Cognitive Behaviour Therapy

Published by Taylor & Francis (Routledge)
Online ISSN: 1650-6073
Publications
Article
Effects of the September 11, 2001 terrorist attacks in the USA were investigated in 25 patients with obsessive compulsive disorder and 27 normal controls 4-6 months after the attacks. Participants completed a 15-item questionnaire to retrospectively assess changes in mood, cognition, behavior and somatic complaints since September 11, 2001. Overall, both patients with obsessive compulsive disorder and normal controls reported minor changes in mood, behavior and somatic complaints. However, normal controls reported severe to extreme initial impact, slightly more cognitive symptoms (uncertainty about the future, intrusive recollections and greater desire to be with loved ones) and a slightly greater degree of overall impact on emotion and behavior at 1, 2 and 3 months after September 11 than did patients with obsessive compulsive disorder. Results support previous research that has found a relatively minor lasting impact of September 11 on both clinical and normal populations. Differences in cognition and coping mechanisms between normal controls and patients with obsessive compulsive disorder are proposed.
 
Article
Post-event processing is the cognitive rumination that follows social events in cognitive models of social anxiety. The aim of this study was to examine factors that may predict the extent to which individuals engage in post-event processing. Anxious rumination, social anxiety, anxiety sensitivity and post-event processing related to a recent anxiety-provoking social event were assessed in a college student sample (n = 439). Social anxiety and anxious rumination, but not anxiety sensitivity, significantly predicted the extent to which the participants engaged in post-event processing related to an anxiety-provoking social event. Factors that appear to impact on the post-event period include the nature of the social situation and the ethnicity of the participant. It appears that both general rumination over anxious symptoms, and specific rumination related to social events are relevant for cognitive models of social anxiety.
 
Article
The purpose of the present investigation was to examine the psychological impact of remote exposure to the events and aftermath of the terrorist attacks in the USA on September 11th, 2001, and to assess what differences, if any, exist between individuals classified with probable panic disorder and those without. Telephone interviews were conducted with 122 residents of the capital city of the Canadian prairie province of Saskatchewan in spring 2002 in order to gather information regarding current mood, fears and avoidance behaviours as well as current post-traumatic stress disorder symptoms specific to September 11th. Consistent with previous findings and despite the remote nature of exposure, results indicated that the psychological well-being and behaviour of participants with probable panic disorder was more adversely affected by the events and aftermath of September 11th than those without panic disorder. These results suggest that remote viewing of traumatic events can have a significant and lingering impact on psychological well-being and behaviour and that these effects are more pronounced in those with panic disorder. Implications of the findings and future research directions are discussed.
 
Article
Several surveys have reported the negative psychological impact on the general public of the terrorist attacks in the USA of September 11th, 2001. Yet the attacks also led many people to make positive changes in their relationships, values and priorities. A survey of 80 adults in Ottawa, Canada demonstrated that greater perceived threat and greater initial distress reactions significantly predicted the extent to which people reported positive changes in their lives (e.g. closer to family, refocused priorities). Initial distress and greater perceived threat also correlated positively with whether people provided help after the disaster. Follow-up data on 40 of these participants 11 months later revealed significant stability over time for the extent of positive life changes reported, and demonstrated that degree of initial distress and perceived threat continued to correlate positively with life change reports at this later point in time. The data are consistent with the argument that the perception of growth may develop out of one's personal experience of emotional pain.
 
Article
Deliberate self-harm was studied in 14-year-old adolescents from four schools in southern Sweden with a test-retest design, using a nine-item version of the Deliberate Self-Harm Inventory. At Time 1, 40.2% of the adolescents indicated deliberate self-harm on at least one occasion compared with 36.5% at Time 2. Test-retest data showed high stability over periods of up to 2 months in duration. Cross-validation of the results from Time 1 to Time 2 showed robust correlations between deliberate self-harm and general psychopathology, a relative absence of positive feelings toward parents, and a ruminative style of emotional regulation. Further, rumination/negative thinking and a relative absence of positive feelings toward parents were predictors of self-harm independently of general psychopathology. In addition, deliberate self-harm correlated with symptoms of eating disorder and negative body esteem in girls.
 
Article
To summarize, in their editorial Andersson and Asmundson (2006) have raised a number of important issues concerning the interface between CBT and religion. In this commentary I have illustrated how the issues are much more complex than they may initially seem. There are many other complexities and problems that have not been touched on in this commentary. Like Andersson and Asmundson, I hope the initial discussion of the topic in this journal will encourage a more detailed discussion of the issues, and pave the way toward empirical investigations of how CBT and the various religions of the world can work together to reduce psychopathology, improve well-being, and promote tolerance.
 
Standard CFA and bifactor model fit indices for four alternative models of the ABS-2 
Fit Indices for the alternative factor models of the abbreviated version of the ABS-2 
Article
The Attitudes and Belief Scale-2 (ABS-2: DiGiuseppe, Leaf, Exner, & Robin, 1988. The development of a measure of rational/irrational thinking. Paper presented at the World Congress of Behavior Therapy, Edinburg, Scotland.) is a 72-item self-report measure of evaluative rational and irrational beliefs widely used in Rational Emotive Behavior Therapy research contexts. However, little psychometric evidence exists regarding the measure's underlying factor structure. Furthermore, given the length of the ABS-2 there is a need for an abbreviated version that can be administered when there are time demands on the researcher, such as in clinical settings. This study sought to examine a series of theoretical models hypothesized to represent the latent structure of the ABS-2 within an alternative models framework using traditional confirmatory factor analysis as well as utilizing a bifactor modeling approach. Furthermore, this study also sought to develop a psychometrically sound abbreviated version of the ABS-2. Three hundred and thirteen (N = 313) active emergency service personnel completed the ABS-2. Results indicated that for each model, the application of bifactor modeling procedures improved model fit statistics, and a novel eight-factor intercorrelated solution was identified as the best fitting model of the ABS-2. However, the observed fit indices failed to satisfy commonly accepted standards. A 24-item abbreviated version was thus constructed and an intercorrelated eight-factor solution yielded satisfactory model fit statistics. Current results support the use of a bifactor modeling approach to determining the factor structure of the ABS-2. Furthermore, results provide empirical support for the psychometric properties of the newly developed abbreviated version.
 
Article
Although cognitive theories of anxiety suggest that anxious individuals are characterized by abnormal threat-relevant schemas, few empirical studies have estimated the nature of these cognitive structures using quantitative methods that lend themselves to inferential statistical analysis. In the present study, socially anxious (n = 55) and non-anxious (n = 62) participants completed 3 Q-Sort tasks to assess their knowledge of events that commonly occur in social or evaluative scenarios. Participants either sorted events according to how commonly they personally believe the events occur (i.e. "self" condition), or to how commonly they estimate that most people believe they occur (i.e. "other" condition). Participants' individual Q-Sorts were correlated with mean sorts obtained from a normative sample to obtain an estimate of schema abnormality, with lower correlations representing greater levels of abnormality. Relative to non-anxious participants, socially anxious participants' sorts were less strongly associated with sorts of the normative sample, particularly in the "self" condition, although secondary analyses suggest that some significant results might be explained, in part, by depression and experience with the scenarios. These results provide empirical support for the theoretical notion that threat-relevant self-schemas of anxious individuals are characterized by some degree of abnormality.
 
Article
Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.
 
Behavioural Approach Test (BAT) Step Behaviour 
Means and Standard Deviations of Dependent Measures Condition
Article
Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than ERP. Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders.
 
Article
The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.
 
Article
Drinking motivated by the desire to cope with painful emotions has been shown to be strongly related to alcohol dependence; the resulting maladaptive pattern of substance use can, therefore, be conceptualized as a form of experiential avoidance (an attempt to decrease contact with unpleasant internal states). Acceptance-based interventions, which specifically address experiential avoidance, are multifaceted, and the mechanisms of action are only beginning to be understood. Using a treatment analogue design to look at the underlying components of acceptance-based interventions, the authors tested the effects of brief mindfulness instructions on the emotional responding of alcohol-dependent college students and compared these results with those from a sample of nondependent students. Multidimensional self-reported and psychophysiological emotional responses to pleasant, unpleasant, and neutral pictorial stimuli did not differ between alcohol-dependent and nondependent participants or between the alcohol-dependent participants receiving the mindfulness versus neutral condition. Alcohol-dependent participants' severity of alcohol dependence was found to be related to both self-reported and psychophysiological responses to the unpleasant pictures; these results support the notion that alcohol-dependent participants may use alcohol to cope with unpleasant emotions.
 
Participant characteristics for the two groups 
A flow diagram of the trial. One participant in the control group withdrew before collection of baseline data and one withdrew during the treatment period. Only the treatment group completed 7-month follow-up assessments.  
Article
Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash-associated disorders were recruited from a patient organization and randomized to either a treatment or a wait-list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10-session protocol emphasizing values-based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7-month follow-up. The authors discuss implications of these findings and offer suggestions for further research in this area.
 
Monthly average costs per participant 
Article
Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62-1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.
 
Percentage of participants finishing the training chapters. 
Correlation between the satisfaction with study conditions and age or tinnitus distress.
Article
Objectives: Recent studies on tinnitus have focused on the efficacy of Internet-based interventions. Other core features of the quality of service, e.g. acceptance and attrition, have often been overlooked. This study analyses Internet-based training regarding acceptance and attrition in a trial on minimal-contact interventions for acute tinnitus. Whenever possible, we give information on other forms of training for comparison. Methods: In a randomised controlled trial with 337 participants, 87 persons took part in the Internet training. Results: The participants were as satisfied with the Internet-based training as with a face-to-face group training. There was a 34.48% dropout from the Internet-based training (dropout attrition). The training attrition from the Internet-based training was even higher at 64.4%. Conclusions: Two out of three indicators for acceptance-satisfaction and dropout attrition-provide comparable results between the Internet-based training and a face-to-face group training. The third indicator, training attrition, shows a better result for the group training. Future research should focus on attrition in order to enhance the overall effectiveness of training.
 
Two-factor model and standardised loadings. Note: * p , .001  
Bifactor model and standardised loadings. Note: * p , .05; ** p , .001.
Article
The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker-Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.
 
Article
Acceptance and Commitment Therapy (ACT) training often includes experiential elements aimed at improving therapist psychological flexibility, yet the effects of ACT training on therapist psychological flexibility have yet to be evaluated. This pilot study examines the effects of experiential phone consultation as an adjunct to a standard continuing education workshop on psychological flexibility and burnout among therapists learning ACT. In this study, counselors taking a 2-day ACT workshop were randomly assigned to either six 30-min phone consultation sessions (n = 10) or no additional contact (n = 10). The results show that those in the consultation condition reported higher psychological flexibility at the 3-month follow-up compared to the workshop-only condition. Improvements in ACT knowledge, overall burnout, and personal accomplishment were found in both groups, independent of whether they received phone consultation, and this increase was maintained over time. In conclusion, ACT phone consultation contributed to counselor psychological flexibility above the workshop alone and appears to be feasible as a means to improve counselor psychological flexibility.
 
Article
Preliminary data are presented on the pattern of treatment response of combining interoceptive exposure (IE) with trauma-related exposure therapy (TRE) in five female patients with posttraumatic stress disorder (PTSD) and comorbid chronic musculoskeletal pain originating from motor vehicle accidents. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Four participants reported a reduction in PTSD symptoms after completing treatment, and three no longer met diagnostic criteria for PTSD. Although both interventions were associated with reductions in PTSD symptoms, TRE was associated with greater reductions in PTSD symptoms than IE and was particularly effective at reducing avoidance. IE was associated with larger reductions in anxiety sensitivity than TRE. Pain symptoms lessened slightly during IE and then worsened following TRE. Anxiety decreased after completing treatment, whereas panic and depressive symptoms responded less so. Three individuals completed a 3-month follow-up assessment. There was no change in their PTSD diagnostic status, and all experienced a slight loss of pre-post gains, particularly involving the return of pain. Clinical and research implications are discussed.
 
Article
Inter-rater reliability and accuracy are measures of rater performance. Inter-rater reliability is frequently used as a substitute for accuracy despite conceptual differences and literature suggesting important differences between them. The aims of this study were to compare inter-rater reliability and accuracy among a group of raters, using a treatment adherence scale, and to assess for factors affecting the reliability of these ratings. Paired undergraduate raters assessed therapist behavior by viewing videotapes of 4 therapists' cognitive behavioral therapy sessions. Ratings were compared with expert-generated criterion ratings and between raters using intraclass correlation (2,1). Inter-rater reliability was marginally higher than accuracy (p = 0.09). The specific therapist significantly affected inter-rater reliability and accuracy. The frequency and intensity of the therapists' ratable behaviors of criterion ratings correlated only with rater accuracy. Consensus ratings were more accurate than individual ratings, but composite ratings were not more accurate than consensus ratings. In conclusion, accuracy cannot be assumed to exceed inter-rater reliability or vice versa, and both are influenced by multiple factors. In this study, the subject of the ratings (i.e. the therapist and the intensity and frequency of rated behaviors) was shown to influence inter-rater reliability and accuracy. The additional resources needed for a composite rating, a rating based on the average score of paired raters, may be justified by improved accuracy over individual ratings. The additional time required to arrive at a consensus rating, a rating generated following discussion between 2 raters, may not be warranted. Further research is needed to determine whether these findings hold true with other raters and treatment adherence scales.
 
Article
Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.
 
Path analyses for Model 1. The relationships linking willingness (WILL), homework compliance (HW), cognitive skill acquisition (SKILL), and change in depression severity on BDI, HSCL-58 (HSCL), and HRSD for patient and independent homework compliance ratings.  
Path analyses for Model 2. The relationships linking the combined homework process score (Willingness6Homework Compliance Ratings6Cognitive Skill Acquisition) and change in depression severity on BDI, HSCL-58 (HSCL), and HRSD for patient and independent homework compliance ratings.  
Article
There is a need to understand the mechanism through which homework contributes to clinically meaningful change in therapy. Theoretically meaningful factors such as willingness to complete therapeutic assignments and cognitive skill acquisition have not been carefully studied in prior research. Depressed outpatients (N = 46) received cognitive behavioural group therapy for a 10-week period and were assigned relevant homework activities. Patient self-report and independent ratings of homework compliance were obtained on a session-by-session basis. Using path analysis, the authors found evidence that willingness to complete homework assignments and mastery of skill in cognitive restructuring helped account for the relationship between homework compliance and reduced symptom severity (R2 = .40). However, paths were only significant when patient self-report of homework compliance was used in the model. The present study highlights the problems in assessing homework compliance and in assuming that independent assessment of compliance is more accurate than patient self-report.
 
Article
Previous research suggests that social anxiety disorder (SAD) has a specific relationship with impairment in friendship quality; however, potential moderators of this relationship have not been tested. The current study examines whether the specific effect of SAD on friendship quality is stable or varies across gender and ethnicity in a large epidemiological dataset. Results indicate that the underlying construct of friendship quality differed slightly but significantly between men and women; as a result, effects of SAD were tested in men and women separately. After partially constraining friendship quality across ethnic groups, our results indicated that the relationship between SAD and friendship quality remained robust in all groups. In addition to replicating the finding that SAD specifically relates to perceived friendship quality, the current study highlights the need to test whether underlying constructs such as friendship quality are consistent across the groups that make up heterogeneous samples.
 
Article
Intolerance of uncertainty (IU) has been identified as a potential maintaining factor for generalised anxiety disorder; however, there is a growing evidence to suggest that IU may contribute to other anxiety and depressive disorders. Moreover, certain components of IU (namely prospective and inhibitory IU) have been shown to be differentially associated with symptoms of emotional disorders. The aim of this study was to determine the extent to which individuals with various anxiety and depressive disorders endorsed IU, firstly as a trait variable (with prospective and inhibitory components) and secondly in reference to regularly occurring, diagnostically relevant situations (situation-specific IU). The degree to which diagnosis predicted IU was examined in a highly comorbid clinical sample (N = 218). Regardless of specific diagnoses, the degree of comorbidity emerged as a significant predictor of prospective IU and situation-specific IU. Conversely, specific diagnoses of social phobia, generalised anxiety disorder, depression, and obsessive compulsive disorder were uniquely related to inhibitory IU. These findings suggest that IU is a transdiagnostic construct and have implications for current diagnosis-specific and transdiagnostic theory and clinical practice.
 
Results of treatment outcome comparisons across DOCS symptom dimensions 
Results of comparisons between programs in DOCS symptom dimension scores at admission 
Article
Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.
 
Cognitive behavioural therapy " does exactly what it says on the tin. " The two cognitive " ingredients " are verbal thoughts and mental imagery.  
An experimental psychopathology subcomponents model of depression focusing on mental imagery and interpretation bias.  
An experimental psychopathology subcomponents model of depression focusing on mental imagery and interpretation bias: therapeutic directions. (Narrow arrows indicate potential treatment targets.)  
Article
Abnormalities in mental imagery have been implicated in a range of mental health conditions. Imagery has a particularly powerful effect on emotion and as such plays a particularly important role in emotional disorders. In depression, not only is the occurrence of intrusive negative imagery problematic, but also the lack of positive (in particular, future-directed) imagery is important. The authors suggest that, in depression, imagery can exacerbate the effects of interpretation bias. This article outlines an experimental psychopathology subcomponents model of depression that focuses specifically on the role of imagery and interpretation bias in the maintenance of the disorder. The authors propose that negative intrusive imagery, a lack of positive imagery, and negative interpretation bias serve both independently and interactively to maintain depressed mood. Finally, the authors consider the implications of this imagery-based approach for the development of new cognitive treatments in this area.
 
Sample characteristics of each study arm and the whole sample 
Tinnitus Coping Training 
Results of completer (means, standard deviations, ANCOVAs) and intention-to-treat analyses (ANCOVAs) of tinnitus distress, depressiveness and psychosomatic discomfort 
Number of participants reporting clinical significant change in tinnitus distress (completer and intention-to-treat data) Completer Intention-to-treat 
Article
Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition. Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed. At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%. The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.
 
Mean Stroop latencies and Stroop interference in milliseconds 
tachistoscopic identi®cation scores on supraliminally and subliminally exposed words and nonexposed words 
Article
The present study tested, and found support for, the hypotheses that crime victims with acute post-traumatic stress disorder have: (i) a general memory impairment for faces; and (ii) a memory bias for faces that they perceive as hostile, even when these faces are not arranged to show any hostile face expressions. It is suggested that crime victims with acute post-traumatic stress disorder perform worse on recognition memory due to impaired concentration, and that they allocate their limited attentional resources to the detection of hostility in others in order to avoid being victimized again. This produces a memory bias for perceived hostility even in relatively innocuous everyday interactions with others, which contributes to maintaining the sense of serious current threat that characterizes post-traumatic stress disorder.
 
Article
The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, "real world" settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.
 
Article
This study assessed the viability of a microswitch cluster (i.e. a combination of microswitches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behavior in a boy with profound multiple disabilities. The boy was initially taught an adaptive foot-movement response that activated a motion microswitch and produced preferred stimuli. Subsequently, his foot response led to preferred stimuli only if it occurred in the absence of aberrant behavior (i.e. hand mouthing and eye poking which were detected through optic microswitches). Moreover, full access to the stimuli required that the boy refrain from aberrant behavior during their presentation as well. The study also included a 3-month post-intervention check and a social validation assessment. Data showed that the boy (i) increased his adaptive responding, (ii) learned to perform this responding largely free from aberrant behavior and refrained from that behavior for most of the session time, and (iii) maintained this performance at the post-intervention check. The social validation ratings of 40 teachers and teacher assistants significantly favored the last intervention period (in which aberrant behavior was reduced) over the initial period.
 
Article
Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom-focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information-gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score> or =16) underwent treatment. Five showed a decrease in their baseline Y-BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y-BOCS< or =12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.
 
Overview of exercise regimen. 
Illustration of a typical prescribed exercise session. 
Types of exercise endorsed across the exercise regimen, by Cohort. 
Article
The majority of "responders" to first-line cognitive-behavioural therapy (CBT) and pharmacological treatments for obsessive-compulsive disorder (OCD) are left with residual symptoms that are clinically relevant and disabling. Therefore, there is pressing need for widely accessible efficacious alternative and/or adjunctive treatments for OCD. Accumulating evidence suggests that physical exercise may be one such intervention in the mood and anxiety disorders broadly, although we are aware of only two positive small-scale pilot studies that have tested its clinical benefits in OCD. This pilot study aimed to test the feasibility and preliminary efficacy of adding a structured physical exercise programme to CBT for OCD. A standard CBT group was delivered concurrently with a 12-week customized exercise programme to 11 participants. The exercise regimen was individualized for each participant based on peak heart rate measured using an incremental maximal exercise test. Reports of exercise adherence across the 12-week regimen exceeded 80%. A paired-samples t-test indicated very large treatment effects in Yale-Brown Obsessive-Compulsive Scale scores from pre- to post-treatment in CBT group cohorts led by expert CBT OCD specialists (d = 2.55) and junior CBT clinician non-OCD specialists (d = 2.12). These treatment effects are very large and exceed effects typically observed with individual and group-based CBT for OCD based on leading meta-analytic reviews, as well as previously obtained treatment effects for CBT using the same recruitment protocol without exercise. As such, this pilot work demonstrates the feasibility and significant potential clinical utility of a 12-week aerobic exercise programme delivered in conjunction with CBT for OCD.
 
The effect of the three-way interaction of BMI £ ASI £ exercise on peak fear. (SUDS ¼ Subjective Units of Distress Scale; BMI ¼ body mass index; ASI ¼ Anxiety Sensitivity Index; Peak Fear ¼ highest level of fear during exercise or rest period; ASI ¼ M is the sample mean of ASI (10.88); ASI ¼ 25 is clinical ASI cutoff; BMI ¼ M is the sample mean of BMI (24.03; normal range); BMI ¼ M þ 1SD is sample mean plus 1 standard deviation (28.30; overweight range); BMI ¼ M þ 2SD is sample mean plus 2 standard deviations (32.57; obese range). 
Article
A growing body of work suggests that obese adults are less likely to adhere to exercise than normal-weight adults because they experience greater levels of discomfort and distress during exercise sessions. The present study introduces and provides a preliminary test of the hypothesis that the distress experienced during exercise among persons with elevated body mass index is particularly high among those who fear somatic arousal (i.e. elevated anxiety sensitivity [AS]). Young adults were randomly assigned to complete 20 min of treadmill exercise (at 70% of their age-adjusted predicted maximum heart rate) or 20 min of rest. Body mass, AS, and negative affect were measured at baseline, and fear was measured at 4-min intervals during the experimental phase. Consistent with the authors' hypothesis, there was a significant Exercise x BMI x ASI interaction (sr(2) = .08), suggesting that the greatest fear levels during exercise were observed among participants with high body mass, but only if they also had elevated AS. These findings offer a new approach for identifying specific vulnerable individuals and have clear clinical implications, given that the amplification factor of AS can be modified with clinical intervention.
 
Article
Several randomized controlled trials have indicated that cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome. In 1 of these studies 13 therapists applied cognitive behaviour therapy for chronic fatigue syndrome in 83 chronic fatigue syndrome patients. In the present study therapists' adherence and perceptions of the manual are studied. Following completion of the study the therapists were asked to complete a questionnaire. Audiotaped sessions were conducted to verify the therapists' adherence. Analyses of the audiotapes showed that in 87% of the sessions this appeared to be the case. The questionnaire revealed that the therapists found it more difficult to treat patients with chronic fatigue syndrome than to treat patients with psychological or other physical problems. Treatment aspects posing the most problems were integrating individual problems into the standardized treatment, dealing with the patients' lack of confidence in the treatment and handling insufficient motivation.
 
Article
Cognitive behaviour therapy is effective for obsessive-compulsive disorder and for obsessive-compulsive spectrum disorders such as trichotillomania. Unfortunately, many people with these disorders, especially those living in rural areas, have limited access to treatment. Telephone-administered cognitive behaviour therapy may help address this problem. In a recent study of telephone treatment for obsessive-compulsive disorder, we found that such treatment was often effective (42% in remission at post-treatment, and 47% in remission at 12-week follow-up). This article presents 2 case reports of the same treatment, applied to obsessive-compulsive spectrum disorders (trichotillomania and compulsive skin picking). Treatment was associated with symptom reduction for both participants, although one subsequently relapsed. Possible reasons for relapse are discussed. The findings encourage further studies to identify the characteristics of people most likely to benefit from telephone treatment for spectrum disorders.
 
Article
Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients' access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N = 420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d = 0.82, 99% CI = 0.55-1.08, p = 0.001), but not on comorbid depression (d = 0.33, 99% CI = - 0.01-0.67, p = 0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d = 0.45, 95% CI = 0.03-0.87, p = 0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.
 
Article
Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder--particularly those living in rural areas--do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.
 
Description of the sample as a function of treatment condition 
Means and standard deviations for each questionnaire before and after treatment 
Results of the repeated measures analyses of variance for each evaluation instrument 
Article
Telehealth, or health care via videoconferencing, constitutes a clinical option that makes it possible to treat patients remotely. A growing number of studies have demonstrated that telehealth is a feasible and effective method for diagnostic interviews and psychiatric consultations. However, few studies have assessed the effectiveness of psychotherapy given by videoconference. This study examines the effectiveness of cognitive behavioural therapy (CBT) administered by videoconference for posttraumatic stress disorder (PTSD). Forty-eight participants with PTSD were recruited for the study: 16 in the videoconferencing condition and 32 in a control face-to-face condition. Each participant received CBT for 16 to 25 weeks and completed various questionnaires before and after treatment. The results show a significant decline in the frequency and severity of posttraumatic symptoms after treatment in both conditions. A clinical improvement in overall functioning was also observed. No significant difference was observed in the effectiveness of the two therapeutic conditions. The examination of effect sizes supports these results. A number of clinical implications and certain avenues for future research are discussed.
 
Article
The Quality of Life Inventory (QOLI) is an established rating scale of self-perceived quality of life across 16 domains. Norms for different psychiatric conditions when rated via the Internet, responsiveness to change following treatment, and the clinical impact of importance-weighting items have yet to be examined. To investigate these unanswered questions, important for the continued and expanded use of the QOLI, we compiled archival screening and post-treatment data from 20 studies featuring Internet-delivered psychological interventions for seven different psychiatric conditions and an undergraduate sample, totalling over 4000 participants. Disorder-specific norms were indicated by between-group analyses and are reported here, item-by-item. The QOLI showed adequate responsiveness to change and construct validity. Discrepancies were found when conducting between-group analyses with and without weighted items (more significant differences when items were not weighted) on both the screening and post-treatment data, suggesting that weighting is a procedure that is likely to have an impact when analysing QOLI results. Limitations and the needs for future research are discussed.
 
Article
Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.
 
Article
This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.
 
Article
The purpose of this brief paper is to review the current status of one-session treatment (OST) for specific phobias in children and adolescents. Following a brief historical overview and description of OST, we systematically describe eight studies that have examined its efficacy in children and adolescents aged between 7 and17 years. We also explore phobia subtypes, age, gender, and comorbidity as possible moderators of treatment outcome. Studies have been conducted in Australia, Austria, the Netherlands, the USA, and Sweden. Although there is limited evidence that OST works better for animal phobias than other subtypes of phobias and for girls than boys, across studies there is considerable evidence that it is generally effective across phobia subtypes and for both boys and girls. No age differences in outcomes were noted, nor were any differences noted due to comorbidity. OST was found to be equally effective with children and adolescents with co-occurring multiple phobias and other anxiety disorders. Moreover, in at least one study, it was found to reduce untreated phobic and anxiety disorders in addition to the treated phobias. It is concluded that OST is a highly effective intervention for the treatment of specific phobias in children and adolescents.
 
Article
This pilot study aimed to explore the clinical outcomes and therapeutic relationship for clients of an adult mental health service using Beating the Blues, a computerised cognitive behaviour therapy (CCBT) package. Sixteen participants completed the programme and reported a significant reduction in Beck Depression Inventory scores posttreatment. Participants' mean item ratings on the relationship measure were above the neutral midpoint, but no association was found between the therapeutic relationship and outcome. The results are discussed in terms of the utility of CCBT as part of a stepped-care model and how further research might usefully explore the nature of the relationship formed between clients and CCBT programmes.
 
Article
The present investigation examined heart-focused anxiety and perceived physical health in terms of affect-relevant cigarette smoking motives and outcome expectancies. Participants were a community sample of 140 adult daily smokers (81 women, mean age = 29.60 years, SD = 11.98). In terms of smoking motives, both heart-focused anxiety and perceived physical health incrementally predicted smoking for negative affect reduction motives above and beyond relevant covariates (gender, weekly alcohol consumption, daily smoking rate). Yet heart-focused anxiety, but not perceived physical health, was incrementally predictive of habitual motives, relative to the same covariates. With regard to smoking outcome expectancies, heart-focused anxiety was incrementally predictive of negative reinforcement outcome expectancies, whereas perceived physical health was not. Alternatively, perceived physical health was incrementally predictive of negative personal consequence outcome expectancies, but heart-focused anxiety was not. Findings are discussed in relation to the role of perceived health vulnerabilities in clarifying affect-oriented smoking motives and expectancies.
 
Selected characteristics of randomized controlled studies examining the effects of computerized and Internet-based psychotherapies for adult depression 
Meta-analyses of studies examining the effects of computerized and Internet-based psychological treatments for adult depression 
Article
Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29-0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45-0.77) and unsupported (d = 0.25; 95% CI: 0.14-0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.
 
Article
The aim of this investigation was to evaluate the incremental validity of anxiety sensitivity (fear of arousal-related physical and psychological sensations) relative to health factors (smoking variables, alcohol use and exercise level), in predicting perceived health and disability among a sample of 225 young adult daily smokers (102 females; M(age) = 23.9 years, SD = 8.8). Consistent with prediction, anxiety sensitivity, relative to smoking-relevant variables, alcohol consumption (a single frequency by quantity composite) and exercise activity, predicted lower perceived general health and impairments in mental health and social functioning; no incremental effects were evident for anxiety sensitivity for predicting impairments in physical functioning, role functioning, or increased healthcare usage. These findings are discussed with respect to better understanding cognitive factors that affect perceptions of health status and functioning among daily smokers.
 
Flow of participants through trial. Note. SCBT, Standard Cognitive Behaviour Therapy; ECBT, Enhanced Cognitive Behaviour Therapy; WLC, Wait-List Control. 
Proportion of participants in each treatment condition who demonstrated clinically significant change on the WI according to the definition by Jacobson and Truax (1991). Note. CSC, Clinically Significant Change; SCBT, Standard Cognitive Behaviour Therapy; ECBT, Enhanced Cognitive Behaviour Therapy; WLC, Wait-List Control. 
Mixed-factor 3 (Time) £ 2 (Treatment) ANCOVAs for Working Alliance Inventory and Nijmegen Motivation List-2 subscales 
Article
Seniors have been consistently under-represented in the health anxiety treatment literature. The aim of this study was to test the efficacy of a six-session enhanced cognitive behaviour therapy (ECBT) programme for subclinical health anxiety in seniors, and to examine whether the programme fostered therapeutic alliance and motivation for psychotherapy as compared to a standard cognitive behavioural therapy (SCBT) programme and wait-list control (WLC). Fifty-seven seniors with subclinical health anxiety were randomly assigned to six weeks of SCBT, ECBT, or WLC. At pre-treatment, post-treatment, and three-month follow-up, participants completed questionnaires on health anxiety and its dimensions, and other related psychological constructs. Therapeutic alliance and motivation measures were completed after Sessions 1, 3, and 6. At post-treatment, participants in the SCBT and ECBT groups showed significantly lower health anxiety when compared to WLC, with reductions on the subscale measuring disease fear/phobia. Significantly, more participants in the SCBT (66.7%) and ECBT (55.6%) conditions demonstrated clinically significant change on health anxiety compared to the WLC condition (11%). Gains were maintained at three months. There were minimal differences found between the SCBT and ECBT groups on therapeutic alliance and motivation. The findings indicated that both forms of CBT were efficacious for reducing some of the health anxious thoughts and beliefs in seniors.
 
Top-cited authors
Gerhard Andersson
  • Linköping University
Per Carlbring
  • Stockholm University
Pim Cuijpers
  • Vrije Universiteit Amsterdam
Gordon J G Asmundson
  • University of Regina
Thomas Berger
  • Universität Bern