Traditional Cognitive Behavioral Therapy Research Articles

‘I know it, but I don’t feel it’: Reflections on using compassion focused therapy (CFT) to tackle the limitations of traditional cognitive behavioural therapy (CBT) after acquired brain injury (ABI)

After ABI, CBT is often recommended for clients with psychological distress, but clients commonly report dissonance between their cognitive understanding of therapy and their emotions – the ‘head–heart lag’. CFT may help shift this ‘knowing/feeling’ disconnect, particularly for those with high self-criticism and shame (which often present after ABI). A case reflection is presented where CFT had a successful outcome after traditional CBT had not been sufficiently effective in shifting the client’s emotional state.

Exploring Acceptance and Commitment Therapy for parents of preterm infants.

The start of a parenting journey in the neonatal intensive care unit (NICU) presents many stressors to parents. Previous research has shown parents of infants admitted to the NICU experience heightened stress, anxiety, and depression. Mental health support varies across Canadian NICUs with mixed results. One promising intervention that has not been explored in the NICU is Acceptance and Commitment Therapy (ACT), a behavioural therapy that has had positive mental health-related outcomes in similar parental populations. ACT differs from previous mental health interventions such as traditional Cognitive Behavioural Therapy (CBT) as it involves mindfulness and acceptance to increase psychological flexibility. Increased psychological flexibility is linked to greater emotional well-being, a higher quality of life, and decreased stress, anxiety, and depression. There is a need for research investigating the utility of ACT in improving mental health outcomes for parents of preterm infants.

A meta-analysis of the efficacy of acceptance and commitment therapy for children

Compared to the use of Acceptance and Commitment Therapy (ACT) in the treatment of adult psychopathology, there are fewer empirical studies on children, which makes it difficult to summarize the use of ACT in children. The current study presented the results of a meta-analysis of 14 randomized controlled trials (RCTs) on the efficacy of ACT for 1189 children. Compared with treatment as usual (TAU) and waitlist, ACT significantly improved the symptoms of primary outcome measures such as anxiety and depression [SMD = −0.59, CI(-0.87, −0.31), p < 0.001; SMD = −0.86, CI(-1.13, −0.59), p < 0.001]. However, there was no significant difference between ACT and traditional cognitive behavioral therapy (CBT). On secondary outcomes such as quality of life and well-being, ACT performed similarly to traditional CBT and TAU, but outperformed the untreated control group [SMD = 1.74, CI (0.78, 2.69), p < 0.001; I2 = 82.8%]. Our findings indicate that ACT is more effective than TAU and untreated groups in treating anxiety, depression and other mental and behavioral disorders, while not superior to traditional CBT. We also found that there was no significant difference in effects on improving the positive mental factors and behaviors for children compared to existing and usual treatments, but ACT did outperform the untreated group. More high-quality research with an improved design that focuses on these positive mental factors and behaviors of children are needed to understand the efficacy of ACT for children.

Effects of Acceptance and Commitment Therapy and Cogntive Behavioral Therapy Based Psychoeducation Programs on Test Anxiety

The aim of this study is to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) based psychoeducation program on test anxiety of high school senior students and compare the effectiveness of traditional Cognitive Behavioral Therapy (CBT). Study was conducted in a weak experimental design. Short Symptom Inventory, Test Anxiety Inventory, Avoidance and Fusion Scale Youth-8 and Automatic Thoughts Scale were used as data collection tools. Participants meeting the inclusion criteria were assigned to three groups as ACT (11 student), CBT (11 student) and control (11 student) group. ACT group received seven session and CBT group received eight session psychoeducation intervention for seven-week; control group received no intervention. The results of the study showed that; the mean scores of the subjects in the ACT, CBT and control groups obtained from the TAI pre-test and post-test measurements differ significantly [F(2-30) = 9.123; p

A brief, computerized intervention targeting error sensitivity reduces the error-related negativity.

Research has identified the neural response to errors (the error-related negativity; ERN) as a marker of current anxiety, as well as risk for future anxiety. Previous work found that traditional cognitive behavioral therapy approaches do not impact the ERN. However, none of these approaches directly target the psychological constructs linked to an increased ERN (e.g., error sensitivity). In the current study, we examine the extent to which a brief, computerized intervention ("Treating the ERN"; i.e., TERN) might impact the ERN by reducing error sensitivity. Results suggest that TERN reduced the ERN and that the impact of the intervention was larger amongst individuals with an increased baseline ERN. This study is an important first step in the development of a novel intervention approach that directly targets error sensitivity, and thereby the ERN.

A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Therapy in a Sample of Women Struggling to Achieve Orgasm

IntroductionThis study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction. AimTo compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm. MethodsA convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion. Main Outcome MeasureWe applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05). ResultsStatistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants. Clinical ImplicationsTo the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties. ConclusionWhen women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments.Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312–324.

Acceptability, feasibility, and efficacy of Internet cognitive behavioral therapy (iCBT) for pediatric obsessive-compulsive disorder: a systematic review

BackgroundObsessive-compulsive disorder (OCD) is a chronic mental health disorder characterized by recurring obsessions and compulsions affecting 1–3% of children and adolescents. Current treatment options are limited by accessibility, availability, and quality of care. New technologies provide opportunities to address at least some of these challenges. This paper aims to investigate the acceptability, feasibility, and efficacy of traditional cognitive behavioral therapy with Internet cognitive behavioral therapy (iCBT) for pediatric OCD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.MethodWe searched EMBASE, Medline, PsycINFO, CENTRAL, LILACS, CINAHL, and Scopus. Results include articles from 1987 to March 2018. Main inclusion criteria were patients aged 4–18, primary diagnosis of OCD, and iCBT.ResultsOf the 2323 unique articles identified during the initial search, six studies with a total of 96 participants met our inclusion criteria: three randomized controlled trials, one single-case multiple-baseline design, one open-label trial, and one case series. Four studies reported a significant decrease in OCD severity on the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) following iCBT, one study reported significant decrease in CY-BOCS scores for iCBT relative to waitlist, and the case series reported (some) symptom reduction in all participants. Six studies reported high rates of feasibility, and five studies reported good acceptability of iCBT.ConclusionAt present, evidence regarding acceptability, feasibility, and efficacy of iCBT for pediatric OCD is limited. Results are promising but need to be confirmed and refined in further research.Systematic review registrationPROSPERO CRD4201808587

AR-Therapist: Design and Simulation of an AR-Game Environment as a CBT for Patients with ADHD.

Attention Deficit Hyperactivity Disorder is one of the most common neurodevelopmental disorders in which patients have difficulties related to inattention, hyperactivity, and impulsivity. Those patients are in need of a psychological therapy use Cognitive Behavioral Therapy (CBT) to enhance the way they think and behave. This type of therapy is mostly common in treating patients with anxiety and depression but also is useful in treating autism, obsessive compulsive disorder and post-traumatic stress disorder. A major limitation of traditional CBT is that therapists may face difficulty in optimizing patients’ neuropsychological stimulus following a specified treatment plan. Other limitations include availability, accessibility and level-of-experience of the therapists. Hence, this paper aims to design and simulate a generic cognitive model that can be used as an appropriate alternative treatment to traditional CBT, we term as “AR-Therapist.” This model takes advantage of the current developments of augmented reality to engage patients in both real and virtual game-based environments.

Internet Cognitive-Behavioral Therapy: Basics for the Child and Adolescent Psychiatrist

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for a range of behavioral health disorders, including depression and anxiety. CBT is traditionally conducted in-person and has been shown to have at least a 50% response rate with decrease in symptoms.1 However, there are barriers that prevent traditional CBT from being an available option. Children and adolescents may lack access to in-person CBT treatments due to various issues, such as time conflicts with school hours, lack of transportation to clinics where CBT is delivered, and an overall paucity of CBT services in the community. Additionally, patients may be reluctant to access in-person care due to stigma associated with behavioral health conditions and treatments.

Randomized controlled trial of a culturally-adapted program for Latinas with binge eating.

Binge eating disorder (BED) is the most prevalent eating disorder among Latinas. Furthermore, Latinas report more frequent binge eating and higher levels of associated mental health symptoms as compared with non-Latino White women. Research demonstrates that Latinas' eating problems largely go undetected and untreated and that they face numerous barriers to seeking professional help. Cognitive-behavioral therapy (CBT)-based guided self-help (CBTgsh) for binge eating is a more affordable and disseminable intervention than traditional CBT treatment. In this paper, we present the findings from a randomized controlled trial (RCT) of a culturally adapted CBTgsh program in a sample of overweight and obese Latinas with BED, the first RCT of this type with an ethnic minority population. Study participants (N = 40) diagnosed with BED were randomly assigned to the CBTgsh (n = 21) or waitlist (n = 19) condition. Treatment with the CBTgsh program resulted in significant reductions in frequency of binge eating, depression, and psychological distress and 47.6% of the intention-to-treat CBTgsh group were abstinent from binge eating at follow-up. In contrast, no significant changes were found from pre- to 12-week follow-up assessments for the waitlisted group. Results indicate that CBTgsh can be effective in addressing the needs of Latinas who binge eat and can lead to improvements in symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive Model for Processing Trauma in Non-PTSD Sequelae

This article proposes a model for practitioners to assist those who have recently experienced a significant distressing event, but not of the type that satisfies Category A for a diagnosis of posttraumatic stress disorder, to process trauma-related thoughts and feelings. While not intended to treat psychological disorders, the aim is to avoid psychopathology and to optimize functioning and quality of life. The nature of different thoughts and feelings are examined, and it is argued that traditional cognitive behavioral therapy and acceptance and commitment therapy can be applied to process these in a complementary, interactive, and dynamic fashion. Presented as a simple visual metaphor, the model provides a guide to assist and psychoeducate clients to identify the nature of the different trauma-related thoughts and feelings they experience, and how to best process these. A detailed vignette illustrates how the model works in practice.

Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder

Traditional cognitive-behavioral therapy (CBT) for anxiety disorders has been designed to target reductions in negative affect (NA) associated with defense-related processes. However, a subset of anxiety disorders, including social anxiety disorder (SAD), are also characterized by low positive affect (PA) resulting from separate deficits in appetitive-related processes. In contrast to CBT, “third-wave” approaches, such as acceptance and commitment therapy (ACT), align more consistently with motivational processes and, as a result, PA. However, the differential effect of CBT and ACT on PA and NA has yet to be investigated. Using secondary data from a randomized controlled trial, the present study sought to compare CBT’s (n = 45) and ACT’s (n = 35) effect on PA and NA in SAD. Findings were compared to a wait-list (WL) control condition (n = 31), as well as normative data from a general adult sample. Baseline PA and NA were also examined as moderators and predictors of theory-relevant treatment outcomes. NA decreased significantly in both CBT and ACT from pre to posttreatment. Although ACT outperformed WL in reducing NA, this effect was not observed for CBT. PA increased significantly in both CBT and ACT from pre to posttreatment, with neither ACT nor CBT outperforming WL in increasing PA. Neither PA nor NA were found to moderate theoretically relevant treatment outcomes. Findings suggest that ACT and CBT share common treatment mechanisms, making them more similar than distinct. Further efforts should be focused on optimizing CBT’s and ACT’s influence on threat and reward learning, and elucidating common processes of change.

The Impact of Integrating Physical Health into a Brief CBT Approach for Medically Ill Veterans.

The current study explored the use and preliminary outcomes of physical health treatment elements integrated into a traditional brief cognitive behavioral therapy (bCBT) approach for medically ill veterans with depression and/or anxiety. Data were collected as part of a pragmatic randomized trial examining patient outcomes of bCBT versus an enhanced usual care condition. bCBT was delivered to participants by Veterans Health Administration (VA) mental health providers in the primary care setting. Using a skill-based approach, providers and participants selected modules from a list of intervention strategies. Modules included Taking Control of Your Physical Health, Using Thoughts to Improve Wellness, Increasing Pleasant Activities, and Learning How to Relax. Skill module use and impact on treatment completion and clinical outcomes were explored for participants randomized to bCBT who received at least one skill module (n = 127). Utilization data showed that participants and providers most commonly selected the physical health module for the first skill session. Receiving the "physical health" and "thoughts" modules earlier in treatment were associated with a higher likelihood of treatment completion (defined as four or more sessions). Preliminary outcome data suggest that the physical health skill module was equally effective or superior to other bCBT skill modules. Results suggest that incorporating physical health elements with a bCBT approach hold the potential to positively impact treatment engagement/completion and may result in improved outcomes for medically ill patient populations.

Computerized Cognitive Behavioral Therapy for Substance Use Disorders: A Summary of the Evidence and Potential Mechanisms of Behavior Change.

Cognitive-behavioral therapy (CBT) is one of the most evaluated behavioral interventions for substance use disorders, with considerable empirical evidence supporting its efficacy. However, despite CBT's strong support from efficacy trials, broad dissemination and implementation have been challenging. Furthermore, there remains limited understanding regarding CBT's mechanisms of behavior change; the theory-driven assumption that individuals acquire new skills for coping with triggers for substance use has notoriously lacked statistical support. The emergence of computer-delivered interventions has the potential to address dissemination and implementation challenges, as well as offer advantages toward understanding treatment mechanisms. This article will provide a summary of the current evidence supporting one particular computerized CBT program, CBT4CBT. Multiple clinical trials in different treatment settings have indicated CBT4CBT's efficacy at reducing rates of alcohol and drug use when provided as an add-on to standard addiction treatment, as well as when provided with minimal clinical monitoring (i.e., virtual stand-alone). These effects have also been relatively durable after treatment termination, consistent with findings of traditional CBT. It is important to note that the evaluation of individuals' cognitive and behavioral coping skills prior and following treatment has indicated the acquisition/improvement of these skills may be a mechanism of behavior change for those who engage with CBT4CBT. Thus, computerized delivery may be a strategy for enhancing individuals' learning of cognitive and behavioral skills for successfully avoiding substance use. Future work should aim to identify the optimal type of setting, clinician role, and patient characteristics for targeted dissemination and implementation.

Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy

Previous research suggests that a stronger focus on positive emotions and positive mental health may improve efficacy of Cognitive Behavior Therapy (CBT). Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT (P-CBT; CBT in a solution-focused framework, amplified with optional positive psychology exercises) versus traditional, problem-focused CBT (T-CBT). Forty-nine patients with major depressive disorder (recruited in an outpatient mental health care facility specialized in mood disorders) received two treatment blocks of eight sessions each (cross-over design, order randomized). Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first, but significantly more in P-CBT compared to T-CBT during the second treatment block. Rate of improvement on the less-frequently measured secondary outcomes was not significantly different. However, P-CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Effect sizes for the combined treatment were large (pre-post Cohen's d = 2.71 for participants ending with P-CBT, and 1.85 for participants ending with T-CBT). Positive affect, optimism, subjective happiness and mental health reached normative population averages after treatment. Overall, findings suggest that explicitly focusing on positive emotions efficiently counters depressive symptoms.

Baseline Client Interpersonal Agency Moderates the Indirect Effect of Treatment on Long-term Worry in Variants of CBT for Generalized Anxiety Disorder

In a recent trial for generalized anxiety disorder (GAD), cognitive-behavioral therapy (CBT) integrated with motivational interviewing (MI) promoted more long-term worry reduction than CBT alone (Westra, Constantino, & Antony, 2016). A follow-up analysis found that CBT vs. MI-CBT clients evidenced greater increases in friendly submissiveness (FS) across treatment, which in turn promoted lower long-term worry (Constantino, Romano, Coyne, Westra, & Antony, 2018). It was unsurprising that traditional directive CBT promoted more FS than when person-centered MI was integrated; however, given that problematic low agency characterizes GAD, that greater FS promoted better outcome was unexpected. To further unpack this unexpected result, we tested the following moderated mediation hypothesis: for clients with more vs. less problematic low agency at baseline, CBT would still promote more in-session FS than MI-CBT, but this increase would in turn predict increased worry over follow-up. Clients receiving CBT (n = 43) or MI-CBT (n = 42) rated their interpersonal problems at baseline and their worry after treatment and across 12-month follow-up. Therapists rated clients’ in-session FS multiple times. As predicted, multilevel modeling revealed that for clients with more problematic low agency, CBT vs. MI-CBT facilitated greater FS, which in turn related to increased worry across follow-up. For clients with more problematic high agency, CBT’s facilitation of greater FS related to reduced worry across follow-up. A baseline interpersonal problem characteristic of GAD may have implications for treatment matching and for appreciating different pathways to long-term improvement, or deterioration, for different GAD subgroups.

New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies.

New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.

A Mobile Sleep-Management Learning System for Improving Students' Sleeping Habits by Integrating a Self-Regulated Learning Strategy: Randomized Controlled Trial.

BackgroundInsomnia can significantly affect students’ learning performance. Researchers have indicated the importance and challenge of coping with insomnia using nondrug treatments, such as cognitive behavioral therapy (CBT) for insomnia. However, it is easy for the traditional CBT for insomnia to be interrupted owing to the overly lengthy period of sleep therapy. Self-regulated learning (SRL) strategies are known to be an effective approach for helping students improve their time management, as well as their ability to set learning goals and adopt learning strategies.ObjectiveThe objective of this study was to propose a mobile sleep-management learning system integrated with SRL strategies and CBT.MethodsA total of 18 undergraduate students from a university in northern Taiwan participated in the 2-week experiment of using this sleep-management system.ResultsThe experimental results showed that the proposed approach was useful and easy for students to use. In addition, the number of students with insomnia significantly decreased; that is, the proposed approach could help students improve their sleep quality and cultivate better sleeping habits, which is important for them to enhance their learning efficiency.ConclusionsWith the assistance of this proposed approach, students can plan their daily life by setting goals, applying strategies, monitoring their life habits process, and modifying strategies to cultivate good learning and healthy lifestyle habits.Trial RegistrationGovernment Research Bulletin MOST104-3011-E038-001; https://www.grb.gov.tw/search/planDetail? id=11568383&docId=467988 (Archived by WebCite at http://www.webcitation.org/73MnPHNri)

Study protocol for a single-blind, randomised controlled, non-inferiority trial of internet-based versus face-to-face cognitive behaviour therapy for obsessive–compulsive disorder

IntroductionExpert guidelines recommend cognitive–behavioural therapy (CBT) as a first-line treatment for obsessive–compulsive disorder (OCD), but the majority of patients with OCD do not have access to CBT. Internet-delivered CBT (ICBT)...

Facets of Mindfulness Predict Depressive and Anxiety Symptom Improvement Above CBT Skills

Mindfulness training is increasingly being incorporated into traditional cognitive behavioral therapy (CBT) approaches. Although the acquisition and use of both CBT and mindfulness skills have been independently linked with positive therapeutic outcomes, the additional therapeutic benefit provided by mindfulness skills above and beyond traditional CBT skills (e.g., behavioral activation, cognitive reappraisal) is unclear. The present study tested the incremental predictive validity of mindfulness skills above CBT skills in predicting depressive and anxiety symptom improvement within a psychiatric hospital unit incorporating training in both CBT and mindfulness skills. Adult patients (N = 134, mean age = 34.0, 47.8% females, 90.3% White) with depression and anxiety receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of CBT skills (Cognitive Behavioral Therapy-Skills Checklist), mindfulness skills (Five Facet Mindfulness Questionnaire), and both depressive (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder Scale-7) symptoms. We tested whether mindfulness skills and/or CBT skills predicted depressive and anxiety symptom improvement. Higher levels of both mindfulness skills (rs = − .15 to − .51) and CBT skills (rs = − .12 to − .21) were cross-sectionally associated with lower depressive and anxiety symptoms. However, while controlling for CBT skills, two mindfulness facets (nonreactivity to inner experience and acting with awareness) predicted subsequent depressive (ts < − 2.49, ps < .014) and anxiety (ts < − 2.31, ps < .022) symptom improvement, thus demonstrating incremental predictive validity. Findings suggest the potential therapeutic benefits of mindfulness skills training for depressed and anxious patients within the context of short-term, intensive psychiatric treatment.