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.     

伤害回避的脑机制及其生物基础

伤害回避是指个体对厌恶刺激信号做出强烈的反应,并学会被动地回避惩罚的一种倾向,这一倾向使得个体反复思考未来的结局,并谨慎小心地对待不确定情景中的事件,进而更有可能诱发情感障碍。伤害回避涉及的神经网络包括三个子网络,即额顶叶-前扣带皮层的连接、皮层-杏仁核的连接和白质通道的结构性连接,这三个子网络分别与羞怯感-易疲劳性、预期担心以及不确定环境中的害怕情绪有关。而其生物基础则包括单一基因多态性和基因多态间的交互作用。今后的研究应该集中在深化伤害回避神经网络与生物基础间的联合机制、研究三种及以上基因多态间的交互作用、考察其他因素对基因效应的调节作用、注重伤害回避四种亚型相关神经网络之间的连接、探讨5-HT4等其他几种5-羟色胺受体多态性与伤害回避的关系以及分析伤害回避内部机制在抗抑郁治疗中的作用等方面。     

Traditional group therapy and computer-administered treatment for test anxiety

Abstract

Traditional group therapy for test anxiety, modelled after Weissberg (1976), was compared with the computer-administered treatment of Thoresen, Insel, Roth, Ross, and Seyler (1986). Both treatments contained cognitive and behavioral elements including systematic desensitization and Jacobsonian relaxation techniques. The participants were 36 test-anxious students seeking treatment within a university counseling center. Effectiveness of each treatment was assessed by studying changes in test anxiety (total, worry, emotionality), as measured by the Test Anxiety Inventory (Spielberger, 1980). and changes in grade point average (GPA). There was a statistically significant reduction in the three test anxiety measures for both treatments. No significant differences in GPA, as a result of the treatment, were found. There was no significant difference in reduction of test anxiety between the treatments. These findings support the efficacy of the computerized treatment which may be a suitable alternative to group therapy and, in some situations, may be the treatment of choice.     

Multifaceted Approaches in Spouse Abuse Treatment

SUMMARY

The understanding of spouse abuse has changed considerably in the last 30 years, shifting from a perspective based on individual psychopathology to that of a pervasive social problem. Current treatment solutions for stopping violence are limited to those that address resocializing the batterer. Several states often restrict the use of state funds for batterers' groups and forbid couples treatment as a primary treatment option in spite of the fact that most couples choose to remain in their relationships in the presence of repeated violence. This article argues for broadening options to include a specific type of couples treatment as a part of a coordinated community response to remediate domestic violence. Solution-focused therapy is described as an example of treatment of relationships that makes safety a priority and is not victim-blaming. It is suitable treatment both for couples who wish to stay together and those seeking a safe way to separate.     

Transitioning from the Battlefield to Home: An Innovative Program for Israeli Soldiers

Soldiers moving from the army to civilian life encounter significant challenges during this time of transition, both in Israel and internationally. Identifying this period of time as a critical one, the Peace of Mind program is an innovative intervention designed specifically to address the issues occurring therein. This unique model focuses on mental health and normalization of responses, as well as on the processing of traumatic experiences. It is based on the considerable experience at the Israel Center for the Treatment of Psychotrauma in the fields of resilience building and trauma treatment. After reviewing the literature on returning soldiers, the model is described and several vignettes are presented.     

PTSD and Epigenetic Research: Decentering the Physical Body

To prevent youth violence, the GREAT Families program was implemented with a selective sample of 1,196 families of sixth-grade children from low-income schools in 4 cities making the transition to adolescence. To assess intervention effects, we used pre- and posttest data to estimate a structural model to test the hypothesis that random assignment to the intervention would predict changes in parenting practices, which in turn would predict changes in exposure to violence (i.e., a mediational model). We found that participation in GREAT was significantly related to changes in parenting practices and these changes significantly predicted changes in violence exposure. Furthermore, adolescents who reported greater increases in exposure to violence also tended to experience greater decreases in parental monitoring, discipline, and involvement. Implications for future research and prevention efforts are discussed.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

Adventure based counselling,individual counselling and object relations: a critical evaluation of a qualitative study

Adventure based counselling is a short-term experiential psychotherapeutic approach, which utilises adventurous activities and being in natural environmental in order to facilitate therapeutic change in clients. The present paper critically appraises the results of a qualitative study that investigated how clients with self-reported anxiety and depression experienced participating in an innovative counselling intervention with combined individual counselling with such an adventurous outdoor transaction. Interpretative Phenomenological Analysis, as described by Smith and Osborn (2008), was used in order record and analyse the experiences of four male and six female students who were treated at the Teesside's University Counselling Service. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing, whereas the outdoor transaction as providing an experiential venue for achieving personal change. Interviewees felt that without the outdoor transaction the therapeutic significance of the counselling process would not have reached its full potential. Likewise, without the individual counselling, the outdoor transaction would just have an entertaining event and not a venue for personal change. These findings are discussed in relation to object relations theory.     

I am happy in my faith: the influence of religious affiliation,saliency, and practice on depressive symptoms and treatment preference

Religion is thought to significantly impact numerous areas of mental health, including depression. Using a 63-item questionnaire, the influence of religious affiliation, saliency, and practice on levels of depressive symptoms and treatment preference in a non-clinical sample of Christians, Muslims, Atheists, and Agnostics (N = 471) was investigated. No significant differences in depressive symptoms were found between affiliations. Saliency and frequency of practice had a weak negative correlation with depressive symptoms for Christians, but were not significant for Muslim participants. No significant differences of preference were found between affiliations for social, cognitive, and medical treatments. Treatment preference of religious-based treatments differed significantly between affiliations. Findings suggest that affiliation is not significantly related to depressive symptoms or treatment preference, and the influence of saliency and practice differs between religions. Limitations and implications of the current study are discussed, and directions for further research are identified.