Cognitive Therapy and Research最新文献

Background: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard measure of OCD and the most common tool to assess OCD severity and treatment outcome. Relying on Y-BOCS total scores likely to capture overall severity well, but may obscure important qualitatively different OCD profiles. The current study aimed to identify profiles of OCD and their association to obsession/compulsion content domains (e.g., contamination), and treatment outcomes.

Methods: Participants were adults 759 (49% women) seeking partial/residential treatment for severe OCD. The sample was on average 29.81(SD=11.95) years old and predominantly White (85%). Latent profile analysis was used to identify patterns of OCD symptoms using the self-reported Y-BOCS severity scale (Y-BOCS-SS). Profiles were validated using generalized linear models to capture the association between profiles and obsession/compulsion content and changes in OCD severity, depression, and quality-of-life.

Results: Three profiles were identified: a "Severe with Lower Resistance" Profile (69% of sample) characterized by high severity with the greatest relative effort to resist symptoms, a "Moderate" profile (25%) characterized by uniform endorsement of items in the moderate range, a "Low Compulsion" (6%) profile characterized by high mean endorsement of obsession items and low endorsement of compulsion items. The profiles varied significantly in terms of endorsement of different obsession/compulsion domains but did not vary significantly in terms of treatment outcomes as measured by changes in OCD, depression, and quality-of-life.

Conclusions: Relying on Y-BOCS total score may fail to capture qualitatively different, albeit rare, presentations of OCD. However, these profiles were not predictive of treatment response.

Background: Patients' perceived improvement has utility in contextualizing markers of treatment success, often measured through PTSD severity, other clinical factors, and clinically meaningful improvement (CMI). This study investigated the relationship between perceived improvement, self-reported PTSD symptom changes, and changes in other clinical factors in veterans undergoing PTSD treatment.

Methods: Data were collected from 259 veterans who completed a two-week Cognitive Processing Therapy-based intensive PTSD treatment program. Self-report measures, including the Patient Global Impression of Improvement (PGI-I) and PTSD Checklist for DSM-5 (PCL-5), assessed symptom severity and perceived improvement. Ordinal logistic regression analyses examined associations between PTSD symptom changes, other clinical factors (e.g., depression, self-efficacy, emotion regulation), and perceived improvement.

Results: The average PCL-5 improvement was 20.93 points, with 87.65% of veterans reporting feeling at least a little better post-treatment. All CMI thresholds were related to perceived improvement. Reductions in PTSD severity significantly predicted higher perceived improvement while self-efficacy and emotion regulation also emerged as significant predictors. In contrast, changes in depression symptoms, negative posttraumatic cognitions, and resilience were not significant.

Conclusions: Perceived improvement in PTSD treatment aligns closely with reductions in PTSD severity and self-regulatory capacities, emphasizing their importance in subjective recovery. While the PGI-I may not fully replace other measures, its alignment with key outcomes and brevity make it a valuable patient-centered tool for assessing treatment effectiveness. Future research should assess the PGI-I's potential to complement or replace existing measures, and evaluate long-term outcomes across diverse treatment settings.

Background: Depression and anxiety are associated with patterns of negative thinking that can be targeted through cognitive restructuring as a part of cognitive therapy (CT) or cognitive behavioral therapy (CBT). Our team has created a set of cognitive distortion schemata (CDS) n-grams based on theories underlying CT to measure the linguistic markers that indicate cognitive vulnerability to depression. These CDS were specifically designed to examine online language. Our prior work supports a relationship between CDS and a diagnosis of depression, but less is known about the relationship between online language, CDS, and anxiety. The current study measures if CDS can be detected in people who report anxiety symptoms, and whether CDS increase with symptom severity.

Methods: 1,377 participants were recruited from a study assessing social media use and mental health symptoms, the Studies of Online Cohorts of Internalizing Symptoms and Language (SOCIAL). From this, 804 timelines were harvested, and after removing missing data and bots, our final sample was 537 respondents who posted 999,859 tweets. This is a longitudinal, multi-method design, using surveys and text-based analysis of social media timelines. We used bootstrap resampling to compare differences in CDS prevalence in anxious and depressed participants.

Results: CDS can be observed in anxiety disorders, significantly increase as a function of anxiety symptom severity, and are related to depression and anxiety comorbidity.

Conclusions: Using behavioral, affective, and cognitive indicators of distorted thinking from social media may yield new insight into the trajectories of depression and anxiety. This work has implications for the future of CT/CBT and other online interventions that target distorted thinking styles.

Purpose: Content-based models, which focus on observable symptom content, have dominated much of the literature on heterogeneity in OCD. However, alternate models emphasize the motivations underlying different symptom presentations, including harm avoidance (HA) and incompleteness (INC). To promote understanding of these motivations, we examined their associations with various content-based symptom dimensions, obsessive belief patterns, and other clinical characteristics.

Methods: We examined a large set of demographic and clinical characteristics and their associations with HA and/or INC among individuals (N = 218) receiving treatment for OCD and related disorders in a partial hospital/residential program. We also examined the extent to which HA and INC mapped onto dimensions in prevailing symptom content and obsessive belief models.

Results: Results showed that women reported more HA than men, and INC was associated with an earlier age of onset. HA and INC were not differentially associated with sexual orientation, self-view, quality of life, depression, or suicidality. HA and INC mapped onto symptom content and obsessive belief models in some, but not all the ways we expected. Notably, contamination/washing in our sample was associated with INC, but not HA.

Conclusions: Understanding motivations underlying OCD symptoms may lead to personalized care and improvement in treatment outcomes. We suggest that future research should continue to examine the motivational model, as well as ways in which presentations of each motivation may differ.

Purpose: Emerging research investigating mechanisms underpinning PTSD has identified emotion regulation (ER) flexibility - the ability to flexibly use ER strategies according to contextual demands - as one promising mechanism. To date, however, no study has investigated whether brief training in ER flexibility can minimise negative affect elicited from evocative stimuli. This study investigated the impact of instructed ER flexibility on emotional responding in probable PTSD.

Methods: Participants (N = 148) viewed images that differed in negative emotional intensity (high or low). For each image, participants followed instructions to adopt either a flexible or inflexible ER approach through randomisation to either an ER flexible condition or one of three control conditions (Inflexible Reappraisal, Inflexible Distraction, Context Insensitive). In the ER Flexible condition, participants were instructed to switch between distraction and reappraisal according to the emotional intensity of the image. The control conditions required participants to either employ a single ER strategy (Inflexible Distraction and Inflexible Reappraisal) or switch between strategies in a way that did not align with image intensity (Context Insensitive). Negative affect was rated after each image.

Results: Participants with probable PTSD in the ER Flexible condition demonstrated the lowest levels of negative affect. For participants without probable PTSD, negative affect did not differ between the ER conditions.

Conclusions: Findings suggest that individuals with probable PTSD benefitted from being instructed in ER flexibility. This finding supports the adaptiveness of ER flexibility and provides a preliminary temporal link between instructed ER flexibility and improved emotional responding for those with PTSD.

Supplementary information: The online version contains supplementary material available at 10.1007/s10608-024-10536-3.

Background: Internalizing disorders are the most common psychiatric disorders in youth and are associated with a host of deleterious outcomes (e.g., self-harm, substance use, interpersonal difficulties), highlighting the critical need for identifying risk factors that confer risk for these disorders. The present study investigated the unique and shared roles of two prominent cognitive biases-anxiety sensitivity and interpretation biases-as predictors of internalizing symptom severity in clinically anxious youth, above and beyond the effects of negative emotionality and after accounting for sociodemographic covariates.

Method: A diverse sample of clinically anxious youth (N = 105; M_age = 10.09 years, SD = 1.22; 56.7% female; 49% ethnic minority) completed a diagnostic interview and self-report measures of interpretation biases, anxiety sensitivity, and internalizing symptom severity.

Results: Hierarchical regression analyses revealed that both anxiety sensitivity (b = 0.77, 95% CI [0.53, 1.00], sr ²  = 0.11) and interpretation biases (b = 0.21, 95% CI [0.11, 0.30], sr ²  = 0.05) accounted for an additional 22% of unique variance in internalizing symptom severity (p <.001), above and beyond the effects of negative emotionality. Post hoc exploratory analyses identified the disease and social concerns facets of anxiety sensitivity, and the overgeneralization facet of interpretation biases, as predictors of internalizing symptoms.

Conclusion: Future research should examine whether targeting cognitive biases would be beneficial among temperamentally labile youth.

Background: According to the Hopelessness Theory of Depression, a negative cognitive style increases an individual's vulnerability to depression during stressful life events. The Cognitive Style Questionnaire (CSQ) is a widely used self-report measure to assess negative cognitive style or cognitive vulnerability. A limitation of the CSQ is its length, limiting its use in larger-scale research and applied settings. This research aims to validate a brief version of the CSQ.

Method: We conducted two studies to develop and validate the CSQ-brief form (CSQ-BF) by (1) empirically determining which scenarios from the CSQ should be included and (2) validating the CSQ-BF. In study one, 207 university students completed the full-scale CSQ, and the six best-fitting items were selected for the CSQ-BF. In study two, 321 university students completed several self-report measures of depressive symptoms, stressor exposure, affect, and the CSQ-BF.

Results: A factor analysis supported that the full-scale CSQ is comprised of a single factor structure. Six items were selected for the CSQ-BF based on factor loadings and item categories (to maximize content validity). Results from study two confirmed that the CSQ-BF had strong psychometric properties and could be completed in less time.

Conclusion: The CSQ-BF offers a more convenient tool for measuring cognitive vulnerability to depression.

Background: While low self-esteem is an established risk factor for depressive and anxiety disorders, psychological underpinnings of unstable self-esteem remain understudied. We investigated the role of autonomy-connectedness, the psychological capacity for self-governance, in self-esteem and its change trajectories and instability.

Methods: Data spanning 12 years of the Longitudinal Internet studies for the Social Sciences [LISS] panel, a large, nationally representative population sample (N = 5367, ages 16-91), were used.

Results: Mixed model analyses revealed that autonomy-connectedness was positively associated with self-esteem. Autonomy-connectedness component Sensitivity to others predicted less deterioration of self-esteem over time. Latent growth mixture modeling exploring individual differences revealed seven latent classes differing in slope and self-esteem instability over time. Individuals with healthy autonomy were more likely to belong to classes with above average self-esteem, but not necessarily more stable self-esteem trajectories. A subgroup (11%) displayed alarming autonomy deficits, which corresponded with low, stable self-esteem, as well as high levels of depressive and anxiety symptoms.

Conclusions: Autonomous individuals have higher self-esteem and better mental health, but autonomy deficits were not necessarily associated with unstable self-esteem trajectories. Being sensitive to others buffers against declining self-esteem in older age. Results are discussed in light of depression and anxiety vulnerability.

Supplementary information: The online version contains supplementary material available at 10.1007/s10608-025-10604-2.

Purpose: Dysfunctional threat appraisal plays a key role in both the development and treatment of PTSD. It is unclear how these appraisals can best be measured. This study aimed to explore the specific negative outcome predictions held by patients with PTSD and to develop and validate the Threat Appraisal in PTSD Scale (TAPS).

Methods: We used data from a non-clinical (N = 309) and clinical sample (N = 125) to assess the psychometric properties of the TAPS.

Results: The TAPS had excellent internal consistency and test-retest reliability, and convergent and discriminative validity were adequate. The TAPS showed to be sensitive to change following treatment. The TAPS demonstrated incremental validity beyond general cognitions in predicting PTSD symptoms in the combined sample, but not in the patient sample. An exploratory factor analysis suggested three factors: 'losing control', 'externalizing reactions', and 'physical reactions', and patients seemed most concerned about outcomes related to 'losing control'.

Conclusions: These findings imply that the TAPS could be clinically beneficial, enabling patients and therapists to recognize dysfunctional expectancies and tailor therapeutic interventions accordingly.

Supplementary information: The online version contains supplementary material available at 10.1007/s10608-025-10582-5.

Purpose: Cognitive vulnerability to anxiety can partly be explained by an interplay of attentional biases and control processes. This suggests that when aiming to reduce anxiety, simultaneously reducing an attentional bias for threat and strengthening control processes would be the optimal approach. We investigated whether a combined web-based Attentional Bias Modification (ABM) with affective Working Memory Training (WMT) was effective in reducing trait anxiety relative to control conditions and whether state anxiety moderated ABM effects.

Methods: In this pre-registered randomized controlled trial, adults with heightened trait anxiety (n = 433) received either an active or control visual search ABM combined with an active or control emotional chessboard WMT training (2 × 2 design). Trait anxiety (primary outcome) was assessed at pre- (T1), mid- (T2), and post-training (T3), and at 1, 2, and 3-months follow-up. Attentional Bias (AB) and Working Memory (WM) capacity were assessed at T1, T2, T3, and FU3. State anxiety was measured prior to each training session.

Results: Irrespective of the training conditions, participants showed a decrease in trait anxiety over time. The ABM training was associated with stronger reductions in AB. The WMT training was not associated with more improvements in WM capacity relative to the control condition. No moderating effects of state anxiety, baseline AB or WM capacity were observed.

Conclusions: The findings suggested that the current type of ABM combined with WMT in a web-based format, without therapist support, was not effective in reducing trait anxiety beyond control conditions.The study was registered in the Netherlands Trial Register (NTR-NL4525, https://www.onderzoekmetmensen.nl/en/trial/23135).

Supplementary information: The online version contains supplementary material available at 10.1007/s10608-024-10565-y.