Cognitive Therapy and Research

Negative illness representations such as self-blame impede treatment-seeking behavior and therapy motivation in individuals with eating disorders (EDs). However, only one study so far has investigated how different explanatory models influence these beliefs in EDs. We aimed to expand these findings by introducing an explanatory model based on network theory (NT). We presented three explanatory models to a diverse web-recruited sample (n = 290, 141 females, 149 males) with clinically elevated ED symptomatology. Participants either watched a video with a biological-genetic (BG), cognitive-behavioral (CB) or an NT explanatory model and were asked about illness representations before and after watching the video. The BG group showed significantly greater reductions in self-blame but a significant decrease in personal control and less optimistic expectation regarding timeline compared to the CB and NT groups. There were no group differences regarding the perception of the clinician, comprehensibility of the explanatory model and credibility of a CBT intervention. Given the increasing popularity of biological-genetic explanatory models of EDs, it is important to note the disadvantages we found to be associated with these models. Our findings indicate that explanatory models emphasizing cognitive-behavioral (CB) principles and/or network theoretical (NT) underpinnings of EDs may serve to promote optimism and greater perceptions of personal agency in affected populations. This trial's registration number is 316.

The efficacy of virtual reality exposure therapy (VRET) for fear of flying has been well established. Yet, little is known about the extent to which anxiety sensitivity and self-efficacy predict the efficacy of VRET. We aimed at investigating these cognitive predictors as well as the contribution of the therapeutic alliance to treatment outcome. In a within-subjects design with 67 patients with fear of flying, four sessions of an exposure-based treatment using VRET were given. Sessions were held every week, each consisting of two virtual flights of 25 min. Results showed that pre-treatment levels of anxiety sensitivity, initial improvement in self-efficacy (and not pre-treatment levels of self-efficacy), and the quality of the therapeutic alliance significantly predicted treatment outcome. The findings provide evidence that initial changes in self-efficacy, pre-treatment anxiety sensitivity, and therapeutic alliance are significant predictors of response to VRET for specific phobia.

Prior research has shown that difficulties in emotion regulation is associated with overall levels of posttraumatic stress symptoms (PTSS). However, it is currently unclear which facets of difficulties in emotion regulation (e.g., lack of emotion regulation strategies, impulse control problems, non-acceptance of emotional responses) are associated with specific PTSS clusters. This information may be valuable in refining treatment approaches in PTSS. The aim of the current study was to use structural equation modeling to test the relationships between Difficulties in Emotion Regulation Scale (DERS) subfactors and PTSS in a trauma-exposed community sample (N = 746). Results indicated that impulse control difficulties were most consistently associated across PTSS clusters (i.e., re-experiencing, avoidance, and hyperarousal), while lack of emotion regulation strategies and emotional clarity were uniquely associated with numbing symptoms, after covarying for neuroticism. However, other facets of difficulties in emotion regulation (i.e., non-acceptance of emotional responses and difficulties engaging in goal-directed behavior while upset) were not associated with PTSS. These findings provide further support for the role of difficulties in emotion regulation in specific PTSS clusters. Additionally, they suggest that impulse control problems may be important in the development of most PTSS and thus most beneficial to target clinically, while lack of emotional clarity and effective emotion regulation strategies may be specific to numbing symptoms.

Hopelessness about the future is an important component of depression in general and suicidal behavior in particular. Despite this, little research has examined the concept of hopelessness. A study is reported which adapted a verbal fluency paradigm to examine the ease with which hospitalized parasuicides, hospital controls, and nonhospital controls were able to think about future positive (things they were looking forward to) and future negative (things they were not looking forward to) events. The parasuicide subjects showed a deficit in being able to think of future positive events, both for the immediate future and for the longer-term future. but there were no differences between the groups on being able to think of future negative events. Several possible explanations of the results are discussed and some suggestions are made for future research.

Perhaps the single most important (re)discovery of 20th-century psychology has been that of the self. Conceptualizations of self are diverse, and the nature of its cognitive representation raises important issues about traditional concepts of memory. After discussing the relationship between identityconstructing processes and resistance to change, selected exercises in self-exploration are discussed and illustrated. It is concluded that the experiences of the “serving self” (i.e., the psychotherapist) are of fundamental significance for our understanding and refinement of professional services.

Studies have found experiential avoidance mediates the relationship between sexual victimization and psychological symptoms; however, this work has been conducted primarily with Caucasian samples. The purpose of this study was to examine whether this model is applicable to a more ethnically diverse sample. Structural equation modeling was used to test a model in which avoidance mediated the relationship between sexual victimization and symptoms of post-traumatic stress disorder and depression. The model was tested simultaneously in a sample of ethnic minority women (n = 190) and in a sample of Caucasian woman (n = 473), with parameter estimates specifying the relationships among the variables fixed to be equal in both samples. The results indicated that the model was an excellent fit for the data, and support the hypothesis that sexual victimization influences depression and post-traumatic stress disorder via the same mechanisms in both Caucasian and minority samples. Findings add to the growing literature suggesting that chronic experiential avoidance may be a maladaptive process underlying the relationship between sexual victimization and negative psychological outcomes.

The comparability of data generated by think aloud and thought listing was investigated. High math-anxious students completed two sets of mathematics problems. During one set they thought aloud while problem solving and during the other they listed their cognitions after completing each problem. Assessment method order and problem set order were counterbalanced in a split-plot design. The dependent variables included 11 cognitive content variables, subjective anxiety, number of problems correct, and amount of time for each problem set-assessment phase. Students were significantly more anxious and took longer to list thoughts than to think aloud. Differences on number of problems correct approached significance. On the average, think aloud produced about twice as many thoughts as thought listing and significantly more thoughts in four categories: review of information, strategic calculations, conclusions, and attention control. Thought listing produced significantly more positive problem-solving evaluations and more positive self-evaluations. An analysis on proportions revealed the same differences plus a significantly greater proportion of thoughts in five other categories for thought listing. The implications for cognitive assessment were discussed.

Worry-related negative metacognitive beliefs about worrying maintain and predict pathological worry. For the current proof-of-principle study, we developed a computerized cognitive bias modification based—reappraisal training (RT), to modify the appraisal of negative metacognitive beliefs in a high-worrying sample. A functional and dysfunctional RT were pitted against each other to investigate whether appraisals of one’s thinking and coping changed following training. Moreover, training effects on the number of negative thoughts and interpretations of the worry content were examined. Participants (N = 81) were trained to adopt a functional (disconfirmation of negative metacognitive beliefs) or dysfunctional (confirmation of negative metacognitive beliefs) appraisal style using a series of vignettes that had to be completed in line with the intended training direction. Changes in negative thoughts from pre- to post-RT were assessed with a behavioral state worry task, and transfer to interpretations with an open-ended stem sentence task. Findings support the use of the RT to alter a metacognitive appraisal bias, as participants receiving the functional RT reported fewer negative appraisals of one’s thinking and coping than participants in the dysfunctional RT group. Number of negative thoughts and interpretations were not directly affected by training. This study employed an analog sample and future research should replicate findings in a clinical sample for which negative metacognitions are more relevant. These findings highlight the potential of metacognitive RT for future translational studies with (clinical) samples characterized by repetitive negative thinking and/or negative metacognitive beliefs.