Cognitive and Behavioral Practice最新文献

{"title":"Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans","authors":"Harrison R. Weinstein,&nbsp;Erika M. Roberge,&nbsp;Suzanne C. Parker","doi":"10.1016/j.cbpra.2022.05.004","DOIUrl":"10.1016/j.cbpra.2022.05.004","url":null,"abstract":"<div><p>Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; <em>M</em>_age = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (<em>n</em> = 27) were matched with archival records of individuals who received standard CPT (<em>n</em> = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; <em>M</em>_PCL-5 = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), <em>X</em>²(1, <em>N</em> = 54) = 12.00, <em>p</em> = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, <em>X</em>²(1, <em>N</em> = 54) = 5.33, <em>p</em> = .020, <em>φ</em> = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 3","pages":"Pages 314-325"},"PeriodicalIF":2.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48295754","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":"School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial","authors":"Julie M. Petersen,&nbsp;Carter H. Davis,&nbsp;Tyler L. Renshaw,&nbsp;Michael E. Levin,&nbsp;Michael P. Twohig","doi":"10.1016/j.cbpra.2022.02.021","DOIUrl":"10.1016/j.cbpra.2022.02.021","url":null,"abstract":"<div><p>Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study is a pilot, randomized waitlist-controlled trial of a school-based, group Acceptance and Commitment Therapy–based (ACT) intervention for adolescents with anxiety. Students at two separate schools (<em>N</em> = 26) with elevated anxiety were randomized to a 12-week waitlist or to immediate treatment. Participants in the immediate treatment condition reported statistically significant decreases in anxiety and class absences at posttreatment and follow-up compared to the waitlist group. No statistically significant differences were found between groups for depression, psychological flexibility, positive mental health, and student well-being. However, medium within-condition effect sizes were seen in the treatment group for all outcomes. Participants reported the treatment as favorable with good acceptance ratings. Overall, this study supports ACT as a viable intervention for schools and other clinical settings providing services to adolescents with anxiety.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 3","pages":"Pages 436-452"},"PeriodicalIF":2.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49557011","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":"The Unified Protocols for Children and Adolescents in Partial Hospitalization: Using Implementation Science Frameworks to Guide Adaptation","authors":"Sarah M. Kennedy,&nbsp;Daniel P. Wilkie,&nbsp;Lauren Henry,&nbsp;Jami Moe-Hartman,&nbsp;Kayin President,&nbsp;Kaila Townson,&nbsp;Laura G. Anthony,&nbsp;Jessica L. Hawks","doi":"10.1016/j.cbpra.2022.04.006","DOIUrl":"https://doi.org/10.1016/j.cbpra.2022.04.006","url":null,"abstract":"<div><p>Partial hospitalization programs (PHPs) and other acute mental health treatment programs, which are becoming increasingly common, may help divert children and adolescents from inpatient psychiatric care and provide a concentrated dose of intervention to individuals living in low-resource areas. However, there have been relatively few examinations of the effectiveness of PHPs in addressing emotional concerns (e.g., anxiety, depression, irritability) and functional impairment in youth. Further, evidence-based treatments originally designed for delivery in an outpatient weekly format may require significant adaptation to be appropriate for delivery in acute mental health settings, which differ significantly from weekly outpatient care in program structure, patient acuity, and staffing. In this intervention development and adaptation report, we present the rationale for adapting a transdiagnostic approach to treating emotional disorders—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A)—for a hospital-based, general psychiatric partial hospitalization program. We use implementation science frameworks to describe our iterative approach to treatment adaptation and testing and to describe in detail proactive, planned adaptations to the UP-C/A for partial hospitalization that occurred prior to initial implementation and pilot testing. Three case examples (child, preadolescent, adolescent) are presented to illustrate how a transdiagnostic approach to care such as the UP-C/A can be used intensively in an acute mental health setting to address emotional and behavioral concerns, including safety.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 3","pages":"Pages 367-383"},"PeriodicalIF":2.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49730997","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":"Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series","authors":"Katherine A. Buckheit,&nbsp;Eileen Barden,&nbsp;Rachael Shaw,&nbsp;Kyle Possemato,&nbsp;Nadine R. Mastroleo,&nbsp;Sheila A.M. Rauch","doi":"10.1016/j.cbpra.2022.02.020","DOIUrl":"10.1016/j.cbpra.2022.02.020","url":null,"abstract":"<div><p>Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 3","pages":"Pages 551-563"},"PeriodicalIF":2.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10513004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159065","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}

{"title":"Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans","authors":"Edward C. Wright,&nbsp;Jennifer Schuster Wachen,&nbsp;Cynthia Yamokoski,&nbsp;Tara Galovski,&nbsp;Kris Morris,&nbsp;Elizabeth M. Goetter,&nbsp;Brian Klassen,&nbsp;Vanessa Jacoby,&nbsp;Liza Zwiebach,&nbsp;Jo Sornborger,&nbsp;Katherine A. Dondanville,&nbsp;Brooke A. Fina,&nbsp;Sheila A.M. Rauch","doi":"10.1016/j.cbpra.2022.06.005","DOIUrl":"10.1016/j.cbpra.2022.06.005","url":null,"abstract":"<div><p>Despite strong evidence of their effectiveness in reducing symptoms of posttraumatic stress disorder (PTSD), prolonged exposure therapy (PE) and cognitive processing therapy (CPT) remain challenging for some service members and veterans to access and complete. Delivering PE and CPT in time-condensed or “massed” formats may reduce barriers to receiving care. PE and CPT have now been implemented across a range of tempos (e.g., multiple sessions per day across 1 week, one session per day for 3 weeks) and to multiple target populations, in a variety of contexts from individual therapy alone to full intensive outpatient programs. A massed format of treatment delivery has advantages for both patients and providers, including quicker time to recovery, less opportunity for avoidance, and improved treatment completion rates. The time-limited nature of massed treatment also creates accompanying challenges, such as less time to practice homework and greater impact when factors delay or disrupt progress. This paper discusses lessons learned from providers across diverse settings who are experienced in both delivering massed PE and CPT and managing such programs, primarily with military populations.</p></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"30 3","pages":"Pages 397-416"},"PeriodicalIF":2.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42249314","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":"Exploring the Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders With Latinxs: A Record-Review Study at a Culturally Specific Clinic for Latinxs","authors":"","doi":"10.1016/j.cbpra.2023.06.001","DOIUrl":"10.1016/j.cbpra.2023.06.001","url":null,"abstract":"<div><div><span>The Unified Protocol (UP) is a transdiagnostic cognitive behavioral therapy that targets the core affective processes underlying anxiety, depression, and other emotional disorders. Given the high rates of anxiety and depression and comorbidity among Latinxs, transdiagnostic treatments are a potentially effective intervention for this group. This record review study examined treatment outcomes for 20 Spanish-speaking Latinxs with an anxiety disorder receiving the UP at a community clinic. Six participants dropped out of treatment (30%) and 14 (70%) completed and responded to treatment. An intent-to treat analysis revealed a statistically significant improvement between pre- and posttreatment scores on the PHQ-9 (95% CI, 5.26, 11.04, t [19] = 5.894, </span><em>p</em> &lt; .001) and the GAD-7 (95% CI, 4.49, 9.11, t [19] = 6.17, <em>p</em> &lt; .001). We also included an in-depth case study, illustrating how the UP can be used with Spanish-speaking Latinxs. Our results provide preliminary support for the UP for use with a subset of Latinx adults with anxiety (with or without comorbid depression).</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"31 4","pages":"Pages 469-481"},"PeriodicalIF":2.9,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43608995","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":"Novel Application of Skills for Psychological Recovery as an Early Intervention for Posttraumatic Stress Disorder, Depression, and Alcohol Misuse in Survivors of Recent Sexual Assault: A Case Series","authors":"","doi":"10.1016/j.cbpra.2023.05.003","DOIUrl":"10.1016/j.cbpra.2023.05.003","url":null,"abstract":"<div><div>Skills for Psychological Recovery (SPR) is an evidence-informed, early intervention for teaching survivors coping skills in the aftermath of recent disasters. Although SPR has not been tested following recent sexual assault, there is theoretical support for applying SPR to the needs of recent sexual assault survivors. The current study is the first to describe the application of SPR among survivors of recent sexual assault. SPR was administered by two master-level clinicians over the telephone to five people who experienced a sexual assault in the last month. Clients completed up to five SPR sessions. Mean scores of measures of Posttraumatic Stress Disorder (PTSD; PTSD Primary Care Screen), depression (Patient Health Questionnaire–2), and alcohol misuse (Alcohol Use Disorders Identification Test–Concise) were calculated pre- and post-intervention. Clients reported a reduction in PTSD symptoms (pre-intervention mean = 4.4; post-intervention mean = 2.8), depression (pre-intervention mean = 3.6; post-intervention mean = 2.2), and alcohol misuse (pre-intervention mean = 4.5; post-intervention mean = 3.2) at post-intervention. Results are presented using a case series approach. Findings suggest that SPR may be an effective strategy for reducing early trauma-related symptoms among recent survivors of sexual assault. Future investigations should explore the feasibility, acceptability, and efficacy of delivering SPR with larger, multiculturally diverse samples of recent sexual assault survivors.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"31 4","pages":"Pages 498-510"},"PeriodicalIF":2.9,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45685803","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":"Acceptance and Commitment Therapy Approach for Problematic Chemsex Among Men Who Have Sex With Men","authors":"","doi":"10.1016/j.cbpra.2023.05.002","DOIUrl":"10.1016/j.cbpra.2023.05.002","url":null,"abstract":"<div><div><span><span>Chemsex, a phenomenon involving the use of psychoactive substances in sexual contexts to facilitate or enhance sexual experiences, is substantially increasing among men who have sex with men (MSM), and has been described as a significant risk factor for mental and physical illness<span>. However, no specialized treatment approach has yet been established. Acceptance and commitment therapy (ACT) could potentially be an appropriate psychotherapeutic framework, especially considering the MSM and sexual minority unique challenges and the role of psychological flexibility in this context. The present paper describes the assessment and ACT interventions, reports and discusses the results, of 10 adult MSM who self-referred to an outpatient psychiatry and addiction department in France for self-reported problematic chemsex that interfered with their </span></span>quality of life. They completed symptom- and process-based measures at three different timepoints. Results were quantitatively analyzed, and the clinician’s session notes and patients’ experiences/accounts, recorded verbatim, served as a support for evaluating the global effects of ACT interventions. Results on outcome measures showed clinically notable and statistically significative improvements in psychological flexibility, anxiety and depression symptoms, as well as sexual addiction intensity between pre- and posttreatment, which were all persistent at 3- to 4-month follow-up. Process measure results indicated a high and consistent </span>therapeutic alliance throughout therapy. This exploratory study, directly derived from clinical practice, suggests promising preliminary results. It can provide clinicians with a useful resource for using ACT as a potentially effective approach for problematic chemsex and comorbidities, and may guide future investigation to inform treatment development efforts, especially for MSM and sexual minority communities.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"31 4","pages":"Pages 451-468"},"PeriodicalIF":2.9,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44207588","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":"Clarifying the Core Problem Concept in DBT: A Case Illustration","authors":"","doi":"10.1016/j.cbpra.2023.04.003","DOIUrl":"10.1016/j.cbpra.2023.04.003","url":null,"abstract":"<div><div>In her later years of teaching and training, Linehan (personal communication) spoke of an assessment construct that she referred to as a client’s “core problem.” In this paper, we trace the historical roots of this concept, review and clarify its current operationalization, anticipate common therapist questions and challenges to identifying a client’s core problem, and provide a case example to illustrate its utility for Dialectical Behavior Therapy (DBT) case formulation and treatment planning. We propose that conceptualizing a client’s core problem holds great promise for enhancing the therapist’s effective and efficient delivery of DBT.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"31 4","pages":"Pages 521-538"},"PeriodicalIF":2.9,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42258513","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":"Low-Cost Virtual Reality to Support Imaginal Exposure Within PTSD Treatment: A Case Report Study Within a Community Mental Healthcare Setting","authors":"","doi":"10.1016/j.cbpra.2023.03.003","DOIUrl":"10.1016/j.cbpra.2023.03.003","url":null,"abstract":"<div><div>Revisiting what happened during (or after) a traumatic event is an important part of the treatment process in trauma-focused cognitive therapy (TF-CT). However, clinicians may have difficulty helping patients to intentionally retrieve these memories in order to engage with their content. As such, clinical tools to support the access and delivery of imaginal exposure content within treatment may prove to be particularly useful for therapists. This case report introduces work undertaken with Mr. A, a 38-year-old male, who 2 years prior had experienced a city centre assault. Initial assessment revealed a PCL-5 score of 64 and he met DSM-5 criteria for posttraumatic stress disorder (PTSD). Mr. A received 10 sessions of TF-CT wherein the traditional imaginal exposure components were implemented via a newly developed virtual reality (VR) development workflow called “VR Photoscan.” After 10 sessions, results showed PCL-5 scores decreased from 64 to 19 and Mr. A no longer met DSM-5 PTSD criteria. VR Photoscan was used during 4/10 sessions and included (1) reliving, (2) memory updating, and (3) stimulus discrimination activities. Mr. A also reported VR Photoscan as helpful regarding preparation for site visits. In conclusion, VR Photoscan technology provided a more visceral exposure experience which supported Mr. A to revisit the trauma memory. He reported high levels of satisfaction with the quality of the virtual environment and no issues using the VR technology. Produced with lower costs and shorter development times than typical computer-generated environments, VR Photoscan may be more easily implemented within routine care, although further research is required.</div></div>","PeriodicalId":51511,"journal":{"name":"Cognitive and Behavioral Practice","volume":"31 4","pages":"Pages 577-594"},"PeriodicalIF":2.9,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42823140","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}