Cognitive Therapy and Research最新文献

Background

Clinical data are usually analyzed with the assumption that knowledge gathered from group averages applies to the individual. Doing so potentially obscures patients with meaningfully different trajectories of therapeutic change. Needed are “idionomic” methods that first examine idiographic patterns before nomothetic generalizations are made. The objective of this paper is to test whether such an idionomic method leads to different clinical conclusions.

Methods

51 patients completed weekly process measures and symptom severity over a period of eight weeks. Change trajectories were analyzed using a nomothetic approach and an idiographic approach with bottom-up clustering of similar individuals. The outcome was patients’ well-being at post-treatment.

Results

Individuals differed in the extent that underlying processes were linked to symptoms. Average trend lines did not represent the intraindividual changes well. The idionomic approach readily identified subgroups of patients that differentially predicted distal outcomes (well-being).

Conclusions

Relying exclusively on average results may lead to an oversight of intraindividual pathways. Characterizing data first using idiographic approaches led to more refined conclusions, which is clinically useful, scientifically rigorous, and may help advance individualized psychotherapy approaches.

Background

The present study examined the relative roles of approach and avoidance motivation in eating pathology using a multi-method approach combining self-report and physiological measures. The potential effect of internalized ideals and fears was also investigated.

Methods

Fifty-seven undergraduate women completed a picture-viewing task in which they viewed images of women’s bodies (thin and non-thin) and affective images. Self-report ratings of valence and arousal were measured along with physiological indicators of approach (postauricular reflex) and avoidance (startle blink reflex) motivation.

Results

Greater eating pathology was associated with more negative valence ratings of both thin and non-thin images. There was a significant interaction between valence ratings of non-thin bodies and fear of the unattractive self in relation to eating pathology, such that eating pathology was highest in those who rated non-thin images as more unpleasant and internalized fears of being/becoming unattractive. Thin-ideal internalization did not significantly interact with ratings of thin images to predict eating pathology. There were no significant findings when examining physiological data.

Conclusions

Results from self-report measures suggest that eating pathology is associated with avoidant reactions to both thin and non-thin bodies and highlight the importance of internalized appearance-related fears.

Background

Interventions teaching cognitive-behavioral skills feature prominently among evidence-based treatments for emotional disorders. However, the relative impact of interventions that teach one cognitive-behavioral skill in-depth (i.e., an entrée intervention) versus those that provide limited coverage of multiple skills (i.e., a sampler intervention) remains unclear. In this study, we compared these two approaches using unguided single-session internet-based cognitive-behavioral interventions.

Methods

A total of 657 participants living in the U.S. with elevated depressive symptoms were randomly assigned to the entrée, sampler, or no-intervention control conditions. The entrée approach focused in-depth on developing one skill and the sampler condition introduced three skills. Both interventions lasted approximately 30 min. All participants completed measures of depressive symptoms, loneliness, and coping skill use and quality before the intervention and a week after the intervention.

Results

There were no condition differences in change in depressive symptoms, coping skill usage, coping skill quality, or loneliness. Those in the sampler condition were less likely to drop out than those in the entrée condition. In addition, condition differences were moderated by initial depressive symptom severity, such that among the more severely depressed the sampler condition led to greater symptom reduction than the entrée and control conditions.

Conclusions

We did not find overall differences between the entrée, sampler, and control conditions on primary outcomes. Nonetheless, the differences that did emerge suggest offering a variety of skills improves retention and provides greater relief for those with high initial depressive symptom severity in single-session internet-based interventions.

Clinicaltrials.gov ID NCT04643964, registered on 11/12/2020.

Purpose

Research suggests that performance on the Death-Implicit Association Test (D-IAT) converges with explicit indicators of suicide risk (e.g., suicidal ideation, suicidal behaviors). However, the utility of the D-IAT in acute care settings has been questioned given limited studies and inconsistent findings. Additionally, it remains unclear whether the D-IAT incrementally improves the assessment of suicide risk beyond explicit measures.

Method

The present study evaluated the validity of the D-IAT in a large sample of psychiatric inpatients who attempted suicide within the past two years (N = 203; M age = 32.93 [SD = 12.61]; 50.7% female; 63.5% White; 22.7% Hispanic/Latino). The D-IAT was scored three ways: (1) conventional D scoring where positive scores indicate stronger implicit associations with death, (2) dichotomized D scores where participants were categorized based on positive or negative D score, and (3) DD scoring, which is a novel procedure that differentiates self-identification with death (Me-DD) from a lack of identification with life (Not Me-DD).

Results

D and Not Me-DD were weakly associated with suicide cognitions, hopelessness, suicidal ideation, and wishes to live/die and there were corresponding mean differences based on dichotomized D scores. D and Not Me-DD were also weakly correlated with number of lifetime suicide attempts. Me-DD evidenced fewer significant associations than Not Me-DD suggesting that a lack of association with life may be the central component of D scores.

Conclusions

Findings suggest that the D-IAT may not be a useful standalone measure of suicide risk in high-risk populations.

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.