Behaviour Research and Therapy最新文献

{"title":"Neuromodulation of heart rate and heart rate variability in a randomized controlled trial of tDCS-augmented in vivo exposure for specific fears","authors":"Adam R. Cobb ,&nbsp;Lisa M. McTeague ,&nbsp;Patrick O'Connor ,&nbsp;Francisco Gonzalez-Lima ,&nbsp;Michael J. Telch","doi":"10.1016/j.brat.2025.104701","DOIUrl":"10.1016/j.brat.2025.104701","url":null,"abstract":"<div><div>This study evaluated the prediction that tDCS-augmented in vivo exposure (IVE) for specific fears would result in durable changes in heart rate (BPM) and heart-rate variability (HRV) during and just after exposure to feared targets. In a double-blind, placebo-controlled trial, participants with contamination- and animal phobia (<em>N</em> = 49) were randomized to active tDCS (1.7 mA, 20 min; <em>n</em> = 27), or sham tDCS (1.7 mA, 30 s; <em>n</em> <em>=</em> 22), followed by a single session of 30 min of IVE. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC. BPM and HRV were acquired during behavioral approach tasks involving brief (30 s) exposure to feared targets at pre-treatment, post-treatment, and a 1-month follow-up, as well as during six 5-min. trials of exposure. Active tDCS produced significantly greater reductions in BPM, and marginally greater increases in HRV from pre-treatment to 1-month in an extinction context, compared to sham tDCS. Similarly, active tDCS produced significantly greater reductions in BPM, and increases in HRV during IVE, relative to the sham tDCS group. Findings for the generalization context were non-significant. Consistent with the main outcome findings, tDCS may offer an effective means of enhancing outcomes in exposure therapy, perhaps through top-down modulation of autonomic arousal.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104701"},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143167322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring behavioral responses to a social stressor: Does the Social Performance Rating Scale have utility beyond social anxiety disorder?","authors":"Auburn R. Stephenson ,&nbsp;Elizabeth C. Stade ,&nbsp;Ayelet Meron Ruscio","doi":"10.1016/j.brat.2025.104700","DOIUrl":"10.1016/j.brat.2025.104700","url":null,"abstract":"<div><div>The observer-rated Social Performance Rating Scale (SPRS) indexes anxious behaviors exhibited in social contexts. Although the SPRS has been used almost exclusively to study social anxiety disorder (SAD), other emotional disorders are also characterized by heightened responses to social stressors, hinting that the SPRS could serve as a transdiagnostic state measure of behavioral anxiety. To explore this possibility, adults with generalized anxiety disorder or major depressive disorder (<em>n</em> = 105) and adults with no psychopathology (<em>n</em> = 35) delivered a speech to a committee of mock behavioral experts. Behavioral anxiety observed during the speech was rated using the SPRS, then examined in relation to clinical and state measures of anxiety and depression. Contrary to our hypotheses, behavioral anxiety was not associated with clinician- or self-rated anxiety or depression severity. Instead, behavioral anxiety was heightened among individuals who specifically fear and avoid public speaking; who perceived the speech task to be more stressful; and who reported more emotional distress, somatic hyperarousal, and anxious and pessimistic thoughts at the time of the speech. The SPRS is a valid measure of anxious behavior in the many individuals, with and without SAD, who experience acute anxiety in social-evaluative contexts. As behavioral measures are resource-intensive to collect, research is needed to establish whether the SPRS predicts anxious behavior and functional impairment in real-world settings, over and above easier-to-obtain self-report measures.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104700"},"PeriodicalIF":4.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372300","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":"Effectiveness of cognitive behavioral therapy for adult mental disorders: A large-scale naturalistic study across 29 university outpatient clinics","authors":"Julia Velten ,&nbsp;Hanna Christiansen ,&nbsp;Jürgen Hoyer ,&nbsp;Tina In-Albon ,&nbsp;Tania Lincoln ,&nbsp;Wolfgang Lutz ,&nbsp;Jürgen Margraf ,&nbsp;Henning Schöttke ,&nbsp;Rudolf Stark ,&nbsp;Katja Werheid ,&nbsp;Ulrike Willutzki ,&nbsp;Georg W. Alpers ,&nbsp;Stephan Bartholdy ,&nbsp;Elisa-Maria Berger ,&nbsp;Eva-Lotta Brakemeier ,&nbsp;Anne-Kathrin Bräscher ,&nbsp;Timo Brockmeyer ,&nbsp;Isabel Dziobek ,&nbsp;Lydia Fehm ,&nbsp;Thomas Forkmann ,&nbsp;Julian A. Rubel","doi":"10.1016/j.brat.2025.104691","DOIUrl":"10.1016/j.brat.2025.104691","url":null,"abstract":"<div><div>Practice-based evidence has emerged as an important complementary paradigm to studies in controlled trials. This paper presents results of a large research-practice network at German university outpatient clinics; the KODAP initiative. Pre-post effect sizes, direct assessments of change, and rates of clinically significant and reliable improvement are reported in a heterogeneous clinical sample of 6624 adult patients treated between 2023 and 2014 in 29 psychotherapeutic outpatient clinics. Clinical diagnoses, determined with structured diagnostic clinical interviews at baseline across all clinics, encompassed a wide range of psychopathology. Effectiveness was comparable to other studies in naturalistic settings (<em>d</em> ≈ 0.75–0.95) and somewhat lower than changes reported in disorder-specific CBT efficacy trials. In direct assessments of change, only 1.9% of the patients reported symptom worsening and 3.4% reported no change during treatment. Overall, the results show the potential of multi-site naturalistic research initiatives in general and the effectiveness of outpatient CBT at German university outpatient clinics in particular.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104691"},"PeriodicalIF":4.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143204779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating therapist differences: Therapists’ interpersonal skills and their effect on treatment outcome","authors":"Brian Schwartz ,&nbsp;Miriam I. Hehlmann ,&nbsp;Anne-Katharina Deisenhofer ,&nbsp;Julian A. Rubel ,&nbsp;Lea Fischer ,&nbsp;Wolfgang Lutz ,&nbsp;Henning Schöttke","doi":"10.1016/j.brat.2025.104689","DOIUrl":"10.1016/j.brat.2025.104689","url":null,"abstract":"<div><h3>Objective</h3><div>Therapists differ in their average treatment outcomes. However, it remains unclear which characteristics differentiate more from less effective therapists. This study examined the association between therapist interpersonal skills and treatment outcome as well as the moderating effect of initial impairment.</div></div><div><h3>Method</h3><div>Interpersonal skills were assessed with the Therapy-Related Interpersonal Behaviors (TRIB) scale, a group-discussion based rating system, in 99 incoming therapy trainees. The trainees treated <em>n</em> = 1031 outpatients with psychological therapies, whose treatment outcomes were assessed with the Symptom-Checklist 90 Revised (SCL-90-R). Linear mixed models were conducted to predict outcome by therapists’ interpersonal skills beyond initial impairment, number of sessions, therapist age, gender, and theoretical orientation. The moderating effect of initial impairment was calculated as cross-level interaction.</div></div><div><h3>Results</h3><div>The therapist effect (TE) in this sample was 5.6%. Interpersonal skills were a significant predictor of outcome (<em>b</em> = −0.124, <em>p</em> &lt; .001) and explained 1.3% of variance beyond all control variables. The TE in the final model was <em>VPC</em> = .036 indicating that 26.79% of the TE were attributable to interpersonal skills. The impairment–skills interaction was significant (<em>b</em> = −0.172, <em>p</em> &lt; .001). The effect of interpersonal skills on outcome increased with more severe initial impairment. Results were replicated in a second outcome measure (Outcome Questionnaire 30).</div></div><div><h3>Conclusions</h3><div>Interpersonal skills were found to be important characteristics to differentiate between more and less effective therapists, especially when treating severely distressed patients. Considering them in therapist selection and matching, outcome prediction, and clinical training could improve the effectiveness of psychological therapies.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104689"},"PeriodicalIF":4.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What makes a trauma ‘pathological’? – Perceived peritraumatic threat influences the development of intrusive memories","authors":"Philipp Herzog ,&nbsp;Hannah Willems ,&nbsp;Janine Wirkner ,&nbsp;Tobias Kube ,&nbsp;Edgar Nazarenus ,&nbsp;Julia A. Glombiewski ,&nbsp;Eva-Lotta Brakemeier ,&nbsp;Richard J. McNally ,&nbsp;Jan Richter","doi":"10.1016/j.brat.2025.104690","DOIUrl":"10.1016/j.brat.2025.104690","url":null,"abstract":"<div><div>Intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD). While dysfunctional cognitions are known posttraumatic contributors, peritraumatic processes are less understood. Perceived threat, alongside emotional factors, is theorized as significant, but experimental studies are lacking. Using the trauma film paradigm (TFP), we investigated peritraumatic threat's impact on intrusion development. Healthy participants (<em>N</em> = 93) viewed different distressing film clips (low, medium, high threat). Differences among the experimental groups were examined in the frequency and distress of intrusive memories, as well as distress and expectations. As hypothesized, the frequency of intrusive memories increased with increasing threat load, as did the distress and expectations related to intrusions. Fear elicited by film clips did not mediate this effect. Perceived threat is a crucial peritraumatic factor in intrusive memory formation, suggesting that a trauma perceived as highly threatening increases intrusion likelihood. Understanding traumatic factors influencing posttraumatic symptoms helps in targeting preventive interventions.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104690"},"PeriodicalIF":4.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost of fear: Impairments of decision-making in specific phobia","authors":"Ulrike Senftleben ,&nbsp;Esther Seidl ,&nbsp;Lieselotte Leonhardt ,&nbsp;Kevin Hilbert ,&nbsp;Stefan Scherbaum ,&nbsp;Markus Muehlhan ,&nbsp;Katja Beesdo-Baum ,&nbsp;Judith Schäfer","doi":"10.1016/j.brat.2025.104688","DOIUrl":"10.1016/j.brat.2025.104688","url":null,"abstract":"<div><h3>Background</h3><div>Decision-making processes may play a pivotal role in the etiology and maintenance of specific phobia. However, empirical evidence is limited. This study examined whether decision-making is only impaired in presence of fear-related stimuli or whether general impairments exist but are more pronounced in the presence of fear-related stimuli. Further, we examine which components of the decision-making process might be impaired.</div></div><div><h3>Methods</h3><div>We examined a spider phobia group (SP, n = 109) relative to matched healthy controls (HC, n = 81) using a virtual decision game. To tap the approach-avoidance-conflict, either a fear-related version (using spiders) or a non-phobic version of the task was used in a between-subjects design to measure how the presence of fear-related or non-phobic stimuli was associated with optimal decision-making (collecting rewards). Based on drift diffusion modelling, underlying decision-making processes such as processing ability and cautiousness were investigated.</div></div><div><h3>Results</h3><div>No clear evidence for general impairments of decision-making for SP participants relative to HC in the absence of fear-related stimuli was found, but a strong phobia-specific impairment when fear-related stimuli were present. These avoidant decisions were associated with a reduced ability to process the optimal choice option and increased cautiousness in the SP group.</div></div><div><h3>Conclusions</h3><div>Decision-making processes in specific phobia are specifically impaired in the presence of fear-related stimuli, which might contribute to maladaptive, costly avoidance behavior.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104688"},"PeriodicalIF":4.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downstream effects of observational threat learning: Generalization and reversal learning across development","authors":"Oded Cohen ,&nbsp;Yael Skversky-Blocq ,&nbsp;Madeleine Mueller ,&nbsp;Jan Haaker ,&nbsp;Tomer Shechner","doi":"10.1016/j.brat.2024.104670","DOIUrl":"10.1016/j.brat.2024.104670","url":null,"abstract":"<div><div>Observational threat learning is a complex social learning process through which typical and atypical fears develop. While studies have demonstrated the effectiveness of observational learning for the acquisition and extinction of threat, the intricacies of this learning process and how it varies across development have been less explored. To this end, we examined the extent to which children, adolescents, and adults generalized threat responses following observational threat learning. We also tested the capacity for reversal acquisition of these threat associations, again through observation. Participants (<em>n</em> = 159) from three age groups underwent four consecutive learning phases: observational threat acquisition, direct generalization, observational reversal threat acquisition, and a direct reversal test. Threat responses were measured using psychophysiological and subjective indices. Results indicated that following successful observational threat learning, children, adults, and adolescents experienced threat generalization. Developmental differences emerged for reversal threat acquisition, with adolescents demonstrating poorer learning than children and adults. The study expands current knowledge on how observational threat learning is used in changing circumstances and how it unfolds across development.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104670"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873181","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":"Optimizing in vivo exposure using occasional reinforced extinction with aversive imagery in spider fearful individuals","authors":"Dorothee Scheuermann ,&nbsp;Christiane A. Melzig ,&nbsp;Christoph Benke","doi":"10.1016/j.brat.2024.104671","DOIUrl":"10.1016/j.brat.2024.104671","url":null,"abstract":"<div><div>Although exposure-based therapy is widely recognized as effective for treating various anxiety disorders, a significant proportion of patients fail to benefit or experience a return of fear following successful treatment. One promising strategy involves occasional presentation of fear-evoking stimuli during extinction (occasional reinforced extinction, ORE). This study investigates a novel approach to translate ORE into clinical practice by incorporating occasional vivid imagery of individuals' worst-case fear scenarios during in-vivo exposure. Forty-seven spider-fearful individuals were randomly assigned to receive either a one-session in-vivo standard exposure treatment (Exp-Only) or an one-session in-vivo exposure treatment supplemented with occasional mental imagery of their worst-case spider scenario (Exp + ORE). Fear of spider questionnaires and a generalization behavioral approach test were administered prior to and one week after treatment. Both groups showed improvement from baseline to post-assessment, but the Exp + ORE group demonstrated significantly greater reductions in self-reported fear and avoidance of spiders compared to standard exposure training. During the generalization behavioral approach test, subjective distress and approach behavior toward the spider significantly improved from baseline to post-assessment in all participants, with no discernible group differences. Findings moreover indicate that occasional imagery during exposure lead to greater expectancy violation compared to standard exposure, providing insights into potential underlying mechanisms of the ORE approach. Incorporating mental imagery into the occasional reinforced extinction approach could hold promise for enhancing the efficacy of exposure-based treatments for anxiety disorders in clinical settings.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104671"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prosody-focused feedback enhances the efficacy of anti-depressive self-statements in depressed individuals – A randomized controlled trial","authors":"Jonathan F. Bauer ,&nbsp;Lena Schindler-Gmelch ,&nbsp;Maurice Gerczuk ,&nbsp;Björn Schuller ,&nbsp;Matthias Berking","doi":"10.1016/j.brat.2024.104667","DOIUrl":"10.1016/j.brat.2024.104667","url":null,"abstract":"<div><div>This study was aimed to evaluate whether the efficacy of invoking anti-depressive self-statements to cope with depressed mood can be enhanced for depressed individuals by systematically guiding them to amplify the expression of conviction in their voice. Accordingly, we recruited <em>N</em> = 144 participants (48 clinically depressed individuals, 48 sub-clinically depressed individuals, and 48 non-depressed individuals). Participants were randomly assigned to an experimental or control condition. Across study conditions, participants completed a mood induction procedure, then read aloud scripted anti-depressive self-statements designed to reduce depressed mood. Participants in the experimental condition received instructions to heighten the prosodic expression of conviction in their voice; participants in the control condition received no prosodic expression instructions. Results showed that depressed participants achieved a more pronounced decrease of depressed mood in the experimental condition than in the control condition. Further, the results indicated no effects in sub-clinically depressed and non-depressed individuals. Finally, heightened conviction expressed by participants in the experimental condition was associated with lower depressed mood and diminished depressive symptom severity. Overall, our findings suggest that fostering the prosodic expression of conviction in depressed persons’ voices, while they vocalize anti-depressive self-statements, represents a promising method for augmenting the efficacy of cognitive interventions for depression.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104667"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing an extended process model of emotion regulation in PTSD","authors":"Hope O'Brien ,&nbsp;Kim Felmingham ,&nbsp;Winnie Lau ,&nbsp;Meaghan O'Donnell","doi":"10.1016/j.brat.2024.104668","DOIUrl":"10.1016/j.brat.2024.104668","url":null,"abstract":"<div><div>Emotion regulation is a topic of growing interest in the field of post-traumatic stress disorder (PTSD). Despite the field's concentrated efforts in this area, the research has not matched advancements in the general emotion regulation literature, which have proposed more holistic models to understanding to how individuals identify and respond to emotions. In looking at emotion regulation in PTSD, this paper reviews the current state of the literature using the Extended Process Model proposed by Gross (2015). Considering emotion perception, beliefs, emotion regulation strategies (in terms of choice, flexibility of use, and repertoire of strategies available), and tactics, it discusses how these constructs help us understand the pathogenesis of PTSD and identifies areas in need of further research, including assessing the role of culture and improving measurement of emotion regulation constructs. Clinical implications of the emotion regulation literature for PTSD treatment are discussed.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104668"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}