Cognitive Therapy and Research

Mechanisms of Change in Cognitive Behavioral Therapy for Body Dysmorphic Disorder Abstract Although cognitive-behavioral therapy (CBT) is highly efficacious for body dysmorphic disorder (BDD), not all patients benefit, and mechanisms underlying response remain unknown. In this first report of the mechanisms underlying improvement with CBT for BDD, we examined whether cognitive (maladaptive beliefs, perfectionism, schemas) and behavioral (checking, grooming, avoidance behaviors) changes mediate the effect of CBT on BDD symptom reduction. Forty-five participants with BDD who enrolled in a CBT for BDD treatment development study were included in two sets of analyses: (1) between-subject mediation of the effect of 12 weeks of CBT versus waitlist, and (2) within-subject mediation of longitudinal change in BDD symptom severity during 24 weeks of CBT. No significant mediators emerged in the between-subject analysis. Checking, grooming, avoidance behaviors, and maladaptive beliefs mediated within-subject improvements over time. Findings suggest that BDD symptom reduction occurs through the very mechanisms that have been hypothesized to maintain BDD in CBT models. Targeting certain cognitive (beliefs about appearance) and behavioral (checking, grooming, and avoidance behaviors) mechanisms in future treatment trials may enhance symptom improvement during CBT. National Clinical Trials Registration Identifier # NCT00106223.

Correction to: Effects of Neuropsychological Systems on Psychopathology Through Cognitive Emotion Regulation Strategies in Individuals with Suicide Attempts The original version of this article contains an error in the abstract section. The 3rd line of the abstract section “In a cross-sectional design, 399 suicide attempters completed the Carver and White BIS/BAS scales, the Cognitive Emotion Regulation Questionnaire-Short version (CERQShort), the Beck Scale for Suicidal Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II)” should read as “In a cross-sectional design, three hundred suicide attempters completed the Carver and White BIS/BAS scales, the Cognitive Emotion Regulation Questionnaire-Short version (CERQShort), the Beck Scale for Suicidal Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II)”. The original article has been updated.

Cultivating Self-Compassion Promotes Disclosure of Experiences that Threaten Self-Esteem Abstract The present study investigated whether cultivating self-compassion facilitates disclosure of self-esteem threatening experiences to others, and whether it does so indirectly by reducing shame. Eighty-five female undergraduates recalled an event that threatened their self-esteem and were randomly assigned to write about it in a self-compassionate (n = 29), self-esteem enhancing (n = 30), or non-directive (free writing; n = 26) way. Participants then learned that self-disclosure can decrease distress and were invited to share their event in writing to a stranger. Contrary to the central hypothesis, there was no main effect of condition on self-disclosure; however, post hoc analyses demonstrated that condition interacted with self-esteem threat to predict length and depth of disclosure. For participants whose events were more self-esteem threatening, cultivating either self-compassion or self-esteem promoted deeper disclosures than free writing, and self-compassionate writing alone fostered longer disclosures. For less self-esteem threatening events, free writing promoted deeper and longer disclosures than cultivating self-compassion or self-esteem. Shame was not a significant mediator. Results highlight the potential utility of self-compassion or self-esteem enhancing interventions for facilitating the disclosure of distressing events that threaten self-worth.

Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors Abstract Traumatic Brain Injury (TBI) associated cognitive impairments may pose an obstacle to homework engagement in Cognitive Behavior Therapy (CBT) for depression and anxiety. The current study examined the association of demographic, injury-related and CBT process variables with homework engagement in CBT adapted for TBI -related cognitive impairments (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions, representing 31 therapist-client dyads, were assessed from the independent observer perspective. Client homework engagement, therapist competence in assigning and reviewing homework, and working alliance strength, were measured. Multi-level mixed model regressions showed that older client age, more time since injury, stronger working alliance and greater therapist competence in homework review, were significantly associated with higher levels of homework engagement. The findings highlight how CBT-ABI therapists can possibly enhance homework engagement for clients with TBI.

Fostering Cognitive Change in Cognitive Therapy of Depression: An Investigation of Therapeutic Strategies Abstract There is little evidence regarding which therapist strategies promote cognitive change in cognitive therapy (CT) of depression. Drawing from a sample of CT patients, we selected two consecutive sessions for which patients reported markedly different amounts of cognitive change (CC; i.e., a low and high cognitive change session). We then investigated whether four observer-rated psychotherapy process variables differentiated high and low CC sessions. Our analyses focused on 62 patients with large session-to-session differences in self-reported CC. Results from single predictor models showed the therapeutic alliance and therapists’ use of cognitive methods predicted high versus low CC session type. In a model including multiple predictors, only cognitive methods remained significant. These findings are consistent with the view that cognitive methods promote CC in CT.

A Network Approach to Understanding the Emotion Regulation Benefits of Aerobic Exercise Abstract Regular and even single sessions of aerobic exercise may benefit emotional health. Experiments show that prior exercise hastens emotional recovery following a stressor despite not changing reports of rumination or other emotion regulation difficulties. We use network analyses to explore whether traditional approaches for conceptualizing and measuring rumination (i.e. sum scores) could be occluding exercise-induced changes to emotion regulation. Participants (n = 226) were randomly assigned to a cycling (n = 113) or stretching control condition (n = 113). They then underwent a stressful speech task, followed by a recovery period. State rumination was measured through self-report. Graphical LASSO and relative importance networks and accompanying strength centrality indices were computed. Similar patterns emerged in both models. Declines in the strength centrality of self-criticism in the cycling group stood out. Exercise may alter the relations between rumination processes and target self-criticism in particular. This perspective offers important information about how exercise enhances well-being through emotion regulation as well as how to intervene on emotion regulation deficits more generally.

Autobiographical Memory and Episodic Future Thinking in Severe Health Anxiety: A Comparison with Obsessive–Compulsive Disorder Abstract Severe health anxiety is characterized by intrusive worries about harboring a serious illness. In the present study, 32 patients with severe health anxiety, 32 control participants and a clinical control group of 33 patients with obsessive–compulsive disorder (OCD) reported unprompted and anxiety-related autobiographical memories and episodic future thoughts. Compared to control participants, the patient groups displayed similar patterns in the characteristics of the reported events and regarding the maladaptive cognitive and behavioral strategies used, when the events came to mind. Patients with severe health anxiety reported more events related to their own illness or death than either of the other groups, and exploratory analyses suggested that they were more inclined than OCD patients to check their own bodies when anxiety-related events came to mind. Autobiographical memories and episodic future thoughts have not previously been examined in patients with severe health anxiety, but could play an important role in this disorder.

Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing Abstract The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT.

A Brief Worry Reappraisal Paradigm (REAP) Increases Coping with Worries Abstract The current study examined a novel computerized cognitive reappraisal paradigm (REAP) for worry management in college-aged adults with a range of PSWQ scores (n = 98). Participants listed three current worries and were randomized to either REAP or a worry condition. For the REAP condition, participants selected positive reappraisal statements of their worries over negative ones. Before and after completing the reappraisal or worry task, participants discussed each worry. Participants rated their worries on coping ability, distress, and probability the worry would materialize. Relative to worry, the REAP group rated an increase in ability to cope with their worries whereas the results failed to provide evidence for a similar increase among the worry group. If similar findings emerge in clinical populations, REAP may eventually serve as a useful tool in augmenting cognitive behavioral therapy protocols.

The Association of Trait Mindfulness and Self-compassion with Obsessive-Compulsive Disorder Symptoms: Results from a Large Survey with Treatment-Seeking Adults Abstract Little is known about the role of mindfulness and self-compassion in obsessive-compulsive disorder. This cross-sectional study examined associations of mindfulness and self-compassion with obsessive-compulsive disorder symptoms and with the obsessive beliefs and low distress tolerance thought to maintain them. Samples of treatment-seeking adults (N = 1871) and non-treatment-seeking adults (N = 540) completed mindfulness, self-compassion, obsessive-compulsive disorder, anxiety, depression, obsessive beliefs and distress tolerance questionnaires. Participants with clinically significant obsessive-compulsive disorder symptoms reported lower trait mindfulness and self-compassion compared to participants with clinically significant anxiety/depression and to non-clinical controls. Among the clinical sample, there were medium-large associations between mindfulness and self-compassion and obsessive-compulsive disorder symptoms, obsessive beliefs and distress tolerance. Mindfulness and self-compassion were unique predictors of obsessive-compulsive disorder symptoms, controlling for depression severity. Once effects of obsessive beliefs and distress tolerance were controlled, a small effect remained for mindfulness (facets) on obsessing symptoms and for self-compassion on washing and checking symptoms. Directions for future research and clinical implications are considered in conclusion.