 months later when controlling for manic symptoms at baseline.

Method: This was a prospective 4-month follow-up design using self-report measures. Forty people with a diagnosis of bipolar disorder completed a measure of manic symptoms, a measure of appraisals associated with bipolar disorder, and a single-item measure, 'To what extent do you feel like being "high" is a natural part of your personality?', at baseline and follow-up.

Results: The single-item measure showed modest stability over time and construct validity in its correlation with a standardised measure of appraisals in bipolar disorder. As predicted, the single-item measure correlated with manic symptoms at follow-up when controlling for manic symptoms at baseline.

Conclusions: The belief that being 'high' is a natural part of one's personality is a potential predictor of manic symptoms. Further research needs to study the potential mediating mechanisms such as activating behaviours, and control for indicators of the bipolar endophenotype.

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: 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: Mental imagery plays a key role in the onset and maintenance of psychological disorders, and has become the target of psychological interventions for the treatment of several anxiety-related conditions. However, there are currently no transdiagnostic measures designed to assess the varied dimensions of mental imagery relevant to psychopathology.

Aim: To develop and validate a new measure assessing the experiences and appraisals of negative mental imagery.

Method: The initial item pool was generated through a comprehensive literature review and interviews with subject-matter experts. An online community sample provided data for the exploratory (n=345) and confirmatory (n=325) factor analyses.

Results: The new 16-item Negative Mental Imagery Questionnaire demonstrated four subscales (Intrusiveness, Controllability, Beliefs about Mental Imagery, and Realness). Reliability and validity were good to excellent for both the full- and sub-scales.

Conclusions: Appraisals of mental imagery captured by the new measure are consistent with previous research on mental imagery and psychopathology.

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.

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.

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.