Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

Collaborative memory and part-set cueing impairments: The role of executive depletion in modulating retrieval disruption

When people are exposed to a subset of previously studied list items they recall fewer of the remaining items compared to a condition where none of the studied items is provided during recall. This occurs both when the subset of items is provided by the experimenter (i.e., the part-set cueing deficit in individual recall) and when they are provided during the course of a collaborative discussion (i.e., the collaborative inhibition effect in group recall). Previous research has identified retrieval disruption as a common mechanism underlying both effects; however, less is known about the factors that may make individuals susceptible to such retrieval disruption. In the current studies we tested one candidate factor: executive control. Using an executive depletion paradigm we directly manipulated an individual's level of executive control during retrieval. Results revealed no direct role of executive depletion in modulating retrieval disruption. In contrast, executive control abilities were indirectly related to retrieval disruption through their influence at encoding. Together these results suggest that executive control des not directly affect retrieval disruption at the retrieval stage, and that the role of this putative mechanism may be limited to the encoding stage.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

The benefit of retrieval practice over elaborative restudy in primary school vocabulary learning

The testing effect is the phenomenon that retrieval practice of learning material after studying enhances long-term retention more than restudying. We examined retrieval practice in primary school vocabulary learning in two experiments. Nine-year-old children studied word definitions and completed exercises according to three learning conditions: pure restudy, elaborative restudy or retrieval practice. Children in the pure restudy condition reread and partly copied the definitions. In the elaborative restudy condition children reread the definitions and connected semantically related words to the target words. Children in the retrieval practice condition recalled the words based on their definitions. Overall, on the fill-in-the-blank test after one week children in the retrieval practice condition outperformed children in the other conditions, but on the multiple-choice test there were no differences. Retrieval practice may be effective for primary school vocabulary learning, but there is uncertainty about the practical value and the magnitude of the retrieval practice effect.     

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.     

认知行为治疗的生物学机制

现阶段认知行为治疗的生物学机制尚不明确。本文将从脑功能、神经电生理、神经内分泌与免疫以及遗传与表观遗传这四个方面对认知行为治疗的生物学机制进行讨论, 综合心理、生理和遗传三方面的结果, 从微观、中间和宏观多层面提出了认知行为治疗生物学机制的整合模型。并进一步对目前研究的局限性进行了讨论, 为未来探究认知行为治疗的生物学机制提供了新的方向。     

Ethnicity and the therapeutic relationship: views of young people accessing cognitive behavioural therapy

Few studies have explored the views of black and minority ethnic (BME) adolescents engaging in cognitive behavioural therapy. This study aimed to examine BME adolescent service users' perceptions of how ethnicity featured in the therapeutic relationship and its relevance to their presenting difficulties. Interpretative phenomenological analysis was used to explore the experiences of five young people using an adolescent mental health service. Four interrelated themes emerged from the analysis and are considered in detail. The complexities of participants' views are discussed and recommendations are made for therapists as to how to enquire about, acknowledge and remain attuned to the client's ethnicity.     

The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children

The main aim of this study was to determine whether pre-treatment levels of child perfectionism impacted on anxiety treatment outcomes for school-aged children. In addition, it was investigated whether child perfectionism decreased following treatment for anxiety. Participants were sixty-seven clinically anxious children aged 6–13 years (female = 34; majority Caucasian) who were enrolled in a group-based cognitive behaviour therapy program, and their parents. They completed self-report questionnaires on anxiety and depressive symptoms and were administered a diagnostic interview to determine the type and clinician rated severity of anxiety and related disorders pre- and post-treatment and at 6-month follow-up. Self- and parent-rated perfectionism were also measured pre-treatment, while a subset of children completed perfectionism measures post-treatment as well. Self-Oriented Perfectionism, but not Socially Prescribed Perfectionism, predicted poorer self-reported treatment outcome (higher levels of anxiety symptoms) immediately following treatment and at 6-month follow-up when using a multi-informant approach. Additionally, both Self-Oriented and Socially Prescribed child perfectionism significantly reduced immediately following treatment. Despite reductions in child perfectionism following anxiety treatment, higher Self-Oriented Perfectionism may impact negatively on child anxiety treatment outcome.     

Asking ‘why’ still increases intrusions: A response to Ayduk and Kross (2008)

In their response piece, Ayduk and Kross (Ayduk, O., & Kross, E. (2008). Asking ‘why’ from a distance facilitates emotional processing: a reanalysis of Wimalaweera and Moulds (2008). Behaviour Research and Therapy) raised a number of interesting and important points regarding the findings reported in our recently published paper (Wimalaweera, S., & Moulds, M.L. (2008). Processing memories of anger-eliciting events: the effect of asking ‘why’ from a distance. Behaviour Research and Therapy, 46, 402-409.). Their additional analyses of our dataset resulted in a thought-provoking response to our paper. We are grateful for their interest in and consideration of our findings, and for the opportunity to respond to their concerns. We concur with many of the points that they raised. Nonetheless, a number of their procedures and interpretations warrant comment and clarification. Most critically, we correct what appears to be a fundamental misunderstanding of our argument that encouraging distanced-why recall facilitates rather than results in avoidance. In so doing, we address their repeated criticism that the avoidance subscale of the Impact of Event Scale was omitted from the original analyses. Second, we address the rationale for the lack of consistency in the inclusion of all of the experimental conditions in the additional analyses, particularly in light of the theoretical relevance of the immersed-what condition to elucidating the processes that facilitate emotional processing. We call for a consistent analytic strategy, emphasize the need for replication with larger samples, and urge caution in the extrapolation of experimental findings to clinical recommendations.     

Abstract recall of a happy memory to repair sad mood in dysphoria: A possible link to negative cognition

The capacity to repair sad mood through the deliberate recall of happy memories has been found to be impaired in dysphoric individuals. Rumination, or adopting an abstract processing mode, has been proposed as a possible mechanism underpinning this effect. In low and high dysphoric participants, we examined the relative consequences of adopting an abstract or concrete processing mode during happy memory recall or engaging in distraction for (1) mood repair and (2) cognitive content. Recalling a happy memory in either an abstract or concrete way resulted in greater happiness than distraction. Engaging in abstract recall of a happy memory resulted in high dysphoric participants generating negative evaluations and negative generalisations. These findings raise the interesting possibility that abstract processing of positive memories has the potential to generate negative cognition.     

Riding the waves: A functional‐cognitive perspective on the relations among behaviour therapy,cognitive behaviour therapy and acceptance and commitment therapy

Different types of therapy explain psychopathology and the effects of psychotherapy differently. Different explanations are, however, not necessarily mutually exclusive. Based on the idea that functional and cognitive explanations are situated at different levels, we argue that functional therapies such as traditional Behaviour Therapy (BT) and Acceptance and Commitment Therapy (ACT) are not necessarily incompatible with Cognitive Behaviour Therapy (CBT). Whether a functional and a cognitive therapy actually align depends on whether they highlight the same type of environmental causes. This functional‐cognitive perspective reveals various differences and communalities among BT, CBT and ACT.     

The joy-maker in the garden: cognitive behavioural therapy in The Secret Garden (1911)

Cogntive Behavioural Therapy appears in the classic children’s novel The Secret Garden (1911) by Frances Hodgson Burnett. This essay demonstrates how “thinking about thinking” helps three central characters (Mary, Colin, and Archie) overcome depression and prolonged grief. They learn to challenge habitual cognitive distortions and socially endorsed absolutist myths such as: 1) I alone am special. 2) What I can see with my eyes is all that is real; there is no supernatural realm. 3) If people must speak of God, they should use the (only) proper name. 4) I must suffer without hope. The essay explains CBT, a form of psychotherapy that began in the 1980s and is used around the world today. It also explains Burnett’s “Beautiful Thought” which is rooted in the New Testament and also in the New Thought Movement of mid-1800s. After an analysis of how CBT appears in the characters and plot of The Secret Garden, the essay provides guidance for how adults can help children to think criticially about beliefs; to be self-reflective; to experience beauty through nature, the arts, and gardening; and to trust in benevolent spiritual forces.     

Transfer of old ‘reactivated’ memory retrieval cues in rats

The present studies examined whether the retrieval of an old ‘reactivated’ memory could be brought under the control of new contextual cues. In Experiment 1 rats trained in one context were exposed to different contextual cues either immediately, 60 or 120 min after a cued reactivation of the training memory. When tested in the shifted context, subjects exposed shortly after reactivation treated the shifted context as the original context. This transfer diminished with longer post-reactivation delays. Experiment 2 replicated the basic finding and demonstrated that the transfer of the old retrieval cues was specific to the contextual cues present during exposure. These findings are consistent with previous research [i.e., Briggs, J. F., Fitz, K. I., & Riccio, D. C. (in press). Transfer of memory retrieval cues in rats. Psychonomic Bulletin & Review] showing the transfer of retrieval cues for a new memory, and demonstrating a similarity (in this case) between newly acquired and old reactivated memories.     

The list strength effect: A contextual competition account

Research on the list strength effect (LSE) has shown that learning some words on a list more strongly than others impairs memory for the weakly learned words when tested with a recall task. Norman (2002) demonstrated that the LSE also occurs within the recollection process of a recognition test. In this study, a mechanistic dual-process account of the LSE was tested that simultaneously makes predictions concerning additional sources of context in interference effects. In two experiments, we attempted to replicate Norman's (2002) findings and provide the basis for our modeling efforts. We found evidence for a recollection LSE in raw measures of responding, with memory performance also benefiting from reinstatement of perceptual characteristics at test. However, large differences in the hits between the lists were accompanied by small differences in false alarms, such that when d' is calculated, differences between the lists are not significant. We propose an account of the LSE whereby the actual effect of competition between items on the list is small, although present, and difficult to distinguish from large effects of bias due to the strength manipulations. We argue that our findings provide support for a mechanistic explanation of LSE that is based on competition of source activation and changes in the thresholds for responses.     

Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders

Objective

The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment.

Method

One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up.

Results

There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline.

Conclusions

The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.     

The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice

There is increasing interest in questions about how far the demonstrated efficacy of psychological therapies in research trials can be translated into clinical effectiveness in routine practice. This paper summarises outcome data from several hundred patients treated with CBT in routine clinical practice in a National Health Service psychology service, and compares their outcomes with some of the published research. Although the data have flaws common in ordinary clinical practice (no untreated controls, missing data, uncontrolled pharmacotherapy, etc.), the analyses suggest that CBT in this context is an effective treatment, albeit with probably not quite such good results as it achieves in research trials. Using clinical significance statistics on standardised measures, about half of the sample reliably improved over a course of therapy, including about a third who recovered to normal range.     

Predicting first intercourse among urban early adolescent girls: The role of emotions

Little is known about how girls perceive their ongoing or future sexual experiences, especially the emotions that they associate with these experiences. This study examined how early adolescent girls characterise first intercourse experiences in terms of positive and negative emotions over a one-year period. A US sample of 162 girls (12–14 years), primarily Latina and Black, completed two interviews one year apart that assessed sexual cognitions, affect, and behaviour. Girls anticipated primarily negative emotions associated with first intercourse, but recalled primarily positive emotions for first and recent intercourse experiences. In addition, girls’ emotion scores proved more useful than two types of cognitions (intentions and perceived readiness) and pre-intercourse sexual experience in predicting transitions to intercourse over the one-year period.