{"title":"A reason for caution: the identification of sudden gains may depend on the outcome measure used.","authors":"Ashleigh B Correa, Madelyne A Bisby, Blake F Dear","doi":"10.1080/16506073.2025.2556723","DOIUrl":"10.1080/16506073.2025.2556723","url":null,"abstract":"<p><p>Sudden gains are rapid, substantial, and lasting symptom reductions between sessions which have been associated with better treatment outcomes. Frequent symptom measurements in treatment change research can be burdensome; ultra-brief scales can reduce this burden, increase completion rates, and enable the examination of a broader range of constructs. This study compared the timing, prevalence, and treatment outcomes associated with sudden gains during an internet-delivered treatment using standard and ultra-brief self-report measures of depression and anxiety. Existing data (<i>N</i> = 937) from a five-week internet-delivered treatment for depression and anxiety in university students was analysed. Anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and its brief version the GAD-2, and depression symptoms were measured using the Patient Health Questionnaire 9-item Scale (PHQ-9) and its brief version the PHQ-2. More sudden gains were identified by the PHQ-9 than the PHQ-2, and more by the GAD-2 than the GAD-7. Critically, the standard and ultra-brief measures identified different individuals as having experienced a sudden gain. Sudden gains were associated with higher baseline symptom severity. These results seem to raise important questions about the detection of sudden gains, and the comparability of findings across studies using different measures.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"745-758"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tove Wahlund, Sean Perrin, Klara Olofsdotter Lauri, Malin Burman, Simone Dagerborn, Micaela Meregalli, Maja Västhagen, Maral Jolstedt, Martina Nord, Eva Serlachius, Sarah Vigerland, Erik Andersson
{"title":"Internet-delivered cognitive behavioral therapy for adolescents with excessive worry: a randomized controlled trial with mediation analysis.","authors":"Tove Wahlund, Sean Perrin, Klara Olofsdotter Lauri, Malin Burman, Simone Dagerborn, Micaela Meregalli, Maja Västhagen, Maral Jolstedt, Martina Nord, Eva Serlachius, Sarah Vigerland, Erik Andersson","doi":"10.1080/16506073.2025.2515196","DOIUrl":"10.1080/16506073.2025.2515196","url":null,"abstract":"<p><p>Excessive worry is common during adolescence and across psychiatric disorders. This study investigates whether: (1) internet-delivered cognitive behavioral therapy (ICBT) focused on exposure to uncertainty is effective in reducing excessive worry; (2) improvements in worry are associated with reductions in other psychiatric symptoms; and (3) changes in intolerance of uncertainty (IU) mediate worry outcomes. Adolescents (<i>N</i> = 62; aged 13-17 years) with excessive worry (≥30 total score on Penn State Worry Questionnaire for Children) were randomly allocated to 8 weeks of ICBT (<i>n</i> = 31) or a waitlist for ICBT (Waitlist, <i>n</i> = 31). Self-reported worry (primary outcome) was measured weekly for 12 weeks and controlled effects assessed at week 12 post-baseline. IU and a comparator mediator (depression) were measured every other week for 12 weeks during the treatment/waitlist phase. ICBT yielded significantly large reductions in worry compared to Waitlist (bootstrapped <i>d</i> = 0.59). Worry reductions mediated improvements in anxiety and depression symptoms. Changes in depression, but not IU, mediated worry outcomes. A brief course of worry-focused ICBT yielded moderate reductions in worry that was associated with improvements in anxiety and depression. Contrary to expectation, changes in IU did not explain worry reductions in this uncertainty- focused treatment. Further studies are needed to identify potential change mechanisms.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"629-651"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there a dissociative subtype of exposure to PMIEs among army veterans?","authors":"David Potik, Yael Idisis, Tomer Einat","doi":"10.1080/16506073.2025.2597844","DOIUrl":"10.1080/16506073.2025.2597844","url":null,"abstract":"<p><p>Previous research has demonstrated that post-traumatic stress disorder (PTSD) symptoms and exposure to potentially morally injurious events (PMIEs) frequently co-occur in military veterans and share similar adverse mental and behavioral health outcomes. While studies have established a robust association between PTSD and dissociative symptoms in veterans, evidence supporting a direct link between exposure to PMIEs and dissociative symptoms has largely been anecdotal. In this cross-sectional study, a volunteer sample of 189 Israeli male combat veterans completed validated self-report questionnaires assessing PTSD symptoms, exposure to PMIEs, and dissociative symptoms. The results show cooccurrence of PTSD symptoms and depersonalization and/or derealization symptoms, hereby suggesting the existence of a dissociative subtype of PTSD, characterized by elevated PTSD symptoms alongside persistent or recurrent symptoms of depersonalization and/or derealization. Moreover, PTSD symptoms were found to mediate the relationship between PMIE exposure and dissociative symptoms. Notably, one of the facets of exposure to PMIEs, the commission of moral transgressions, was significantly associated with depersonalization/derealization symptoms, suggesting a dissociative subtype of PMIE exposure. These findings provide empirical support for the trauma model, which conceptualizes dissociative symptoms as resulting from severe trauma, and underscore the importance of offering specialized treatments for veterans who report having committed moral transgressions.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"795-813"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy R Senger, Zachary S Ayers, Michael J Zvolensky, Matthew W Gallagher
{"title":"Health anxiety as a mediator between resilience factors, and physical health and well-being over time during the COVID-19 pandemic.","authors":"Amy R Senger, Zachary S Ayers, Michael J Zvolensky, Matthew W Gallagher","doi":"10.1080/16506073.2025.2597846","DOIUrl":"10.1080/16506073.2025.2597846","url":null,"abstract":"<p><p>Gratitude and hope are established predictors of mental and physical health and well-being. Scarce literature investigates relevant mediators of these relationships in a single model and during the COVID-19 pandemic. The current study investigated the mediating role of health anxiety (measured three months after baseline) in the relationship of gratitude and hope at baseline with alcohol use, fatigue, pain, and well-being six months later. The sample was composed of 788 mostly male (58.1%), White (70.3%), middle-aged adults (<i>M</i><sub><i>age</i></sub> = 38.0, <i>SD</i> = 11.8). Structural equation models (SEM) were used to analyze the data. Gratitude at baseline's indirect effect of health anxiety three months later was both small and negative for alcohol use (<i>ab</i> = ‒.06, 95% CI [-.10, -.03]) and pain (<i>ab</i> = ‒3.01, 95% CI [-4.34, -1.68]). Health anxiety appears to be a robust mediator of the relationship between gratitude and mental and physical health outcomes. Hope was a stronger and more direct predictor of well-being compared to gratitude. The findings of this study may provide evidence for examining health anxiety levels as a risk factor when trying to promote resilience factors in individuals who report health issues, particularly during times of environmental contagion.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"814-826"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen H Kallesøe, Eva Ørnbøl, Kaare Bro Wellnitz, Charlotte Ulrikka Rask
{"title":"The role of illness perception and behaviour in the treatment of adolescents with multisystem functional somatic disorders: a post hoc mediation analysis of the AHEAD trial.","authors":"Karen H Kallesøe, Eva Ørnbøl, Kaare Bro Wellnitz, Charlotte Ulrikka Rask","doi":"10.1080/16506073.2025.2521719","DOIUrl":"10.1080/16506073.2025.2521719","url":null,"abstract":"<p><p>Psychological interventions can reduce symptom load and disability in adolescents with various functional somatic disorders (FSD). However, mechanisms of change are less investigated, especially in those with multisystem symptomatology. In a post-hoc analysis, illness perception, illness behaviour, and psychological inflexibility (experiential avoidance and fusion) were examined as mediators of changes in self-perceived physical health in adolescents 3 months after receiving group-based Acceptance and Commitment Therapy versus Enhanced Usual Care. Baseline levels of proposed mediators were also assessed for moderation effects. Data from 91 adolescents (15-19 years) with multisystem FSD (duration ≥1 year) from the RCT \"ACT for Health in Adolescents\" (AHEAD) were used in a classic mediation analysis. Mediators were measured at baseline (before assessment), 5.5 months (2 weeks after end-of-treatment), and 8 months (3 months after end-of-treatment). Improvements in negative illness perceptions and psychological inflexibility (experiential avoidance) mediated the effect of AHEAD on physical health at 8 months. The mediation effect increased with higher baseline levels, but the moderation effects were non-significant. AHEAD reduced negative illness perception and psychological inflexibility (experiential avoidance) and, consequently, improved physical health in adolescents with multisystem FSD. Reducing these factors may be important treatment targets in future treatment programmes for adolescents with FSD.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"668-689"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola Walker, Bernie Gibson, Jonathan Emerson, Davy de Geeter, Barry Tolchard
{"title":"A feasibility study of a new version of self-practice/self-reflective (SP/SR) groupwork for cognitive behaviour therapy training.","authors":"Nicola Walker, Bernie Gibson, Jonathan Emerson, Davy de Geeter, Barry Tolchard","doi":"10.1080/16506073.2026.2724074","DOIUrl":"https://doi.org/10.1080/16506073.2026.2724074","url":null,"abstract":"<p><p>Clients receiving cognitive behaviour therapy (CBT) may disengage from therapy for different reasons, including limited self-awareness and interpersonal skills among the modifiable therapist factors. In this feasibility study, we evaluated recruitment, retention, acceptability, utility of outcome measures, adverse events, and cost of a self-practice/self-reflective (SP/SR) groupwork intervention facilitated by Institute of Group Analysis (IGA)-trained practitioners, alongside outcomes. CBT trainees undertook six SP/SR sessions over 12 months delivered by IGA-trained facilitators. Emotional-relational skills were assessed with the Cognitive Therapy Scale-Revised at baseline and after 12 months, and Counsellor Self-Awareness Scale, Perceived Stress Scale. Confidence in Using Emotional-Relational Skills data were analysed using growth curve modelling. Of 33 trainees, 30 (91%) consented; three withdrew from training (10% attrition); no adverse events were reported; missing data were minimal; the intervention was delivered within the £10,000 budget; and course satisfaction was 59%. Trainee emotional-relational competence scores increased from 8.02 (baseline) to 9.48 (post-intervention) (p<0.01), and growth curve modelling showed changes in average scores across all measures, with variability at baseline and in rates of change. Implementation and evaluation of IGA-facilitated SP/SR Groupwork in a CBT training programme is feasible, albeit with mixed acceptability findings, supporting progression to a future randomised pilot trial. .</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"1-17"},"PeriodicalIF":3.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Group and online application of the Unified Protocol in Argentina: controlled pilot study.","authors":"Marcela Kaplan, Milagros Celleri, Florencia Klajner, Camila Cremades, Cristian Garay","doi":"10.1080/16506073.2026.2720138","DOIUrl":"https://doi.org/10.1080/16506073.2026.2720138","url":null,"abstract":"<p><p>Emotional disorders (ED), including anxiety and depression, are highly prevalent in Argentina and share dysfunctional emotional regulation mechanisms. The Unified Protocol (UP) is a transdiagnostic intervention designed to address these common processes. This is the first randomized controlled trial (RCT) to evaluate its effectiveness on a group and online format in the Argentinian population. A parallel-group RCT was conducted with 39 participants (mean age = 33.54; 67% women) diagnosed with various EDs according to DSM-5 criteria. Subjects were randomly assigned to a treatment group (<i>n</i> = 22), which received 10 90-min sessions of the UP, or to a waiting list control group (<i>n</i> = 23). Mixed linear models assessed changes in emotional dysregulation (DERS), anxiety (BAI), depression (BDI-II), hopelessness (BHS), affect (PANAS), neuroticism (IPIP-FFM), mindfulness (MAAS), and quality of life (MQLI). At post-treatment (week 10), the intervention group showed significant improvements across all outcomes compared with controls. Significant reductions were observed in emotional dysregulation, anxiety, depression, hopelessness, neuroticism, and negative affect, alongside increases in positive affect, mindfulness, and quality of life. Participants reported high satisfaction and perceived usefulness. Findings support the effectiveness and acceptability of the UP group online format in the Argentine context, facilitating the scalability of evidence-based treatments.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"1-24"},"PeriodicalIF":3.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simone Hain, Ella L Oar, Alexandra Mruk, Richard J Stevenson
{"title":"One-session treatment for trypophobia: a controlled multiple baseline trial.","authors":"Simone Hain, Ella L Oar, Alexandra Mruk, Richard J Stevenson","doi":"10.1080/16506073.2026.2723119","DOIUrl":"https://doi.org/10.1080/16506073.2026.2723119","url":null,"abstract":"<p><p>Trypophobia, an aversion to clustered patterns such as lotus seed pods or honeycombs, has been increasingly recognised as a condition associated with both fear and disgust. Despite its prevalence and significant functional impairment, few studies have examined effective treatments. The current study developed and evaluated a novel One-Session Treatment (OST) for trypophobia designed to target both emotional components. Traditional OST, an intensive cognitive-behavioural therapy combining psychoeducation, cognitive challenges, modelling, and exposure, was augmented with counterconditioning (pairing an aversive stimuli with pleasant experiences) and revaluation techniques to modify negative valence. Using a multiple-baseline single-case controlled design, participants were randomly assigned to a 1-, 2-, or 3-week baseline conditions before receiving the intervention. Trypophobic symptoms, diagnostic status, and performance on a behavioural approach task were assessed pre-treatment, post-treatment, and at 1-month follow-up. Symptoms remained stable during the baseline period but showed significant reductions following treatment, with gains maintained at 1-month follow-up. Both fear and disgust towards trypophobic stimuli decreased, and participants demonstrated increased approach behaviour. These findings support the preliminary effectiveness of an intensive, augmented OST in addressing both affective dimensions of trypophobia and highlight the possibility that targeting disgust-based avoidance processes may be beneficial for improving outcomes.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"1-18"},"PeriodicalIF":3.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Line Nordgren, Ata Ghaderi, Brjánn Ljótsson, Örjan Dahlström, Hanna Aabakken, Sara Svedberg, Hugo Hesser
{"title":"Add-on effect of a brief internet-delivered emotion regulation intervention for eating disorders: a replicated single-case experimental design.","authors":"Line Nordgren, Ata Ghaderi, Brjánn Ljótsson, Örjan Dahlström, Hanna Aabakken, Sara Svedberg, Hugo Hesser","doi":"10.1080/16506073.2026.2716624","DOIUrl":"https://doi.org/10.1080/16506073.2026.2716624","url":null,"abstract":"<p><p>Emotion dysregulation is a potentially important process to target in eating disorder treatment. This study aimed to investigate whether emotion dysregulation may be improved in individuals with eating disorders using a brief online treatment designed specifically to increase emotion regulation skills. A replicated single-case experimental randomized AB-design was used to investigate the added effect of emotion regulation interventions (B phase), beyond the effects of eating disorder treatment focusing on normalization of eating and refrainment from compensatory behaviors (A phase). Twelve individuals with eating disorders were recruited from psychiatric outpatient services, and eight received an 8-week online treatment. The start of B phase in treatment (i.e. emotion regulation interventions) was randomized for each participant. Emotion dysregulation and negative affect were assessed every third day in both phases (20 assessments in total). Visual and baseline-corrected Tau analyses revealed short-term positive experimental effects on negative affect and emotion regulation for four participants, suggesting that emotion regulation interventions may be beneficial for some individuals. The study also demonstrated the feasibility and acceptability of delivering and evaluating treatment in this intensified online format, allowing for future detailed investigation of treatment processes and components at the intraindividual level.</p>","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":" ","pages":"1-18"},"PeriodicalIF":3.4,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madeleine L. Connolly, Siming Sun, Shania J.E. Kelly, Jeni E. Lansing, Thomas A. Murray, Emily B.K. Thomas, Nathaniel G. Wade, Jacob D. Meyer
{"title":"Does cognitive behavioral therapy change the daily activity patterns of adults with depression? A secondary analysis of the CBT+ trial","authors":"Madeleine L. Connolly, Siming Sun, Shania J.E. Kelly, Jeni E. Lansing, Thomas A. Murray, Emily B.K. Thomas, Nathaniel G. Wade, Jacob D. Meyer","doi":"10.1080/16506073.2026.2720134","DOIUrl":"https://doi.org/10.1080/16506073.2026.2720134","url":null,"abstract":"","PeriodicalId":10535,"journal":{"name":"Cognitive Behaviour Therapy","volume":"35 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148767389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}