认知行为疗法在儿童社会退缩行为干预中的新进展

社会退缩行为指儿童在社会情境中抑制自己参与同伴互动并表现出独处的行为。社会退缩阻碍儿童形成良好的社交能力,影响其人格和认知的健康发展,因而对儿童社会退缩行为进行及时干预显得十分重要。研究对认知行为疗法在儿童社会退缩行为干预中的进展进行了整合,包括虚拟现实暴露疗法、学校情境下的认知行为治疗及网络认知行为治疗。未来研究应设计针对社会退缩行为不同亚类型的干预方案,以及在干预中重视情绪调节的训练和教师的介入。     

认知行为疗法治疗儿童青少年强迫症的应用研究

强迫症已经被认为是儿童青少年常见的心理障碍之一。强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相对较少。认知行为疗法被广泛认为是治疗儿童青少年强迫症的有效心理治疗方案,但对于认知行为治疗儿童青少年强迫症的实证研究还有待进一步深入。     

认知行为疗法治疗儿童青少年强迫症的应用研究

强迫症已经被认为是儿童青少年常见的心理障碍之一.强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相时较少.认知行为疗法被广泛认为是治疗儿童青少年强迫症的有效心理治疗方案,但对于认知行为治疗儿童青少年强迫症的实证研究还有待进一步深入.     

认知行为疗法在心理剧中的运用

心理剧的各个阶段都融合了认知行为疗法的元素。近年来,主要通过两种形式将认知行为疗法运用于心理剧中：一种是将认知行为疗法特有的技术应用于心理剧中;另一种是对古典心理剧中的角色赋予更多认知的功能。本文最后对认知行为疗法在心理剧中的运用进行了评价。     

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。     

交往在儿童认知发展中的作用

一、引言皮亚杰发生认识论中关于儿童守恒概念的研究是人们早已熟悉的课题。他的认知发展阶段理论在世界各地跨文化研究中得到了大量支持的材料,但也受到来自不同方面的挑战。当代认知心理学家通过训练或改进实验技术使前运演阶段的儿童完成具体运演阶段的作业。Gellman(1969年)让儿童自己运用各种方式摆弄物体,成人给以反馈信息使4和5岁的幼儿园儿童获得守恒。70年代以来,欧洲的心理学界出现了一种新的研究趋向,即“发生社会心理学”。他们重视社会作用对儿童认知发展的因果关系,注意到儿童之间相互交往对认知发展的作用,     

理性情绪行为疗法在军人心理疏导中的运用

理性情绪行为疗法（REBT）是一种在临床和教育领域运用非常广泛的一种认知行为疗法。它强调认知对人的情绪与行为的决定作用,提供了一种战胜不合理信念、改变不良情绪的有效方式,引导青年官兵克服由于现实生活和自然环境压力导致的心理困惑和情绪障碍,培养官兵积极健康科学的认知模式,这对部队的稳定发展具有积极的现实意义。     

案例概念化在临床上的应用

随着心理治疗方法的发展, 案例概念化作为治疗工作的重要组成部分, 日益成为临床关注的热点。案例概念化主要指在一定治疗理论的基础上, 就来访者的问题成因和维持因素提出假设, 为构建治疗方案提供指导蓝图。西方的临床研究表明案例概念化能有效地促进咨询师和来访者对于问题的认识和理解, 提高治疗效果。以认知行为治疗理论为基础, 具体地介绍案例概念化技术在焦虑症和抑郁症的临床应用。     

论行为疗法与森田疗法在神经症治疗中的优势互补

针对神经症的行为疗法与森田疗法进行了多方面的比较,认为两种疗法在临床实践中都是以行为为核心的;但二者所侧重的行为并不相同,在治疗目标上也不相同,行为疗法与森田疗法在神经症治疗中存在优势互补的可能性与必要性.     

浅谈儿童焦虑症的病因与治疗方法

据调查,近年来我国患焦虑症的儿童越来越多,存在着心理障碍特别明显,如厌学、抑郇、焦虑、恐怖等。其中,焦虑症也为普遍一些。一、儿童如何产生焦虑症呢？通常情况下,心理健康的儿童,能以积极。有效的心理活动,平稳、正常的心理状态,对学校和自然环境作出良好适应。如何做不到这一点,     

Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40%–50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9–14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At posttreatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at 2-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to posttreatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.     

The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.     

Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

The Effectiveness of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in a Frontline Service Setting

The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty‐nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent‐to‐treat sample, there were no significant changes in worry or depression from pre‐ to posttreatment. Treatment completers showed significant pre‐ to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self‐reported worry and depression.     

A Case Study of Individually Delivered Mindfulness-Based Cognitive Behavioral Therapy for Severe Health Anxiety

Health anxiety involves persistent worry about one's physical health, despite medical reassurance. Cognitive-behavioral therapy (CBT) is currently the most widely used, evidence-based treatment for health anxiety. Mindfulness-based cognitive therapy (MBCT) is an evidence-based cognitive-behavioral treatment approach that may be useful for health anxiety due to its focus on nonjudgmental awareness and acceptance of physical and emotional events. MBCT has largely been evaluated in a group format; however, the majority of outpatient CBT providers rely also on individual treatments. No research to date has examined the utility of MBCT delivered as an individual therapy for patients with health anxiety. The purpose of the current case study is to describe the delivery, acceptability, and effects of an individually delivered mindfulness-based cognitive-behavioral intervention on health anxiety symptoms for a young woman with severe health anxiety referred to outpatient behavioral medicine by her primary care provider. The treatment was a 16-session, patient-centered intervention largely delivered using MBCT techniques, supplemented by traditional cognitive-behavioral techniques. The patient completed a validated self-report measure of health anxiety symptoms (SHAI) at the beginning of each session. The treatment was found to be acceptable, as evidenced by high treatment attendance and patient feedback. The patient reported significant cognitive, affective, and behavioral improvements, including a 67% reduction in medial visits. Health anxiety scores on the SHAI showed a 52% decrease from the first to last session, reliable change index score of 12.11, and fell below the clinical cutoff at the final session, demonstrating clinical significance. These results suggest that it is feasible to adapt MBCT for the individual treatment of health anxiety, and that controlled trials of individual MBCT are warranted.     

Cognitive Behavioral Therapy for Social Anxiety Disorder: Predictors of Treatment Outcome in a Quasi-Naturalistic Setting

We examined the outcomes of individual cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) in a sample of 93 adults seeking treatment in a university outpatient clinic specializing in CBT for SAD. Treatment followed the structure of a manual, but number of sessions varied according to client needs. After approximately 20 weeks of therapy, patients’ social anxiety had decreased and their quality of life had increased. Patients with more severe SAD or comorbid major depressive disorder (MDD) at pretreatment demonstrated higher levels of social anxiety averaged across pre- and posttreatment. However, clinician-rated severity of SAD, comorbid MDD, or comorbid generalized anxiety disorder did not predict treatment outcome. Higher pretreatment scores on measures of safety behaviors and cognitive distortions were associated with higher social anxiety averaged across pre- and posttreatment and predicted greater decreases from pre- to posttreatment on multiple social anxiety outcome measures. We found no predictors of change in quality of life. Those with high levels of safety behaviors and distorted cognitions may benefit more from CBT, perhaps due to its emphasis on targeting avoidance through exposure and changing distorted thinking patterns through cognitive restructuring methods. Our study lends support to the body of research suggesting that manualized CBT interventions can be applied flexibly in clinical settings with promising outcomes for patients over a relatively short course of therapy.     

Predictors and Outcomes of Sudden Gains and Sudden Regressions in Cognitive Behavioral Therapy for Youth Anxiety

Sudden gains (SGs), referring to large, stable symptom improvement occurring between consecutive treatment sessions, have been associated with improved outcomes among adults with various psychological disorders. Little research exists on SGs or sudden symptom worsening (i.e., sudden regressions [SRs]) during treatment for youth disorders. The current study examined predictors and outcomes of SGs/SRs via multiple informants in youth anxiety treatment. Participants were 118 youth (age M = 11.6, SD = 2.5; 53.8% female) and their caregivers receiving a cognitive-behavioral therapy protocol for a principal anxiety disorder. Anxiety symptom severity was assessed weekly via the State-Trait Anxiety Inventory for Children–Trait–Child/Parent versions. SGs and SRs occurred in 45.8 and 31.3% of youth, respectively. SRs were more common among youth with comorbid mood or externalizing disorders, while SGs occurred more often among youth with greater pretreatment anxiety symptom severity. SGs were not associated with posttreatment outcomes, but SRs predicted significantly higher posttreatment internalizing symptoms based on child report (β = .23, p = .03) and externalizing symptoms based on child (β = .15, p = .04) and parent report (β = .16, p = .03), controlling for overall magnitude of symptom change. SRs among youth receiving cognitive-behavioral therapy for anxiety are associated with pretreatment clinical complexity and poorer posttreatment outcomes and may serve as a warning sign to clinicians of possible treatment failure.