Intelligence,Executive Functions,and Decision Making as Predictors of Antisocial Behavior in an Adolescent Sample of Justice‐Involved Youth and a Community Comparison Group

A clinical sample of justice‐involved male adolescents and a community comparison group were compared on a battery of cognitive ability tasks (intelligence and executive functions), decision making measures, and other individual difference measures, including ratings of self‐control, recognition of morally debatable behaviors, and antisocial beliefs. The clinical sample displayed lower performance on cognitive abilities and decision making than the community comparison group. In particular, the clinical group displayed less otherside thinking and more hostile attribution biases in unintentional situations compared with the community comparison group. Cognitive abilities and the decision making performance predicted group membership. Then, group membership, ratings of self‐control, attitudes about morally debatable behaviors, and antisocial beliefs predicted ratings of antisocial behavior in the full sample. These findings suggest that measures of cognitive ability and decision making make separate contributions to explaining antisocial behaviors. In addition, the predictors of group membership and antisocial behavior did not overlap, suggesting that antisocial behavior engagement in clinical samples may be separable from the continuum of antisocial behavior across the full sample. Cognitive science models of decision making can provide a framework for understanding antisocial behavior in clinical and community samples of adolescents. Copyright © 2015 John Wiley & Sons, Ltd.     

抑郁症认知治疗理论及实践进展

认知治疗分化为认知行为与认知分析治疗两个流派。抑郁的贝克认知模型、归因模型、自我价值关联模型以及抑郁的注意过程等认知理论为认知治疗奠定了基础。认知行为治疗、认知行为分析系统心理治疗以及基于冥想的认知治疗等已经在实践中被较有力的临床证据检验。认知治疗在抑郁症的治疗中已显示出广泛的应用前景。     

The effect of cognitive behavior therapy on decision making in adolescents who self-harm: a pilot study

Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also investigated whether improvement in decision making following treatment was linked to self-harm cessation. Adolescent self-harmers receiving CBT (n = 24) or no treatment (n = 9) and healthy controls (n = 22) were longitudinally compared on the Iowa gambling task (IGT). Significant IGT improvements were only observed for adolescents who self-harm following CBT. CBT may benefit adolescent self-harmers and generate decision-making improvements.     

Homework

In commemoration of Dr. Aaron T. Beck’s enormous contributions to our field, I comment on the state of our knowledge regarding the role of homework in cognitive behavioral therapy. The available evidence suggests homework is a contributor to positive therapeutic outcomes in cognitive behavioral therapy. Although therapists play an important role in facilitating clients’ engagement with homework as they develop greater facility with CBT skills, little is known about the contributions of specific approaches to promoting homework engagement. I highlight some of these strategies and discuss the need for researchers to empirically evaluate them.     

Tools of Engagement: Practical Considerations for Utilizing Technology-Based Tools in CBT Practice

Treatment engagement in cognitive behavioral therapy (CBT) is associated with positive outcomes. Technology-based tools present an opportunity to facilitate engagement in CBT. This paper will first review specific CBT engagement-related constructs, modalities/formats for applying technology in treatment delivery, specific engagement features available in CBT-based apps, and the relationship between CBT engagement and outcome. The Fogg Behavior Model may inform a process for enhancing CBT engagement, specifically utilizing technology towards achieving perceived simplicity and activating behaviors. Two vignettes are presented that apply the Fogg Behavior Model (FBM) and Persuasive Design framework to illustrate CBT engagement related constructs and practical considerations in applying technology-based tools to support CBT engagement. The vignettes focus on homework adherence with a thought record as well as activity scheduling. This paper concludes with a brief discussion of clinician engagement with technology applying the FBM, considerations of cultural responsiveness and inclusiveness, and additional implications for future research.     

Cognitive behavioral therapy in practice: therapist perceptions of techniques,outcome measures,practitioner qualifications,and relation to research

Cognitive behavioral therapy (CBT) has a strong evidence base for several psychiatric disorders, however, it may be argued that currently there is no overall agreement on what counts as ‘CBT’. One reason is that CBT is commonly perceived as encompassing a broad range of treatments, from purely cognitive to purely behavioral, making it difficult to arrive at a clear definition. The purpose of the present study was to explore practicing therapists’ perceptions of CBT. Three hundred fifty members of two multi-disciplinary interest groups for CBT in Sweden participated. Mean age was 46 years, 68% were females, 63% psychologists and mean number of years of professional experience was 12 years. Participants completed a web-based survey including items covering various aspects of CBT practice. Overall, therapist perceptions of the extent to which different treatment techniques and procedures were consistent with CBT were in line with current evidence-based CBT protocols and practice guidelines, as were therapists’ application of the techniques and procedures in their own practice. A majority of participants (78%) agreed that quality of life or level of functioning were the most important outcome measures for evaluating treatment success. Eighty percent of therapists believed that training in CBT at a basic level was a requirement for practicing CBT. There was a medium size Spearman correlation of r_s=.46 between the perceived importance of research to practice and the extent to which participants kept themselves updated on research. Implications for training, quality assurance, and the effectiveness of CBT in clinical practice are discussed.     

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.     

Patient utilization of cognitive-behavioral therapy for OCD

The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate “dose” of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.     

Homework Compliance and Quality in Cognitive Behavioral Therapies for Anxiety Disorders and Obsessive-Compulsive Disorder

Homework assignments are an integral part of cognitive behavioral therapy, providing patients with opportunities to practice skills between sessions. Generally, greater homework compliance is associated with better treatment outcomes. However, fewer studies have examined the effect of homework quality on treatment outcomes. This study examined homework compliance and quality as predictors of outcome and attrition across five CBT protocols. A sample of 179 individuals with principal diagnoses of generalized anxiety disorder, panic disorder, social anxiety disorder, or obsessive-compulsive disorder were randomized to receive a transdiagnostic CBT protocol (the Unified Protocol) or a single-diagnosis CBT protocol corresponding to their principal diagnosis. The Unified Protocol had a lower homework burden than the majority of the single-diagnosis protocols, which varied in degree of assigned homework. Despite this, there were no differences in average homework compliance or quality across principal diagnosis, treatment condition, or their interaction. Homework quality was significantly related to all symptom outcomes (self-reported and clinician-rated anxiety and depressive symptoms, clinician-rated clinical severity). Homework compliance was significantly related to clinician-rated anxiety symptom outcomes. Additionally, greater homework quality and compliance were both significantly associated with increased odds of completing treatment, suggesting homework variables can be useful and easily obtainable predictors of treatment retention.     

Psychological Consequences of Failing to Attribute Negative Outcomes to Discrimination

The present research examines the psychological consequences of not making attributions to discrimination in response to negative feedback. In two studies, 100 and 80, respectively, female undergraduates at large US research universities were exposed to conditions that simulated three distinct reasons for not making an attribution to discrimination which parallel three theoretical information processing stages. The psychological consequences examined included changes in activation of and explicit thoughts about sexism, affective state, excuses for poor performances, and negative attitudes toward the perpetrator. Results illustrated that there are psychological consequences of failing to make an attribution to discrimination, and that the three ways to fail to make an attribution to discrimination are distinct in that each resulted in unique consequences.     

A Cognitive Tool for Ethical Decision Making: A Case for ACED IT

The present study examined two forms of a cognitive tool (ACED IT map), which is designed to facilitate ethical decision making, along with expressive writing. Results demonstrated that participants completing the original ACED IT were more likely to identify (a) more steps to implementing a solution, (b) more barriers to solution implementation, and (c) more solutions to those barriers than participants who completed the modified ACED IT, those who engaged in expressive writing, and those in the control group. These findings suggest that cognitive tools such as ACED IT may be of considerable value for individuals who are presented with ethical dilemmas.     

Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy

Self-report measures of motivation for changing anxiety have been weakly and inconsistently related to outcome in cognitive behavioral therapy (CBT). While clients may not be able to accurately report their motivation, ambivalence about change may nonetheless be expressed in actual therapy sessions as opposition to the direction set by the therapist (i.e., resistance). In the context of CBT for generalized anxiety disorder, the present study compared the ability of observed in-session resistance in CBT session 1 and two self-report measures of motivation for changing anxiety (the Change Questionnaire & the Client Motivational for Therapy Scale) to (1) predict client and therapist rated homework compliance (2) predict post-CBT and one-year post-treatment worry reduction, and (3) differentiate those who received motivational interviewing prior to CBT from those who received no pre-treatment. Observed in-session resistance performed very well on each index, compared to the performance of self-reported motivation which was inconsistent and weaker relative to observed resistance. These findings strongly support both clinician sensitivity to moments of client resistance in actual therapy sessions as early as session 1, and the inclusion of observational process measures in CBT research.     

Cognitive change and enhanced coping: missing mediational links in cognitive behavior therapy with anxiety-disordered children

In this review, we examine the recent cognitive behavior therapy (CBT) outcome literature with anxiety-disordered children and, specifically, explore the status of cognitive change and increased coping ability as (1) specific treatment effects, and (2) possible mediators of the efficacy of CBT. In the past decade, the number of controlled CBT studies with clinically diagnosed anxiety-disordered children has increased substantially. CBT aims to restructure distorted or maladaptive cognitions and teach the anxious child to effectively use diverse coping strategies. Our review shows that in recent CBT research with anxiety-disordered children the use of domain-specific measures like cognitive and coping measures is, unfortunately, not common practice. Furthermore, only one study examined the issue of treatment mediation. Generally, recent CBT research has not been designed to test mediational issues and does not clarify whether cognitive change and enhanced coping—the presumed central components of CBT—are in fact responsible for its efficacy. Implications for the direction of future CBT research with anxiety-disordered children are discussed.     

The Job Demands and Resources Decision Making (JD-R-DM) Model

This study explores the effects of nurses’ daily job characteristics (i.e., job demands and resources) and general work engagement on their daily decision making (i.e., analytical and intuitive) and consequently their daily performance (i.e., task and contextual). Participants completed a baseline questionnaire and a diary for five consecutive days. Results reveal a positive influence of the job demands “work pressure” and “predictability” on analytical decision making. In turn, analytical decision making promotes task performance. Work pressure also negatively influences intuitive decision making which, in turn, stimulates task and contextual performance. However, the job resource (i.e., autonomy) had a nonsignificant relationship with decision making. General work engagement had positive effects on analytical decision making and moderated the relationship between intuitive decision making and contextual performance. For those high on work engagement, the relation was stronger compared to their counterparts low on work engagement. Results corroborate that expanding and testing decision-making theories can increase understanding on how the work environment and engagement influence employee decision making and performance.     

Panic Disorder: Cognitive Behavioral and Pharmacological Treatment Strategies

The past decade has seen significant advances in both psychosocial, notably cognitive behavioral (CBT), and pharmacological treatments for panic disorder. Given the widely acknowledged efficacy of both forms of treatment, it is reasonable to consider that the combination of approaches should yield an extremely potent strategy to treating panic disorder. The present report summarizes scientific evidence for the singular and combined treatment approaches to panic disorder. Data across studies indicate that combined treatments yield immediate and short-term benefits above those provided by either pharmacologic treatment or CBT alone. In the long-term, however, these benefits disappear. In fact, the combination of benzodiazepines and CBT appears to produce poorer end-state functioning than CBT alone. Other data indicate that the sequencing of pharmacotherapy and CBT may be useful for benzodiazepine fading. Although these data are preliminary, combined treatments do not appear to be the treatment of choice for patients with panic disorder. Treatment algorithms are suggested based on existing data.     

Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review

This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label “CBT” encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.     

Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.     

Who's to blame: Attributions regarding causality in spouse abuse

Spouse abuse is examined from the perspective of attribution theory. Aggressors are seen as attributing their violent behavior to external causes, whether by projecting their negative traits onto their spouses or by finding excuses which blame temporary environmental factors. In contrast, victims often attribute the abuse to defects within themselves or situational factors affecting their spouses. The attribution process seems affected by the frequency, intensity and duration of the abuse, with temporal factors playing an important role in the woman's internalizing style. Furthermore, inadequate early coping efforts play a powerful role in establishing cognitive-perceptual patterns that serve to perpetuate the abuse.     

Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more?

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with "straying" to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders.