Cognitive and Behavioral Practice最新文献

Mental health professionals who work in private practice and other clinical settings have huge opportunities to contribute to the science of our field. But they rarely do so. This article describes ways that practitioners who have research training can capitalize on recent developments in practice, science, and technology to conduct research in their private practice. I describe a model for conducting research as a practitioner that entails tightly integrating the research into clinical practice, and I point out why conducting research in your private practice is worth doing. The remainder of the paper provides a primer, describing strategies for implementing in a clinical setting all the elements of the research enterprise: addressing ethical and legal issues, keeping up to date with the scientific literature, selecting a good research question, conducting a single-case experimental design, finding collaborators and assistants, collecting the data, analyzing the data, writing the paper and getting it published, and handling time and money. Although this paper focuses on research in a solo or group private practice setting, many of the strategies described here can also prove useful in the conduct of research in hospital or community settings.

The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time.

The demand for psychological services in the United States is higher than the available supply of qualified mental health professionals. As a result, there is a substantial need for low-cost interventions that are more accessible and amenable to scale-up independent of the availability of clinicians. Previous studies have found that self-directed bibliotherapy can be an effective intervention with minimal therapist contact. Using the Plan-Do-Study-Act (PDSA) improvement process framework, we implemented self-directed therapy in our outpatient anxiety disorders specialty clinic. We identified four self-directed therapy resources (two books and two smartphone apps) based on cognitive behavioral or acceptance and mindfulness principles. We conducted initial 30-minute billable bibliotherapy consultations with six patients on our waitlist, where we provided the rationale for self-guided treatment, introduced the four resources, helped the patient identify one resource to use, and answered any questions. Eight weeks later, we met with five of these patients for a second billable 30-minute consultation (one had already started individual therapy) and gathered information regarding feasibility and acceptability of these resources as well as helped the patient make continued or better use of the resource until beginning therapy. This case series suggests that self-directed interventions can be effectively implemented in this manner, though with mixed outcomes and effects on patients and their course of care. We describe improvements we intend to implement in future iterations of self-directed therapy.

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.

During a period of intense racial unrest in the nation, we were working as clinicians delivering a manualized protocol to LGBTQ adults of varying racial and ethnic backgrounds. Intrigued by the differences in our modes of engagement with clients, we, a Black, cis female therapist and White, cis male therapist, set out to further explore how our positionalities informed our communications with, and expectations of, White and non-White clients during this time. In this paper, we reflect on these differences when delivering therapy in cross-racial and same-race dyads. We highlight where our experiences overlap as clinicians trained in the same program and where they diverge due to our respective worldviews. We conclude with considerations for practitioners to engage with race in psychotherapeutic treatment.

User experiences are essential to the adoption of an intervention and can be integral to intervention design. We applied two concepts from the technology acceptance model (i.e., perceived ease of use, perceived utility) to understand how mental health professionals experienced a novel system of resources (i.e., engagement system) designed to improve problem identification, coordination, and treatment planning decisions related to addressing problems of low treatment engagement in school mental health services. We conducted a 1-hour focus group with 10 mental health professionals (provider n = 8, supervisor n = 2) using prompts to elicit their perspectives about the effort involved in using the engagement system and about the usefulness of the system in their work. The focus group was transcribed and segmented into 70 excerpts by trained coders. We analyzed the transcript using a consensual qualitative research approach. Ease of use was coded in 15 (39%) excerpts and utility was coded in 24 (61%) excerpts. The valences of excerpts were neutral (n = 18; 46%), positive (n = 10; 26%), and negative (n = 11; 28%). Thirty-nine (56%) excerpts discussed the engagement system. Excerpts pertained to problem identification (n = 18; 46%), coordination (n = 18; 46%), and treatment planning (n = 3; 8%). Findings revealed that resources and procedures were rated differently on their perceived ease of use and utility. Participants reported that the coordination resource had high utility and positively impacted their clinical practice and supervision, while the problem identification resources had low ease of use and were burdensome or difficult to use. Some lessons learned include the value of designing resources that provide structure to clinical decision processes yet allow for some flexibility, the need for simpler and automated procedures to reduce provider burden, and the importance of clear guidelines on how resources should and should not be used. We used this feedback to inform changes to the engagement system prior to testing in a randomized trial. This brief report highlights how applying the technology acceptance model to evaluate interventions can aid in the successful implementation of novel clinical interventions.