Behav Ther [JOURNAL]
Sun
200 papers
Low-Burden Detection of Clinical Worsening in Body Dysmorphic Disorder Using Smartphone Sensor and Demographic Data.
Weingarden H, Holstein V, Jonathan GK … +3 more , Armey M, Onnela JP, Wilhelm S
Behav Ther · 2026 Mar · PMID 41741096 · Full text
Body dysmorphic disorder (BDD) is characterized by distressing preoccupations with perceived appearance flaws, leading to functional impairment and suicidal ideation (SI). Traditional approaches for monitoring clinical d...
Body dysmorphic disorder (BDD) is characterized by distressing preoccupations with perceived appearance flaws, leading to functional impairment and suicidal ideation (SI). Traditional approaches for monitoring clinical deterioration in BDD include self-reports and clinician assessments, which can miss acute changes in risk due to infrequent administration and recall biases. Alternatively, real-time monitoring via smartphones and wearable devices can enable low-burden early detection of deterioration, identifying intervention opportunities before someone's condition critically worsens. This study tests the feasibility of using smartphone sensor and demographic data to predict daily clinical acuity. Eighty-two participants with BDD completed ecological momentary assessments (EMA) over 28 days, reporting levels of SI, BDD-related avoidance, and time spent on BDD-related concerns. Smartphone sensor data were collected for 3 months that overlapped with EMA. Machine learning models were trained to predict same-day levels of SI, avoidance, and time spent on BDD using the Global Positioning System (GPS), accelerometer, and demographic data. We evaluated model performance using mean absolute error, Pearson and Spearman correlations, and permutation tests. Random forest (RF) models using time and random split validation outperformed dummy regressor models across outcomes (maximum SI, mean SI, maximum avoidance, mean avoidance, time spent on BDD-related behaviors). Pearson correlations for RF models showed strong predictive performance for BDD-related time (r = .74-.75) and mean and max SI (r = .70-.73). Mean and max avoidance was moderately well predicted (r = .56-.62). Step count and demographic factors (e.g., education, living situation) were the most consistent and important features. This study provides initial evidence that smartphone sensor and demographic data can be used to monitor real-time clinical worsening in BDD, without burdening the patient. This work has potential for building just-in-time interventions that are delivered as deterioration onsets, to prevent its escalation. Future research should test these models in real-world datasets collected over longer periods and subsequently explore integration into interventions and clinical decision making. Trial Registration: ClinicalTrials.gov Identifier: NCT04254575.
Assessing the Temporal Dynamics in Self-Regulated Learning Constructs as Predictors of Engagement in a Digital Health Intervention.
Liu C, Fuller-Tyszkiewicz M, Linardon J … +2 more , Jarman HK, Messer M
Behav Ther · 2026 Mar · PMID 41741095 · Publisher ↗
The promise of self-guided digital health interventions (DHIs) is consistently hampered by their poor engagement. While past research has identified various predictors of engagement, effect sizes have been small, and man...
The promise of self-guided digital health interventions (DHIs) is consistently hampered by their poor engagement. While past research has identified various predictors of engagement, effect sizes have been small, and many have failed to replicate across studies. This poor predictive performance may, in part, be due to the field's overreliance on predictor assessments at pre-intervention (i.e., at baseline), which overlooks the possibility that those factors driving engagement can fluctuate across the user journey. Self-regulated learning (SRL) is a potentially relevant process underlying engagement with DHIs, as majority deliver their therapeutic content as self-guided psychoeducation materials. The present study therefore examined whether key SRL variables fluctuated across a 6-week randomized controlled trial of a dialectical behavior therapy DHI for adults with recurrent binge eating (n = 113), and also whether these changes influenced their predictive ability of three engagement outcomes: number of (1) modules and (2) weekly assessments completed, and (3) skill activities unlocked. Longitudinal analyses revealed considerable temporal variation in SRL variables over time, and that majority of this variance was attributed to within-person differences (intraclass correlations <.40). Correlation coefficients between SRL variables and engagement outcomes increased in strength with time, indicating that later measurements of SRL had greater predictive ability compared to their measurements at baseline. Broadly, our findings highlight the need for researchers to more carefully plan future DHI trials investigating engagement by factoring the temporal dimension of engagement and its predictors into study design.
Applying the Principles of Direct-to-Consumer Marketing to Recruit Mothers and Fathers to Parenting Programs: A Randomized Controlled Trial.
Salari R, Sarkadi A, Fabian H … +2 more , Malek S, Dahlberg A
Behav Ther · 2026 Jan · PMID 41620248 · Publisher ↗
Parenting programs are effective in promoting positive changes and improving the mental health of children and parents. However, low program uptake undermines the incorporation of these programs into routine community se...
Parenting programs are effective in promoting positive changes and improving the mental health of children and parents. However, low program uptake undermines the incorporation of these programs into routine community settings. Therefore, we examined whether redesigning the program flyer using insight from consumer science could increase parental participation. In this randomized controlled trial, 164 preschools were randomly assigned to a control condition or one of four experimental conditions. Parents of children in each condition were invited to participate in a universal parenting program using either the usual flyer used by local practitioners (control flyer) or one of four new flyers. The new flyers were designed based on prior research findings on why parents participate in universal parenting programs. Because fathers and mothers have been shown to have different reasons for attending parenting programs, we tailored the flyers separately for mothers and fathers. The four flyers were one mother-specific flyer, one father-specific flyer and two mixed-content flyers. The number of participants recruited varied significantly across the flyers. Overall, the redesigned mother-specific and father-specific flyers, but not the mixed-content flyers, outperformed the control flyer in recruiting parents. In addition, compared with the two mixed-content flyers, the mother-specific flyer attracted significantly more mothers and the father-specific flyer attracted more fathers. However, we found no difference between the two specific flyers themselves. Simple direct-to-consumer (DTC) marketing strategies tailored specifically to mothers or fathers can potentially increase program uptake. Future studies should further examine the importance of the visual and content of DTC messages.
Loneliness Predicts Symptom Outcomes Following a Digital Intervention for Appearance Concerns.
Patel TA, Sala MC, Cougle JR
Behav Ther · 2026 Jan · PMID 41620247 · Publisher ↗
Digital mental health interventions have proliferated in the past decade, though it is not clear whether social isolation or loneliness influences their efficacy. The present study sought to determine whether loneliness...
Digital mental health interventions have proliferated in the past decade, though it is not clear whether social isolation or loneliness influences their efficacy. The present study sought to determine whether loneliness predicted symptom outcomes following a digital treatment for appearance concerns. Women elevated in appearance concerns (N = 203) were randomized to one of two interventions where participants were either instructed to reduce appearance-related safety behaviors (ARSB; i.e., actions people take to reduce appearance anxiety) or general unhealthy behaviors. Both treatments led to similar reductions in loneliness. However, we found that baseline loneliness moderated the effect of condition on social anxiety such that, at low levels of loneliness, ARSB reduction led to lower social anxiety than control, though these effects were absent at high levels of loneliness. We also found that, in the ARSB treatment condition (but not the control condition), pretreatment loneliness predicted symptoms of social anxiety at posttreatment and predicted social anxiety, eating disorder symptoms, and depression at follow-up. Taken together, loneliness appears to play an important role in the efficacy of this digital intervention, findings which may have implications for the broader digital treatment literature.
Treatment of Youth Misophonia: A Randomized Controlled Trial Comparing Transdiagnostic Cognitive-Behavioral Therapy to Psychoeducation and Relaxation Training.
Lewin AB, Milgram L, Cepeda SL … +6 more , Karlovich A, Dickinson S, Bolen M, Harmon SL, Small BJ, Ehrenreich-May J
Behav Ther · 2026 Jan · PMID 41620246 · Publisher ↗
Misophonia is a distinct clinical disorder that lacks official diagnostic classification. Despite growing evidence of the prevalence and impairment associated with this condition, little research has tested possible evid...
Misophonia is a distinct clinical disorder that lacks official diagnostic classification. Despite growing evidence of the prevalence and impairment associated with this condition, little research has tested possible evidence-based interventions. The current study presents outcomes from a two-site randomized controlled trial (N = 43) comparing the efficacy of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; n = 29) to a psychoeducation and relaxation training (PRT; n = 14) intervention for youth with misophonia. Participants in each condition received 10 telehealth treatment sessions and completed symptom assessments at 5- and 10-weeks postenrollment. Across both conditions, 47% of youth were treatment responders. Approximately half (54%) of youth receiving UP-C/A were treatment responders, and approximately one quarter (25%) of youth receiving PRT were treatment responders. Compared to those receiving PRT, participants receiving UP-C/A treatment exhibited greater improvement in misophonia symptoms and global functioning on some but not all outcome measures. Participants in each condition reported comparable treatment satisfaction. Results suggest that existing evidence-based interventions may be effectively applied, in a brief format, to treat youth misophonia. Moreover, findings highlight the high acceptability of cognitive-behavioral intervention (i.e., UP-C/A) for this youth sample. Future large-scale trials with a longer treatment duration and a follow-up period are needed to inform the development of evidence-based interventions for youth misophonia.
What Makes Personalized Treatment Work? Mechanisms of Change in Personalized Treatment for Eating Disorders: A Proof-of-Concept Study.
Levinson CA, Slipetz L, Henry T … +2 more , Crumby E, Pennesi JL
Behav Ther · 2026 Jan · PMID 41620245 · Publisher ↗
Eating disorders (EDs) are severe illnesses with high rates of mortality; however, evidence-based ED treatments only work for 50% of individuals. Part of the reason that treatments do not work is that EDs are highly hete...
Eating disorders (EDs) are severe illnesses with high rates of mortality; however, evidence-based ED treatments only work for 50% of individuals. Part of the reason that treatments do not work is that EDs are highly heterogenous, signifying a need to personalize treatment. As such, idiographic (i.e., one-person) methods have been used to develop personalized treatment for EDs. Our team demonstrated that a new Transdiagnostic Network-Informed Personalized Treatment (T-NIPT-ED) that uses idiographic modeling to select evidence-based treatment modules for EDs was feasible, acceptable, and decreased ED and cooccurring symptoms (e.g., depression). However, it remains unknown how T-NIPT-ED works and if T-NIPT-ED intervenes effectively on the hypothesized mechanisms of change. The current study (N = 75 with an ED) tested if central symptoms (i.e., hypothesized mechanisms of change) assessed for 15 days (5 times a day; 75 timepoints at two times of day [150 timepoints]) pre- and posttreatment with ecological momentary assessment changed through treatment. We used mixed effects linear regression to test (a) if symptoms in broad categories of affect, cognitions, behavior, comorbid conditions, and physiology changed from pre- to posttreatment and (b) if specific symptoms matched to corresponding evidence-based treatment modules changed with treatment. We found that if a participant had a central symptom in an affective or behavioral category, overall affect and behaviors decreased respectively. We also found that participants with the following central symptoms targeted in treatment evidenced reductions in these mechanisms: shame, self-criticism, body checking, rumination, overvaluation of weight/shape, and guilt. Our results suggest that T-NIPT-ED is effective at reducing ED-related affect and behaviors. Furthermore, these data suggest that several modules targeted at specific mechanisms hypothesized to maintain EDs are effective in the context of personalized treatment.
State of the Science: Alcohol Use and Acculturation-Related Factors Across Diverse Populations.
Lui PP, Chang CY, Rufo C … +3 more , Peterson RC, Bazzano ML, Cano MÁ
Behav Ther · 2026 Jan · PMID 41620244 · Publisher ↗
Alcohol consumption can pose health risks and cause social problems, hence harmful drinking is a global health concern. Acculturation has been theorized and examined as a key driver for drinking behaviors. In this State...
Alcohol consumption can pose health risks and cause social problems, hence harmful drinking is a global health concern. Acculturation has been theorized and examined as a key driver for drinking behaviors. In this State of the Science article, we define sociocultural and psychological acculturation, and describe three causal theories associated with socialization and learning, stress and coping, and accessibility and opportunity. Data have shown small-to-moderate associations linking acculturation factors to drinking outcomes. Many existing studies measure acculturation with demographic proxies and static cultural orientation indicators. Underlying causal mechanisms are typically inferred rather than tested directly, with limited focus on key proximal factors such as stress responses, drinking motives, and cultural norms. Furthermore, current alcohol interventions lack alignment with acculturation science and fail to target modifiable, drinking-related factors. To advance the field and bridge research-to-practice gaps, studies should move beyond broad demographic markers and examine systematically the psychological and social pathways linking acculturation to alcohol use. We advocate for the adoption of context-specific measures, daily life study methods to capture acculturation's dynamic effects on drinking, and research across diverse global populations. We call for the field to integrate the acculturation framework into the broader alcohol research and mainstream interventions to address individual and cultural variations in drinking behaviors, incorporate sociocultural influences into existing models of alcohol use to bridge gaps in generalizability, and enhance intervention effectiveness.
Longitudinal Association Between Depressive Symptoms and Sleep Problems in Adolescents Following a Natural Disaster: Understanding the Role of Psychological Inflexibility.
Liu Z, Xiao Y, Ye Y … +3 more , Li Y, He Z, Zhou X
Behav Ther · 2026 Jan · PMID 41620243 · Publisher ↗
Previous studies have investigated the temporal associations between depressive symptoms and sleep problems in traumatized adolescents. However, controversy remains regarding the directionality and underlying mechanisms...
Previous studies have investigated the temporal associations between depressive symptoms and sleep problems in traumatized adolescents. However, controversy remains regarding the directionality and underlying mechanisms of these associations, because within- and between-individual effects have not been differentiated. To examine this issue, the current study used the random-intercept cross lagged panel model (RI-CLPM) to assess the temporal associations between depressive symptoms, sleep problems and psychological inflexibility in adolescents following Typhoon Lekima. A sample of 1,341 adolescents completed self-report questionnaires at three time points (November 2019, November 2020, and November 2021). RI-CLPM analysis was used to examine the autoregressive and cross-lagged effects among variables. The results indicated stable and direct predictive within-individual effects from depressive symptoms to psychological inflexibility, and from psychological inflexibility to sleep problems, as well as potential mediation effects from depressive symptoms to sleep problems via psychological inflexibility. Meanwhile, between-individual effect analyses revealed positive relationships among depressive symptoms, sleep problems and psychological inflexibility. These findings indicate that higher levels of depressive symptoms predict subsequent worse sleep problems via possible moderation effects of psychological inflexibility, suggesting that prior intervention should focus more on alleviating symptoms of depressive symptoms and improving psychological flexibility after natural disasters.
Acceptability and Feasibility of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Brazil.
de Mathis MA, Flygare O, Costa DLC … +7 more , Morais I, Rocha J, Borcato S, Shavitt RG, Miguel EC, Batistuzzo MC, Rück C
Behav Ther · 2026 Jan · PMID 41620242 · Publisher ↗
This study describes the implementation of an Internet-based cognitive-behavior therapy program (ICBT) developed in Sweden for individuals seeking OCD treatment in Sao Paulo, Brazil. After translating and adapting the tr...
This study describes the implementation of an Internet-based cognitive-behavior therapy program (ICBT) developed in Sweden for individuals seeking OCD treatment in Sao Paulo, Brazil. After translating and adapting the treatment manual (OCD-NET), we conducted an open-label trial including 35 adults with OCD. The ICBT treatment was conducted in 10 modules and was based on Exposure and Response Prevention (EPR). The RE-AIM implementation science framework was used to evaluate Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our primary outcome was the reduction of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score. The study enrolled 35 participants, with 30 completing all of the ICBT protocol (85.7%). OCD severity decreased significantly over time, with 60% of participants showing a treatment response, and 30% were in remission at the 6-month follow-up. At posttreatment, 54.5% of the participants (95% CI, 37.8-70.4) were classified as treatment responders, and 27.3% (95% CI, 14.8-44.7) were in remission. At the 6-month follow-up, 60% (95% CI, 41.9-75.7) were responders, and 30% (95% CI, 16.4-48.3) were in remission. Depressive symptoms measured by PHQ-9 (SE = 1.68, [95% CI 15.2 to 21.9], p < .001) also improved. Our results provide preliminary evidence that ICBT is effective and feasible to be implemented in an upper-middle-income country. Further research investigating the acceptability and feasibility of ICBT in marginalized populations living in underserved areas is necessary.
State of the Science: Intolerance of Uncertainty.
Dugas MJ, Koerner N, Freeston MH
Behav Ther · 2026 Jan · PMID 41620241 · Publisher ↗
Over 30 years ago, a group of researchers at Laval University, Canada, conceptualized the construct of intolerance of uncertainty (IU) and proposed a self-report measure of IU, the Intolerance of Uncertainty Scale (IUS;...
Over 30 years ago, a group of researchers at Laval University, Canada, conceptualized the construct of intolerance of uncertainty (IU) and proposed a self-report measure of IU, the Intolerance of Uncertainty Scale (IUS; Freeston et al., 1994). At the time, we were interested in identifying a cognitive vulnerability factor for the development and maintenance of worry and GAD. Initial nonclinical and clinical research by the Laval group suggested that IU, as measured by the IUS, was a sensitive and relatively specific marker of worry and GAD. Subsequent studies by countless other research groups indicate that although IU does show some evidence of specificity to worry and GAD, it is also a transdiagnostic and trans-situational construct. In the current State of the Science paper, we review the research on IU, with a focus on (1) initial studies on the specificity of IU to worry and GAD, (2) the construct and measurement of IU, (3) the transdiagnostic and trans-situational nature of IU, (4) cultural and related considerations, (5) IU and cognitive processing, (6) the neural and psychophysiological correlates of IU, (7) treatment and IU, and (8) future directions. Overall, it can be concluded that the construct of intolerance of uncertainty, despite the fact that its definition and measurement remain actively debated, has established itself as a central construct in the field of mental health and psychopathology. Indeed, research on IU over the past three decades has led to significant improvements in both theory and clinical practice, and to a better understanding of what people think, feel, and do when experiencing uncertainty.
Family Accommodation of Pediatric Irritability: Development and Psychometric Properties of the Family Accommodation Scale for Irritability.
Whiting C, Fling K, Meigs JM … +7 more , Naim R, Haller SP, Henry LM, Silverman WK, Lebowitz ER, Brotman MA, Tseng WL
Behav Ther · 2026 Jan · PMID 41620240 · Full text
Irritability in children and adolescents is an important mental health concern that presents across a range of disorders. Family accommodation refers to the way families alter their behavior to prevent or reduce child di...
Irritability in children and adolescents is an important mental health concern that presents across a range of disorders. Family accommodation refers to the way families alter their behavior to prevent or reduce child distress. Despite its clinical relevance, the role of family accommodation in pediatric irritability remains underexplored. This study developed and validated a novel parent- and child-report form of the Family Accommodation Scale for Irritability (FASI). We recruited 131 youths (61.83% male, 36.64% female, 1.53% unknown sex; 63.36% White, 12.21% multiracial, 9.92% Black or African American, 3.05% American Indian/Alaska Native, 2.29% Asian, 9.16% unknown race) ages 8-17 years (M = 12.23, SD = 2.49) with varying irritability symptom severity. Both parents and their children completed the FASI and measures of child irritability, anxiety, and depression. Irritability was also assessed by clinician report. Confirmatory factor analyses (CFAs) were used to test factor structures. Internal consistency, convergent and divergent validity, and cross-informant agreement on the FASI were also assessed. CFA supported a two-factor model of family accommodation, representing "participation in behaviors" and "modification of family routines." Internal consistency and convergent and divergent validity supported the reliability and validity of the scale. Child age showed a significant negative correlation with parent-reported, but not child-reported, family accommodation. Accommodation did not vary with child sex. These results show that family accommodation of irritability can be reliably and validly assessed using the parent- and child-reported FASI scales. Future studies may use this measure to advance understanding of the role that family accommodation plays in pediatric irritability, and its potential as an intervention target.
What Do Adolescents Think About an App Designed to Reduce Cognitive Risk Factors for Eating Disorders? A Mixed Methods Study.
Carratalá-Ricart L, Arnáez S, Merchán OI … +6 more , Corberán M, Saman Y, Pascual-Vera B, Doron G, García-Soriano G, Roncero M
Behav Ther · 2026 Jan · PMID 41620239 · Publisher ↗
In recent years, there has been a growing interest in eHealth interventions as a means of reducing risk factors related to eating disorders (EDs). However, these interventions are often faced with high dropout rates and...
In recent years, there has been a growing interest in eHealth interventions as a means of reducing risk factors related to eating disorders (EDs). However, these interventions are often faced with high dropout rates and low adherence. The objective of this study was to analyze the usability and acceptability of GGED-AD, a mobile app designed to reduce cognitive risk factors associated with EDs in adolescents. The study involved 42 adolescents (61.9% female) with a mean age of 13.98 years, and employed a convergent mixed-methods approach. The results indicate that GGED-AD has satisfactory usability and acceptability-it was considered easy to use, attractive, encouraging of positive behaviors, and was perceived as useful by the participants. However, certain difficulties were observed, such as in understanding some specific content. Consequently, this study offers valuable insights for improving the design of GGED-AD and of similar eHealth interventions, with the objective of enhancing their potential for adoption in "real world" settings.
Diversity in Randomized Controlled Trials for Parent Management Training: A Systematic Review.
Garcia A, Cao-Noya JA, Lopez J … +1 more , Benuto LT
Behav Ther · 2026 Jan · PMID 41620238 · Publisher ↗
The NIH Revitalization Act was passed by the United States Congress in 1993 and mandated that researchers include women and minorities in clinical research. However, the extent that researchers have adhered to the NIH Re...
The NIH Revitalization Act was passed by the United States Congress in 1993 and mandated that researchers include women and minorities in clinical research. However, the extent that researchers have adhered to the NIH Revitalization Act in randomized controlled studies of parent training programs for treatment of child disruptive behavior is unknown. This systematic review examined how minority inclusion was addressed in randomized controlled trials (RCTs) of parent management training for child disruptive behavior. This review focused on a variety of parent training programs such as The Incredible Years, Parent-Child Interaction Therapy, and Coping Power. The researchers identified 35 studies that met the inclusion criteria. When ethnic and racial minority data was analyzed, it was found that 44% of participants were White; 13.16% were African American; 18.41% were Latinx; 2.91% were Asian; and 5.85% were reported as "other." Ethnic and racial data was not reported for 15.96% of participants. Overall, racial and ethnic inclusion in RCTs for parent training programs has improved in recent years and there is proximal concordance between population make-up and representation of African Americans and (to a lesser degree) Latinxs in parenting intervention RCTs. However there remains a need for improved inclusion that more closely represents the racial and ethnic make-up of the general population for other groups (e.g., Asians and Indigenous populations).
Negative Cognitions After the Death of a Close Person: Time-Varying and Time-Invariant Components and Their Associations with Prolonged Grief.
Missler MA, van der Laan G, Boelen PA
Behav Ther · 2026 Jan · PMID 41620237 · Publisher ↗
The loss of a significant other may shatter positive or neutral cognitions about the self, life, and the future, confirm preexisting negative cognitions in these areas, or lead to threatening misinterpretations about one...
The loss of a significant other may shatter positive or neutral cognitions about the self, life, and the future, confirm preexisting negative cognitions in these areas, or lead to threatening misinterpretations about one's own grieving. Negative cognitions are a risk factor for the development of prolonged grief disorder (PGD). Using latent trait-state occasion (TSO) modeling, the aim of this study was to examine the longitudinal structure of negative loss-related cognitions over time, and to examine the associations between time-invariant (TI; trait) and time-variant (TV; occasional) components of four types of negative cognitions with symptoms of prolonged grief (PG). Data from the Utrecht Longitudinal Study on Adjustment to Loss were used, in which bereaved people's grief responses were measured every 6 weeks over the course of 1 year (11 waves). We included 223 participants who experienced their loss in the year before. Using TSO modeling, we could distinguish between the degree of variance in negative cognitions explained by the stable trait factor (TI component) and by temporary, situation-dependent circumstances (TV component). Descriptive results indicated a decrease in both negative cognitions and PG scores over time. While the TSO model for negative cognitions about the self showed inadequate fit to the data, the other models showed that negative cognitions about life, the future, and threatening misinterpretations largely consisted of a TI component, which was more strongly associated with PG severity compared to the TV components. Thus, negative views on life, pessimism over the future, and negative interpretations of one's grief reactions seem to be relatively stable over time and less sensitive to changing circumstances. This supports the potential usefulness of cognitive restructuring, behavioral experiments, and exposure in the treatment of PG. Overall, this study confirms the role of negative cognitions in the development and maintenance of symptoms of PG.
Effects of Parent-Coached Exposure Therapy Versus CBT on Avoidance, Impairment, and Remission in Childhood Anxiety.
Gloe LM, Biggs BK, Geske JR … +4 more , Reneson-Feeder ST, Dammann JE, Hofschulte DR, Whiteside SPH
Behav Ther · 2026 Jan · PMID 41620236 · Publisher ↗
The most effective therapy for childhood anxiety disorders (CADs), cognitive-behavioral therapy (CBT), leaves more than 50% of youth symptomatic, has yet to demonstrate superiority over treatment as usual, and requires m...
The most effective therapy for childhood anxiety disorders (CADs), cognitive-behavioral therapy (CBT), leaves more than 50% of youth symptomatic, has yet to demonstrate superiority over treatment as usual, and requires more sessions than is typical in clinical settings. Parent-coached exposure therapy (PCET) is designed to increase the effectiveness and efficiency of treatment by focusing on exposure and including parents in all sessions. This study evaluated whether PCET had a greater effect than CBT on secondary outcomes. Participants were 78 predominantly White patients (78% female) ages 7-17 with CADs in a randomized controlled trial that were assigned to PCET or the gold-standard CBT. Data were collected from youth, parents, and independent evaluators (IEs) at pre-, mid- and posttreatment on avoidance, functioning, and treatment response. Across treatment conditions, youth showed improvement on all measures. Compared to those in CBT, participants in PCET demonstrated greater reductions in avoidance (parent- and IE rated), functional impairment (parent rated), and response/remission (IE rated) at midtreatment. Only differences in avoidance remained significant at posttreatment. There were no differences identified in therapeutic alliance. Approximately two thirds of patients had symptoms in the nonanxious range with PCET at posttreatment. Findings suggest that PCET more quickly addresses avoidance and impairment in CADs than current treatment options. These findings build on the primary outcome results, suggesting PCET may offer a more effective and efficient intervention than traditional CBT, without sacrificing therapeutic alliance.
Improving the State of the Science in Global Training: Promoting the World Confederation of Cognitive and Behavioural Therapies' Training Guidelines.
Training and Accreditation Committee of the World Confederation of Cognitive and Behavioural Therapies
Behav Ther · 2026 Jan · PMID 41620235 · Publisher ↗
Advanced professional skills and activities such as psychotherapy require training. However, models and methods for training practitioners to effectively deliver cognitive-behavioural therapies (CBTs) have not been clear...
Advanced professional skills and activities such as psychotherapy require training. However, models and methods for training practitioners to effectively deliver cognitive-behavioural therapies (CBTs) have not been clearly articulated and/or consistently applied. To address the need for global guidance in providing training in the CBTs, the World Confederation of Cognitive and Behavioural Therapies (WCCBT) recently put forward training guidelines. This State of the Science article presents the need and rationale for the WCCBT Training Guidelines and describes their assumptions and content. Such guidelines can improve the training of CBT therapists and thus ensure the global community receives the highest level of care and best possible clinical outcomes. The implications of the guidelines for trainers, practitioners, and organizations are discussed, and indications for dissemination and evaluation are articulated.
Shared and Unique Effects of Enacted Stigma Based on Sexual Identity, Age, and Race/Ethnicity Among a Sample of Sexual and Gender Minority Older Adults.
Dyar C, Morgan E
Behav Ther · 2025 Nov · PMID 41139112 · Publisher ↗
Numerous daily diary studies have demonstrated that sexual minority enacted stigma is associated with elevated same-day anxious/depressed affect. Despite the multiple marginalized identities held by many sexual and gende...
Numerous daily diary studies have demonstrated that sexual minority enacted stigma is associated with elevated same-day anxious/depressed affect. Despite the multiple marginalized identities held by many sexual and gender minorities (SGM), studies have rarely examined other types of enacted stigma (e.g., racism, ageism) experienced by SGM at the daily level. Further, it is unclear whether enacted stigma based on different identities have similar or distinct effects on anxious/depressed affect. The current study aimed to examine the effect of experiencing enacted stigma based on any marginalized identity on anxious/depressed affect (i.e., a common enacted stigma effect) and to determine if specific types of enacted stigma have unique effects above and beyond this common enacted stigma effect. We utilized ecological momentary assessment data from a sample of SGM older adults (50+ in age; 38% people of color). Experiencing any type of enacted stigma was associated with elevated anxious/depressed affect during the same observation. No specific types of enacted stigma predicted anxious/depressed affect above and beyond the common enacted stigma effect. Among SGM of color, experiencing multiple types of enacted stigma during the same observation was associated with additional anxious/depressed affect, but this did not generalize to the full sample. Results suggest that enacted stigma has a concurrent effect on anxious/depressed affect regardless of the targeted identity and specific types of enacted stigma do not have additional effects. This has potential implications for future research on effects of enacted stigma at the daily level, particularly among samples with multiple marginalized identities.
Interoceptive Accuracy, Sensitivity, and Attention are Associated with Suicidal Thoughts and Behaviors.
Reid-Russell A, Nock MK
Behav Ther · 2025 Nov · PMID 41139111 · Full text
Suicide is a leading cause of death. Although significant research has focused on suicide, surprisingly little examines the role of interoception, or the perception of internal bodily states. We examined associations bet...
Suicide is a leading cause of death. Although significant research has focused on suicide, surprisingly little examines the role of interoception, or the perception of internal bodily states. We examined associations between dimensions of interoception and suicidal thoughts and behaviors (STBs). This online study (N = 450) assessed self-reported interoceptive accuracy, sensitivity, and attention as well as STBs. People with recent STBs reported perceiving body sensations less accurately (i.e., lower interoceptive accuracy), difficulty perceiving lower intensity sensations (i.e., lower interoceptive sensitivity), and paying more attention to sensations (i.e., greater interoceptive attention). Interoceptive sensitivity moderated the association between negative affect and recent suicidal behaviors, such that people with lower interoceptive sensitivity (i.e., difficulty perceiving lower intensity sensations) were more likely to report suicidal behaviors at all levels of negative affect, whereas people with higher interoceptive sensitivity were more likely to report suicidal behaviors only at high levels of negative affect. This study examines cross-sectional, self-reported associations between interoceptive processes and STBs. Future work should focus on examining objective measures of interoception and longitudinal associations. We provide evidence that the process of perceiving and understanding internal body states may differ for people with suicidal thoughts and behaviors - people with suicidal thoughts and behaviors described perceiving their body sensations inaccurately, especially when sensations were low intensity, and attending to their body sensations often. Interoception may represent an important, underexamined process for understanding STBs.
Fibromyalgia and Depression: A Network Analysis Approach.
Malka T, Marom-Harel H, Frumer L … +8 more , Agmon-Levin N, Taub R, Glick I, Admon R, Hanuka S, Peretz-Tamari N, Brown A, Horesh D
Behav Ther · 2025 Nov · PMID 41139110 · Publisher ↗
Fibromyalgia (FM) is a complex disorder characterized by chronic and widespread musculoskeletal pain. FM and depression are highly comorbid; however, their relationship remains unclear. In line with the hypothesis that t...
Fibromyalgia (FM) is a complex disorder characterized by chronic and widespread musculoskeletal pain. FM and depression are highly comorbid; however, their relationship remains unclear. In line with the hypothesis that there are bidirectional relationships between symptoms of both disorders, a network analysis was conducted. This method is a graphical representation of a partial correlation matrix between individual symptoms, which enables an understanding of how these symptoms relate to one another. Data were pooled from three studies conducted on patients with FM (n = 219). Well-established network analyses methods were used to illustrate the network of FM and depressive symptoms, determine the centrality and bridge strength of each symptom, and identify clusters from within the data. Most clusters detected included both FM and depression symptoms. The most central symptoms that also exhibited high bridge strength were cognitive and psychological: (1) negative affect, and (2) memory problems. Surprisingly, pain did not emerge as central to this network. Utilizing a network analysis approach to examine symptom-to-symptom relationships yielded novel insight into the maintenance of this comorbidity. The research and clinical implications of the findings, such as developing treatments targeting the most central symptoms and avenues for further research, are discussed.
Engagement in Ecological Momentary Assessment of Suicidal Thoughts and Behaviors: A Mixed Methods Study.
Ball MI, Fishbein NS, Ramlal N … +7 more , Hu N, Maimone JS, Bear A, Kleiman EM, Stein MB, Nock MK, Bentley KH
Behav Ther · 2025 Nov · PMID 41139109 · Full text
Ecological momentary assessment (EMA) holds great potential for understanding suicidal thoughts and behaviors (STBs) in real time. However, since the burden of EMA can lower participant engagement, more research is neede...
Ecological momentary assessment (EMA) holds great potential for understanding suicidal thoughts and behaviors (STBs) in real time. However, since the burden of EMA can lower participant engagement, more research is needed to understand how individuals engage with it, particularly during high suicide risk periods. This study aims to better understand participant engagement with EMA using both qualitative and quantitative indices. One hundred adults were enrolled in an EMA study during psychiatric inpatient hospitalization for STBs and completed six brief EMA surveys per day assessing STBs and related factors during hospitalization and for four weeks after. At the end of the study, participants completed a qualitative interview assessing motivations to participate, study perceptions, perspectives on EMA, engagement barriers, and recommendations. Participants completed 14,464 EMA surveys in total, with an average completion rate of 58%. Engagement was higher during hospitalization (66%) than after (54%). In interviews, most found EMA acceptable (59% enjoyed participation), noting that surveys often increased emotional awareness (51%). Some found EMA repetitive or tedious, and only a small minority found it distressing. Primary motivations were financial compensation (73%) and contributing to research (69%). Main barriers were schedules (92%) and momentary distress (60%). Recommendations largely focused on improving EMA administration, such as survey frequency. Most qualitative themes did not significantly differ by EMA engagement, although lower engagers gave more recommendations and had more unique barriers than high engagers. Quantitative and qualitative findings indicate EMA of STBs is generally acceptable during and after psychiatric hospitalization, with important recommendations for improvement. Integrating participant experiences is critical as researchers and clinicians work to optimize EMA with individuals at risk for suicide.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe