Differences in baseline and process variables between non-responders and responders in Internet-based cognitive behavior therapy for chronic tinnitus

Although Internet-based cognitive behavior therapy (iCBT) is an effective treatment for chronic tinnitus, several patients do not improve. In the current study, baseline and process variables were compared between non-responders and responders. Data from patients participating in two randomized controlled trials on iCBT for chronic tinnitus were re-analyzed. Based on the literature, a pre-post difference on the “Tinnitus Handicap Inventory” (THI) of less than seven points improvement was used to operationalize non-response. Associations between non-response and baseline variables (age, gender, and questionnaire scores), patient progress (THI), the process of the therapeutic alliance (“Working Alliance Inventory-Short Revised”; WAI-SR), as well as other process variables (number of logins, amount of messages sent from therapists to patients) were investigated. The results showed that non-responders had a less favorable change on the THI than responders already at mid-treatment (p < .05). The alliance (WAI-SR) during iCBT was not associated with non-response. Non-responders showed more severe sleep disturbances, logged in less in the iCBT platform, and received fewer messages from the therapists than responders, but these differences were mostly not significant anymore when correcting for multiple testing. To conclude, no symptom change in the first half of iCBT for chronic tinnitus patients is a risk factor of not benefiting from iCBT.     

Varying Levels and Types of Engagement in an Online Relationship Enhancement Program for Couples Following Breast Cancer

Engagement in online interventions, defined as the extent to which participants are involved in and attentive to the contents of the intervention, has been shown to predict treatment outcome. However, participant engagement and program completion are often quite low. Aiming to provide insights that could help improve engagement, this study explores engagement in an online intervention for young couples with breast cancer, Couplelinks, by describing the development of a method to assess engagement, presenting a framework for understanding varying engagement levels, and discussing strategies used by Couplelinks facilitators to work with participants of differing engagement levels. The measure of engagement developed for this study was a composite consisting of indices of average completion time, accountability, and attitude. Utilizing this composite measure, the following distinct “couple types,” with varying levels of engagement, were discerned: (a) “keen” couples, (b) “compliant” couples, (c) “apologetic” couples, and (d) “straggling” couples. Facilitators’ approaches to working with each type of couple and suggestions for potential therapeutic applications are discussed. The finding that couples vary in terms of engagement level, and not solely based on facilitator skill and/or involvement, supports the need to better understand the concept of engagement in order to make online interventions more effective.     

Relationships between psychoevolutionary fear of evaluation,cognitive distortions,and social anxiety symptoms: A preliminary structural equation model

Social anxiety disorder is a mental health condition that affects 4.7% of Australians each year. The complex interplay between psychoevolutionary and cognitive models has become the focus of research in recent years, particularly with the development of the bivalent fear of evaluation model (i.e., negative and positive evaluation fears). The present study aimed to test a model of social anxiety symptoms using structural equation modelling, integrating previously fragmented evidence. A sample of 255 participants (75.3% female; M_age = 31.9, SD = 10.3) undertook an online survey, including Social Phobia Scale, Brief Fear of Negative Evaluation—Straightforward, Fear of Positive Evaluation, Concerns of Social Reprisal, and Disqualifications of Positive Social Outcomes measures. The hypothesised model for social anxiety symptoms described the data reasonably well (χ²(1) = 4.917, p = .027, CFI = .995, GFI = .992, SRMR = .017), explaining 57.1% of social anxiety variance. Study hypotheses were supported with bivalent fear of evaluation accounting for unique variance in cognitive distortions, which in turn accounted for unique variation in social anxiety symptoms. Effect sizes indicate bivalent fears of evaluation and disqualification of positive social outcomes as important predictors of social anxiety symptoms. Although replication in a clinical cohort and experimental confirmation are needed, the findings suggest a focus on disqualification of positive social outcomes to alleviate social anxiety symptoms.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

Internet-Delivered Exposure-Based Cognitive-Behavioral Therapy for Adolescents With Functional Abdominal Pain or Functional Dyspepsia: A Feasibility Study

Functional abdominal pain (FAP) and functional dyspepsia (FD) are common in adolescents and associated with low quality of life. Exposure-based cognitive-behavioral therapy (CBT) is efficient for adult and adolescent irritable bowel syndrome (IBS), but has never been evaluated for adolescent FAP/FD. The aim of this study was to evaluate the feasibility and potential efficacy of a novel disorder-specific Internet-delivered CBT (Internet-CBT) for adolescents with FAP or FD, using an uncontrolled open pilot including 31 adolescents. The Internet-CBT consisted of 10 weekly online modules, which focused mainly on exposure to abdominal symptoms. Parents received modules to help them reduce unhelpful parental behaviors. Participants reported the treatment to be credible, and an overall satisfaction with the treatment. Data attrition rate was low (7%) and adherence to treatment was acceptable. We saw a significant and large effect on the primary outcome, pain intensity, at posttreatment (d = 1.20, p < .001) that was further improved after 6 months (d = 1.69, p < .001). Participants also made significant and large improvements on gastrointestinal symptoms (d = 0.84, p < .001) and quality of life (d = 0.84, p < .001) that were sustained or further improved at follow-up 6 months after treatment. This study demonstrated that exposure-based Internet-CBT, tailored for adolescents with FAP or FD, is a feasible treatment that potentially improves pain intensity, gastrointestinal symptoms, and quality of life.     

Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CI_asymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CI_asymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Rational beliefs,happiness and optimism: An empirical assessment of REBT's model of psychological health

This study sought to test the validity of the psychological health model of Rational Emotive Behaviour Therapy (REBT). Specifically, this study sought to investigate if rational beliefs were associated with happiness and optimism. A multinational sample of 397 university students completed self‐report measures of rational beliefs, happiness and optimism. Structural equation modelling (SEM) was used in order to test the validity of the REBT model of psychological health. The result of the SEM analysis provided empirical support for REBT's psychological health model of happiness and optimism. The model as a whole explained 33% of variance in levels of happiness and 40% of variance in levels of optimism. Self‐acceptance beliefs were positively and directly associated with happiness and optimism. Preference beliefs were positively and indirectly associated with happiness and optimism via self‐acceptance beliefs. REBT may offer a viable psychotherapeutic method to not only alleviate psychological distress, but also build positive emotion. Current findings may help to bridge the divide between the fields of positive psychology and clinical psychology.     

Measuring Experiential Avoidance: Reliability and Validity of the Dutch 9-item Acceptance and Action Questionnaire (AAQ)

Three studies evaluated psychometric properties of the Dutch version of the 9-item Acceptance and Action Questionnaire (AAQ)—a self-report measure designed to assess experiential avoidance as conceptualized in Acceptance and Commitment Therapy (ACT). Study 1, among bereaved adults, showed that a one-factor model, with AAQ-items constituting a single dimension of experiential avoidance, fitted the data well. The internal consistency and temporal stability of the AAQ were satisfactory. In Study 2, among undergraduate students, and Study 3, among 60 outpatients, higher AAQ scores were found to be significantly associated with psychopathology, maladaptive coping strategies, and neuroticism, attesting to the validity of the measure. In support of its incremental validity, Study 3 showed that the AAQ remained significantly associated with depression and anxiety after controlling for neuroticism and thought suppression. The current studies complement prior research supporting the psychometric properties of the AAQ and the ACT conceptualization of experiential avoidance.