Behaviour Research and Therapy最新文献_第8页

The physiological signature of imagery rescripting: Associations between heart rate and session-level outcomes 图像描述的生理特征：心率与会话水平结果之间的关系。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-10-04 DOI: 10.1016/j.brat.2025.104879

Jessica Uhl , Wolfgang Lutz , Eshkol Rafaeli

Objective

Imagery rescripting (IR) as an emotion-focused technique involves an evoking as well as a rescripting phase, which incorporates cognitive restructuring. The different components of IR might be characterized by different physiological patterns. The main aim of this study is to test whether clients' physiological arousal during the evoking phase and clients’ physiological arousal during the rescripting phase follows specific patterns and predicts improvement on next-session outcomes.

Methods

The results are based on 108 therapy sessions from an imagery-based treatment with 64 clients with test anxiety. The treatment protocol involves two consecutive IR sessions of past events related to test anxiety. Clients’ heart rate (HR) was continuously monitored, next-session outcome was assessed with the State Test Anxiety Measure and Outcome Rating Scale.

Results

Clients showed on average an increase in HR during the evoking phase and a decrease during the rescripting phase in the first IR session. These effects reduced in the second IR session. In addition, no latent subgroups were identified. Furthermore, an increase in HR during the evoking phase was significantly associated with lower next-session test anxiety and marginally associated with higher next-session well-being.

Conclusion

The results provide initial evidence that clients’ physiological arousal during the evoking phase of IR might play a role in the effectiveness of IR.

目的：意象重写（IR）作为一种以情绪为中心的技术，包括一个唤起和一个重写阶段，其中包括认知重构。IR的不同成分可能具有不同的生理模式。本研究的主要目的是检验来访者在唤起阶段的生理唤醒和在重写阶段的生理唤醒是否遵循特定的模式，并预测下一次治疗结果的改善。方法：结果是基于108个治疗疗程的图像为基础的治疗64个客户的测试焦虑。治疗方案包括两个连续的与考试焦虑相关的过去事件的IR会话。持续监测患者的心率（HR），用状态测试焦虑量表和结果评定量表评估下一阶段的结果。结果：在第一次IR会话中，客户平均表现出在唤起阶段的HR增加和在重新描述阶段的HR减少。这些影响在第二次IR治疗中减少。此外，未发现潜在亚群。此外，在唤起阶段，人力资源的增加与较低的下一次考试焦虑显著相关，与较高的下一次考试幸福感轻微相关。结论：本研究结果初步证明，来访者在心理刺激诱发阶段的生理觉醒可能对心理刺激的有效性起作用。

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引用次数: 0

The imagery rescripting protocol for obsessive-compulsive disorder (ImRs-OCD): A decade of iterative refinement in treatment sequencing following ERP 强迫症（ImRs-OCD）的图像重写协议：ERP后治疗顺序的十年迭代改进。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-10-02 DOI: 10.1016/j.brat.2025.104878

Gayle Maloney , Arnoud Arntz , Christopher Pittenger

Obsessive-Compulsive Disorder (OCD) is a debilitating psychological condition that remains resistant to treatment in a significant proportion of clients, even following completion of first-line psychological and pharmacological treatments. This paper describes a sequenced treatment protocol combining Exposure and Response Prevention (ERP) with Imagery Rescripting for OCD (ImRs-OCD) as an adjunctive intervention for individuals with treatment-resistant OCD. The ImRs-OCD protocol has undergone multiple rounds of refinement over the past 10 years through iterative protocol development, based on clinician and client feedback. We describe the evolution of the protocol, key adaptations for OCD, illustrative case examples, and preliminary evidence supporting its efficacy. A standardised 10-step ImRs-OCD protocol is presented, along with guidelines for implementation and a set of standard rescripting questions and handouts. This work aims to provide guidance to clinicians and to encourage further research into imagery rescripting as a comprehensive treatment approach for treatment-resistant OCD.

强迫症（OCD）是一种使人衰弱的心理状态，在很大一部分患者中，即使在完成了一线心理和药物治疗后，仍然对治疗有抵抗力。本文介绍了一种结合暴露与反应预防（ERP）和影像处方治疗强迫症（ImRs-OCD）的序列治疗方案，作为治疗难治性强迫症患者的辅助干预措施。在过去的10年里，基于临床医生和客户的反馈，ImRs-OCD协议经历了多轮的改进。我们描述了该方案的演变，强迫症的关键适应，说明性案例，以及支持其有效性的初步证据。提出了标准化的10步ImRs-OCD协议，以及实施指南和一套标准的处方问题和讲义。这项工作旨在为临床医生提供指导，并鼓励进一步研究图像处方作为治疗难治性强迫症的综合治疗方法。

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引用次数: 0

Effectiveness of body exposure for the treatment of body image disturbance: A meta-analysis 身体暴露治疗身体形象障碍的有效性：一项meta分析

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-30 DOI: 10.1016/j.brat.2025.104876

Hannah Weins , Noemi Berliner , Alina Riefler , Jana Kessel , Fridtjof W. Nussbeck , Andrea S. Hartmann

Body image disturbance (BID) is a defining feature of several psychiatric disorders, notably eating disorders and body dysmorphic disorder. Although body exposure (BE) has been proposed as an effective intervention, the strength of its effects and the factors influencing its efficacy remain uncertain. We conducted random-effects meta-analyses of randomized controlled trials in which BE was delivered as a stand-alone intervention. Outcomes included negative affect, BID-related measures, arousal, and disorder-specific symptoms. Potential moderators (e.g., attention focus, facilitator presence) were examined. BE produced moderate effects on BID-related measures (0.60, 95 % CI [0.40, 0.80]) and disorder-specific symptoms (0.76, 95 % CI [0.15, 1.36]), but did not significantly reduce negative affect (0.30, 95 % CI [−0.07, 0.67]). Arousal could not be assessed due to insufficient data, and no significant moderators emerged, likely reflecting the small, heterogeneous evidence base. These results support BE as an effective approach for reducing BID and disorder-specific symptoms and highlight the need for experimental research comparing BE variations and targeting broader outcome domains to guide individualized, evidence-based clinical practice.

身体形象障碍（BID）是几种精神疾病的典型特征，尤其是饮食障碍和身体畸形障碍。虽然身体暴露（BE）已被认为是一种有效的干预措施，但其作用强度和影响其疗效的因素仍不确定。我们对随机对照试验进行了随机效应荟萃分析，其中BE作为独立干预措施。结果包括负面影响、bid相关测量、觉醒和障碍特异性症状。研究了潜在的调节因素（例如，注意力集中、引导者在场）。BE对bid相关措施（0.60,95% CI[0.40, 0.80]）和疾病特异性症状（0.76,95% CI[0.15, 1.36]）产生中等影响，但没有显著减少负面影响（0.30,95% CI[- 0.07, 0.67]）。由于数据不足，无法对觉醒进行评估，也没有出现显著的调节因子，这可能反映了证据基础的小而异构。这些结果支持BE作为减少BID和疾病特异性症状的有效方法，并强调需要进行实验研究，比较BE的变化和针对更广泛的结果领域，以指导个体化、循证临床实践。

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引用次数: 0

‘Episodic Threat Conditioning’: a novel approach to simultaneously measure Pavlovian threat conditioning and episodic memory “情景威胁条件反射”：一种同时测量巴甫洛夫威胁条件反射和情景记忆的新方法

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-30 DOI: 10.1016/j.brat.2025.104882

Olivier T. de Vries , Sascha B. Duken , Nadža Džinalija , Merel Kindt , Vanessa A. van Ast

The powerful ways future behavior and cognition can be affected by emotional events are typically studied either by means of Pavlovian conditioning or episodic memory paradigms, which both rest on the idea that associations are formed between distinct stimuli experienced closely together in space or time. However, due to their incompatible methods, little is known about how physiological read-outs of Pavlovian conditioning and episodic memory work in concert to affect behavior and other cognitive processes, how they relate to each other, or whether they reflect the activity of distinct associative processes in the first place. To shed light on such questions, a paradigm is needed that can assess both conditioned psychophysiology and episodic memory. We reasoned that multimodal stimuli, consisting of congruent image-sound combinations, have the potential to serve as potent unconditioned stimuli in a paradigm where participants encode a large number ‘mini-conditioning events’. Measuring both pupil dilation and facial electromyography, we found that psychophysiological responses to 20 unique aversive USs – but not positive USs - transferred to arbitrary predictors already after a single paired presentation in this novel paradigm. Real-life emotional aversive and stressful events are likely to involve both Pavlovian conditioning and episodic memory processes. The ‘Episodic Threat Conditioning’ paradigm enables their simultaneous assessment, thereby providing an opportunity to gain more holistic insight into how different expressions of memory interact in mental health and disease.

情绪事件对未来行为和认知的强大影响通常是通过巴甫洛夫条件反射或情景记忆范式来研究的，这两种范式都基于这样一种观点，即在空间或时间上紧密相连的不同刺激之间形成了联系。然而，由于它们的方法不相容，巴甫洛夫条件反射和情景记忆的生理读出是如何协同影响行为和其他认知过程的，它们是如何相互关联的，或者它们是否首先反映了不同的联想过程的活动，人们对这些问题知之甚少。为了阐明这些问题，需要一种既能评估条件心理生理学又能评估情景记忆的范式。我们推断，在参与者编码大量“迷你条件反射事件”的范式中，由一致的图像-声音组合组成的多模态刺激有可能成为有效的非条件刺激。通过测量瞳孔扩张和面部肌电图，我们发现，在这种新模式下，对20种独特的厌恶USs（而不是积极USs）的心理生理反应在单对呈现后就已经转移到任意预测因子上。现实生活中的情绪厌恶和压力事件可能涉及巴甫洛夫条件反射和情景记忆过程。“情景威胁条件反射”范式使他们能够同时进行评估，从而为更全面地了解记忆的不同表达如何在心理健康和疾病中相互作用提供了机会。

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引用次数: 0

Joy beyond fear: Positive emotions after exposure in patients with anxiety disorders and their link to threat expectancy and treatment outcome 超越恐惧的快乐：焦虑障碍患者暴露后的积极情绪及其与威胁预期和治疗结果的联系

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-30 DOI: 10.1016/j.brat.2025.104880

Thomas Borchert , Ingmar Heinig , Volker Arolt , Christina Bartnick , Udo Dannlowski , Jürgen Deckert , Katharina Domschke , Thomas Fydrich , Stephan Goerigk , Alfons O. Hamm , Maike Hollandt , Jürgen Hoyer , Tilo Kircher , Katja Koelkebeck , Ulrike Lueken , Jürgen Margraf , Peter Neudeck , Paul Pauli , Jan Richter , Winfried Rief , Andre Pittig

Exposure-based CBT is effective in treating anxiety disorders, but individual responses vary substantially, underlining the need to identify and boost mechanisms underlying exposure. In this study, the role of positive emotions occurring after exposure was examined. In an analysis of 8416 exposure records of 648 anxiety patients undergoing exposure therapy, the degree of positive emotions hope and joy occurring after exposure exercises, their predictors, and their role regarding treatment success were investigated. Positive emotions after exposure were medium to high and increased slightly across repeated exposure exercises. They were associated with exposure-related learning indicators (i.e., expectancy violation and change as well as the prediction-error learning rate) and were mainly predicted by adjusted threat expectancy assessed after completing exposure, controlling for baseline depressive symptoms and affect. Higher positive emotions independently predicted better treatment outcome beyond learning indicators, and partially mediated the association between learning indicators and treatment outcome. These findings indicate that positive emotions are partly associated with successful learning during exposure but seem to have a unique contribution to overall treatment success, underlining the need to strengthen positive emotions via different possible means.

基于暴露的CBT在治疗焦虑症方面是有效的，但个体的反应差异很大，这强调了识别和促进暴露机制的必要性。本研究考察了暴露后积极情绪的作用。通过对648例接受暴露治疗的焦虑患者的8416份暴露记录的分析，探讨了暴露练习后出现的积极情绪、希望和喜悦的程度、影响因素及其对治疗成功的作用。暴露后的积极情绪是中等到高的，在重复的暴露练习中略有增加。它们与暴露相关的学习指标（即期望违反和改变以及预测错误学习率）有关，主要通过完成暴露后评估的调整威胁期望来预测，控制基线抑郁症状和影响。高的积极情绪独立地预测了学习指标之外更好的治疗结果，并部分介导了学习指标与治疗结果之间的关联。这些发现表明，积极情绪在一定程度上与暴露期间的成功学习有关，但似乎对整体治疗成功有独特的贡献，强调了通过不同可能的手段加强积极情绪的必要性。

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引用次数: 0

Awareness as a key component of mindfulness reduces psychological stress in adolescents: Evidence from multi-method studies 意识是正念的一个关键组成部分，可以减少青少年的心理压力：来自多方法研究的证据。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-30 DOI: 10.1016/j.brat.2025.104877

Yaoyao Zhang , Xin Liu , Huimin Wu , Mingxin Shi , Cheng Guo

Objective

The components of mindfulness include awareness and acceptance. However, the effects of awareness and acceptance on psychological stress in adolescents remain controversial, and the underlying cognitive processes less attention. Therefore, this study aimed to examine their independent effects, and the relevant cognitive processes.

Methods

A cross-sectional survey study (Study 1, N = 3304, M_age = 15.53 years) employed regression models to examine the relationships between awareness, acceptance, and psychological stress. A randomized controlled trial (Study 2, N = 304, M_age = 15.07 years) was conducted by randomly assigning participants to four groups: an awareness group (MA), an awareness and acceptance group (MA + A), an active control group (AC), and a blank control group (BL). Study 2 aimed to examine the effects of awareness and acceptance on adolescents’ psychological stress. A cross-sectional observational study (Study 3, N = 111, M_age = 16.77 years) was conducted to examine the non-temporal mediating role of attention control.

Results

Study 1 indicated that both awareness and acceptance were negatively associated with psychological stress, with awareness showing a stronger negative relationship. Study 2 showed that adolescents’ psychological stress improved in both the MA and MA + A groups, with the MA group showing a more significant reduction than both the MA + A (d = −0.23) and BL groups (d = −0.56). Study 3 showed that conflict monitoring of attention control played a non-temporal mediating role in the relationship between awareness and psychological stress in adolescents. Conclusions: This study emphasizes the importance of awareness and conflict monitoring in developing mindfulness-based stress reduction programs for adolescents.

目的：正念的组成部分包括意识和接受。然而，认知和接受对青少年心理压力的影响仍然存在争议，潜在的认知过程较少受到关注。因此，本研究旨在检验它们的独立作用，以及相关的认知过程。方法：采用横断面调查研究（study 1, N = 3304，年龄= 15.53岁），采用回归模型检验意识、接受度与心理压力之间的关系。采用随机对照试验（Study 2, N = 304，年龄= 15.07），将参与者随机分为4组：意识组（MA）、意识与接受组（MA + A）、主动对照组（AC）和空白对照组（BL）。研究二旨在探讨认知和接受对青少年心理压力的影响。本研究采用横断面观察性研究（study 3, N = 111, Mage = 16.77 years）来检验注意控制的非时间中介作用。结果：研究1表明，认知和接受与心理压力均呈负相关，其中认知负相关更强。研究2显示，MA组和MA + A组青少年的心理压力均有改善，其中MA组比MA + A组（d = -0.23）和BL组（d = -0.56）有更显著的降低。研究3表明，注意控制的冲突监测在青少年意识与心理压力的关系中起非时间中介作用。结论：本研究强调了意识和冲突监测在发展以正念为基础的青少年减压项目中的重要性。

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引用次数: 0

Using the death/suicide implicit association task to prospectively predict near-term suicidal behavior in high-risk veterans 使用死亡/自杀内隐关联任务前瞻性预测高风险退伍军人近期自杀行为。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-25 DOI: 10.1016/j.brat.2025.104874

Megan S. Chesin , Alejandro Interian , Vibha Reddy , Arlene King , Kayla Maloney , Rachael Miller , Rokas Perskaudas , Kailyn Rodriguez , Lauren St Hill , John Keilp , Catherine E. Myers

The 90-day period after a suicide attempt or hospitalization for suicidal behavior is a period of increased risk for psychiatric patients. However, predicting who among patients at suicide risk will engage in suicidal behavior in this window remains an elusive task. Neurocognitive task performance, such as performance on the Death/Suicide Implicit Association Task (D/S IAT), shows some promise for aiding in the prediction of suicidal behavior beyond risk factors routinely assessed in clinical practice, such as self-reported suicidal ideation. This study considered whether performance on the D/S IAT could prospectively predict suicidal behavior within a 90-day window. Sixty Veterans at high risk for suicide completed the D/S IAT at multiple timepoints over a one-year period. Each testing session was then coded according to whether the participant displayed suicidal behavior within 90 days following that testing session. As a secondary aim, drift diffusion modeling (DDM) was used to estimate latent cognitive processes mediating D/S IAT performance, including decisional efficiency. Two applications of the Generalized Estimating Equations (GEE) method were used to evaluate the incremental utility of (1) D/S IAT performance and (2) DDM-derived latent variables on predicting 90-day suicidal behavior over standard suicide risk factors including suicide attempt history, major depressive or bipolar disorder, and suicidal ideation at the time of testing. Age was also included in the models given the impact of age on reaction times and thus D/S IAT performance. The odds of 90-day suicidal behavior were significantly increased as implicit bias linking the self-concept to the concept of life as opposed to death weakened. The latent cognitive process of reduced decisional efficiency towards categorizing the concept of life relative to death as “like me” predicted 90-day suicidal behavior. D/S IAT performance may add to near-term suicidal behavior prediction. Reduced decisional efficiency is emerging as a general cognitive factor implicated in suicidal behavior.

自杀未遂或因自杀行为住院治疗后的90天是精神病患者风险增加的时期。然而，预测有自杀风险的患者中谁会在这段时间内做出自杀行为仍然是一项难以捉摸的任务。神经认知任务表现，如在死亡/自杀内隐联想任务（D/S IAT）中的表现，显示出在临床实践中常规评估的风险因素（如自我报告的自杀意念）之外，帮助预测自杀行为的一些希望。本研究考虑了D/S IAT的表现是否可以在90天内预测自杀行为。60名自杀风险高的退伍军人在一年的时间里在多个时间点完成了D/S IAT测试。然后根据参与者在测试后90天内是否表现出自杀行为，对每个测试阶段进行编码。作为次要目的，漂移扩散模型（DDM）被用来估计潜在的认知过程介导的D/S IAT性能，包括决策效率。采用广义估计方程（GEE）方法的两种应用来评估(1)D/S IAT性能和(2)ddm衍生的潜在变量对预测90天自杀行为的增量效用，这些潜在变量高于标准自杀危险因素，包括自杀企图史、重度抑郁症或双相情感障碍，以及在测试时的自杀意念。考虑到年龄对反应时间和D/S IAT性能的影响，年龄也被包括在模型中。随着将自我概念与生命概念相联系的内隐偏见减弱，90天内自杀行为的几率显著增加。将生命概念与死亡分类为“像我一样”的决策效率降低的潜在认知过程预测了90天内的自杀行为。D/S IAT表现可能会增加近期自杀行为的预测。决策效率降低是一个普遍的认知因素，与自杀行为有关。

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引用次数: 0

The combination of physical exercise and slow-paced breathing on psychophysiological indices of emotion reactivity, psychosocial stress reactivity and recovery: A multimodal investigation 体育锻炼与慢节奏呼吸相结合对情绪反应、社会心理应激反应和恢复等心理生理指标的影响：一项多模式调查。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-25 DOI: 10.1016/j.brat.2025.104852

Emmanuelle Schoonjans , Zefeng Li , Jens Allaert , Evi Wezenbeek , Pieter Van den Berghe , Simon Helleputte , Stefanie De Smet , Rudi De Raedt , Marie-Anne Vanderhasselt

Stress is a major public health problem calling for scalable interventions. Physical activity (PA) and slow-paced breathing (SPB) can reduce stress, both by modulating cardiac parasympathetic activity. Given their shared target but different mechanisms, combining SPB and PA could enhance their stress-reducing effects. This study therefore explores whether SPB (vs control breathing at a faster rate) after PA increases the impact of PA on psychophysiological indices of emotional reactivity and psychosocial stress reactivity and recovery. In a crossover randomized design, 77 healthy volunteers completed twice a baseline, a bout of PA (at a personalized intensity), 3 × 5 min of breathing (SPB at 5,5 or control breathing at 15 breaths per minute), an emotional reactivity task with negative versus neutral images, a psychosocial stress task and a recovery phase. We measured psychophysiological indices of stress (i.e., heart rate, vmHRV, skin conductance, blood pressure, pupil dilation as well as self-reported stress and mood indices, rumination and coping strategy). Compared to control breathing, SPB decreased worry and made the difference between cardiac reactivities to negative and neutral images lower (as measured through interbeat intervals [IBI]). No effects on other psychophysiological indices of stress were found. Our results are the first to emphasize the potential of combining PA and SPB to reduce worrying and attenuated cardiovascular reactivity to emotional valence. However, the lack of effects on other stress indices indicates the need for future research to explore its broader applicability as a stress management technique.

压力是一个重大的公共卫生问题，需要采取可扩展的干预措施。体育活动（PA）和慢节奏呼吸（SPB）可以通过调节心脏副交感神经活动来减轻压力。鉴于它们的作用靶点相同但作用机制不同，SPB和PA联合使用可以增强它们的减压效果。因此，本研究探讨了PA后的SPB（与以更快的速度控制呼吸相比）是否会增加PA对情绪反应性和社会心理应激反应性和恢复的心理生理指标的影响。在交叉随机设计中，77名健康志愿者完成了两次基线，一次PA（以个性化强度），3 × 5分钟呼吸（SPB为5,5或控制呼吸，每分钟15次呼吸），负面和中性图像的情绪反应任务，心理社会压力任务和恢复阶段。我们测量了压力的心理生理指标（即心率、vmHRV、皮肤电导、血压、瞳孔扩张以及自我报告的压力和情绪指数、反刍和应对策略）。与控制呼吸相比，SPB减少了焦虑，并使心脏对阴性和中性图像的反应性差异更小（通过心跳间隔[IBI]测量）。应激对其他心理生理指标无影响。我们的研究结果首次强调了PA和SPB结合的潜力，以减少担忧和减弱心血管对情绪效价的反应。然而，对其他应力指标的影响不足，表明需要进一步研究以探索其作为应力管理技术的更广泛适用性。

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引用次数: 0

Same same but different: Threat expectancy change and fear reduction as readouts of exposure rationales are only weakly associated and contribute differentially to treatment outcome in anxiety disorders 相同但不同：威胁预期的改变和恐惧的减少与暴露理由的读数只有微弱的关联，并且对焦虑症的治疗结果有不同的贡献。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-24 DOI: 10.1016/j.brat.2025.104856

Sophie Thaon de Saint André , Ingmar Heinig , Volker Arolt , Christina Bartnick , Udo Dannlowski , Jürgen Deckert , Katharina Domschke , Thomas Fydrich , Stephan Goerigk , Alfons O. Hamm , Maike Hollandt , Jürgen Hoyer , Tilo Kircher , Katja Koelkebeck , Ulrike Lueken , Jürgen Margraf , Peter Neudeck , Paul Pauli , Jan Richter , Winfried Rief , Andre Pittig

Responses to exposure therapy vary across individuals, emphasizing the need for a deeper understanding of its underlying mechanisms. This study examined two key processes during exposure that serve as readouts of different clinical rationales: (1) within-session fear reduction (measured as the decline from peak to end fear within an exposure exercise) and (2) threat expectancy processes (assessed via expectancy violation, expectancy change, and learning rate). Data from 516 patients with anxiety disorders who completed at least 10 exposure exercises in a clinical trial were analyzed. Results showed that expectancy measures and fear reduction were only weakly correlated within exposure exercises. While no significant differences were found in their time courses, both readouts independently predicted treatment success. Specifically, a higher learning rate and greater relative fear reduction were associated with better outcomes. These findings highlight the clinical relevance of monitoring fear reduction and expectancy-related readouts as indicators of two distinct exposure rationales — the fear reduction rationale and the threat expectancy rationale. Although it remains unclear whether they reflect separate mechanisms of change or different aspects of a shared mechanism, addressing both rationales may help optimize and personalize exposure therapy.

个体对暴露疗法的反应各不相同，因此需要更深入地了解其潜在机制。本研究考察了暴露过程中的两个关键过程，作为不同临床原理的读数：(1)会话内恐惧减少（以暴露练习中从恐惧高峰到恐惧结束的下降来衡量）和(2)威胁预期过程（通过预期违反、预期变化和学习率来评估）。研究人员分析了516名焦虑症患者的数据，这些患者在一项临床试验中完成了至少10次暴露练习。结果显示，在暴露练习中，期望测量和恐惧减少只有微弱的相关性。虽然在时间过程中没有发现显著差异，但两种读数都独立地预测了治疗成功。具体来说，更高的学习率和更大的相对恐惧减少与更好的结果相关。这些发现强调了监测恐惧减少和预期相关读数作为两种不同暴露原理的指标的临床相关性-恐惧减少原理和威胁预期原理。虽然目前尚不清楚它们是否反映了单独的变化机制或共同机制的不同方面，但解决这两个基本原理可能有助于优化和个性化暴露治疗。

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引用次数: 0

Understanding factors related to treatment retention in an online mental health support service: Analysis of a service database 了解在线心理健康支持服务中与治疗保留相关的因素：服务数据库的分析

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-24 DOI: 10.1016/j.brat.2025.104875

Breanne Hobden , Lauren Pollock , Vincent Lau , Sarah Leask , Kristy Fakes

Background

Engagement with and retention in mental health treatment remains a significant barrier to accessing effective mental health care. Early discontinuation of mental health treatments negatively impacts recovery, as well as other aspects of life such as education, employment and overall mental wellbeing. This study examined, among adults aged ≥18 years, the factors associated with mental health treatment retention via an online service in Australia.

Methods

A secondary analysis of 2021–2025 data from Talked, an Australian online therapy platform. Attendance of 1–2 therapy sessions was classed as lower retention; attendance of 3+ sessions was classed as higher retention. The association between treatment retention and sociodemographic, health and treatment-related variables were explored via multivariable logistic regression.

Results

Data for 7424 individuals were analysed. Among the sample, 52.7 % (n = 3911) engaged in 1–2 treatment sessions, and 47.3 % (n = 3513) engaged in 3+ treatment sessions. Those who had previously undertaken therapy, those reporting consuming alcohol more frequently and those who had selected three or more mental health-related issues at time of therapy booking, had greater odds of engaging with treatment. Those with dependents had lower odds of engaging with treatment.

Conclusions

The factors found to be associated with treatment retention can be used to identify targeted strategies to enhance treatment retention. These findings support the role of early identification and prioritisation of at-risk clients at the time of booking, such as those with dependants, and those who had not undertaken previous therapy, as they may require increased flexibility and accessibility considerations for psychological support.

参与和坚持精神卫生治疗仍然是获得有效精神卫生保健的一个重大障碍。早期停止心理健康治疗对康复以及生活的其他方面，如教育、就业和整体心理健康产生负面影响。本研究在澳大利亚通过在线服务调查了年龄≥18岁的成年人中与心理健康治疗保留相关的因素。方法对澳大利亚在线治疗平台talk的2021-2025年数据进行二次分析。参加1-2次治疗被归为低保留率；出席3次以上的会议被视为较高的留存率。通过多变量逻辑回归探讨治疗保留与社会人口学、健康和治疗相关变量之间的关系。结果分析了7424人的数据。样本中有52.7% （n = 3911）参与了1-2次治疗，47.3% （n = 3513）参与了3次以上治疗。那些以前接受过治疗的人，那些报告饮酒频率更高的人，以及那些在预约治疗时选择了三个或更多心理健康问题的人，接受治疗的几率更大。那些有依赖者的人接受治疗的几率较低。结论发现与治疗保留相关的因素可用于确定有针对性的策略以提高治疗保留。这些发现支持了在预约时早期识别和优先考虑高危客户的作用，例如那些有家属的人，以及那些以前没有接受过治疗的人，因为他们可能需要增加心理支持的灵活性和可及性。

{"title":"Understanding factors related to treatment retention in an online mental health support service: Analysis of a service database","authors":"Breanne Hobden , Lauren Pollock , Vincent Lau , Sarah Leask , Kristy Fakes","doi":"10.1016/j.brat.2025.104875","DOIUrl":"10.1016/j.brat.2025.104875","url":null,"abstract":"<div><h3>Background</h3><div>Engagement with and retention in mental health treatment remains a significant barrier to accessing effective mental health care. Early discontinuation of mental health treatments negatively impacts recovery, as well as other aspects of life such as education, employment and overall mental wellbeing. This study examined, among adults aged ≥18 years, the factors associated with mental health treatment retention via an online service in Australia.</div></div><div><h3>Methods</h3><div>A secondary analysis of 2021–2025 data from <em>Talked</em>, an Australian online therapy platform. Attendance of 1–2 therapy sessions was classed as lower retention; attendance of 3+ sessions was classed as higher retention. The association between treatment retention and sociodemographic, health and treatment-related variables were explored via multivariable logistic regression.</div></div><div><h3>Results</h3><div>Data for 7424 individuals were analysed. Among the sample, 52.7 % (n = 3911) engaged in 1–2 treatment sessions, and 47.3 % (n = 3513) engaged in 3+ treatment sessions. Those who had previously undertaken therapy, those reporting consuming alcohol more frequently and those who had selected three or more mental health-related issues at time of therapy booking, had greater odds of engaging with treatment. Those with dependents had lower odds of engaging with treatment.</div></div><div><h3>Conclusions</h3><div>The factors found to be associated with treatment retention can be used to identify targeted strategies to enhance treatment retention. These findings support the role of early identification and prioritisation of at-risk clients at the time of booking, such as those with dependants, and those who had not undertaken previous therapy, as they may require increased flexibility and accessibility considerations for psychological support.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"194 ","pages":"Article 104875"},"PeriodicalIF":4.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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