The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

线索在多媒体学习中的作用

线索在多媒体学习中作为一种重要的教学设计形式,具有引导注意、组织和整合信息的功能。综述已有研究发现,线索具有引导学习者加工特定位置信息、忽视无关信息干扰的功能;在特定条件下帮助学习者整合图-文信息,并且提高学习者的学习效果;但对于线索信息组织功能尚缺少充分而有力的证据。关于线索对学习效果的影响,大部分研究证实线索能够促进学习。但是由于线索的多样性以及学习材料的复杂性,线索能否有效地提高学习效果仍然存在争议。从认知负荷理论视角综述发现,线索加入并没有明显降低学习者感知到的主观认知负荷;从知觉加工视角而言,线索作为突显的刺激会吸引学习者的注意,从而简化学习者在知觉加工阶段的视觉搜索。未来研究仍然需要关注以下问题:(1)线索是否真的被学习者所注意和加工?(2)重视学习材料多样性比较和不同线索类型差异探讨,(3)关注学习者经验影响,(4)如何在教学设计上保证线索的有效性。     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress

This study tested whether sensory integration (SI) treatment combined with psychotherapy would improve symptom outcome over psychotherapy alone in the treatment of complex posttraumatic stress, as measured by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) clinical construct in a group of 10 adult patients with histories of childhood abuse. DESNOS symptoms were assessed at three time periods (T1, baseline; T2, after experimental group SI treatment; and T3, after wait-list control group SI treatment) using the Structured Interview for Disorders of Extreme Stress (SIDES). The Sensory Learning Program? (SLP), developed by the Sensory Learning Institute of Boulder, Colorado, was used as the SI treatment modality. Results indicated significant differential improvement for the group treated with SLP in SIDES Total Score (T1/T2 and T2/T3), Self Perception (T1/T2 and T2/T3), Affect Regulation (T2/T3), and Alterations in Meaning (T1/T2).     

The integrative attitude–a personal journey

The origins of clinical psychotherapy date from the beginning of last century and the development of broadly four foundational schools–psychoanalytic, cognitive-behavioural, humanistic and transpersonal psychologies. The imperative to integrate these schools, however, is relatively recent and in the last 25 years a professional integration movement has developed, exemplified by the formation of SEPI and the UKAPI, and ‘integrative psychotherapist’ is now the most popular nomenclature used in the profession. This article gives a brief history of the integration movement, reviews some issues raised by developments so far, and discusses the personal dilemma that integration evokes in the would-be integrative practitioner. Using my own journey I espouse an integrative attitude that is based on the nature of integration as an evolving personal process rather than an ideal, fixed, profession-wide position. I describe three interweaving modalities of integration I call constructive, complicit and contiguous integration, which form a developmental framework that aims to encourage the individual activity of questioning, inventing, researching and interrogating the discipline within its philosophical, professional and social context. In concluding, this article exhorts the profession to see integration as a personal journey, as a way of being that is constantly becoming and unfolding in relation with the therapist's training, experience and interaction with peers and clients. The result is indefinable and unnameable, and perhaps represents the soul of integrative psychotherapy.     

Rehabilitative Beit Midrash as a means for advancing the community integration of Ultra Orthodox Jewish persons with severe mental illness

ABSTRACT

Religious Jews with severe mental illness often encounter barriers to involvement in religious activities in their community affecting their ability to become integrated into their community. Therefore, a study was conducted in Israel examining the contribution to community integration through a programme providing religious persons with mental illness an opportunity to participate in religious studies. An A-B research design was implemented among 42 Ultra-Orthodox Jewish persons with severe mental illness utilising a culturally-oriented structured instrument. The study showed that the opportunity for involvement in religious studies could advance the participants’ sense of social interaction in their community as well as their sense of psychological integration with other religious people. It also strengthened their confidence in their ability to further get involved in religious studies in the community. Rehabilitation services providing persons with severe mental illness an opportunity for involvement in religious studies can act as a springboard for advancing their community integration.     

Exploring early developmental changes in face scanning patterns during the perception of audiovisual mismatch of speech cues

Young infants are capable of integrating auditory and visual information and their speech perception can be influenced by visual cues, while 5-month-olds detect mismatch between mouth articulations and speech sounds. From 6 months of age, infants gradually shift their attention away from eyes and towards the mouth in articulating faces, potentially to benefit from intersensory redundancy of audiovisual (AV) cues. Using eye tracking, we investigated whether 6- to 9-month-olds showed a similar age-related increase of looking to the mouth, while observing congruent and/or redundant versus mismatched and non-redundant speech cues. Participants distinguished between congruent and incongruent AV cues as reflected by the amount of looking to the mouth. They showed an age-related increase in attention to the mouth, but only for non-redundant, mismatched AV speech cues. Our results highlight the role of intersensory redundancy and audiovisual mismatch mechanisms in facilitating the development of speech processing in infants under 12 months of age.     

Multisensory integration in the Müller-Lyer illusion: From vision to haptics

The Müller-Lyer figure is a powerful illusion in both vision and touch, although it is still unclear whether the visual and haptic illusory effects are due to modality-specific or shared processes. In order to investigate the hypothesis of a common underlying mechanism, the performance of 24 undergraduates in a manual bisection task of the Judd variant of the Müller-Lyer figure was assessed under visual, haptic, and visuo-haptic presentations (Experiment 1). In the bimodal condition participants saw the arrowheads on the front and touched the shaft on the back of a stimulus-supporting board. Illusory effects were comparable in touch and vision and were present, albeit reduced, in the bimodal visuo-haptic condition. In Experiment 2 we used the bimodal task of Experiment 1, manipulating the spatial position of the horizontal shaft on the backside of the board. The visual arrowheads affected haptic bisection, bringing about the illusory effects, only when the shaft was aligned with them. In conclusion, illusory effects transfer cross-modally from vision to haptics only in the presence of spatial coincidence, which appears to be a crucial factor for cross-modal integration. Implications for multisensory processes are discussed.     

Cross-modal integration of emotional face and voice in congruous and incongruous pairs: The P2 ERP effect

The study investigates cross-modal simultaneous processing of emotional tone of voice and emotional facial expression by event-related potentials (ERPs), using a wide range of different emotions (happiness, sadness, fear, anger, surprise, and disgust). Auditory emotional stimuli (a neutral word pronounced in an affective tone) and visual patterns (emotional facial expressions) were matched in congruous (the same emotion in face and voice) and incongruous (different emotions) pairs. Subjects (N=31) were required to watch and listen to the stimuli in order to comprehend them. Repeated measures ANOVAs showed a positive ERP deflection (P2), more posterior distributed. This P2 effect may represent a marker of cross-modal integration, modulated as a function of congruous/incongruous condition. Indeed, it shows an ampler peak in response to congruous stimuli than incongruous ones. It is suggested P2 can be a cognitive marker of multisensory processing, independently from the emotional content.