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.

A large minority of psychotherapists endorse practicing integrative therapy, drawing from different schools of therapy, and an increasing number of contemporary therapies are designed by combining elements or components from different treatment models (e.g., modular treatments, process-based therapy). As a result, clients are likely to be the recipients of a number of different techniques or strategies, based on different theoretical models, emphasizing different change principles. This paper sets out to explore the potential challenges introduced by integrative treatments, exemplified with the diverse therapies found under the umbrella of cognitive behavioral therapies (CBTs). Although several scholars have proposed a unifying agenda for CBTs by underscoring commonalities and shared change principles, which is an important perspective, the extent to which compatibility exists between CBTs remains an underexplored scientific question. In this paper, we argue that integrative therapy can risk detracting from a positive outcome when the compatibility between distinct strategies or components is not ensured. We call for practitioners and researchers to ensure combinatory congruency, that is, compatibility between components manifested as their efficient and effective delivery together. We conclude by suggesting ways in which combinatory congruency can be established in the design phase of an integrative treatment or as an important step in additive and dismantling studies of existing integrative treatment packages.

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.