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Maps of subjective feelings.

Maps of subjective feelings. | Cognitive & General Psychotherapy Research | Scoop.it

(Available in free full text)  Subjective feelings are a central feature of human life, yet their relative organization has remained elusive. We mapped the “human feeling space” for 100 core feelings ranging from cognitive and affective processes to somatic sensations; in the analysis, we combined basic dimension rating, similarity mapping, bodily sensation mapping, and neuroimaging meta-analysis. All feelings were emotionally loaded, and saliencies of bodily and mental experiences were correlated. Feelings formed five groups: positive emotions, negative emotions, cognitive processes, somatic states, and homeostatic states. Feeling space was best explained by emotionality, mental experience, and bodily sensation topographies. Subjectively felt similarity of feelings was associated with basic feeling dimensions and the bodily sensation maps. This shows that subjective feelings are categorical, emotional, and embodied.Subjective feelings are a central feature of human life. We defined the organization and determinants of a feeling space involving 100 core feelings that ranged from cognitive and affective processes to somatic sensations and common illnesses. The feeling space was determined by a combination of basic dimension rating, similarity mapping, bodily sensation mapping, and neuroimaging meta-analysis. A total of 1,026 participants took part in online surveys where we assessed (i) for each feeling, the intensity of four hypothesized basic dimensions (mental experience, bodily sensation, emotion, and controllability), (ii) subjectively experienced similarity of the 100 feelings, and (iii) topography of bodily sensations associated with each feeling. Neural similarity between a subset of the feeling states was derived from the NeuroSynth meta-analysis database based on the data from 9,821 brain-imaging studies. All feelings were emotionally valenced and the saliency of bodily sensations correlated with the saliency of mental experiences associated with each feeling. Nonlinear dimensionality reduction revealed five feeling clusters: positive emotions, negative emotions, cognitive processes, somatic states and illnesses, and homeostatic states. Organization of the feeling space was best explained by basic dimensions of emotional valence, mental experiences, and bodily sensations. Subjectively felt similarity of feelings was associated with basic feeling dimensions and the topography of the corresponding bodily sensations. These findings reveal a map of subjective feelings that are categorical, emotional, and embodied. [There’s a good commentary & helpful further links about this article on the BPS website - https://tinyurl.com/y8o6bxes ].

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Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus: A Randomized Clinical Trial.

(Available in free full text) Importance  Accessible clinical care is not always available to individuals with distressing tinnitus. Internet-based cognitive behavioral therapy has the potential to increase access to evidence-based services that manage tinnitus. Research comparing the effectiveness of this internet-based intervention with face-to-face care is required.  Objective  To evaluate whether an internet-based cognitive behavioral therapy intervention is at least as effective as established individualized face-to-face clinical care in reducing tinnitus distress and tinnitus-related difficulties.Design, Setting, and Participants  A randomized, multicenter, 2-arm parallel group, noninferiority trial with 2-month follow-up was performed between October 4, 2016, and July 14, 2017. Invited to participate were 374 adults based in the United Kingdom who had been referred to their local tinnitus clinics because of bothersome tinnitus. The experimental group received the internet-based intervention online, and the active control group underwent the usual face-to-face tinnitus care at 1 of 3 UK-based National Health Service hospitals. Participants were randomly assigned (1:1) to either intervention using variable permuted block sizes of 4 and 6. Of 92 participants who were randomized (46 each in the experimental and control groups), 88 participants completed the assessment immediately after intervention and 74 participants completed the follow-up assessment.Interventions  Participants were randomized to receive either 8 weeks of guided internet-based cognitive behavioral therapy or a mean of 2 to 3 individualized face-to-face appointments in a tinnitus clinic.  Main Outcomes and Measures  The primary outcome was a change in tinnitus distress (assessed by the Tinnitus Functional Index). Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life.  Results  Of 92 patients overall, 55 (60%) were men with a mean (SD) age of 52.96 (12.07) years and mean (SD) tinnitus duration of 6.54 (9.25) years. The between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, –4.17 to 14.53) at the initial assessment and 5.52 (95% CI, –4.60 to 15.61) at follow-up; both differences were within the noninferiority margin of 13 points for the lower 95% CI. For the secondary outcomes, only outcomes for insomnia fell outside the noninferiority margin, both after intervention and at follow-up, favoring internet-based cognitive behavioral therapy.  Conclusions and Relevance  This is the first trial, to our knowledge, to compare an internet-based intervention with standard individualized face-to-face care for tinnitus. It revealed that both interventions are equally effective for reducing tinnitus distress and most tinnitus-related difficulties.

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Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample.

Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample. | Cognitive & General Psychotherapy Research | Scoop.it

Obsessive-compulsive symptoms focusing on interpersonal relationships may include obsessive doubts and preoccupation centered on the relationship (i.e., relationship-centered) or the relationship partner (i.e. partner-focused). Although general obsessive beliefs have been associated with relationship obsessive-compulsive disorder (ROCD), perfectionism and catastrophic relationship beliefs may particularly relevant to the maintenance and development of such symptoms. We assessed the unique contributions of specific perfectionism dimensions and catastrophic relationship beliefs to relationship-centered and partner-focused ROCD symptoms. Participants included 124 individuals recruited online reporting that they had received a diagnosis of ROCD by a qualified clinician completed a battery of questionnaire tapping maladaptive beliefs previously associated with obsessive-compulsive disorder (OCD), multidimensional perfectionism and catastrophic relationship beliefs. Perfectionistic concern over mistakes and doubts about actions, catastrophic beliefs regarding being in the wrong relationship and of being alone were found to be unique predictors of relationship-centered ROCD symptoms over and above mood symptoms. Only catastrophic fears of being in the wrong relationships predicted partner-focused ROCD symptoms. Perfectionistic tendencies as well as specific relationship-related beliefs may be more strongly implicated than OCD-related maladaptive beliefs in the development and maintenance of relationship-centered ROCD symptom. More research is needed to identify more specific beliefs associated with partner-focused ROCD symptoms.

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A systematic review of therapist effects:A critical narrative update and refinement to review.

A systematic review of therapist effects:A critical narrative update and refinement to review. | Cognitive & General Psychotherapy Research | Scoop.it

Objective To review the therapist effects literature since Baldwin and Imel's (2013) review.  Method Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted.  Results Twenty studies met inclusion criteria (3 RCTs; 17 practice-based datasets) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 2% to 29% (weighted average = 5%). For RCTs, 1%–29% (weighted average = 8.2%). For practice-based studies, 0.2–21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies as opposed to maximising on the availability of large routine patient datasets.  Conclusions Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.  Highlights • Therapist effects in naturalistic studies averaged 5% (range 0.2–21.0%). • Therapist effects in university counseling centers averaged 2.4% (range 0.4–19.1%). • Therapist effects in RCTs were 8.2% (range 1–29%). • There was considerable heterogeneity and greater therapist effects were consistently linked to higher patient severity. • Many studies still have insufficient numbers of therapists and are not specifically designed as studies of therapists. 

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Updated CDC 'Guideline'.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Updated CDC 'Guideline'. | Cognitive & General Psychotherapy Research | Scoop.it

US Centers for Disease Control & Prevention recent updated 'guideline':  Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, long-term illness that affects many body systems. People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have severe fatigue and sleep problems. ME/CFS may get worse after people with the illness try to do as much as they want or need to do. This symptom is known as post-exertional malaise (PEM). Other symptoms can include problems with thinking and concentrating, pain, and dizziness. According to an Institute of Medicine (IOM) report published in 2015, an estimated 836,000 to 2.5 million Americans suffer from ME/CFS, but most of them have not been diagnosed.

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How can we make psychotherapy supervision more effective?

How can we make psychotherapy supervision more effective? | Cognitive & General Psychotherapy Research | Scoop.it

All counsellors & psychotherapists in the UK need to have regular supervision if they want to maintain their professional accreditation.  A central reason for this is to support therapists in being as helpful as possible for their clients.  Unfortunately current approaches to supervision don't seem to do this particularly well.  In a recent issue of the Cognitive Behavior Therapy journal, Alfonsson et al in their article "The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review" clearly state "No study could show benefits from supervision for patients."  And this depressing conclusion simply affirms what previous research has already highlighted for psychotherapy more generally ... see "Supervisor variance in psychotherapy outcome in routine practice" and "Does psychotherapy supervision contribute to patient outcomes? Considering thirty years of research", with the latter paper commenting "We do not seem to be any more able to say now (as opposed to 30 years ago) that psychotherapy supervision contributes to patient outcome."  This is pretty damning … what on earth can be done to make supervision more effective?  Here are three research-based suggestions.

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The Loss of a Sense of Control as a Major Contributor to Physician Burnout: A Neuropsychiatric Pathway to Prevention and Recovery.

The Loss of a Sense of Control as a Major Contributor to Physician Burnout: A Neuropsychiatric Pathway to Prevention and Recovery. | Cognitive & General Psychotherapy Research | Scoop.it

Burnout has become a major concern in health care. Multiple surveys have documented the alarming percentage of physicians experiencing the symptoms and signs of burnout. The consequences of burnout have been well described, and include increased medical errors, unprofessional conduct, reduced patient satisfaction, stress-related health problems, drug addiction, depression, suicidal ideation, and marital and family discord.  An extensive literature describes potential solutions, including meditation and mindfulness, stress and resiliency training, small discussion groups, coaching, time management, exercise, and reduced work shifts.  In our view, these approaches do not adequately address a primary contributor to burnout.  We believe that resiliency research offers a neurocognitive construct that provides a more comprehensive view of a major underlying factor that can lead to burnout, as well as a more scientifically informed approach to prevention.  The degree of control that an animal or human can exert over a stressor has a substantial impact on the emotional, behavioral, neurobiological, and physiological effects of that stressor … Resilience research reveals that the most effective approaches for dealing with stress involve active or proactive coping mechanisms.  Active coping refers to goal-directed behaviors such as gathering information, acquiring skills, problem solving, making decisions, confronting when necessary, and seeking social support.  These strategies are associated with greater resilience to adversity and better stress tolerance compared with passive or reactive coping styles ….

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Nitrated meat products are associated with mania in humans and altered behavior and brain gene expression in rats.

Mania is a serious neuropsychiatric condition associated with significant morbidity and mortality. Previous studies have suggested that environmental exposures can contribute to mania pathogenesis. We measured dietary exposures in a cohort of individuals with mania and other psychiatric disorders as well as in control individuals without a psychiatric disorder. We found that a history of eating nitrated dry cured meat [bacon, salami, chorizo, bratwurst, etc] but not other meat or fish products was strongly and independently associated with current mania (adjusted odds ratio 3.49, 95% confidence interval (CI) 2.24–5.45, p < 8.97 × 10−8). Lower odds of association were found between eating nitrated dry cured meat and other psychiatric disorders. We further found that the feeding of meat preparations with added nitrate to rats resulted in hyperactivity reminiscent of human mania, alterations in brain pathways that have been implicated in human bipolar disorder, and changes in intestinal microbiota. These findings may lead to new methods for preventing mania and for developing novel therapeutic interventions. [note nitrated meats have already been shown to be significantly carinogenic].

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Childhood inflammatory markers and intelligence as predictors of subsequent persistent depressive symptoms: a longitudinal cohort study.

Background To identify developmental sub-groups of depressive symptoms during the second decade of life, a critical period of brain development, using data from a prospective birth cohort. To test whether childhood intelligence and inflammatory markers are associated with subsequent persistent depressive symptoms.  Methods IQ, a proxy for neurodevelopment, was measured at age 8 years. Interleukin 6 (IL-6) and C-reactive protein, typical inflammatory markers, were measured at age 9 years. Depressive symptoms were measured six times between 10 and 19 years using the short mood and feelings questionnaire (SMFQ), which were coded as binary variable and then used in latent class analysis to identify developmental sub-groups of depressive symptoms.  Results Longitudinal SMFQ data from 9156 participants yielded three distinct population sub-groups of depressive symptoms: no symptoms (81.2%); adolescent-onset symptoms (13.2%); persistent symptoms (5.6%). Lower IQ and higher IL-6 levels in childhood were independently associated with subsequent persistent depressive symptoms in a linear, dose–response fashion, but not with adolescent-onset symptoms. Compared with the group with no symptoms the adjusted odds ratio for persistent depressive symptoms per s.d. increase in IQ was 0.80 (95% CI, 0.68–0.95); that for IL-6 was 1.20 (95% CI, 1.03–1.39). Evidence for an association with IL-6 remained after controlling for initial severity of depressive symptoms at 10 years. There was no evidence that IL-6 moderated or mediated the IQ-persistent depressive symptom relationship.  Conclusions The results indicate potentially important roles for two distinct biological processes, neurodevelopment and inflammation, in the aetiology of persistent depressive symptoms in young people.

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Further evidence of inflammation's possible relevance for chronic depression.

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Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies.

Background It is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination.  Aims We aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups.MethodWe searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive–behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms).  Results Gains with psychotherapy were maintained for up to 24 months. For cognitive–behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive–behavioural therapy.  Conclusions Not only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean.

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Women’s sexual dysfunction associated with psychiatric disorders and their treatment.

Women’s sexual dysfunction associated with psychiatric disorders and their treatment. | Cognitive & General Psychotherapy Research | Scoop.it

(Available in free full text) Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients’ sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients’ wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.

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12-month trajectories of depressive symptoms among nurses—Contribution of personality, job characteristics, coping, and burnout.

12-month trajectories of depressive symptoms among nurses—Contribution of personality, job characteristics, coping, and burnout. | Cognitive & General Psychotherapy Research | Scoop.it

Background Job related factors have been associated with higher risk for developing depression, but past studies lacked full consideration of individual factors such as personality and coping. We sought to evaluate associations of personality, coping, job characteristics, and burnout with 12-month trajectories of depressive symptoms among nursing workers. Methods Cohort of nursing workers (N = 281) in a private hospital system, with baseline assessments of personality, job characteristics, and coping. Burnout and depression were measured at baseline and during monthly follow-ups. Linear mixed modeling was used to examine contributions to between- and within-individual variation in monthly depressive symptoms. Results Personality trait of negative affectivity accounted for 36% of between-individual variation in depressive symptoms over 12 months, while job characteristics and coping explained an additional 5% and 8% of this variation, respectively. Exhaustion dimension of burnout was associated with between-individual variation in depressive symptoms (fixed effect β coefficient 2.44, p < 0.001), but not with within-individual variation in symptoms. Disengagement dimension of burnout was not associated with between-individual variation in depressive symptoms, but contributed to within-individual variation in depressive symptoms over time (fixed effect β coefficient 0.52, p = 0.01). Limitations Participants were nursing workers within a single hospital system. Participants who were excluded due to missing baseline data were more likely of non-white race, which may also limit the generalizability of our results. We used latent variables to represent certain job and coping characteristics, which may make our results less comparable with other studies examining the role of these factors in work-associated depression. Conclusions Future interventions to prevent depression in healthcare workers should consider multiple job and individual factors. Potential components include strategies to manage negative affectivity and reduce avoidant coping, such as cognitive reframing and mindfulness-based techniques, and organizational approaches to address burnout through augmentation of job resources.

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A comparison between the clinical significance and growth mixture modelling early change methods at predicting negative outcomes

Abstract Objective: Routine outcome monitoring benefits treatment by identifying potential no change and deterioration. The present study compared two methods of identifying early change and their ability to predict negative outcomes on self-report symptom and wellbeing measures. Method: 1467 voluntary day patients participated in a 10-day group Cognitive Behaviour Therapy (CBT) program and completed the symptom and wellbeing measures daily. Early change, as defined by (a) the clinical significance method and (b) longitudinal modelling, was compared on each measure.  Results: Early change, as defined by the simpler clinical significance method, was superior at predicting negative outcomes than longitudinal modelling. The longitudinal modelling method failed to detect a group of deteriorated patients, and agreement between the early change methods and the final unchanged outcome was higher for the clinical significance method.  Conclusions: Therapists could use the clinical significance early change method during treatment to alert them of patients at risk for negative outcomes, which in turn could allow therapists to prevent those negative outcomes from occurring.

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The assessment of successful emotion regulation skills use: Development and validation of an English version of the Emotion Regulation Skills Questionnaire.

The assessment of successful emotion regulation skills use: Development and validation of an English version of the Emotion Regulation Skills Questionnaire. | Cognitive & General Psychotherapy Research | Scoop.it

(Available in free full text) Emotion regulation has become an important topic in mental health and psychotherapy research. Skills supposingly relevant for adaptive responses towards emotions include the abilities to be consciously aware of emotions, identify and correctly label emotions, understand what has caused and maintains one’s present emotions, modify the intensity or duration of one's emotions, accept and tolerate undesired emotions, confront situations likely to cue negative emotions, and provide effective self-support when working to cope with challenging emotions. To economically assess these abilities, a self-report measure has been developed in German and validated in various studies. To facilitate the use of the measure in English speaking countries, we have developed and validated an English version of the Emotion Regulation Skills Questionnaire (ERSQ) in a student sample (n = 263) and a sample of individual clinical sample (n = 35). Findings from this study provide significant evidence for the reliability and validity of the ERSQ. Thus, the measure can be used to assess a broad range of important emotion regulation skills in an economic way.

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Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis.

Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. | Cognitive & General Psychotherapy Research | Scoop.it

Objectives Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain–gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective.  Methods We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidepressants versus placebo, or psychological therapies versus control therapy or “usual management” were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI).  Results The search strategy identified 5316 citations. Fifty-three RCTs, reported in 51 separate articles, were eligible for inclusion: 17 compared antidepressants with placebo, 35 compared psychological therapies with control therapy or “usual management”, and one compared both psychological therapy and antidepressants with placebo. Four of the trials of psychological therapies, and one of the RCTs of antidepressants, were identified since our previous meta-analysis. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57–0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs, although with heterogeneity between RCTs of the latter (I2 = 49%, P = 0.07). The RR of symptoms not improving with psychological therapies was 0.69 (95% CI 0.62–0.76). Cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy were all beneficial when data from two or more RCTs were pooled. There was significant heterogeneity between studies (I2 = 69%, P < 0.001) and significant funnel plot asymmetry. There were also issues regarding trial design, including lack of blinding.  Conclusions Antidepressants are efficacious in reducing symptoms in IBS patients. Psychological therapies also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result.

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Specific and general cognitive predictors of Sexual Orientation-Obsessive Compulsive Disorder.

Specific and general cognitive predictors of Sexual Orientation-Obsessive Compulsive Disorder. | Cognitive & General Psychotherapy Research | Scoop.it

(Available in free full text) Sexual Orientation-Obsessive Compulsive Disorder (SO-OCD) is yet understudied in the literature. The current study was prompted to test the role of specific and general beliefs potentially involved in the genesis and maintenance of SO-OCD. As such, 263 patients with SO-OCD, 42 patients with OCD (NSO-OCD) and 116 non-clinical participants (NCP) were administered the Sexual Orientation-Obsessive Beliefs Scale (SO-OBS), which was designed to evaluate specific beliefs hypothesized to relate to SO-OCD, together with other measures assessing SO-OCD symptoms, general obsessive beliefs, depression and anxiety. The final SO-OBS consisted of 12 items and showed a four-factor structure and a very good internal consistency. Regression analysis and multivariate analysis of covariance (MANCOVA) highlighted the significant role of beliefs regarding the negative impact of homosexuality on one's identity and beliefs about the meaning of sexual problems in heterosexual intercourse as well as a more marginal role of black/white beliefs regarding what it is “right” to feel in heterosexual sexuality. There were no significant differences between SO-OCD and NSO-OCD patients on homophobic beliefs. Despite some limitations of the study, including the limitation to heterosexual individuals with SO-OCD, the identification of these specific cognitive factors has important implications for the prevention and treatment of SO-OCD.

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Brain-computer-interface-based intervention re-normalizes brain functional network topology in children with attention deficit/hyperactivity disorder.

Brain-computer-interface-based intervention re-normalizes brain functional network topology in children with attention deficit/hyperactivity disorder. | Cognitive & General Psychotherapy Research | Scoop.it

(Available in free full text) A brain-computer-interface (BCI)-based attention training game system has shown promise for treating attention deficit/hyperactivity disorder (ADHD) children with inattentive symptoms. However, little is known about brain network organizational changes underlying behavior improvement following BCI-based training. To cover this gap, we aimed to examine the topological alterations of large-scale brain functional networks induced by the 8-week BCI-based attention intervention in ADHD boys using resting-state functional magnetic resonance imaging method. Compared to the non-intervention (ADHD-NI) group, the intervention group (ADHD-I) showed greater reduction of inattention symptoms accompanied with differential brain network reorganizations after training. Specifically, the ADHD-NI group had increased functional connectivity (FC) within the salience/ventral attention network (SVN) and increased FC between task-positive networks (including the SVN, dorsal attention (DAN), somatomotor, and executive control network) and subcortical regions; in contrast ADHD-I group did not have this pattern. In parallel, ADHD-I group had reduced degree centrality and clustering coefficient as well as increased closeness in task-positive and the default mode networks (prefrontal regions) after the training. More importantly, these reduced local functional processing mainly in the SVN were associated with less inattentive/internalizing problems after 8-week BCI-based intervention across ADHD patients. Our findings suggest that the BCI-based attention training facilitates behavioral improvement in ADHD children by reorganizing brain functional network from more regular to more random configurations, particularly renormalizing salience network processing. Future long-term longitudinal neuroimaging studies are needed to develop the BCI-based intervention approach to promote brain maturation in ADHD.

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Perspective mistaking: Accurately understanding the mind of another requires getting perspective, not taking perspective.

Taking another person’s perspective is widely presumed to increase interpersonal understanding. Very few experiments, however, have actually tested whether perspective taking increases accuracy when predicting another person’s thoughts, feelings, attitudes, or other mental states. Those that do yield inconsistent results, or they confound accuracy with egocentrism. Here we report 25 experiments testing whether being instructed to adopt another person’s perspective increases interpersonal insight. These experiments include a wide range of accuracy tests that disentangle egocentrism and accuracy, such as predicting another person’s emotions from facial expressions and body postures, predicting fake versus genuine smiles, predicting when a person is lying or telling the truth, and predicting a spouse’s activity preferences and consumer attitudes. Although a large majority of pretest participants believed that perspective taking would systematically increase accuracy on these tasks, we failed to find any consistent evidence that it actually did so. If anything, perspective taking decreased accuracy overall while occasionally increasing confidence in judgment. Perspective taking reduced egocentric biases, but the information used in its place was not systematically more accurate. A final experiment confirmed that getting another person’s perspective directly, through conversation, increased accuracy but that perspective taking did not. Increasing interpersonal accuracy seems to require gaining new information rather than utilizing existing knowledge about another person. Understanding the mind of another person is therefore enabled by getting perspective, not simply taking perspective.

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Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review.

Objective Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. Method In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. Conclusion The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.

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Personal risk factors associated with burnout among psychotherapists: A systematic review of the literature.

Abstract Objectives Emotionally taxing job demands place psychotherapists at risk for burnout, often to the detriment of the therapist, clients, and the profession of psychotherapy (Maslach, 2007). The aim of the present systematic review was to (a) explore the levels of both burnout and job stress in psychotherapists, (b) identify tools used to measure work-related stress and burnout, and (c) identify personal risk factors for developing burnout among psychotherapists. Method Databases PsycINFO, Medline, EMBASE, ASSIA, and CINHAL were searched. Forty articles met inclusion criteria. Results Over half of sampled psychotherapists reported moderate-high levels of burnout, with the majority of results based on quantitative cross-sectional self-report surveys. Younger age, having less work experience, and being overinvolved in client problems were the most common personal risk factors for moderate-high levels of stress and burnout among psychotherapists. Conclusion It appears that psychotherapists commonly experience some burnout, and personal factors influence burnout development. [For a helpful discussion of this study see the BPS Research Digest at https://tinyurl.com/y8tnwvl3 ].

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Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial.

Background Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.  Methods Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.  Results After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.  Conclusions Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

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Is cognitive–behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis.

Background It is not clear whether relaxation therapies are more or less effective than cognitive and behavioural therapies in the treatment of anxiety. The aims of the present study were to examine the effects of relaxation techniques compared to cognitive and behavioural therapies in reducing anxiety symptoms, and whether they have comparable efficacy across disorders.  Method We conducted a meta-analysis of 50 studies (2801 patients) comparing relaxation training with cognitive and behavioural treatments of anxiety.  Results The overall effect size (ES) across all anxiety outcomes, with only one combined ES in each study, was g = −0.27 [95% confidence interval (CI) = −0.41 to −0.13], favouring cognitive and behavioural therapies (number needed to treat = 6.61). However, no significant difference between relaxation and cognitive and behavioural therapies was found for generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias (considering social anxiety and specific phobias separately). Heterogeneity was moderate (I2 = 52; 95% CI = 33–65). The ES was significantly associated with age (p < 0.001), hours of cognitive and/or behavioural therapy (p = 0.015), quality of intervention (p = 0.007), relaxation treatment format (p < 0.001) and type of disorder (p = 0.008), explaining an 82% of variance.  Conclusions Relaxation seems to be less effective than cognitive and behavioural therapies in the treatment of post-traumatic stress disorder, and obsessive–compulsive disorder and it might also be less effective at 1-year follow-up for panic, but there is no evidence that it is less effective for other anxiety disorders.

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Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials.

Importance  The physical benefits of resistance exercise training (RET) are well documented, but less is known regarding the association of RET with mental health outcomes. To date, no quantitative synthesis of the antidepressant effects of RET has been conducted.  Objectives  To estimate the association of efficacy of RET with depressive symptoms and determine the extent to which logical, theoretical, and/or prior empirical variables are associated with depressive symptoms and whether the association of efficacy of RET with depressive symptoms accounts for variability in the overall effect size.  Data Sources  Articles published before August 2017, located using Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science.  Study Selection  Randomized clinical trials included randomization to RET (n = 947) or a nonactive control condition (n = 930).Data Extraction and Synthesis  Hedges d effect sizes were computed and random-effects models were used for all analyses. Meta-regression was conducted to quantify the potential moderating influence of participant and trial characteristics.  Main Outcomes and Measures  Randomized clinical trials used validated measures of depressive symptoms assessed at baseline and midintervention and/or postintervention. Four primary moderators were selected a priori to provide focused research hypotheses about variation in effect size: total volume of prescribed RET, whether participants were healthy or physically or mentally ill, whether or not allocation and/or assessment were blinded, and whether or not the RET intervention resulted in a significant improvement in strength.  Results  Fifty-four effects were derived from 33 randomized clinical trials involving 1877 participants. Resistance exercise training was associated with a significant reduction in depressive symptoms with a moderate-sized mean effect ∆ of 0.66 (95% CI, 0.48-0.83; z = 7.35; P < .001). Significant heterogeneity was indicated (total Q = 216.92, df = 53; P < .001; I2 = 76.0% [95% CI, 72.7%-79.0%]), and sampling error accounted for 32.9% of observed variance. The number needed to treat was 4. Total volume of prescribed RET, participant health status, and strength improvements were not significantly associated with the antidepressant effect of RET. However, smaller reductions in depressive symptoms were derived from randomized clinical trials with blinded allocation and/or assessment.  Conclusions and Relevance  Resistance exercise training significantly reduced depressive symptoms among adults regardless of health status, total prescribed volume of RET, or significant improvements in strength. Better-quality randomized clinical trials blinding both allocation and assessment and comparing RET with other empirically supported treatments for depressive symptoms are needed.

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Temporal dynamics and longitudinal co-occurrence of depression and different anxiety syndromes in youth: Evidence for reciprocal patterns in a 3-year prospective study.

Temporal dynamics and longitudinal co-occurrence of depression and different anxiety syndromes in youth: Evidence for reciprocal patterns in a 3-year prospective study. | Cognitive & General Psychotherapy Research | Scoop.it

Background Depression is highly comorbid with anxiety in youth. It is frequently reported that anxiety precedes depression; however, evidence surrounding the temporal precedence of anxiety over depression is mixed. Many studies of anxiety-depression co-occurrence lump distinct forms of anxiety, obscuring information regarding trajectories of specific anxiety syndromes. This study sought to more accurately describe the development of anxiety and depression over time by moving beyond the question of temporal precedence to investigate a developmentally dynamic model of anxiety-depression co-occurrence. Methods A community sample of 665 youth (M= 11.8, SD= 2.4; 55% female) completed repeated self-report measures of depression and anxiety (social, physical, and separation anxiety) over a 3-year longitudinal study. Prospective associations between distinct syndromes of anxiety with depression were analyzed using an autoregressive cross-lagged path model over four time points. Results Physical symptoms and depression symptoms reciprocally predicted each other, above and beyond the stability of either domain. Social anxiety and depression symptoms similarly predicted each other in a systematic pattern. Limitations Our study is limited in its generalizability to other forms of anxiety, like worry. Additional research is needed to determine whether similar patterns exist in clinical populations, and whether these processes maintain symptoms once they reach diagnostic levels. Conclusions The development of syndromes of depression, physical, and social anxiety during childhood and adolescence occurs in a predictable, systematic reciprocal pattern, rather than sequentially and unidirectionally (i.e., anxiety syndromes precede depression). Results are clinically useful for predicting risk for disorder, and demonstrate the necessity of tracking symptom levels across domains.

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Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial.

Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial. | Cognitive & General Psychotherapy Research | Scoop.it

Objective: The authors assessed the efficacy of trauma memory reactivation performed under the influence of propranolol, a noradrenergic beta-receptor blocker, as a putative reconsolidation blocker, in reducing symptoms of posttraumatic stress disorder (PTSD).  Method: This was a 6-week, double-blind, placebo-controlled, randomized clinical trial in 60 adults diagnosed with long-standing PTSD. Propranolol or placebo was administered 90 minutes before a brief memory reactivation session, once a week for 6 consecutive weeks. The hypothesis predicted a significant treatment effect of trauma reactivation with propranolol compared with trauma reactivation with placebo in reducing PTSD symptoms on both the Clinician-Administered PTSD Scale (CAPS) and the patient-rated PTSD Checklist–Specific (PCL-S) in an intention-to-treat analysis.  Results: The estimated group difference in posttreatment CAPS score, adjusted for pretreatment values (analysis of covariance), was a statistically significant 11.50. The within-group pre- to posttreatment effect sizes (Cohen’s d) were 1.76 for propranolol and 1.25 for placebo. For the PCL-S, the mixed linear model’s estimated time-by-group interaction yielded an average decrease of 2.43 points per week, for a total significant difference of 14.58 points above that of placebo. The pre- to posttreatment effect sizes were 2.74 for propranolol and 0.55 for placebo. Per protocol analyses for both outcomes yielded similar significant results.  Conclusions: Pre-reactivation propranolol, a treatment protocol suggested by reconsolidation theory, appears to be a novel and efficacious treatment for PTSD. Replication studies using a long-term follow-up in various trauma populations are required.

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