Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

Cognitive behaviour therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study

Background

Mental health problems such as depression and anxiety are common in Multiple Sclerosis (MS) and are often under treated.

Aims

This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous randomised controlled trials (RCTs) of cognitive behaviour therapy (CBT) in this population.

Methods

49 patients were deemed appropriate for CBT and 29 accepted treatment. Assessments were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale. Results in the form of a standardized effect of treatment were compared with five previous RCTs.

Results

The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety. The uncontrolled effect size was large but inferior to those found in published RCTs.

Conclusions

Cognitive behaviour therapy is effective for people with MS in routine clinical practice. Possible limits on effectiveness include more liberal patient selection, lack of specificity in rating scales and heterogeneity of target problems. Given the high rates of distress in this population, routine psychological interventions within neurology services are justifiable. Future research should aim to maximise CBT in such settings.     

Cognitive Flexibility and Pro‐environmental Behaviour: A Multimethod Approach

While cognitive flexibility has been hypothesized to relate to adaptive, long‐term‐oriented behaviour, empirical support for such a relationship is scarce. In the present article, we examine the role of cognitive flexibility as a correlate of long‐term‐oriented behaviour in the domain of environmental conservation. In a first study (N = 143), we explored potential associations between multiple self‐report scales and performance‐based measures of cognitive flexibility and pro‐environmental behaviour. Based on its results, we conducted a pre‐registered confirmatory study (N = 264) focusing on the most promising correlations found in our exploratory study. This study generated conclusive support for a positive medium‐sized correlation between cognitive flexibility and pro‐environmental behaviour. Exploratory hierarchical regression analyses further revealed that cognitive flexibility accounted for a small portion of variance in pro‐environmental behaviour above and beyond the Big Five. While appearing robust on the level of self‐reports, the relationship between cognitive flexibility and pro‐environmental behaviour did not reliably extend to the level of performance tasks, possibly because of their relatively specific scope. These results illustrate the contribution of cognitive flexibility to understanding individual differences in long‐term‐oriented, pro‐environmental behaviour. © 2019 European Association of Personality Psychology     

Restructuring Metaphors: Using Mental Re-Mapping in Cognitive Coaching

This article outlines different aspects of dealing with metaphors within the cognitive coaching framework. It focuses on the connection between metaphor, language and perception. Metaphors are an intimate part of most linguistic expressions. Since coaching is a structured verbal interaction it involves the exchange of metaphors between a client and a coach. The cognitive coaching literature concentrates mainly on techniques that help clients to pinpoint logical inconsistencies in their thinking. Such techniques have proven to be very helpful, but not all clients have the ability to benefit from this traditional rational disputing. In these situations the coach can make use of another technique, which still derives from cognitive principles. The first part of the article focuses on the theoretical aspects of metaphors as linguistic expressions while the second part addresses a specific client case. Suggestive techniques on how to restructure metaphors are described in connection with the client case.

Dissemination of Therapist-Assisted Internet Cognitive Behaviour Therapy: Development and Open Pilot Study of a Workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.     

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.     

Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles

In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, patients who were offered CBT but dropped out of treatment early had outcomes that were no worse than patients who stayed in. The explanation for this curious finding might be that the drop-outs and the stay-ins had different but equally valid recovery styles. Two case studies from the trial are presented to illustrate these recovery styles: sealing-over and integrating. Discussion focuses on the idea that, rather than try to alter patients' recovery styles, a more appropriate aim might be to match treatment to the patients' styles.     

Cognitive control of saccadic eye movements

The saccadic eye movement system provides researchers with a powerful tool with which to explore the cognitive control of behaviour. It is a behavioural system whose limited output can be measured with exceptional precision, and whose input can be controlled and manipulated in subtle ways. A range of cognitive processes (notably those involved in working memory and attention) have been shown to influence saccade parameters. Researchers interested in the relationship between cognitive function and psychiatric disorders have made extensive use of saccadic eye movement tasks to draw inferences as to the cognitive deficits associated with particular psychopathologies. The purpose of this review is to provide researchers with an overview of the research literature documenting cognitive involvement in saccadic tasks in healthy controls. An appreciation of this literature provides a solid background against which to interpret the deficits on saccadic tasks demonstrated in patient populations.     

How Cognitive Behavioural,Rational Emotive Behavioural or Multimodal Coaching could Prevent Mental Health Problems,Enhance Performance and Reduce Work Related Stress

This case study describes the therapeutic work with a client suffering from depression. A cognitive approach was used and a brief summary of the problem and the therapy is outlined. The client had suffered from procrastination for a long time and this was one of the key areas to be addressed in therapy. This case is presented to highlight that cognitive behavioural, rational emotive behavioural or multimodal coaching may be able to prevent mental health problems. It is possible that the client’s problem with procrastination could have been tackled in psychologically based coaching at an earlier stage. Psychological coaching could have provided the client with tools to deal with the procrastination and increase her self-awareness. This could have prevented the development of the depression or helped the client to intervene at an earlier stage.

Cognitive behaviour therapy with adults with intractable epilepsy and psychiatric co-morbidity: preliminary observations on changes in psychological state and seizure frequency

Cognitive behaviour therapy (CBT) was undertaken with six adults with chronic, poorly controlled seizures and co-existing psychiatric and/or psychosocial difficulties. During 12 sessions of CBT from an experienced CBT Nurse Specialist, treatment focused concurrently on epilepsy-related problems, associated psychopathology and on the development of psychological strategies to reduce seizure occurrence. At the end of treatment participants rated their initial epilepsy-related problem as having less impact on their daily lives and at one-month follow-up reported less deleterious impact on everyday life in terms of their psychological difficulties. In addition participants demonstrated significant improvements in terms of their self-rated work and social adjustment, and in their decreased use of escape-avoidance coping strategies. These positive findings occurred despite the absence of a significant decrease in seizure frequency. Issues raised by the complexity and severity, both of these patients' psychological/psychosocial difficulties and their epilepsy, are discussed in relation to the optimal length of treatment that may be required when adopting a CBT model in this patient group.     

“认知科学”与“第二代认知科学”刍议

以计算隐喻为核心假设的传统认知心理学以及联结主义心理学均不能克服离身心智（disembodied mind）的根本缺陷,当代认知心理学正面临着新的范型转换。以具身性和情境性为重要特征的第二代认知科学将日受重视,并促使认知神经科学进入新的发展阶段。作者认为在身心关系上应该坚持生理只是心理的必要条件,而非充分条件的立场,克服生理还原论的危险;应该重新审视基于二元论的生理机制这种说法;心理学传统中的科学主义和人文主义有可能在第二代认知科学强调认知情境性的基础上达成某种融合;第一代认知科学对意识的研究是不成功的,因为对知觉、注意、记忆、思维等心理过程的研究不能代替意识的研究,同时还应避免以意识内容的研究取代心理学研究的倾向。第二代认知科学中的动力系统理论关于变量（因素）之间的偶合（coupling）关系完全不同于变差分析中的变量之间的交互作用关系”,其动力系统模式可能更有助于破解意识的产生（涌现）之谜,并引发心理学研究的方法论的变革新潮。第二代认知科学的兴起将启发人们对身心关系、生理还原论、意识研究在心理学中的地位、人工智能对心智完全模拟的可能性等重大问题重新思考     

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Cognitive function and young drivers: The relationship between driving,attitudes, personality and cognition

Young drivers (aged 17–25 years) are the highest risk age group for driving crashes and are over-represented in car crash statistics in Australia. A relationship between cognitive functioning and driving in older drivers (60 years and older) has been consistently supported in previous literature, however, this relationship has been neglected in research regarding younger drivers. The role of cognitive functioning in young people’s driving was investigated both independently and within a current model of younger peoples driving performance. With young drivers as participants, driving behaviour, attitudes, personality and cognitive functioning were tested and driving performance was operationalised through two measures on a driving simulator, speeding and lane deviations. Cognitive functioning was found to contribute to driving behaviour, along with driving attitudes and personality traits, in accounting for young people’s driving performance. The young drivers who performed better on cognitive functioning tasks engaged in less speeding behaviour and less lane deviation on the driving simulator than those who performed worse on these tasks. This result was found independent of the role of driving behaviour, driving attitudes and personality traits, accounting for unique variance in driving ability.     

多级评分认知诊断模型述评

认知诊断评估旨在探讨个体内部的知识掌握结构,并提供关于学生优缺点的详细诊断信息,以促进个体的全面发展。当前研究者已开发了大量0-1评分的认知诊断模型,但对于多级评分认知诊断模型的研究还比较少。本文对已有的多级评分认知诊断模型进行了归纳,介绍了模型的假设,计量特征以及适用范围,为实际应用者和研究者在多级评分认知诊断模型的比较和选用上提供借鉴和参考。最后,对未来关于多级评分诊断模型的研究方向进行了展望。     

Drop the Small Talk When Establishing Baseline Behaviour in Interviews

The present experiment investigated the behavioural patterns of interviewees when comparing their baseline behaviour, prior to the interview, with their behaviour during the investigative interview. Similar to what has been advised in the police literature, the truthful baseline behaviour was established prior to the interview through non‐threatening questions. The investigative part of the interview then followed in which the interviewee was aware that they would be assessed on whether they were lying. During the investigative part, interviewees either discussed the job that they had (truth tellers, n = 128) or pretended to have (liars, n = 115). Findings revealed that both liars and truth tellers' behavioural patterns differed between the baseline behaviour and the investigative part of the interview. The findings suggest small talk should not be used as a baseline comparison with the investigative part of the interview when determining if the interviewee is being deceitful. An alternative way of using a baseline lie detection method, the comparable truth method, is discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

Safety Behaviour Enhances the Acceptability of Exposure

Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.     

Connectionism and the Philosophical Foundations of Cognitive Science

This is an overview of recent philosophical discussion about connectionism and the foundations of cognitive science. Connectionist modeling in cognitive science is described. Three broad conceptions of the mind are characterized, and their comparative strengths and weaknesses are discussed: (1) the classical computation conception in cognitive science; (2) a popular foundational interpretation of connectionism that John Tienson and I call "non-sentential computationalism"; and (3) an alternative interpretation of connectionism we call "dynamical cognition." Also discussed are two recent philosophical attempts to enlist connectionism in defense of eliminativism about folk psychology.     

Evidence-based training in cognitive-behavioural coaching: can personal development bring less distress and better performance?

Coaching has become during the past years an emergent guidance profession. Cognitive-behavioural coaching (CBC) emphasises the importance of enhancing the emotion–regulation abilities of clients and replacing their non-productive behaviours. Qualified professionals are needed in order to effectively facilitate the desired changes in their clients. We aimed to investigate the effectiveness of the personal development component within a training programme in CBC. Pre- to post-training comparisons showed a reduction in the participants’ level of depressed mood, as well as an improvement in their work performance. The active components were the emotion–regulation skills acquired and the quality of their homework tasks. Implications are discussed underlying the use of an evidence-based approach for training professionals in the field of CBC.     

The dual pathway to creativity model: Creative ideation as a function of flexibility and persistence

The dual pathway to creativity model argues that creativity—the generation of original and appropriate ideas—is a function of cognitive flexibility and cognitive persistence, and that dispositional or situational variables may influence creativity either through their effects on flexibility, on persistence, or both. This model is tested in a number of studies in which participants performed creative ideation tasks. We review work showing that cognitive flexibility, operationalised as the number of content categories surveyed, directly relates to idea originality, but that originality can also be achieved by exploring a few content categories in great depth (i.e., persistence). We also show that a global processing mode is associated with cognitive flexibility, but only leads to high originality in tasks that capitalise on cognitive flexibility. We finally show that activating positive mood states enhance creativity because they stimulate flexibility, while activating negative mood states can enhance creativity because they stimulate persistence. Implications for theory and practice are discussed.