Cognitive and Behavioral Practice最新文献

Sanvello is a cognitive-behavioral therapy (CBT) app available as a web platform and a native app for both Android and iOS. Sanvello can be used for free, with additional premium content available in a paid version. It is targeted for adults with mild to moderate symptoms of depression, anxiety, and stress and has a solid evidence base to support its efficacy. Sanvello is user-friendly and intuitive, with good user experience and appropriate privacy and data security measures. Sanvello’s free version consists mainly of self-care and peer support content, allowing users to engage with tools such as in-app activities personalized through initial user assessments, and community pages. A paid version provides additional content through a subscription model and coaching available for a monthly fee. Professional support is available either through insurance coverage of a pay-per-appointment model. Despite a solid evidence base, various features, and a library of content, identified areas of improvement include expanding the psychoeducation materials and articles to include more timely resources and the diversity of its potential users. For these reasons, we have rated Sanvello with a 5 in utility, and ease of use/overall appeal along with a 4 in appropriateness of content and research evidence. Overall, Sanvello provides a variety of evidence-based cognitive and behavioral skills and, for those with the paid version, the opportunity to connect with professionals for additional support.

Practitioners may hesitate to treat patients with a history of nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) using exposure therapy due to concerns that exposures will increase these risk-related behaviors. However, when NSSI/STBs are exacerbated by distress associated with anxiety disorders or obsessive-compulsive disorder (OCD), lack of treatment can worsen disability. This case report describes the treatment of a 14-year-old gender-fluid individual with symptoms of multiple anxiety disorders, OCD, and borderline personality disorder (including emotion dysregulation, chronic suicidality, and NSSI). Treatment involved dialectical behavioral therapy (DBT) for “stage one” of treatment, including maintaining behavioral control over self-harm and suicidal behaviors, followed by intensive exposure and response prevention (ERP) during “stage two” of treatment. Upon discharge, the client had maintained an absence of NSSI/STBs, demonstrated reductions in anxiety and OC symptoms, observed further decreased familial accommodation, and improved daily functioning. In addition, the client’s parents exhibited an improved capacity to regulate their own emotions (before responding to the client), more validating responses, and reduction in familial accommodation. This case report supports the feasibility, efficacy, and safety of exposure therapy for individuals in “stage two” of DBT and highlights the role of exposure as an important emotion regulation strategy to reduce OCD and anxiety symptoms in patients with a history of self-harm and suicidality. Challenges, successes, and future directions are discussed.

Sexual minority men seek out mental health treatment at approximately twice the rate of the general population, with minority stress being the most likely explanation for this population’s heightened mental and behavioral health concerns and associated treatment seeking. However, little research identifies sexual minority men’s mental health treatment goals, thereby potentially hindering tailored treatment development and clinicians’ preparation. The present study qualitatively identifies treatment goals among 94 ethnically diverse, majority cisgender sexual minority men who participated in a trial of LGBTQ-affirmative CBT. Analyses identified 44 unique treatment goals across 10 themes (e.g., Increase Affirmation and Acceptance of Sexual Minority Identity, Address Instant Gratification as a Form of Coping). Results highlight the relevance of this population’s sexual minority identities and associated stressors to their treatment goals, prepare clinicians to expect to address these goals when working with sexual minority men, extend existing goal taxonomies to consider this population’s distinct treatment needs, and highlight the importance of goal-driven evidence-based practice for this population.

Prolonged Grief Disorder (PGD) is a potential deleterious outcome of bereavement that is associated with significant negative psychological consequences. The condition is thought to be maintained through a dynamic interplay between painful memories, maladaptive appraisal patterns, and unhelpful coping behaviors, including a persistent avoidance of reminders of the loss. Grief-focused cognitive behavior therapies (GF-CBT) targeting these mechanisms have been found to ameliorate symptoms, with treatments that include exposure-based processing of memories of the loss showing superior outcomes. However, data indicate that treatments involving exposure-based techniques are typically underutilized by mental health clinicians. In this clinical report we describe a series of cases that illustrate common challenges encountered in implementing GF-CBT and outline practical approaches to address these challenges.

In bereavement, some individuals develop complicated grief reactions (CGR), including symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Symptoms of PGD often co-occur with other complicated grief reactions, e.g., PTSD and depression, pointing to the need for a transdiagnostic understanding of CGR to inform treatment. In this paper, a transdiagnostic cognitive-behavioral therapy for CGR called “CBTgrief” is explained, including its theoretical framework and treatment content. CBTgrief is based on previous cognitive-behavioral conceptualizations of PGD, PTSD, and depression and includes 12 sessions consisting of exposure, cognitive restructuring, and behavioral activation. Preliminary findings of CBTgrief are evaluated in terms of feasibility, acceptability, and treatment satisfaction in a sample of eight older bereaved individuals treated for different types of CGR in a naturalistic clinical setting. Additionally, theory-driven hypotheses about changes in CGR and theoretical proposed core maintaining processes are evaluated using Bayesian informative hypotheses testing. Preliminary findings, limitations, implications, and future directions are discussed.

Caregiver engagement and implementation of behavioral strategies are essential to effective interventions targeting childhood behavior problems. The aim of this preliminary investigation was to better understand caregiver decision-making when selecting different treatment regimens in an open trial format. Treatment packages included: (1) an intensive treatment program (ITP), involving a compressed 20-hour intervention occurring 2 hours per day for 10 days; and (2) a standard dosage treatment as usual (TAU) behavioral treatment program, involving weekly 50-minute appointments. Sixty-seven families with a child between 4–11 years old (M age = 5.82) with clinically significant problem behaviors self-referred to a hospital-based outpatient behavior therapy program. Results suggest that while caregivers chose a standard treatment regimen at a ratio of 2:1, compressed treatment (ITP) was associated with increased caregiver engagement and more significant reductions in child target behavior using both direct and indirect measures. Findings provide preliminary support for the use of high dosage treatment regimens as a means of increasing caregiver engagement and in the reduction of problem behavior in young children.