Behaviour Research and Therapy最新文献

{"title":"Mechanisms of change in cognitive functional therapy: A longitudinal mediation analysis of the RESTORE clinical trial for disabling chronic low back pain","authors":"Robert Schütze ,&nbsp;Bernard Liew ,&nbsp;J.P. Caneiro ,&nbsp;Peter O'Sullivan ,&nbsp;Peter Kent ,&nbsp;Mark Hancock ,&nbsp;Jan Hartvigsen ,&nbsp;Kieran O'Sullivan ,&nbsp;Alison McGregor ,&nbsp;Amity Campbell ,&nbsp;Stephanie Attwell ,&nbsp;Anne Smith","doi":"10.1016/j.brat.2025.104853","DOIUrl":"10.1016/j.brat.2025.104853","url":null,"abstract":"<div><div>Chronic low back pain (CLBP) is an urgent global health priority given its high prevalence and impact as the leading cause of disability. While several efficacious treatments exist, most have modest effects. Improving outcomes requires a better understanding of treatment mechanisms to enable optimisation. This study explored the mechanisms of cognitive functional therapy (CFT), a biopsychosocial intervention with large, durable effects for adults with disabling CLBP. A longitudinal mediation analysis was performed on data from the RESTORE multisite clinical trial comparing CFT (<em>n</em> = 327) to usual care (<em>n</em> = 165). Mediators (self-efficacy, fear, catastrophising, and pain intensity) were specified based on behavioural theories underlying CFT and previous research. The joint mediation of treatment effects on disability (Roland Morris Disability Questionnaire) and pain intensity (numerical rating scale), were examined using a counterfactual framework for mediation analysis. As hypothesised, earlier changes in self-efficacy, fear, catastrophising, and pain intensity mediated improvements in disability at the end of treatment and at 12-month follow-up, explaining up to 61 % of the effect. Similarly, self-efficacy, fear, and catastrophising mediated the effect of CFT on pain intensity, explaining up to 62 % of the effect. Results are consistent with previous CLBP mediation research highlighting self-efficacy, fear, and catastrophising as likely common mechanisms among effective biopsychosocial treatments. CFT demonstrates large, durable, and clinically important effects on these mechanisms. Findings shed light for clinicians and researchers on how CFT works, although the role of other mechanisms such as movement changes requires further exploration, along with research analysing how different treatment components activate these mechanisms.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104853"},"PeriodicalIF":4.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009546","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":"A multilevel machine learning algorithm to predict session-by-session outcome for patients receiving cognitive-behavioural therapy","authors":"Juan Martín Gómez Penedo ,&nbsp;Alice E. Coyne ,&nbsp;Manuel Meglio ,&nbsp;Marjolein Fokkema ,&nbsp;Rebekka Wassmann ,&nbsp;Wolfgang Lutz ,&nbsp;Julian Rubel","doi":"10.1016/j.brat.2025.104848","DOIUrl":"10.1016/j.brat.2025.104848","url":null,"abstract":"<div><h3>Aims</h3><div>New innovations in predictive models, such as machine learning, could enhance the effectiveness of measurement-based care systems by generating more accurate session-by-session psychotherapy outcome predictions. In this study, we developed a tree-based model that integrates the strengths of multilevel and machine learning models to predict patients’ trajectories of clinical improvement during cognitive-behavioural therapy (CBT).</div></div><div><h3>Methods</h3><div>We used a sample of 1008 outpatients who were treated at a CBT university clinic in Germany. The total sample was randomly divided into a training (2/3 of the sample) and a test (remaining 1/3) set. Grounded on patient demographic and clinical information at baseline, we developed a generalized linear mixed model tree algorithm to predict patients' session-by-session outcome change during the first ten sessions. <strong>Results</strong>: The best-fitting model in the training set identified 10 groups of patients based on their presenting characteristics and improvement trajectories. In the test set, the algorithm resulted in a correlation of 0.65 between the observed and predicted values for the outcome variable (cross-validation <em>R</em>² = 0.42). Developing failure boundaries based on the tree-based approach allowed us to correctly identify 67.6 % of the test set patients who did not reliably improve within the first 15 sessions of treatment. <strong>Discussion</strong>: This study provides preliminary support for the integration of multilevel and machine learning models via generalized linear mixed model trees. The algorithms developed could help support routine implementation of precision mental health care strategies by informing therapists’ treatment planning and session-by-session responsiveness for different patient subgroups.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104848"},"PeriodicalIF":4.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049346","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":"Corrigendum to \"Intolerance of uncertainty enhances adolescent fear generalization in both perceptual-based and category-based tasks: fNIRS studies\" [Behaviour Research and Therapy 183 (2024) 104650].","authors":"Xiao Zhou, Lihui Huang, Benjamin Becker, Haoran Dou, Jinxia Wang, Xukai Zhang, Ying Mei, Hong Li, Yi Lei","doi":"10.1016/j.brat.2025.104811","DOIUrl":"10.1016/j.brat.2025.104811","url":null,"abstract":"","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":" ","pages":"104811"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565415","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":"Introduction to special issue honoring Dianne L. Chambless (1948-2023).","authors":"Alyson K Zalta, Thomas Rodebaugh, Jedidiah Siev","doi":"10.1016/j.brat.2025.104822","DOIUrl":"10.1016/j.brat.2025.104822","url":null,"abstract":"","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":" ","pages":"104822"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620912","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":"Identifying the active ingredients of cognitive-behavioural therapy: Conceptualisation, methods and evidence.","authors":"Edward R Watkins","doi":"10.1016/j.brat.2025.104802","DOIUrl":"10.1016/j.brat.2025.104802","url":null,"abstract":"","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":" ","pages":"104802"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295144","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":"Extinction learning and return of fear in a large sample of children and adolescents with and without anxiety disorders","authors":"Tabea Flasinski ,&nbsp;Silvia Schneider ,&nbsp;Verena Pflug ,&nbsp;Michael W. Lippert ,&nbsp;Jürgen Margraf ,&nbsp;Hanna Christiansen ,&nbsp;Alfons O. Hamm ,&nbsp;Tina In-Albon ,&nbsp;Susanne Knappe ,&nbsp;Jan Richter ,&nbsp;Marcel Romanos ,&nbsp;Brunna Tuschen-Caffier ,&nbsp;Dirk Adolph","doi":"10.1016/j.brat.2025.104850","DOIUrl":"10.1016/j.brat.2025.104850","url":null,"abstract":"<div><div>Anxiety disorders are the most prevalent mental health problems in childhood and adolescence, highlighting the importance to study their underlying mechanisms. One key process in fear reduction, particularly in exposure-based cognitive behavioral therapy, is extinction learning. While extensively studied in adults, its role in youth remains underexplored. The aim of the present study was to examine fear extinction learning and return of fear in a large sample of children and adolescents (<em>N</em> = 274; age range 8–16 years, <em>M</em> = 11.07, <em>SD</em> = 2.22; 55.8 % female) with separation anxiety disorder, social anxiety disorder, and specific phobia (<em>n</em> = 217) in comparison to non-anxious controls (<em>n</em> = 57). All children participated in a 2-day fear conditioning paradigm. Fear acquisition, extinction, and reinstatement were assessed using subjective (valence, arousal, contingency) and psychophysiological (startle) indicators of emotional reactivity. Successful differential fear acquisition could be observed in both groups. Extinction learning was also successful as the fear response to the CS+ decreased. Contradicting previous findings suggesting impairment in extinction in children with anxiety disorders, we could not find differences in fear extinction learning between anxious and non-anxious children and adolescents; both groups learned to inhibit their fear response when the CS+ no longer predicted the occurrence of the aversive outcome. Further research is needed to disentangle the role of fear extinction learning within childhood anxiety disorders and determine whether children with anxiety disorders generally do not show deficits in extinction learning or whether this deficit is limited to disorder specific stimuli.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104850"},"PeriodicalIF":4.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932026","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":"A pilot randomized controlled trial of cognitive restructuring for PTSD and alcohol misuse following recent sexual assault: Initial efficacy and feasibility","authors":"Michele A. Bedard-Gilligan ,&nbsp;Cynthia A. Stappenbeck ,&nbsp;Heidi J. Ojalehto ,&nbsp;Emily R. Dworkin ,&nbsp;Jennifer M. Cadigan ,&nbsp;Tracy Simpson ,&nbsp;Debra L. Kaysen","doi":"10.1016/j.brat.2025.104847","DOIUrl":"10.1016/j.brat.2025.104847","url":null,"abstract":"<div><div>Sexual assault is a pervasive problem, particularly for US college women. Although many recover naturally, a significant minority develop posttraumatic stress disorder (PTSD) or alcohol misuse. Intervening acutely can prevent chronic psychopathology from developing. This study tested the efficacy of a newly developed one-session + four coaching call intervention (BRITE) adapted from Cognitive Processing Therapy (CPT), an evidence-based treatment for chronic PTSD. Individuals over 18, who identified as female, with symptoms of PTSD and alcohol misuse were recruited within 10 weeks of sexual assault for a RCT comparing BRITE to symptom monitoring. Participants (<em>N</em> = 57) were young (<em>M</em> = 21.63 years) and predominately White (61.4 %). PTSD and alcohol use were assessed at baseline, weekly for 5 weeks, and at 3-month follow-up by masked evaluators. Participants assigned to BRITE reported significantly less PTSD symptoms (<em>d</em> = 2.69; 95 % CI: 1.92, 3.45) than symptom monitoring (<em>d</em> = 1.19; 95 % CI: 0.59, 1.79), when comparing baseline vs. 3-month follow-up. For alcohol misuse, participants reported fewer drinks per drinking day from baseline to 3-month follow-up in BRITE (<em>d</em> = 0.63 (95 % CI: 0.05, 1.20) and symptom monitoring (<em>d</em> = 0.13; 95 % CI: −0.42, 0.69) although the group difference was not significant. There was a similar pattern for other alcohol use outcomes (i.e., heavy episodic drinking frequency, alcohol use consequences). Pilot findings support this newly developed, brief, and accessible cognitive approach for promoting acute recovery with a vulnerable population.</div></div><div><h3>Clinical trials registration</h3><div>NCT02808468.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104847"},"PeriodicalIF":4.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018761","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":"The effect of behavioral rehearsal in the training of clinical psychology students in cognitive therapy for social anxiety disorder: A randomized controlled trial","authors":"Jon Fauskanger Bjaastad ,&nbsp;Kjersti Lillevoll ,&nbsp;Asle Hoffart ,&nbsp;Toril Sørheim Nilsen ,&nbsp;Jane Kjoteroe ,&nbsp;Peter Prescott ,&nbsp;Jan Ivar Røssberg ,&nbsp;David M. Clark ,&nbsp;Kitty Dahl ,&nbsp;Catharina Elisabeth Arfwedson Wang ,&nbsp;Veronica Lorentzen","doi":"10.1016/j.brat.2025.104849","DOIUrl":"10.1016/j.brat.2025.104849","url":null,"abstract":"<div><h3>Objective</h3><div>The present study investigated the effects of including behavioural rehearsal (i.e., expert demonstration followed by role-playing treatment components) in the training of clinical psychology students in cognitive therapy for social anxiety disorder.</div></div><div><h3>Method</h3><div>A randomized controlled design was used where fifth year clinical psychology students (<em>N</em> = 94, <em>M age =</em> 26.2 years, <em>SD =</em> 3.81) were randomized to behavioural rehearsal or a bona fide control training condition (expert demonstration and discussions), as part of a 16-h training course in cognitive therapy for social anxiety disorders. Videotapes (<em>N</em> = 94) of participants role-playing therapists after training were rated for therapist competence (primary outcome measured by three competence variables) by raters who were unaware of the training condition allocation. Secondary outcomes (therapists’ self-efficacy, therapist worry levels and satisfaction with training) were collected by self-report at post-training and at 6-month follow-up.</div></div><div><h3>Results</h3><div>Participants in the behavioural rehearsal condition achieved higher competence scores compared to the control condition. Differences between groups were found for all three competence variables, with large effect sizes (<em>d</em> = 1.23–1.40, 95 % CI [.78, 1.85]). Large between-group effect sizes were also found for all individual items of competence (<em>d</em> = .80–1.22, 95 % CI [.38, 1.66]). No effects were found for secondary outcomes.</div></div><div><h3>Conclusions</h3><div>The results suggest that inclusion of behavioural rehearsal in training leads to higher competence among clinical psychology students when delivering cognitive therapy for social anxiety disorder. Training providers should consider incorporating behavioural rehearsal in cognitive therapy training.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104849"},"PeriodicalIF":4.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932027","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":"Unpaired unconditional stimuli during fear extinction at full and reduced intensity reduce re-acquisition","authors":"Ottmar V. Lipp ,&nbsp;Luke J. Ney ,&nbsp;Camilla C. Luck ,&nbsp;Allison M. Waters ,&nbsp;Michelle G. Craske","doi":"10.1016/j.brat.2025.104846","DOIUrl":"10.1016/j.brat.2025.104846","url":null,"abstract":"<div><div>Presenting unpaired unconditional stimuli (US) during extinction has been shown to reduce the contextual renewal of conditional fear and to slow re-acquisition. The present study investigated whether this reduced return of fear is also observed if the intensity of the US presented during extinction is lower than that presented during acquisition. Three groups of participants (N = 121) were trained in a differential fear conditioning procedure that employed habituation, acquisition, extinction, renewal test, and re-acquisition phases. To induce renewal, the context was changed during extinction training in an ABA design. Group Standard received no US presentations during extinction training whereas group Unpaired received five unpaired USs during extinction at the physical intensity used during acquisition. The intensity of the unpaired USs was halved in group Reduced. Electrodermal responses in the three groups did not differ during habituation, acquisition, extinction or the renewal test where no renewal was observed in any group. However, significant differential electrodermal responses were observed on the first block of re-acquisition training after standard extinction, but not after unpaired extinction regardless of US intensity. This suggests that unpaired US presentations can strengthen extinction learning even if presented at a reduced intensity. This finding opens the possibility of translating the unpaired US extinction approach into applied settings.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104846"},"PeriodicalIF":4.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912101","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":"Extinction, avoidance, and generalization: Fear learning processes and their relations with anxious and depressive traits","authors":"Lu Leng ,&nbsp;Tom Beckers ,&nbsp;Bram Vervliet","doi":"10.1016/j.brat.2025.104841","DOIUrl":"10.1016/j.brat.2025.104841","url":null,"abstract":"<div><div>Research shows anxious individuals exhibit slower extinction (EXT), more avoidance (AVO), and broader generalization (GEN) in Pavlovian fear conditioning, potentially contributing to maladaptive anxiety (chronic, avoidant, overgeneralized). However, studies typically focused on one of these processes, it remains unclear (1) whether the deficits in each process reflect separate or the same vulnerability factors; (2) whether deficits in any of these processes is more detrimental; (3) whether deficits in these processes cluster into distinct profiles that form an unique detrimental factor. Additionally, despite the high comorbidity rate with anxiety, the role of depression in these processes is surprisingly understudied. The current study tested EXT-AVO-GEN processes in the same individuals measuring both anxiety and depressive traits. To avoid the arbitrary selection of any indices for EXT-AVO-GEN processes, multiple index operationalizations were employed to ensure robust findings. Results showed small to no correlations, both among EXT-AVO-GEN processes and their correlations with personality characteristics. Cluster analysis identified no distinct profiles, and if such profiles were nonetheless forced to emerge, they were not associated with the anxious or depressive traits. According to these findings, EXT-AVO-GEN are likely to be independent processes and their deficits seem to have different underlying drivers. Therefore, studying EXT-AVO-GEN processes in combination may not offer additional comprehension about pathological fear development. Linear mixed-effects models, however, revealed stronger correlations between EXT-AVO-GEN and anxiety/depression, suggesting that they may be more sensitive in detecting individual differences compared to indices, as they capture trial-by-trial dynamics, which indices often fail to fully account for.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"193 ","pages":"Article 104841"},"PeriodicalIF":4.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906935","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}