Cognitive Behavioral Therapy Model Research Articles

Response to unexpected social inclusion: A study using the cyberball paradigm.

BackgroundDysfunctional expectations are considered core characteristics of Major Depressive Disorder (MDD) and should be focused in psychotherapy. Dysfunctional expectations are especially pronounced in the interpersonal area (social expectations). In the present study, we examine the effect of unexpected social inclusion (expectation violation) on the change of generalized and specific depression-typical social expectations.MethodWe conducted an online study to investigate the impact of social inclusion after a period of social exclusion (unexpected social inclusion) on social expectation change (sample size 144) in a non-clinical sample. Depressive symptoms were assessed via self-reporting. Participants took part in two rounds of the online ball-game Cyberball. In the first round, all participants were socially excluded by their two co-players (acquisition of negative social expectations). In the second round, participants were either once more excluded (expectation confirmation) or included equally (expectation violation) by the same co-players. Specific and generalized social expectations were assessed after each round.ResultsSpecific and generalized social expectations increased following expectation violation. Even though depressive symptoms were related to lower levels of social expectations, we found that depressive symptoms did not moderate expectation change after positive expectation violations.ConclusionsIn the present experimental setup including the use of the online ball-game Cyberball, the establishment and change of social expectations can be experimentally manipulated. Under the given circumstances and in a non-clinical sample, negative expectations can be updated after unexpected positive experiences regardless of the number of depressive symptoms. The results are discussed in the context of current models of Major Depressive Disorder (MDD), expectation change, and cognitive behavioral therapy.

Developing cognitive-behavioral therapy in relieving the symptoms of depression, generalized anxiety and social anxiety in adolescents. Case study

Adolescents are characterized by distinct features of the affective sphere, and bio-social conditions trigger affective disadvantages revealed by an advanced level of depression and anxiety. This is exacerbated at this stage by the fact that value and content orientations have become more diffuse, and the adolescent's personality is increasingly prone to disorders of the emotional, mental, cognitive and behavioral spheres. elucidation of the mechanisms that determine the occurrence of emotional disorders in adolescents, the possibility of reducing emotional disorders in adolescents has been demonstrated, the model of cognitive behavioral therapy has been used to alleviate the symptoms of depression, generalized anxiety and social anxiety. in adolescents

Integration of Clinical Neuroscience Into Psychotherapy: A Narrative Review of Neuroscience-Informed Psychotherapy Models for the Treatment of Depression and Anxiety Disorders

The development of neuroscience-informed psychotherapy models that attempt to refine existing psychotherapy models, especially for the treatment of depression and anxiety disorders, is a current topic in psychotherapy research. This narrative review appraised the existing literature on neuroscience-informed psychotherapy models to understand the extent to which the integration of neuroscience can advance the practice of psychotherapy for the treatment of depression and anxiety disorders. The literature search on online databases identified 21 articles that report five different neuroscience-informed psychotherapy models specifically designed to overcome the limitations of top-down-focused cognitive behavioural therapy (CBT) models for depression and anxiety disorders, such as inconsistent treatment effects. Unlike conventional top-down-focused CBT models, which primarily focus on promoting top-down regulation of the brain by improving the cognitive functioning regulated by the higher brain system, the models reviewed commonly focus on promoting bottom-up regulation of the brain by improving the emotional and physiological functioning regulated by the lower brain system with a diverse combination of techniques. However, most reviewed neuroscience-informed psychotherapy models lack research evidence from clinical trials that support the efficacy of these models. The development of a neuroscience-informed psychotherapeutic model is still in its infancy. Future neuroscience-informed therapeutic models will need to be continuously modified, adjusted, and developed by integrating the latest psychotherapy and neuroscientific knowledge and feedback from clinical trials and case studies. Such research may promote the credibility and effectiveness of neuroscience-informed therapeutic models.

Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing Therapeutic Components of Cognitive Behavioral Therapy.

Cognitive behavioral therapy (CBT) packages for anxiety disorders, such as phobias, usually include gradual exposure to anxious contexts, positive self-verbalizations, and relaxation breathing. The objective of this research was to analyze the specific neural activation produced by the self-verbalizations (S) and breathing (B) included in CBT. Thirty participants with clinical levels of a specific phobia to small animals were randomly assigned to three fMRI conditions in which individuals were exposed to phobic stimuli in real images: a group underwent S as a technique to reduce anxiety; a second group underwent B; and a control group underwent exposure only (E). Simple effects showed higher brain activation comparing E > S, E > B, and S > B. In particular, in the E group, compared to the experimental conditions, an activation was observed in sensory-perceptive and prefrontal and in other regions involved in the triggering of emotion (i.e., amygdala, supplementary motor area, and cingulate gyrus) as well as an activation associated with interoceptive sensitivity (i.e., insula and cingulate cortex). According to the specific tool used, discrepancies in the neural changes of CBT efficacy were observed. We discuss the theoretical implications according to the dual model of CBT as a set of therapeutic tools that activate different processes.

Cognitive behavioural therapy (group) for schizophrenia.

Cognitive behavioural therapy (group) for schizophrenia.

Clinical case study of abbreviated cognitive behavioral therapy through an intersectional lens for women health-care workers during the era of COVID-19.

The unprecedented demands of the coronavirus 2019 disease (COVID-19) have imposed a significant degree of psychological distress on women health-care workers (WHCWs). Women comprise 76% of the health-care workforce in the United States and are subject to experience higher psychosocial ramifications in the pandemic era due to gender disparities. Accordingly, women who are dually mothers may be navigating complex interactions of role strain by managing abnormally high parental and occupational workloads. The psychological toll is exacerbated for women holding multiple oppressed identities across domains such as economic status, race and ethnicity, gender identity, sexual orientation, and other identities of salience. To address WHCWs' unique needs during the COVID-19 pandemic, the authors present a clinical case example through an intersectional framework illustrating how an abbreviated, 4-session cognitive behavioral therapy model may be implemented to support women disproportionally affected by social and systemic factors with a focus on sexism and discrimination against mothers for this particular participant. This case study describes the treatment of a patient in an integrated women's health clinic to demonstrate how to clinically support WHCWs while promoting social justice and gender-based equity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial.

BackgroundAdolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet.ObjectiveThis study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial.MethodsParticipants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models.ResultsIn total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms.ConclusionsAlthough adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness.Trial RegistrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246

Cognitive and behavioural factors contributing to distress in LGBTQ+students: a prospective mediation study

We applied a cognitive behavioural therapy (CBT) model of psychological distress and examined cognitive and behavioural predictors and mediators of depression, anxiety and suicidality among lesbian, gay, bisexual, trans, queer and other sexual or gender minority (LGBTQ+) students. LGBTQ + university students (N = 385) completed questionnaires at baseline, 1 and 2 months. Structural equation modelling (SEM) was used to test the relationship between baseline negative beliefs (about the self, others and the future) and depression, anxiety and suicidality 2 months later, via cognitive and behavioural response mediators (perseverative thinking, avoidance and self-compassion) assessed at 1 month. The final model demonstrated acceptable fit: χ 2 (16) = 73.36, p < .001, comparative fit index (CFI)=0.96, Tucker–Lewis index (TLI)=0.93, root-mean-square error of approximation (RMSEA) = 0.09 (90% CI [0.07–0.12]), standardized root-mean-square residual (SRMR) = 0.04, accounting for significant variance in depression/anxiety (48%) and suicidality (27%). For depression/anxiety, negative beliefs had a direct effect and an indirect effect via perseverative thinking and avoidance. For suicidality, negative beliefs had a direct effect. A cognitive behavioural conceptualization may improve our knowledge of the psychological mechanisms involved in depression, anxiety and suicidality in LGBTQ + students. Negative beliefs about the self, others or the future, perseverative thinking, and avoidance are promising targets for prevention and treatment.

The philosophical assumptions across the ‘three waves’ of cognitive–behavioural therapy: how compatible are they?

SUMMARYUnderstanding the philosophical foundations of cognitive–behavioural therapy (CBT) is vital to drive theory and research forwards and to effectively conduct therapy using varied methods and techniques from different CBT models that may be rooted in distinct philosophical tenets. In the evolution of CBT as the most empirically validated form of psychotherapy, each of its three waves (behavioural therapy, cognitive therapy and acceptance-based therapies) has brought unique contributions to improve its effectiveness. Although some of the philosophical assumptions underlying the different CBT waves may be considerably dissimilar, in this clinical reflection I review the distinctive and cross-cutting features of such backgrounds, while suggesting a conciliation of epistemological perspectives that is capable of informing the practice of CBT in a consistent manner.

Psychotherapeutic Interventions and Processes

Cognitive behavioral therapy (CBT) has been one of the most influential developments in psychiatry ever. Since it was developed and introduced, a vast number of treatment protocols focused on specific psychiatric syndromes have been developed. Although this has benefitted many patients and advanced the field, CBT as a treatment with its focus on alleviating psychiatric syndromes seemed to have reached a plateau and a process-focus approach is now emerging within the family of CBT models. This represents a new form of idiographic functional analysis guided by models that integrate a coherent set of change processes. Here, I describe the foundations of this new approach to mental health, called process-based therapy (PBT) and discuss its scientific and clinical implications.

Client and counsellor experiences of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents

Although South Africa has high rates of child and adolescent trauma exposure and associated mental health difficulties, there is a poor evidence base for trauma interventions with youth in this setting. In a resource-constrained context, there is a need for brief evidence-based trauma treatments. However, abbreviated interventions may reduce the acceptability and tolerability of treatment for clients and impact treatment delivery by providers. We developed an abbreviated eight-session version of trauma-focused cognitive behavioural therapy. Using a sequential mixed-methods design, we piloted this intervention with 10 adolescents and their caregivers to assess the acceptability and tolerability of the abbreviated trauma-focused cognitive behavioural therapy model for participants, the degree of counsellor fidelity to the abbreviated treatment manual and counsellor experiences of implementation. The treatment completion rate was 90% and post-traumatic stress disorder symptoms reduced over the course of treatment for all treatment completers. Although there was flexibility in timing and dosing of delivery, counsellor fidelity to treatment components and treatment length was high. Thematic analysis of interviews with participants and counsellors indicated that, within this abbreviated trauma treatment, the therapeutic alliance was able to provide a solid foundation for trauma processing, there was adequate time to practice coping skills and the compressed trauma processing component was difficult but tolerable. Counsellors indicated that a degree of flexibility within fidelity to the abbreviated treatment model enhanced their implementation of the treatment. The findings provide evidence to support a formal evaluation of the abbreviated trauma-focused cognitive behavioural therapy treatment protocol.

Supporting young people to manage gender-related distress using third-wave cognitive behavioural theory, ideas and practice.

The Gender Identity Development Service (GIDS) supports gender diverse young people, and their families but currently does not provide weekly psychological therapy as part of its core work. In addition, local Child and Adolescent Mental Health Services (CAMHS), may feel deskilled in providing support for this population. We, a group of three Clinical Psychologists, aim to share some common themes and observations gained from our work in GIDS. We talk about how existing Cognitive Behavioural Therapy (CBT) models can be relevant and helpful for the challenges facing gender diverse young people, without pathologising, or aiming to change a young person's gender identity. An illustrative case study is presented, based on an amalgamation of young people we have worked with highlighting how third-wave cognitive behavioural theory, ideas and practice can be used to support young people to manage gender-related distress. Further reflections on the broader socio-political context, and implications for clinical practice and future research are discussed.

Conflicts of Identity – How Counsellors Practice CBT 5 Years Post Qualification

Cognitive Behaviour therapy (CBT) relies on homogenous practice for it’s evidence base. However training to an accreditable standard in the UK requires 3 years of “core professional” training in addition to 1 years CBT training for IAPT (Improving Access to Psychological Therapy, trained for primary care cases only) and 2 years for more complex roles. The core professional training has unique aspects which may differ between professional groups (Nursing, Counselling, Occupational Therapy, etc) have varied ideological standpoints and practice rituals, and have the potential to conflict with aspects of CBT. This study asks the question “How do (BACP accreditable) Counsellors and psychotherapists (Hereafter counsellors) in High Intensity IAPT roles practice CBT”? and achieves this through analysis of a focus group of 5 counsellors with at least 3 years CBT experience using a thematic analysis methodology. Five themes were identified - processes in transition, ongoing processes reconciling roles, Features retained from counselling practice, Features changed from counselling practice, and features of CBT resisted and not adopted. Results suggest a broad adaptation to CBT with some aspects of counselling (Responsiveness to the client, knowing the whole of the client) emphasised more or differently to conventional views on CBT Practice. Counsellors do not adopt, or try to avoid adopting, some of the more positivist aspects of CBT, and this remains an ongoing source of conflict in the application of CBT. Implications: Counsellors do not fully conform to the CBT model of practice. Further research is necessary to establish whether this affects outcomes.

Music, Arts and Cognitive Behavioural Therapy to Treat Sleep Disorders

Insomnia is a global burden. Cognitive behavioural therapy models to treat pathological sleeplessness have significant effect sizes, hence the common recommendation of CBT-I. Akin to this approach, the present article presents a novel model which relates to the broader spectrum of sleep disorders and involves music- and arts-specific health benefits such as (i) vocal rituals as soothing sleep cues and means to make irritating cognitions fade, (ii) control of sleepiness and inappropriate daytime naps through music-based martial arts techniques, (iii) voice- and movement-based relaxation and psychosomatic re-balancing, as well as profound music immersion and music-induced altered states of consciousness, (iv) arts-based psychotherapy to cope with pathological factors, such as nightmare objects and (v) psychoeducation to understand the benefits of the arts for healthy sleep. Cultural features of sleep habits, differences between fact-to-face and online practices, individualised arts-based CBT and the multidimensional healing power of the arts are discussed and encourage further research to optimise both personalised and standardised arts-based cognitive behavioural therapy in sleep medicine and public health.

'A life I can cope with'. An alternative model of cognitive behavioural therapy (CBT)for CFS/ME.

ObjectivesThis study aimed to explore the experience of cognitive behavioural therapy (CBT) aimed at better management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), rather than increasing activity.DesignThis was a qualitative study using grounded theory analysis.MethodsSemi‐structured interviews were conducted with 13 adults who had engaged in CBT at a specialist CFS/ME service in which CBT is aimed at improved management of the condition.ResultsA model was produced in which participants felt more able to cope with CFS/ME. Reduced fatigue did not seem to be a necessary precondition to managing. This has implications for CBT for CFS/ME.ConclusionsSpecialist CBT for CFS/ME may result in improved coping and reduced distress, independently of changes in fatigue.Patient or Public ContributionThe researcher met with a representative from the university's service user advisory group (SAGE), who had lived experience of CFS/ME. They commented on possible questions for the interview topic guide and provided advice on ways in which ethical issues specific to CFS/ME could be considered, for example, prevention of harm during interviews. Second, for quality assurance as part of respondent validation, a proposed draft of the grounded theory was discussed with participants.

Comparing the Effectiveness of Cognitive Behavioral Couple Therapy and EIS Model on Sexual Function, Among Pregnant Women

Comparing the Effectiveness of Cognitive Behavioral Couple Therapy and EIS Model on Sexual Function, Among Pregnant Women

Simulating the computational mechanisms of cognitive and behavioral psychotherapeutic interventions: insights from active inference

Cognitive-behavioral therapy (CBT) leverages interactions between thoughts, feelings, and behaviors. To deepen understanding of these interactions, we present a computational (active inference) model of CBT that allows formal simulations of interactions between cognitive interventions (i.e., cognitive restructuring) and behavioral interventions (i.e., exposure) in producing adaptive behavior change (i.e., reducing maladaptive avoidance behavior). Using spider phobia as a concrete example of maladaptive avoidance more generally, we show simulations indicating that when conscious beliefs about safety/danger have strong interactions with affective/behavioral outcomes, behavioral change during exposure therapy is mediated by changes in these beliefs, preventing generalization. In contrast, when these interactions are weakened, and cognitive restructuring only induces belief uncertainty (as opposed to strong safety beliefs), behavior change leads to generalized learning (i.e., “over-writing” the implicit beliefs about action-outcome mappings that directly produce avoidance). The individual is therefore equipped to face any new context, safe or dangerous, remaining in a content state without the need for avoidance behavior—increasing resilience from a CBT perspective. These results show how the same changes in behavior during CBT can be due to distinct underlying mechanisms; they predict lower rates of relapse when cognitive interventions focus on inducing uncertainty and on reducing the effects of automatic negative thoughts on behavior.

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus.

This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating. Twenty-three women (n=9 with type 1 diabetes and disordered eating, n=5 with type 1 diabetes recovering from disordered eating, and n=9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models. The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors. This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.

Treatment for Anxiety and Comorbid Depressive Disorders: Transdiagnostic Cognitive-Behavioral Strategies.

Anxiety and depressive disorders are common psychiatric conditions with high rates of co-occurrence. Although traditional cognitive-behavioral therapy (CBT) protocols targeting individual anxiety and depressive disorder diagnoses have been shown to be effective, such "single-diagnosis" approaches pose challenges for providers who treat patients with multiple comorbidities and for large-scale dissemination of and training in evidence-based psychological treatments. To help meet this need, newer "transdiagnostic" CBT interventions targeting shared underlying features across anxiety, depressive, and related disorders have been developed in recent years. Here we provide a rationale for and description of the transdiagnostic CBT model, followed by an overview of key therapeutic strategies included in transdiagnostic CBT protocols for patients with anxiety disorders and comorbid depression. We conclude with a brief review of the empirical evidence in support of transdiagnostic CBT for individuals with anxiety and depressive disorders and identify directions for future research.

TF-CBT Group Intervention for Children in High Conflict Custody Disputes

This article proposes a conceptual group approach using trauma-based cognitive behavioral therapy for children involved in high conflict custody disputes. Traditionally, interventions for this population have focused on repairing the relationship between parent and child and less on addressing the traumatic symptoms with which the child is suffering. The proposed intervention focuses solely on the needs of the child and provides an outline for seven sessions during which the PRACTICE model of trauma-focused cognitive behavioral therapy is used. Additionally, ethical implications and directions for future research are discussed.