Cognitive Therapy and Research最新文献

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.

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.