完美主义及其认知-行为治疗研究

完美主义是一种深刻影响人格的心理特征,与心理病理学现象有极为密切的联系。完美主义已经引起了心理界的关注。从完美主义的定义出发,提出完美主义认知和行为特征,总结了完美主义的评估方法及完美主义与心理障碍的关系研究,最后对完美主义的认知-行为治疗的方法和步骤进行了阐述。     

完美主义及其认知——行为治疗研究

完美主义是一种深刻影响人格的心理特征,与心理病理学现象有极为密切的联系.完美主义已经引起了心理界的关注.从完美主义的定义出发,提出完美主义认知和行为特征,总结了完美主义的评估方法及完美主义与心理障碍的关系研究,最后对完美主义的认知一行为治疗的方法和步骤进行了阐述.     

Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy

Since the introduction of Beck’s cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.     

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Homework Compliance Counts in Cognitive-Behavioral Therapy

Background: Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders. However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously. The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders. Methods: 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy. Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview. Participants made ratings of treatment expectancy after the first session. Homework compliance was assessed each session by the treating clinician. Results: Contrary to hypotheses, treatment expectancy and homework compliance were poorly correlated. Regression analyses revealed that homework compliance, but not treatment expectancy, predicted a significant portion of the variance in treatment outcome (10%). Conclusions: The present research suggests that although treatment expectation and homework compliance likely represent unique constructs of treatment engagement, homework compliance may be the more important treatment engagement variable for outcomes. The present research suggests that improvement of homework compliance has the potential to be a highly practical and effective way to improve clinical outcomes in CBT targeting anxiety disorders.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Cognitive-Behavioral Therapy: The Truth Behind the Allegations

In response to several pejorative statements about Cognitive Behavioral Therapy in a recent issue of Psychotherapy (Silverman, 1999), a point by point counter argument to these criticisms are presented. Among other contentions, Silverman (1999) disparaged empirically validated methods as being simplistic and scientifically impoverished. The validity of these statements are challenged and empirical evidence is presented to support each counter argument. The efficacy of Cognitive Behavioral Therapy for a broad range of disturbances and presenting problems is presented. The future of Cognitive Behavioral Therapy and other empirically validated protocols are discussed, as well as recommendations for their use.     

Feminist Cognitive-Behavioral Therapy for Negative Body Image

Negative body image in women is evidence of internalized cultural messages about obtaining an unrealistic and changing body image ideal. Feminist therapy for negative body image balances an emphasis on socio-cultural and intrapsychic issues, while cognitive-behavioral therapy addresses specific thought patterns and dysfunctional behaviors. This paper reviews the literature on these approaches and gives specific suggestions for developing an integrated model. Ideas for setting the stage for therapy and using psychoeducational material are presented. Discussion also includes feminist cognitive restructuring, including normalizing and relabelling beliefs and developing counterarguments and adaptive restatements. Behavioral interventions include confronting avoidance behaviors and body image distortion, and including kinesthetic experiences and nurturing behaviors.     

Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder

The onset of appearance-related concerns associated with body dysmorphic disorder (BDD) typically occurs in adolescence, and these concerns are often severe enough to interfere with normal development and psychosocial functioning. Cognitive behavioral therapy (CBT) is an effective treatment for adults with BDD. However, no treatment studies focusing on adolescents with BDD have been conducted. The need for an effective treatment in this population led to the development of a brief CBT protocol with family involvement. The treatment focuses on enhancing an adolescent's quality of life through the reduction of maladaptive thoughts and behaviors, and incorporates skills training and parent training. Similar treatment packages have already been shown to be efficacious for children and adolescents with similar disorders, such as obsessive-compulsive disorder and social phobia. The following case illustrates the application of this brief CBT protocol for BDD in an adolescent, and highlights clinical considerations needed when adapting CBT for a pediatric population. Treatment was associated with clinically significant improvement in symptoms of BDD, self-esteem, depression, and quality of life. This report extends extant literature by suggesting that CBT may be a helpful treatment for adolescents with BDD.     

Cognitive-Behavioral Therapy for Insomnia in Older Adults

Sleep is disturbed by a range of factors across the lifespan. However, older adults experiencing disruptions in their sleep are often simultaneously contending with a range of comorbid medical and psychiatric conditions that compound the biological changes in sleep that commonly occur with age. Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard, nonpharmacological intervention for sleep disturbances, and is a cost-effective treatment approach that can occur in either individual or group format. It has also been shown effective in older adults with medical, psychiatric, and cognitive comorbid disorders. This review highlights the success of CBT-I with older adults, as well as studies that illustrate the use of alternative delivery methods and treatment modifications for complex clinical presentations.     

Cognitive-Behavioral Therapy in the Digital Age: Presidential Address

Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field’s challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

Multisurface Interpersonal Assessment in a Cognitive-Behavioral Therapy Context

The interpersonal paradigm of personality assessment provides a rich nomological net for describing and assessing constructs of interpersonal functioning. The aim of this article is to demonstrate for clinicians how the use of a multisurface interpersonal assessment (MSIA) battery can augment psychotherapy (e.g., cognitive-behavioral therapy). We present 2 clinical case examples and specify interpretative guidelines for MSIA that integrate multiple circumplex profiles (e.g., problems, traits, sensitivities, strengths, values, and efficacies) for each patient. Subsequently, we demonstrate how this approach provides a context to better understand patient symptoms and difficulties, and discuss how it can inform case conceptualization, treatment planning, and intervention.     

Treating Scrupulosity in Religious Individuals Using Cognitive-Behavioral Therapy

Scrupulosity, the obsessional fear of thinking or behaving immorally or against one's religious beliefs, is a form of obsessive-compulsive disorder that has been relatively understudied to date. Treating religious patients with scrupulosity raises a number of unique clinical challenges for many clinicians. For example, how does one distinguish normal beliefs from pathological scrupulosity? How does one adapt exposures to a religious patient whose fears are related to sinning? How far should one go in exposures in such cases? How and when does one include clergy in treatment? We address these issues and report a case example of the successful treatment of an ultra-Orthodox Jewish woman using the treatment principles that we recommend for religious individuals with scrupulosity.     

Mothers and Fathers in Family Cognitive-Behavioral Therapy for Anxious Youth

Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials and found to be an efficacious treatment. Studies have investigated the effects of increased parental/family involvement in treatment. In the majority of these studies, however, parental involvement is synonymous with maternal involvement leaving the role of fathers unknown. Studies including parents in treatment have yet to examine the independent contribution of mothers and fathers to child outcome. We examined the relationship between both mother (n = 45) and father (n = 45) attendance and engagement in therapy sessions, maternal and paternal psychopathology, and child (n = 45) treatment outcome when parents were included in a Family CBT program for anxiety-disordered youth. Some indications were found for the notion that greater rates of mother and father attendance in session, as well as higher ratings of mother and father engagement in session, are associated with improved child outcome. Parental psychopathology was not associated with attendance, engagement, or child outcome. Recommendations for future research are offered.     

Cognitive-Behavioral Therapy With An East Indian Family*

This article discusses the use of the cognitive-behavioral approach to family therapy with an immigrant Indian family residing in the United States. Issues of acculturation and the emancipation of a young adolescent female are addressed as conflicts arise between her and her parents. The use of cognitive-behavior therapy (CBT) is presented as a flexible mode of treatment because it allows for the modification of schemas in a way that is respectful to cultural underpinnings and allows the family the freedom to change in a manner that does not compromise their cultural values. Further discussion is directed toward the cultural variables that may be accommodated by the CBT approach and the elements that make the approach adaptable, particularly in cases involving Indian culture.The authors thank Eric Frey of Lehigh University for his assistance with the literature review.     

Cognitive-Behavioral Therapy for Body Dysmorphic Disorder by Proxy

Body dysmorphic disorder (BDD) is a distressing or impairing preoccupation with a perceived defect in physical appearance. BDD by proxy (BDDBP) is a significant but understudied variant of BDD in which the primary preoccupation involves perceived imperfections of another person. Like BDD, individuals with BDDBP engage in time-consuming rituals to “fix” the other person’s appearance or alleviate distress. Avoidance is common and the impact of BDDBP on social functioning is profound. Cognitive-behavioral therapy (CBT) is the best-studied and most promising psychological treatment for BDD, but no studies have examined its generalizability to the BDDBP variant. We tested feasibility, acceptability, and treatment outcome of CBT modified for BDDBP in a sample of 6 adults with primary BDDBP. Treatment was delivered in weekly individual sessions over 12–20 weeks. Mean symptom severity (BDDBP-YBOCS) dropped from the moderately severe range at pretreatment to the subclinical range at posttreatment, t(6) = 10.7, p < .001, d = 3.3. One hundred percent of treatment completers were responders (≥ 30% reduction in BDDBP-YBOCS). Insight also improved. Treatment gains were maintained at 3-month follow-up. To our knowledge, this represents the first treatment study for BDDBP.