Cognitive and Behavioral Practice最新文献

{"title":"A New Generation of Psychedelic-Assisted Psychotherapy: The Example of Combining MDMA With Trauma-Focused Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder","authors":"Barbara O. Rothbaum,&nbsp;Paula P. Schnurr","doi":"10.1016/j.cbpra.2025.05.001","DOIUrl":"10.1016/j.cbpra.2025.05.001","url":null,"abstract":"<div><div>Posttraumatic Stress Disorder (PTSD) is a treatable condition, with effective psychotherapies and medications offering a range of treatment options for patients. Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are recommended as first-line approaches. However, even the best treatments do not work well enough for everyone, indicating a need for enhanced treatment outcomes. While the evidence on how to achieve this remains limited and inconclusive, there is growing interest in exploring novel approaches. In this commentary we focus on how psychedelic substances, particularly MDMA (3,4-methylenedioxymethamphetamine), hold promise for enhancing PTSD mental health treatment outcomes, using MDMA (3,4-methylenedioxymethamphetamine)-assisted cognitive-behavioral therapy (CBT) for PTSD. Recent Phase 3 randomized controlled trials have demonstrated benefits of MDMA-assisted psychotherapy for PTSD, with high response and remission rates. However, challenges exist in implementing this approach due to its time-intensive nature and unique therapy protocol. Combining psychedelics with established trauma-focused psychotherapies presents an intriguing avenue for improving treatment outcomes. Psychedelics may work by enhancing connections and insights, facilitating emotional processing and adaptive coping mechanisms. By incorporating psychedelics into existing cognitive behavioral frameworks, such as prolonged exposure and cognitive processing therapy, it may be possible to achieve synergistic effects and enhance the efficiency of therapy delivery. In conclusion, the evidence supports psychedelic-assisted therapy as a viable option for PTSD treatment, particularly MDMA. Combining psychedelics with CBT holds promise for synergistic treatment effects, improved efficiency, and real-world implementation. Future research should explore various combinations of psychedelics with evidence-based treatments to optimize care for PTSD and other mental health disorders and provide patients with additional therapeutic options.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 393-396"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Study of the METEMP Protocol: Massed Exposure Therapy Enhanced With 3,4-Methylenedioxymethamphetamine (MDMA) for Posttraumatic Stress Disorder","authors":"Jessica L. Maples-Keller,&nbsp;Barbara O. Rothbaum","doi":"10.1016/j.cbpra.2025.02.001","DOIUrl":"10.1016/j.cbpra.2025.02.001","url":null,"abstract":"<div><div>This case study provides a detailed description of a participant in an open label clinical trial receiving the METEMP intervention, Massed Exposure Therapy Enhanced with 100 mg 3,4-methylenedioxymethamphetamine (MDMA) for posttraumatic stress disorder. After thorough medical and psychiatric screening to ensure eligibility and appropriateness for this treatment, two clinical psychologists treated a 57-year-old woman with PTSD over a 10-day treatment period. An independent rater not involved in treatment conducted a CAPS-5-R at baseline, 1 week, and 1 month following treatment as the primary outcome. Quantitative results suggest significant PTSD symptom reduction (pretreatment CAPS-5-R = 85, 1-week posttreatment = 1, 1-month posttreatment = 1). PCL-5 and PHQ-9 suggest significant decreases in self-reported PTSD (43 at pretreatment to 1 at 1-month posttreatment) and depression (10 at pretreatment to 0 at 1-month posttreatment). We provide specific details on this novel combined treatment and how PE was modified for MDMA administration. The treatment protocol appears feasible and will continue to be tested in this open label pilot trial before subsequent investigation in a randomized controlled trial.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 378-392"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charting a New Frontier: Integrating Cognitive Behavioral Therapy Approaches with 3,4-methylenedioxymethamphetamine","authors":"Leslie A. Morland,&nbsp;Kayla Knopp,&nbsp;Chandra Khalifian,&nbsp;Christopher S. Stauffer","doi":"10.1016/j.cbpra.2025.04.001","DOIUrl":"10.1016/j.cbpra.2025.04.001","url":null,"abstract":"<div><div>Clinical psychology has seen a resurgence of interest in the use of psychedelic-assisted therapy (PAT) for the treatment of a range of mental health diagnoses in the past several years. Although PAT research outcomes are promising, many questions remain unanswered, including identifying the most effective approaches to integrating psychedelics with existing cognitive behavioral therapies (CBTs) for different indications, populations, and settings. This special feature highlights cutting-edge research on the integration of psychedelics with several established CBTs, including Acceptance and Commitment Therapy, Prolonged Exposure, and Cognitive-Behavioral Conjoint Therapy. We focus primarily on 3,4-methylenedioxymethamphetamine (MDMA), an agent that has shown promise in having unique synergy with the psychotherapeutic mechanisms of change in many of our current CBT approaches. The authors aim to explore this potential synergy, including how psychedelics may enhance CBTs as well as the role of CBTs in facilitating the long-term integration of psychedelic-driven changes.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 315-320"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MDMA-Assisted Acceptance and Commitment Therapy for Posttraumatic Stress Disorder: Rationale for a New Approach","authors":"Matthew S. Herbert,&nbsp;Brian H. Blanco,&nbsp;Dimitri Perivoliotis,&nbsp;Jason Luoma,&nbsp;Gisele Fernandes-Osterhold,&nbsp;Andrew Bismark,&nbsp;Josh D. Woolley","doi":"10.1016/j.cbpra.2025.01.001","DOIUrl":"10.1016/j.cbpra.2025.01.001","url":null,"abstract":"<div><div>There is promise for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy as a highly effective and durable treatment for posttraumatic stress disorder (PTSD). However, the Food and Drug Administration rejected MDMA-assisted psychotherapy in its current form, expressing concerns about the lack of standardization and empirical basis of psychotherapy methods. This highlights the need to consider alternative psychotherapeutic approaches to integrate with MDMA for the treatment of PTSD. We propose that the evidence-based cognitive behavioral therapy, acceptance and commitment therapy (ACT), is particularly well-suited to be paired with the administration of MDMA for PTSD. Specifically: (1) the subjective effects of MDMA directly support key ACT processes; (2) ACT methods could help prepare patients for MDMA administration, increasingly the likelihood of efficacy and tolerability; (3) ACT provides a “process-directed” approach to assist the therapist and support the patient during MDMA administration sessions; and (4) ACT may help optimize the integration of MDMA experiences to shape adaptive functioning and promote quality of life following treatment. We provide examples of how ACT methods could be used for many of these goals. In sum, we believe ACT provides a highly scalable, structured yet flexible, evidence-based framework well-suited to be integrated with MDMA as a new treatment approach for PTSD.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 329-338"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Example of a Female Veteran Completing Brief Cognitive Behavioral Conjoint Therapy Augmented With 3,4-methylenedioxymethamphetamine (MDMA)","authors":"Leslie A. Morland,&nbsp;Kayla Knopp,&nbsp;Bettye Chargin,&nbsp;Tamara R. Wachsman,&nbsp;Chandra Khalifian,&nbsp;Dimitri Perivoliotis,&nbsp;Anne C. Wagner","doi":"10.1016/j.cbpra.2025.01.002","DOIUrl":"10.1016/j.cbpra.2025.01.002","url":null,"abstract":"<div><div>This case study highlights a female military veteran and her intimate partner who participated in an open label clinical trial receiving brief Cognitive-Behavioral Conjoint Therapy (bCBCT) enhanced with two 3,4-methylenedioxymethamphetamine (MDMA) sessions to treat posttraumatic stress disorder (PTSD) and relationship functioning. Both partners participated in therapy and only the veteran diagnosed with PTSD received MDMA. Results suggest significant PTSD symptom reduction for the veteran (pretreatment CAPS-5 severity = 51, immediate posttreatment CAPS-5 = 22, 3-months posttreatment CAPS-5 = 28, and 6-months posttreatment CAPS-5 = 21) and maintenance of high relationship satisfaction (pretreatment CSI-32 = 136, immediate post CSI-32 = 140, 3-months posttreatment CSI-32 = 137, and 6-months posttreatment CSI-32 = 129). This case illustrates a novel and scalable delivery of MDMA-assisted bCBCT using an outpatient model and highlights the importance of including loved ones, such as intimate partners, in MDMA treatment and integration.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 364-377"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MDMA-Assisted Group Therapy for PTSD: Development of a Novel Protocol","authors":"Christopher S. Stauffer,&nbsp;Philip Bouleh,&nbsp;Brian T. Anderson","doi":"10.1016/j.cbpra.2025.03.001","DOIUrl":"10.1016/j.cbpra.2025.03.001","url":null,"abstract":"<div><div>Posttraumatic stress disorder (PTSD) presents unique psychosocial challenges among veterans. Group therapy is used widely in the Veterans Health Administration to treat PTSD, yet further research is needed to optimize group interventions. The integration of group therapy with 3,4-methylenedioxymethamphetamine (MDMA) represents a promising strategy for PTSD recovery given potential synergy between the therapeutic effects of group cohesion and the prosocial effects of MDMA.</div><div>This paper describes the development of a clinical research protocol for a single-arm, open-label study assessing the feasibility, safety, and preliminary effectiveness of MDMA-assisted group therapy in a sample of Veterans diagnosed with PTSD within the veterans Affairs Portland Healthcare System. Enrolled veterans will be assigned to one of 3 cohorts of 4–6 participants each (up to <em>N</em> = 18). In addition to individual and group preparation and integration, this novel protocol includes both individual and group MDMA sessions. PTSD symptom severity will be measured by blinded raters using the Clinician-Administered PTSD Scale for <em>DSM-5</em> at baseline and at 1-month follow-up.</div><div>As the first clinical trial combining group therapy with MDMA-assisted therapy for PTSD, this study will provide valuable data on feasibility, the unique risks and benefits of this model, and preliminary effect sizes for the development of larger randomized controlled trials.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 339-350"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing in Vivo and Imaginal Exposure in the Context of MDMA-Assisted Therapy for Social Anxiety Disorder: A Case Report","authors":"Jason B. Luoma,&nbsp;M. Kati Lear,&nbsp;Kyong Yi,&nbsp;Brian Pilecki","doi":"10.1016/j.cbpra.2025.02.002","DOIUrl":"10.1016/j.cbpra.2025.02.002","url":null,"abstract":"<div><div>This case report describes the application of in vivo and imaginal exposure techniques within MDMA-assisted therapy (MDMA-AT) for social anxiety disorder (SAD). The treatment, conducted as part of a randomized controlled trial, consisted of three nondrug preparation sessions, two drug sessions, and six nondrug integration sessions. Exposure interventions included imaginal exposure to shame-related memories during MDMA sessions, in vivo social exposures during MDMA sessions, imagery rescripting exercises during integration sessions, and social activation homework between sessions. The participant, a man in his late 30s with generalized SAD, showed significant reduction in symptoms and functional impairment as measured by the Leibowitz Social Anxiety Scale and Sheehan Disability Scale. Qualitative reports indicated increased social engagement, reduced anxiety in social situations, and a shift towards more self-compassion. The participant found both imaginal and in vivo exposures during MDMA sessions particularly impactful, reporting they allowed him to access intrinsic desires for social connection and performance that were previously masked by anxiety. This case suggests MDMA-AT incorporating exposure techniques may be a promising treatment for SAD, warranting further research.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 351-363"},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intentional Choices of Metaphors for Psychedelic-Assisted Therapy","authors":"Mitch Earleywine,&nbsp;Henry A. MacConnel,&nbsp;Joseph A. De Leo","doi":"10.1016/j.cbpra.2025.04.002","DOIUrl":"10.1016/j.cbpra.2025.04.002","url":null,"abstract":"<div><div>Metaphors applied in psychedelic-assisted therapy (PAT) influence expectations and outcomes. They might help minimize therapist burnout as well. Nevertheless, relatively few publications address their conscious application, especially within a cognitive behavioral framework. Metaphors in PAT related to journeys, rewiring the brain, and medicines are prevalent, but these approaches may not appeal to all clients and might not provide an ideal focus for interventions devoted to learning and cognition, such as those used in cognitive-behavioral therapies. This paper introduces “batting practice” from the sport of baseball as an alternative metaphor. Batting practice emphasizes autonomy, agency, and responsibility, as well as the incremental and skill-building nature of PAT within a cognitive-behavioral perspective. Depicting the therapist as a coach also has advantages, reimagining the therapist-client interaction and time “in the cage,” emphasizing active engagement, ongoing effort, gradual improvements, and periods of progress and stagnation. The batting practice metaphor also emphasizes persistence, patience, mindfulness, and teamwork, paralleling the processes of ongoing integration present in PAT. Application of this metaphor can highlight a focus on the process (“practice”) rather than outcomes, as well as learning opportunities that improve skills across a season or lifetime. We also highlight potential shortcomings of this metaphor to encourage flexibility and enhance awareness as discussions of PAT metaphors continue. Ideally, clients and therapists can collaborate on metaphorical language to optimize outcomes in psychedelic-assisted CBT.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 3","pages":"Pages 321-328"},"PeriodicalIF":2.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconnecting Hope: The Treatment of Eating Disorders in Rural America","authors":"Jenny E. Copeland,&nbsp;Jacob Hefner,&nbsp;Sarah E. Estep,&nbsp;Carolyn Black Becker","doi":"10.1016/j.cbpra.2023.08.001","DOIUrl":"10.1016/j.cbpra.2023.08.001","url":null,"abstract":"<div><div>Eating disorders (EDs), a significant public health concern, impact millions of Americans every year. Many people with EDs are often overlooked for multiple reasons, including the stereotype that EDs predominantly affect thin, White, affluent young women and girls. One historically overlooked group is impoverished individuals in rural areas of the United States (U.S.), who may, in fact, be at an increased risk for EDs. The Reconnect Eating Disorders treatment program (REDTP) at Ozark Center is the first comprehensive, evidence-based, multidisciplinary ED treatment program to be developed in a Certified Community Behavioral Health Organization (CCBHO) in the U.S. CCBHOs are a unique model of financially sustainable integrated care well-suited to the treatment of biopsychosocial illnesses such as EDs because CCBHOs offer a full range of services to treat both physical and mental health. This paper details the development of REDTP, including its team, barriers, and successes. The role of Community Support Specialists/Reconnect Coaches and Healthcare Home/Medical Support is reviewed, which includes providing outpatient care and intensifying treatment for the most acute clients. Key domains of growth for REDTP included selecting core evidence-based treatments, building a team and defining team roles, and intensive training to develop evidence-based ED expertise. Persistent barriers included staffing limitations for providing intensive treatment to a small number of clients. Adult case studies of REDTP clients are presented. Recommendations for future ED and other specialized treatment programs in low resource agencies are provided.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 1","pages":"Pages 78-90"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of Men’s Externalizing Depression Constructs Among Black American Men and Middle-Aged and Older White Men","authors":"Douglas Gazarian ,&nbsp;Michael E. Addis","doi":"10.1016/j.cbpra.2023.08.004","DOIUrl":"10.1016/j.cbpra.2023.08.004","url":null,"abstract":"<div><div>Research on the dissemination and implementation of gender-based care for men has rarely considered diversity within the male-identifying population. The present study evaluated the acceptability of men’s externalizing depression (MED) constructs across purposive samples of men understudied in the MED literature and at higher risk for MED-related outcomes (Black American men and middle-aged and older White men). Following brief psychoeducation, participants rated MED constructs for comprehensibility and perceived clinical value. Using a convergent mixed-methods design, we examined how attitudes varied by sample and experimentally-manipulated psychoeducational variables pertaining to different MED conceptual models. Across samples and psychoeducation conditions, we observed similarly strong levels of acceptability for MED as a gender-based conceptualization of mixed internalizing-externalizing symptoms. Small differences emerged as a function of sample-psychoeducation interactions. Quantitative and qualitative data converged to suggest race-gender intersections influence men’s construal of psychological symptoms. Overall, results supported MED as an acceptable formulation of symptoms across multiple subpopulations of men in the context of an international, online community sample.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"32 1","pages":"Pages 134-146"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}