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.     

Prediction of outcome with group cognitive therapy for depression

This paper tested a social-cognitive model of depressive episodes and their treatment within a predictive study of treatment response. Clinically depressed volunteers were given self-efficacy questionnaires and other measures before and after they were treated with cognitive therapy, and their progress was monitored over the succeeding 12 months. Improvements in depression during treatment were closely associated with self-efficacy regarding control of mood and with self-monitored levels of negative cognition. Remission over the following 12 months was predicted by the initial response to treatment, by a shorter duration of the episode prior to treatment, and by a post-treatment assessment of self-efficacy regarding control of negative cognition. Self-efficacy remained a significant predictor after post-treatment depression scores and episode duration were entered in a prediction equation. However, a programme of additional treatment based on the depression model did not result in improved depression status. Apart from the failure of the additional treatment, the results are consistent with a social-cognitive model of depressive episodes that emphasises the role of self-efficacy and skills regarding control of negative moods.     

Treatment outcome of a group cognitive therapy program for depression

A 12-session group program of cognitive therapy, designed by the first author, was evaluated with 35 persons suffering from major or minor depressive disorders. Effect-size scores were generated using the method of Nietzel, Russel, Hemmings, and Gretter (1987) and compared with cut-off points calculated using the method of Jacobson and Revenstorf (1988) and the norms established by Nietzel et al. (1987) in their meta-analysis. The effects of the Group Cognitive Therapy Program were found to be clinically significant according to the criteria of Jacobson and colleagues (Jacobson and Revenstorf, 1988; Jacobson, Follette and Revenstorf, 1984) for 73% of patients. It is concluded that the Group Cognitive Therapy Program is a clinically efficacious and cost-effective treatment for persons suffering from nonpsychotic, primary, unipolar depression.     

Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy

Using a sample of over 125 patients with irritable bowel syndrome (IBS) who were treated with cognitive therapy administered in small groups, we sought to predict end of treatment and 3-month follow-up improvement in two changes indices of gastrointestinal (GI) symptoms (Pain/Discomfort Index which assessed change in abdominal pain, abdominal tenderness and bloating and Bowel Regularity Index which assessed change in diarrhea and constipation). We also sought to predict scores on IBS specific quality of life (QOL) and overall level of psychological distress using the Global Severity Index (GSI) of the Brief Symptom Inventory (BSI). Significant, but modest, levels of prediction were found for prediction of improvement in GI symptoms (4-15% of variance). Stronger significant prediction was obtained for the QOL and global psychological distress measure with R(2)'s ranging from 0.36 to 0.50. A wide variety of demographic, GI symptom, psychological status and psychiatric status variables entered the final prediction equations.     

Midsagittal brain shape correlation with intelligence and cognitive performance

Brain shape might influence cognitive performance because of the relationships between functions, spatial organization, and differential volumetric development of cortical areas. Here we analyze the relationships between midsagittal brain shape variation and a set of basic psychological measures. Coordinates in 2D from 102 MRI-scanned young adult human brains were superimposed through a Procrustes approach, and the residual variation was regressed onto 21 cognitive tests performed by the same individuals. Most of the composite and specific variables (including general intelligence, working memory, attention, and executive functions) do not show meaningful correlations with midsagittal brain morphology. However, variables related to mental speed display subtle but consistent correlations with brain shape variation. Such correlations are small, suggesting that the influence of midsagittal brain geometry on individual cognitive performance is negligible. Nevertheless, this evidence can supply information on brain biology and evolution. Areas associated with the parietal cortex appear to be involved in relationships between brain geometry and mental speed. These areas have been associated with relevant endocranial differences between living and extinct humans, and are important as functional and structural components of brain organization. The limited correlation between brain geometry and mental speed among modern individuals might be more relevant when the large paleoneurological variation of the genus Homo is taken into account.     

Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder

Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts, and thought control. The present study investigated if pretreatment severity of obsessive beliefs, as well as the change in obsessive beliefs following treatment, predicted intensive, residential cognitive behavioral therapy (CBT) treatment outcome. A series of hierarchical regression analyses were carried out to investigate the relations between obsessive beliefs and treatment outcome. Results indicated that inflated pretreatment responsibility/threat estimation beliefs were significantly related to less overall obsessive compulsive (OC) symptom reduction at discharge, explaining 2% of the overall variance. Changes in obsessive beliefs broadly, and importance/control of thoughts specifically, were positively related to overall OC symptom reduction at discharge, respectively explaining 18% and 3.6% variance. Results are modestly consistent with a number of theoretical models, which argue that inflated responsibility, threat estimation, and thought control are important to the maintenance and treatment of OCD.     

Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety

Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.     

Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder

Several studies have demonstrated a positive relationship between competence and outcome in CBT for depression but studies of CBT for anxiety disorders are lacking. The present study explores the relationship between competence and outcome in cognitive therapy (CT) for social anxiety disorder, using hierarchical linear modeling analyses (HLM). Data were drawn from a multicenter randomized controlled trial. Five trained raters evaluated videotapes of two therapy sessions per patient using the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP). Overall adherence to the treatment manual and patient difficulty were also assessed. Patient outcome was rated by other assessors using the Clinical Global Impression Improvement Scale (CGI-I) and the Liebowitz Social Anxiety Scale (LSAS). Results indicated that competence significantly predicted patient outcome on the CGI-I (β = .79) and LSAS (β = .59). Patient difficulty and adherence did not further improve prediction. The findings support the view that competence influences outcome and should be a focus of training programs. Further research is needed to compare different ways of assessing competence and to understand the complex relationships between competence and other therapy factors that are likely to influence outcome.     

Relationship between intelligence and vocabulary

This study explored the correlations of scores on the Wechsler Intelligence Scale for Children-III in screening language problems and scores on the three Comprehensive Receptive and Expressive Vocabulary Test subscales. Participants were 243 students ages 6 to 17 years in Grades K-11 who were identified as learning disabled, learning disabled with speech impairment, mentally retarded, and speech impaired. Analysis indicated strong correlations between the two measures, particularly between the CREVT General Vocabulary and WISC-III Verbal IQ (r = .80), WISC-III Verbal Comprehension Index (r =.83), and the Vocabulary subtest (r =.76). These results held across the grades. Supporting earlier studies of relationships of Verbal IQ and Receptive Vocabulary, correlations were lower between participants in Grades K through 2 than those in higher grades on the WISC-III Verbal IQ and the Receptive Vocabulary subtest. An analysis of the accuracy of the WISC-III for classifying students with language problems indicated improvement in classification over chance. These findings suggest that the WISC-III may be an effective screen for language problems.     

Rational cognitive therapy with public offenders

In addressing the issue of how offenders may help themselves face the world in prison and outside, this article outlines how the principles of rational emotive therapy as outlined by Ellis and Maultsby can be simplified for use with this population in order to provide them a method for understanding and alleviating unhelpful emotional reactions. An example is provided to illustrate how a rational self-analysis model can be taught as written homework in individual or group sessions. Using the RSA model, offenders are taught to review and better understand the meanings of irrational words and how they upset themselves. Overall, our experience has been that offenders of many persuasions can be taught to be more rational and logical—an essential foundation for successful rehabilitation. This article is reproduced with permission in a slightly modified form from an earlier article authored by Smith and Lombardo “Rational Cognitive Therapy: An Executive Summary” that appeared inThe Correctional Psychologist, 27, 1995, pp. 2–5.     

Piagetian tasks measure intelligence and intelligence tests assess cognitive development: A reanalysis

A reanalysis of the intercorrelations of Wechsler subtests, achievements tests, and Piagetian tasks originally published by Stephens et al. (1972) has corrected errors in the original design and has used models which allow both differences and similarities to appear. Unit weighted composites of the two sets of tests were formed after first partialling chronological age out of the complete table of intercorrelations. The correlation between the composites is .876 which corrects, using split-half estimates of reliabilities, to .918. Next the matrix of partial correlations was factored and the factors rotated to a hierarchical structure. Piagetian tasks contribute almost equally to the definition of the general factor in intelligence along with the Wechsler subtests and the achievement tests. The general factor, furthermore, makes the single largest contribution to the variance of most of the measures of both sets. The smaller group factors consist of an Academic Achievement factor and three Piagetian factors. Of the latter the largest and most clearly identified is the factor called Operational Thought in the earlier analysis, but is here described simply as Conservation. It is concluded that the evidence for communality in function far outweighs the differences between intelligence tests and Piagetian tasks.     

Sudden gains and outcome: a broader temporal analysis of cognitive therapy for depression

Individual Beck Depression Inventory (BDI) time courses of 38 clients receiving cognitive therapy (CT) and a modified form of CT were studied in order to investigate temporal changes during CT for depression. The primary aim was to determine if alternative methods of defining and computing gains occurring early in CT would alter the conclusions drawn in the current literature. Three types of gains were studied: sudden gains (previously studied sudden, substantial, and stable improvements in depression during 1 between-session interval after Session 2), first-session gains (occurring after first sessions), and pretreatment gains (occurring after pretreatment assessments). Positive outcomes were predicted by first-session gains and by sudden gains occurring in the first half of treatment, highlighting the importance of early change in CT for depression.     

Effects of cognitive training on the structure of intelligence

Targeted cognitive training, such as n-back or speed of processing training, in the hopes of raising intelligence is of great theoretical and practical importance. The most important theoretical contribution, however, is not about the malleability of intelligence. Instead, I argue the most important and novel theoretical contribution is understanding the causal structure of intelligence. The structure of intelligence, most often taken as a hierarchical factor structure, necessarily prohibits transfer from subfactors back up to intelligence. If this is the true structure, targeted cognitive training interventions will fail to increase intelligence not because intelligence is immutable, but simply because there is no causal connection between, say, working memory and intelligence. Seeing the structure of intelligence for what it is, a causal measurement model, allows us to focus testing on the presence and absence of causal links. If we can increase subfactors without transfer to other facets, we may be confirming the correct causal structure more than testing malleability. Such a blending into experimental psychometrics is a strong theoretical pursuit.     

Differential effects of cognitive inhibition and intelligence on creativity

There are different conceptions about how cognitive inhibition is related to creativity. Creativity has either been associated with effective inhibition, or with disinhibition, or with an adaptive engagement of inhibition. In this study, we examined the relationship of cognitive inhibition, assessed by means of the random motor generation task, with different measures of creativity. We also analyzed whether this relation is mediated by intelligence. We generally found a positive correlation of inhibition and creativity measures. Moreover, latent variable analyses indicate that inhibition may primarily promote the fluency of ideas, whereas intelligence specifically promotes the originality of ideas. These findings support the notion that creative thought involves executive processes and may help to better understand the differential role of inhibition and intelligence in creativity.     

The role of cognitive architectures in general artificial intelligence

The term “Cognitive Architectures” indicates both abstract models of cognition, in natural and artificial agents, and the software instantiations of such models which are then employed in the field of Artificial Intelligence (AI). The main role of Cognitive Architectures in AI is that one of enabling the realization of artificial systems able to exhibit intelligent behavior in a general setting through a detailed analogy with the constitutive and developmental functioning and mechanisms underlying human cognition. We provide a brief overview of the status quo and the potential role that Cognitive Architectures may serve in the fields of Computational Cognitive Science and Artificial Intelligence (AI) research.     

Intimate partner violence exposure predicts PTSD treatment engagement and outcome in cognitive processing therapy

Intimate partner violence (IPV) exposure was examined as a predictor of treatment engagement (i.e., starting and completing therapy) and treatment outcome in 150 women taking part in a dismantling study of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD; Resick et al., 2008). Results indicate that women in a current intimate relationship with recent IPV (i.e., past year) were less likely to begin treatment relative to women who reported past IPV only or no history of IPV. For women who began treatment, IPV exposure was not predictive of whether or not they completed treatment. Among women who began treatment, the frequency of IPV was associated with treatment outcome such that women who experienced more frequent IPV exhibited larger reductions in PTSD and depression symptoms over the course of treatment, but experienced similar levels of PTSD and depression severity at the 6-month follow-up. Findings highlight the importance of targeting treatment engagement among women who report recent IPV and suggest that women who have experienced frequent IPV respond well to CPT treatment in spite of their IPV experiences.     

Initial experiences with cognitive therapy of schizophrenic patients

Based on earlier experiences of various groups of authors, we developed and modified a programme of cognitive therapy for schizophrenic patients. The aim of the application of the therapeutic programme to subacute patients was to decrease subjectively perceptible basic disorders and to improve the functions of performance. The present results and experiences with 4 groups consisting of a total of 31 patients encourage us to continue applying cognitive procedures of therapy. Problems of the ascertainment of measuring values and fundamental questions of therapeutic efficacy are discussed.     

Socially emotional brain-inspired cognitive architecture framework for artificial intelligence

Artificial Intelligence of the next generation needs to interact with users socially, convincing them in its ability to understand human minds, including emotions. For this to happen, an artificial emotional intelligence is needed, capable of adequate, believable behavior in social emotional interactions. Building on previous developments, the present work extends the general framework of emotional Biologically Inspired Cognitive Architecture (eBICA: Samsonovich, 2013, 2018), endowing it with fluents describing, in addition to appraisals, somatic markers, feelings, emotions, moods, emotional reactions and biases. Key building blocks that integrate them are moral schemas and semantic maps. The model describes interaction of three factors: plans and commitments, moral and ethical values, and somatic comfort. Learning in this framework includes self-organization of semantic maps that in turn may provide guidance for active humanlike learning. Implications for empirical studies and practical applications are discussed together with the expected impact.