Treating Procrastination Using Cognitive Behavior Therapy: A Pragmatic Randomized Controlled Trial Comparing Treatment Delivered via the Internet or in Groups

Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress. Cognitive behavior therapy (CBT) is believed to reduce procrastination, but few studies have investigated its effectiveness in a regular clinical setting. The current study explored its effects using a pragmatic randomized controlled trial comparing treatment delivered during 8 weeks as self-guided CBT via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures on procrastination, depression, anxiety, and well-being were distributed at pre- and posttreatment as well as 6-month follow-up. An outcome measure of procrastination was administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed large within-group effect sizes on procrastination, Cohen’s d of 1.29 for ICBT, 95% Confidence Interval (CI) [0.81, 1.74], and d of 1.24 for group CBT, 95% CI [0.76, 1.70], and small to moderate benefits for depression, anxiety, and well-being. In total, 33.7% were regarded as improved at posttreatment and 46.7% at follow-up. No differences between conditions were observed after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in self-guided ICBT showed some signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for those struggling with severe procrastination, but that a group format may be better for some to sustain their benefits over time and that the clinical significance of the results need to be investigated further.     

Is the Impact of Psychotherapy Processes on Outcomes Already Quacking and Waddling? Comment “A Primer on Psychotherapy Process Research (Pfeifer & Strunk, 2015)”

The article by Pfeifer and Strunk on psychotherapy process research offers a highly thoughtful review on the state of psychotherapy process research in cognitive therapy for depression, and the inherent challenges in establishing causal relationships between process and outcomes. In this commentary, I argue that the goal of internal validity in psychotherapy process research may be unattainable, and possibly unnecessary. Finally, I suggest that psychotherapy process research should shift from “does it affect change?” to “how does it affect change?”, “when does it affect change?”, and “for whom does it affect change?”     

Reasons Why Rational Emotive Behavior Therapy Is Relatively Neglected in the Professional and Scientific Literature

Although rational emotive behavior therapy (REBT) has been the pioneering cognitive behavior therapy (CBT) of the twentieth century, and although its main methods are very popular among practicing clinicians as well as members of the public, it has been relatively neglected in the professional and scientific literature. Reasons for this neglect are discussed and some steps are suggested to make REBT more effective and more scientifically accepted.     

Reasons Why Rational Emotive Behavior Therapy Is Relatively Neglected in the Professional and Scientific Literature

Although rational emotive behavior therapy (REBT) has been the pioneering cognitive behavior therapy (CBT) of the twentieth century, and although its main methods are very popular among practicing clinicians as well as members of the public, it has been relatively neglected in the professional and scientific literature. Reasons for this neglect are discussed and some steps are suggested to make REBT more effective and more scientifically accepted.     

Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents With ADHD Using a Randomized Controlled Trial

Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents’ reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

森田疗法与认知行为疗法的比较分析

阐述森田疗法和认知行为疗法的基本理论,在此基础上对两种疗法作比较分析。尽管这两种心理治疗方法在治疗程序和具体操作方法上迥然不同,但在发病机制的解释和治疗原理方面,它们又有很多相似之处,对存在这种现象的原因进行了探讨。     

A Special Feature in Commemoration of Aaron T. Beck’s Contributions to the Science and Practice of CBT

This special feature in Cognitive and Behavioral Practice is a commemoration to Aaron T. Beck’s contributions to the science and practice of CBT. The fact that so many leading scholars participated, including several Past Presidents of the Association for Behavioral and Cognitive Therapies, speaks volumes about the high regard held for Beck. Included are papers that cover the Beckian model of depression, its refinement and application to obsessions, compulsions, hoarding, as well as how the model addresses interpretational biases in emotional psychopathology and has been adapted for youth. Additionally there are papers conveying how Beck’s phenomenological approach to understanding the client’s perspective is useful in attending to cultural differences, and in mitigating the mental health impact of marginalization and discrimination. Expert commentaries are extended to relational processes (case formulation, therapeutic relationship, collaboration and guided discovery, alliance, rupture repair, homework), change processes (cognitive reappraisal, dialectical thinking, acceptance and defusion, emotional schemas), and to important scientific advances (conceptualizing processes within techniques, data analytic advances that bridge the scientist-practitioner gap, and technology augmentation). Many of the contributions herein also include brief personal stories to help illustrate the enormity of Beck’s contributions.     

Rethinking safety behaviors in insomnia: examining the perceived utility of sleep-related safety behaviors

Harvey's cognitive model of insomnia (2002a) proposes that sleep-related safety behaviors play a central role in the maintenance of insomnia because such maladaptive coping strategies are thought to reinforce threat-based appraisals of the likelihood and consequences of poor sleep. Research to date has assessed the frequency of safety behavior use in those with insomnia only; however, in addition to the frequency of occurrence, the function of safety behaviors (i.e., a belief that they will prevent a feared outcome from occurring), may be an important consideration. The purpose of this study was to examine sleep-related safety behaviors based on an expanded theoretical understanding of such behaviors across psychological disorders; that is, by examining both their frequency and perceived utility. Undergraduate students (N = 376) completed an online survey about their sleep, mood, and use of sleep-related safety behaviors. Insomnia severity was associated with a greater perceived need to use safety behaviors (i.e., utility) but not with frequency of safety behavior use. Higher perceived utility of safety behaviors was also associated with unhelpful beliefs about sleep, fear and avoidance of fatigue, and both general and sleep-specific helplessness. These results suggest that these behaviors and the associated underlying maladaptive beliefs may be important targets in cognitive behavioral therapy for insomnia. The current study extends the existing literature and refines the concept of safety behaviors in insomnia to include both the function and frequency of these behaviors.     

A Study of Volunteer Clients Who Experienced Live Sessions of Rational Emotive Behavior Therapy in Front of a Public Audience

This is a study of the responses of 100 selected subjects who gave their reactions to experiencing a live session of Rational Emotive Behavior Therapy (REBT) with Albert Ellis in front of a public audience. Ninety-seven of the respondents found their session helpful; only 13 felt uncomfortable discussing their problems in public; 99 of them felt that Dr. Ellis focused on their main problem; 94 of them reported that they somewhat or very much used Dr. Ellis's suggestions; 90 of them felt that the members of the audience suggestions were helpful; and 93 of them said that they would like to work with Dr. Ellis again at a public therapy session. Limitations of this study are discussed.     

What Cognitions Predict State Anger?

This study evaluated the relationship between specific cognitions and state anger. Clinical outpatients (23%), workplace recruits (37%), and college students (40%) (N = 236, mean age = 31.68) completed a questionnaire, the Anger Episode Record (AER), which asked them to describe an experience that elicited feelings of irritation, annoyance, anger, fury, or rage. They rated the intensity of their anger, cognitions, physiological responses, behaviors, and consequences for the specific episode. A stepwise multiple regression suggests that cognitions for revenge accounted for the greatest variance in predicting state anger, R = .26, p = .00, followed by demands on event, R = .32, p = .00, self-efficacy, R = .37, p = .00, and demands of others, R = .39, p = .04, respectively. The role of these cognitions in psychotherapy and interventions for angry clients is discussed.     

Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

This study evaluated an inference‐based approach (IBA) to the treatment of obsessive‐compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. “Maybe the door is open”, “My hands could be dirty”) as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty‐four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y‐BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.     

医学模式的转变与对腰痛患者实施认知行为治疗

随着医学模式从生物医学模式向生物-心理-社会医学模式的转变,心理社会因素对腰痛患者疼痛的影响亦日益引起社会的普遍关注.从心理社会因素对腰痛患者疼痛的影响探讨医学模式转变的必要性以及给腰痛患者实施认知行为治疗的可行性.     

Cognitive-Behavioral Constructs and Children's Behavioral and Emotional Problems

Each cognitive behavior therapy has produced research concerning the cognitive construct it posits to mediate psychopathology. This study attempted to compare the major cognitive behavioral constructs to determine how they are related to each other and how each is related to teachers' perception of externalized and internalized behavioral and emotional problems. Children between the ages of 9 to 13 were classified as internalized, externalized, mixed, or no behavior and emotional problems groups according to their scores on the Teacher's Report Form of the Child Behavior Checklist and teachers' ratings on the Walker Problem Identification Scale. Measures of Ellis' (1962) irrationality, Beek's (1976) negative automatic thoughts, Spivack's (Spivack, Platt, & Shure, 1976) social problem skills, and Meichenbaum's (1977) guiding self statements were administered to the children. The results indicated that the various cognitive constructs were only moderately correlated with each other. Irrational beliefs and cognitive distortions were correlated higher than other comparisons. The correlations between the measures of the constructs suggest they are slightly related but represent different constructs. The emotional and behavioral problems groups scored higher than the no problems group on some subtest of irrational beliefs and negative cognitive thoughts. Also, the measures of emotional and behavior problems correlated significantly with some subtest of irrational beliefs and negative automatic thoughts. Irrational beliefs appeared to be related to internalized and externalized emotional and behavioral problems, while negative automatic thoughts appeared to be best related to internalized emotional and behavioral problems. The measures of problem solving skills and guiding self statements appear to be best related to externalized problems.     

Executive Coaching and REBT: Some Comments from the Field

Executive Coaching comprises personal counseling, business advice, and advice about managing for people who are in executive management. This involves a one-to-one helping relationship between coach and client. In each case for which executive coaching is sought, there are problems the client has encountered which requires changes in client behavior. REBT, with its blend of easy understandability and direct applicability to client problems, is an ideal tool for use in executive coaching. Clients readily understand the A-B-C-D connections and are able to effect changes in behavior. The article includes case examples.     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.     

Combining Pharmacotherapy with Cognitive‐Behavioral Interventions for Obsessive‐Compulsive Disorder

This paper reviews the evidence‐based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive‐compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin re‐uptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision‐making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.