Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark

Anxiety is highly prevalent in pre-adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre-adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre-adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8–12 years were randomised to a 30-minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.     

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.     

The countertransference impact of autistic defence in an otherwise neurotic patient

This paper investigates the question of why, in the psychoanalytic psychotherapy of a patient with encapsulated autistic pathology, the steady maintenance of a therapeutically neutral stance can be especially difficult. Transference and countertransference vicissitudes are examined. The author notices that the patient's intolerance of ‘opposites’ (cf. Tustin, 1986), combined with extreme antipathy to having that intolerance noticed, can elicit corresponding, and potentially destabilizing, countertransference reactions. These reactions comprise an unstable tension between co‐existing pressures towards fusion with, or expulsion of, the patient, their co‐existence under further pressure to remain unnoticed. Until perceived, this state of affairs risks collusion with the pressure either to merge with or to expel the patient, and compromises the capacity to notice the detail of the transference process and even to notice co‐existent positive and negative transference images. Detailed clinical illustration is given, including a session where it was difficult to notice the patient's experience of a couple as a combined object. The author finds these observations of bipolar countertransference tensions illuminated by Green's concepts of positive and negative narcissism and of the disobjectalizing function, and specifically accounted for by Ribas's theory of autism as radical drive defusion.     

Decreasing influence of arbitrarily applicable verbal relations of recreational gamblers: A randomized controlled trial

Twenty‐one recreational gamblers were randomly assigned to two groups; one group was exposed to a conditional discrimination relational training task to bias choice allocation to a black machine presented concurrently with a red machine, and the other group underwent the same relational training task immediately followed by a defusion procedure, designed to expand upon the relations developed in the initial relational task. Both groups completed a simulated slot‐machine task before and after the relational training task, with or without the defusion procedure. Results showed that 9 of 11 participants in the relational training only group showed an increased bias toward the black machine, compared to only 4 of 10 in the relational training plus defusion group; this latter group also showed greater matched responding. Results suggest that expanding verbal–relational networks may reduce the influence of any single verbal relation on gambling choice behavior.     

Variations on the concept of traumatism: Traumatism,traumatic, trauma1

In this paper, the author outlines Freud's fundamental hypotheses concerning the concept of traumatism, then goes on to differentiate three notions (French being a particularly apposite language for such a venture): ‘traumatism’, ‘traumatic’ (in a substantive sense) and ‘trauma’. These three terms correspond to the three turning points in Freud's theory with respect to the concept of traumatism (1895‐97, 1920, 1938). The author evokes also the developments that are due to Ferenczi, particularly in his later writings (1928‐33), where he defi ned and discussed the question of ‘trauma’ in contemporary clinical practice; the author goes on to explore the different variations on this theme as regards mental functioning. He then defi nes, from a metapsychological point of view, the differences between ‘traumatisms’ that have been ‘worked over by secondary processes’, organised and governed by the pleasure‐unpleasure principle (‘traumatism’) and ‘early’ or ‘primary traumatisms’, which interfere with the process of binding the instinctual drives (‘trauma’); states of mind infl uenced by a traumatic imprint (‘traumatic’) are looked upon as belonging to both categories of the above mentioned traumatisms. The author illustrates his hypotheses with a clinical example.     

Measuring decentering as a unidimensional construct: The development and initial validation of the Decentering Scale for Sport

Decentering, the ability to observe one's thoughts and feelings from a detached view, has gained increased attention in recent years. With this renewed interest comes a need for a reliable and valid tool to measure decentering in sport contexts. Therefore, in this multi-study paper we report the development and initial validation of a sport-specific self-report measure of decentering, the Decentering Scale for Sport (DSS). Based on an initial pool of context-specific items with acceptable content validity, a unidimensional decentering construct was confirmed in four independent athletic samples (n = 1255). Satisfactory internal consistency reliability and partial measurement invariance across gender and sport type was demonstrated. Convergent and concurrent validity of the DSS was established by showing positive and medium to large associations with mindfulness, well-being, flow, vitality, enjoyment and positive affect, and negative and medium to large associations with cognitive fusion, experiential avoidance, anxiety and negative affect. Discriminant validity of decentering with mindfulness and self-compassion was also established. Findings suggest that the DSS is a reliable and valid measure of decentering in sport contexts, and can be applied in future research and applied practice to measure decentering.     

Laboratory analogue investigation of defusion and reappraisal strategies in the context of symbolically generalized avoidance

The present study examined and compared the effects of 2 analogues of cognitive treatments—cognitive defusion and cognitive reappraisal—on symbolically generalized avoidance established using a basic behavioral laboratory paradigm. This back‐translation design contributes to the development and validation of principle‐based definitions of the applied constructs of defusion and reappraisal. Eighty‐eight participants first underwent basic laboratory procedures designed to establish symbolically generalized avoidance in response to an arbitrary stimulus (a nonsense word). Participants were then randomized to defusion, reappraisal, or control conditions. The response variables were (a) equivalence responding—indicative of the trained relational network and analogous to the cognitive content responsible for symbolic generalization—and (b) avoidance—the behavioral impact of symbolic generalization. A between‐groups analysis revealed that defusion and reappraisal significantly increased the odds of nonavoidance responding. Discrete‐time survival mediation analyses provided preliminary support for the classification of defusion as a functional context intervention and reappraisal as a relational context intervention.     

Acceptance and Defusion

The waves and generations of behavioral and cognitive therapy are normal features of a progressive science. Two of the key processes in modern CBT are briefly examined: defusion and acceptance. Both had important antecedents in the work of Aaron Beck, among others; at the same time, they both represent meaningful changes. This dialectic of continuity and change is to be celebrated—it means our current work stands on the shoulders of past intellectual giants. The entire field owes a permanent debt of gratitude to Aaron T. Beck.