An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study

ABSTRACT

Designing new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components. A priori rules identified components carried forward to round 2, in which experts re-rated items and final consensus items were identified. Consensus was achieved for nine content components (ensuring understanding; developing and maintaining a good therapeutic alliance; explaining the rationale for CBT; eliciting feedback; identifying and challenging avoidant behaviour; activity monitoring; undertaking an initial assessment; relapse prevention methods; homework assignments); and three process components (ensuring therapist competence; scheduling sessions flexibly; scheduling sessions for 45–60 mins). Five of the twelve components identified were generic therapeutic competences rather than specific CBT items. There was less agreement about the effectiveness of cognitive components of CBT. This is an important first step in the development of novel approaches to delivering CBT that may increase access to treatment for patients.     

FROM ANGELS TO ALIENS: HUMANKIND'S ONGOING ENCOUNTERS WITH,AND EVOLVING INTERPRETATIONS OF, THE GENUINE CELESTIAL UNKNOWN

Throughout history, people have observed aerial events that appeared extraordinary and anomalous. In earlier eras, these were often interpreted through a lens that invoked special classes of divine beings, such as angels (who, compared with gods, are regarded as more likely to interact with humans). Today, in our ostensibly secular scientific age, there is a tendency to assume such observers were mistaken, and that with the benefit of modern knowledge, these events can be “debunked” and attributed to conventional naturalistic explanations. However, recent years have seen a burgeoning interest and even concern over the issue of unidentified aerial phenomena. Through the lens of our “space age,” these are sometimes interpreted using notions such as extraterrestrial agents. Ultimately though, this article suggests that both categories of explanation, from angels to aliens, may be the perennial human quest to render comprehensible, through the prism of prevailing beliefs and traditions, an ongoing encounter with celestial phenomena that remain genuinely unknown but deeply significant.     

Más Allá De Las Barreras: Competency and Practice Considerations in Language,Cultural, and Social Issues When Delivering Group CPT to Hispanic Immigrants

ABSTRACT

High rates of underassessed trauma and psychiatric disorders, particularly post-traumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This article aims to outline these and provide future directions for research.     

On the Interaction of Prior Knowledge and Stimulus Structure in Category Learning

Contemporary theories of categorization propose that concepts are coherent in virtue of being embedded in a network of theories about the world. Those theories function to pick out some of the many possible features of a set of objects as most salient for purposes of classification, a process that is complex and still poorly understood (Murphy & Medin, 1985). Part of what makes this account incomplete is a lack of information as to (1) what makes a feature salient on a given occasion and (2) how feature salience interacts with category structure to determine the course of learning. We report on the results of three studies of category learning using complex schematic drawings to show that (1) the contrast set defined by one's initial encounters with category exemplars can be a source of individual differences in feature salience assignments; (2) such effects are short-lived in the face of clear evidence about actual feature diagnosticity; and (3) more robust prior hypotheses interact with category structure to either enhance learning or impede it. The enhancement occurs when the hypothesis emphasizes category-relevant features, even if the hypothesis is in fact incorrect. A hypothesis that assigns high salience to irrelevant features impedes learning. Learning does occur as feedback concerning category structure leads to enhanced salience for relevant features. Salience of irrelevant features remains high, however, suggesting that such learning as occurs involves augmentation and not total revision of the (incorrect) prior hypothesis.     

‘Pissed Off and Confused’/‘Grateful and (Re)Moved’: Affect,Privilege and National Commemoration in Aotearoa New Zealand

This article explores affect, colonial privilege, and the cultural politics of national commemoration in Aotearoa New Zealand. Based on focus-group interviews around two major national days, we examine means through which feelings and emotions are deployed in ways that enable the reproduction of social advantage. Situating affect within patterns of relationship, four interrelated affective-discursive practices are explored. In relation to Waitangi Day, agents tend to work under the rubric of anger and confusion. For Anzac Day, being grateful and moved shapes the interaction, although participants often indicate preferences towards “having a day off.” Given the colonial context in which these practices circulate, analysis observes the associated freedom and ease by which affective-discursive privilege is (re)produced. Often incongruent and rarely challenged, privilege allows associated actors to do what they want, when they want, however they want. This affective climate authorizes the ongoing reproduction of, and justification for, membership to a higher-status ethnic group of which unearned opportunities and entitlements remain its everyday, expected currency.     

Interpretation of ambiguous emotional information in clinically anxious children and adolescents

Cognitive theories of anxiety based on adult data predict that individuals vulnerable to anxiety should show threat - related interpretations of ambiguous material and it is proposed that this is an important maintaining factor in anxiety disorders. In the present study, interpretation of ambiguous emotional/neutral information was examined in child and adolescent anxious patients. Two groups of participants, anxious patients (n = 17) and healthy controls (n = 40), were presented with a series of homographs, each with a threatening and a neutral interpretation. For each homograph, the participants were asked to construct a sentence using the homograph. Anxious children and adolescents produced significantly more sentences consistent with threatening homograph interpretations and less consistent with neutral interpretations than did normal controls. Regression analyses revealed no relationship between age and this interpretive bias. Preliminary developmental and theoretical implications are discussed.     

The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults

In Section III of the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5), an Alternative Model for Personality Disorders (AMPD) is proposed, including a criterion for personality functioning impairment (Criterion A) to assess severity of personality pathology. The present study examined the structure, reliability, and convergent validity of the Dutch version of a five-item screening scale for Criterion A—the Five-Item Screening Scale for Personality Disorders (FISSPD; Skodol et al., in Personality Disorders: Theory, Research, and Treatment, 2, 4-22, 2011)—in a community sample of 1,477 adolescents and 546 adults. To assess convergent validity, identity and personality (pathology) questionnaires were completed by adolescents and adults. Confirmatory factor analysis yielded a single factor structure for the FISSPD, which proved to be (partially) invariant across age and gender. Adequate reliability coefficients were obtained for the FISSPD. In both the adolescent and adult sample, significant correlations were found between the FISSPD and consolidated identity (negative) and disturbed identity/lack of identity (positive). In the adult sample, the FISSPD showed significant correlations with several personality disorders (and especially with the borderline personality disorder), maladaptive personality traits (Criterion B of the AMPD), and general personality impairment. In the adolescent sample, the FISSPD was positively correlated with borderline personality disorder characteristics. Furthermore, significant correlations were found with the Big-Five personality traits in the adolescent sample: the FISSPD correlated significantly positive with neuroticism, and negative with extraversion, agreeableness, and conscientiousness. In sum, the present study supports the reliability and validity of the FISSPD to screen for (severity of) personality pathology.

     

Recognizing Unfamiliar Faces: The Effects of Distinctiveness and View

Three experiments are reported in which the effects of viewpoint on the recognition of distinctive and typical faces were explored. Specifically, we investigated whether generalization across views would be better for distinctive faces than for typical faces. In Experiment 1 the time to match different views of the same typical faces and the same distinctive faces was dependent on the difference between the views shown. In contrast, the accuracy and latency of correct responses on trials in which two different faces were presented were independent of viewpoint if the faces were distinctive but were view-dependent if the faces were typical. In Experiment 2 we tested participants'recognition memory for unfamiliar faces that had been studied at a single three-quarter view. Participants were presented with all face views during test. Finally, in Experiment 3, participants were tested on their recognition of unfamiliar faces that had been studied at all views. In both Experiments 2 and 3 we found an effect of distinctiveness and viewpoint but no interaction between these factors. The results are discussed in terms of a model of face representation based on inter-item similarity in which the representations are view specific.