Behaviour Research and Therapy最新文献

{"title":"Supporting parents to reduce children's anxiety: A meta-analysis of interventions and their theoretical components","authors":"Karen Rienks ,&nbsp;Elske Salemink ,&nbsp;Liina Björg Laas Sigurðardóttir ,&nbsp;G.J. Melendez-Torres ,&nbsp;Janneke P.C. Staaks ,&nbsp;Patty Leijten","doi":"10.1016/j.brat.2025.104692","DOIUrl":"10.1016/j.brat.2025.104692","url":null,"abstract":"<div><div>Parent-focused interventions hold promise for reducing child anxiety, but their content varies greatly, and little is known on the intervention content. We estimated the effects of parent-focused interventions on child anxiety and the most effective combinations of theoretical components.</div><div>We searched PsycINFO, Medline, and Web of Science in October 2022 for randomized trials on parent-focused interventions to reduce children's anxiety. We used robust variance estimation to estimate main effects and differential effects by individual theoretical components, and network meta-analysis to estimate the effects of clusters of components (preregistration: PROSPERO CRD42022362983).</div><div>We identified 26 studies (<em>k</em> = 157, <em>N</em> = 4098). Parent-focused interventions had a significant medium effect on children's anxiety (<em>d</em> = −0.59; 95% CI [−0.92, −0.26]). Interventions used seven theoretically distinct components. No significant differential effects were found, but all clusters of components that produced significant effects contained a behavioral component. Adding cognitive and emotional components to behavioral components seemed beneficial.</div><div>This meta-analysis highlights the potential of parent-focused interventions for children's anxiety, and of behavioral components in particular, but is limited by the very low certainty of evidence. More high-quality research is needed to understand the exact potential of parent-focused interventions on children's anxiety, and their most effective components.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104692"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029500","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":"Mediators and Moderators of two online interventions for managing pain, fear of progression and functional ability in rheumatoid arthritis","authors":"Louise Sharpe ,&nbsp;Rachel E. Menzies ,&nbsp;Jack Boyse ,&nbsp;Madelyne A. Bisby ,&nbsp;Bethany Richmond ,&nbsp;Jemma Todd ,&nbsp;Amy-Lee Sesel ,&nbsp;Blake F. Dear","doi":"10.1016/j.brat.2024.104676","DOIUrl":"10.1016/j.brat.2024.104676","url":null,"abstract":"<div><div>This is a secondary analysis of a trial comparing online mindfulness-based stress reduction with cognitive-behaviour therapy for people with rheumatoid arthritis. Both interventions were administered over eight weeks with five lessons and accompanied by weekly therapist contact. For the purposes of this study, we investigated the pain severity, fear of progression and functional ability as the outcome variables because the treatments had differential effects on these three outcomes but had equivalent effects on other variables. We examined mediators and moderators of relative treatment efficacy of mindfulness based stress reduction (n = 91) versus cognitive-behaviour therapy (n = 103) for these outcomes. For pain severity, no significant mediators or moderators were identified. However, amongst those with low pain severity, mindfulness-based stress reduction was more efficacious than cognitive-behaviour therapy for fears of progression. Furthermore, mindfulness-based stress reduction was more efficacious than cognitive-behaviour therapy for functional ability for those with high trait mindfulness at baseline. Changes in fear of progression during treatment fully mediated the effect of treatment group on functional ability over follow-up. While both online mindfulness-based stress reduction and cognitive-behaviour therapy were efficacious for people with rheumatoid arthritis, mindfulness-based stress reduction was more effective in reducing fears of progression and improving functional ability for those with low levels of pain severity and high levels of mindfulness at baseline, respectively. These results highlight the importance of treating fear of progression for people with rheumatoid arthritis as reductions in fears of progression over treatment led to improvements in functional ability six months later.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104676"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916018","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":"Efficacy and working mechanisms of a Go/No-Go task-based inhibition training in smoking: A randomized-controlled trial","authors":"Franziska Motka ,&nbsp;Charlotte E. Wittekind ,&nbsp;Leonie Ascone ,&nbsp;Simone Kühn","doi":"10.1016/j.brat.2024.104672","DOIUrl":"10.1016/j.brat.2024.104672","url":null,"abstract":"<div><h3>Objective</h3><div>Deficits in inhibitory control contribute to smoking behavior. Inhibitory control training (ICT), which involves repeatedly inhibiting responses to general or substance-related stimuli, shows promise in reducing problematic substance use. This preregistered randomized-controlled trial is the first to investigate the efficacy of general and smoking-specific Go/No-Go task-based ICT on smoking behavior compared to control groups receiving no ICT. Three potential working mechanisms were examined: inhibitory enhancement, automatic stimulus-stop associations, and stimulus devaluation.</div></div><div><h3>Method</h3><div>Individuals who smoke (<em>N</em> = 122) were randomly assigned to complete 28 sessions of smoking-specific Go/No-Go, general Go/No-Go, Sham training, or to a Waitlist control condition. Clinical outcomes included daily cigarettes (primary outcome), carbon monoxide levels, tobacco dependence severity, and craving, assessed at post-intervention and 3-month follow-up.</div></div><div><h3>Results</h3><div>Go/No-Go training resulted in a significantly greater reduction in tobacco dependence (<em>β</em> = −0.88, <em>p</em> = .004) and craving (<em>β</em> = −4.31, <em>p</em> = .012) post-intervention compared to both control groups. The greater reduction in craving remained significant when compared to the Sham training group only (<em>β</em> = −4.64, <em>p</em> = .026). No significant effects of group were observed on daily cigarette consumption (<em>β</em> = −1.97, <em>p</em> = .093) or carbon monoxide levels (<em>β</em> = 2.16, <em>p</em> = .818) post-intervention. At the 3-month follow-up, no significant effects of group emerged (all <em>p</em>s &gt; .794). Smoking-specific Go/No-Go training did not outperform general Go/No-Go training (all <em>p</em>s &gt; .075). No working mechanism for clinical outcome improvements was identified.</div></div><div><h3>Conclusions</h3><div>Preliminary evidence suggests that (smoking-specific) GNG training reduces tobacco dependence severity and craving post-intervention in individuals who smoke compared to non-ICT-based control conditions. Its efficacy as an add-on in smoking cessation needs to be investigated.</div></div><div><h3>Clinical trial registration number</h3><div>DRKS00014652.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104672"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903965","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":"Diverging paths: Modeling the relation between adverse effects, attitudes, perceived adherence, and treatment effect in an internet-based cognitive-behavioral intervention for obsessive-compulsive disorder","authors":"Anna Baumeister ,&nbsp;Lea Schuurmans ,&nbsp;Josephine Schultz ,&nbsp;Johanna Schröder ,&nbsp;Steffen Moritz ,&nbsp;Lena Jelinek","doi":"10.1016/j.brat.2024.104673","DOIUrl":"10.1016/j.brat.2024.104673","url":null,"abstract":"<div><h3>Background and aim</h3><div>The efficacy of internet-based interventions (IBI) for various psychiatric disorders is widely established, but little is known about the mechanisms or possible influencing factors. One of the most prominent problems in IBI is low adherence, but the relationship between adherence and level of improvement is still unclear. Patients’ attitudes and beliefs about IBI as well as the experience of adverse effects—another widely neglected topic—may also influence the effectiveness of these interventions. This secondary analysis is aimed at investigating the relationship between adverse effects, attitudes, perceived adherence (i.e., patient's impression of their compliance), and treatment effect in an IBI for obsessive-compulsive disorder (OCD).</div></div><div><h3>Methods</h3><div>Participants were 151 individuals with symptoms of OCD, of which 59.96% (<em>n</em> = 90) took part in the post-assessment. Attitudes toward IBI were assessed before they used an IBI for OCD; subjective adherence perception and experience of negative effects were assessed afterward. OCD symptom severity was evaluated at two time points, the difference score defining the treatment effect. A path analysis was conducted to test the hypothesized model. Objective and subjective adherence measures were correlated exploratively.</div></div><div><h3>Results</h3><div>The path analysis revealed that attitude toward IBI and adverse effects were negatively associated with adherence perception but adherence perception was not associated with the treatment effect. Objective and subjective adherence measures did not correlate.</div></div><div><h3>Conclusion</h3><div>The results did not support the hypothesized model. Since both attitudes toward IBI and adverse effects were negatively associated with adherence perception, managing users’ expectations clearly before using IBI might improve adherence. The role of adherence perception on the treatment effect is yet to be clarified.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104673"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878254","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":"Using network analysis to characterize clinical improvement during cognitive processing therapy","authors":"Ante J. Schlesselmann ,&nbsp;Richard J. McNally ,&nbsp;Philip Held","doi":"10.1016/j.brat.2024.104678","DOIUrl":"10.1016/j.brat.2024.104678","url":null,"abstract":"<div><h3>Objective</h3><div>Cross-sectional network studies find mixed results regarding changes in network structure as a response to treatment across disorders. This study characterized improvement in mental health following Cognitive Processing Therapy (CPT) for PTSD in veterans from the perspective of network psychometrics and explored how cross-sectional networks inform our understanding of PTSD recovery.</div></div><div><h3>Methods</h3><div>Veterans with PTSD participated in CPT-based intensive treatment programs (ITPs), offered in two-week (N = 635) or three-week (N = 457) formats. PTSD symptoms were self-reported on the PTSD Checklist for DSM-5 (PCL-5) at pre-, mid-, and post-treatment. Cross-sectional networks for each time point were compared using network comparison tests. Linear regression tested if the relationship of initial treatment gains from admission to mid-treatment with overall outcomes was associated with the expected influence centrality of a node.</div></div><div><h3>Results</h3><div>Substantial improvement in PTSD symptoms were found, but network structure remained largely unaffected, with global edge strength increasing from pre-to post-treatment. Initial treatment gains in nodes with high expected influence were associated with overall treatment outcomes. A post-hoc simulation based on a common-cause model produced similar regression results, indicating that while our findings align with spreading activation, they are not exclusive to this mechanism.</div></div><div><h3>Conclusion</h3><div>The indiscernibility of cross-sectional networks between pre- and post-treatment raises questions about whether cross-sectional networks can illuminate PTSD recovery beyond traditional measures of treatment response.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104678"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972812","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":"Return of negative interpretation bias after positive interpretation training as a dynamic predictor of treatment outcome in fear of public speaking","authors":"Vera Bouwman ,&nbsp;Lynn Mobach ,&nbsp;Bethany A. Teachman ,&nbsp;Elske Salemink","doi":"10.1016/j.brat.2025.104685","DOIUrl":"10.1016/j.brat.2025.104685","url":null,"abstract":"<div><div>Despite various efforts in the field, no consistent predictors of treatment outcome in anxiety disorders have been identified. Based on the Dynamic System Theory, this study proposes a novel, dynamic predictor of treatment outcome in those with public speaking anxiety. It was assessed whether speed of return to one's interpretation bias equilibrium after an experimentally-induced perturbation (i.e., interpretation training targeting negative interpretation bias as a critical maintaining factor for anxiety) predicts subsequent outcome to online exposure treatment. Women with subclinical public speaking anxiety (<em>N</em> = 100, <em>M</em> age = 23.13, <em>SD</em> = 3.89) were randomly allocated to a positive interpretation training (<em>n</em> = 50) or a neutral interpretation training (<em>n</em> = 50). Dynamic changes in negative interpretations were measured using Experience Sampling Method. Later, participants followed an online one-session exposure therapy for public speaking anxiety. Positive interpretation training resulted in a stronger reduction in negative interpretations compared to the neutral interpretation training. Fear of public speaking decreased from before to after the exposure therapy. Consistent with our central hypothesis, results showed that slower return to one's interpretation bias equilibrium after the positive interpretation training was associated with a greater decline in fear of public speaking after exposure treatment. These results show the potential of a dynamic approach in predicting treatment outcome in public speaking anxiety. This study contributes to the field of clinical psychology, as finding more reliable predictors of treatment outcome before the start of therapy could contribute to the efficiency of care delivery.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"185 ","pages":"Article 104685"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972810","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":"Psychotherapy process variables in implementation of CBT for inflammatory bowel disease:Therapist competence, fidelity, and patient themes","authors":"Melissa Hunt,&nbsp;Chung Sang Tse,&nbsp;Lily Suh,&nbsp;Ella Yang,&nbsp;Camillia Bui,&nbsp;Alana Davis,&nbsp;Ray Siddiqi,&nbsp;Venus Tian","doi":"10.1016/j.brat.2025.104702","DOIUrl":"10.1016/j.brat.2025.104702","url":null,"abstract":"<div><h3>Objective</h3><div>Inflammatory Bowel Diseases (IBD) are a group of chronic immune-mediated digestive disorders that can cause significant psychological distress and disability. IBD-informed cognitive behavioral therapy (CBT) may reduce psychiatric co-morbidity and improve health related quality of life. We herein examine the psychotherapy process variables relevant to implementation of a manualized CBT for IBD protocol delivered by therapists with no prior knowledge of IBD.</div></div><div><h3>Method</h3><div>In the ADEPT Trial (<em>Addressing Disability Effectively with Psychosocial Telemedicine</em> - NCT05635292), 30 patients with IBD received up to 8 sessions of manualized CBT for IBD delivered via telehealth by one of 5 licensed PhD level clinical psychologists skilled in CBT but naïve to IBD prior to the study. All treating psychologists received training in IBD-informed CBT. Videos of the CBT sessions were rated by trained raters for psychotherapy process variables including therapist competence, fidelity to the manual, therapeutic relationship, and the content of patient themes. We also evaluated the association between process variables and outcome, measured as reductions in the IBD-Disability Index.</div></div><div><h3>Results</h3><div>All general therapists were highly competent in delivering IBD-informed CBT after training and showed fidelity to the treatment manual. Fidelity to teaching deep diaphragmatic breathing was associated with greater reductions in disability. Patient themes were associated with baseline disability and outcome.</div></div><div><h3>Conclusions</h3><div>IBD-informed CBT can be delivered successfully by CBT therapists with no prior knowledge of IBD as a flexible modular therapy manual applied to a medically complex patient population.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"186 ","pages":"Article 104702"},"PeriodicalIF":4.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143204780","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":"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}