Cognitive Behavioral Practitioners Research Articles

Treating the Psychological Distress in Children with Adventitious Blindness

Less than half of those who need mental health counseling receive it globally, underscoring the urgent need for psychology-focused intervention. According to data, 30.9% of Nigerians experience psychological anguish. This study investigated the efficacy and moderators of group cognitive behaviour therapy in psychologically distressed schoolchildren with adventitious blindness in Nigeria. A total of 98 students with adventitious blindness were recruited and participated in this study. The participants were assessed at three points using Perceived Emotional Distress Inventory. A mixed model ANCOVA with repeated measures shows that the CBT treatment had a dependable significant effect in decreasing psychological distress. The results showed that sociodemographic factors do not significantly moderate the efficacy of CBT treatment on the reduction of psychological distress in schoolchildren with adventitious blindness. In conclusion, the effect of a group cognitive behavioural therapy had a consistent significant reduction in psychological distress and none of their sociodemographic characteristics moderated the effects. Therefore, cognitive-behavioural practitioners should collaborate with special schools to diagnose and provide CBT treatment to schoolchildren living with adventitious blindness.

The TANDEM trial: protocol for the process evaluation of a randomised trial of a complex intervention for anxiety and/or depression in people living with chronic obstructive pulmonary disease (COPD)

BackgroundTANDEM is a randomised controlled trial of a complex healthcare intervention to improve the psychological and physical health of people living with chronic obstructive pulmonary disease (COPD) and anxiety and/or depression. Based on health psychology theory set out in a logic model, respiratory health professionals were recruited and trained to deliver a cognitive behavioural approach intervention (The TANDEM intervention) under the supervision of senior cognitive behavioural practitioners. Here, we describe the protocol for the process evaluation commissioned alongside the trial. A realist approach that includes attention to describing contexts and mechanisms has been adopted.MethodsWe set up a multi-disciplinary team to develop and deliver the process evaluation. The mixed-methods design incorporates quantitative process data; monitoring of intervention fidelity; qualitative interviews with patients, carers, health professionals (facilitators) and clinical supervisors about their perspectives on acceptability of the intervention; and exploration with all stakeholders (including management/policy-makers) on future implementation. Normalisation process theory (NPT) will inform data collection and interpretation with a focus on implementation. Quantitative process data will be analysed descriptively. Qualitative interview data will be analysed before the trial outcomes are known using analytic induction and constant comparison to develop themes. Findings from the different elements will be reported separately and then integrated.ConclusionDetailed description and analysis of study processes in a research trial such as TANDEM enables research teams to describe study contexts and mechanisms and to examine the relationship with outcomes. In this way, learning from the trial goes beyond the randomised control trial (RCT) model where effectiveness is prioritised and makes it possible to explore issues arising for post-trial study implementation.Trial registrationISRCTN ISRCTN59537391. Registered on 20 March 2017. Trial protocol version 6.0, 22 April 2018.Process evaluation protocol version 4.0, 1 November 2020.

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

Can We Talk? Fostering Interchange Between Scientists and Practitioners

In response to three surveys of (mostly) cognitive-behavioral practitioners about barriers to treatment success with cognitive-behavioral therapy for patients with generalized anxiety disorder, panic disorder, and social phobia (McAleavey, Castonguay, & Goldfried, 2014-this issue; Szkodny, Newman, & Goldfried, 2014-this issue; Wolf & Goldfried, 2014-this issue), the author proposes several methods for tapping clinical expertise in the development and dissemination of psychological interventions. These include: following surveys with interviews of a subset of clinicians to obtain richer information, systematically incorporating answers to questions and problems trainees raise in supervision in efficacy or effectiveness trials, organizing clinical roundtables at meetings of the Association for Behavioral and Cognitive Therapies to discuss ways to address barriers identified in these surveys, and encouraging papers on these topics in Cognitive and Behavioral Practice. At the same time the author emphasizes that clinical observations are not facts and need to be verified in empirical research.

Continuing Professional Development: The Personal and Public Interface

With the biennial circuit of Health and Care Professions Council (HCPC) audits now established for occupational therapists, continuing professional development (CPD) is familiar throughout the United Kingdom (UK). Whereas HCPC audit provides a mechanism for occupational therapists to demonstrate Standards of Proficiency (HCPC 2012), it also enables occupational therapists to showcase their unique professional knowledge. The personal interface of CPD is, perhaps, most familiar. As occupational therapists establish professional roles, gaining experience, many seek to develop their expertise through training, reflection and mentorship. Such opportunities tend to be contextualised to particular services or practice areas. The training agenda has been particularly constrained of late, with efficiency savings meaning that study time and financial support for CPD are increasingly withheld by employers. The public interface of CPD is possibly less considered, but nevertheless is complex and intriguing. The HCPC agenda recognises the profession, but the Standards of Proficiency list statements relating to registrants’ scope of practice. This system facilitates more occupational therapists into skill or service led roles, rather than professionspecific core practice. Occupational therapists are increasingly employed in specialist posts open to wider applicants, such as cognitive behavioural practitioners or moving and handling experts. Such positions may not always require specialist occupational knowledge or use occupation as the primary means of therapy. What does this say about our

Evidence‐based practice and the need for paradigmatic pluralism in cognitive behavioural psychotherapy

The scientist-practitioner model, which is based on positivistic methodological assumptions, is influential in the development, training and practice of cognitive behavioural psychotherapists. As the emergence of 'Nurse Cognitive Behavioural Therapist' training in the early 1970s in Britain, many of those trained have been mental health nurses and with the emergence of the Increased Access to Psychological Therapies agenda many more are likely to undergo training. Despite some acceptance of its relevance, the scientist-practitioner model is subject of criticism on the grounds of its achievability and contemporary relevance, and its exclusion of other modalities of counselling and psychotherapy without an, as yet, disseminated evidence base. In line with key policy-related work, the empirical and political issues inscribed within the scientist-practitioner model have direct implications for the educational preparation and ongoing professional development of cognitive behavioural practitioners. Specifically, in this polemical paper it is argued that there is a moral and educational need for 'senior' practitioners to question the philosophy of science assumptions underpinning the overwhelming dominance of the quantitative-experimental approach in cognitive behavioural psychotherapy. Such a critically evaluative and pluralistic stance would arguably distinguish senior practitioners in terms of them being able to make broad rather than narrow appraisals of the evidence base for their practice. A recognition of the relevance of paradigmatic and epistemological pluralism in cognitive behavioural work would, it is argued, confer considerable advantages on our practice communities and clients. A range of emerging implications for cognitive behavioural education, practice and relational ethics are described and discussed.

Idiopathic Hand and Arm Pain: Delivering Cognitive Behavioral Therapy as Part of a Multidisciplinary Team in a Surgical Practice

Cognitive behavioral therapists may have a unique and growing role in orthopedics departments. In helping patients cope with pain, particularly where there is no specific biomedical treatment or cure, cognitive behavioral practitioners can help prevent, early on, the transition from an acute pain complaint to a costly, disabling, and interfering chronic pain syndrome (CPS; see Singh, M. K., Patel, J., & Galagher, R. (2005). Chronic pain syndrome. Physical Medicine and Rehabilitation. Retrieved April 25, 2008, from. http://www.emedicine.com/pmr/topic32.htm for a thorough description). Idiopathic hand and arm pain is a prevalent, costly, and distressing condition. It is defined as pain in the hand or arm that is vague, diffuse, with unclear pathology, or pain that is over and above what is expected based on an objective medical finding ([Ring, D., Katzielsky, J., Malhotra, L., Lee, S. G., & Jupiter, J. B. (2005). Psychological factors associated with idiopathic arm pain. Journal of Bone and Joint Surgery, 87, 374 --380]). Diagnosing and treating pain in general is challenging, and it is particularly challenging when there is no clear objective pathology, as in idiopathic pain. Patients with vague, diffuse, nonspecific pain complaints often present to orthopedic departments in hope of pain relief or cure via surgical procedures, yet surgeons are poorly equipped to deal with situations where pure medical management is unwarranted. This may be detrimental to patient care and lead to chronic pain syndrome. This article reviews research and common clinical issues in patients with idiopathic hand and arm pain who present to orthopedic departments; presents a multidisciplinary team approach in coordinating and providing care for these patients; and describes two case examples of the use of cognitive and behavioral interventions as part of this team approach. Utilizing cognitive and behavioral approaches may be a way to increase the quality of life of patients presenting with idiopathic arm pain, prevent transition to chronic pain syndrome, and circumvent costly and largely ineffective surgical procedures.

Making sense of CORE System data: Attrition, effectiveness, concordance and information capture

The value of outcome research has been the subject of recent debate. This paper argues that outcome research is a worthy and crucially important activity and goes on to describe four practice-based studies addressing questions about effectiveness. The four studies were all conducted in a department of psychological services employing counsellors, clinical psychologists, cognitive-behavioural practitioners and psychotherapists. The studies used CORE System data to answer questions about attrition, effectiveness, concordance and information capture. The paper argues that the systematic collection of such data can be used by managers and individual therapists to monitor and improve services. The CORE System allows a unique benchmarking system and the paper demonstrates how this can be used to locate a service in a wider context.

Comments on innovations in cognitive behavioral treatments of anxiety disorders

Authors of the present series of articles offer cognitive behavioral practitioners some exciting new possibilities for enhancing the treatment of anxiety disorders. In this article, I speculate about the promise of these innovations and discuss some of the practical issues to be addressed if advances in technology are to be widely adopted by clinicians in nonacademic settings.

Performance enhancement in sport: A cognitive behavioral domain

The clinical technology developed by cognitive behavioral practitioners has become the foundation for psychological efforts to enhance athletic performance. To provide a backdrop for this sport intervention research, the history of applied sport psychology is briefly noted. Then, the empirical literature which supportes the use of cognitive behavioral intervention strategies in athletic contexts is considered. This work includes the treatment evaluation evidence for performance improvement of non-elite sport participants, and correlational evidence that supports the consideration of psychological variables in the performance of elite athletes. The intervention strategies under review include imagery and mental rehearsal, arousal management, goal-setting, self-instruction and self-monitoring, and multi-component treatment programs. The implications of this research for applied sport psychology and the broader field of clinical intervention are discussed.