The Roles of Adherence and Usage Activity in Adolescents’ Intervention Gains During Brief Guided Online Acceptance and Commitment TherapyHämäläinen, Tetta; Kaipainen, Kirsikka; Keinonen, Katariina; Lappalainen, Päivi; Puolakanaho, Anne; Lappalainen, Raimo; Kiuru, Noona
2023 Journal of Cognitive Psychotherapy
doi: 10.1891/jcp-2021-0038pmid: 35470151
Objective: This study investigated the roles of adherence and usage activity in adolescents’ ( n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT). Method: Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention. Results: First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K -means cluster analysis in regard to adherence, usage activity and intervention gains: (1) “Adhered, committed users with relatively large intervention gains” (35%), (2) “Less committed users with no intervention gains” (42%), and (3) “Non-committed users with no intervention gains” (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion. Conclusions: The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.
A Case Study of a Woman With Obsessions Related to COVID-19Hunter, Anna B.; Turk, Cynthia L.; Kriegshauser, Kathryn D.
2023 Journal of Cognitive Psychotherapy
doi: 10.1891/jcp-2021-0001pmid: 37369537
This de-identified case study seeks to increase the understanding of the process and impact of modifying exposure and response prevention (ERP) to address obsessions associated with COVID-19. The case study presents the assessment, diagnosis, and treatment of obsessive-compulsive disorder via televideo utilizing ERP for a woman who presented with difficulty with contamination and harm obsessions related to COVID-19. Over the course of 7 months, including an initial evaluation, this client attended 24 treatment sessions via synchronous video telehealth. Psychoeducation, self-monitoring, in vivo and imaginal exposures, response prevention, and behavioral activation strategies were utilized. Following treatment, this client was successfully managing symptoms and her scores on the Yale Brown Obsessive-Compulsive Scale and Sheehan Disability Scale had decreased significantly.
Fearful Temperament, Catastrophizing, and Internalizing Symptoms in Clinically Anxious YouthBusch, Haley E. Conroy; Viana, Andres G.; Raines, Elizabeth M.; Trent, Erika S.; Zvolensky, Michael J.; Storch, Eric A.
2023 Journal of Cognitive Psychotherapy
doi: 10.1891/jcp-2021-0022pmid: 35470150
A fearful temperament in childhood is associated with child internalizing symptoms. However, the cognitive mechanisms explaining this association are poorly understood. We examined the effects of child fearful temperament on child internalizing symptoms and the underlying role of catastrophizing cognitions among clinically anxious youth. Children ( N = 105; M age = 10.09 years, SD = 1.22; 56.7% female; 62% ethnic minority) completed a diagnostic interview; self-report measures of temperament, catastrophizing, and internalizing symptoms; and behaviorally-indexed measures of catastrophizing and anxiety. Indirect effects were found for child fearful temperament on child self-reported internalizing symptoms by way of self-reported (but not behaviorally-indexed) catastrophizing cognitions. Models predicting behaviorally-indexed child anxiety were not significant. Our findings suggest that targeting fearful temperament during childhood before catastrophizing cognitions develop may have clinical utility. Likewise, among children temperamentally at-risk, addressing catastrophic cognitions may prevent later internalizing psychopathology.
Different Psychological Processes in Traditional and ACT-Enhanced ERP for Obsessive-Compulsive DisorderBuchholz, Jennifer L.; Abramowitz, Jonathan S.; Hellberg, Samantha N.; Ojalehto, Heidi J.; Twohig, Michael
2023 Journal of Cognitive Psychotherapy
doi: 10.1891/jcp-2021-0004pmid: 37463698
Background: Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experiences. Aims: Accordingly, the present study aimed to examine the effect of ACT+ERP on appraisals of intrusive thoughts, relative to standard ERP. Methods: Forty-eight adults who received 16 treatment sessions as part of a randomized controlled trial comparing standard ERP to ACT+ERP completed the Interpretation of Intrusions Inventory (III) at pre-treatment, post-treatment, and follow-up. Results: Results showed a significant main effect of time for all III subscales, suggesting that appraisals of intrusive thoughts shift over the course of treatment. The effect of the condition × time interaction, however, differed between the III subscales. Specifically, a significant interaction emerged for the control of thoughts subscale, such that individuals who received ACT+ERP experienced greater reductions in beliefs about the need to control thoughts. The interaction term was not significant for importance of thoughts or responsibility subscales. Conclusions: Findings suggest that augmenting ERP with ACT enhances change in beliefs about the need to control thoughts, but not in beliefs about responsibility and the importance of thoughts. Clinical implications and future research directions will be discussed.
An Investigation of the Moderating Role of Estradiol in Interoceptive Exposure Therapy for Women With Panic DisorderLevy, Hannah C.; Goldblum, Rachel S.; Mullins, Jessica; Tolin, David F.
2023 Journal of Cognitive Psychotherapy
doi: 10.1891/jcp-2022-0012pmid: 37369539
Emerging research in animal models and healthy women indicates that the sex hormone estradiol may moderate fear of extinction. There is limited research on estradiol in exposure-based therapy among clinically anxious women. The current pilot study aimed to address this gap by comparing exposure outcomes in women with panic disorder (PD) who had high (HE) vs. low estradiol (LE). Twenty-eight women (14 per group) with PD completed two interoceptive exposure sessions on consecutive days as well as self-report measures of panic severity. Electrodermal activity was assessed continuously throughout the exposure sessions. Results showed that although anxiety sensitivity and subjective distress improved from pre- to postexposure, suggesting that the intervention was effective in reducing panic-related anxiety, there were no differences in outcomes between the HE and LE groups. The findings suggest that estradiol may not moderate outcomes in exposure therapy in clinically anxious samples, although replication in larger samples will be needed.