Behav Ther [JOURNAL]
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200 papers
How Can Sexual and Gender Minority Latter-day Saints Resolve Identity Conflict and Improve Their Mental Health? Results From a 2- to 4-Year Longitudinal Study.
Lefevor GT, Skidmore SJ
Behav Ther · 2025 May · PMID 40287185 · Publisher ↗
Sexual and gender minority (SGM) clients who are raised in conservative religious traditions often find themselves caught between competing narratives about how to best improve mental health and resolve conflict between...
Sexual and gender minority (SGM) clients who are raised in conservative religious traditions often find themselves caught between competing narratives about how to best improve mental health and resolve conflict between their sexual/gender and religious identities. In an effort to guide these individuals and the therapists who serve them, we present longitudinal data from 359 sexual and gender minority individuals raised in the Church of Jesus Christ of Latter-day Saints (i.e., SGM Latter-day Saints). These data, gathered at baseline in 2020 or 2022 and then again 2 and/or 4 years later in 2022 and/or 2024, answer the question "What can I do today that is most likely to yield positive mental health and conflict resolution in the future?" All analyses were preregistered prior to data collection of the most recent longitudinal wave. Bivariate analyses between baseline variables and depression/conflict resolution in 2024 suggest that (a) self-compassion, (b) social support, (c) authentic religious engagement, (d) reduced internalized homonegativity, (e) outness, and (f) seeing masturbation as more acceptable were all related to subsequent alleviated depression or enhanced conflict resolution. Regression analyses conducted separately for conflict resolution and depression suggest that only self-compassion, internalized homonegativity, and authentic religious engagement emerged as indicators of subsequent depression or conflict resolution. These findings suggest that the most important actions SGM individuals can take today to have better mental health and less conflict in 2 or 4 years include developing compassionate stances toward themselves, reducing stigmatizing views of themselves, and engaging authentically with their faith (if applicable).
The Effects of Parent-Child Interaction Therapy on Parent Feeding Practices and Children's Problematic Mealtime Behaviors.
Campbell SM, Edwards EJ, Hambour V … +6 more , Horan N, Hawes T, Swan K, Wotton M, Melloy B, Zimmer-Gembeck MJ
Behav Ther · 2025 May · PMID 40287184 · Publisher ↗
Many children are fussy or demanding about food, and managing these behaviors can be difficult and distressing for parents. Yet, no previous study had examined whether Parent-Child Interaction Therapy (PCIT), an interact...
Many children are fussy or demanding about food, and managing these behaviors can be difficult and distressing for parents. Yet, no previous study had examined whether Parent-Child Interaction Therapy (PCIT), an interactive parenting support program that coaches caregivers while they interact with their young children, improves problematic mealtime behaviors and food-related parenting practices. In this study, 178 parents in Australia (M = 35.1 years, SD = 7.5 years; 93% female) of young children (M = 4.5 years, SD = 1.3, 76% male) completed up to two baseline surveys (prior to a waitlist, pre-PCIT) and a third survey after PCIT. The surveys included measures of their parenting practices in general and related to feeding and mealtimes, beliefs about eating, and children's mealtime behavior (e.g., food avoidance, mealtime aggression) and general externalizing symptoms. Using paired t-tests, no changes were found during baseline (pre-waitlist to pre-PCIT), but from pre- to post-PCIT, medium to large improvements were found in parent mealtime demandingness and responsiveness, aversion to mealtime, child eating behaviors, general parenting practices, and child externalizing behavior. However, positive mealtime environment did not improve and improvements in general parenting and behavior were larger than for eating-related parenting and child behavior. The findings suggest that PCIT can be effective for reducing most problematic mealtime behaviors and can improve multiple parental feeding practices.
Underlying Working Mechanisms of Virtual Reality Exposure: Exploring the Role of Fearful Expectancies and Habituation.
Scheveneels S, Carpentier N
Behav Ther · 2025 May · PMID 40287183 · Publisher ↗
While research has primarily focused on establishing the efficacy of virtual reality (VR) exposure, relatively scant attention has been paid to the underlying working mechanisms that drive the effects. The present study...
While research has primarily focused on establishing the efficacy of virtual reality (VR) exposure, relatively scant attention has been paid to the underlying working mechanisms that drive the effects. The present study examined the role of fearful expectancies and fear reduction (habituation) in VR exposure. Fearful expectancies were measured before, during (retrospectively), and after a VR exposure session in 121 participants with elevated fear of spiders. In addition, skin-conductance and heart rate were measured throughout the exposure session to examine fear reduction within the exercises and across the session. Fearful expectancies decreased after VR exposure. Larger decreases were associated with better outcomes 1 week (in the verbal and behavioral measures) and 3 months (in one of the verbal measures) after exposure. Levels of expectancies during exposure were not associated with the outcome. We did not find evidence that expectancies about own reactions were better testable in VR exposure than expectancies about the spider. Fear reduction within the exercises or across the session did generally not predict VR exposure outcome. It is recommended to focus on various operationalizations and experimental manipulations of the mechanisms, as well as to compare these mechanisms between VR and in vivo exposure in future research.
The Role of Pain and Blood Simulation of Nonsuicidal Self-Injury in Emotion Regulation Among Adolescents With Depression Based on the Principle of Harm Reduction: An Experimental Study.
Wang L, Zou HO, Qu YH … +2 more , Hong JF, Chen J
Behav Ther · 2025 May · PMID 40287182 · Publisher ↗
This study aims to explore the role of pain and blood in emotion regulation during nonsuicidal self-injury (NSSI) among adolescents with depression, which included 108 depressed adolescents with NSSI and 110 depressed ad...
This study aims to explore the role of pain and blood in emotion regulation during nonsuicidal self-injury (NSSI) among adolescents with depression, which included 108 depressed adolescents with NSSI and 110 depressed adolescents without NSSI, to assess the impact of pain and blood on subjective emotional states, and pulse frequency (Pf), respiratory frequency (Rf), galvanic skin response (GSR), and electromyography (EMG). Significant condition×group×time interactions for positive emotions (β = -0.082, SE = 0.026, P = 0.002), Pf (β = -0.045, SE = 0.013, P = 0.001) and GSR (β = -0.041, SE = 0.018, P = 0.027) were found, indicating a significant increase in positive emotions and a significant decrease in Pf and GSR in the NSSI group post-pain/blood stimulus, especially within the first 10 seconds (for Pf, GSR)/3.5 minutes (for positive emotions) following stimulus. And Pf and GSR showed a more pronounced decrease over time in the NSSI group during the pain condition than in the blood condition. These findings highlight the significance of pain and blood in emotion regulation for adolescents with depression who engage in NSSI. Moreover, clinical healthcare professionals may be inspired by the pain and blood stimulus of NSSI based on the harm reduction principle, which provides new ideas for exploring potential interventions that can assist adolescents with depression regulate their emotions and reduce the occurrence of NSSI. And more relevant studies need to be carried out in this area.
Naturalistic Evaluation of HeadGear: A Smartphone App to Reduce Depressive Symptoms in Workers.
Deady M, Collins DAJ, Glozier N … +6 more , Gardiner E, Arena A, Gayed A, Bryant R, Calvo RA, Harvey SB
Behav Ther · 2025 May · PMID 40287181 · Publisher ↗
Mobile health (mHealth) apps have the potential to expand access to evidence-based interventions for mental health conditions, including depression. HeadGear was developed to prevent depression and improve well-being amo...
Mobile health (mHealth) apps have the potential to expand access to evidence-based interventions for mental health conditions, including depression. HeadGear was developed to prevent depression and improve well-being among the working population and was associated with significant positive effects in an efficacy trial. This study presents the results from a naturalistic trial intended to evaluate real-world usage of the app. We examined the naturalistic use of HeadGear between March 2019 and March 2022, using app analytic data, in-app event data, and surveys assessing depressive symptoms, well-being, and work performance repeated at 30-day intervals over 5-month app usage. During the observation period, HeadGear was widely disseminated to the public, and downloaded 26,455 times. Of those who downloaded the app, 12,995 completed baseline. The mean age of users was 38.23 (SD = 12.39) and 60% were women. Approximately one in four met criteria for probable depression at baseline. Depressive symptoms showed consistent improvement at all time points (Cohen's d ranging from 0.24 at 1 month to 0.13 at 5 months). A similar pattern emerged for well-being. Work performance showed improvement to 2-month follow-up only. The strongest change was found for those with greater symptom severity at baseline, and those with high app engagement. Attrition at follow-up points was high. Findings regarding the real-world use of HeadGear are promising and highlight the use of such apps among those with higher symptom severity (despite the intended use of the app as a prevention tool). Further work is required to tailor mHealth apps to reach their full potential through an enhanced understanding of the utility of individual features for effectiveness and engagement.
Beyond Jacobson and Truax: Estimation of Clinical Significance Trajectories in the Coping Power Intervention Using Measurement Error-Corrected Multilevel Modeling.
Morgan-López AA, Saavedra LM, McDaniel HL … +9 more , West SG, Ialongo NS, Bradshaw CP, Tonigan AT, Montgomery BW, Powell NP, Qu L, Yaros AC, Lochman JE
Behav Ther · 2025 May · PMID 40287180 · Full text
Coping Power (CP) is a preventive intervention that focuses on reducing child externalizing problems. Although it is typically delivered in a group format (GCP), individually delivered CP (ICP) has produced greater mean...
Coping Power (CP) is a preventive intervention that focuses on reducing child externalizing problems. Although it is typically delivered in a group format (GCP), individually delivered CP (ICP) has produced greater mean reductions in externalizing problems. However, standard analysis of randomized trials loses individual-level information regarding which youth improve, fail to improve, or get worse, whereas clinically significant change (CSC) metrics capture information on individual change. The present study is a secondary analysis of an ICP/GCP trial (N = 360) that examines differences in CSC-based individual-level inferences on externalizing. A novel method for assessing CSC under measurement error-corrected multilevel modeling was used, overcoming three limitations of traditional CSC methods: (a) restriction to two time points, (b) use of total scores, and (c) assumption of constant reliability across time and participants. Because of concerns about Type II errors with all CSC methods, an individual-level effect size metric for CSC was also developed. Based on individualized Cohen's d estimates, individual-level improvements in externalizing from 4th through 11th grades of d ≥ 0.5 were significantly greater in ICP (73%) versus GCP (45%). Further, GCP saw significantly higher percentages of youth with worsening of externalizing, underscoring concerns about diminished effects for GCP. Half of the sample had improvement that was not statistically significant but exceeded d ≥ 0.5, highlighting the susceptibility to Type II errors of CSC's results based on statistical significance. An examination of ICP/GCP differences under advanced CSC analysis gives more nuanced information than conventional randomized controlled trial analysis and greater precision in estimating individual-level outcomes than standard CSC methodologies.
Self-Guided Behavioral Activation Using an Online Single-Session Intervention: Content and Lexical Analyses of Activity Scheduling.
Peipert A, Rutter LA, Howard J … +1 more , Lorenzo-Luaces L
Behav Ther · 2025 May · PMID 40287179 · Publisher ↗
The Common Elements Toolbox (COMET) is a self-guided online single-session intervention (SSI) containing cognitive-behavioral elements, including behavioral activation (BA). Little is known about the process of activity...
The Common Elements Toolbox (COMET) is a self-guided online single-session intervention (SSI) containing cognitive-behavioral elements, including behavioral activation (BA). Little is known about the process of activity scheduling in BA. Using data from an 8-week randomized controlled trial of COMET with 409 online workers with a history of psychopathology, two raters coded the types of activities individuals scheduled during the intervention. Additionally, we compared the activities to a BA dictionary developed from therapist-led psychotherapy. We explored baseline clinical and demographic variables that were predictive of the activity category scheduled and explored the scheduled activity category as a predictor of depression, anxiety, and well-being post-intervention. Results yielded 9 different activity types, most commonly sedentary hobbies (41%), physical activity (29%), and active hobbies (18%). We found a small overlap (17%) between the self-guided BA activities in our COMET sample and those in the existing BA dictionary. Demographic variables were predictive of activity category, but clinical variables were not. The type of activity scheduled was not predictive of post-intervention outcomes. In self-guided BA, individuals, particularly men, less educated participants, and racial-ethnic minorities, tend to pick sedentary activities. Findings underscore the need for adaptive and personalized interventions.
Impact of a Brief Parenting Intervention on Parent and Infant Imitation.
Gillenson CJ, Valente MJ, Hagan MB … +2 more , Cafatti Mac-Niven A, Bagner DM
Behav Ther · 2025 May · PMID 40287178 · Publisher ↗
Research examining the effect of behavioral parenting interventions, such as parent-child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examine...
Research examining the effect of behavioral parenting interventions, such as parent-child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examined the effect of a brief, home-based adaptation of PCIT, the Infant Behavior Program (IBP), on changes in observed frequency of parent and infant imitation, moderating effects of parent language (English, Spanish), and mediational effects of parent and infant imitation on the effect of intervention on infant behavior problems. Participants were 60 12- to 15-month-olds with elevated behavior problems and their primary caregiver, all of which were mothers. Parent-infant dyads were randomly assigned to receive either the IBP or standard pediatric primary care. Parents receiving the IBP demonstrated significantly higher rates of observed imitation at postintervention and at the 3-month follow-up compared to those receiving standard care, and the effect at postintervention was stronger for English-speaking than for Spanish-speaking families. Although the IBP did not directly affect changes in infant imitation at postintervention or the 3-month follow-up, rates of infant imitation increased significantly for those who received the IBP at the 6-month follow-up. Additionally, moderation results suggested that the IBP led to improvements in infant imitation at post for Spanish-speaking families but not for English-speaking families. There were no significant mediational effects of parent or infant imitation. Future research is needed to examine the impact of increases in imitation on other aspects of child development, such as social-cognitive and language abilities, and to examine how cultural factors may play a role in individual differences in imitation.
Misconceptions Among Mental Health Treatment Providers About OCD and PTSD.
Pinciotti CM, Ponzini GT, Colombo GM … +9 more , McLean CP, Fletcher TL, Hundt NE, Wadsworth LP, Van Kirk N, Wells SY, Abramowitz JS, Goodman WK, Storch EA
Behav Ther · 2025 May · PMID 40287177 · Full text
Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) share overlapping features for which similar cognitive behavioral treatment (CBT) strategies can be employed. However, the comorbid presence of...
Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) share overlapping features for which similar cognitive behavioral treatment (CBT) strategies can be employed. However, the comorbid presence of these conditions poses unique clinical considerations, and a nuanced approach to assessment, conceptualization, and treatment is needed when working with individuals with co-occurring OCD and PTSD. Treatment providers may not be aware of these nuances and may hold misconceptions about co-occurring OCD and PTSD, impacting their approach to assessment, conceptualization, and treatment. The current study sought to examine possible misconceptions among mental health treatment providers of differing specializations. Among 146 primarily CBT-oriented treatment providers (20.3% generalist, 13.0% PTSD specialist, 32.6% OCD specialist, and 34.1% OCD/PTSD specialist), exploratory factor analysis categorized misconceptions relating to Trepidation, Differential Diagnosis, Flexibility, OCD is Trauma, Trauma Misconceptions, and Compartmentalization. Overall, OCD specialists endorsed misconceptions most frequently, including those of Trepidation and underestimating the prevalence of trauma and PTSD in individuals with OCD. In contrast, PTSD specialists were more likely to endorse providing patients reassurance for their OCD-related fears, and OCD/PTSD providers were more likely to apply rigid Differential Diagnosis criteria not supported by research or diagnostic criteria to intrusive thoughts and safety behaviors. Misconceptions are explained through the lens of differing conceptualization and treatment approaches between areas of specialization.
A Comparison of Pragmatic and Scalable Strategies to Assess Fidelity to Cognitive Processing Therapy in Routine Care Settings.
Stirman SW, Gumport NB, Calloway A … +21 more , Gunter C, Marques L, Hernandez S, Song J, Johnson C, Youn SJ, Elhusseini S, Deguzman-Lucero RM, Loskot T, Bash H, Silvan YA, Canale C, Park AL, Lagdamen J, Bartuska AD, Jo B, Barnett P, Kuhn E, DeRubeis R, Vogt D, Creed TA
Behav Ther · 2025 May · PMID 40287176 · Publisher ↗
Fidelity monitoring is crucial for successful implementation of evidence-based practices, but traditional methods such as observation and video recording are impractical for routine mental health care due to their high r...
Fidelity monitoring is crucial for successful implementation of evidence-based practices, but traditional methods such as observation and video recording are impractical for routine mental health care due to their high resource demands. A reliable, low-burden fidelity (adherence and competence) assessment can support the implementation of cognitive behavioral therapies (CBTs). This study evaluated two pragmatic alternatives to the time and cost-intensive "gold standard" observer ratings based on session recordings to assess fidelity in Cognitive Processing Therapy (CPT). We assessed the feasibility of clinician-completed adherence checklists and ratings of worksheets that were completed during sessions in public and private mental healthcare settings by a diverse sample of patients with significant trauma histories and their therapists. We also examined whether fidelity ratings using these approaches were associated with observer ratings of fidelity and with subsequent PTSD symptom change. Results indicated high overall rater agreement for adherence and competence on CPT worksheets and session recordings. We found significant associations among traditional observer ratings of adherence and our two low-burden alternatives for assessing adherence. Clinician-completed adherence checklists were also associated with subsequent symptom change. Checklists and worksheets required substantially less time to rate than session recordings. Overall, checklists and worksheets emerged as reliable and feasible methods for fidelity assessment, potentially diminishing the necessity for time- and labor-intensive fidelity ratings based on session recordings. Our findings suggest a scalable approach for integrating fidelity monitoring and support into policies aimed at enhancing the accessibility and effectiveness of evidence-based care.
Evaluating the Effectiveness of Safety Plans for Mitigating Suicide Risk in Two Samples of Psychiatrically Hospitalized Military Veterans.
Kearns JC, Crasta D, Spitzer EG … +6 more , Gorman KR, Green JD, Nock MK, Keane TM, Marx BP, Britton PC
Behav Ther · 2025 Mar · PMID 40010911 · Publisher ↗
Although safety plans (SPs), following the Stanley-Brown Safety Planning Intervention protocol, are required for suicidal veterans receiving treatment in the Veterans Health Administration (VHA), prior studies have shown...
Although safety plans (SPs), following the Stanley-Brown Safety Planning Intervention protocol, are required for suicidal veterans receiving treatment in the Veterans Health Administration (VHA), prior studies have shown that they are frequently incomplete or are not sufficiently personalized to the unique circumstances of each patient. In two studies, we examined SP completeness, SP quality (i.e., degree to which the SP was clear, actionable, and personalized), and SP fidelity (i.e., sum of completeness and quality). We also examined which SP steps were associated with a reduced likelihood of future psychiatric rehospitalizations (Study 1) and suicide attempts (Study 2) following hospital discharge. Participants were veterans admitted to two VHA acute inpatient psychiatric units for suicide risk (Study 1: N = 78; Study 2: N = 132). SPs were coded by independent raters on completeness, quality, and fidelity; step scores (e.g., Step 1 quality) were summed to create whole-plan scores (e.g., SP quality). In Study 1, 52.5% of participants had an SP and, in Study 2, 93.1% of participants had an SP. In Study 1, whole plan scores were not associated with subsequent psychiatric hospitalization status, but higher Step 2 (internal coping) fidelity scores were associated with decreased likelihood of rehospitalization (AHR = 0.05, 95% CI [0.30, 0.84], p = .008). In Study 2, higher whole-plan quality (AHR = 0.79, 95% CI [0.66, 0.95], p = .012) and fidelity (AHR = 0.84, 95% CI [0.71, 0.99], p = .040) scores were associated with a decreased likelihood of future suicide attempt. Step 1 (warning signs) quality (HR = 0.48, 95% CI [0.30, 0.76], p = .002) and fidelity scores (AHR = 0.57, 95% CI [0.37, 0.90], p = .016) were associated with a decreased likelihood of future suicide attempt. The association of SP characteristics differs by outcome of interest, and fidelity of internal coping strategies may contribute to preventing rehospitalizations, whereas quality and fidelity of warning signs may help prevent future suicide attempts. Overall, results suggest that mandating SPs without training and implementation strategies to ensure quality is not enough.
Affective and Behavioral Responses to Time-Out in Preschool Children With Conduct Problems and Varying Levels of Callous-Unemotional Traits.
Kimonis ER, Cooper F, Neo B … +4 more , Fleming GE, Chan ME, McDonogh C, Dit Bressel PJ
Behav Ther · 2025 Mar · PMID 40010910 · Publisher ↗
Punishment insensitivity characterizes individuals with callous-unemotional (CU) traits. This has been put forward as an explanation for their persistent conduct problems despite intervention. The purpose of the current...
Punishment insensitivity characterizes individuals with callous-unemotional (CU) traits. This has been put forward as an explanation for their persistent conduct problems despite intervention. The purpose of the current study was to compare the emotional and behavioral responses to parent-implemented time-out within a behavioral parent training intervention between children with conduct problems who are high versus low on CU traits. Children (N = 87; M age = 4.88 years, SD = 1.32; 78% male) referred to a specialty clinic for the treatment of conduct problems were observed and coded during time-out, and their parents rated their conduct problem severity and CU traits using psychometrically robust measures. Children with conduct problems and high CU traits showed significantly more calm/neutral emotion and less negative emotion upon initial placement in time-out by parents, but did not engage in more negative behaviors or spend longer in time-out relative to children with conduct problems alone. After a minimum of 3 weeks of exposure to this form of parental discipline, most children complied with effective parental commands in that they did not require time-out for noncompliance during the fourth discipline-focused treatment session. Findings have implications for understanding why children with CU traits continue showing high levels of conduct problems post behavioral interventions, and they lend further support for the need to personalize treatment to their distinct needs.
Psychometric Properties of the Modified Scale for Suicidal Ideation-Self-Report-Revised With High-Risk Adolescents.
López R, Esposito-Smythers C, Lee P … +2 more , Leichtweis RN, Miller IW
Behav Ther · 2025 Mar · PMID 40010909 · Publisher ↗
In treatment-seeking samples, approximately 40% of adolescents with suicidal ideation transition to engaging in suicidal behavior. Thus, assessment of the severity of suicidal ideation during care is critically important...
In treatment-seeking samples, approximately 40% of adolescents with suicidal ideation transition to engaging in suicidal behavior. Thus, assessment of the severity of suicidal ideation during care is critically important. However, few free, self-report, evidence-based measures that assess for severity of suicidal ideation exist. To address this need, the present study examined several psychometric properties of a revised version of the Modified Scale for Suicidal Ideation-Self Report (MSSI-SR-R) with adolescents. A sample of 284 adolescents (M = 15.30; SD = 1.42; range = 12-18; 62.7% White; 75.7% Non-Hispanic/Latinx) enrolled in a partial hospital program (PHP) completed the MSSI-SR-R at the beginning of treatment. The factor structure of the MSSI-SR-R was assessed using bifactor exploratory structural equation modeling. Measurement invariance across sexual identity was also examined. Internal consistency was calculated using omega. Validity was assessed by comparing scores on the MSSI-SR-R to well-validated self-report measures of suicidal thought and behaviors as well as depressive symptoms. Results supported a bifactor model with a general factor and two specific factors (i.e., Desire/Ideation and Plans/Preparation), which was invariant across sexual identity. The MSSI-SR-R total score demonstrated good reliability and was positively associated with measures of suicidal ideation and behaviors as well as depressive symptom severity. Though additional psychometric work is needed, the MSSI-SR-R demonstrated good psychometric properties. It may offer utility in clinical settings as a brief, free, and validated assessment of severity of suicidal ideation.
Body Dissatisfaction Is Central to Military Eating Disorder Pathology: A Multi-Time-Point Network Analysis.
Kinkel-Ram SS, Grunewald W, Tubman LCSD … +3 more , Esche MA, Levinson CA, Smith AR
Behav Ther · 2025 Mar · PMID 40010908 · Publisher ↗
Military membership may put individuals at risk for eating disorders (EDs) due to military specific risk factors such as strict physical fitness requirements, increased salience of weight, and exposure to trauma. Current...
Military membership may put individuals at risk for eating disorders (EDs) due to military specific risk factors such as strict physical fitness requirements, increased salience of weight, and exposure to trauma. Current ED assessments and treatments do not account for these military-specific risk factors. Empirically identifying maintaining factors for EDs can clarify which specific ED symptoms may be efficacious treatment targets for service members and veterans. Thus, we employed network analysis within a military sample to identify central ED symptoms and compare if these symptoms changed across three time-points. We hypothesized that body dissatisfaction and overexercise would be identified as central symptoms across all three time-points. Individuals in the military (73.7% male, 84.8% active duty, M = 30.74) completed the Eating Pathology Symptom Inventory (EPSI; Forbush et al., 2013) at baseline (n = 216), and at 1-month (n = 191) and 3-month follow-up (n = 176). We computed cross-sectional graphical LASSO networks and found that the most central symptoms were related to body dissatisfaction, overexercise, binge eating and diet pill/diuretics; these symptoms were largely stable across multiple time-points. Body dissatisfaction was identified as central across all three time-points and overexercise, binge eating, and diet pill/diuretics were identified as central across two timepoints. These findings are in line with network studies among men and clinical patients that find weight/shape concerns consistently emerge as central ED symptoms. Given that overexercise and diuretics are both central symptoms and frequently employed by military populations, providers should assess these symptoms and work to treat them in a culturally responsive way when they arise.
Exploring the Effectiveness and Acceptability of a Self-Help Acceptance-Based Behavior Intervention for Anxiety in Black Adults: An Uncontrolled Pilot Study.
Miller AN, Graham-LoPresti J, Liverant G … +2 more , Roemer L, Orsillo SM
Behav Ther · 2025 Mar · PMID 40010907 · Publisher ↗
An estimated one in five Black Americans meet criteria for an anxiety disorder in their lifetimes (Alvarez et al., 2019), but only about 20% of these receive mental health services. Self-help materials that have been sho...
An estimated one in five Black Americans meet criteria for an anxiety disorder in their lifetimes (Alvarez et al., 2019), but only about 20% of these receive mental health services. Self-help materials that have been shown to be effective in reducing anxiety and worry could be one method of increasing access to evidence-informed treatments for Black Americans. The current study explored the acceptability and effectiveness of the Worry Less, Live More: The Mindful Way Through Anxiety Workbook (WLLM), a self-help workbook based on acceptance-based behavioral therapy, for reducing anxiety in a sample of Black individuals. Sixty-five Black individuals residing in the United States received the WLLM workbook and were asked to read it over 16 weeks at their own pace without intervention from researchers: 40 of those participants completed the follow-up survey. A majority of the participants agreed that the approach was a good match for them (70%) that it aligned with their personal and cultural views (60%), and that the strategies from the workbook were helpful for them when dealing with the stress related to encountering racial stressors (71%). There were significant improvements over time on self-reported general anxiety (d = .50, anxious arousal (d = .41), cognitive fusion (d = .45), and acceptance (d = .76), but no significant changes in engagement in values-based action over time. This study provided preliminary support for the acceptability of WLLM's acceptance-based approach for Black adults.
A Pilot Randomized-Controlled Trial of Sleep Scholar: A Brief, Internet-Based Insomnia Intervention for College Students.
Crosby ES, Troop-Gordon W, Witte TK
Behav Ther · 2025 Mar · PMID 40010906 · Publisher ↗
This randomized-controlled trial examined the efficacy of Sleep Scholar, a brief, internet-based insomnia intervention tailored to the needs of college students. College students commonly experience insomnia and various...
This randomized-controlled trial examined the efficacy of Sleep Scholar, a brief, internet-based insomnia intervention tailored to the needs of college students. College students commonly experience insomnia and various other mental health symptoms, including suicide ideation. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is a promising suicide prevention effort for college students because insomnia is robust risk factor for suicide ideation and CBT-I reduces suicide ideation. Moreover, CBT-I can be brief, self-guided, and internet-based. CBT-I also may elicit less stigma than treatment specifically targeting suicide ideation. However, existing forms of brief CBT-I are neither self-guided nor internet-based, and existing forms of self-guided, internet-based CBT-I are not brief. In addition, previous iterations of CBT-I are not typically designed to address the unique sleep needs of college students. For this registered clinical trial, we recruited 61 college students with at least subclinical insomnia symptoms. Participants were randomized to either Sleep Scholar or a control condition, Building Healthy Habits. Participants completed pretreatment daily sleep diaries and surveys, a posttreatment assessment of acceptability and satisfaction, a 1-week and 1-month survey follow-up, and daily sleep diaries throughout the 1-month follow-up period. Results showed that Sleep Scholar was more acceptable and satisfactory compared to the control condition at posttreatment. However, Sleep Scholar was not more effective for improving sleep or mental health symptoms compared to the control condition. These findings suggest that modifications to Sleep Scholar are needed to improve its efficacy.
A Pilot Open Trial of a Text Message Safety Behavior Fading Intervention for Appearance Concerns Among Women.
Patel TA, Cougle JR
Behav Ther · 2025 Mar · PMID 40010905 · Publisher ↗
Appearance concerns are a key feature in body dysmorphic disorder and eating disorders, and they have been found to be a common feature of social anxiety disorder. Given the lack of transdiagnostic treatments for appeara...
Appearance concerns are a key feature in body dysmorphic disorder and eating disorders, and they have been found to be a common feature of social anxiety disorder. Given the lack of transdiagnostic treatments for appearance concerns, we developed a preliminary text-based intervention targeting appearance-related safety behaviors (ARSBs; i.e., maladaptive behavioral strategies that seek to mitigate the feared consequences of the evaluation of appearance). The intervention utilized a daily text-message protocol where individuals are asked to fade their behaviors, provided encouragement, and log ARSB use in the past day. We evaluated the efficacy of ARSB fading in two successive cohorts of women with elevated appearance concerns (Study 1 N = 38, Study 2 N = 39). We found that across both studies participants experienced large reductions in appearance concerns (d = .93-1.36) and eating disorder symptoms (d = 1.06-1.20) that were maintained 1 month after treatment. Further, participants experienced small-to-medium reductions in social anxiety (d = 0.38-0.58) and depression (d = 0.52-0.96) from pre- to posttreatment. Notably, there were missing data in both studies (31%-50%), but multiple imputation was used to observe stability of effects. We also collected and incorporated feedback on the treatment to optimize the treatment before conducting the second trial. While these changes did not lead to significant differences in study outcomes, the second cohort demonstrated greater adherence to treatment and found the treatment to be more credible than the first cohort. Further, we found that greater baseline ARSBs predicted greater pre- to follow-up changes in appearance concerns. Taken together, text-based ARSB fading appears to be a promising treatment, and further research on the treatment appears warranted.
Latent Trajectories of Depressive Symptoms During a Transdiagnostic Partial Hospitalization Program.
Moscardini EH, Hudson CC, Kumar D … +7 more , Lewin R, McDermott TJ, Giangrande EJ, Shea LM, Tretyak V, Beard C, Björgvinsson T
Behav Ther · 2025 Mar · PMID 40010904 · Publisher ↗
Partial hospitalization programs (PHPs) offer a critical level of care that bridges the gap between outpatient and inpatient treatment. Many PHPs implement transdiagnostic approaches, treating patients with a wide range...
Partial hospitalization programs (PHPs) offer a critical level of care that bridges the gap between outpatient and inpatient treatment. Many PHPs implement transdiagnostic approaches, treating patients with a wide range of presenting problems. Despite research suggesting that transdiagnostic PHPs are associated with favorable treatment outcomes, research has yet to examine possible heterogeneity in symptom trajectories as well as factors which may be related to said heterogeneity. We analyzed daily depression symptoms (both cognitive/affective and somatic) of 2,640 patients receiving treatment in a transdiagnostic PHP and identified latent subgroups characterized by heterogeneous trajectories. We then sought to determine if certain patient demographic factors or diagnostic factors were related to trajectories of depression symptoms throughout treatment. Results indicated three classes of trajectories for both cognitive/affective and somatic symptoms of depression: (1) low initial symptoms with steady improvement, (2) consistently high symptoms, and (3) initial worsening then rapid improvement. Female sex and greater psychiatric comorbidity were significantly associated with the consistently high symptom trajectory. Implications and future directions are discussed.
Partner-Caregivers' Interpretation Bias and Sexual Satisfaction: Gender and Congruency in Pain-Related Beliefs.
Alizadeh P, Mohammadi AZ, Heidari M … +2 more , Alidoust S, Khatibi A
Behav Ther · 2025 Mar · PMID 40010903 · Publisher ↗
It has been suggested that family caregivers of chronic pain patients may develop cognitive biases similar to those observed among patients in previous studies. However, there is a gap in knowledge regarding the effect o...
It has been suggested that family caregivers of chronic pain patients may develop cognitive biases similar to those observed among patients in previous studies. However, there is a gap in knowledge regarding the effect of such biases on patients' adaptation to pain. In this study, we examined the relationship between partner-caregivers' interpretation bias and sexual satisfaction among married heterosexual couples. We further examined the relationship between caregivers' interpretation bias and congruency in the beliefs that patients and caregivers hold about the experience of pain. The sample comprised 32 married couples in a caregiving relationship and 28 married individuals who were neither patients nor caregivers, serving as control participants. Caregivers and controls completed a modified version of the interpretation bias task. Patients and caregivers filled out the Sexual Satisfaction Index and a Patient's Pain-Related Disabilities Checklist. Results confirmed that a biased negative interpretation exists among caregivers when compared to partners of pain-free individuals. A noticeable gender effect was observed in the effect of interpretation bias on patients' sexual satisfaction. Female partner-caregivers' negative interpretation bias was associated with a lower level of sexual satisfaction among male patients. In contrast, the same bias was associated with higher levels of sexual satisfaction among female patients when observed among male partner-caregivers. Furthermore, a moderate but not symmetrical positive interpretation was associated with higher levels of congruence on the level of patients' disability within couples. The findings are another step toward incorporating the social circuit of individuals with chronic pain conditions into intervention protocols.
Generalization Between Perceptually Similar Stimuli Is Associated With Improvement in Social Anxiety Following Cognitive-Behavioral Therapy.
Barry TJ, Treanor M, LeBeau RT … +3 more , Ruiz J, Himle JA, Craske MG
Behav Ther · 2025 Mar · PMID 40010902 · Publisher ↗
Cognitive-behavioral therapy (CBT) for anxiety disorders requires that people learn to inhibit their fear during exposure to stimuli that no longer pose a threat. We investigate whether individual differences in this inh...
Cognitive-behavioral therapy (CBT) for anxiety disorders requires that people learn to inhibit their fear during exposure to stimuli that no longer pose a threat. We investigate whether individual differences in this inhibitory learning ability, measured prior to treatment, can predict responsiveness to CBT for social anxiety disorder. Participants (N = 128) were randomized to CBT or a wait-list control and completed tests of fear generalization and extinction prior to and following the intervention period. Contrary to expectations, individual differences in extinction, measured at pretreatment, were not associated with treatment responses but there was evidence that these abilities changed over time due to treatment. Individual differences in fear generalization at pretreatment were associated with treatment responses. Weaker generalization between dangerous and perceptually similar but novel safe stimuli was associated with enhanced responding to CBT. These findings contribute to the development of a mechanistic approach to patient stratification where participants who are least likely to respond to CBT can be identified prior to treatment.
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