Cognitive Therapy and Research最新文献

Background

Military personnel who complete cognitive processing therapy (CPT) can still experience residual symptoms of posttraumatic stress disorder (PTSD). Gaining a deeper understanding of the characteristics that influence response to CPT may increase the likelihood of treatment success. Emotion regulation and trait resilience are associated with PTSD severity and may influence treatment response in active duty service members with PTSD.

Methods

This secondary analysis explored the association among reports of baseline emotion regulation (Cognitive Emotion Regulation Questionnaire-Short Form) and trait resilience (Response to Stressful Experiences Scale) with PTSD severity reductions in a sample of active duty service members (N = 268) who participated in a clinical trial that compared group-delivered and individual CPT. Population averaged models were utilized to examine if baseline predictors were related to change in PTSD severity from pre- to posttreatment.

Results

Trait resilience predicted PTSD severity changes such that participants who reported less trait resilience at baseline demonstrated greater PTSD severity reductions over a course of CPT. There was also a main effect of adaptive emotion regulation on PTSD severity. Post-hoc correlation analyses revealed that baseline adaptive emotion regulation was positively associated with PTSD severity at pre- and posttreatment.

Conclusions

Findings imply that service members with lower trait resilience may particularly benefit from CPT. Whether trait resilience moderates PTSD outcomes specific to CPT will require a trial with an alternative comparison treatment arm.

Clinical Trial Registration

ClinicalTrials.gov identifier: NCT02173561 (6/25/2014)

Background

Insomnia is highly prevalent and cognitive behavioural therapy is the first-line treatment for it. This study aimed to assess the efficacy of remote cognitive behavioural therapy for insomnia, specifically, treatment fully delivered through the internet, mobile phones and telephones for sleep and other health outcomes in adults diagnosed with insomnia or reporting insomnia symptoms. This study also aimed to evaluate the effect of various intervention components as subgroup variables to explain the efficacy of remote cognitive behavioural therapy on health outcomes.

Methods

Randomised controlled trial studies were obtained from five electronic databases. The PEDro scale was used to assess the quality of the studies. A random effect model was used to assess the mean difference, standardised mean difference and standard deviation of the outcome variables. Heterogeneity among the study articles was assessed using I² and Q tests. Egger regression analysis was used to assess publication bias.

Results

Remote cognitive behavioural therapy for insomnia had significant and positive effects on improving sleep outcomes, depression, anxiety, fatigue and mental health compared with the control conditions. Its effect on physical health was not significant. The effect of the therapy was enhanced when the total length of intervention was shorter than 6 weeks, delivered via the internet and did not include therapist support.

Conclusion

Remote cognitive behavioural therapy for insomnia is effective in improving sleep quality, depression, anxiety, fatigue and mental health in insomnia patients.

Abstract

Abstract

Background

This research proposes that cognitive biases involving the categorisation of food in terms of calorie content may contribute to restrictive eating in anorexia nervosa (AN). The current study sought to discriminate the validity of two novel hypotheses: (1) People with AN more readily categorise food in terms of calorie content rather than in terms of alternative dimensions (e.g., tastiness), and (2) people with AN have difficulty reclassifying food initially categorised in terms of calorie content, in terms of alternative dimensions.

Methods

To test these hypotheses, a novel food categorisation task was developed and delivered to people with a self-reported lifetime diagnosis of AN (N = 48) and to people with no history of an eating disorder (N = 133). Participants categorised food in terms of calorie content or tastiness.

Results

Results revealed that the AN group, relative to the comparison group, was faster to categorise food in terms of calorie content and slower to reclassify food initially categorised in terms of calorie content.

Conclusions

These findings suggest that AN is characterised by both an inflated tendency to categorise food in terms of calorie content and to become subsequently stuck on this categorisation.

Background

The military to civilian transition process is often associated with a negative impact on psychosocial functioning. Contemporary approaches to understand this are moving away from focussing on posttraumatic stress disorder (PTSD), to examine the military cultural and environmental impacts of service. Schema theory can provide a useful conceptual framework for understanding these issues. The aim of this study was to explore Early Maladaptive Schemas (EMS) across three samples: transitioned military personnel, veterans and first responders with PTSD, and general adults.

Method

This cross-sectional research used a transitioned military sample recruited specifically for this study (N = 94) and two comparison samples of veterans and first responders diagnosed with PTSD (N = 218), and general adults (N = 264) from previous research. Participants completed a Young Schema Questionnaire (YSQ). Independent t-tests were conducted to compare the three samples.

Results

Transitioned military personnel were significantly higher than the general adults on the EMS of Vulnerability to Harm, Entitlement, Emotional Inhibition, Punitiveness and Unrelenting Standards and lower on the schema of Enmeshment. Transitioned military personnel were significantly lower than the PTSD sample on 11 out of the 18 EMS.

Conclusions

The cluster of EMS evident in the transitioned military sample were conceptualised as ‘The Military Mode’. This conceptual framework can be used to understand the psycho-social issues experienced by transitioned military personnel and to inform interventions to promote successful transition.

Background

Rumination is a well-established contributor to the severity of depression and anxiety. It is unknown, however, whether individual differences in the temporal dynamics of rumination over time predict longitudinal increases in depression or anxiety.

Methods

The current study examined whether the dynamic indices of ruminative inertia and variability assessed over 14 days via ecological momentary assessment predicted change in symptoms of depression, general anxiety, and social anxiety at a 90-day follow-up (n = 115).

Results

Controlling for ruminative variability, baseline levels of the dependent variable, sex, and mean levels of momentary rumination, ruminative inertia did not predict change in symptoms of depression, general anxiety, or social anxiety at the 90-day follow-up. In contrast, greater ruminative variability predicted increases in symptoms of both depression and social anxiety but not general anxiety at follow-up. Individuals endorsing higher baseline levels of depressive symptoms demonstrated greater amounts of inertia and variability in their momentary rumination. Greater ruminative variability but not inertia was also associated with higher baseline levels of general anxiety and social anxiety.

Conclusions

These results suggest that ruminative variability may be a risk factor for increases in symptoms of depression and social anxiety over time and a potentially useful target for clinical intervention.

Background

Recent research has found a strong link between loneliness and social anxiety above and beyond other psychological constructs. Given these strong relationships, the present study sought to determine if mechanisms that maintain social anxiety may also play a role in loneliness. Specifically, the present study used two samples to explore the role of social safety behavior (SBs; behaviors intended to avoid, prevent, or manage threat) in loneliness.

Methods

In Study 1, we explored this relationship in an unselected sample (N = 98). In Study 2, participants (N = 132) with elevated social anxiety were randomized to a two-week SB fading manipulation or a no-instruction control.

Results

SBs were positively associated with loneliness, independent of co-occurring social anxiety. Further, changes in SBs were associated with changes in loneliness one-month later, and social anxiety was no longer significantly associated with loneliness once SBs were entered in these models. SB fading led to significantly lower loneliness at post-manipulation, relative to the control condition, though this effect was only found in individuals high in baseline loneliness. Additionally, a moderated mediation model found that for individuals high in pre-manipulation loneliness, change in loneliness was accounted for by change in negative interpretation bias, a key mechanism in both loneliness and social anxiety.

Conclusions

Taken together, these findings indicate that targeting SB may be a viable method of addressing loneliness, though further research is needed.

Background

Depression often leads to clinical admission. Stimulating positive memory bias through repeated retrieval can counteract a ruminative depressotypic processing style. Cognitive Bias Modification (CBM)-Memory is a psychological intervention, which was evaluated as possible adjunct treatment for depressed inpatients.

Methods

A randomized controlled pilot study with a one-week follow-up was implemented to compare the effect of a four-session positive CBM-Memory intervention to a neutral CBM-Memory version. Training-congruent retrieval (as manipulation check), and transfer to rumination (as mechanistic target) and depressive symptoms (self-rated and clinician-rated; indication of clinical relevance) were assessed.

Results

In the intention-to-treat sample (N = 81, M_age=35.6/SD = 11.9, 60% female), condition-congruent memory retrieval of previously presented target words was found after the training and at follow-up (large effect-sizes). Positive CBM-Memory intervention resulted in sustained recall bias and largest rumination reduction with a small-medium effect size. Additionally, the conditions did not differ significantly on the reduction in depressive symptoms.

Conclusions

Positive CBM-Memory intervention yielded positive recall bias, which was still present one week later. Additionally, the positive condition did yield more decrease in trait (but not state) rumination, providing some support for rumination as mechanistic target of positive CBM-Memory. However, there was no evidence for transfer of the training effect to depressive symptoms, indicating no superiority on clinical recovery of the positive over the neutral condition. Future research should examine a higher dosage, integration of CBM in the treatment provision, and its long-term effects in a well-powered trial.