Behaviour Therapy

According to the cognitive behavioral model of severe health anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe health anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. health anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in health anxiety. The study supports the validity of the cognitive behavioral model of health anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for health anxiety.

Introduction: Current autism interventions, including Applied Behaviour Analysis (ABA) and occupational therapy approaches, often prioritise discrete behavioural elements, overlooking the multi-layered, dynamic interplay between developmental domains. This oversimplification risks reducing intervention fidelity and may compromise long-term outcomes for children on the autism spectrum. Methods: This conceptual paper synthesises findings from recent empirical studies (2019-2025) on early developmental trajectories, neurocognitive processes, and social-emotional-cognitive interactions in autism. Using systematic literature selection criteriarelevance to behavioural intricacies, author expertise alignment, and methodological robustness-we identified recurrent "Intricacy Zones" spanning motor, sensory, attentional, social, cognitive, and neurobiological dimensions. Results: The proposed Behavioural Intricacies Analysis (BIA) framework integrates these zones into a dynamic observational model guided by three principles: Contextual Embeddedness (behaviour analysed within situational and relational contexts), Configurational Complexity (meaning emerging from factor configurations rather than additive elements), and Developmental Relevance (interpretation aligned to neurodevelopmental stage). Operational definitions and measurable criteria are provided to maintain analytic precision. Discussion: BIA offers a theoretically grounded alternative to element-based models, enabling more ecologically valid and personalised intervention planning. It addresses a critical gap in autism therapy by emphasising the identification and modification of underlying behavioural configurations rather than surface behaviours. The framework's clinical utility lies in enhancing diagnostic sensitivity, guiding targeted therapeutic design, and reducing the risk of intervention misalignment caused by oversimplified assessment tools. Conclusion: By systematising the observation and interpretation of behavioural intricacies, BIA supports a paradigm shift toward interventions that honour the complexity of child development. Future empirical validation is required to establish its efficacy and adaptability across diverse neurodevelopmental profiles.

Drawing on extensive experience in training and supervising clinicians in enhanced cognitive behaviour therapy (CBT-E), we have identified ten prevalent misconceptions and communication gaps. These misunderstandings can impact the implementation of CBT-E and may potentially reduce its effectiveness. They include misconceptions regarding CBT-E's flexibility, suitability for certain patient groups, realworld applicability, and alignment with anti-weight stigma principles. Such misunderstandings may make clinicians hesitant to recommend or deliver CBT-E appropriately. In the present paper, we address these misconceptions and gaps in communication and provide evidence-based guidance on CBT-E practice. We aim to enhance clinicians' confidence in using CBT-E flexibly and appropriately, with the hope that this will improve its effectiveness. Key learning aims (1) Recognise common misconceptions and communication gaps about enhanced cognitive behaviour therapy (CBT-E) for eating disorders. (2) Develop an understanding of how CBT-E can be implemented across diverse clinical settings and patient populations. (3) Strengthen therapists' confidence in delivering CBT-E flexibly while maintaining fidelity to its evidence-based framework.

The purpose of this small pilot study was three-fold: (a) to begin development of a coding scheme for supervisor and therapist skill acquisition, (b) to preliminarily investigate a pilot train-the-trainer paradigm for skill development, and (c) to evaluate self-reported versus observed indicators of skill mastery in that pilot program. Participants included four supervisoretherapist dyads (N ¼ 8) working with public mental health sector youth. Master trainers taught cognitive-behavioral therapy techniques to supervisors, who in turn trained therapists on these techniques. Supervisor and therapist skill acquisition and supervisor use of teaching strategies were repeatedly assessed through coding of scripted role-plays with a multiple-baseline across participants and behaviors design. The coding system, the Practice Element Train the Trainer e Supervisor/Therapist Versions of the Therapy Process Observational Coding System for Child Psychotherapy, was developed and evaluated though the course of the investigation. The coding scheme demonstrated excellent reliability (ICCs [1,2] ¼ 0.81e0.91) across 168 video recordings. As calculated through within-subject effect sizes, supervisor and therapist participants, respectively, evidenced skill improvements related to teaching and performing therapy techniques. Self-reported indicators of skill mastery were inflated in comparison to observed skill mastery. Findings lend initial support for further developing an evaluative approach for a train-the-trainer effort focused on disseminating evidence-based practices.

The purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and posttraumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51 women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE• exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women.

Study of individual treatment mechanisms in youth interventions facilitates evidence-based development, selection and implementation of treatment components that are most effective for each individual child. This position paper aims to bring together two important topics from the area of youth intervention research: mediators of treatment outcomes and single-case experimental design methodology. We start by outlining the benefits of studying within-person mechanisms and propose how statistical mediation analysis and single-case methods can be integrated to enable this type of research. Further, we review existing methodology for the study of individual youth treatment mechanisms and provide recommendations for the clinical practice research.

Obsessive Compulsive Disorder, or OCD for short is a mental disorder in which the individual experiences intrusive thoughts and repetitive, compulsive behavior. The reason the individual may perform this behavior is to relieve the stress from their intrusive thoughts.
Because of this, they can feel significant anxiety, and OCD symptoms often interrupt people’s lives immensely.

Transcranial direct current stimulation is a promising neuromodulation method for treating depression. However, compared with pharmacological treatment, previous studies have reported that a relatively limited proportion of patients respond to tDCS treatment. In addition, the neurophysiological mechanisms underlying tDCS treatment remain unclear, making it difficult to identify response predictors for tDCS treatment based on neurophysiological function. Because treatment effects are achieved by repetitive application of tDCS, studying the immediate effects of tDCS in depressive patients could extend understanding of its treatment mechanisms. However, immediate changes in a single session of tDCS are not well documented. Thus, in the current study, we focused on the immediate impact of tDCS and its association with pre-stimulus brain activity. To address this question, we applied anodal tDCS to the left dorsolateral prefrontal cortex (DLPFC) or dorsomedial prefrontal cortex (DMPFC) in 14 patients with major depressive disorder (MDD) and 19 healthy controls (HCs), at an intensity of 1.0 mA for 20 min in a single session. To evaluate anxiety, the state trait anxiety inventory was completed before and after tDCS. We recorded resting electroencephalography before tDCS, and calculated electrical neuronal activity in the theta and alpha frequency bands using standardized low-resolution electromagnetic tomography. We found that, during application of left DLPFC tDCS to patients with MDD, the anxiety reduction effect of tDCS was related to higher baseline theta-band activity in the rostral anterior cingulate cortex (rACC) and no medication with benzodiazepine used as hypnotic. For DMPFC stimulation in MDD, the anxiety reduction effect was associated with lower baseline alpha-band activity in the left inferior parietal lobule. In contrast, in HCs, the anxiety reduction effect was associated with higher baseline alpha activity in the precuneus during DMPFC stimulation. The current results suggest that the association between pre-tDCS brain activity and the anxiety reduction effect of tDCS depends on psychopathology (depressed or non-depressed) as well as the site of stimulation (DMPFC or left DLPFC) and insomnia. Furthermore, the results suggest that tDCS response might be associated with baseline resting state electrophysiological neural activity.

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Major Depressive Disorder (MDD) represents a multifactorial psychiatric condition characterized by complex neurobiological alterations involving frontostriatal circuits, limbic structures, and specialized neural networks. This narrative review synthesizes recent scientific evidence on the neural correlates of depression, focusing on functional and structural alterations documented through advanced neuroimaging techniques, with particular attention to neurobiological differences across major depressive subtypes.

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The present study examined the efficacy of a brief, written exposure therapy (WET) for posttraumatic stress disorder (PTSD). Participants were 46 adults with a current primary diagnosis of motor vehicle accident-related PTSD. Participants were randomly assigned to either WET or a wait list (WL) condition. Independent assessments took place at baseline and 6-, 18-, and 30weeks post baseline (WL condition not assessed at 30 weeks). Participants assigned to WET showed significant reductions in PTSD symptom severity at 6-and 18-week post-baseline, relative to WL participants, with large between-group effect sizes. In addition, significantly fewer WET participants met diagnostic criteria for PTSD at both the 6-and 18-week post-baseline assessments, relative to WL participants. Treatment gains were maintained for the WET participants at the 30-week post baseline assessment. Notably, only 9% of participants dropped out of WET and the WET participants reported a high degree of satisfaction with the treatment. These findings suggest that a brief, written exposure treatment may efficaciously treat PTSD. Future research should examine whether WET is efficacious with other PTSD samples, as well as compare the efficacy of WET with that of evidence-based treatments for PTSD.

Objective: Exposure based large-group one-session treatments (LG-OSTs) proved feasible in different situational fears and showed promising short-and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). Moreover, we aimed to identify predictors of LG-OST outcome in order to provide individualized treatment recommendations in the future. Methods: Participants' fear of heights was assessed at pre-and post-treatment as well as at 5 months follow-up using questionnaires and a behavioral approach test (BAT). Pre-treatment indices of negative emotional traits and positive mental health, the extent by which fear-evoking expectancies were violated during exposure, and post-treatment group perception processes were assessed in order to predict the outcome. The LG-OST procedure proved feasible and effective in terms of both subjective and behavioral fear of heights. Post-treatment effects sizes of questionnaires assessing fear of heights ranged between d = 0.94 -1.43. After the treatment, about half of the participants (49.5%) were able to ascend an aerial fire ladder up to a maximum of 30 m (vs. pre-treatment 17.3%). Follow up results showed the long-term stability of effects. Among psychological constructs, positive mental health and expectancy violation were the strongest predictors of LG-OST long-term outcome. We conclude that exposure based LG-OSTs are feasible, effective and very efficient compared to individual face-to-face settings. Thus, they represent very promising treatment alternatives for situational fears including fear of heights. Moreover, clinical research may benefit from LG-OST protocols as its high standardization may facilitate the search for mediators and moderators of exposure outcomes.

For young people with eating disorders (EDs), family-based therapy (FBT) is generally recommended as firstline treatment. Although there is an abundance of evidence demonstrating the efficacy of FBT, less than half of young people achieve full remission with this treatment. Enhanced cognitive behaviour therapy (CBT-E) is an established alternative to FBT, demonstrating effectiveness in individuals who have not achieved full remission with FBT. It is also recommended when family therapy is unacceptable, contraindicated, or ineffective. Despite some overlapparticularly in addressing maintaining factors and prioritising weight normalisationthe two treatments diverge significantly in conceptualisation of the eating disorder, proposed mechanisms of action, role of both young people and parents, and strategies and processes of therapy. These differences may contribute to one treatment being effective where the other has not, but can present challenges and difficulties for the young person, family and clinician when transitioning from FBT to CBT-E. In this paper, we provide guidance for clinicians delivering CBT-E with young people who have a history of FBT treatment. We highlight common issues encountered among this cohort, discuss how they can present a barrier to successful implementation of CBT-E, and describe solutions. Key learning aims (1) To learn the commonly encountered barriers to treatment when implementing CBT-E for young people who have previously engaged in FBT. (2) To learn strategies to overcome these barriers focusing on the young person, parents and multidisciplinary team.

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N ¼ 14) and a 3-month waitlist condition (WL, N ¼ 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.

There are few studies examining the relationship between psychopathology and positive experiences and traits. Although initial studies suggest persons with posttraumatic stress disorder (PTSD) are at increased risk for excessive social anxiety, there have been no studies to date evaluating how these conditions might interact to affect positive experiences and traits. Using self-report scales, informant ratings, and experiencesampling methodologies, we examined the association of social anxiety with well-being and character strengths in veterans with and without PTSD. Controlling for PTSD and trait negative affect, social anxiety was negatively related to global ratings of well-being and character strengths. Social anxiety also accounted for incremental variance in day-to-day well-being (i.e., daily affect balance, percentage of pleasant days, positive social activity, self-esteem, gratitude) over a 14-day assessment period. Although veterans with PTSD reported lower levels of global and daily well-being and character strengths than veterans without PTSD, a diagnosis of PTSD failed to exhibit unique relationships with these constructs. Building on a growing body of work, these data suggest that social anxiety is uniquely associated with disturbances in positive experiences, events, and traits. Our findings support the value of directly addressing social anxiety in the study and treatment of PTSD.

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Scopo del presente articolo è fornire un contributo alla definizione degli scopi che effettivamente regolano l’attività ossessiva. A tal fine verranno presentati i dati emersi da una prima indagine clinica finalizzata a identificare gli obiettivi perseguiti con i comportamenti ossessivi da un gruppo di pazienti giunto alla nostra osservazione. Per ciascun paziente, al fine di identificarne le principali ossessioni e compulsioni, tre psicoterapeuti cognitivi hanno compilato uno schema diviso in 5 parti. Successivamente, a 18 giudici indipendenti, tutti psicologi e all’oscuro delle finalità dello studio, è stato chiesto di classificare la parte relativa alla prima valutazione dello schema secondo 4 categorie scelte sulla base della letteratura: Timore di colpa, Timore del giudizio altrui, Timore di contaminazione da sostanze disgustose, Timore di un danno ma senza colpa. I risultati suggeriscono che l’attività ossessiva dei pazienti fosse finalizzata, principalmente, a due scopi: prev...

Obsessive-compulsive disorder and body dysmorphic disorder have many similarities in clinical presentation. Obsessive-compulsive disorder has historically been considered an anxiety disorder, whereas body dysmorphic disorder has been grouped among the somatoform disorders. Researchers in these areas are currently debating whether the similarities warrant the inclusion of body dysmorphic disorder within a proposed category of obsessive-compulsive spectrum disorders. This article describes the association between obsessive-compulsive disorder and body dysmorphic disorder as evidenced by the emerging literature, and presents theoretical and clinical implications of this association.

Body dysmorphic symptoms in youth with Obsessive-Compulsive disorder: Prevalence, clinical correlates, and cognitive behavioral therapy outcome. Þórhildur Ólafsdóttir Lokaverkefni til MS gráðu í klínískri sálfraeði Leiðbeinandi: Guðmundur Skarphéðinsson Sálfraeðideild Heilbrigðisvísindasvið Háskóla Íslands Júní 2019 3 Ritgerð þessi er lokaverkefni til MS gráðu í klínískri sálfraeði. Óheimilt að afrita ritgerðina á nokkurn hátt nema með leyfi rétthafa.

The purpose of this study was to investigate whether the presence of tic disorder is negatively associated with sertraline (SRT) outcomes, but not with continued cognitive-behavioral therapy (CBT), in a sample of youth who were unresponsive to an initial full course of CBT. In the Nordic Long-Term OCD Study, children and adolescents with OCD who were rated as nonresponders to 14 weeks of open-label CBT were randomized to continued CBT (n=28) or SRT treatment (n=22) for an additional 16 weeks of treatment. We investigated whether the presence or absence of comorbid tic disorder moderated treatment outcomes on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Twelve out of 50 (24.0%) participants were diagnosed with comorbid tic disorder, with 7 receiving continued CBT and 5 receiving SRT, respectively. In patients without tic disorder, results showed no significant between-group differences on average CY-BOCS scores. However, in patients with comorbid tic disorder, ...

Investigations of targeted coping skills could help guide initial treatment decisions for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who often endorse worse coping skills than those with AD but not PTSD. Although improvement in coping skills is associated with enhanced alcohol use outcomes, no study has evaluated the utility of teaching specific coping skills in the context of comorbid PTSD/AD. We compared the effects of teaching two coping skills (cognitive restructuring [CR] and experiential acceptance [EA]) or an attention control condition on drinking and PTSD symptoms among 78 men and women with comorbid PTSD/AD during a 5-week daily follow-up assessment. Both CR and EA skills were associated with decreased drinking compared to control, and that change in drinking over time did not significantly differ between those who received CR and EA. Individuals who received CR skills, however, consumed less alcohol on a given day than t...

This paper presents themes from qualitative analysis of interviews with parents and practitioners, aiming to consider how families benefit, or do not, from services' intervention. Eleven London families in contact with child protection services were followed for five years. In-depth, repeat interviews were conducted with mothers and with practitioners they nominated as helpful. The families had originally been referred to a therapeutic parenting programme because their child was considered to be at risk for future antisocial behaviour due to their conduct problems, and additional risk factors in the family. However not all families completed, or even began that programme . The interviews explored families' interactions with all services over the five years including social work, mental health and family support provision. The analysis suggested a number of changes in parenting which appeared to be related to improved outcomes for children and their families. For example, changes in mothers' conceptualisation of their child's behaviour, brought about through therapeutic intervention, could transform parent-child relationships and thereby improve longerterm outcomes. However, other mothers could bring about change without these cognitive shifts, through use of strategies to manage children's behaviour or improve mothers' own wellbeing. Services sometimes played an important role in these changes. The analysis also suggested features of provision which prevented intervention with families being effective. Services' focus on parenting, and the associated perceived blame, can sometimes undermine parents and be counter-productive, whereas empowering parents through developing shared goals seems more useful.

This study explores longitudinally a four-factor structure of pathological personality trait dimensions (PPTDs) to examine both its structural stability and intraindividual changes among PPTDs over time. Personality Disorder (PD) scales of the Millon Clinical Multiaxial Inventory-III were administered to 361 low-income women with various psychiatric conditions (drug dependence, depression), who were followed in a two-wave study over 5-years. Cross-sectional and longitudinal factor analyses outlined a robust factorial structure of PPTDs, extrinsically invariant over time, representing Negative Emotionality, Introversion, Antagonism and Impulsivity. Despite moderate rank-order stability in the PPTDs, results also indicated substantial intra-individual variability in the degree and direction of change, consistent with trajectories of change in participants' clinical diagnoses. Results are discussed in light of current debates on the structure and dynamic of pathological personality.

This study explores longitudinally a four-factor structure of pathological personality trait dimensions (PPTDs) to examine both its structural stability and intraindividual changes among PPTDs over time. Personality Disorder (PD) scales of the Millon Clinical Multiaxial Inventory-III were administered to 361 low-income women with various psychiatric conditions (drug dependence, depression), who were followed in a two-wave study over 5-years. Cross-sectional and longitudinal factor analyses outlined a robust factorial structure of PPTDs, extrinsically invariant over time, representing Negative Emotionality, Introversion, Antagonism and Impulsivity. Despite moderate rank-order stability in the PPTDs, results also indicated substantial intra-individual variability in the degree and direction of change, consistent with trajectories of change in participants' clinical diagnoses. Results are discussed in light of current debates on the structure and dynamic of pathological personality.

Chapter 1 -Introduction to the Thesis I'd also like to thank all the other wonderful human beings in the School of Psychology, both staff and students, who supported me perhaps more than they realise throughout the past few years. Especially, and in no particular order, Michelle Mattison, Liz Whelen, Bryan Hiller, Jayne Kirby and many others, you know who you are. Finally, thank you to all of my fabulous friends for your never ending help and enthusiasm. xii xii

His interest in psychology began in 1969 when he began working with autistic ch~ldren at the Michael Reese Hospital Dysfunctioning Child Center in Chicago. In 1971 ne began an internship in child research at the Loyola Child Guidance Center where he developed his interest in systematic contingency management techniques. While at the Loyola Day School he was involved with research, prograrn.development and the training of volunteer personnel in a classroom of nonverbal, emotionally disturbed children. Later in 1973 he became a training psychologist with the Title I Language Development Program, a position he held iii until July, 1974.

Objective: Hoarding disorder (HD) is a common and potentially debilitating psychiatric disorder. Thus far, psychological treatments have yielded modest effects and/or were time-consuming and costly to deliver. The aim of the present study was to test the efficacy of a brief group cognitive-behavioral therapy (CBT) for adults with HD and to test hypothesized mediators of treatment outcome. Method: Eighty-seven adults with a primary diagnosis of HD were randomized to either immediate CBT or wait list. CBT consisted of 16 weekly, 90-min group sessions that emphasized in-session practice of discarding and refraining from acquiring, decision-making and problem-solving training, emotional distress tolerance, motivational interviewing strategies, and contingency management. Participants were assessed at pretreatment, midtreatment, and posttreatment by an independent evaluator unaware of treatment condition. Results: CBT was efficacious for the symptoms of HD compared with wait list. Saving-related cognitions, but not subjective cognitive impairment, partially mediated treatment outcomes. Conclusion: Brief Group CBT is an efficacious and feasible treatment for adults with HD, and is partially mediated by reductions in maladaptive beliefs about possessions. Superiority trials comparing CBT to active treatments, and additional research into mechanisms of treatment outcome, are warranted. Hoarding disorder (HD) is a common and often severe psychiatric illness. As a new diagnosis, it has received less research attention than many other disorders. Treatment efficacy for HD also lags behind that of many other psychiatric disorders. This study suggests that a relatively brief (16session) Group CBT is efficacious for adults with HD, with 83% of patients classified as improved. These results support the consideration of Group CBT as a first-line treatment for HD.

Cognitive-behavioral therapy (CBT) is considered first-line treatment for childhood obsessive-compulsive disorder (OCD). Despite CBT's efficacy, too many children and adolescents do not fully respond to treatment, making the identification of predictors of treatment response highly relevant. Executive functions (EF) have been suggested to constitute such predictors, but studies with pediatric samples are scarce. In the present study, we investigated latent level EF test performance and ratings of daily life EF behavior as predictors of CBT response in pediatric OCD. We further examined the stability of EF from pre-to post-treatment and the association of EF changes with OCD severity change. EF test performance significantly predicted exposure-based CBT outcome. Patients with better EF test performance had significantly elevated risk of non-response relative to patients with poorer performance. Daily life EF behavior in OCD probands improved after treatment relative to controls. The findings suggest that EF performance impacts CBT outcome, and that exposure-based CBT is well-suited for children and adolescents with OCD and poorer EF test performance. This study supports the relevance of EF in CBT for childhood OCD and denotes a possible need for development of enhanced treatments for children and adolescents with OCD and superior EF performance.

Background-Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant's hospitalization in a pediatric cardiac intensive care unit (PCICU). Objectives-This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU? Methods-This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD.

Assessment methods relying on biased or inaccurate retrospective recall may distort knowledge about the nature of disorders and lead to faulty clinical inferences. Despite concerns about the accuracy of retrospective recall in general and in particular with obsessive-compulsive disorder (OCD) patients, the accuracy of retrospective recall for one's own symptoms assessed in vivo is unknown in this population. This study used a prospective ecological momentary assessment (EMA) methodology to create a criterion against which to assess recall accuracy in OCD patients. Although results indicated that patients' retrospective recall of OCD symptoms was fairly accurate, they consistently overestimated the magnitude of OCD symptom covariation with non-OCD facets (e.g., sleep duration, contemporaneous stress level, etc.). Findings suggest that even when recall of OCD symptoms is accurate, patients may be inaccurate in estimating symptom covariation. The findings have implications for the research, case conceptualization, and assessment of OCD, and may extend to other disorders.

This study sought to identify brain regions that underlie symptom changes in severely affected IBS patients undergoing cognitive therapy (CT). Five healthy controls and 6 Rome II diagnosed IBS patients underwent psychological testing followed by rectal balloon distention while brain neural activity was measured with O-15 water positron emission tomography (PET) before and after a brief regimen of CT. Pre-treatment resting state scans, without distention, were compared to posttreatment scans using statistical parametric mapping (SPM). Neural activity in the parahippocampal gyrus and inferior portion of the right cortex cingulate were reduced in the posttreatment scan, compared to pre-treatment (x, y, z coordinates in MNI standard space were -30, -12, -30, P = 0.017; 6, 34, -8, P = 0.023, respectively). Blood flow values at these two sites in the controls were intermediate between those in the pre-and post-treatment IBS patients. Limbic activity changes were accompanied by significant improvements in GI symptoms (e.g., pain, bowel dysfunction) and psychological functioning (e.g., anxiety, worry). The left pons (-2, -26, -28, P = 0:04) showed decreased neural activity which was correlated with post-treatment anxiety scores. Changes in neural activity of cortical-limbic regions that subserve hypervigilance and emotion regulation may represent biologically oriented change mechanisms that mediate symptom improvement of CT for IBS.

 CS-US pairings can add to the effects of CS-US contingency instructions.  We investigate whether US expectancy ratings can account for these effects.  Mediational analyses did not support this hypothesis.  Exploratory analyses revealed that fear ratings do mediate these effects.  We discuss the validity of US expectancy and fear ratings.

Objective: To compare a mindfulness-based intervention with cognitive behavioral therapy (CBT) for the group treatment of anxiety disorders. Method: One hundred five veterans (83% male, mean age ¼ 46 years, 30% minority) with one or more DSM-IV anxiety disorders began group treatment following randomization to adapted mindfulnessbased stress reduction (MBSR) or CBT. Results: Both groups showed large and equivalent improvements on principal disorder severity thru 3month follow up (ps < .001, d ¼ À4.08 for adapted MBSR; d ¼ À3.52 for CBT). CBT outperformed adapted MBSR on anxious arousal outcomes at follow up (p < .01, d ¼ .49) whereas adapted MBSR reduced worry at a greater rate than CBT (p < .05, d ¼ .64) and resulted in greater reduction of comorbid emotional disorders (p < .05, d ¼ .49). The adapted MBSR group evidenced greater mood disorders and worry at Pre, however. Groups showed equivalent treatment credibility, therapist adherence and competency, and reliable improvement. Conclusions: CBT and adapted MBSR were both effective at reducing principal diagnosis severity and somewhat effective at reducing self-reported anxiety symptoms within a complex sample. CBT was more effective at reducing anxious arousal, whereas adapted MBSR may be more effective at reducing worry and comorbid disorders.

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Two experiments investigated whether the establishment of aversion to alcoholic beverages resulted from aversion conditioning to the taste/flavor characteristics of ethanol or to the specific characteristics of particular beverage(s) (i.e. ethanol + congeners). In Experiment 1 rats (n = 72) received a pairing of whiskey, bourbon, rum or ethanol. each at a 5 y0 ethanol concentration, with an injection of 0.15 M LiCI. Relative to toxin and to beverage control groups, aversion effects to whiskey and bourbon were greater than those to ethanol. aversion effects to rum being intermediate. In Experiment 2 rats (n = 162) received whiskey, rum or ethanol paired with an LiCl injection and were tested for aversion to the conditioning beverage and to each of the other beverages. Relative to controls, aversion effects were generally greater to the conditioning beverage than to the generalization test beverages. Generalization depended upon which alcoholic beverage was the conditioning beverage and which. the generalization test beverage. Specifically, conditioning to whiskey yielded a reliable generalization gradient: greater aversion effects to whiskey, than to rum, than to ethanol. Conditioning to rum yielded similar aversion effects to whiskey and ethanol. Conditioning to ethanol produced comparable aversion to ethanol and whiskey and reliably less to rum.

The present study examined predictors and moderators of dropout among 165 adults meeting DSM-IV criteria for posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Participants were randomized to 24 weeks of naltrexone (NAL), NAL and prolonged exposure (PE), pill placebo, or pill placebo and PE. All participants received supportive AD counseling (the BRENDA manualized model). Logistic regression using the Fournier approach was conducted to investigate baseline predictors of dropout across the entire study sample. Rates of PTSD and AD symptom improvement were included to evaluate the impact of symptom change on dropout. Trauma type and rates of PTSD and AD improvement significantly predicted dropout, accounting for 76% of the variance in dropout. Accidents and &quot;other&quot; trauma were associated with the highest dropout, and physical assault was associated with the lowest dropout. For participants with low baseline PTSD severity, faster PTSD improvement predicted high...

Perception of personal identity cannot be separated from the perception of the social context and one&#39;s social identity. Full involvement in group psychotherapy may require not only the awareness of personal impairment, but also social identification. The aim of the current study was to examine the association between social identification and symptom improvement in group-based psychotherapy. 169 participants received 12 sessions of group-based cognitive behavioral therapy for social anxiety disorder. Social identification, the extent to which a person identifies with those who suffer from the same psychological problem as themselves and/or with those lacking psychopathology (non-sufferers), and clinical outcome were assessed at baseline, mid-and posttreatment, and 1, 3, and 6-months follow-up. At baseline, patients aspired for closeness with non-sufferers, and viewed themselves as distant from fellow sufferers and non-sufferers. After treatment, participants viewed not only the...

Cognitive-behavioral therapy (CBT) and pharmacotherapy are similarly effective for treating panic disorder with mild or no agoraphobia, but little is known about the mechanism through which these treatments work. The present study examined some of the criteria for cognitive mediation of treatment change in CBT alone, imipramine alone, CBT plus imipramine, and CBT plus placebo. Ninety-one individuals who received 1 of these interventions were assessed before and after acute treatment, and after a 6-month maintenance period. Multilevel moderated mediation analyses provided preliminary support for the notion that changes in panic-related cognitions mediate changes in panic severity only in treatments that include CBT.

This review concluded that cognitive-behavioural therapy was efficacious in reducing anxiety sensitivity in both treatment-seeking patients and those at risk. There were a number of limitations in the review which suggest that the authors' conclusions should be treated with caution.

The Padua Inventory (PI) of obsessions and compulsions is one of the most usually applied tests to assess obsessive-compulsive symptomatology in research contexts as well as for clinical and screening purposes. A reliability generalization meta-analysis was accomplished to estimate the average reliability of the PI scores and to search for characteristics of the samples and studies that can explain the variability among reliability estimates. An exhaustive literature search enabled us to select 39 studies (53 independent samples) that reported alpha and/or test-retest coefficients with the data at hand for the PI total score and subscales. An excellent average coefficient alpha was found for the PI total score (M = .935; 95%CI = .922-.949) and for Impaired Mental Control subscale (M = .911; 95%CI = .897-.924), being good for Contamination (M = .861; 95%CI = .841-.882) and Checking (M = .880; 95%CI = .856-.903), and fair for Urges and Worries (M = .783; 95%CI = .745-.822). The averag...

Background: Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. Objective: This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. Methods: This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. Results: The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] -0.633; 95% CI -0.861 to -0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (-0.372; 95% CI -0.704 to -0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD -0.391; 95% CI -0.560 to -0.221), and long-term follow-up (SMD -0.357; 95% CI -0.541 to -0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future.

Alcohol Use Disorder (AUD) is a debilitating condition with serious adverse effects on health and psycho-social functioning. The most effective psychological treatments for AUD show moderate efficacy and return to dysregulated alcohol use after treatment is still common. The aim of the present study was to evaluate Metacognitive Therapy (MCT) as applied to AUD. Five patients were treated using a non-concurrent multiple baseline design with follow-up at 3-and 6-months time points. Each patient received 12 onehour sessions of MCT. Following MCT all patients demonstrated large and clinically meaningful reductions in weekly alcohol use and number of binge drinking episodes that were upheld at follow-up in almost all cases. Metacognitive beliefs, as secondary outcome, also changed substantially. The findings from this study offer preliminary evidence of positive effects associated with MCT in AUD and support the need for a definitive trial of MCT in addictive behaviors.

Título: Desarrollo y validación de una versión española del Team Climate Inventory: un análisis de invariancia factorial. Resumen: El presente estudio analiza las propiedades psicométricas y la validez de una versión española del Team Climate Inventory (TCI). El TCI es un instrumento para la medición del clima de los equipos de trabajo, que se desarrolla a partir de una teoría de cuatro factores aplicada a la innovación de equipo . El estudio muestra una fiabilidad satisfactoria del instrumento, estimada con índices Alpha de Cronbach y Omega. El análisis factorial exploratorio retuvo cuatro factores más un quinto, tal como se encontró en otras validaciones del TCI. El análisis factorial confirmatorio permitió averiguar que el mejor ajuste a los datos se obtuvo con el modelo de cinco factores. En el estudio, además, se compararon dos muestras (una de equipos de trabajo sanitarios españoles y otra de equipos de trabajo latinoamericanos pertenecientes a una empresa de desarrollo informático) con un total de 1099 participantes, cuya comparación muestra evidencias de invarianza factorial. Finalmente, se aportan evidencias de validez basadas en la predicción del rendimiento de equipo y de la satisfacción de los miembros. Palabras clave: Clima de equipo; rendimiento de equipo; invarianza factorial.

The question of whether the concepts of aggressiveness and assertiveness are generahzable across cultures is examined by comparing the responses of U.S., Israeli and Portugese college students on the Interpersonal Behavior Survey (IBS). The IBS, a 272-item self-report questionnaire. was translated into Hebrew and Portugese, and then tested for cross-cultural equivalency. The subjects were 97 American, I01 Israeli and 102 Portugese undergraduate students. Factor analyses for the three samples showed that American, Israeli and Portugese students view aggressiveness and assertiveness as distinct response classes. The similarity of factor structures across nations was tested using Cattell's Salient Variable Similarity Index. The results from the nation comparisons confirmed the hypothesis that Americans, Israeli and Portuguese have similar conceptions of aggressiveness and assertiveness. A potential problem with using the Salient Variable Similarity Index was also identified.

Objectives: Although the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) includes ancillary symptom dimensions -insight, avoidance, degree of indecisiveness, inflated sense of responsibility, pervasive slowness/disturbance of inertia, and pathological doubting -, we know little about their clinical/scientific utility. We examined these ancillary dimensions in childhood obsessivecompulsive disorder (OCD), and tested their associations with clinical characteristics. Methods: Treatment-seeking children and adolescents (n=173) with a DSM-5 OCD diagnosis were recruited from six centers in India and evaluated with a semi-structured proforma for sociodemographic/clinical details, the Structured Clinical Interview for DSM-5, the CY-BOCS, the Children's Depression Rating Scale, and the Family Interview for Genetic Studies. Regression analysis was used to study the associations between ancillary dimensions (independent variables) and clinical variables (dependent variables). Results: 87.9% of the sample reported at least a mild-moderate severity of ancillary dimensions, which were highly intercorrelated. Multiple ancillary dimensions were correlated with illness severity on the CY-BOCS. On regression analysis, only insight and avoidance retained significance. There were few differential associations between OCD symptom and ancillary dimensions. Conclusion: Ancillary dimensions are more a feature of illness severity than differentially associated with individual symptom dimensions in childhood OCD. Insight and avoidance should be considered for inclusion in the assessment of illness severity in childhood OCD.