Cognitive and Behavioral Practice最新文献

{"title":"Application of a Quality Improvement Process to Evaluate Self-Directed Therapy for Patients on a Waitlist in an Outpatient Anxiety Disorders Specialty Clinic","authors":"David F. Bradley,&nbsp;Terence H.W. Ching,&nbsp;Lauren Languido,&nbsp;Robert E. Brady","doi":"10.1016/j.cbpra.2021.11.006","DOIUrl":"10.1016/j.cbpra.2021.11.006","url":null,"abstract":"<div><p>The demand for psychological services in the United States is higher than the available supply of qualified mental health professionals. As a result, there is a substantial need for low-cost interventions that are more accessible and amenable to scale-up independent of the availability of clinicians. Previous studies have found that self-directed bibliotherapy can be an effective intervention with minimal therapist contact. Using the Plan-Do-Study-Act (PDSA) improvement process framework, we implemented self-directed therapy in our outpatient anxiety disorders specialty clinic. We identified four self-directed therapy resources (two books and two smartphone apps) based on cognitive behavioral or acceptance and mindfulness principles. We conducted initial 30-minute billable bibliotherapy consultations with six patients on our waitlist, where we provided the rationale for self-guided treatment, introduced the four resources, helped the patient identify one resource to use, and answered any questions. Eight weeks later, we met with five of these patients for a second billable 30-minute consultation (one had already started individual therapy) and gathered information regarding feasibility and acceptability of these resources as well as helped the patient make continued or better use of the resource until beginning therapy. This case series suggests that self-directed interventions can be effectively implemented in this manner, though with mixed outcomes and effects on patients and their course of care. We describe improvements we intend to implement in future iterations of self-directed therapy.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 229-237"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47805611","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":"Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care","authors":"Rebecca L. Kauten,&nbsp;Sarah P. Carter,&nbsp;Max Stivers,&nbsp;Laura A. Novak,&nbsp;Margaret M. Baer,&nbsp;Jessica M. LaCroix,&nbsp;Nicholas E. Grant,&nbsp;Britt Sickmann,&nbsp;David B. Goldston,&nbsp;Alyssa Soumoff,&nbsp;Marjan Ghahramanlou-Holloway","doi":"10.1016/j.cbpra.2021.10.007","DOIUrl":"10.1016/j.cbpra.2021.10.007","url":null,"abstract":"<div><p>While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, &amp; Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 273-286"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49251991","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":"Race in the Space: Clinical Considerations for Addressing Race in Treatment","authors":"Faithlynn Morris,&nbsp;Zachary W. Rawlings","doi":"10.1016/j.cbpra.2021.12.001","DOIUrl":"https://doi.org/10.1016/j.cbpra.2021.12.001","url":null,"abstract":"<div><p>During a period of intense racial unrest in the nation, we were working as clinicians delivering a manualized protocol to LGBTQ adults of varying racial and ethnic backgrounds. Intrigued by the differences in our modes of engagement with clients, we, a Black, cis female therapist and White, cis male therapist, set out to further explore how our positionalities informed our communications with, and expectations of, White and non-White clients during this time. In this paper, we reflect on these differences when delivering therapy in cross-racial and same-race dyads. We highlight where our experiences overlap as clinicians trained in the same program and where they diverge due to our respective worldviews. We conclude with considerations for practitioners to engage with race in psychotherapeutic treatment.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 248-255"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49708722","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":"Cover 2: Editorial Board","authors":"","doi":"10.1016/S1077-7229(23)00022-6","DOIUrl":"https://doi.org/10.1016/S1077-7229(23)00022-6","url":null,"abstract":"","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Page IFC"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49718058","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":"Is It Easy to Use and Useful? Mental Health Professionals’ Perspectives Inform Development of a Novel Treatment Engagement System for Youth Mental Health Services☆☆☆","authors":"Wendy Chu,&nbsp;Kimberly D. Becker,&nbsp;Maya M. Boustani,&nbsp;Alayna L. Park,&nbsp;Bruce F. Chorpita","doi":"10.1016/j.cbpra.2021.11.003","DOIUrl":"10.1016/j.cbpra.2021.11.003","url":null,"abstract":"<div><p>User experiences are essential to the adoption of an intervention and can be integral to intervention design. We applied two concepts from the technology acceptance model (i.e., perceived ease of use, perceived utility) to understand how mental health professionals experienced a novel system of resources (i.e., engagement system) designed to improve problem identification, coordination, and treatment planning decisions related to addressing problems of low treatment engagement in school mental health services. We conducted a 1-hour focus group with 10 mental health professionals (provider <em>n</em> = 8, supervisor <em>n</em> = 2) using prompts to elicit their perspectives about the effort involved in using the engagement system and about the usefulness of the system in their work. The focus group was transcribed and segmented into 70 excerpts by trained coders. We analyzed the transcript using a consensual qualitative research approach. Ease of use was coded in 15 (39%) excerpts and utility was coded in 24 (61%) excerpts. The valences of excerpts were neutral (<em>n</em> = 18; 46%), positive (<em>n</em> = 10; 26%), and negative (<em>n</em> = 11; 28%). Thirty-nine (56%) excerpts discussed the engagement system. Excerpts pertained to problem identification (<em>n</em> = 18; 46%), coordination (<em>n</em> = 18; 46%), and treatment planning (<em>n</em> = 3; 8%). Findings revealed that resources and procedures were rated differently on their perceived ease of use and utility. Participants reported that the coordination resource had high utility and positively impacted their clinical practice and supervision, while the problem identification resources had low ease of use and were burdensome or difficult to use. Some lessons learned include the value of designing resources that provide structure to clinical decision processes yet allow for some flexibility, the need for simpler and automated procedures to reduce provider burden, and the importance of clear guidelines on how resources should and should not be used. We used this feedback to inform changes to the engagement system prior to testing in a randomized trial. This brief report highlights how applying the technology acceptance model to evaluate interventions can aid in the successful implementation of novel clinical interventions.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 256-262"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42549842","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":"Cultural Considerations for Treating PTSD in Latinx Sexual Assault Survivors With Prolonged Exposure","authors":"Natalia M. Garcia,&nbsp;Agustina Colombo Eiff,&nbsp;Adriana Lopez-Esteban,&nbsp;Lori Zoellner","doi":"10.1016/j.cbpra.2021.12.002","DOIUrl":"https://doi.org/10.1016/j.cbpra.2021.12.002","url":null,"abstract":"<div><p>There is growing interest in the implementation of culturally responsive mental health care that balances treatment fidelity and cultural fit (Castro et al., 2004). Prolonged exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD) and has been successfully implemented in low-income and ethnoracial minority samples (Feske, 2008) and with Latinx individuals specifically (Vera et al., 2011). However, cultural and systemic factors may contribute to Latinx individuals experiencing higher conditional risk for PTSD (Alcántara et al., 2013), disparities in mental health care utilization (Alves-Bradford et al., 2020), and challenges with PTSD treatment delivery (Valentine et al., 2017). Culturally responsive implementation of PE with Latinx clients involves making culturally informed but person-specific assessments of clients, with adaptations as needed. We propose several culturally responsive strategies for therapists to consider when conducting PE with Latinx sexual assault survivors, such as building trust and rapport early on, conducting culturally informed assessment, investing in psychoeducation, optimizing imaginal exposure and <em>in vivo</em> exposure, and problem-solving barriers to homework engagement. Therapists are encouraged to approach this work with cultural humility (Fisher-Borne et al., 2015; Tervalon &amp; Murray-Garcia, 1998) through open listening, critical self-reflection, and consideration for the way in which Latinx identity intersects with other important identity characteristics that can impact treatment relevance and engagement.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 179-194"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49732386","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":"Well, That Was Awkward: When Clients Develop Romantic Feelings for Therapists","authors":"Ana Rabasco,&nbsp;Amy Mariaskin,&nbsp;Dean McKay","doi":"10.1016/j.cbpra.2021.09.004","DOIUrl":"10.1016/j.cbpra.2021.09.004","url":null,"abstract":"<div><p>Clients can develop feelings of romantic or sexual attraction to their therapists. From a cognitive-behavioral perspective, how should therapists handle these situations? Although the topic of client attraction is comprehensively covered in the psychoanalytic and psychodynamic literature, it is woefully neglected in our cognitive-behavioral therapy (CBT) focused training programs and literature. This paper aims to address this gap by using CBT principles to provide explanations for why clients develop feelings of attraction to their therapists. In addition, this paper offers general guidelines for how to manage client attraction from a CBT perspective. Three case vignettes are used to illustrate those concepts. Recommendations for future research and training in this area are also provided.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 238-247"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43988517","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":"Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study","authors":"Brock H. Partlow ,&nbsp;Erica L. Birkley","doi":"10.1016/j.cbpra.2021.12.003","DOIUrl":"https://doi.org/10.1016/j.cbpra.2021.12.003","url":null,"abstract":"<div><p>Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown &amp; Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown &amp; Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 299-310"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49708813","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":"An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD","authors":"Leila K. Capel,&nbsp;Patricia Zurita Ona,&nbsp;Clara Moller,&nbsp;Michael P. Twohig","doi":"10.1016/j.cbpra.2022.01.004","DOIUrl":"10.1016/j.cbpra.2022.01.004","url":null,"abstract":"<div><p>Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 218-228"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43787636","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":"Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic","authors":"Dianne M. Hezel,&nbsp;Amy M. Rapp,&nbsp;Shannon Glasgow,&nbsp;Gail Cridland,&nbsp;H. Blair Simpson","doi":"10.1016/j.cbpra.2021.12.005","DOIUrl":"10.1016/j.cbpra.2021.12.005","url":null,"abstract":"<div><p>In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 2","pages":"Pages 263-272"},"PeriodicalIF":2.9,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9645736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}