Behav Ther [JOURNAL]
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200 papers
The Perfectionism Paradox: The Role of Perfectionism on Depression and Suicidal Ideation Symptom Severity During Partial Hospitalization.
Bockhorst JL, Lindberg MS, Moscardini EH … +1 more , Beard C
Behav Ther · 2025 Nov · PMID 41139108 · Publisher ↗
Perfectionism has a well-established relation with mental health concerns, notably depression and suicidal ideation (SI) severity. Previous research has also shown perfectionism is associated with diminished treatment ga...
Perfectionism has a well-established relation with mental health concerns, notably depression and suicidal ideation (SI) severity. Previous research has also shown perfectionism is associated with diminished treatment gains; however, nearly all analyses on this topic are derived from a single dataset at the outpatient level. Our aim was to examine whether perfectionism and its dimensions, as assessed by the Big Three Perfectionism Scale-Short Form (BTPS-SF), are associated with improvements in depression and SI symptom severity during a transdiagnostic partial hospital program (PHP). We analyzed perfectionism scores at baseline and depression and SI scores at baseline and discharge from N = 738 adult patients attending a PHP. The total perfectionism score, and the self-critical and rigid perfectionism dimensions, were significantly associated with baseline depression and SI scores. The total perfectionism score, and the self-critical perfectionism dimension, were significantly associated with diminished treatment gains in depression and SI symptom severity from baseline to discharge. Our results suggest that perfectionism is associated with the baseline severity of psychopathology, specifically depression and SI severity, and may inhibit therapeutic gains. This study expands the existing literature on perfectionism's deleterious relation with psychopathology and treatment effectiveness to more acute levels of care. Clinicians may wish to consider screening for perfectionism and potentially addressing it as a target of treatment.
Effects of a Cognitive Behavioral Therapy-Based Workshop Intervention on Social Anxiety Among Secondary Vocational Students: A Randomized Controlled Trial.
Li H, Tang X
Behav Ther · 2025 Nov · PMID 41139107 · Publisher ↗
Social anxiety and related mental health problems in secondary school students require urgent attention. Workshop interventions are particularly suited for school settings, as they can be delivered in a single day and ac...
Social anxiety and related mental health problems in secondary school students require urgent attention. Workshop interventions are particularly suited for school settings, as they can be delivered in a single day and accommodate large groups of participants. This study examined the effects of a 1-day workshop, grounded in cognitive behavioral therapy (CBT), on outcomes such as social anxiety among secondary school students. A total of 89 secondary school students participated in the study, with 44 assigned to the intervention group and 45 to a wait-list control group. The effects of group (intervention vs. wait-list control) and time (pre-intervention T1, post-intervention T2, and 1-month follow-up T3) on social anxiety symptoms, negative emotional symptoms, social anxiety knowledge, attitudes toward professional help-seeking, social anxiety stigma, and fear of negative evaluation were analyzed using linear mixed models. Compared to the control group, the intervention group demonstrated significant improvements in social anxiety symptoms, negative emotional symptoms, social anxiety knowledge, and professional help-seeking attitudes. At the 1-month follow-up, social anxiety knowledge had the largest effect size (d = 1.00), and social anxiety symptoms, negative emotional symptoms, and professional help-seeking attitudes had medium effect sizes (d = 0.45-0.64). The CBT-based workshop enhanced social anxiety knowledge and attitudes toward seeking professional help among secondary students, and these effects persisted at the 1-month follow-up. Furthermore, the workshop reduced secondary students' social anxiety and negative emotions-a change that, although not as rapid as immediately after the intervention, was significant at the 1-month mark.
Attention Allocation in OCD: Contrasting Obsession-Provoking Stimuli With Stimuli Signaling the Completion of Compulsive Acts.
Basel D, Asher R, Lazarov A
Behav Ther · 2025 Nov · PMID 41139106 · Publisher ↗
Research on attention allocation in obsessive-compulsive disorder (OCD) shows that obsessive-compulsive individuals are biased toward stimuli reflecting the completion of compulsive acts (end-states stimuli) over traditi...
Research on attention allocation in obsessive-compulsive disorder (OCD) shows that obsessive-compulsive individuals are biased toward stimuli reflecting the completion of compulsive acts (end-states stimuli) over traditional obsession-provoking threatening stimuli. Yet, past research compared individuals with high and low levels of obsessive-compulsive symptoms, restricting generalizability to clinical OCD, while also inherently confounding OCD and anxiety symptoms. The present addressed both limitations. Participants with OCD (n = 32), participants with anxiety disorders (AN; n = 30), and healthy control participants (HC; n = 33) freely viewed 2-by-2 picture matrices, each presented for 8 seconds, contrasting two types of pictures: obsession-provoking threat pictures and end-state pictures. Gaze data was recorded throughout. Participants' subjective discomfort experienced while viewing the different pictures was also assessed. Participants with OCD dwelled longer on end-state stimuli, compared to obsession-provoking threat stimuli, while AN and HC participants demonstrated no difference in dwell time between the two picture types. While all participants experienced less discomfort when viewing end-sate pictures, compared with obsession-provoking threat pictures, this difference was largest among OCD participants. Moreover, an indirect-only mediation effect emerged when using this difference in subjective discomfort as a mediator of group differences in attention allocation to the two picture types. Finally, task reliability was found to be high. Biased attention allocation toward stimuli associated with the completion of compulsive acts over obsession-provoking threat stimuli generalizes to clinical OCD. This biased attention allocation pattern may, in turn, serve as a novel target for attention bias modification procedures in OCD.
Children's Literature on Anxiety: A Systematic Review and Content Analysis.
Crane ME, Ney JS, Holland KE … +6 more , Rabner J, Meyer ML, Leon AJ, Farina AM, Brown MR, Kendall PC
Behav Ther · 2025 Nov · PMID 41139105 · Full text
Children's literature can teach life lessons and effective coping strategies, and can be a way to disseminate practice elements (i.e., building blocks of evidence-based practices) for mental health as a universal prevent...
Children's literature can teach life lessons and effective coping strategies, and can be a way to disseminate practice elements (i.e., building blocks of evidence-based practices) for mental health as a universal prevention strategy. We conducted a content analysis on the presence of practice elements for youth anxiety in children's literature picture books about anxiety. Analytic plan was preregistered on OSF. Books 1,640 children's literature books were screened, and 191 books were coded for eight practice elements for youth anxiety: psychoeducation, labeling body sensations, relaxation, cognitive, problem solving, contingency management (e.g., rewards and praise), exposure, and post-exposure processing. Characters in the books modeled an average of 2.39 practice elements (SD = 1.76). The most frequently modeled practice elements were cognitive (60% of books), exposure (46%), and labeling body sensations (42%). The least commonly modeled practice element was contingency management (7%). Books written by mental health professionals were more likely to demonstrate post-exposure processing. Books with additional self-help information were more likely to model post-exposure processing and relaxation skills. Books written for youth age 9-12 years modeled more practice elements than books written for youth age 8 years and younger. Children's books on youth anxiety model relatively few practice elements. Although exposure was one of the most used practice elements, 54% of books with an anxious character do not model having that character face their fears-a key strategy for youth anxiety. Additionally, few books demonstrate use of rewards and praise by caregivers, who often read stories with their children. Clinicians, caregivers, and librarians are encouraged to purchase books written by therapists or with self-help information, given that these books are more likely to model practice elements.
Two Studies on the Role of Appearance Concerns in Social Anxiety and Depression.
Patel TA, Zech JM, Cougle JR
Behav Ther · 2025 Nov · PMID 41139104 · Publisher ↗
Appearance concerns are a core feature of multiple psychiatric disorders, including body dysmorphic disorder and eating disorders; however, some have argued that they may also play a key role in social anxiety and depres...
Appearance concerns are a core feature of multiple psychiatric disorders, including body dysmorphic disorder and eating disorders; however, some have argued that they may also play a key role in social anxiety and depression. The present study sought to determine whether reductions in appearance concerns explain reductions in social anxiety and depression in two separate studies. Two studies examined the effects of fading appearance-related safety behaviors (ARSB; i.e., behaviors meant to avoid or reduce a perceived feared outcome related to appearance) experimentally (Study 1) or in a treatment context (Study 2). In Study 1 (N = 94), we found that changes in appearance concerns fully accounted for the effect of fading ARSBs on social anxiety and depression in a clinical sample of women; further, pre- to mid-manipulation changes in appearance concerns (across conditions) predicted residual change in social anxiety at post. In Study 2, among a large community sample of women (N = 203) who participated in a 1-month smartphone-based treatment for appearance concerns, we found that pre- to posttreatment changes in appearance concerns mediated the effect of ARSB fading on social anxiety at 1-month follow-up. Additionally, we found that regardless of condition, changes in appearance concerns predicted residual change in depression one-month later. Taken together, the present findings suggest that appearance concerns may maintain symptoms of social anxiety and depression, and changes in appearance concern may indirectly lead to changes in these outcomes.
Initial Score Reliability and Validity of an Observer-Rated Caregiver-Clinician Alliance Scale in Treatment for Youth Anxiety.
McLeod BD, Ross E, Li G … +5 more , Cross R, Jones HA, Southam-Gerow MA, Chorpita BF, Weisz JR
Behav Ther · 2025 Nov · PMID 41139103 · Publisher ↗
The caregiver-clinician alliance plays a vital role in youth psychosocial treatment. However, the psychometric properties of observer-rated instruments designed to assess the caregiver-clinician alliance have not been ad...
The caregiver-clinician alliance plays a vital role in youth psychosocial treatment. However, the psychometric properties of observer-rated instruments designed to assess the caregiver-clinician alliance have not been adequately assessed. To address this gap, this study examined the interrater reliability, item performance, and validity of scores on the Therapy Process Observational Coding System for Child Psychotherapy-Alliance Caregiver scale (TPOCS-A) used to assess the caregiver-clinician alliance in two independent samples of youth with primary anxiety problems who participated in randomized effectiveness trials. The first sample was comprised of 38 racially and ethnically diverse youth (M age = 10.83 years, SD = 2.11; 57.9% female), whereas the second sample was comprised of 55 racially and ethnically diverse youth (M age = 9.89 years, SD = 1.71; 54.5% female). Treatment sessions from both samples were coded by independent coders using the TPOCS-A along with observer-rated instruments of alliance, treatment adherence, and clinician competence. Across the samples, the interrater reliability, ICC(2,2), of the TPOCS-A Caregiver item scores ranged from -.04 to .78. TPOCS-A items were used to form two subscales (Bond & Task, Goal), and internal consistency ranged from .56 to .77 across the samples. Scores on the TPOCS-A Caregiver subscales (Bond & Task, Goal) evidenced convergent validity with scores on observer-report caregiver-clinician alliance instruments and discriminant validity with scores on adherence and competence instruments. Overall, the findings provide preliminary support for the reliability and validity of the TPOCS-A Caregiver scale and subscale scores.
Cognitive Reappraisal as a Potential Mechanism of Unified Protocol for Emotional Disorders.
Tang M, Long LJ, Torre M … +4 more , Spencer-Laitt D, Moreno-Villamizar JD, Barlow DH, Farchione TJ
Behav Ther · 2025 Nov · PMID 41139102 · Full text
This study aimed to investigate changes in cognitive reappraisal as a mechanism of the unified protocol (UP) for emotional disorders. Data were collected as part of a larger randomized clinical equivalence trial that ass...
This study aimed to investigate changes in cognitive reappraisal as a mechanism of the unified protocol (UP) for emotional disorders. Data were collected as part of a larger randomized clinical equivalence trial that assessed the efficacy of the UP, a transdiagnostic cognitive-behavioral therapy (CBT), relative to well-established single-disorder protocols and a wait-list control. The present sample included 132 individuals with primary diagnoses of panic disorder, generalized anxiety disorder, social anxiety disorder, or obsessive-compulsive disorder who were randomized to either the UP or the control group. They were assessed at five major time points during treatment, as well as a 6- and 12-month follow-up. Measures included the Overall Anxiety Severity and Impairment Scale for anxiety symptoms, the Overall Depression Severity and Impairment Scale for depression symptoms, and the Emotion Regulation Questionnaire to assess cognitive reappraisal. Multilevel mixed-effects models showed that cognitive reappraisal skills improved significantly over time in the UP group compared to a wait-list control group. Within the UP group, increases in cognitive reappraisal predicted subsequent reductions in anxiety and depression scores at the following time point. The greatest degree of improvement in cognitive reappraisal was observed at the last two time points during treatment, and these gains were sustained across the follow-up period. These findings underscore the importance of cognitive reappraisal, suggesting that it functions as a key transdiagnostic mechanism contributing to the UP's efficacy in treating emotional disorders. This research highlights the necessity for targeted interventions to enhance reappraisal skills, informing the optimization of the UP for individuals with emotional disorders.
Online Group Metacognitive Therapy for Repetitive Negative Thinking: A Pilot Study.
Mazza S, Kieran M, Tonta KE … +4 more , Erceg-Hurn DM, Swan A, Campbell BNC, McEvoy PM
Behav Ther · 2025 Nov · PMID 41139101 · Publisher ↗
Group metacognitive therapy (MCT) for anxiety and depression has been shown to be effective, but access could be increased if delivered via telehealth. This pilot study compared outcomes for individuals with anxiety diso...
Group metacognitive therapy (MCT) for anxiety and depression has been shown to be effective, but access could be increased if delivered via telehealth. This pilot study compared outcomes for individuals with anxiety disorders and depression who received group MCT via telehealth (N = 23) to historical controls that received face-to-face (F2F) MCT (N = 52). Patients received six weekly, 2-hour group sessions plus a 1-month follow-up of MCT in a community mental health clinic and completed measures of repetitive negative thinking (RNT), metacognitive beliefs (positive and negative), and symptoms (anxiety, depression) at pretreatment, posttreatment, and follow-up. Group MCT via telehealth achieved medium to very large effects on all outcomes to posttreatment and follow-up. The telehealth and F2F MCT groups did not significantly differ on any demographic or clinical variable at pretreatment. Between-group effect sizes, rates of reliable and clinically significant change, and participant evaluations of treatment acceptability and satisfaction were similar for the two modes of delivery at posttreatment and/or follow-up. Overall, these preliminary findings indicate that telehealth-delivered group MCT is a promising transdiagnostic intervention for anxiety disorders and depression.
A Comparison of In-Person and Digital Suicide Safety Planning Quality: A Randomized Controlled Trial of Three Safety Planning Administration Methods.
Hendley T, Starkey A, Yaccarino C … +2 more , Bolner J, Hill RM
Behav Ther · 2025 Nov · PMID 41139100 · Publisher ↗
Suicide safety planning-type interventions encompass a family of brief interventions that assist in maintaining one's safety during crises (e.g., experiencing suicidal thoughts and behavior) and can be administered in va...
Suicide safety planning-type interventions encompass a family of brief interventions that assist in maintaining one's safety during crises (e.g., experiencing suicidal thoughts and behavior) and can be administered in various administration methods, both in-person and digitally. Given that research suggests the importance of safety planning quality for promoting positive clinical outcomes, it is important to evaluate the quality of safety plans created using various administration methods. The present study sought to compare digital and in-person administration methods of suicide safety planning with respect to the quality of safety plans produced using each administration method. Conducted in a university lab space, participants (college students, 18 years or older, with past-year suicidal ideation; n = 135) were randomly assigned to one of three safety planning administration methods: traditional, in-person (n = 43), the Safety Planning Assistant (n = 44), and mysafetyplan.org (n = 48). Participants also completed a 2-week follow-up. Results indicate that traditional in-person safety planning and the Safety Planning Assistant produce significantly greater quality safety plans than mysafetyplan.org, F(2, 130) = 30.960, p < .001, η = .349. Additionally, those with higher quality plans reported higher satisfaction and spent a significantly longer amount of time developing their plans, F(2, 130) = 23.874, p < .001, η = .269. The Safety Planning Assistant produced comparable quality to that of traditional in-person safety planning, indicating that this self-administered safety planning tool may be a viable option in fast-paced settings where resources may be limited.
Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans.
Erickson AJ, Carlson GC, Kelly MR … +10 more , Mitchell MN, Fung CH, Song Y, McGowan SK, Josephson K, Zeidler M, Washington DL, Yano EM, Alessi CA, Martin JL
Behav Ther · 2025 Sep · PMID 40849117 · Full text
Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the ob...
Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire-9) and generalized anxiety (Generalized Anxiety Disorder-7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (-3.95 ≤ b ≤ -4.35, p < .001) and anxiety (-4.29 ≤ b ≤ -4.75, p < .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ b ≤ 0.584, p < .001), with change in insomnia severity accounting for 88%-97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.
Cognitive-Behavioral Factors Associated With Posttraumatic Stress Symptoms Following Two "Armed and Dangerous Person" Campus Lockdowns.
Friedman JB, Juel EK, Myers NS … +2 more , Ojalehto HJ, Abramowitz JS
Behav Ther · 2025 Sep · PMID 40849113 · Full text
Consistent with the cognitive-behavioral model of posttraumatic stress disorder (PTSD), research has found associations among posttraumatic cognitions, avoidance coping, and posttraumatic stress symptoms (PTSS). Less is...
Consistent with the cognitive-behavioral model of posttraumatic stress disorder (PTSD), research has found associations among posttraumatic cognitions, avoidance coping, and posttraumatic stress symptoms (PTSS). Less is known, however, about the occurrence of these relationships in the context of "armed and dangerous person" university lockdowns that affect campus communities at large. This cross-sectional study evaluated predictors of PTSS following two sequential lockdowns. In the aftermath of these lockdowns, campus community members (N = 287) completed self-report measures assessing posttraumatic cognitions, avoidance coping, and PTSS. Results indicated that posttraumatic cognitions involving negative views of oneself or the world (but not self-blame), avoidance coping, and physical proximity were positively associated with PTSS. These relationships remained robust after controlling for general distress and retrospectively reported peritraumatic fear. Findings are interpreted and discussed in light of conceptual models of PTSD and provide paths for early screening of those experiencing community-wide stressors, such as university lockdowns.
Differences in Emotion Regulation Indices in Participants With a History of Nonsuicidal Self-Injury Based on Sexual and Gender Minority Identity.
Ahrenholtz MS, Bresin K
Behav Ther · 2025 Sep · PMID 40849123 · Publisher ↗
Theories posit nonsuicidal self-injury (NSSI) regulates emotions through the reduction of negative affect and increasing of positive affect, and prior research using daily diary methods show differences across emotion dy...
Theories posit nonsuicidal self-injury (NSSI) regulates emotions through the reduction of negative affect and increasing of positive affect, and prior research using daily diary methods show differences across emotion dynamics (i.e., mean level, variation, inertia, and differentiation) based on NSSI history. The current study aimed to replicate and expand work done by Bresin (2014) by examining emotion dynamics using ecological momentary assessment and exploring group differences based on sexual and gender minority identity. To our knowledge, no research has explored emotion dynamic differences based on identity. We hypothesized a replication of Bresin's (2014) results and conducted exploratory analyses for sexual and gender minority status. Analyses of ecological momentary assessment data (5 times a day for 28 days) showed that individuals with a history of NSSI reported higher mean level and within-person variance of negative affect, and lower positive affect inertia. Sexual and gender minority individuals also reported lower positive affect inertia. Interaction effects found that sexual and gender minority individuals with a history of NSSI had lower negative affect inertia compared to cisgender straight individuals with a history of NSSI. Results from Bresin (2014) were replicated for mean-level and within-person variation of negative affect, as well as positive affect inertia using ecological momentary assessment data, strengthening the conclusion that individuals with a history of NSSI differ from controls across emotion dynamics. Future research should assess the role of minority stress on this association to continue to explore the differing results based on sexual and gender minority identity. The results of this study should inform theory and treatment surrounding affect and NSSI.
Dysfunctional Beliefs About Sleep in Suicidal Adolescents: Associations and Treatment Implications.
Bullinger L, Gazor A, Buerkert S … +3 more , Dieste SM, David Brown W, Stewart SM
Behav Ther · 2025 Sep · PMID 40849122 · Publisher ↗
Cognitive behavior therapy for insomnia has shown increasing promise in reducing suicidality in adults and may be effective in reducing suicidality in adolescents. Dysfunctional beliefs about sleep (DBs) are a primary ta...
Cognitive behavior therapy for insomnia has shown increasing promise in reducing suicidality in adults and may be effective in reducing suicidality in adolescents. Dysfunctional beliefs about sleep (DBs) are a primary target of such interventions. However, there are few studies of DBs in adolescents, let alone suicidal adolescents. Our study (1) assessed the sleep and suicide-related correlates of DBs, and (2) examined if change in DBs was associated with change in sleep, in a sample of acutely suicidal adolescents aged 12-18 years in an intensive cognitive behavior therapy-informed treatment program that did not target sleep. Measures of DBs (using the 16-item Dysfunctional Beliefs About Sleep Scale's (DBAS) total score and four subscale scores: Consequences, Helplessness, Expectations, and Medications), sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation were administered at program admission and discharge. Total DBs were concurrently associated (all ps < .05) with sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation, and reduction of DBs was associated with improvement in sleep over treatment. There was some variability in the association between types of DBAS and variables of interest, with the Helplessness subscale showing the strongest and most consistent associations. Limitations include subjective measurements only, a lack of specific insomnia symptom measures, and a nondiverse sample. DBs show promise as a target in the management of suicidal adolescents. Our findings also suggest that the development of an adolescent-specific scale could enhance construct measurement validity.
The Emotional Pendulum in ADHD: Insights From Ecological Momentary Assessment of Emotional States in Young Adults.
Yitzhak N, Cohen M, Traub Bar-Ilan R … +3 more , Maeir A, Eldar E, Nahum M
Behav Ther · 2025 Sep · PMID 40849121 · Publisher ↗
Emotion dysregulation, and specifically emotional instability, characterizes adults with ADHD. This study utilized ecological momentary assessment (EMA) to track emotional states and examine patterns of emotional instabi...
Emotion dysregulation, and specifically emotional instability, characterizes adults with ADHD. This study utilized ecological momentary assessment (EMA) to track emotional states and examine patterns of emotional instability within individuals over different time scales. Specifically, it focused on two aspects: overall emotional variability over time, and emotional lability, reflected in emotional states fluctuations within and across days. We further examined the interaction of these emotional instability factors with the subjective experience of emotion regulation difficulties. Young adults with (n = 57) and without (HC; n = 54) ADHD diagnosis completed a self-report questionnaire for emotion regulation difficulties, followed by a 5-day EMA protocol of 5 emotion reports/day. Individuals with ADHD displayed significantly higher intra-individual emotional variability, but no group differences were found for emotional lability, both between and across days. This higher emotional variability was linked to self-reported emotion regulation difficulties in the ADHD group. Finally, using cluster analysis, we found a higher probability of individuals with ADHD being included in a cluster characterized by elevated emotional variability and emotion regulation difficulties. This study demonstrates that young adults with ADHD may experience a broader range of emotions in their daily lives, which may be related to the way they evaluate their challenges in emotion regulation. The findings highlight the need to address emotion dysregulation difficulties in clinical practice, as understanding these emotional dynamics could enhance personalized therapeutic strategies for ADHD, and help design interventions tailored to the breadth and intensity of emotional experiences in ADHD.
Exploring Structural Adaptations to Cognitive Processing Therapy: A Systematic Review and Meta-Analysis.
Sandanapitchai P, Nixon RDV
Behav Ther · 2025 Sep · PMID 40849120 · Publisher ↗
In the evolving field of psychological interventions for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT) has emerged as a first-line treatment, backed by robust empirical evidence. Despite the pr...
In the evolving field of psychological interventions for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT) has emerged as a first-line treatment, backed by robust empirical evidence. Despite the proven efficacy of CPT in improving PTSD symptoms, individuals face significant barriers when seeking treatment. To overcome these challenges, CPT has undergone testing in diverse settings, accompanied by structural modifications deviating from its commonly delivered format of weekly (or bi-weekly) face-to-face contact, including changes in delivery method, length or intensity of sessions, or format (e.g., group). We conducted a systematic review and meta-analysis to assess the effectiveness of these structural adaptations within CPT for treating PTSD. Fifteen randomized controlled trials (RCTs) and 12 non-RCTs were included for the review. The meta-analysis of the 15 RCTs revealed significant improvements in PTSD and depression outcomes with structural adaptations of CPT. Generally, no significant differences were found when comparing these adaptations with standard CPT or non-CPT treatments, although this is accompanied by the caveat of likely modest power for subanalyses involving different comparator types. The findings suggest that adapting the delivery of CPT typically yields similar outcomes in PTSD symptom improvement as standard CPT and confirms its flexibility in addressing barriers to PTSD treatment access. Limitations and future directions are discussed.
Necesito Un Psicólogo: A Feasibility Study Examining a Behavioral Activation Telenovela Intervention for Depressed Latinas.
Chavez-Najera RL, Benuto LT
Behav Ther · 2025 Sep · PMID 40849119 · Publisher ↗
Latines in the United States experience considerable rates of depression and while behavioral activation is an effective treatment for depression, internal and external barriers contribute to the underutilization of beha...
Latines in the United States experience considerable rates of depression and while behavioral activation is an effective treatment for depression, internal and external barriers contribute to the underutilization of behavioral health services among Spanish-speaking Latines (SSLs). Fortunately, internet-based interventions have the potential to mitigate these barriers given their increased privacy, cost-effectiveness, and logistical flexibility. The present (pilot) study examined clinical outcomes and feasibility (engagement, satisfaction) with a culturally attuned behavioral activation telenovela intervention (BAD-TI) for SSLs using a quasi-experimental design. The BAD-TI is modeled after the telenovela entertainment genre (a limited-run serial drama popular in Latin America). The six-episode animated telenovela series chronicles the behavioral health journey of Maria, a Latina who is in her 40s and is experiencing depression. The six units from behavioral activation treatment for depression (BATD), including the core skills from each unit, are depicted in the telenovela series. Results indicated that 21 of the 32 participants (65.63%) who enrolled in the study completed treatment and 11 of the 32 participants (34.38%) dropped out of treatment. Intent-to-treat analysis revealed that participants experienced a statistically significant reduction in depressive symptom from pre- to posttreatment. Satisfaction ratings for the intervention and engagement with the intervention was high. Results from this study suggest that behavioral activation delivered via an online telenovela intervention format is a feasible and acceptable treatment approach for depressed SSLs.
The Impact of Parental Cognitions on Outcomes of Behavioral Parent Training for Children With Conduct Problems.
Fleming GE, Sawrikar V, Kaouar S … +3 more , Neo B, McDonogh C, Kimonis ER
Behav Ther · 2025 Sep · PMID 40849118 · Publisher ↗
Despite decades of support for behavioral parent training, studies consistently comprise a proportion of families who do not experience sustained improvement in child conduct problems. Recent innovations to enhance treat...
Despite decades of support for behavioral parent training, studies consistently comprise a proportion of families who do not experience sustained improvement in child conduct problems. Recent innovations to enhance treatment effects use predictors of treatment response to guide efforts to personalize treatment. We investigated whether baseline parental cognitions predicted response to Parent-Child Interaction Therapy (PCIT) in a sample of N = 61 children (M = 4.78 years, SD = 1.23, 74% boys) with conduct problems. Families received PCIT at an Australian urban university-based clinic. Parental positive and negative relational schemas were coded from baseline 5-minute speech samples. Linear mixed-effects models showed that mothers' unhelpful cognitions predicted significantly less improvement in child conduct problems and internalizing problems, parenting stress, and observed parenting behaviors from baseline to follow-up. In contrast, children of fathers with unhelpful cognitions began treatment with more severe problems than other children, but experienced similar or greater magnitude of improvement in child conduct problems, paternal parenting stress, and observed paternal negative parenting behaviors during treatment relative to other children. Findings suggest that PCIT may be a useful alternative to parent-only behavioral parent training for fathers with unhelpful cognitions. We also discuss methods for tailoring PCIT for mothers with unhelpful cognitions to enhance treatment effects. These trials were registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12616000280404; ACTRN12616000221459).
Effects of a Multifamily App-Enhanced Cognitive-Behavioral Therapy Delivered via Telehealth for Parents of Adolescents With Mood or Psychotic Spectrum Disorders.
Weintraub MJ, Ichinose MC, Zinberg JL … +6 more , Salimian A, Brown RD, Morgan-Fleming G, Gamarra JM, Tran T, Miklowitz DJ
Behav Ther · 2025 Sep · PMID 40849116 · Full text
Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring's psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents' mental...
Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring's psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents' mental health in this population. This study involved a multifamily group cognitive-behavioral therapy (CBT) for adolescents with mood or psychotic spectrum disorders and their parents, and tested whether a mobile application (app) could increase therapeutic engagement and skill practice. In a secondary analysis of a randomized controlled trial, we examined whether provision of an adjunctive app was associated with increases in parents' engagement in treatment skill practices and improvements in their emotional and parenting stress. Sixty adolescents and their primary parents were randomized into group cohorts to receive either an app-enhanced group delivery of the CBT unified protocol (AppUP) or the standard delivery of the group UP without an app, both delivered via telehealth. Families were followed over the 9-week treatment and 3 months posttreatment (21 weeks total). Unexpectedly, parents in AppUP reported fewer skill practices than parents in the standard UP. There were no differences between treatment conditions in parents' psychological distress. In a within-group examination of the full sample (i.e., both treatment conditions), parents with higher psychological distress upon entry to the study showed greater decreases in their distress over the 21-week trial than those with lower distress at entry. These improvements in distress levels were positively associated with parents' treatment skill practice and improvements in family functioning. Greater parental engagement in skill practice across both treatment conditions was also associated with improvements in adolescents' psychiatric functioning. Among adolescents with mood or psychotic spectrum disorders, parental engagement in group CBT may contribute to reductions in parents' distress and improvements in the mental health of offspring.
Racial Trauma and Mental Health: The Adaptive Role of Psychological Flexibility for Young Black Adults.
Brooks Stephens JR, Murphy ER, Gallagher MW … +1 more , Walker RL
Behav Ther · 2025 Sep · PMID 40849115 · Publisher ↗
Although recent work has highlighted the relation of racial trauma and adverse mental health sequelae specifically among Black Americans, the potential mechanisms underlying these associations remain relatively unknown....
Although recent work has highlighted the relation of racial trauma and adverse mental health sequelae specifically among Black Americans, the potential mechanisms underlying these associations remain relatively unknown. The present study examined psychological flexibility as a mediator of the association between racial trauma and symptoms of depression, suicide ideation, and anxiety. A sample of 417 Black young adults between the ages of 18 and 29 (53.5% male; M = 24.7, SD = 2.5) were recruited from a southwestern public university and social media to complete an online self-report survey. Structural equation modeling (SEM) analyses revealed significant indirect effects of racial trauma on increased symptoms of depression, anxiety, and suicide ideation via lower levels of psychological flexibility. This study demonstrated a link between racial trauma and depressive symptoms, anxiety, and suicide ideation, providing further evidence for the significant psychological burden of racial trauma. Additionally, study findings suggest that psychological flexibility is a key intervention target that may reduce the adverse impact of race-based traumatic stress for Black young adults.
Testing Reciprocal Within-Person Changes in Aversive Reactions to Emotions and Skill Use in the Unified Protocol.
Croom HE, Southward MW, Sauer-Zavala S
Behav Ther · 2025 Sep · PMID 40849114 · Publisher ↗
Emotional disorders are thought to be maintained in large part by the experience of frequent and intense negative emotions and aversive reactions to these emotions. The Unified Protocol for Transdiagnostic Treatment of E...
Emotional disorders are thought to be maintained in large part by the experience of frequent and intense negative emotions and aversive reactions to these emotions. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was designed to teach patients skills to manage aversive reactions and reduce the frequency and intensity of negative emotions. However, it is unclear how skill use and aversive reactions are related to each other in this treatment. Participants (N = 70; M = 33.75, 67% female, 74% White, 74% heterosexual) completed measures of aversive reactivity, skillfulness, anxiety, and depression before each session. We used hierarchical linear modeling to explore if within-person changes in aversive reactivity predicted residualized session-to-session changes in skill use and if within-person changes in skill use predicted residualized session-to-session changes in aversive reactivity. We then used multilevel mediation analyses to test whether aversive reactivity or skill use mediated the effect of the other construct on changes in anxiety and depression. Within-person increases in skillfulness significantly predicted session-to-session improvements in cognitive skills and mindfulness but did not predict improvements in any aspect of aversive reactivity. Within-person changes in aversive reactivity did not significantly predict changes in skillfulness. Between-person changes in skillfulness were significantly related to changes in between-person aversive reactivity. Only the indirect effect of skillfulness through mindfulness on anxiety/depression was significant. These results suggest that aversive reactivity and skillfulness may be relatively independent constructs.
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