Cognitive Therapy and Research最新文献

Background

Cognitive behavioral therapy has proven to be effective in the treatment of panic disorder and/or agoraphobia (PD/A). However, psychotherapy is often not available in a timely manner. Hence, there is a need for alternative and easily accessible interventions. The current study, thus, aimed to evaluate a smartphone-based self-management-tool for panic disorder and/or agoraphobia.

Method

107 participants were randomly assigned to either an intervention group (app “Mindable”) or a waitlist control group. Primary outcome was panic and agoraphobic symptom severity, further outcomes included perceived quality of life, anxiety control beliefs, and functional impairment. Linear mixed models were used to analyze the data in intent-to-treat- and completer-data sets.

Results

After the eight-week observation period, participants in the intervention group reported significantly stronger reductions in panic and agoraphobic symptoms (R² = 0.20) and a higher increase in anxiety-related control beliefs (R² = 0.125) than participants in the control condition. Despite this symptom reduction, only 4.3% of participants in the app group and none in the control group were considered as remitted. Quality of life and functional impairment improved in all participants over time, but no significant group x time interactions were found.

Discussion

A smartphone-based self-management tool is an easily accessible intervention to reduce panic and agoraphobic symptoms and enhance anxiety control in people with PD/A. As no symptom remission could be achieved, this approach may be suitable as part of a stepped care approach for anxiety disorders.

Trial Registration

Registration number: DRKS00029090, registered on 10.06.2022.

This paper stands in the learning tradition of H. J. Eysenck who, sixty-three years ago in 1961, wrote that pathological/psychological disorders are learned/conditioned responses or habits that are non-adaptive. Eysenck argued that persons who receive Psychological Treatment (i.e. ‘psychotherapy’) are best served when their symptom complaints are addressed with well-established learning guidelines. In a similar vein, our proposal presents a general overview of learning and following Eysenck’s lead, describes six general characteristics (Eysenck listed 6 characteristics of ‘psychotherapy’) of a learning-based proposal for Psychological Treatment. Our proposal places a heavy emphasis on the therapist’s role as teacher. In addition, four acquisition learning examples are presented showing how one constructs a learning approach that addresses psychological symptom categories.

Study

Intolerance of uncertainty (IU), a disposition to see uncertainty as negative, is a unique construct associated with a number of internalizing disorders and has been a target in cognitive behavioral interventions. Given the overlap between internalizing disorders and alcohol use, exploring IU in the context of drinking behavior provides a promising area of inquiry. Past work identified associations between IU and drinking motives, important predictors of alcohol-related outcomes, with less work examining drinking behavior.

Objective

We explored the role of IU and drinking motives on drinking patterns and potentially problematic drinking in a community sample of emerging adults (18–25 years).

Method

Survey data was collected from 551 emerging adults (Mage = 22.26, SD = 2.25; 42.50% cisgender women, 42.28% cisgender men, 9.44% gender diverse; 37.93% white; 16.18% Hispanic/Latine) using an online participant recruitment tool. Participants completed demographic questions, motivations for drinking (DMQ-R), quantity and frequency of alcohol use (DDQ-R), potentially problematic drinking behavior (AUDIT), and attitudes towards uncertainty with a two-factor and single factor operationalization (IUS-27 and IUS-12).

Results

Across models, statistically significant indirect effects were found, such that greater IU was associated with higher coping and enhancement motives and increased average and maximum drinks per week and AUDIT scores.

Conclusion

While consistent with the prior literature, novel relations were found between IU and drinking indices via drinking motives. Future work should explore relations between IU and drinking outcomes longitudinally and whether interventions targeting IU have benefit in the prevention of maladaptive alcohol use.

Purpose

The struggle with sense of self has a fundamental impact on health and wellbeing in people with chronic pain. Acceptance and Commitment Therapy (ACT) particularly includes a process related to sense of self, called self-as-context (SAC). A measure of SAC, called the Self Experiences Questionnaire-8 (SEQ-8) has been developed in people with chronic pain. A brief version of the SEQ can facilitate more efficient assessment in clinical settings, and further research using intensive assessment to produce situation and time-sensitive information on SAC. The aim of the study was to establish a two-item version of the SEQ.

Methods

This study used secondary analyses of data from 453 people with chronic pain.

Results

The newly validated SEQ-2 demonstrated acceptable reliability, Cronbach’s α = 0.77, and performed well in assessing SAC, with 88.6% of the variance in the SEQ-8 explained by the SEQ-2. The construct validity of the SEQ-2 was supported by its associations with other theoretically-specified processes, r = .25-0.51, p < .001. and measures of functioning, |r|=0.18-0.40, p < .001. The incremental validity of the SEQ-2 was relatively limited, |β|=0.08-0.34. Conclusions: The SEQ-2 appears to be an acceptable measure of SAC. The brief version of the SEQ can facilitate the application of individualised research methods and personalised pain treatments, informed by intensive assessment.

Background

In the DSM-5, body-focused repetitive behaviors (BFRBs) are now classified in the obsessive-compulsive and related disorders section. Differential diagnosis is complicated by the overlap of BFRBs with other disorders, especially non-suicidal self-injurious behavior (NSSI) and stereotypic movement behavior (SMB). The present study examined participants’ motives for performing BFRBs to provide a better understanding of how BFRBs may differ from NSSI and SMB and to determine whether BFRB is best characterized as an obsessive-compulsive spectrum disorder.

Methods

A total of 268 individuals with various BFRBs were assessed with respect to their motives for performing BFRBs, comorbid diagnoses, emotions accompanying their BFRBs, and whether they felt an urge to perform the behavior on others as well as themselves.

Results

The main motives for performing BFRBs were release of stress (84.7%), boredom (51.5%), and gratification/pleasure (34.7%). Approximately one third of the sample were unable to provide a clear motive. The majority were ambivalent about their behavior. Participants rarely engaged in cutting; 16.4% performed a BFRB on someone else’s body or wanted to do so. OCD was self-reported by only 7.5% of the participants.

Discussion

Ambivalence towards symptoms is high in individuals with BFRBs; the main motive for performing the behavior was emotion regulation, particularly of stress. Limitations of the study are the self-reported assessment and the high attrition during the assessment. Further research is needed to clarify whether BFRBs, NSSI, and SMB should be kept separate or should be combined into one category, perhaps with specifiers. The current classification of BFRBs as an OCD-related disorder should be reconsidered.

Background

Interpretation biases are a form of cognitive bias in which ambiguous information is resolved in a consistent manner; threat-related interpretation biases are documented across a range of psychiatric disorders. Intolerance of uncertainty (IU) is the tendency to perceive uncertainty as threatening. Despite the relevance of IU to threat-related interpretation biases, relatively little work has examined the associations between these constructs, particularly in the context of posttraumatic stress disorder (PTSD).

Method

This study examined the associations between IU, PTSD, and threat-related interpretation biases among 342 trauma-exposed adults (n = 156; 45.6% with provisional PTSD). Participants completed an online survey, including the Prospective IU and Inhibitory IU subscales of the Intolerance of Uncertainty Scale-12 (IUS-12), the PTSD Checklist for DSM-5 (PCL-5), and the Interpretation Bias Index for PTSD (IBIP). Responses to the IBIP were summed to capture explicit biases (i.e., the extent to which ambiguous sentences were perceived as threatening). Additionally, timing data were collected and used as an exploratory metric of implicit biases (i.e., the speed with which participants resolved threat-related ambiguity).

Results

PTSD symptom severity was associated with both explicit and implicit threat biases. Prospective and inhibitory IU were each robustly associated with explicit threat biases, whereas only inhibitory IU was associated with implicit biases toward threat.

Conclusions

Results indicate that PTSD symptoms and IU are each associated with threat-related interpretation biases among trauma-exposed individuals.

Background

Increased endorsement of metacognitions and poorer executive functioning have been associated with increased adolescent psychological distress. However, it is unknown whether poorer executive functioning strengthens the metacognitions–psychological distress relationship.

Methods

This cross-sectional study investigated unique and interactive contributions of self-reported positive metacognitions (beliefs that repetitive thinking is beneficial), negative metacognitions (beliefs that repetitive thinking is uncontrollable) and an objective test of executive function on self-reported psychological distress in N = 85 Australian adolescents (49% female, 51% male) aged 12–14 years (M = 13.22, SD = 0.45).

Results

Results of the hierarchical regression revealed both positive and negative metacognitions significantly, positively, and strongly predicted psychological distress. Furthermore, poorer executive functioning significantly strengthened the negative metacognitions–psychological distress relationship. These findings indicate that adolescents who endorse beliefs that their repetitive thinking is uncontrollable, dangerous, or helpful are more likely to be psychologically distressed. Furthermore, findings indicate adolescents with poorer inhibition were particularly vulnerable to the impact of negative metacognitions (e.g., repetitive thinking is uncontrollable) on psychological distress. This vulnerability is likely because negative metacognitions are highly intrusive, rendering their activation difficult to ignore.

Conclusions

Overall, findings support the self-regulatory executive function model, indicating metacognitions and executive functioning influence adolescent psychological distress. These findings have practical implications for clinical interventions.

Purpose

Optimism and social problem solving were examined as predictors of depressive symptoms and suicidal behaviors in Latinx adults.

Methods

A total of 572 (424 female and 148 male) Latinx college students participated in the present study.

Results

Regression analyses, controlling for sociodemographic factors (e.g., age, sex, immigration status) and past suicide attempts, indicated that optimism accounted for a significant amount of the variance in depressive symptoms and suicidal behaviors. Moreover, the inclusion of social problem solving was found to further augment the prediction model by accounting for additional unique variance in depressive symptoms and suicidal behaviors. Within the social problem-solving set, negative problem orientation was consistently found to be the only significant unique predictor. Finally, an examination for an Optimism × Social Problem Solving interaction effect resulted in identifying a significant Pessimism × Negative Problem Orientation effect in predicting depressive symptoms and suicidal behaviors. Importantly, negative problem orientation was associated with both greater depressive symptoms and suicidal behaviors among those with less than high levels of optimism.

Conclusion

These findings point to the additive and interactive role of negative expectancies, namely, pessimism and negative problem orientation, in accounting for greater depressive symptoms and suicidal behaviors in Latinx adults.

Background

There is considerable interest in identifying factors that predict outcome from psychological treatment. This review examines the relationship between readiness / stage of change at entry to CBT treatment and treatment attendance or outcome in people with mental health problems other than addiction.

Methods

Four databases: PsycINFO; MEDLINE; Embase and CINAHL were searched to identify relevant studies published in English from 1st January 1980 onwards. Following title and abstract screening, and full text review of potentially eligible studies, a total of 22 eligible studies were identified, of which 21 were included in the narrative synthesis. The review was registered on PROSPERO REF: CRD42020209173.

Results

Nineteen studies explored the relationship between readiness and symptom outcome, with a majority (n = 13) identifying at least one statistically significant relationship between variables, either directly or in interaction with another measure. A number of these also tested other associations which were non-significant. In contrast, five studies explored the association between readiness and treatment attendance, and findings were inconclusive.

Conclusions

The systematic review found some evidence suggesting that readiness is linked to symptom outcome in CBT, regardless of the type of clinical problem or readiness measure used. The studies adopting an RCT design identified no evidence of differences in the relationship between readiness and outcome when comparing CBT to other psychotherapeutic interventions. Study quality was variable, and a range of methodological limitations and potential avenues for future work are discussed.

Background and Objectives

Autobiographical memories have been found to be related to one’s current psychological state. Biases in autobiographical memories in terms of valence, content, and specificity are thought to be related to one’s well-being and mental health. Previous studies have shown that by using cognitive bias modification techniques that aim to alter one’s interpretation bias, memory valence bias could also be altered. The goal of the current study was to investigate if these techniques can also alter overgenerality of autobiographical memory, a phenomenon strongly associated with different psychopathologies. We hypothesized that creating a positive interpretation would decrease overgenerality of autobiographical memories while a negative interpretation bias would increase overgenerality.

Methods

Sixty participants were recruited and divided into two groups, positive vs. negative imagery Cognitive Bias Modification (i-CBM). Both groups completed an Autobiographical Memory Test (AMT) before and after undergoing one i-CBM session (positive or negative).

Results

positive i-CBM reduced overgenerality of autobiographical memories, while negative i-CBM increased it.

Conclusions

These results suggest that changing one’s cognitive interpretation bias also changes one’s memory bias. Thus, the same task that reduces negative bias from autobiographical memories also reduces overgenerality of autobiographical memories. In addition, the results strengthen the suggestion that the use of imagery and the ability to generate specific autobiographical memories are related. These findings hold great potential for our understanding of the interconnection between the different cognitive memory biases that lay at the base of several psychopathologies.