Behav Ther [JOURNAL]
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200 papers
Written Exposure Therapy for Posttraumatic Stress Disorder and Integration of a Mindfulness-Based App in China: A Pilot Randomized Controlled Trial.
Li M, Zhao Y, Guo Z … +5 more , Wei M, Fan S, Chen Q, Li Y, Zang Y
Behav Ther · 2026 May · PMID 42097790 · Publisher ↗
Despite posttraumatic stress disorder's (PTSD) significant burden in China, accessible and effective treatments remain limited. This pilot randomized controlled trial examined the feasibility, acceptability, and prelimin...
Despite posttraumatic stress disorder's (PTSD) significant burden in China, accessible and effective treatments remain limited. This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of Written Exposure Therapy (WET) for PTSD in China and explored whether adding a mindfulness-based app (MBA) improved insomnia outcomes. Forty-six adults meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for PTSD or subthreshold PTSD with associated insomnia were randomly assigned to WET (n = 15), WET + MBA (n = 15), or minimal contact control (MCC, n = 16). PTSD severity was measured using the PTSD Symptom Scale Interview (PSSI-5) and PTSD Checklist (PCL-5), and insomnia with the Insomnia Severity Index (ISI). Assessments occurred at baseline and posttreatment for all groups, with a 3-month follow-up for WET and WET + MBA. Effect sizes were measured with Hedges's g. Patient satisfaction was high for WET completers and moderate for WET + MBA completers. WET led to significantly greater reductions in PCL-5 (p = .022, g = -.66) and marginally greater reductions in PSSI-5 (p = .053, g = -.66) than MCC at posttreatment, with effects maintained at follow-up. While both conditions reduced insomnia (WET: g = -1.50; WET + MBA: g = -.67), WET alone produced significantly greater improvements than WET + MBA. WET appears to be a promising brief intervention for PTSD in Chinese samples. Exploring MBA clarifies the nuances of combining therapeutic approaches. Cultural adaptation might enhance engagement and inform optimized interventions for PTSD and associated insomnia.
Emotion Regulation Treatment for Irritability and Disruptive Behavior: A Preliminary Investigation.
Turner KA, White BA, Ollendick TH
Behav Ther · 2026 May · PMID 42097789 · Publisher ↗
Children with oppositional-defiant disorder (ODD) represent a heterogeneous group. Within this group, a subtype of ODD has been identified for children with primarily angry/irritable mood symptoms who are at risk for dev...
Children with oppositional-defiant disorder (ODD) represent a heterogeneous group. Within this group, a subtype of ODD has been identified for children with primarily angry/irritable mood symptoms who are at risk for developing mood and anxiety disorders. Despite the prevalence of anger and mood difficulties in children with ODD, evidence-based treatments for disruptive behavior disorders have primarily emphasized providing caregivers more effective parenting strategies to address oppositional and defiant behaviors, rather than directly targeting children's difficulties with emotions. To address the dearth of emotion-focused treatments for ODD, a novel emotion regulation intervention was developed and piloted. Using a nonconcurrent multiple baseline design, 7 children ages 8-11 (3 male, 4 female; all non-Hispanic White) were enrolled in a 13-week intervention with their caregivers. Tantrum behavior, mood, and emotion regulation measures were administered throughout treatment. Treatment feasibility was supported by participant satisfaction ratings as well as high levels of treatment fidelity. Multiple measures support the preliminary efficacy of the intervention in reducing symptoms of ODD as well as initial efficacy in improving child emotion regulation difficulties. Overall, results support further research into emotion regulation-focused interventions for ODD.
Distress Intolerance Is Associated With Emotion Regulation Effort and Difficulty, But Not Success in Daily Life.
Gross AM, Eckland NS, Thompson RJ
Behav Ther · 2026 May · PMID 42097788 · Publisher ↗
Distress intolerance (DI), an individual's perceived inability to tolerate emotional discomfort, is a transdiagnostic factor implicated in many forms of psychopathology. Theory posits that DI impacts mental health in par...
Distress intolerance (DI), an individual's perceived inability to tolerate emotional discomfort, is a transdiagnostic factor implicated in many forms of psychopathology. Theory posits that DI impacts mental health in part through its associations with the emotion regulation (ER) process. Using data from a naturalistic study of emotions in daily life, we empirically tested whether trait DI was associated with important aspects of the ER process, specifically the perceived amount of effort individuals apply to the ER process, their perception of regulation difficulty, and their perceived success with ER. We also examined whether associations between DI and the ER process differed based on momentary negative affect (NA). Participants (N = 179; M = 35.2, SD = 11.9; 50% women) completed an experience sampling protocol during which they reported on their momentary NA and ER in response to emotional shifts five times daily for 14 days (mean number of surveys completed per participant = 48.5 [69.4%]). Participants also completed self-report measures of DI and depression. Multilevel models provided evidence that DI is associated with greater perceived effort and difficulty in ER, but not with perceived success in ER. Importantly, several of these associations remained significant after accounting for momentary NA and depression. Finally, the association between DI and ER effort was stronger during moments of elevated state NA. The findings indirectly suggest DI shapes how individuals appraise the ER process by amplifying the perceived burdensomeness of regulation (i.e., effort, difficulty) without impairing its perceived effectiveness in daily life.
Watch Out, It Bites! An Examination of Threat Information Transmission from Parents to Young Children with Specific Phobias.
Trimarchi L, Simcock G, Calteaux I … +3 more , Waters AM, Ollendick TH, Farrell LJ
Behav Ther · 2026 May · PMID 42097787 · Publisher ↗
Specific phobias are highly prevalent and onset as young as 3 years of age. Evidence suggests children learn fear beliefs and avoidance after being provided negative/threatening information. Little is currently known, ho...
Specific phobias are highly prevalent and onset as young as 3 years of age. Evidence suggests children learn fear beliefs and avoidance after being provided negative/threatening information. Little is currently known, however, about the role of information transmission in clinical samples. This study explores the role of information transmission in early onset specific phobias, as proposed by Rachman (1977), by comparing a clinical group of forty-two parents of children (aged 3 to 6 years) with specific phobia and a nonclinical group including seventeen parents of age-matched children. Parents completed a diagnostic telephone interview and parent psychopathology questionnaire, followed by an in-person novel animal task to ascertain the frequency of information they attend to and putatively provide to their children under three valence conditions (positive, negative, ambiguous). Parents of children with specific phobia putatively provided significantly more negative information to their children than parents of nonclinical children, under ambiguous conditions. The amount of negative information provided within this sample was not related to parent's own anxiety. The findings of this study extend upon previous research showing that it is normative for children to acquire fears after receiving negative/threatening information, providing support for the role of negative/threatening information transmission in pathological fears, with a clinical sample at the time of onset.
Massed Brief Cognitive Behavioral Therapy (mBCBT) for Suicide Prevention: Results of a Pragmatic Clinical Trial.
Bryan CJ, Bryan AO, Khazem LR … +6 more , Baker JC, Rooney EA, McGraw JS, Daruwala SE, Ammendola E, Hiser J
Behav Ther · 2026 May · PMID 42097786 · Publisher ↗
Brief cognitive behavioral therapy (BCBT) for suicide prevention has been shown to significantly reduce suicide attempts in multiple clinical settings and populations. Despite its efficacy, some patients will nonetheless...
Brief cognitive behavioral therapy (BCBT) for suicide prevention has been shown to significantly reduce suicide attempts in multiple clinical settings and populations. Despite its efficacy, some patients will nonetheless engage in suicidal behaviors, typically within months of starting treatment, before they have received all treatment components. Accelerating the pace of BCBT with daily sessions during a compressed timeframe (e.g., 1-3 weeks) could lead to faster reductions in suicide risk. To date, no studies have examined the potential benefits of intensive or "massed" suicide prevention therapies. In this nonrandomized observational study, we examined change in multiple clinical outcomes (suicidal cognitions, suicidal ideation, depression, anxiety, and social-occupational functioning) during and after BCBT among treatment-seeking adult patients with recent suicidal ideation and/or suicidal behaviors. Of 55 patients, 30 chose to attend daily sessions of BCBT over 2 weeks (massed BCBT, or mBCBT) and 25 chose to attend weekly sessions (standard BCBT). Patients in both formats reported improvements in suicidal cognitions, suicidal ideation, depression, and social-occupational functioning by treatment end (week 3 in mBCBT and week 10 in standard BCBT). Anxiety symptoms improved more in standard BCBT than mBCBT. Relative to baseline, clinical gains at the end of mBCBT were maintained at the 3-month follow-up (week 15) but were smaller in magnitude than the gains reported 3 months after standard BCBT (week 22). Results suggest clinical outcomes improved in the short term during mBCBT. Additional research is warranted to evaluate change trajectories over longer follow-up periods.
Psychological Flexibility, Adaptive Emotion Regulation, Self-Compassion, and Autonomy as Mechanisms of Change in Acceptance and Commitment Therapy for Transitional-Age Youth.
Keulen J, Deković M, Matthijssen D … +2 more , Schraven J, Bodden D
Behav Ther · 2026 May · PMID 42097785 · Publisher ↗
Acceptance and Commitment Therapy (ACT) is a promising transdiagnostic intervention for transitional-age youth (15-25 years) with psychological problems. This study aimed to investigate whether psychological flexibility,...
Acceptance and Commitment Therapy (ACT) is a promising transdiagnostic intervention for transitional-age youth (15-25 years) with psychological problems. This study aimed to investigate whether psychological flexibility, adaptive emotion regulation, self-compassion, and autonomy are possible transdiagnostic mechanisms through which ACT reduces psychological problems in transitional-age youth. Data were derived from a randomized controlled trial (RCT) comparing ACT with treatment as usual (TAU). A total of 123 transitional-age youth (M = 17.68, 68.3% female) with various psychological problems participated in the study. Univariate latent growth models were used to assess changes over time in all mechanisms and psychological problems and bivariate latent growth models examined the relationships between changes in each mechanism and changes in psychological problems. Also, we examined whether changes in the four mechanisms served as a potential mediating link between ACT and psychological problems. Results indicated that both ACT and TAU were equally effective in increasing psychological flexibility, adaptive emotion regulation, self-compassion, and autonomy, as well as in reducing psychological problems. In both conditions, increases in psychological flexibility and adaptive emotion regulation were significantly associated with decreases in psychological problems. However, increases in self-compassion and autonomy were unrelated to decreases in psychological problems. These findings emphasize the relevance of psychological flexibility and adaptive emotion regulation as important transdiagnostic intervention targets for psychological problems.
Temporal Precedence of Distress Tolerance in Predicting Anxiety and Depression: A Daily Diary Approach During Mindfulness-Based Intervention.
Li Y, Hu A, Ding Y … +6 more , Tang X, Jiang X, Leng Y, Chen M, Hofmann SG, Liu X
Behav Ther · 2026 May · PMID 42097784 · Publisher ↗
This study used a daily diary method to examine the temporal relationship between distress tolerance (DT), anxiety, and depression during a mindfulness-based intervention (MBI). A total of 83 participants with high emoti...
This study used a daily diary method to examine the temporal relationship between distress tolerance (DT), anxiety, and depression during a mindfulness-based intervention (MBI). A total of 83 participants with high emotional distress completed daily diaries of mindfulness, DT, anxiety and depression over one week before, during, and after the intervention. Linear mixed models showed significant improvements in all measured variables (p < 0.001) one week after the intervention. Dynamic structural equation modeling found that daily DT at time t significantly predicted daily anxiety (β = -0.06, p = 0.006), but not daily depression (β = -0.03, p = 0.076) at time t + 1. In the first three weeks, no significant time-lagged relationships were observed. However, in the last four weeks, daily DT at time t significantly predicted both daily anxiety (β = -0.11, p < 0.001) and daily depression (β = -0.08, p = 0.002) at time t + 1. Reverse relationships were not significant. These findings support the temporal precedence of DT over anxiety and depression, especially when interventions target DT enhancement.
CBT for Public Good: Why We Need to Be More Comfortable Using Someone Else's Toothbrush.
Seligman LD
Behav Ther · 2026 Mar · PMID 41741109 · Publisher ↗
The promise of behavior therapy and, later, cognitive behavioral therapy, was to alleviate human suffering by using a scientific approach to better understand how to develop, test, disseminate, and implement sound psycho...
The promise of behavior therapy and, later, cognitive behavioral therapy, was to alleviate human suffering by using a scientific approach to better understand how to develop, test, disseminate, and implement sound psychological treatments. As a field, we have seen great success, including the development of an ever-growing list of evidence-based treatments. However, the proliferation of "new" treatments does not seem to be matched by a commensurate growth in the number of people we are effectively able to help. Suggestions for how to address our stalled progress have included intensified efforts at dissemination and a focus on open science and replication. Here I suggest that if we are to make meaningful progress, the type of progress that makes a difference in people's lives, we must focus more on the why behind what we do-our theories. In particular, I argue that we must focus on formalized theory, but that for this type of work to flourish, we need to redefine and reshape the contingencies in the field of cognitive behavioral science, rethinking our ideas of how success should be defined.
Between Urges and Actions: Unpacking Affective Dynamics in Nonsuicidal Self-Injury.
Bianco AN, Victor SE, Mitchell SM
Behav Ther · 2026 Mar · PMID 41741108 · Full text
Engagement in nonsuicidal self-injury (NSSI) can be predicted by affective dynamics (e.g., variability, inertia, and intensity). However, little is known about affective dynamics in relation to NSSI urges that are not ac...
Engagement in nonsuicidal self-injury (NSSI) can be predicted by affective dynamics (e.g., variability, inertia, and intensity). However, little is known about affective dynamics in relation to NSSI urges that are not acted upon, a phenomenon worth further study given its high rate of occurrence. Such a phenomenon should be studied in real-time through ecological momentary assessment (EMA), given the varying durations and frequency of NSSI urges. The current study examined affective dynamics in relation to EMA-reported NSSI urges and compared affective dynamics among participants with only EMA-reported NSSI urges to those with both EMA-reported NSSI urges and any EMA-reported NSSI behaviors. The sample included 93 young adults (ages 18-34) with past-month NSSI urges or behaviors. Dynamic structural equation modeling (DSEM) was used to analyze between-person affective dynamics. Results showed that greater NSSI urges were associated with greater negative affect variability and intensity, and lower positive affect intensity. Further, individuals who engaged in any NSSI behavior had significantly higher negative affect variability and intensity than those who only reported NSSI urges (but not behaviors) during EMA, even when controlling for past month NSSI behaviors at baseline. This study has important implications for risk identification and later treatment of NSSI urges.
Validation of the Valued Living Questionnaire-Comprehension Support Version (VLQ-CS) in a Neurotypical Adult Cohort.
Skaliotis J, Miller H, Wong D
Behav Ther · 2026 Mar · PMID 41741107 · Publisher ↗
The Valued Living Questionnaire-Comprehension Support version (VLQ-CS) was previously adapted from the original VLQ to measure value-consistent actions in individuals with cognitive and communication difficulties followi...
The Valued Living Questionnaire-Comprehension Support version (VLQ-CS) was previously adapted from the original VLQ to measure value-consistent actions in individuals with cognitive and communication difficulties following acquired brain injury (ABI). In this study, we aimed to determine if the VLQ-CS is also a valid and reliable measure of valued living in neurotypical adults, and to compare the psychometric properties of the original and adapted VLQ across ABI and neurotypical cohorts. The VLQ-CS was completed by adults without neurological or neurodevelopmental diagnoses with an assessor via Zoom, with an average completion time of 2 minutes. To measure test-retest reliability, participants completed the VLQ-CS again after 2-3 weeks, and the association was analyzed with Intraclass Correlation Coefficients. Convergent validity was assessed with related measures administered at Time 1, including the Valuing Questionnaire and measures of general health, well-being, depression, anxiety, and experiential avoidance. Discriminant validity was assessed with an everyday memory questionnaire. Participants completed measures independently, with the assessor providing support as required. Construct validity was analyzed using the multitrait multimethod (at least 75% of Pearson's correlation coefficients in the hypothesized direction). Seventy-four participants completed the initial assessment, and 70 completed the second. Test-retest reliability ranged from excellent (.91) to good (.78) across VLQ-CS scales. Construct validity was supported. As the VLQ-CS performed comparably to the VLQ and was previously found to have superior psychometrics for individuals with ABI, it may offer a more accessible and inclusive measure for use in research and clinical practice across clinical and nonclinical populations.
Examining the Relationship Between Network-Based Subgroups and Treatment Outcomes Among Individuals With Eating Disorders: A Proof-of-Concept Study.
Ong CW, Cusack CE, Levinson CA
Behav Ther · 2026 Mar · PMID 41741106 · Publisher ↗
Psychological treatment effects and response rates have largely plateaued over the past few decades. A potential answer to this problem is personalized treatment approaches that match treatment to a client's specific pre...
Psychological treatment effects and response rates have largely plateaued over the past few decades. A potential answer to this problem is personalized treatment approaches that match treatment to a client's specific presenting concerns, increasing its precision and efficacy. Examining predictors and moderators of treatment outcome (who is likely to benefit from treatment, and which treatment) is one way to guide personalized decision making. The current study is a proof of concept for the clinical utility of network-based subgroups. We investigated the relationship between network-derived subgroups and treatment response using data from two clinical trials on eating disorders (N = 80). Subgroups were identified using subgrouping group iterative multiple model estimation (S-GIMME). Analyses of variance (ANOVAs) were used to compare changes in eating disorder symptom severity and clinical impairment among subgroups. We found three subgroups comprising 71 of the initial 80 participants: mean age = 34.4 (SD = 11.8), 87.3% cisgender women, 85.9% White non-Hispanic. Subgroups were differentiated by how shame and guilt were related in the network. The subgroup with a contemporaneous pathway from guilt to shame showed the least change in clinical impairment from pre- to posttreatment, F(2, 64) = 5.92, p = .004. Overall, our findings tentatively suggest that network-based subgroups may have utility as prognostic indicators in the context of eating disorders, though replication of present findings is warranted. Limitations included potentially unstable subgroups and use of mostly cisgender women and white samples.
Prolonged Grief, Depressive, and Posttraumatic Stress Symptoms: Random-Intercept Cross-Lagged Panel Analyses.
Janshen A, Boelen PA, Huisman M … +1 more , Eisma MC
Behav Ther · 2026 Mar · PMID 41741105 · Publisher ↗
Prolonged grief symptoms often co-occur with depressive and posttraumatic stress (PTS) symptoms, but the temporal relationships between prolonged grief symptoms and other postloss psychopathology symptoms are not well un...
Prolonged grief symptoms often co-occur with depressive and posttraumatic stress (PTS) symptoms, but the temporal relationships between prolonged grief symptoms and other postloss psychopathology symptoms are not well understood. Insights into the temporal relationships can inform treatment decisions for bereaved adults. Therefore, we aimed to clarify these temporal relationships. Three-hundred seven bereaved adults within their first bereavement year (78% female) completed questionnaires to assess prolonged grief, depressive, and PTS symptoms at five time points at 1.5-month intervals. Random-intercept cross-lagged panel modeling was utilized to inspect reciprocal relationships between these symptoms. Higher prolonged grief symptoms than usual predicted other psychopathology symptoms and vice versa across at least one interval in all bivariate models. In a model including prolonged grief, depressive, and PTS symptoms, within-person fluctuations in acute grief (i.e., grief occurring between 0 and 6 months after loss) levels predicted other postloss symptoms but not vice versa. Most variance could be attributed to stable differences between individuals. Future research should examine the clinical utility of targeting acute grief reactions to prevent the emergence of other postloss psychopathology.
Intensive Exposure and Response Prevention for Anxious Youth With a History of Self-Harm and Suicidality.
Stark AM, Tung ES, Wilner JG … +1 more , Sperling JB
Behav Ther · 2026 Mar · PMID 41741104 · Publisher ↗
A growing body of research points to the increase in suicidal thoughts and behaviors, nonsuicidal self-injury (NSSI), and anxiety within adolescents. Given the increase in these behaviors for adolescents and young adults...
A growing body of research points to the increase in suicidal thoughts and behaviors, nonsuicidal self-injury (NSSI), and anxiety within adolescents. Given the increase in these behaviors for adolescents and young adults within the United States, it has become increasingly likely for clinicians who specialize in anxiety and obsessive-compulsive (OC) disorders to encounter adolescents and young adults with suicidal or self-harming behaviors. However, a paucity of research has examined how to best treat this population with exposure and response prevention (ERP), one of the gold-standard treatments for anxiety and obsessive-compulsive disorder (OCD). The current naturalistic study investigated the efficacy of ERP therapy at an intensive outpatient program in reducing anxiety severity, functional impairment of anxiety, and depression symptoms among adolescents with anxiety disorders and OCD, with a focus on differences in outcomes based on a history of NSSI or suicidal thoughts and behaviors (STBs). Results demonstrated significant improvements across the entire sample, including reductions in anxiety severity, anxiety impact, and depression symptoms. However, adolescents with a history of NSSI/STBs demonstrated higher symptom severity at both admission and discharge compared to those without such a history and showed less change in anxiety and depression scores over the course of treatment compared with the non-NSSI/STB group. The study underscores the effectiveness of ERP for youth with complex mental health presentations. These findings have critical implications for clinical practice, supporting the inclusion of ERP in treatment plans for youth with comorbid anxiety and NSSI/STBs, while emphasizing the need for adapted approaches as well as further research to improve outcomes for those with a history of NSSI/STBs.
The Role of the Therapeutic Alliance in Dropout in Cognitive Processing Therapy for Posttraumatic Stress Disorder.
Shayani DR, Canale CA, LoSavio ST … +2 more , Sloan DM, Hayes AM
Behav Ther · 2026 Mar · PMID 41741103 · Full text
Dropout rates for treatments for adult posttraumatic stress disorder (PTSD) are high. To date, most investigations have focused primarily on patient factors to understand dropout, but it is also important to investigate...
Dropout rates for treatments for adult posttraumatic stress disorder (PTSD) are high. To date, most investigations have focused primarily on patient factors to understand dropout, but it is also important to investigate therapist-patient factors, such as the therapeutic alliance. The alliance is commonly measured as three components: the therapist-patient bond, agreement on tasks, and agreement on goals. The contributions of each of these components to dropout have not been examined but could highlight important points of intervention to increase engagement. An observational coding system, the Working Alliance Inventory-Observer Version-Short Form (WAI-O-S), was used to code these alliance components in audio-recorded early sessions of cognitive processing therapy (CPT), a gold-standard treatment for PTSD. The therapist-patient Bond, Tasks, and Goals subscales were examined as predictors of dropout in CPT. Participants were 63 treatment-seeking adults with PTSD who received CPT as part of a randomized noninferiority trial. Those who completed the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at pretreatment and had at least one session available to code (n = 52) were included in analyses. Of those, 15 (28.8%) dropped out of CPT early (all dropped in ≤9 sessions) and 37 (71.2%) completed treatment. Scores on each of the alliance subscales were averaged across the first seven available session recordings. Logistic regression analyses showed that more disagreement on tasks predicted higher risk of dropout (OR = 0.26, 95% CI [0.08, 0.90], p = .034), whereas the bond and agreement on goals did not predict dropout. These findings highlight the importance of examining the specific components of the alliance and suggest that addressing patient reactions to therapeutic tasks may enhance collaboration and decrease the risk of dropout.
The Impact of Caregiver Trauma on Youth TF-CBT Attrition: Moderation by Youth Emotion Regulation.
Brown MP, Allen B, Davis AL … +3 more , Bucher A, Shacklewood C, Brettler R
Behav Ther · 2026 Mar · PMID 41741102 · Full text
The existing awareness of the intergenerational impacts of trauma highlights the importance of understanding how caregivers' past trauma may affect their child's ability to succeed in trauma-focused treatment, such as tr...
The existing awareness of the intergenerational impacts of trauma highlights the importance of understanding how caregivers' past trauma may affect their child's ability to succeed in trauma-focused treatment, such as trauma-focused cognitive behavioral therapy (TF-CBT). However, research in this area is minimal, and work focusing specifically on TF-CBT attrition is even more limited. This study investigates the predictive power of caregiver trauma on TF-CBT completion and total number of sessions attended. We additionally tested the moderating effects of caregiver depression and youth emotion regulation (ER). Caregivers of participants (N = 108, M = 11.10, 62.96% female, 53.7% White, 14.8% Hispanic/Latino/a) receiving TF-CBT at a clinic within an academic medical center reported on their own trauma experiences as well as their child's ER skills. Analyses found that youth emotion regulation moderated the association between caregiver trauma history and number of sessions attended in that youth whose caregivers had experienced a greater number of maltreatment subtypes and whose children had weaker emotion regulation skills completed a greater number of TF-CBT sessions (β = -.31, p = .021). These findings suggest a complex interaction between caregiver trauma, youth ER, and TF-CBT outcome and further emphasize the importance of considering both caregiver and youth factors in treatment outcome.
Identity-Related Stress and Obsessive-Compulsive Disorder in Sexual and Gender Minority Individuals: A Test of the Cognitive Behavioral-Minority Stress Model.
Pinciotti CM, Castillo AA, Avery JE … +2 more , Storch EA, Feinstein BA
Behav Ther · 2026 Mar · PMID 41741101 · Publisher ↗
Pinciotti and Feinstein's (2025) cognitive behavioral-minority stress model of obsessive-compulsive disorder (OCD) proposes to explain the development, presentation, and maintenance of OCD among sexual and gender minorit...
Pinciotti and Feinstein's (2025) cognitive behavioral-minority stress model of obsessive-compulsive disorder (OCD) proposes to explain the development, presentation, and maintenance of OCD among sexual and gender minority (SGM) individuals. Extrapolating from extant theory and research about the development and maintenance of OCD and, separately, the influence of identity-based stressors on psychopathology among SGM individuals, this model proposes that a combination of early life experiences and identity-based stressors lead to a general predisposition of inflated responsibility to prevent harm, and these beliefs and identity-based stressors subsequently lead to the presence and content of OCD symptoms. Although the cognitive behavioral-minority stress model is grounded in existing theory and research, it has not yet been directly tested. Accordingly, the present study used structural equation models to evaluate this theory in 463 SGM individuals with OCD (Mage = 27.3, 89% female). Inflated responsibility was associated with all OCD symptom dimensions for sexual minority (SM), but only two symptom dimensions for gender minority (GM) individuals. Internalized stigma exhibited unique associations with OCD symptoms for both SM and GM individuals, highlighting its relevance to OCD. Among SM individuals, rejection sensitivity also evidenced associations with OCD symptoms, whereas among gender minority individuals, identity-based physical assault was most consistently associated with OCD symptoms. Findings support the influence of minority stress on OCD symptoms and provide preliminary support for the cognitive behavioral-minority stress model of OCD among SGM individuals. Implications and limitations are discussed, and guidance is offered regarding next steps for this research informed by findings from the present study.
Old Wounds, New Reactions: The Longitudinal Prediction of Rejection Sensitivity on Reactive Aggression Among Chinese Adolescents.
Du X, Liu Y, Ding C … +1 more , Yang J
Behav Ther · 2026 Mar · PMID 41741100 · Publisher ↗
Research has established an association between rejection sensitivity and reactive aggression, yet longitudinal studies examining this association among adolescents across general interpersonal contexts are scarce. This...
Research has established an association between rejection sensitivity and reactive aggression, yet longitudinal studies examining this association among adolescents across general interpersonal contexts are scarce. This study addressed this gap by utilizing a three-wave cross-lagged panel model in a sample of 1,046 Chinese adolescents aged 10-16. Assessments were conducted at three time points within one year, with a six-month interval between each assessment. Findings revealed significant cross-sectional correlations and autoregressive stability for both variables. Notably, cross-lagged analyses indicated that rejection sensitivity consistently predicted increases in reactive aggression over time, suggesting a unidirectional relationship. These results underscore the long-term predictive role of rejection sensitivity in reactive aggression and highlight the need for early interventions to address these adverse effects in adolescents.
A Feasibility and Acceptability Trial of Narrative Exposure Therapy During Pregnancy.
Padin AC, Miller ML, Perera MJ … +5 more , Addante S, Scharff A, Meyer DJ, Shalowitz MU, Stevens NR
Behav Ther · 2026 Mar · PMID 41741099 · Full text
Perinatal posttraumatic stress disorder (PTSD) poses a significant risk to maternal and infant mental and physical health. Addressing PTSD during pregnancy is crucial to improving perinatal health; however, evidence-base...
Perinatal posttraumatic stress disorder (PTSD) poses a significant risk to maternal and infant mental and physical health. Addressing PTSD during pregnancy is crucial to improving perinatal health; however, evidence-based trauma-focused psychotherapy tailored to this population remains understudied. The current study examined the feasibility, acceptability, and potential treatment effects of Narrative Exposure Therapy (NET) in a diverse sample that includes Black/African American and Hispanic/Latina pregnant women. Pregnant participants (N = 29) in this nonrandomized, open-label trial received a course of NET and completed assessment measures before treatment, one-week and one-month posttreatment, and at one-month postpartum. Measures of feasibility (treatment engagement and retention) and acceptability (participant pretreatment expectations and posttreatment feedback) were examined. Exploratory analyses examined within-subjects changes in PTSD and depression symptoms to investigate potential treatment effects. The majority of participants reported positive pretreatment expectations of NET (91.3%), and a high degree of satisfaction (69.6%) and perceived benefit (100%) from NET posttreatment. Linear mixed models showed significant decreases in PTSD and depressive symptoms over time, with sustained symptom improvement extending into the postpartum period. Within-subjects effect size calculations revealed large treatment effects from pretreatment to one-week posttreatment and from pretreatment to postpartum for both PTSD and depression symptoms. Findings suggest that NET is feasible, acceptable, and beneficial during pregnancy, including among minoritized populations, and suggest it is an appropriate approach to treating perinatal PTSD.
Remote Mindfulness Training for Health Following Early Life Adversity: A Randomized Controlled Feasibility Trial.
Lindsay EK, Damon ST, Low CA … +1 more , Marsland AL
Behav Ther · 2026 Mar · PMID 41741098 · Full text
Early life adversity confers lifelong health risk, and mindfulness-based interventions (MBIs) show promise for mitigating risk. This trial evaluated feasibility and acceptability of remote mindfulness and coping interven...
Early life adversity confers lifelong health risk, and mindfulness-based interventions (MBIs) show promise for mitigating risk. This trial evaluated feasibility and acceptability of remote mindfulness and coping interventions among emerging adults who recalled childhood trauma with the goal to inform an efficacy trial examining stress-related health outcomes. Eighty-one healthy adults (ages 18-29) who recalled physical, emotional, or sexual abuse during childhood were enrolled. Participants were randomly assigned to 2-week mindfulness or coping comparison interventions and completed lab-based and ambulatory assessments at preintervention, postintervention, and one-month follow-up. Primary outcomes included measures of feasibility and acceptability. Global psychosocial outcomes were secondary. Enrollment and retention targets were reached; of 891 people recruited, 81 were eligible and enrolled, and 88% completed the trial. The intervention programs met benchmarks for feasibility, acceptability, and safe implementation. Participants completed 95% of intervention lessons and 59% of daily life practice prompts, and 93% reported positive treatment expectancies. Three mindfulness participants (8%) showed substantial increases in mental health symptoms. No serious adverse events were reported, but 53% of participants had challenging emotional experiences during the training. The assessment protocol was feasible, with 87% of ambulatory assessments and 99% of blood samples collected. There were no group differences on feasibility/acceptability outcomes. Participants in both groups showed medium-sized improvements on global mental health and mindfulness measures. Two-week remote mindfulness and control interventions were feasible and acceptable among adults exposed to childhood trauma. Further work is warranted to evaluate whether MBIs can offset health risk.
Early Improvement Predicts Treatment Response in Depression: An Ecological Momentary Assessment Study in an Inpatient and Day Clinic Setting.
Tamm J, Takano K, Just L … +4 more , Ehring T, Rosenkranz T, OPTIMA Study Group, Kopf-Beck J
Behav Ther · 2026 Mar · PMID 41741097 · Publisher ↗
Predicting treatment response through early improvement can reduce patients' time in ineffective treatments before considering alternatives. However, for psychological interventions, there is no consensus on what time wi...
Predicting treatment response through early improvement can reduce patients' time in ineffective treatments before considering alternatives. However, for psychological interventions, there is no consensus on what time window and improvement rate early in the treatment is the most informative for distinguishing treatment responders from nonresponders. This study investigated these aspects in an inpatient and day clinic setting among severe depressed patients who perceived intensive psychological treatment and compared Weekly Questionnaire Assessments (WQA) and Ecological Momentary Assessment (EMA) regarding their power to predict treatment response through early improvement. Fifty-two depressed patients were randomly assigned to one of three intensive 7-week psychological interventions (two individual and two group sessions per week) applied in an inpatient or day clinic setting. Early improvement was assessed three times daily using EMA and weekly using questionnaires (BDI-II). Linear Regression Models and Receiver Operating Characteristic Analyses were conducted to predict treatment response (BDI-II improvement from pre- to postintervention ≥50%) in patients who received a full course of treatment. Moreover, ratios of true negative/false negative predictions were calculated to explore the predictive value of different early improvement definitions: 10%, 20%, 30%, or 40% improvement after 1, 2, 3, or 4 treatment weeks. Both EMA and WQA significantly predicted treatment response after 3 weeks with AUC values of 73% (EMA) and 77% (WQA). A WQA-assessed 10% improvement after 4 weeks yielded the highest ratio of true negative/false negative predictions, with a true negative rate of 22% and a false negative rate of 0%. 10% improvement in depressive symptoms assessed with WQA after 3 to 4 weeks of treatment was the best predictor in our study. Further research is needed to validate the results. This trial design is registered with osf.io/9fuhn.
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