Behaviour Research and Therapy最新文献

{"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}

{"title":"Global precedence effect in fear generalization and the role of trait anxiety and intolerance of uncertainty","authors":"Biao Feng ,&nbsp;Ling Zeng ,&nbsp;Zhihao Hu ,&nbsp;Xinyue Fan ,&nbsp;Xin Ai ,&nbsp;Fuwei Huang ,&nbsp;Xifu Zheng","doi":"10.1016/j.brat.2024.104669","DOIUrl":"10.1016/j.brat.2024.104669","url":null,"abstract":"<div><div>Fear overgeneralization is widely considered to be a core feature of pathological anxiety, and the excessive spread of fear can be a great burden on patients. Although perceptual processing is a basic process of human cognition, the impact of visual perception recognition on fear generalization has not yet been fully explored. In this study, 69 subjects were recruited to explore the effects of the hierarchical features of stimuli on fear generalization and examine the roles of trait anxiety (TA) and intolerance of uncertainty (IU) in this process. The results reveal that compared with the local features, the subjects showed stronger fear responses to global features of the stimuli, and the weakest fear response was to the reversed features. Furthermore, the results preliminarily suggest that in generalization dominated by global features, TA intensifies the fear response; while in generalization dominated by local features, along with TA, IU makes a unique contribution to increasing the magnitude of fear generalization. These results confirm new potential pathways for fear generalization, specifically the configurational hierarchical features of stimuli. This is explained through object recognition and cognitive bias, implying that cognitive processes and personality traits have interacting effects on fear generalization.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104669"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819862","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":"“It's safer to believe that others don't like me” – A qualitative study on the paradoxical value of negative core beliefs in depression","authors":"Tobias Kube ,&nbsp;Lisa Rauch","doi":"10.1016/j.brat.2024.104665","DOIUrl":"10.1016/j.brat.2024.104665","url":null,"abstract":"<div><div>Depression is related to difficulty revising established negative self-beliefs in response to novel positive experiences. This propensity is in some way paradoxical because negative beliefs usually have many obvious negative consequences for the individual (e.g., feeling upset). Using a qualitative approach, the present study sought to explore what makes such negative self-beliefs valuable from the patients’ perspectives. In 14 patients with major depression, we conducted semi-structured interviews that explored the perceived benefits of retaining an individually specified negative core belief as well as the perceived costs of changing it. In a deductive-inductive approach based on a recent theoretical model of the value of beliefs, we found eight themes that may explain why people with depression uphold negative beliefs (intercoder agreement: κ = .81): expectation management, certainty and control, avoiding cognitive dissonance, adaptivity in the past, protection of higher values, attachment and belonging, saving resources, short-term counterevidence. The two most frequently mentioned themes were that retaining negative beliefs helps patients sustain certainty and keep expectations low to prevent future disappointments. While previous research has advanced the understanding of <em>how</em> (i.e., through which mechanisms) people with depression maintain negative self-beliefs, the present study provides novel insights into <em>why</em> they do so.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104665"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792619","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":"Predictors of trauma-related diagnostic overshadowing bias","authors":"Katherine E. Wislocki,&nbsp;Alyson K. Zalta","doi":"10.1016/j.brat.2024.104651","DOIUrl":"10.1016/j.brat.2024.104651","url":null,"abstract":"<div><div>Diagnostic overshadowing occurs when healthcare professionals misattribute an individual's presenting symptoms to other features of an individual's clinical presentation. Mental health providers may incorrectly diagnose and treat trauma-exposed individuals due to trauma-related diagnostic overshadowing bias. No research has investigated provider factors associated with this bias. Mental health provider background and training characteristics were examined as predictors of trauma-related diagnostic overshadowing in a sample of mental health providers (<em>N</em> = 210). Hierarchical regression modeling was used to evaluate predictors related to trauma-related diagnostic overshadowing in diagnostic and treatment decision-making. Providers with diagnostic responsibilities in their professional role were significantly less likely to demonstrate bias in some diagnostic and treatment decisions. Older mental health providers and providers with more clients experiencing traumatic stress demonstrated greater bias in some diagnostic responses. Providers with doctoral degrees, compared to all other degree types, demonstrated less bias through some diagnostic and treatment responses. Bias in diagnostic decisions strongly predicted bias in treatment decision-making. Findings suggest that factors related to clinical experience may be important in predicting trauma-related diagnostic overshadowing. Future work should extend this research to understand which factors affect trauma-related diagnostic overshadowing in real-world settings.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"184 ","pages":"Article 104651"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865772","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}