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Cognitive Behavioral Treatments for Prolonged Grief: Introduction to the Special Feature 长期悲伤的认知行为疗法：专题介绍

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2024-12-10 DOI: 10.1016/j.cbpra.2024.11.003

Donald J. Robinaugh, Naomi M. Simon

Over the past two decades, researchers have devoted enormous effort to developing treatments for prolonged grief disorder that are rooted in cognitive behavioral principles. There is now considerable evidence that these treatments are effective in reducing prolonged grief disorder severity. In this article, we introduce and provide an overview of a special series of articles in Cognitive and Behavioral Practice whose aim is to introduce clinicians and clinical researchers to the treatment of prolonged grief. By bringing together recent empirical research with expert clinical guidance, this special issue provides (a) further support for the efficacy of cognitive behavioral treatments for prolonged grief, (b) valuable insight into how they can be most effectively delivered, and (c) consideration for how to ensure that all individuals impacted by prolonged grief disorder can access the most effective care possible. We close with a brief discussion of paths forward for the continued advancement of cognitive behavioral treatments for prolonged grief.

在过去的二十年里，研究人员投入了巨大的精力来开发基于认知行为原则的治疗长期悲伤障碍的方法。现在有相当多的证据表明，这些治疗方法在降低长期悲伤障碍的严重程度方面是有效的。在这篇文章中，我们介绍并概述了《认知与行为实践》中一系列特别的文章，其目的是向临床医生和临床研究人员介绍长期悲伤的治疗。通过将最近的实证研究与专家临床指导结合起来，本期特刊提供了(a)进一步支持认知行为治疗对长期悲伤的疗效，(b)对如何最有效地提供认知行为治疗的宝贵见解，以及(c)考虑如何确保所有受长期悲伤障碍影响的个体都能获得最有效的治疗。最后，我们简要讨论了持续发展的认知行为治疗长期悲伤的途径。

引用次数: 0

Prolonged Grief Therapy 延长悲伤治疗

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2024-12-18 DOI: 10.1016/j.cbpra.2024.12.002

M. Katherine Shear, Naomi M. Simon

This paper provides a concise introduction to Prolonged Grief Therapy (PGT), an evidence-based treatment for the new PGD diagnosis in DSM-5 and ICD-11. PGD differs from nonclinical grief as well as major depression and PTSD. PGD symptoms show little response to treatments for depression. PGD comorbidity predicts worse treatment outcome for PTSD. Our group began describing PGD in the mid-1990s, using the terms “traumatic” or “complicated” grief, and to develop and test a treatment for this condition. The publication in 2005 of our randomized trial became the first empirically validated treatment for this condition. It is based upon the premise that grief is the natural response to loss that continues for an indefinite period of time after someone close dies. It is based upon the premise that grief is the natural response to loss that evolves and subsides as a bereaved person learns to live in a world of absence. PGD is the result of impediments to this learning process and the treatment aims to facilitate learning to live with a loss and to address impediments to this process. The recency of its inclusion in DSM-5 leaves many clinicians unfamiliar with PGD, the treatment that we validated, the studies in which the treatment was tested and the ways available to learn and use this approach. This paper provides a brief summary of each of these topics.

本文简要介绍了延长悲伤疗法（PGT），这是一种基于证据的治疗方法，适用于DSM-5和ICD-11中新的PGD诊断。PGD不同于非临床悲伤，也不同于重度抑郁症和创伤后应激障碍。PGD症状对抑郁症的治疗反应不大。PGD合并症预示创伤后应激障碍的治疗结果更差。我们的小组在20世纪90年代中期开始描述PGD，使用“创伤性”或“复杂”悲伤的术语，并开发和测试一种治疗这种疾病的方法。我们在2005年发表的随机试验成为第一个经经验验证的治疗这种疾病的方法。它的前提是，悲伤是对失去亲人的自然反应，在亲近的人去世后，悲伤会持续一段不确定的时间。它的前提是，悲伤是对失去亲人的自然反应，随着失去亲人的人学会在一个缺失的世界中生活，悲伤会逐渐发展和消退。PGD是这一学习过程中障碍的结果，治疗的目的是促进学习与失去一起生活，并解决这一过程中的障碍。最近PGD被纳入DSM-5使得许多临床医生不熟悉PGD，我们验证的治疗方法，测试治疗的研究以及学习和使用这种方法的方法。本文提供了这些主题的简要总结。

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引用次数: 0

Using Visual Displays in a Manualized Cognitive-Behavioral Treatment for Adults With ADHD and Comorbid Mood or Anxiety Disorders: A Pilot Study 视觉显示在成人多动症和共病情绪或焦虑障碍的人工认知行为治疗中的应用：一项初步研究

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-09-07 DOI: 10.1016/j.cbpra.2023.08.003

Antonio F. Pagán, Gregory H. Mumma, Andrew K. Littlefield

Attention-deficit/hyperactivity disorder (ADHD) in adults is a major health concern, often occurring with other disorders and functional, occupational, and relational deficits. Unfortunately, many treatment studies for adults with ADHD exclude comorbid mood or anxiety disorders. The present two-part study sought to identify the feasibility, acceptability, and preliminary effectiveness of a treatment for adults with ADHD and comorbid mood or anxiety disorders that used modules from evidence-based cognitive-behavioral (CB) and mindfulness interventions for adult ADHD and mood or anxiety disorders. Selection of modules for each participant’s treatment was guided by participant input (e.g., top problems) and personalized visual displays. Visual displays included a CB case formulation and intraindividual network analyses, using pretreatment ecological momentary assessment (EMA) data completed two or three times a day to assess ADHD and comorbid symptoms. All 9 (6 women) participants completed the pretreatment standardized measures—however, completion of EMA data by 6 participants provides mixed support for the feasibility of utilizing EMA with ADHD adults. Nevertheless, the results indicate feasibility for using this CB treatment combining manualized interventions with treatment personalization using complex visual displays from available EMA data. Seven of 9 (77.8%) participants achieved a reliable change and 5 (55.6%) achieved a clinically significant change in total ADHD symptoms (Barkley Adult ADHD-IV Rating Scale) at posttreatment and/or 3-month follow-up. Inattention symptoms reliably decreased in all participants.

成人注意力缺陷/多动障碍（ADHD）是一个主要的健康问题，通常与其他疾病和功能、职业和关系缺陷一起发生。不幸的是，许多针对ADHD成人的治疗研究排除了共病情绪或焦虑障碍。本研究分为两部分，旨在通过基于证据的认知行为（CB）和正念干预成人ADHD和情绪或焦虑障碍的模块，确定成人ADHD和共病情绪或焦虑障碍治疗的可行性、可接受性和初步有效性。每个参与者的治疗模块的选择由参与者的输入（例如，最重要的问题）和个性化的视觉显示来指导。视觉显示包括一个CB病例配方和个体内部网络分析，使用预处理生态瞬间评估（EMA）数据，每天完成2或3次，以评估ADHD和共病症状。所有9名参与者（6名女性）完成了预处理标准化措施-然而，6名参与者完成的EMA数据为使用EMA治疗ADHD成人的可行性提供了混合支持。然而，结果表明，使用这种CB治疗结合人工干预和个性化治疗的可行性，使用来自现有EMA数据的复杂视觉显示。在治疗后和/或3个月的随访中，9名参与者中有7名（77.8%）实现了可靠的改变，5名（55.6%）实现了ADHD总症状（Barkley成人ADHD- iv评定量表）的临床显著改变。所有参与者的注意力不集中症状都明显减轻。

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引用次数: 0

Challenges in Grief-Focused Cognitive Behavior Therapy for Prolonged Grief Disorder 针对长期悲伤障碍的悲伤焦点认知行为疗法所面临的挑战

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-12-13 DOI: 10.1016/j.cbpra.2023.10.002

Fiona Maccallum, Katie Dawson, Suzanna Azevedo, Richard A. Bryant

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.

长期悲伤障碍（PGD）是丧亲之痛的一种潜在有害结果，与严重的负面心理后果有关。这种情况被认为是通过痛苦回忆、不适应的评估模式和无益的应对行为（包括持续回避失去亲人的回忆）之间的动态相互作用而维持的。针对这些机制的以悲伤为重点的认知行为疗法（GF-CBT）已被发现可以改善症状，其中包括对失去亲人的记忆进行暴露式处理的疗法效果更佳。然而，有数据表明，心理健康临床医生通常没有充分利用涉及暴露技术的治疗方法。在这份临床报告中，我们描述了一系列病例，说明了在实施 GF-CBT 时遇到的常见挑战，并概述了应对这些挑战的实用方法。

引用次数: 0

Cognitive Behavioral Therapy for Childhood Prolonged Grief Disorder for Bereaved Children and Adolescents With Comorbid Problems: Case Vignettes 认知行为疗法对丧失亲人的儿童和青少年的儿童期延长悲伤障碍与合并症的问题：案例小插图

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2024-12-31 DOI: 10.1016/j.cbpra.2024.12.004

A.A.A. Manik J. Djelantik, Mariken Spuij

The cognitive behavioral therapy (CBT) protocol for prolonged grief disorder in children and adolescents has demonstrated effectiveness in multiple studies, including a large randomized controlled trial. However, in clinical practice, we frequently encounter children with prolonged grief disorder who also present with comorbid conditions, such as other mental health disorders (e.g., posttraumatic stress disorder) and developmental disorders (e.g., autism spectrum disorder). This paper aims to describe the CBT protocol for prolonged grief in children and adolescents and to illustrate, through case vignettes and clinical observations, how this protocol may be adapted for use with children with comorbid conditions. We show that thorough clinical assessment is crucial for adapting techniques from other protocols into PGD treatment. Future research should prioritize the inclusion of detailed case studies of children with PGD and comorbidities to advance our understanding and optimize the individualization of treatment strategies.

儿童和青少年长期悲伤障碍的认知行为疗法（CBT）方案已经在多项研究中证明了有效性，包括一项大型随机对照试验。然而，在临床实践中，我们经常遇到患有长期悲伤障碍的儿童，他们同时还伴有其他疾病，如其他精神健康障碍（如创伤后应激障碍）和发育障碍（如自闭症谱系障碍）。本文旨在描述儿童和青少年长期悲伤的CBT协议，并通过案例和临床观察来说明该协议如何适用于患有合并症的儿童。我们表明，彻底的临床评估对于将其他方案的技术应用于PGD治疗至关重要。未来的研究应优先纳入PGD和合并症儿童的详细病例研究，以促进我们的理解和优化治疗策略的个性化。

引用次数: 0

Cognitive-Behavioral Therapy for Complicated Grief Reactions: Treatment Protocol and Preliminary Findings From a Naturalistic Setting 针对复杂悲伤反应的认知行为疗法：自然环境下的治疗方案和初步结果

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2025-02-01 Epub Date: 2023-12-13 DOI: 10.1016/j.cbpra.2023.11.001

Katrine B. Komischke-Konnerup, Maja O'Connor, Herbert Hoijtink, Paul A. Boelen

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.

在丧亲之痛中，有些人会出现复杂悲伤反应（CGR），包括长期悲伤障碍（PGD）、创伤后应激障碍（PTSD）和抑郁症状。PGD 的症状经常与其他复杂悲伤反应（如创伤后应激障碍和抑郁症）同时出现，这表明需要对 CGR 进行跨诊断理解，以便为治疗提供依据。本文解释了一种针对 CGR 的跨诊断认知行为疗法 "CBTgrief"，包括其理论框架和治疗内容。CBTgrief 基于之前对创伤后应激障碍、创伤后应激障碍和抑郁症的认知行为概念，包括 12 个疗程，包括暴露、认知重组和行为激活。在一个自然的临床环境中，对 8 名因不同类型的 CGR 而接受治疗的老年丧亲者进行了抽样调查，从可行性、可接受性和治疗满意度等方面对 CBTgrief 的初步研究结果进行了评估。此外，还使用贝叶斯信息假设检验法评估了有关 CGR 变化和理论上提出的核心维持过程的理论驱动假设。本文讨论了初步研究结果、局限性、影响和未来发展方向。

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引用次数: 0

Conceptualizing Pathways to Depression and Anxiety in Autistic Youth Using the Cognitive and Behavioral Model of Low Self-Esteem. 利用低自尊的认知和行为模型概念化自闭症青少年抑郁和焦虑的途径。

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2024-12-09 DOI: 10.1016/j.cbpra.2024.11.002

Matthew J Hollocks, Jessica M Schwartzman

Autistic youth are more likely to experience both anxiety and depression than their nonautistic peers, yet treatment options are extremely limited. Clinicians working with this population lack a robust evidence base of psychological models within which to formulate and treat these enduring internalizing disorders in autistic youth. Negative self-esteem is a robust risk factor-and treatment target-for internalizing disorders in nonautistic youth that remains largely understudied in autistic youth. The Cognitive and Behavioral Model of Low Self-Esteem (Fennell, 1997) was conceived to guide the development of cognitive-behavioral interventions targeting this construct in the general population. The model highlights how low-self-esteem develops from the interacting effects of temperament and negative experiences, leading to the formation of dysfunctional assumptions, and the subsequent development and maintenance of anxiety and depression. Autistic individuals are known to have specific vulnerabilities across the core elements of this model, making it potentially pertinent for this population. In this paper, we describe a theoretical extension of the model for autistic youth. We then use a blended case example to inform case conceptualization using the model to understand how low self-esteem may develop in an autistic youth and act to maintain anxiety and depression. Future directions for research into the use of the Low Self-Esteem Model in autistic youth are also discussed.

与非自闭症青少年相比，自闭症青少年更有可能经历焦虑和抑郁，但治疗选择却极为有限。与这一人群一起工作的临床医生缺乏一个强有力的心理模型的证据基础，在此基础上制定和治疗自闭症青年中这些持久的内化障碍。消极自尊是非自闭症青少年内化障碍的一个强有力的风险因素和治疗目标，而在自闭症青少年中，内化障碍在很大程度上仍未得到充分研究。低自尊的认知和行为模型（Fennell, 1997）被设想为指导针对普通人群这种结构的认知行为干预的发展。该模型强调了低自尊是如何从气质和负面经历的相互作用中发展起来的，导致了功能失调假设的形成，以及随后的焦虑和抑郁的发展和维持。众所周知，自闭症患者在这个模型的核心要素上有特定的弱点，这使得它可能与这个人群相关。在本文中，我们描述了自闭症青少年模型的理论扩展。然后，我们使用一个混合案例示例来告知案例概念化，使用该模型来理解低自尊如何在自闭症青少年中发展并维持焦虑和抑郁。最后，对低自尊模型在自闭症青少年中的应用进行了展望。

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引用次数: 0

Clarifying the Core Problem Concept in DBT: A Case Illustration 明确DBT的核心问题概念:一个案例说明

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2024-11-01 Epub Date: 2023-06-08 DOI: 10.1016/j.cbpra.2023.04.003

In her later years of teaching and training, Linehan (personal communication) spoke of an assessment construct that she referred to as a client’s “core problem.” In this paper, we trace the historical roots of this concept, review and clarify its current operationalization, anticipate common therapist questions and challenges to identifying a client’s core problem, and provide a case example to illustrate its utility for Dialectical Behavior Therapy (DBT) case formulation and treatment planning. We propose that conceptualizing a client’s core problem holds great promise for enhancing the therapist’s effective and efficient delivery of DBT.

在她晚年的教学和培训中，Linehan（个人通信）谈到了一种评估结构，她称之为客户的 "核心问题"。在本文中，我们将追溯这一概念的历史渊源，回顾并阐明其当前的可操作性，预测治疗师在识别客户核心问题时常见的问题和挑战，并提供一个案例来说明其在辩证行为疗法（DBT）的病例制定和治疗计划中的实用性。我们建议将客户的核心问题概念化，这对提高治疗师有效、高效地实施 DBT 大有裨益。

引用次数: 0

To Proceed Via Telehealth or Not? Considerations for Pediatric Anxiety and Related Disorders Beyond COVID-19 是否通过远程医疗继续？新冠肺炎后儿童焦虑和相关疾病的考虑因素。

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2024-11-01 Epub Date: 2023-03-21 DOI: 10.1016/j.cbpra.2023.01.004

The COVID-19 pandemic accelerated a widespread shift to telehealth among mental health professionals to prioritize both providers’ and clients’ safety. Telehealth is likely here to stay; however, there is limited practical guidance for clinicians about how to make decisions regarding who should proceed with care via telehealth versus in-person. There also is virtually no data on the effectiveness of hybrid approaches to care; yet this can be an attractive option with potential clinical benefit. This paper provides practice-informed guidance to support shared clinical decision-making between clinicians and families to decide whether to engage in therapy services in-person or via telehealth. We specifically focus on decision-making guidance relevant for youth with anxiety or related disorders, given the unique implications of telehealth for these youth. Guided by the three-legged stool of evidence-based practice, we discuss how clinicians can use principles of shared decision-making to inform clinical recommendations about treatment modality.

新冠肺炎大流行加速了心理健康专业人员向远程健康的广泛转变，以优先考虑提供者和客户的安全。远程医疗可能会继续存在；然而，对于临床医生来说，关于如何决定谁应该通过远程医疗与亲自进行护理，实际指导有限。实际上也没有关于混合护理方法有效性的数据；然而，这可能是一个具有潜在临床效益的有吸引力的选择。本文提供了基于实践的指导，以支持临床医生和家庭之间的共同临床决策，从而决定是亲自还是通过远程医疗参与治疗服务。鉴于远程医疗对这些年轻人的独特影响，我们特别关注与焦虑或相关疾病的年轻人相关的决策指导。在循证实践的三条腿大便的指导下，我们讨论了临床医生如何使用共享决策原则来为有关治疗模式的临床建议提供信息。

引用次数: 0

Acceptance and Commitment Therapy Approach for Problematic Chemsex Among Men Who Have Sex With Men 男男性性行为问题的接受与承诺治疗方法

IF 2.9 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Cognitive and Behavioral Practice

Pub Date : 2024-11-01 Epub Date: 2023-06-24 DOI: 10.1016/j.cbpra.2023.05.002

Chemsex, a phenomenon involving the use of psychoactive substances in sexual contexts to facilitate or enhance sexual experiences, is substantially increasing among men who have sex with men (MSM), and has been described as a significant risk factor for mental and physical illness. However, no specialized treatment approach has yet been established. Acceptance and commitment therapy (ACT) could potentially be an appropriate psychotherapeutic framework, especially considering the MSM and sexual minority unique challenges and the role of psychological flexibility in this context. The present paper describes the assessment and ACT interventions, reports and discusses the results, of 10 adult MSM who self-referred to an outpatient psychiatry and addiction department in France for self-reported problematic chemsex that interfered with their quality of life. They completed symptom- and process-based measures at three different timepoints. Results were quantitatively analyzed, and the clinician’s session notes and patients’ experiences/accounts, recorded verbatim, served as a support for evaluating the global effects of ACT interventions. Results on outcome measures showed clinically notable and statistically significative improvements in psychological flexibility, anxiety and depression symptoms, as well as sexual addiction intensity between pre- and posttreatment, which were all persistent at 3- to 4-month follow-up. Process measure results indicated a high and consistent therapeutic alliance throughout therapy. This exploratory study, directly derived from clinical practice, suggests promising preliminary results. It can provide clinicians with a useful resource for using ACT as a potentially effective approach for problematic chemsex and comorbidities, and may guide future investigation to inform treatment development efforts, especially for MSM and sexual minority communities.

"化学性性行为"（Chemsex）是指在性活动中使用精神活性物质来促进或增强性体验的一种现象，在男男性行为者（MSM）中有大幅增加的趋势，并被描述为导致精神和身体疾病的一个重要风险因素。然而，目前还没有专门的治疗方法。接受与承诺疗法（ACT）可能是一种合适的心理治疗框架，特别是考虑到 MSM 和性少数群体所面临的独特挑战以及心理灵活性在其中的作用。本文描述了对 10 名成年 MSM 的评估和 ACT 干预，并报告和讨论了结果。这些 MSM 因自述有问题的化学性行为影响了他们的生活质量而自我转诊到法国的精神病学和成瘾门诊部。他们在三个不同的时间点完成了基于症状和过程的测量。我们对结果进行了定量分析，并将临床医生的治疗记录和患者的经历/叙述逐字记录下来，作为评估 ACT 干预总体效果的支持。结果测量结果显示，治疗前和治疗后，患者在心理灵活性、焦虑和抑郁症状以及性瘾强度方面均有明显改善，且在统计学上具有显著意义，这些改善在 3 至 4 个月的随访中均持续存在。过程测量结果表明，在整个治疗过程中，治疗联盟都保持了高度一致。这项探索性研究直接来源于临床实践，取得了令人鼓舞的初步结果。它可以为临床医生提供有用的资源，将 ACT 作为一种潜在有效的方法来治疗有问题的化学性行为和合并症，并可指导未来的调查，为治疗开发工作提供信息，尤其是针对 MSM 和性少数群体。

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