Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety year old technique

Cognitive defusion techniques are designed to reduce the functions of thoughts by altering the context in which they occur, rather than the attempting to alter the form, frequency, or situational sensitivity of the thoughts themselves. Applied technologies designed to produce cognitive defusion seem to lead to reductions in the believability of negative thoughts, but defusion techniques are generally only parts of complex packages and the role of defusion techniques per se is note yet known. The present study examined the impact of a cognitive defusion technique first described by Titchener nearly 90 years ago: rapidly repeating a single word. In series of eight single-case alternating treatment designs, this defusion technique was compared to a distraction task, and to a thought control task on reductions in the discomfort and believability of self-relevant negative thoughts. The cognitive defusion technique reduced both discomfort and believability more so than the comparison approaches. Control studies showed that the effect was probably not due to demand characteristics.     

Knowing the limits of one's understanding: the development of an awareness of an illusion of explanatory depth

Adults overestimate the detail and depth of their explanatory knowledge, but through providing explanations they recognize their initial illusion of understanding. By contrast, they are much more accurate in making self-assessments for other kinds of knowledge, such as for procedures, narratives, and facts. Two studies examined this illusion of explanatory depth with 48 children each in grades K, 2, and 4, and also explored adults' ratings of the children's explanations. Children judged their understanding of mechanical devices (Study 1) and procedures (Study 2). Second and fourth graders showed a clear illusion of explanatory depth for devices, recognizing the inaccuracy of their initial impressions after providing explanations. The illusion did not occur for knowledge of procedures.     

Framing social information and generalized social phobia

Patients with generalized social phobia (GSP, N=33) and matched community controls (N=31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.     

Beliefs in personality disorders: a test with the personality disorder belief questionnaire

The hypothesis that each personality disorder (PD) is characterized by a specific set of beliefs was tested in a sample of 643 subjects, including non-patient controls, axis-I and axis-II patients, diagnosed with SCID-I and -II interviews. Beliefs of six PDs (avoidant, dependent, obsessive-compulsive, paranoid, histrionic, borderline) were assessed with the Personality Disorder Belief Questionnaire (PDBQ). Factor analyses supported the existence of six hypothesized sets of beliefs. Structural equation modeling (SEM) supported the hypothesis that each PD is characterized by a specific set of beliefs. Path coefficients were however in the medium range, suggesting that PDs are not solely determined by beliefs. Nevertheless, empirically derived cutoff scores of the six belief subscales were reasonably successful in classifying subjects, percentages ranging form 51% to 83%. It appeared that there was a monotonical increase in scores on each belief subscale from non-patient controls, to patients without any PD, to patients with PDs (other than the pertinent PD), to patients with the pertinent PD. This suggests that PD-related beliefs are at least partly associated with (personality) psychopathology in general. Another explanation is that many patients' position on the underlying dimensions is not high enough to lead to a DSM PD diagnosis, but high enough to lead to an elevated belief score.     

The Physical Appearance Ambiguous Feedback Scale (PAAFS): a measure for indexing body image related cognitive bias

Recent conceptualizations of body image disturbance have included an information processing model that includes a focus on an interpretive information processing bias. Study 1 involved the development and validation of a measure of appearance-based cognitive bias, the Physical Appearance Ambiguous Feedback Scale (PAAFS). In Studies 2 and 3, two samples of college females (n=313) were tested and the psychometric characteristics of the PAAFS were evaluated. Reliability was acceptable and convergence with measures of body image and eating disturbance was moderate. In Study 4, 313 college females completed the PAAFS in the laboratory based on an instructional content designed to induce processing bias. Preliminary evidence indicates that the PAAFS appears to be sensitive to instructional set manipulations and dispositional level of body dissatisfaction.     

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Group therapy for pathological gamblers: a cognitive approach

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.     

Does 'mental kinesiophobia' exist?

In this study the relevance of the concept of mental kinesiophobia (respectively cogniphobia or fear of mental exertion) for clients with chronic stress problems was explored. It was hypothesized that cognitive, chronic stress complaints, such as concentration problems or decreased problem solving abilities, could be catastrophized as signs of heightened personal vulnerability, with a chance of becoming permanent. As a consequence, mental exertion is avoided. This line of reasoning comes from the existing concept of kinesiophobia. This concept describes the avoidance behavior in chronic benign pain patients and refers to their fear of inflicting irreversible bodily damage due to physical exertion.An illustrative case of cogniphobia is presented. In an explorative pilot-study it was demonstrated that chronically stressed clients scored significantly higher on an experimental questionnaire measuring avoidance tendencies for mental exertion, compared with actively working employees. Consequences for treatment and suggestions for further study are discussed.