An evaluation of the effectiveness of Diploma-level training in cognitive behaviour therapy

Background

As part of the UK government’s initiative to Increase Access to Psychological Therapies (see http://www.iapt.nhs.uk/for full details of the IAPT programme) there has been an expansion in the provision of post-graduate Diploma training in cognitive behaviour therapy (CBT). Previous evaluations of such training programmes have yielded mixed results but have been limited by small sample sizes and/or limited assessment measures.

Aims

To evaluate the impact of a long-standing Diploma in CBT training programme on a variety of measures of CBT competence.

Method

Trainees’ levels of CBT skill are compared at the beginning and end of CBT training. The effect of therapist factors such as age, professional background and gender on the development of CBT competence is also examined.

Results

Results show that trainees demonstrate higher levels of CBT skills after completing the training than they did before, with the majority achieving pre-determined criteria for competence. Trainees’ gender was not related to their performance but trainees’ age showed a negative association with CBT skill (older trainees performed worse). Trainees’ professional background also had an impact on their level of CBT competence, with trainees who were clinical psychologists demonstrating the highest levels of competence across a range of measures.

Conclusions

CBT Diploma training leads to increases in the level of trainees’ CBT competence, with the majority achieving the levels demonstrated in research trials by the end of training. Thus, this training is likely to lead to improved outcomes for patients. Further research is needed to determine the most efficient ways of enhancing CBT skills.     

The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder

Background

Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high.

Aim

To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for BPD.

Method

EA and depression were assessed in 81 clients at baseline and 4-month intervals during 1 year of therapy. Simple correlations, hierarchical linear modeling, and latent difference score models were used to investigate the association between self-reports of EA and both self-reports and observer-based ratings of depression.

Results

EA was positively associated with greater severity of depression at all points of assessment, and changes in EA were positively associated with changes in depression. Moreover, EA significantly predicted less subsequent reduction in depression whereas no such effect was found for depression on subsequent EA.

Conclusion

The findings are consistent with the hypothesis that EA impedes the reduction of depression in the treatment of BPD and should thus be considered an important treatment target.     

Interpersonal evaluation bias in borderline personality disorder

Background

The cognitive theory of personality disorders hypothesizes that the emotional dysregulation and interpersonal problems in individuals with borderline personality disorder (BPD) are, at least partially, caused by dysfunctional cognitive schemas. These schemas lead to biased evaluation of environmental and interpersonal stimuli.

Method

This study examined the interpersonal evaluations of individuals with BPD, depressive and healthy control participants with the thin-slice judgments paradigm. Participants were asked to evaluate six persons in six film clips, which showed these persons for 10 s, during which these persons entered a room and took a seat. Interpersonal style of the BPD group was investigated with the Inventory of Interpersonal Problems (IIP-C) questionnaire.

Results

Individuals with BPD judged the persons as being more negative and aggressive and less positive than the healthy participants, and more aggressive than the depressive individuals. In addition, individuals with BPD reported more extreme interpersonal behavior relative to the controls.

Conclusions

The findings indicate an aggressivistic evaluation bias and elevated levels of interpersonal problems in individuals with BPD as suggested in the cognitive theory.     

The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery

Background

The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.

Aims

To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.

Method

101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions (‘Overcoming Bulimia Online’), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.

Results

There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.

Conclusions

The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.     

An assessment of the similarities between a measure of positive perfectionism and a measure of conscientious achievement striving

Objectives

The purpose of the study was to examine the similarities between the constructs measured by the positive perfectionism subscale from the Positive and Negative Perfectionism Scale and the achievement striving subscale from the Revised NEO Personality Inventory.

Design

A non-experimental design was adopted.

Method

One-hundred and seventy-nine junior basketball players (age M = 16.50, s = 1.12) completed measures of positive perfectionism, conscientious achievement striving and other external measures.

Results

Analyses revealed that the two scales were highly positively correlated and demonstrated a similar pattern of relationships with the external measures. However, a single latent factor model provided a comparatively poorer fit than a two latent factor model.

Conclusions

There is some evidence that the positive perfectionism and achievement striving constructs measured by the scales in this study are distinguishable as two distinct factors in a confirmatory factor analysis; however, more empirical evidence is needed to establish their substantive differences.     

Contextual and individual influences on antisocial behaviour and psychobiosocial states of youth soccer players

Purpose

The aim of the study was to assess the effects of contextual and individual variables (perceived motivational climate and moral atmosphere, task/ego orientation and perceived competence) on antisocial behaviour and emotion-related psychobiosocial (PBS) states as conceptualised within the individual zones of optimal functioning model.

Participants

The study was conducted on a sample of 382 young male soccer players, aged from 14 to 16 years, drawn from 27 Italian teams.

Method

A cross-sectional design was used. Assessment included measures of reported antisocial behaviour, perceived moral atmosphere, perceived motivational climate, goal orientation, perceived competence, and PBS states. Data analysis involved confirmatory factor analysis of measures and path analysis of the hypothesized relationships.

Results

Results suggest that performance climate and a moral atmosphere, in which aggressive behaviours are encouraged, are likely to determine antisocial behaviour and a range of unpleasant PBS states in young sports participants.

Conclusions

Findings substantiate the importance of the situational factors on ethical aspects and emotional states in youngsters.     

The diagnostic utility of the Screen for Child Anxiety Related Emotional Disorders-71 (SCARED-71)

Objective

This study investigated the diagnostic utility of the 71-item Screen for Child Anxiety Related Emotional Disorders (SCARED-71), as a screening tool for identifying anxiety disorders in youth aged 8-18 years.

Method

The SCARED-71 and the Anxiety Disorder Interview Schedule (ADIS) were administered to clinically referred anxious children (n = 138) and control children (n = 38) as well as their parents.

Results

Results showed that the SCARED-71 differentiated clinically anxious from control children on the total score and on all subscales. Girls generally reported higher levels of anxiety symptoms and there were also significant age effects for various anxiety subscales. Further, reliable cut-off scores were established for the child and parent version of the SCARED-71. The parent version displayed better sensitivity and specificity, and therefore seems to be a more optimal screen for anxiety problems in children and adolescents. Finally, evidence for the predictive validity across anxiety disorders was found.

Conclusion

The SCARED-71 can be used as a screening tool to detect clinically significant anxiety problems in children and adolescents and discriminates reasonably well among specific anxiety disorders.     

Extreme judgments depend on the expectation of following judgments: A calibration analysis

Objectives

Judges avoid extreme judgments in the beginning of evaluation sequences. The calibration hypothesis attributes this bias to judges’ need to preserve their judgmental degrees of freedom. It follows that the expectation of a sequence leads to avoiding extreme judgments in the beginning. Thus, judges may make extreme judgments if they expect only one performance but should avoid extreme judgments if they expect a sequence.

Design

A between-group design was used.

Method

One experimental group (n = 21) expected to judge only one gymnastics performance whereas the other group (n = 20) expected to judge a sequence of performances. Both groups then judged only one identical performance.

Results

Groups differed significantly in the frequency of extreme judgments. Participants expecting one performance used extreme judgment categories more often; participants expecting a series avoided extreme judgments.

Conclusion

The results support calibration processes in sequential judgments. The specification of the underlying process will allow testing possible interventions to avoid serial position biases in serial evaluations in the future.     

The developmental activities engaged in by elite youth soccer players who progressed to professional status compared to those who did not

Objectives

We examined differences in the development pathways of elite youth soccer players in England who progressed to professional status in adulthood compared to those who did not.

Design

Comparative research design.

Method

Participants were elite youth soccer players (n = 32, 15 years of age). They completed the Participation History Questionnaire (PHQ; Ford, Low, McRobert, & Williams, 2010) under supervision.

Results

The participation history profiles of professional players followed the early engagement pathway in which they engaged in significantly more soccer play and practice compared to elite youth players who did not become professional, supporting previous work (e.g., Ford, Ward, Hodges, & Williams, 2009). The two groups of players engaged in four other sports, suggesting greater diversification than previously reported for soccer players, but less than that found in studies of team sport athletes in Australia and North America.

Conclusions

Professional soccer players in England follow an early engagement pathway during childhood and early adolescence.     

Loss of control eating and psychological maintenance in children: An ecological momentary assessment study

Objective

Recent research suggests that binge eating is a common experience in youth. However, it remains largely unknown how children's binge eating presents in everyday life and which psychological factors serve to maintain this binge eating.

Methods

Children aged 8-13 years with binge eating (n = 59), defined as at least one episode of loss of control (LOC) over eating within the past three months, and 59 matched children without LOC history were recruited from the community. Following a combined random- and event-sampling protocol, children were interviewed about their day-to-day eating behavior, mood, and eating disorder-specific cognitions using child-specific cell phones during a 4-day assessment period in their natural environment.

Results

LOC episodes led to a significantly greater intake of energy, particularly from carbohydrates, than regular meals of children with and without LOC eating. While LOC episodes were preceded and followed by cognitions about food/eating and body image, there was minimal evidence that negative mood states were antecedents of LOC eating.

Conclusions

The results provide support for the construct validity of LOC eating in children. Maintenance theories of binge eating for adults apply to children regarding eating disorder-specific cognitions, but the association with affect regulation difficulties requires further investigation.     

The social environment and developmental experiences in elite youth soccer

Objectives

We aimed to examine social-contextual correlates of players’ developmental experiences in an elite youth soccer context. Specifically, we hypothesized that player perceptions of team cohesion and coach rapport would be positively associated with psychological need fulfillment. In turn, psychological need satisfaction was proposed to be positively related to adaptive developmental experiences in youth soccer (i.e., opportunities for leadership, emotional regulation, and goal setting), and negatively related to social exclusion.

Design

Cross-sectional.

Method

133 male elite soccer players, aged between 11 and 18 years old, completed a self-report questionnaire assessing the variables of interest.

Results

Using path analysis and bootstrapping methods, we found support for the overall model fit of the hypothesized conceptual framework and specific study hypotheses.

Conclusions

This study utilizes strong theoretical foundations to underscore the role of the coach and team environment in facilitating positive youth outcomes, and highlights a potential mechanism that may explain these processes.     

The relationship between psychosocial developmental and the sports climate experienced by underserved youth

Objectives

This study was designed to assess developmental outcomes underserved youth report from their sports participation; identify perceptions of the sports climate their coaches create; and, measure the relationships between participants reported gains and perceptions of the psychosocial sports climate.

Method

Participants were 239 urban youth sports participants from an underserved community who completed the Youth Experiences Scale (YES-2), Sport Motivational Climate Scale, Caring Climate Scale and measures of the importance their coaches placed on life skills.

Results

Multivariate analyses revealed a number of significant relationships between YES-2 outcomes and motivation and caring climate predictor variables, which clearly show that the more coaches create caring, mastery-oriented environments, the more likely positive developmental gains result.

Conclusion

These findings are consistent with the previous motivational (Smith, Smoll, & Cumming, 2007) and caring climate (Fry & Gano-Overway, 2010) research and shows that coaching actions and climates have an important influence on personal and social development of young people.     

Emotion-regulation skills as a treatment target in psychotherapy

Background

Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders.

Aim

To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions.

Method

Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial.

Results

Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health.

Conclusion

Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions.     

Cognitive style and depressive symptoms in elderly people - Extending the empirical evidence for the cognitive vulnerability-stress hypothesis

Introduction

Depression is common in older people and its identification and treatment has been highlighted as one of the major challenges in an ageing world. Poor physical and cognitive health, bereavement, and prior depression are important risk factors for depression in elderly people. Attributional or cognitive style has been identified as a risk factor for depression in children, adolescents and younger adults but its relevance for depression and mood in elderly people has not been investigated in the context of other risk factors.

Method

Sixty-four older adults from an ‘extra care’ living scheme (aged 59-97) were recruited for a 6-week prospective study to examine the relationships between cognitive style and depressive symptoms.

Results

Regression analyses revealed that, when other risk factors were controlled for, cognitive style and its interaction with stress predicted changes in depressive symptoms, therefore partially replicating prior research.

Conclusion

Cognitive-stress-vulnerability models also apply to elderly populations, but may be rather predictive of changes in depression when facing lower levels of stress.     

“You’re only as good as your weakest link”: Implicit theories of golf ability

Objectives

The purpose of this study was to examine the antecedents, specificity, and ceiling effects of golfers’ implicit theories of sport ability.

Design

The present study employs a qualitative research design. A constructivist grounded theory methodology was adopted.

Method

Participants (N = 8) were asked to describe their conceptions of golf ability. All responses were recorded, transcribed, and the data were analyzed through a series of iterations, which led to the identification of three dimensions that constitute golfers’ beliefs about ability.

Results

The three dimensions were: acquirable ability, stable ability, and developing natural attributes. Categories within these dimensions offer initial evidence for the role of social agents and the inherent culture of golf in shaping co-existing beliefs in relation to sport ability. Beliefs with regards to ceiling effects of ability are reported, with one theme proposing a ceiling to sport ability, and a contrasting category exemplifying the belief that there is always room for improvement.

Conclusions

The present study contributes to the field by offering initial evidence for the antecedents, specificity, and ceiling effects of golfers’ conceptions of their sport ability. Implications, both theoretical in terms of future research, and practical with regards to practitioners’ role in educating athletes and cultivating an environment conducive to the perception that sport ability is acquirable, are offered.     

Examining the dimensional structure and factorial validity of the Bar-On Emotional Quotient Inventory in a sample of male athletes

Objectives

Research examining how emotional intelligence (EI) relates to the performance of athletes has been conducted using various EI measures including the Bar-On Emotional Quotient Inventory (EQ-i; Bar-On, 1997), but no one has investigated the factor structure of the EQ-i in the area of sport psychology. The current study explored the dimensional structure and factorial validity of the EQ-i in a sample of male athletes.

Design

Confirmatory factor analysis was used to examine [Bar-On, 1997] and [Bar-On, 2004] model of emotional-social intelligence and the 1-5-15 dimensional structure which underpins the EQ-i.

Method

A total sample of 706 male athletes from various sports and competing at the national age group level through to the professional level of competition completed the EQ-i.

Results

Confirmatory factor analyses demonstrated that the 1-5-15 dimensional structure was a poor fit for the data. A re-specification of the model representing the best fit for the data was a 1-4-15 dimensional structure. The factorial validity of the individual subscales was also examined at the item level using confirmatory factor analysis. Thirteen of the 15 subscales showed close, reasonably good, or mediocre fit for the data.

Conclusion

Further construct validation of Bar-On’s model and measure is required. Sport psychologists administering the EQ-i in applied practice should consider using the EQ-i subscales rather than referring back to the 1-5-15 dimensional structure.     

Appearance vs. health motives for exercise and for weight loss

Objective

This study had three primary aims: (1) to investigate differences between restrained and unrestrained eaters in their reasons for exercise and their motives for losing weight; (2) to investigate the association of appearance and health motives for exercise and for losing weight with body image concerns; and (3) to determine whether appearance motives for exercise and for losing weight mediate the link between internalized societal standards of attractiveness and body image concerns.

Design

Cross-sectional survey.

Method

205 women completed measures of dietary restraint, reasons for exercise, motivation for losing weight, internalization of societal standards of attractiveness, and body image concerns.

Results

Unrestrained eaters were more motivated to exercise and to lose weight for health reasons than for appearance reasons, whereas restrained eaters were equally motivated by appearance and health reasons. Appearance-based motives for exercising and for losing weight were positively associated with body image concerns, whereas health-related reasons for exercise were negatively associated with body image concerns. Furthermore, in a multiple mediation analysis, appearance motives for weight loss mediated the relation between internalization of societal standards of attractiveness and body image concerns, but appearance reasons for exercise did not.

Conclusion

These findings indicate that appearance-based motives for exercise and weight loss are associated with negative outcomes. Efforts to promote exercise and weight management should emphasize the health benefits rather than the implications for appearance.     

Knowledge of results after relatively good trials enhances self-efficacy and motor learning

Objectives

This study sought to determine whether learners’ self-efficacy and motor learning was affected by the type of feedback they were provided.

Method

Participants (N = 24, M age = 19.51 years, SD = 1.08) were randomly assigned into one of two groups: knowledge of result after good versus poor trials. The task included throwing a tennis ball with the non-dominate hand to a target while wearing vision distorting goggles. Participants completed the Self-Efficacy Scale (Bandura, 2006) before performing each block of 6 trials. A retention test without knowledge of results was conducted 24 h after the practice phase.

Results

The results demonstrated that learners’ motor learning was increased by providing knowledge of results after good rather than poor trials. Furthermore, the Self-Efficacy Scale results revealed that learners’ self-efficacy was enhanced by positive feedback.

Conclusions

The current findings indicate that positive feedback impacts learner’s self-efficacy, and enhances performance and motor learning.     

Fitness correlates of obligatory versus health motives for exercise: An examination of men in the military

Objectives

To examine quantity of exercise and motives for exercise as predictors of men in the military’s health and fitness level.

Design

Participants completed a survey to address research questions of interest.

Methods

One-hundred and fourteen men who were active duty Air Force members, with a mean age of 31.43 years (SD = 7.43) and an average military time in service of 10.66 years (SD = 7.75), completed a modified version of the Reasons for Exercise Inventory, a survey assessing their quantity of exercise, and reported their most recent score on their Air Force Fitness Test.

Results

Correlational analyses indicated a relation between quantity of exercise and men’s score on the Air Force Fitness Test and a relation between intrinsic motives for exercise and quantity of exercise. Intrinsic motivation was found to moderate the relation between quantity of exercise and men’s health and fitness score.

Conclusions

Men in the military who exercise because of their military obligation are less likely to score high on the Air Force Fitness Test than are men who are motivated to exercise for health benefits.