Behav Ther [JOURNAL]
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200 papers
The Impact of Depressive Symptoms on Overidentification of Anger in Couples: A Daily Diary Study.
Ramadurai R, Sudit ES, Gunthert KC … +1 more , Herr NR
Behav Ther · 2025 Jul · PMID 40541384 · Publisher ↗
Anger is intricately linked to symptoms of depression and has implications for functioning outcomes in romantic couples. There is a lack of research on whether symptoms of depression influence empathic accuracy of anger...
Anger is intricately linked to symptoms of depression and has implications for functioning outcomes in romantic couples. There is a lack of research on whether symptoms of depression influence empathic accuracy of anger in couples, as well as whether perceptions of anger impact relationship quality for both partners. Using daily diary data, we examined these outcomes among 79 cohabitating couples (n = 158). Participants completed a baseline survey assessing relationship satisfaction and depression, as well as daily surveys rating their mood, their perception of their partner's mood, and relationship satisfaction and closeness. Results indicated that partners of individuals with higher depressive symptoms display empathic inaccuracy of anger. They evidenced a bias towards perceiving higher participant anger even when participants themselves report low levels of anger or low overall negative affect. Partner bias towards perceiving their partners as angry predicted poorer ratings of relationship satisfaction and closeness from both partner and participant perspectives. Findings suggest that for couples in which one individual struggles with symptoms of depression, empathic inaccuracy of anger or biased perception of anger may be a mechanism by which interpersonal dysfunction is maintained.
An Idionomic Network Analysis of Trichotillomania Treatment Processes: Gathering Group-Level and Individual-Level Insights to Inform a Personalized Therapeutic Framework.
Woolley MG, Sahdra BK, Bowers EM … +3 more , Capel LK, Twohig MP, Levin ME
Behav Ther · 2025 Jul · PMID 40541383 · Publisher ↗
Trichotillomania, characterized by repetitive hair-pulling, leads to significant distress and impairment. Heterogeneity in symptom profiles challenges the effectiveness of treatment protocols for trichotillomania. Recent...
Trichotillomania, characterized by repetitive hair-pulling, leads to significant distress and impairment. Heterogeneity in symptom profiles challenges the effectiveness of treatment protocols for trichotillomania. Recent research endorses personalized treatment, emphasizing the assessment of biopsychosocial processes to tailor interventions more closely to the individual. This shift to a process-based, person-centered framework necessitates analytic methods capable of probing beyond nomothetic patterns to unveil nuanced individual-level processes. This study utilized Group Iterative Multiple Model Estimation (GIMME) to examine group-level and individual-level network dynamics as an initial step towards a process-based treatment framework for trichotillomania. Ecological momentary assessment data from 54 affected individuals were analyzed to identify shared patterns applicable at the group level and individual level for individualized treatment. Analysis revealed a nomothetic process dynamically related to cognitive fixation on the urge to pull. At the individual level, notable variability in network structures emerged. While centrality measures consistently identified the urge to pull as a pivotal process within GIMME individual-level networks, the influence of other processes differed considerably between individuals. Results indicate that despite some shared components, the heterogeneity within individual networks calls for customized treatment approaches, and the assessment of psychological process dynamics at the individual level. These insights support incorporating idionomic methods into the developmental stages of personalized interventions.
Anxiety, Worry, and Difficulty Concentrating: A Longitudinal Examination of Concurrent and Prospective Symptom Relationships.
Blendermann M, Breaux R, Fried EI … +6 more , Naragon-Gainey K, Starr LR, Stewart J, Teachman BA, COVID-19 Mental Health Workgroup, Hallion LS
Behav Ther · 2025 Jul · PMID 40541382 · Publisher ↗
Difficulty concentrating is an understudied cognitive phenomenon, despite its status as a diagnostic criterion for generalized anxiety disorder and contributor to clinically significant distress and impairment. Worry may...
Difficulty concentrating is an understudied cognitive phenomenon, despite its status as a diagnostic criterion for generalized anxiety disorder and contributor to clinically significant distress and impairment. Worry may constitute a cognitive mechanism by which anxiety leads to difficulty concentrating. The present study examined concurrent and prospective associations between self-reported anxiety, worry, and subjective difficulty concentrating across three timepoints (T1 April/May, T2 July/August, T3 October/November 2020) in 198 adults (M age = 37.94, SD = 13.42; 81% women, 2% gender minority) drawn from a larger study of trajectories of psychopathology during the COVID-19 pandemic. In multilevel models, anxiety was associated with worry both between (β = 0.65, SE = 0.13) and within participants (β = 0.12, SE = 0.11). Difficulty concentrating was also associated with worry between (β = 0.38, SE = 0.03) and within participants (β = 0.09, SE = 0.02). In a structural equation model, worry partially mediated the longitudinal association between anxiety and difficulty concentrating, though this effect was nonsignificant after controlling for difficulty concentrating at T2 and worry, depression, sleep disturbance, and difficulty concentrating at T1. The unadjusted mediation and these other findings are in line with theoretical accounts of worry as a cognitive mechanism linking anxiety to subjective attentional problems.
Examining the Role of Homework Compliance in Acceptance-Enhanced Behavior Therapy for Trichotillomania.
Barber KE, Woods DW, Twohig MP … +3 more , Saunders SM, Compton SN, Franklin ME
Behav Ther · 2025 Jul · PMID 40541381 · Full text
Between-session therapy homework is a key component of cognitive-behavioral therapies, yet its role in trichotillomania treatment remains understudied. The present study examined the associations between homework complia...
Between-session therapy homework is a key component of cognitive-behavioral therapies, yet its role in trichotillomania treatment remains understudied. The present study examined the associations between homework compliance and treatment outcomes in acceptance and commitment therapy (ACT) enhanced behavior therapy (AEBT) for trichotillomania. Participants included 35 adults with trichotillomania who participated in a 12-week randomized controlled trial of AEBT. Therapists documented patient homework assignment completion and rated homework adherence after each session. Trichotillomania symptom severity was assessed posttreatment and at 6-month follow-up. Higher overall homework completion rate and therapist-rated homework adherence predicted lower trichotillomania symptom severity at posttreatment and follow-up. These findings were consistent for homework compliance during early and late treatment phases and for both ACT and behavior therapy-based homework assignments. A stronger therapeutic relationship strengthened the positive effects of homework compliance on symptom reduction. Higher automatic pulling moderated the association between overall homework completion and better outcomes. Predictors of higher homework compliance included higher therapeutic relationship quality, younger age, and lower anxiety. These findings underscore the importance of between-session homework in trichotillomania treatment and support the inclusion of both ACT and behavior therapy assignments. Interventions to promote homework compliance could enhance the efficacy of AEBT and lead to greater symptom improvements.
The Relationship Between the Therapeutic Alliance and Social Anxiety Symptoms Along the Course of Internet-Delivered Cognitive Behavioral Treatment.
Shalom JG, Prihar A, Strauss AY … +3 more , Huppert JD, Andersson G, Aderka IM
Behav Ther · 2025 Jul · PMID 40541380 · Publisher ↗
The therapeutic alliance is a consistent predictor of treatment outcome. In the present study, we examined whether the therapeutic alliance is associated with symptoms of social anxiety along the course of internet-deliv...
The therapeutic alliance is a consistent predictor of treatment outcome. In the present study, we examined whether the therapeutic alliance is associated with symptoms of social anxiety along the course of internet-delivered cognitive behavior therapy (ICBT) for social anxiety disorder (SAD). We examined data from a large treatment trial (n = 182) in which individuals with SAD reported on their social anxiety and alliance with the therapist each week during the treatment (for 11 weeks). We examined the total variance in alliance as well as within- and between-individual variances separately. Consistent with our hypotheses, we found that the total variance in alliance predicted the total variance in social anxiety in the following week. In addition, we found that within-individual variance in alliance was negatively associated with within-individual variance in social anxiety (in the following week). Thus, weekly increases in alliances were associated with weekly reductions in social anxiety in the following week. Finally, we found that between-individual variance in alliance was positively associated with between-individual variance in social anxiety such that individuals who were more socially anxious created stronger alliances with their therapists over the course of treatment. Our findings suggest that the therapeutic alliance is important in ICBT for SAD, that separating variance into within and between components may help identify different psychological processes, and that improving within-individual alliance may lead to reductions in symptoms of social anxiety.
Concentrated Cognitive-Behavior Therapy for Unmedicated Children and Adolescents With Obsessive-Compulsive Disorder in Routine Clinical Care: A Randomized Controlled Trial With a 6-Month Naturalistic Follow-up.
Hermida-Barros L, García-Delgar B, Lera-Miguel S … +12 more , Forcadell E, Moreno E, Primé-Tous M, Jaurrieta N, Segú X, Vilajosana E, Soriano-Mas C, de la Cruz LF, Vieta E, Radua J, Lázaro L, Fullana MA
Behav Ther · 2025 Jul · PMID 40541379 · Publisher ↗
Cognitive-behavior therapy (CBT) is effective for obsessive-compulsive disorder (OCD). Because CBT requires significant time and resources, there is an increased interest in developing shorter formats of CBT for OCD (i.e...
Cognitive-behavior therapy (CBT) is effective for obsessive-compulsive disorder (OCD). Because CBT requires significant time and resources, there is an increased interest in developing shorter formats of CBT for OCD (i.e., fewer sessions or in less time). We conducted a randomized single-blind controlled trial to investigate the effectiveness of concentrated CBT (co-CBT; 20 hours of therapist time across one month) compared to a waiting list (WL) in 30 unmedicated children and adolescents with OCD aged 7-17 in routine clinical care. Co-CBT was superior to the WL in reducing OCD symptom severity at posttreatment (primary endpoint; Cohen's d = 1.76) and these results were maintained through the end of a naturalistic 6-month follow-up. Participants initially randomized to the WL were offered co-CBT at the end of the trial and post-hoc analyses showed that they had similar improvements to those initially randomized to co-CBT. In post-hoc predictor analyses, participants aged 7-12, compared to those aged 13-17, and those with higher baseline OCD severity showed better posttreatment outcomes. Co-CBT is an effective intervention for unmedicated children and adolescents with OCD in routine clinical care. Studies including more robust control groups and larger samples are needed to replicate and expand these findings. Trial registration number: NCT04042038.
An Internet-Delivered Rumination-Focused CBT Intervention for Adults With Depression and Anxiety: A Randomized Controlled Trial.
Tulbure BT, Dudău DP, Marian Ș … +1 more , Watkins E
Behav Ther · 2025 Jul · PMID 40541378 · Publisher ↗
Targeting transdiagnostic psychopathological mechanisms like repetitive negative thinking (RNT; worry, rumination) could improve interventions for depression and anxiety. The goal of the current study was to test whether...
Targeting transdiagnostic psychopathological mechanisms like repetitive negative thinking (RNT; worry, rumination) could improve interventions for depression and anxiety. The goal of the current study was to test whether therapist-supported internet-based RNT-targeting cognitive behavioral therapy reduces RNT, anxiety, and depression in adults with elevated RNT and anxiety and/or depression. To this end, a single-blind, two-arm parallel-group superiority randomized controlled trial (RCT) was conducted with 118 adults across Romania with elevated levels of worry and/or rumination and at least a subclinical/clinical diagnosis of major depressive disorder (MDD), dysthymia, generalized anxiety disorder (GAD), social anxiety disorder (SAD), or panic disorder. Eligible participants were randomized to internet rumination-focused CBT (i-RF-CBT; n = 59) or a waitlist control group (i-RF-CBT delayed 7 weeks; n = 59). Primary outcome was changes in perseverative thinking, anxiety, and depression 7 weeks after randomization. Secondary outcomes included changes on all measures after 6 months in the i-RF-CBT condition only. Participants in the i-RF-CBT arm showed significantly lower levels of perseverative thought [PTQ] (d = 0.44, 95% CI [0.23, 0.64], p<.001), brooding (d = 0.56, 95% CI [0.35, 0.77], p < .001), worry [PSWQ] (d = 0.62; 95% CI [0.40, 0.84], p < .001), anxiety [GAD7] (d = 0.41; 95% CI [0.21, 0.62], p < .001), and depression [PHQ9] (d = 0.38; 95% CI [0.18, 0.58], p < .001) after 7 weeks, relative to waitlist control. Improvements were maintained at the 6-month follow-up. The results showed that i-RF-CBT significantly reduced RNT, worry, rumination, anxiety, and depression in adults with anxiety and/or major depressive disorders, providing proof of principle that this approach can target RNT and that targeting RNT has transdiagnostic benefits on anxiety and depression symptoms.
Naïve Observers' Perceptions of Hospitalized and Community Adolescents' Depressive Symptoms.
Tironi M, Rozenberg A, McLoughlin M … +5 more , Shkel J, Cervantes BR, Los Reyes A, Sharp C, Borelli JL
Behav Ther · 2025 Jul · PMID 40541377 · Publisher ↗
Adolescent depression significantly impacts long-term functioning and well-being, often going undetected and untreated, highlighting the need for innovative detection methods. This study examined whether unfamiliar, naïv...
Adolescent depression significantly impacts long-term functioning and well-being, often going undetected and untreated, highlighting the need for innovative detection methods. This study examined whether unfamiliar, naïve observers could detect depressive symptoms in adolescents, relying solely on behavioral residue (language transcribed from a clinical interview). Identifying whether naïve observers, untrained in detecting psychological symptoms, can utilize verbal output to accurately detect depressive symptoms yields scientific insight that could be expanded upon to support prevention efforts. The study involved 200 adolescent participants (100 hospitalized, 100 community; M = 15.31, henceforth referred to as targets). They reported on their depressive symptoms and completed the Child Attachment Interview (CAI; Shmueli-Goetz et al., 2008). Naïve observers (N = 52 college students split in two rounds), unaware of all other information about targets, read transcripts of targets' CAI interviews; using solely that information, they rated targets' depressive symptoms. Observers also assessed their confidence in their evaluation of targets' symptoms. Results showed a positive association between observers' ratings and targets' self-reported depressive symptoms (Round 1 Cohen's d = 1.25, Round 2 Cohen's d = 1.42) and this association remained significant controlling for linguistic categories connected to depression detected by computer analysis. Observers' ratings discriminated between hospitalized and community adolescents (Round 1 Cohen's d = 1.43, Round 2 Cohen's d = 1.37), though confidence in their ratings was not associated with targets' ratings or group (community or hospitalized). Observers can reliably and accurately identify depressive symptoms in adolescents using attachment interviews, over and above computer analysis alone. This work suggests that naïve observers contribute unique insight into the detection of adolescent depressive symptoms.
Preferences for Justice-Based Exposure and Response Prevention Among Individuals With Identity-Related Obsessive-Compulsive Disorder.
Pinciotti CM, Upshaw BM, Spencer SD … +6 more , Park JM, Franklin ME, Wadsworth LP, Riemann BC, Goodman WK, Storch EA
Behav Ther · 2025 Jul · PMID 40541376 · Publisher ↗
Justice-based exposure and response prevention (ERP) has been touted as an alternative approach to (mis)uses and "Fear Factor" overcorrection applications of ERP for obsessive-compulsive disorder (OCD) with identity-rela...
Justice-based exposure and response prevention (ERP) has been touted as an alternative approach to (mis)uses and "Fear Factor" overcorrection applications of ERP for obsessive-compulsive disorder (OCD) with identity-related themes (i.e., sexual orientation, gender identity, racism, age, disability/diagnostic status, and economic-themed). Justice-based exposure maintains fidelity to the theoretical and evidence-based mechanisms of ERP while avoiding inadvertent stigmatization of marginalized communities. Justice-based ERP also avoids contributing to societal stigma while potentially increasing buy-in among patients. Despite its widespread support across the OCD field, empirical evidence regarding preferences for justice-based ERP is currently lacking. The present study sought to compare perspectives on justice-based and overcorrection ERP approaches to identity-related OCD themes among 450 individuals with current or past identity-related obsessions (85.6% female, M age = 32.0). Participants reviewed idiographic, symptom-specific justice-based and overcorrection ERP hierarchies for each endorsed symptom theme and were asked a series of questions regarding their perspectives on each hierarchy. Participants reported a considerable preference for justice-based exposures over overcorrection exposures for these themes. Specifically, while overcorrection exposures were associated with higher anxiety expectancy, participants were much more likely to report a willingness to engage in justice-based exposures, perceived them to be more relevant and effective, and found them to be less derogatory and offensive than overcorrection exposures. Findings support the notion that (mis)uses and overcorrection exposures for identity-related OCD themes represent a "Fear Factor" approach that prioritizes anxiety increase at the expense of functionality, and that a justice-based approach may be better aligned with participants' values and treatment expectancies.
Targeting Higher-Order Dimensions of Personality in Treatment as a Parsimonious Means to Address Co-Occurring Psychopathology.
Sauer-Zavala S, Kushner M, Fruhbauerova M … +2 more , Croom H, Southward MW
Behav Ther · 2025 Jul · PMID 40541375 · Publisher ↗
People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive...
People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive-behavioral treatment developed to target broad personality domains (i.e., negative affectivity, antagonism, disinhibition) associated with BPD and related conditions. The purpose of the present study was to explore the extent to which BPD Compass can serve as a transdiagnostic intervention for these comorbid conditions. Participants (N = 100; M = 28.13, 73.7% female, 79.6% White, 66% sexual minority) were assigned to either immediately begin treatment (randomized and naturalistic) or receive treatment after an 18-week waiting period. At baseline, participants met criteria for an average of 3.28 (SD = 2.02, range: 0-8) comorbid diagnoses ranging in clinical severity from 3.30 (for substance use disorder) to 4.91 (for persistent depressive disorder). Posttreatment clinical severity ratings (CSRs) for those randomized to receive BPD Compass were below clinical thresholds for all assessed conditions except premenstrual dysphoric disorder, whereas post-waitlist CSRs remained above clinical thresholds for all disorders except bipolar II, agoraphobia, and major depressive disorder. Collapsed across all patients who received BPD Compass, pre- to posttreatment improvements were significant and large in magnitude for most disorders assessed. These results suggest that BPD Compass may be an efficacious transdiagnostic intervention, though our small sample and high rate of dropout warrant further study.
A Pilot Trial of an LGBTQ-Affirmative Cognitive-Behavioral Therapy for Transgender and Gender Expansive Individuals' Mental, Behavioral, and Sexual Health.
Lelutiu-Weinberger C, Filimon ML, Chiaramonte D … +5 more , Leonard SI, Dogaru B, Pana E, Pruneanu C, Pachankis JE
Behav Ther · 2025 Jul · PMID 40541374 · Full text
Transgender and gender expansive (TGE) individuals face minority stress and associated health risks, especially in high-stigma contexts. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-affirmative cogn...
Transgender and gender expansive (TGE) individuals face minority stress and associated health risks, especially in high-stigma contexts. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-affirmative cognitive-behavioral therapy (CBT) is one of the only evidence-based interventions developed to address minority stress to improve psychosocial health. Yet, trials of this treatment have mostly enrolled cisgender sexual minorities, TGE youth, and those living in North American contexts. This study tested the feasibility, acceptability, and preliminary efficacy of LGBTQ-affirmative CBT for TGE adults living in the high-stigma context of Romania. Twenty-five TGE individuals (M = 25.16, SD = 6.39; 44% transgender women, 40% transgender men, 16% nonbinary) reporting depression and/or anxiety symptoms received 16 virtual sessions of LGBTQ-affirmative CBT from trained psychologists. Assessments of mental (e.g., depression), behavioral (e.g., hazardous drinking), and sexual (e.g., HIV-transmission risk behavior) health outcomes, and minority stress and universal risk mechanisms were administered at baseline and 5-month follow-up. Results showed reductions in depression and anxiety symptoms and certain minority stress (e.g., anticipated stigma, identity concealment) and universal risk (e.g., unassertiveness) mechanisms from baseline to follow-up. The intervention was highly feasible (e.g., timely recruitment, high session attendance), and exit interviews revealed high acceptability in terms of the treatment's relevance, goals, imparting minority stress knowledge and identity-related hope and acceptance, format, and therapeutic alliance. LGBTQ-affirmative CBT shows feasibility, acceptability, and preliminary efficacy among TGE individuals living in Romania, with promise for other high-stigma contexts. Future randomized controlled trials and reductions in structural determinants remain priorities.
Improving Parent-Adolescent Conversation to Promote Adolescent Sleep Health Behavior Change: An Open Trial of the Parent Behavior Change Intervention.
Dong L, Gumport NB, Fine ER … +8 more , Michie S, Zhou Q, Mullin A, Alvarado-Martinez CG, Hilmoe Yates HE, Tran M, Portnova V, Harvey AG
Behav Ther · 2025 Jul · PMID 40541373 · Publisher ↗
The Parent Behavior Change Intervention (PBC-I) was developed to target parent-adolescent conversations that promote adolescent health behavior change. We report on an open trial of the PBC-I. Participants were 36 parent...
The Parent Behavior Change Intervention (PBC-I) was developed to target parent-adolescent conversations that promote adolescent health behavior change. We report on an open trial of the PBC-I. Participants were 36 parent-adolescent dyads. Adolescents received the Transdiagnostic Sleep and Circadian Intervention (TranS-C) as parents received the PBC-I. Dyads were assessed at pre- and postintervention for parent use of behavior change techniques (BCT) and positive and negative conversational behaviors, parent-adolescent conflict, adolescent motivation for change, and adolescent sleep outcomes. From pre to post, parents used fewer total and types of BCTs, more positive communication behaviors, and less negative communication behaviors when discussing a sleep-related hot topic. From pre to post, parents reported decreased coercion and less anger intensity, while adolescents reported fewer parental conflict behaviors and less quantity and anger intensity during parent-adolescent disagreement. There was a pre-to-post increase in interest/enjoyment of sleep and a decrease in effort/importance to participate in TranS-C. More positive and less negative communication was associated with select adolescent sleep outcomes. Parents rated the PBC-I as highly acceptable and perceived it as useful. These results provide preliminary evidence that supports the PBC-I in improving the parent-adolescent interpersonal process, which is linked to improved adolescent sleep. The results may be relevant to conversations parents have with adolescents about a range of health behavior changes.
Is the Unified Protocol for Children Effective for the Transdiagnostic Treatment of Children's Emotional Disorders? A Randomized Controlled Trial.
Caiado B, Guiomar R, Gomes-Pereira B … +5 more , Góis AC, de Sousa B, Canavarro MC, Ehrenreich-May J, Moreira H
Behav Ther · 2025 Jul · PMID 40541372 · Publisher ↗
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) aims to reduce internalizing symptoms in children by addressing fundamental mechanisms that underlie emotional disorders throug...
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) aims to reduce internalizing symptoms in children by addressing fundamental mechanisms that underlie emotional disorders through a combination of cognitive, emotional, and behavioral strategies. This study, the largest randomized controlled trial (RCT) to date of UP-C efficacy and the first one conducted outside the U.S., assesses the efficacy of UP-C compared to an active control group. A total of 153 children (6-13 years old; 58.8% girls) with at least one emotional disorder as a primary diagnosis and their parents (88.2% mothers) were randomly assigned to either the UP-C condition (n = 77) or an active control condition (n = 76; receiving a psychoeducational intervention, the ABC of Emotions). Participants completed self-report questionnaires at pretreatment, midtreatment, posttreatment, and at the 3-month follow-up, assessing children's internalizing symptoms and their interference with the child and family functioning. Clinicians assessed the severity of the child's symptoms and monitored clinical improvement throughout the study. Descriptive statistics, comparative tests and Linear Mixed Models were used. Results showed greater satisfaction, lower dropout rates, and better adherence in the UP-C condition, with a reduced need for additional interventions posttreatment compared to the control group. The UP-C demonstrated significantly greater efficacy in reducing internalizing symptoms, with a large effect size, including anxiety and depression, as well as in reducing the interference and severity of child symptoms and in improving clinical gains compared to the control group. These findings provide strong support for UP-C as a feasible, acceptable, and effective treatment for childhood emotional disorders, reinforcing its status as an evidence-based treatment.
Feasibility of Using ChatGPT to Generate Exposure Hierarchies for Treating Obsessive-Compulsive Disorder.
Bernstein EE, Jaroszewski AC, Jacoby RJ … +4 more , Bailen NH, Ragan J, Usmani A, Wilhelm S
Behav Ther · 2025 Jul · PMID 40541371 · Full text
Obsessive-compulsive disorder (OCD) is a chronic, severe condition. Although exposure and response prevention (ERP), the first-line treatment for OCD, is highly effective, too few clinicians are equipped to deliver it. O...
Obsessive-compulsive disorder (OCD) is a chronic, severe condition. Although exposure and response prevention (ERP), the first-line treatment for OCD, is highly effective, too few clinicians are equipped to deliver it. One barrier is the time and expertise required to develop personalized exposure hierarchies. In this study, we examined the feasibility and promise of using large language models (LLMs) to generate appropriate exposure suggestions for OCD treatment. We used ChatGPT-4 (Generative Pretrained Transformer, Version 4) to generate 10-item exposure hierarchies for simulated patient cases that were systematically varied along the following dimensions: OCD subtype, symptom complexity or number, level of detail, patient age, and patient gender. Expert clinicians also generated hierarchies for a subset of prompts. ChatGPT-generated hierarchies were first rated for completeness and degree to which input information was incorporated. Three OCD experts blinded to the aims of the study then rated each ChatGPT- and expert-generated hierarchy's appropriateness, specificity, variability, safety/ethics, and overall usefulness or quality. ChatGPT generated partial (n = 15) or complete (n = 55) responses to 70 of 72 prompts and incorporated most input information (M = 4.29 out of 5, SD = 0.85). The only significant predictor of degree of input information incorporated was number of OCD symptoms; prompts with the most symptoms were rated as incorporating less input information than prompts with both low and moderate number of symptoms, ps < .05. Overall, ChatGPT-generated hierarchies were viewed as appropriate (M = 4.47, SD = 0.58), specific (M = 4.17, SD = 0.65), variable (M = 3.96, SD = 0.79), safe/ethical (M = 4.89, SD = 0.24), and useful (M = 3.99, SD = 0.82). However, expert human-generated hierarchies were still rated as significantly more appropriate, specific, variable, and useful, ps < .05, but not more or less safe and ethical than ChatGPT-generated hierarchies, p = .24. Only the level of symptom detail included in prompts was associated with ratings of ChatGPT-generated hierarchies, ps < .05, such that hierarchies were rated significantly better when prompts had been more detailed. Results suggest that LLMs such as ChatGPT hold great promise in helping generate effective OCD exposure hierarchies, while also highlighting key limitations that require resolution prior to clinical implementation. Given that few clinicians specialize in OCD treatment, it would be advantageous to establish how face-to-face or digital treatment can be augmented with this technology.
State of the Science: Hoarding Disorder and Its Treatment.
Tolin DF, Worden BL, Levy HC
Behav Ther · 2025 Jul · PMID 40541370 · Publisher ↗
This state-of-the-science review describes the relatively new diagnosis of hoarding disorder (HD), characterized by difficulty discarding possessions and resulting clutter in living spaces. We review current theoretical...
This state-of-the-science review describes the relatively new diagnosis of hoarding disorder (HD), characterized by difficulty discarding possessions and resulting clutter in living spaces. We review current theoretical models of HD, including a cognitive-behavioral model, a biopsychosocial model, an attachment model, and an addictions model. We then describe interventions for HD, focusing largely on cognitive-behavioral therapy for hoarding disorder (CBT-HD), the only treatment with conclusive evidence of efficacy. We review the components of CBT-HD and their rationale, noting that clinical results have been modest. The cross-cultural efficacy of CBT-HD is unclear, as are the effects of cultural modifications to the treatment. Future clinical and research directions are discussed.
Dissemination Trial of Provider Training of ACT-Enhanced Behavior Therapy for Trichotillomania: A Waitlist Controlled Study.
Woolley MG, Schwartz SE, Morrison KL … +1 more , Twohig MP
Behav Ther · 2025 May · PMID 40287190 · Publisher ↗
Trichotillomania is a psychiatric disorder characterized by recurrent hair-pulling, leading to distress and impairment. Despite the efficacy of habit reversal training (HRT) and ACT-enhanced behavior therapy (A-EBT), the...
Trichotillomania is a psychiatric disorder characterized by recurrent hair-pulling, leading to distress and impairment. Despite the efficacy of habit reversal training (HRT) and ACT-enhanced behavior therapy (A-EBT), there is a significant knowledge gap among providers about evidence-based treatments. This study aimed to bridge this gap by evaluating the feasibility, acceptability, and effects of internet-delivered therapist training in A-EBT for trichotillomania. A randomized waitlist-controlled implementation trial was conducted with 119 licensed mental health providers assigned to either immediate training or waitlist cohorts. The immediate training group participated in a 1-day online workshop followed by 6 months of consultation. Compared to the waitlist cohort, the immediate training cohort showed significant improvements in knowledge of trichotillomania, its treatments, and self-efficacy in providing the therapy, which were maintained throughout the end of the consultation period. Behavioral outcomes indicated that the immediate training cohort was more likely to self-promote their ability to treat trichotillomania, leading to an increased caseload of clients with trichotillomania and other body-focused repetitive behaviors (BFRBs). Approximately one-third of providers in both groups began treating at least one client with trichotillomania or another BFRB during the training period. In conclusion, training providers in A-EBT for trichotillomania is feasible and effective in improving provider knowledge and self-efficacy, leading to more individuals receiving evidence-based care. Future research should explore long-term impacts on client outcomes and ways to further enhance training dissemination and implementation for trichotillomania and other BFRBs.
Examining the Reciprocal Association Between Worry and Sleep: Disaggregating Between- and Within-Person Effects.
Law C, Sokolovsky AW, Yap DL … +3 more , Erblich J, Gunthert K, Behar E
Behav Ther · 2025 May · PMID 40287189 · Publisher ↗
Studies investigating the reciprocal association between worry and sleep have yielded mixed findings and suffered from methodological limitations. The purpose of this study was to assess the reciprocal association betwee...
Studies investigating the reciprocal association between worry and sleep have yielded mixed findings and suffered from methodological limitations. The purpose of this study was to assess the reciprocal association between worry and various indices of sleep (i.e., sleep onset latency [SOL], total sleep duration [TSD], sleep quality [SQ], and morning lingering [ML]). In a longitudinal daily assessment study, participants (N = 182) completed a sleep diary and a measure of worrisome thinking three times per day for 7 days. We used linear mixed effects models to examine worry predicting sleep, and Tobit regression models to examine sleep predicting worry, and controlled for previous day report of the outcome variable and person- and day-level effects. Results indicate that greater person-level worry, but not day-level worry, was significantly associated with longer SOL, worse SQ, and longer ML. Furthermore, greater person-level SOL, TSD, and ML was associated with greater worry, and greater person-level SQ was associated with less worry. Finally, we found that shorter day-level TSD and lower day-level SQ was associated with greater next-day worry. These findings support a reciprocal person-level association between worry and sleep (except for TSD), and a unidirectional day-level association between TSD and SQ as predictors of worry.
Exploring the Relevance of Perceived Barriers to Treatment in Adults With Body Dysmorphic Disorder Symptoms: Comparing Psychotherapy and Online Interventions.
Bosbach K, Schulte J, Martin A
Behav Ther · 2025 May · PMID 40287188 · Publisher ↗
Although individuals facing Body Dysmorphic Disorder (BDD) endure considerable levels of distress, they often do not engage in empirically effective cognitive-behavioral therapy. Identified barriers to seeking treatment...
Although individuals facing Body Dysmorphic Disorder (BDD) endure considerable levels of distress, they often do not engage in empirically effective cognitive-behavioral therapy. Identified barriers to seeking treatment include logistical challenges, shame and stigmatization, and pessimistic expectations of mental health interventions associated with a lack of insight into having a psychological issue. This study investigates the relevance of these perceived treatment barriers for face-to-face therapy and for online interventions as a potentially accessible alternative or entry to traditional psychotherapy. Through an online survey involving 321 participants (comprising 239 with elevated BDD symptoms and 82 with self-reported probable BDD), we utilize the Barriers to Treatment Questionnaire to assess different perceived barriers. A comparative analysis is conducted to contrast the perceived relevance of barriers to psychotherapy with those reported for online interventions. As a result, perceived barriers to psychotherapy are most prominent in feelings of shame and fear of stigmatization, followed by logistical challenges and negative treatment expectations, and again followed by format-related concerns. Overall perceived barriers to online interventions are lower, though concerns related to the intervention format, such as data security concerns, become more pronounced. Notably, shame and stigmatization remain central factors in both contexts. When offering psychological help to individuals with BDD, the aspects of shame and negative attitudes toward seeking psychological help should be primarily addressed. Considering all their advantages, online interventions should continue to be utilized for BDD, to improve the treatment situation, but it should be noted that this treatment format is not without challenges.
Enhancing Understanding of Eating Psychopathology: A Network Analysis Study.
Marques CC, Castilho P, Castelo-Branco M … +2 more , Pereira AT, Goss K
Behav Ther · 2025 May · PMID 40287187 · Publisher ↗
Compassion Focused Therapy for eating disorders (CFT-E) has been shown to be effective in treating eating psychopathology. Exploring which processes identified by the CFT-E model are most linked with eating disorder symp...
Compassion Focused Therapy for eating disorders (CFT-E) has been shown to be effective in treating eating psychopathology. Exploring which processes identified by the CFT-E model are most linked with eating disorder symptoms could help develop targeted treatments. However, the relationship between these variables requires further investigation. This study explores the interconnections between eating disorder symptoms and processes identified by the CFT-E using a network analysis approach. Participants were 497 individuals (77.3% female) from a community sample who completed measures to assess body dissatisfaction, shape and weight overvaluation, cognitive restraint, bingeing, emotional eating, purging, self-compassion, social comparison through appearance, self-criticism, appearance-related shame, guilt and pride, and positive and negative affect. A regularized partial correlation network was estimated. Appearance-related shame, inadequate self and body dissatisfaction emerged as the central nodes in the network. These findings support the use of interventions targeting shame and self-criticism for the treatment of eating disorder symptoms. Studies with diverse samples are needed to further examine the interconnections between eating psychopathology and the key processes identified by the CFT-E theoretical model.
The Exposure Guide: A Practical Measure of Exposure Quality.
Benito KM, Herren JA, Norris LA … +3 more , Gardiner KM, Choate M, Freeman JB
Behav Ther · 2025 May · PMID 40287186 · Publisher ↗
Quality monitoring is essential for the use of evidence-based interventions (EBIs) in both practice and research settings, yet few quality measures have been developed or validated for any treatment. This study examined...
Quality monitoring is essential for the use of evidence-based interventions (EBIs) in both practice and research settings, yet few quality measures have been developed or validated for any treatment. This study examined the initial psychometric properties of a brief, practical measure of quality for exposure therapy (Exposure Guide; EG) in a sample of youth from three randomized clinical trials for pediatric OCD (N = 103 patients and 368 sessions). The EG was initially developed based on the behavioral principles underlying exposure, delivery factors linked to clinical outcomes in prior literature, and with input from both exposure therapy researchers and partners in community mental health settings. Results indicated good to excellent inter-rater reliability (item ICCs = .64 to 1.00). When compared against a validated, time-intensive coding system, each EG item exhibited large correlations with parallel coding system variables; these were significantly larger than correlations with other variables. Variance components analysis demonstrated EG subscale variability at the level of therapists, patients, and time. The EG demonstrates strong initial reliability and construct validity in a clinical trial context; future studies will be needed to establish psychometric properties in practice settings and to elucidate therapist, patient, and treatment course factors that may influence quality.
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