Cognitive and Behavioral Practice最新文献_第6页

Intensive Exposure Therapy for an Individual With History of Self-Harm and Suicidality 为有自残和自杀史的人提供强化暴露疗法

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-05-01 Epub Date: 2024-01-04 DOI: 10.1016/j.cbpra.2023.12.005

Abigail M. Stark, Julianne W. Tirpak, Esther S. Tung, Victoria Sheppard, R. Meredith Elkins

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.

对于有非自杀性自伤（NSSI）和自杀念头与行为（STBs）病史的患者，医生可能会犹豫是否使用暴露疗法进行治疗，因为他们担心暴露疗法会增加这些与风险相关的行为。然而，当 NSSI/STB 因焦虑症或强迫症（OCD）相关的痛苦而加剧时，缺乏治疗可能会加重残疾。本病例报告描述了对一名 14 岁的性别融合患者的治疗情况，该患者患有多种焦虑症、强迫症和边缘型人格障碍（包括情绪失调、慢性自杀和 NSSI）。治疗的 "第一阶段 "采用辩证行为疗法（DBT），包括保持对自残和自杀行为的行为控制；"第二阶段 "采用强化暴露和反应预防疗法（ERP）。出院时，该求助者仍未发生 NSSI/STB，焦虑和 OC 症状有所减轻，家庭迁就进一步减少，日常功能也有所改善。此外，当事人的父母也表现出调节自身情绪（在对当事人做出反应之前）的能力有所提高，做出了更多肯定性反应，并减少了家庭迁就。本病例报告支持暴露疗法对 DBT "第二阶段 "患者的可行性、有效性和安全性，并强调了暴露疗法作为一种重要的情绪调节策略在减少有自残和自杀史的患者的强迫症和焦虑症状中的作用。报告还讨论了面临的挑战、取得的成功以及未来的发展方向。

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引用次数: 0

Applications of Cognitive Processing Therapy to Post-Injury PTSD: A Case Study 认知加工疗法在受伤后创伤后应激障碍中的应用：案例研究

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-05-01 Epub Date: 2024-04-09 DOI: 10.1016/j.cbpra.2024.01.006

Sacha McBain, Rhea Mundle, Philip Held

Approximately one in three traumatically injured patients will go on to experience post-injury posttraumatic stress disorder (PTSD) and/or depression within a year of injury. In many cases, the nature of a traumatic injury itself constitutes a traumatic event. Traumatic injuries are often followed by subsequent potentially traumatic medical events (i.e., medical trauma) that may characterize post-injury recovery. Adequately addressing the complex biopsychosocial needs of traumatically injured patients in a traditional mental health setting can be challenging. The goal of this case study is to provide mental health professionals additional guidance to meet the needs of traumatically injured patients, including strategies to concurrently treat trauma-related symptoms and aspects of physical recovery that can elicit trauma cues. Specifically, this case study provides guidance to clinicians on the conceptualization and treatment of post-injury PTSD, with a specific focus on medical traumatic stress reactions (i.e., distress related to hospitalization, recovery, and adjustment to injury/disability). To demonstrate clinical considerations and applications of Cognitive Processing Therapy to post-injury PTSD, we focus on the experiences and treatment considerations of a fictional patient who represents an amalgamation of patients the authors have encountered in their clinical practice. Future directions for clinical practice and research to address medical traumatic stress are also discussed.

大约三分之一的创伤患者会在受伤后一年内经历创伤后应激障碍（PTSD）和/或抑郁症。在许多情况下，创伤性伤害的性质本身就构成创伤性事件。创伤性损伤之后往往伴随着随后的潜在创伤性医疗事件（即医疗创伤），这可能是损伤后恢复的特征。在传统的心理健康环境中，充分解决创伤患者复杂的生物心理社会需求可能具有挑战性。本案例研究的目的是为心理健康专业人员提供额外的指导，以满足创伤损伤患者的需求，包括同时治疗创伤相关症状和可能引发创伤线索的身体恢复方面的策略。具体而言，本案例研究为临床医生提供了创伤后应激障碍的概念化和治疗指导，特别关注医疗创伤应激反应（即与住院、康复和适应伤害/残疾相关的痛苦）。为了证明认知加工疗法在创伤后创伤后应激障碍中的临床应用，我们将重点放在一个虚构患者的经历和治疗考虑上，他代表了作者在临床实践中遇到的患者的融合。讨论了今后治疗创伤性应激的临床实践和研究方向。

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引用次数: 0

Individual Video-Based Case Formulation for Participants With Persistent Physical Symptoms Associated With Indoor Environment or Chronic Fatigue 为患有与室内环境或慢性疲劳有关的持续性身体症状的参与者提供基于视频的个人案例分析

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-05-01 Epub Date: 2024-02-08 DOI: 10.1016/j.cbpra.2023.12.012

Katariina Keinonen, Päivi Lappalainen, Raimo Lappalainen, Sanna Selinheimo, Aki Vuokko, Sanna Liesto, Markku Sainio, Tiina Paunio

Persistent physical symptoms (PPS) refer to a wide range of symptoms that cannot be fully explained by traditional medical assessment of bodily pathology or environmental factors. The aim of the current study was to illustrate the application of an online interview and Functional Analytic Clinical Conceptualization to describe psychological and life problems perceived by participants with PPS and to give examples of how a functional analysis approach to case formulation could assist in their treatment. We applied the Functional Analytic Clinical Case Model (FACCM) in the assessment of participants with PPS (n = 50), including three focus groups: those with PPS related to the indoor environment (n = 11), those with PPS related to prolonged fatigue (n = 28), and those with both symptoms (n = 11). Among the 50 participants with PPS, a typical amount of concurrent psychological and life problems was 9. In addition to PPS, the most typical problems reported were symptoms of stress and burnout (74%), low mood (68%), narrowing of daily life (58%), and worrying (52%). The results highlight the complexity of the participants’ life situations. We found that the FACCM was acceptable and useful in identifying potential individual treatment targets.

持续性身体症状（PPS）指的是不能通过传统的身体病理或环境因素的医学评估来充分解释的一系列症状。当前研究的目的是说明在线访谈和功能分析临床概念化的应用，以描述PPS参与者所感知的心理和生活问题，并举例说明如何使用功能分析方法来制定病例，以协助他们的治疗。我们应用功能分析临床病例模型（FACCM）对患有PPS的参与者进行评估（n = 50），包括三个焦点组：与室内环境相关的PPS (n = 11)，与长时间疲劳相关的PPS (n = 28)，以及同时有两种症状的PPS （n = 11）。在50名患有PPS的参与者中，同时存在心理和生活问题的典型数量为9。除PPS外，报告的最典型问题是压力和倦怠症状（74%）、情绪低落（68%）、日常生活狭窄（58%）和担忧（52%）。研究结果凸显了参与者生活状况的复杂性。我们发现FACCM在确定潜在的个体治疗目标方面是可以接受和有用的。

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引用次数: 0

Pilot Trial of a Four-Session Parent Training Tele-Group for Adolescent ADHD 针对青少年多动症的四节课家长培训远程小组试点试验

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-05-01 Epub Date: 2024-02-03 DOI: 10.1016/j.cbpra.2023.12.010

Erin Schoenfelder Gonzalez, Tess Gabert, Jessica Jenness, Fiona MacPhee, Mark Stein, Margaret Sibley

Adolescents with ADHD are at increased risk for myriad functional impairments and comorbidities and need accessible, acceptable, and effective treatment options. Stepped care treatment models employ a “light touch” initial intervention dose to meet lower needs and to reserve mental healthcare system capacity for more severe concerns. The current study employed a mixed methods approach to evaluate the First Approach Skills Training–Parenting Teens (FAST-P) program, a modular 4-session caregiver intervention implemented via telemedicine “tele-group.” The program workbook and 2-hour training video are available free online at www.seattlechildrens.org/FAST. Twenty-two adolescents ages 13–17 with ADHD plus a caregiver enrolled in the study and completed the idiographic Top Problems interview and ratings at baseline and posttest. Caregivers attended the 4-session program and completed acceptability measures and a semistructured qualitative interview.

Group fidelity, attendance, and participant satisfaction were high. After the group, there was significant improvement in caregivers’ top problems. Themes from interviews included nearly all caregivers perceiving benefit from the program, especially to their parenting perspective, understanding of their teen, and communication. Most would have appreciated more sessions and additional topics, but the majority did not plan to seek additional treatments. Program delivery cost to the clinic was $76 per participating family.

FAST-P is a feasible, acceptable, and affordable program for a first step in a “stepped care” model for adolescents with ADHD, with the goal of reducing the need for higher-intensity services. While the program supported caregivers and they perceived benefits, many families indicated they may need more intensive services.

患有多动症的青少年出现各种功能障碍和合并症的风险越来越高，他们需要方便、可接受和有效的治疗方案。阶梯式护理治疗模式采用 "轻触式 "初始干预剂量，以满足较低的需求，并为更严重的问题保留心理保健系统的能力。目前的研究采用了混合方法来评估 "第一方法技能培训--为人父母的青少年（FAST-P）"项目，这是一项通过远程医疗 "远程小组 "实施的模块化、为期 4 个疗程的照顾者干预措施。该计划的工作手册和 2 小时的培训视频可从 www.seattlechildrens.org/FAST 免费在线获取。22 名 13-17 岁患有多动症的青少年和一名照顾者参加了这项研究，并在基线和后期测试中完成了特异性 "首要问题 "访谈和评分。照顾者参加了为期四节的课程，并完成了可接受性测量和半结构化定性访谈。小组结束后，护理人员的首要问题有了明显改善。访谈的主题包括几乎所有的照顾者都认为从该计划中获益匪浅，尤其是在他们的育儿观、对青少年的理解以及沟通方面。大多数人希望能有更多的课程和更多的主题，但大多数人并不打算寻求额外的治疗。FAST-P是一个可行的、可接受的、负担得起的项目，是青少年多动症 "阶梯护理 "模式的第一步，目的是减少对高强度服务的需求。虽然该项目为照顾者提供了支持，他们也感受到了其中的益处，但许多家庭表示他们可能需要更深入的服务。

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引用次数: 0

Acceptability of Men’s Externalizing Depression Constructs Among Black American Men and Middle-Aged and Older White Men 美国黑人男性和中老年白人男性外化抑郁结构的可接受性

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-11-03 DOI: 10.1016/j.cbpra.2023.08.004

Douglas Gazarian , Michael E. Addis

Research on the dissemination and implementation of gender-based care for men has rarely considered diversity within the male-identifying population. The present study evaluated the acceptability of men’s externalizing depression (MED) constructs across purposive samples of men understudied in the MED literature and at higher risk for MED-related outcomes (Black American men and middle-aged and older White men). Following brief psychoeducation, participants rated MED constructs for comprehensibility and perceived clinical value. Using a convergent mixed-methods design, we examined how attitudes varied by sample and experimentally-manipulated psychoeducational variables pertaining to different MED conceptual models. Across samples and psychoeducation conditions, we observed similarly strong levels of acceptability for MED as a gender-based conceptualization of mixed internalizing-externalizing symptoms. Small differences emerged as a function of sample-psychoeducation interactions. Quantitative and qualitative data converged to suggest race-gender intersections influence men’s construal of psychological symptoms. Overall, results supported MED as an acceptable formulation of symptoms across multiple subpopulations of men in the context of an international, online community sample.

对男性基于性别的护理的传播和实施的研究很少考虑到男性认同人口中的多样性。本研究评估了男性外化抑郁（MED）结构的可接受性，目的样本为MED文献中未被充分研究的男性和MED相关结果风险较高的男性（美国黑人男性和中老年白人男性）。经过简短的心理教育后，参与者对MED构念的可理解性和感知的临床价值进行评分。采用融合混合方法设计，我们研究了态度如何随样本和实验操纵的心理教育变量而变化，这些变量与不同的MED概念模型有关。在样本和心理教育条件下，我们观察到MED作为一种基于性别的混合内化-外化症状的概念化，同样具有很强的可接受性。作为样本-心理教育互动的功能，微小的差异出现了。定量和定性的数据显示，种族和性别的交集会影响男性对心理症状的解释。总体而言，在国际在线社区样本的背景下，结果支持MED在多个男性亚群中作为一种可接受的症状表述。

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引用次数: 0

Reconnecting Hope: The Treatment of Eating Disorders in Rural America 重新连接希望：美国农村饮食失调的治疗

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-09-09 DOI: 10.1016/j.cbpra.2023.08.001

Jenny E. Copeland, Jacob Hefner, Sarah E. Estep, Carolyn Black Becker

Eating disorders (EDs), a significant public health concern, impact millions of Americans every year. Many people with EDs are often overlooked for multiple reasons, including the stereotype that EDs predominantly affect thin, White, affluent young women and girls. One historically overlooked group is impoverished individuals in rural areas of the United States (U.S.), who may, in fact, be at an increased risk for EDs. The Reconnect Eating Disorders treatment program (REDTP) at Ozark Center is the first comprehensive, evidence-based, multidisciplinary ED treatment program to be developed in a Certified Community Behavioral Health Organization (CCBHO) in the U.S. CCBHOs are a unique model of financially sustainable integrated care well-suited to the treatment of biopsychosocial illnesses such as EDs because CCBHOs offer a full range of services to treat both physical and mental health. This paper details the development of REDTP, including its team, barriers, and successes. The role of Community Support Specialists/Reconnect Coaches and Healthcare Home/Medical Support is reviewed, which includes providing outpatient care and intensifying treatment for the most acute clients. Key domains of growth for REDTP included selecting core evidence-based treatments, building a team and defining team roles, and intensive training to develop evidence-based ED expertise. Persistent barriers included staffing limitations for providing intensive treatment to a small number of clients. Adult case studies of REDTP clients are presented. Recommendations for future ED and other specialized treatment programs in low resource agencies are provided.

饮食失调（EDs）是一个重大的公共卫生问题，每年影响数百万美国人。由于多种原因，许多患有急症的人经常被忽视，其中包括一种刻板印象，即急症患者主要是瘦弱、富裕的白人年轻女性和女孩。一个历来被忽视的群体是美国农村地区的贫困人群，事实上，他们患ed的风险可能会增加。Ozark中心的重新连接饮食失调治疗计划（REDTP）是美国认证社区行为健康组织（CCBHO）开发的第一个全面的，基于证据的，多学科的ED治疗计划。CCBHO是一个独特的经济可持续的综合护理模式，非常适合治疗生物心理社会疾病，如ED，因为CCBHO提供全方位的服务来治疗身体和心理健康。本文详细介绍了REDTP的开发，包括它的团队、障碍和成功。回顾了社区支持专家/重新连接教练和保健之家/医疗支持的作用，其中包括提供门诊护理和加强对最急性客户的治疗。REDTP增长的关键领域包括选择核心循证治疗，建立团队并定义团队角色，以及强化培训以发展循证ED专业知识。持续存在的障碍包括为少数病人提供强化治疗的人员配备限制。介绍了REDTP客户的成人案例研究。对未来的ED和其他专业治疗方案在低资源机构提供了建议。

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引用次数: 0

Exploring Differences in Presentation and Treatment Outcomes Between Black and White American Adults With Prolonged Grief Disorder 探索患有长期悲伤障碍的美国黑人和白人成年人在表现和治疗结果上的差异

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2024-07-30 DOI: 10.1016/j.cbpra.2024.05.004

Margaret Gacheru, Christine Mauro, Natalia Skritskaya, Nicole Alston, Charles F. Reynolds III, Naomi Simon, Sidney Zisook, Barry Lebowitz, M. Katherine Shear

Prolonged grief disorder (PGD) is a condition of persistent, intense grief and PGD-targeted psychotherapy (PGDT) is an efficacious treatment. This study aimed to compare participants with PGD who self-identified as Black versus White, with respect to baseline features and response to PGDT. We performed a secondary data analysis of 55 Black and 455 White adults from two randomized clinical trials. Racial differences in baseline features were examined using Chi-squared and T-tests. We compared assessment completion and treatment response rates (PGDT vs. no PGDT) by race and evaluated posttreatment self-reported measures using linear models. There were racial differences in the cause of death, relation to the deceased, and taking comfort in religion. Black participants had similar ratings to their counterparts on impairment and grief severity at baseline. However, they had higher scores on a baseline measure of typical grief-related beliefs. Both racial groups had significantly greater response rates to PGDT than the comparison treatment. Similarly, PGDT resulted in lower posttreatment impairment than the comparison treatment for both racial groups. However, only the White participants had a difference in posttreatment grief severity between the treatment groups. This study supports the idea that PGD characteristics are similar in Black and White treatment seeking individuals, and that Black and White participants display improvement in response to PGDT.

延长悲伤障碍（PGD）是一种持续的、强烈的悲伤状态，针对PGD的心理治疗（PGDT）是一种有效的治疗方法。本研究旨在比较自认为是黑人和白人的PGD参与者的基线特征和对PGD的反应。我们对来自两项随机临床试验的55名黑人和455名白人成年人进行了二次数据分析。基线特征的种族差异采用卡方检验和t检验。我们比较了不同种族的评估完成率和治疗反应率（PGDT与无PGDT），并使用线性模型评估了治疗后自我报告的测量结果。在死因、与死者的关系以及在宗教上获得安慰方面存在种族差异。黑人参与者在损伤和悲伤严重程度上的基线评分与同龄人相似。然而，他们在典型悲伤相关信念的基线测试中得分更高。两个种族组对PGDT的反应率显著高于比较治疗。同样，在两个种族组中，PGDT导致的治疗后损伤低于比较治疗。然而，在治疗组之间，只有白人参与者在治疗后的悲伤严重程度上有差异。这项研究支持了这样一种观点，即寻求治疗的黑人和白人个体的PGD特征相似，黑人和白人参与者对PGD的反应有所改善。

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引用次数: 0

The Impact of Exposure Therapy on Cancer-Related Future Cognitions in Severe Health Anxiety 暴露疗法对严重健康焦虑患者癌症相关未来认知的影响

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-09-18 DOI: 10.1016/j.cbpra.2023.07.001

Nora Brier, Lily A. Brown

Individuals with illness anxiety disorder (IAD) experience a preoccupation with having or acquiring a serious illness despite having mild or absent physical symptoms. Formerly hypochondriasis, individuals with IAD experience high rates of disability, contribute to elevated annual health care costs, and experience multiple comorbidities. IAD has been historically difficult to treat for both medical and mental health providers. Research suggests cognitive behavior therapy has mixed results for individuals with IAD. In this fictitious case presentation, we describe a course of successful exposure therapy for IAD drawing on the principals of inhibitory learning theory. Thus, through this example we demonstrate how to overcome common obstacles to successful treatment for IAD, such as willingness to participation, comorbid depression, and therapeutic alliance.

患有疾病焦虑障碍（IAD）的个体尽管有轻微或没有身体症状，但仍然对患有或获得严重疾病感到担忧。以前患有疑病症的IAD患者致残率高，导致年度卫生保健费用增加，并伴有多种合并症。从历史上看，对医疗和精神卫生提供者来说，IAD都是难以治疗的。研究表明，认知行为疗法对IAD患者的效果好坏参半。在这个虚构的案例介绍中，我们描述了一个成功的暴露治疗过程，利用抑制学习理论的原则。因此，通过这个例子，我们展示了如何克服成功治疗IAD的常见障碍，如参与意愿、共病抑郁症和治疗联盟。

引用次数: 0

Development and Pilot Test of a Therapist-Assisted Self-Management Program for Completers of Trauma-Focused Therapy for Posttraumatic Stress Disorder 创伤后应激障碍创伤集中治疗完成者治疗师辅助自我管理计划的开发和试点测试

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-09-06 DOI: 10.1016/j.cbpra.2023.08.002

Shannon M. Kehle-Forbes, Tara Galovski, Melissa A. Polusny, Kyle Possemato, Sean Nugent, Eliza McManus, Allison L. Baier

Veterans who complete an evidence-based trauma-focused therapy (TFT) for posttraumatic stress disorder (PTSD) report continued treatment needs to build self-efficacy, promote continued skill application, and bolster engagement in valued activities. This paper describes the rationale, development, and treatment structure of a novel 4-session therapist-assisted self-management program, named EMPOWER, for TFT completers. A mixed methods approach was used to evaluate the acceptability and feasibility of the intervention in an open pilot trial with 12 veterans. Therapists delivered the treatment with fidelity and participants reported high acceptability and satisfaction with EMPOWER. Quantitatively, participants reported meaningful improvements in quality of life and small improvements in community engagement; however, there were no clinically meaningful changes in self-efficacy, PTSD symptoms, depression, or functioning pre- to postintervention. Qualitatively, participants noted EMPOWER met their post TFT needs and that the structure of treatment was helpful in continuing to practice TFT skills. They also noted improvements in self-efficacy for self-managing PTSD symptoms and an increase in valued activities. Findings suggest EMPOWER is feasible, acceptable, and meets veterans’ post-TFT treatment needs. A larger-scale, randomized trial of EMPOWER is warranted to evaluate the impact of EMPOWER on self-efficacy, clinical symptoms, functioning, and quality of life.

完成创伤后应激障碍（PTSD）循证创伤治疗（TFT）的退伍军人报告说，继续治疗需要建立自我效能感，促进持续的技能应用，并加强对有价值活动的参与。本文描述了一种新的4期治疗师辅助自我管理计划的原理、发展和治疗结构，名为EMPOWER，用于TFT完成者。在12名退伍军人的公开试验中，采用混合方法评估干预的可接受性和可行性。治疗师提供了忠实的治疗，参与者报告了对EMPOWER的高接受度和满意度。在数量上，参与者报告了生活质量的有意义的改善和社区参与的微小改善；然而，干预前后在自我效能、PTSD症状、抑郁或功能方面没有临床意义的变化。从质量上讲，参与者指出EMPOWER满足了他们在TFT后的需求，治疗的结构有助于继续练习TFT技能。他们还注意到自我管理创伤后应激障碍症状的自我效能的改善，以及有价值活动的增加。研究结果表明，EMPOWER是可行的，可接受的，满足退伍军人tft后的治疗需求。有必要对EMPOWER进行更大规模的随机试验，以评估EMPOWER对自我效能、临床症状、功能和生活质量的影响。

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引用次数: 0

Older Bereaved Individuals’ Experiences of Cognitive-Behavioral Therapy for Complicated Grief Reactions: A Qualitative Multistage Focus Group Approach 老年丧亲者对认知行为疗法治疗复杂悲伤反应的体验：多阶段焦点小组定性方法

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2024-08-30 DOI: 10.1016/j.cbpra.2024.06.002

Christina Buur , Thomas Mackrill, Lisbeth Hybholt , Eva Rames Nissen, Maja O’Connor

Bereavement is particularly common in old age. A small proportion of bereaved people develop complicated grief reactions (CGR) characterized by elevated symptoms of depression, prolonged grief disorder, anxiety, and/or posttraumatic stress. Cognitive-behavioral therapy for CGR (CBTgrief) is found to be an effective treatment. Detailed knowledge about older adults’ experiences of CBTgrief is needed to optimize treatment and to give recommendations to practice. To explore older adults’ experience of CBTgrief to gain insight into elements that were helpful or less helpful. Four multistage focus group interviews were conducted with nine older adults who lost a partner and received CBTgrief and three researchers. Five participants received group therapy and four individual therapy (mean age = 69.67 years, 89% women). The participants found exposure exercises, psychoeducation in grief, and letter writing particularly helpful. The participants requested options for family sessions, a combined individual/group format, and follow-up sessions. Awareness of potential memory problems and adapting to new practical tasks should receive greater focus in therapy. This study gives important insights into older adults’ experiences of CBTgrief and evaluates the helpful and less helpful elements in grief therapy. This may guide improvements in the treatment of bereaved older adults with CGR.

丧亲之痛在老年人中尤为常见。一小部分失去亲人的人会出现复杂的悲伤反应（CGR），其特征是抑郁症状加重、长期悲伤障碍、焦虑和/或创伤后应激。认知行为疗法是治疗CGR （CBTgrief）的有效方法。需要详细了解老年人的cbt悲伤经历，以优化治疗并为实践提供建议。探索老年人的cbt悲伤经历，以深入了解哪些因素是有益的，哪些因素是无益的。研究人员对9名失去伴侣并接受cbt治疗的老年人和3名研究人员进行了四次多阶段焦点小组访谈。5例接受团体治疗，4例接受个体治疗（平均年龄69.67岁，89%为女性）。参与者发现暴露练习、悲伤心理教育和写信特别有帮助。参与者要求选择家庭会议、个人/团体联合形式和后续会议。意识到潜在的记忆问题和适应新的实际任务应该在治疗中得到更多的关注。本研究对老年人的cbt悲伤经历提供了重要的见解，并评估了悲伤治疗中有益和无益的因素。这可能会指导对失去亲人的老年CGR患者的治疗。

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引用次数: 0