{"title":"Survivor Guilt: A Cognitive Approach.","authors":"Hannah Murray, Yasmin Pethania, Evelina Medin","doi":"10.1017/S1754470X21000246","DOIUrl":"10.1017/S1754470X21000246","url":null,"abstract":"<p><p>Survivor guilt is a common experience following traumatic events in which others have died. However, little research has addressed the phenomenology of survivor guilt, nor has the issue been conceptualised using contemporary psychological models which would help guide clinicians in effective treatment approaches for this distressing problem. This paper summarises the current survivor guilt research literature and psychological models from related areas, such as posttraumatic stress disorder, moral injury and traumatic bereavement. Based on this literature, a preliminary cognitive approach to survivor guilt is proposed. A cognitive conceptualisation is described, and used as a basis to suggest potential treatment interventions for survivor guilt. Both the model and treatment strategies require further detailed study and empirical validation, but provide testable hypotheses to stimulate further research in this area.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"14 ","pages":"e28"},"PeriodicalIF":2.1,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39466322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cognitive therapy for moral injury in post-traumatic stress disorder.","authors":"Hannah Murray, Anke Ehlers","doi":"10.1017/S1754470X21000040","DOIUrl":"10.1017/S1754470X21000040","url":null,"abstract":"<p><p>Moral injury is the profound psychological distress that can arise following participating in, or witnessing, events that transgress an individual's morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found in other professionals such as healthcare workers coping with the COVID-19 pandemic and civilians following a wide range of traumas. In this article, we describe how to use cognitive therapy for post-traumatic stress disorder (CT-PTSD) to treat patients presenting with moral injury-related PTSD. We outline the key techniques involved in CT-PTSD and describe their application to treating patients with moral injury-related PTSD. A case study of a healthcare worker is presented to illustrate the treatment interventions.</p><p><strong>Key learning aims: </strong>(1)To recognise moral injury where it arises alongside PTSD.(2)To understand how Ehlers and Clark's cognitive model of PTSD can be applied to moral injury.(3)To be able to apply cognitive therapy for PTSD to patients with moral injury-related PTSD.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"14 ","pages":"e8"},"PeriodicalIF":2.1,"publicationDate":"2021-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Rodriguez-Quintana, Seo Youn Choi, Emily Bilek, Elizabeth Koschmann, Jeffrey Albrecht, Michael Prisbe, Shawna Smith
{"title":"The Cognitive Behavioral Therapy Competence Scale (CCS): initial development and validation.","authors":"Natalie Rodriguez-Quintana, Seo Youn Choi, Emily Bilek, Elizabeth Koschmann, Jeffrey Albrecht, Michael Prisbe, Shawna Smith","doi":"10.1017/s1754470x21000362","DOIUrl":"https://doi.org/10.1017/s1754470x21000362","url":null,"abstract":"<p><strong>Background: </strong>Nearly one-third of youth are affected by a mental health disorder, and the majority do not receive adequate care. To improve clinical outcomes among youth, efforts have been made to train providers in evidence-based mental health practices, such as cognitive behavioral therapy (CBT). Such efforts call for valid assessment measures that can inform and evaluate training activities.</p><p><strong>Aims: </strong>This study presents the development and validation of the CBT Competence Scale (CCS), a brief self-report measure to assess provider competence for CBT delivery.</p><p><strong>Method: </strong>Participants were 387 school mental health professionals (SMHPs) working with students in Michigan, USA. Initial items (<i>n</i>=59) were developed to evaluate competence in delivering common elements of CBT, with competence conceptualized as covering domains of knowledge, perception, and use of CBT techniques. CCS validation proceeded in three steps: using item response theory to select the most important items for assessing knowledge, evaluating the factor structure using exploratory and then confirmatory factor analyses, and examining reliability and validity of the resultant measure.</p><p><strong>Results: </strong>The validated CCS measure consists of four dimensions of CBT competence across 33 items: Non-behavioral skills, Behavioral skills, Perceptions, and Knowledge. The CCS demonstrated excellent internal consistency and good construct-based validity.</p><p><strong>Conclusions: </strong>The CCS holds promise as a valid, informative measure of CBT competence appropriate for the school setting, with potential for application in other environments such as mental health clinics.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40549820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lilian Skilbeck, Christopher Spanton, Ian Roylance
{"title":"Beyond the COVID-19 pandemic: 'Learning the hard way' - adapting long-term IAPT service provision using lessons from past outbreaks.","authors":"Lilian Skilbeck, Christopher Spanton, Ian Roylance","doi":"10.1017/S1754470X20000379","DOIUrl":"10.1017/S1754470X20000379","url":null,"abstract":"<p><p>Infectious disease outbreaks have occurred sporadically over the centuries. The most significant ones of this century, as reported by the World Health Organization, include the EVD epidemic, SARS pandemic, Swine Flu pandemic and MERS pandemic. The long-term mental health consequences of outbreaks are as profound as physical ones and can last for years post-outbreak. This highlights the need for enhancing the preparedness of pragmatic mental health service provision. Due to its magnitude, the novel COVID-19 pandemic has proven to be the most impactful. Compared with previous outbreaks, COVID-19 has also occurred at higher rates in frontline staff in addition to patients. As COVID-19 is more contagious than earlier outbreaks, there is a need to identify infected people quickly and isolate them and their contacts. This is the current context in which mental health services including IAPT have had to operate. Evidently, Improving Access to Psychological Therapies (IAPT) services are a major mental health service provider in the UK that have demonstrated variability in their response to COVID-19. While some IAPT services quickly adapted their existing strengths and resources (e.g. remote working), other services were less prepared. To date, there are no clear unitary guidelines on how IAPT services can use their pre-existing resources to respond to the long-term effects of outbreaks. In light of this, the current paper aims to reflect on the lessons learned from past outbreaks in order to consider how an enhanced remit of IAPT might integrate with other services to meet the long-term needs of patients and staff affected by COVID-19.</p><p><strong>Key learning aims: </strong>(1)To understand the development of IAPT within the NHS mental health services.(2)To understand the nature of past outbreaks and COVID-19.(3)To reflect on lessons from past outbreaks in order to understand how IAPT can respond to the long-term effects of COVID-19.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e34"},"PeriodicalIF":2.1,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual.","authors":"Paul Cromarty, Dominic Gallagher, Julianne Watson","doi":"10.1017/S1754470X20000343","DOIUrl":"10.1017/S1754470X20000343","url":null,"abstract":"<p><p>The worldwide coronavirus pandemic has forced health services to adapt their delivery to protect the health of all concerned, and avoid service users facing severe disruption. Improving Access to Psychological Therapies (IAPT) services in particular are having to explore remote working methods to continue functioning. Australian IAPT services have utilised remote delivery methods and disruptive technologies at their core from inception. This was to maintain fidelity and clinical governance across vast distances but has allowed training, supervision and service delivery to continue virtually uninterrupted through coronavirus restrictions. On this basis, key recommendations for remote working are outlined. Remote methods are defined as (1) real time delivery, (2) independent delivery and (3) blended delivery. These are applied across three broad areas of remote training, remote clinical supervision and remote service delivery. Recommendations may be of great benefit to IAPT training institutions, clinical supervisors and service providers considering a move towards remote delivery. Challenges, adaptations and examples of applying remote methods are outlined, including case examples of methods applied to low-intensity and high-intensity cognitive behavioural therapy. Remote methods can safeguard service continuity in times of worldwide crisis and can contribute to reducing the impact of increased mental health presentations post-COVID-19.</p><p><strong>Key learning aims: </strong>To understand the core areas of remote training, clinical supervision and service delivery.To review and distinguish between three broad methods of remote working.To understand how to plan remote working via key recommendations and case examples.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e33"},"PeriodicalIF":3.5,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X20000343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Warnock-Parkes, Jennifer Wild, Graham R Thew, Alice Kerr, Nick Grey, Richard Stott, Anke Ehlers, David M Clark
{"title":"Treating social anxiety disorder remotely with cognitive therapy.","authors":"Emma Warnock-Parkes, Jennifer Wild, Graham R Thew, Alice Kerr, Nick Grey, Richard Stott, Anke Ehlers, David M Clark","doi":"10.1017/S1754470X2000032X","DOIUrl":"https://doi.org/10.1017/S1754470X2000032X","url":null,"abstract":"<p><p>Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay seeking face-to-face therapy, often due to anxiety about travelling to appointments and meeting mental health professionals in person. Individual cognitive therapy for SAD (CT-SAD), based on the Clark and Wells (1995) model, is a highly effective treatment that is recommended as a first-line intervention in NICE guidance (NICE, 2013). All of the key features of face-to-face CT-SAD (including video feedback, attention training, behavioural experiments and memory-focused techniques) can be adapted for remote delivery. In this paper, we provide guidance for clinicians on how to deliver CT-SAD remotely, and suggest novel ways for therapists and patients to overcome the challenges of carrying out a range of behavioural experiments during remote treatment delivery.</p><p><strong>Key learning aims: </strong>To learn how to deliver all of the core interventions of CT-SAD remotely.To learn novel ways of carrying out behavioural experiments remotely when some in-person social situations might not be possible.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e30"},"PeriodicalIF":3.5,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X2000032X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amita Jassi, Khodayar Shahriyarmolki, Tracey Taylor, Lauren Peile, Fiona Challacombe, Bruce Clark, David Veale
{"title":"OCD and COVID-19: a new frontier.","authors":"Amita Jassi, Khodayar Shahriyarmolki, Tracey Taylor, Lauren Peile, Fiona Challacombe, Bruce Clark, David Veale","doi":"10.1017/S1754470X20000318","DOIUrl":"10.1017/S1754470X20000318","url":null,"abstract":"<p><p>People with obsessive compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19. This paper shares the perspectives of expert clinicians working with OCD considering how to identify OCD in the context of COVID-19, changes in the presentation, and importantly what to consider when undertaking cognitive behaviour therapy (CBT) for OCD in the current climate. The expert consensus is that although the presentation of OCD and treatment may have become more difficult, CBT should still continue remotely unless there are specific reasons for it not to, e.g. increase in risk, no access to computer, or exposure tasks or behavioural experiments cannot be undertaken. The authors highlight some of the considerations to take in CBT in light of our current understanding of COVID-19, including therapists and clients taking calculated risks when developing behavioural experiments and exposure tasks, considering viral loading and vulnerability factors. Special considerations for young people and perinatal women are discussed, as well as foreseeing what life may be like for those with OCD after the pandemic is over.</p><p><strong>Key learning aims: </strong>(1)To learn how to identify OCD in the context of COVID-19 and consider the differences between following government guidelines and OCD.(2)To consider the presentation of OCD in context of COVID-19, with regard to cognitive and behavioural processes.(3)Review factors to be considered when embarking on CBT for OCD during the pandemic.(4)Considerations in CBT for OCD, including weighing up costs and benefits of behavioural experiments or exposure tasks in light of our current understanding of the risks associated with COVID-19.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e27"},"PeriodicalIF":3.5,"publicationDate":"2020-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X20000318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mark Freeston, Ashley Tiplady, Lauren Mawn, Gioia Bottesi, Sarah Thwaites
{"title":"Towards a model of uncertainty distress in the context of Coronavirus (COVID-19).","authors":"Mark Freeston, Ashley Tiplady, Lauren Mawn, Gioia Bottesi, Sarah Thwaites","doi":"10.1017/S1754470X2000029X","DOIUrl":"10.1017/S1754470X2000029X","url":null,"abstract":"<p><p>The paper forms part of a series of papers outlining the theoretical framework for a new model of uncertainty distress (this paper), treatment implications arising from the model, and empirical tests of the model. We define uncertainty distress as <i>the subjective negative emotions experienced in response to the as yet unknown aspects of a given situation</i>. In the first paper we draw on a robust body of research on distinct areas including: threat models of anxiety, perceived illness uncertainty and intolerance of uncertainty. We explore how threat and uncertainty are separable in anxiety and how we can understand behaviours in response to uncertainty. Finally, we propose a clinically, theoretically and empirically informed model for uncertainty distress, and outline how this model can be tested. Caveats, clinical applications and practitioner key points are briefly included, although these are more fully outlined in the treatment implications article. While we outline this model in the context of novel coronavirus (COVID-19), the model has broader applications to both mental and physical health care settings.</p><p><strong>Key learning aims: </strong>(1)To define the concept of uncertainty distress.(2)To understand the role of threat, over-estimation of threat, perceived uncertainty, actual uncertainty, and intolerance of uncertainty in distress maintenance.(3)To understand how people may behave in response to uncertainty distress.(4)To describe a model of uncertainty distress.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e31"},"PeriodicalIF":3.5,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X2000029X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Death anxiety in the time of COVID-19: theoretical explanations and clinical implications.","authors":"Rachel E Menzies, Ross G Menzies","doi":"10.1017/S1754470X20000215","DOIUrl":"https://doi.org/10.1017/S1754470X20000215","url":null,"abstract":"<p><p>The recent COVID-19 pandemic has triggered a surge in anxiety across the globe. Much of the public's behavioural and emotional response to the virus can be understood through the framework of terror management theory, which proposes that fear of death drives much of human behaviour. In the context of the current pandemic, death anxiety, a recently proposed transdiagnostic construct, appears especially relevant. Fear of death has recently been shown to predict not only anxiety related to COVID-19, but also to play a causal role in various mental health conditions. Given this, it is argued that treatment programmes in mental health may need to broaden their focus to directly target the dread of death. Notably, cognitive behavioural therapy (CBT) has been shown to produce significant reductions in death anxiety. As such, it is possible that complementing current treatments with specific CBT techniques addressing fears of death may ensure enhanced long-term symptom reduction. Further research is essential in order to examine whether treating death anxiety will indeed improve long-term outcomes, and prevent the emergence of future disorders in vulnerable populations.</p><p><strong>Key learning aims: </strong>(1)To understand terror management theory and its theoretical explanation of death anxiety in the context of COVID-19.(2)To understand the transdiagnostic role of death anxiety in mental health disorders.(3)To understand current treatment approaches for directly targeting death anxiety, and the importance of doing so to improve long-term treatment outcomes.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e19"},"PeriodicalIF":3.5,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X20000215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rob Saunders, John Cape, Judy Leibowitz, Elisa Aguirre, Renuka Jena, Mirko Cirkovic, Jon Wheatley, Nicole Main, Stephen Pilling, Joshua E J Buckman
{"title":"Improvement in IAPT outcomes over time: are they driven by changes in clinical practice?","authors":"Rob Saunders, John Cape, Judy Leibowitz, Elisa Aguirre, Renuka Jena, Mirko Cirkovic, Jon Wheatley, Nicole Main, Stephen Pilling, Joshua E J Buckman","doi":"10.1017/S1754470X20000173","DOIUrl":"https://doi.org/10.1017/S1754470X20000173","url":null,"abstract":"<p><p>Treatment outcomes across Improving Access to Psychological Therapies (IAPT) services in England have improved year-on-year, with the national average proportion of patients in recovery at the end of treatment now exceeding the 50% target. This is despite the number of referrals and numbers of treated patients also increasing year-on-year, suggesting that services have evolved local practices and treatment delivery to meet needs whilst improving performance. This study explores whether there have been changes in clinical practice with regard to: (1) the number of sessions and length of treatments; (2) the number of cancellations and non-attendance; and (3) the recording of problem descriptor information, and the association with treatment outcomes in IAPT. Routinely collected data from seven IAPT services involved in the North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) were brought together to form a dataset of nearly 88,000 patients who completed a course of IAPT treatment. Results showed that there was a slight increase in the average number of sessions, and decreases in the length of time in treatment, as well as decreases in both the number of non-attended appointments and the use of inappropriate problem descriptors. These findings highlight a number of areas where potentially small changes to clinical practice may have had positive effects on patient outcomes. The value of using IAPT data to inform service improvement evaluations is discussed.</p><p><strong>Key learning aims: </strong>(1)How changes to treatment-delivery factors are associated with IAPT patient outcomes.(2)The link between clinical practice and potential service performance.(3)How analysing routinely collected data can be used to inform service improvement.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":"13 ","pages":"e16"},"PeriodicalIF":3.5,"publicationDate":"2020-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X20000173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25396039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}