Cognitive and Behavioral Practice最新文献

Acceptance and commitment therapy (ACT) offers a promising, transdiagnostic treatment approach for a wide range of mental health concerns in adolescents. Although research on ACT for adolescents is still developing, there is encouraging theoretical and empirical support in this area. The ability of ACT to adjust and account for developmental considerations and contexts in adolescence is discussed, alongside the theoretical support for using ACT with adolescents. A broad review of 34 studies on ACT with adolescents is then presented—ACT with adolescents has some preliminary support for anxiety, depression, disordered eating, chronic pain, and more. Detailed examples of how to implement each ACT process with adolescents are presented, along with a brief review of assessment tools. We hope this paper will act as an initial guide for clinicians implementing ACT with adolescents.

Women with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) demonstrate the greatest psychiatric severity when entering mental health treatment, and poorest rates of treatment completion and relapse compared to those with either disorder alone. Mindfulness-based interventions (MBIs) for women with comorbid PTSD–SUD may be an effective treatment approach as it targets mechanisms underlying self-medication of trauma-related symptoms via substance use. Little is known, however, of the benefits of MBIs for this population. Thus, the purpose of this study was to qualitatively elucidate mechanisms of action in a pilot MBI adapted for women with comorbid SUD and PTSD, with the goal of identifying the most salient aspects of MBIs that target self-medication of PTSD symptoms via substance use. Following completion of a trauma-integrated MBI, women (N = 39) diagnosed with PTSD–SUD were invited to attend one of ten, 60-minute, audio-recorded focus groups. A semistructured interview protocol was utilized to investigate how participants perceived the utility of MBIs in mitigating PTSD and SUD symptoms over the course of the intervention. Conventional content analysis guided qualitative analysis and reporting. Participants described four mechanisms through which they experienced MBIs attenuating the relationship between PTSD and SUD: increased attention to trauma- and substance-related triggers occurring in the present moment; greater cultivation of nonjudgmental acceptance to aversive experiences; development of self-compassionate attitudes toward suffering; and increased tolerance to aversive experiences. Building upon these mechanisms of action, we propose a moderated mediation model, in which increased present-moment awareness, nonjudgmental attitudes toward distress, and self-compassion reduce impulsivity and negative affect, which then increases tolerance for aversive experiences, thereby attenuating the relationship between PTSD and SUD symptoms. Interventions targeting the four proposed mechanisms may be considered when treating women diagnosed with comorbid PTSD–SUD.

After over 50 years of research and debate, the cognitive and behavioral scientific community has overwhelmingly condemned attempts to change a person’s gender identity or sexuality. Despite evidence that conversion practices are ineffective and harmful, politicians debate the rights of LGBTQIA+ individuals while change efforts continue. Using the advocacy coalition framework, this paper discusses the influence of research, policy, and debate in the context of larger social and political change. As members of a policy advocacy coalition, cognitive and behavioral practitioners have the power to influence laws and other forms of policy.

Sudden, unexpected death losses are among the most common traumatic experiences and place survivors at risk for a variety of bereavement-related mental health problems, including posttraumatic stress, depression, and prolonged grief reactions. Although survivors of sudden, unexpected deaths are most likely to seek support for emotional distress in the early aftermath of a loss, no early mental health interventions have specifically been evaluated for this vulnerable population. This study reports findings from an open trial of Skills for Psychological Recovery (SPR)—a brief, evidence-informed early intervention for trauma and bereaved survivors and their families—with a sample of 21 adult sudden loss survivors. Participants within 1 year of the sudden, unexpected death of a loved one received up to five sessions of SPR and completed self-report measures of mental health outcomes pre- and postintervention and again at 3-month follow-up. Results showed statistically significant reductions in posttraumatic stress, depression, and grief symptoms that were maintained at follow-up. A case description is provided to illustrate the use of SPR with this population. These findings suggest that SPR may be an acceptable, scalable early intervention for sudden loss survivors. Limitations, including lack of a comparison group and reliance on self-report measures, are discussed.

The civil rights of LGBTQ persons throughout the U.S. are currently under attack by conservative right-wing extremists who would roll back antidiscrimination protections and prohibit access to care for trans youth, among other things. The exercise of religious freedom is often used as the basis for these initiatives, but these efforts are tantamount to the imposition of religious beliefs on vulnerable communities. The solution for LGBTQ persons offered by the extreme right wing is often sexual orientation/gender identity change efforts, or SOGICE, commonly known as so-called “conversion therapy,” despite the lack of efficacy and adverse consequences of these methods. SOGICE bans have been instituted in many jurisdictions because of potential harm to the public. Strategies for protecting such bans are discussed.

This special feature of Cognitive and Behavioral Practice serves to remind psychological scientists and other mental health clinicians of the importance of understanding our responsibilities in the field with specific reference to sexual orientation and gender identity “conversion therapy” efforts: from considering our ethical responsibilities in our practice (Davison) to understanding the widespread iatrogenic impacts of “conversion therapy” practice in all its subtleties (Anderson et al.), from staying abreast of the contemporary anti-LGBTQ+ talking points (Haldeman) to understanding how this rhetoric targets specific subpopulations in the U.S. currently (Hope & Puckett). We conclude this special series by reminding the reader that structures within our institutions and day-to-day functioning uphold and foster an unethical and iatrogenic practice. We point out the need to be alert. Clinical psychological science is not value-free. Pretending that it is serves the obfuscation of scientific findings and equips scholars who hold vested interests in seeing the dangerous practice of “conversion therapy” legitimized and disseminated in a larger scale.

Despite efforts to improve the sociopolitical landscape for sexual and gender minorities, including legislation to ban sexual orientation and gender identity change efforts (SOGICE), new threats have arisen with a sharp increase in state legislatures enacting anti-TGD (transgender and gender diverse) legislation. Some of these laws and the accompanying hostile climate may prevent mental health providers from providing the best evidence-based care for their TGD clients. This paper briefly reviews the current sociopolitical climate, the impact of the climate on TGD people, and challenges faced by mental health providers serving TGD clients. We conclude with recommendations for supporting TGD clients in the current sociopolitical context and a call for advocacy to continue efforts to ban SOGICE and protect access to social, legal, and medical gender affirmation for youth and adults.

Childhood constipation and painful defecation is common, affecting 68% to 86% of children. Over 90% withhold stool, some only defecating in a diaper. Behavioral therapy is effective for encopresis, but there is minimal research on treating toilet avoidance. This study investigates a novel protocol to eliminate diapers in children with toilet avoidance.

A diaper fading protocol was used with four children with toilet avoidance. Children were instructed to defecate in the bathroom, moving progressively closer to the toilet until they eventually sat on the toilet with the diaper. As needed, diapers were then faded by cutting increasingly wider slits in the base of the diaper so that stool could pass into the toilet. The cut widened until the diaper was eliminated entirely.

Four children (three boys, average 5.22 years old) successfully completed toilet training using the diaper fading protocol in an average of 9.75 sessions. Delivery of treatment via telehealth was shown to be effective. The diaper fading protocol effectively and flexibly assisted toilet training in four children with stool withholding and toileting avoidance. Future work should investigate whether caregivers can utilize the protocol without ongoing support, or on a consultation basis only, to reduce the burden on health care workers with long waitlists.

Cognitive Behavioral Therapy (CBT) is used widely throughout the world in diverse populations for successful treatment of a wide range of psychiatric and comorbid conditions. Over the years clinicians have been making efforts to culturally adapt CBT to various groups. This paper discusses the assessment and treatment of a young female from Pakistan with depression and anxiety with comorbid headache. After ruling out all organic causes, the treatment continued over 20 sessions with the initial phase consisting of introduction to CBT, risk assessment, and identification of treatment goals. Following this, the patient was helped in identifying automatic thoughts, feelings, and behaviors. Finally, tools such as thought substitutions, reappraisals, and positive diversions were used effectively to decrease automatic negative thoughts. A focus on the patient’s religio-cultural identity was maintained throughout. Understanding of contextual factors like religio-cultural values and family dynamics helped to bring about favorable therapy outcomes. A case conceptualization that cohesively addressed factors relating to ethnicity, class, and gender yielded a positive result in our case. Involvement of the family and psychoeducation regarding neurobiological causes also proved to be helpful. Such an approach can facilitate a culturally responsive application of CBT in Pakistani youth experiencing comorbid medical and psychiatric disorders.