Cognitive Therapy and Research

Hopelessness is a complex phenomenon with important clinical consequences, such as depression and suicidality. Despite its major impact on mental health, little is known about the structure of hopelessness. In this study, hopelessness was investigated in a large community sample (n = 1985), recruited to be highly representative of general population in Germany. In the context of network analysis, state-of-the-art techniques were adopted (i) to investigate which thoughts and beliefs (nodes) are the most central ones and (ii) to shed light on the specific associations (edges) among them. Stability and accuracy were also checked to ensure trustworthiness of the findings. The analyses revealed that expecting more negative than positive future events and having important goals blocked along with feelings of giving-up were the most central elements of hopelessness. Moreover, being unable to imagine the future and perceiving it as vague and uncertain were both coupled with anticipating a dark future. Theoretical and clinical consequences of this study were discussed.

A large literature suggests that cognition inclose relationships influences interpersonal processesand outcomes. The present study sought to extend thisarea of inquiry by investigating whether valenced cognitions about a target-child influencesmother's mood, whether preexisting trait conceptions ofthe child moderates this effect, and whethercognition-induced mood alters subsequent traitconceptions of the target. Eightymothers listed and wroteabout positive or negative characteristics of theirchildren. Regardless of child-trait conceptions,activating positive information elevated mothers' mood. In contrast, activating negative informationlowered mood only in mothers with relatively negativechild-trait conceptions. Mood induced by the cognitiveactivation procedure also independently contributed to postactivation child-trait conceptions ofthe child. Results suggest that negative traitconceptions of a child may create a cognitive contextthat makes parents vulnerable to negative affectivereactions to child behavior.

The stress inoculation paradigm for helping clients deal with pain consists of education about the psychological dimensions of pain à la Melzack, training in a number of coping skills relevant to each dimension, and practice in applying these skills to the noxious stimulus. In order to determine which of these treatment components have a reactive effect, 70 screened clients were randomly assigned to one of five treatment conditions. The cold pressor and pressure algometer tasks, respectively, yielded three direct and three generalization measures. On all direct measures coping skills training resulted in highly significant improvement. Neither education (i.e., insight)nor exposure had any effect. In comparison to a nonspecific treatment the stress inoculation package proved useful on two direct measures; however, on the generalization measures neither stress inoculation nor any of its components had any impact. Heart rate changes, observed for exploratory purposes, were consistent with current research and speculation.

The cognitivist assertion that the depressive's negative cognitions are erroneous and immune to corrective environmental feedback rests on the implicit assumption that the feedback is not particularly negative in comparison to the feedback encountered by nondepressives. This paper reviews data concerning two related types of negative information available to the depressive: the actual circumstances in the depressive's life and the meanings attached to those circumstances by persons other than the depressive. It is suggested that depressed persons may be confronted by more negative information than nondepressed persons. The negative information may disconfirm positive beliefs about reality or elicit and validate negative beliefs. It is concluded that the cognitions concerning the self or the world of the depressive are not necessarily erroneous or impervious to the available information. The theoretical and clinical implications from a reciprocal influence perspective are discussed.

Homework, or practice of skills learned in treatment, is a critical component of cognitive-behavioral therapy (CBT). However, no matter how much effort clients put into their therapy homework, this effort can only be useful if adherence to homework is related to improvement in symptoms. Although homework adherence (the extent to which clients practice skills learned in therapy outside of sessions) has been studied with respect to psychotherapy outcomes, ‘homework utility’, a potentially important mechanism of action in cognitive behavioral treatments, has yet to be operationally defined as a distinct construct, and it has yet to be studied with respect to psychotherapy outcome. We therefore propose an operational definition of therapy homework utility: the extent to which homework adherence is associated with parallel symptom improvement across time throughout treatment for each individual client. In this capacity, an indicator of homework utility is operationalized as the within subject correlation of session-by-session homework adherence with session-by-session symptom change. We used a sample of clients who underwent CBT for attention-deficit hyperactivity disorder in adulthood as an example to quantify homework utility and examine its association to treatment outcome. Consistent with our hypotheses, homework utility was significantly associated with overall therapy outcome. Homework utility may be an important construct relevant to the mechanism of action of structured psychotherapies, and examining within subject sessions-by-session correlations with symptomatic change may be a useful way to examine other psychotherapy process variables.

The seven papers included in this volume converge in many of their assumptions about the representation of the self, yet a number of issues remain unresolved. These issues, including the structure and functioning of self-representations, and the role of negativity, affect, and the “other” in the self-system, are discussed here.

To evaluate a causal relationship between biased information processing and fear responding, as posited by many cognitive models of anxiety disorders, spider-relevant interpretations were trained to be non-threatening in an analog phobic sample. Participants high in spider fear (N = 61) were randomly assigned to a ‘Positive training’ condition, or to a ‘Neutral training’ or ‘No training’ control condition. ‘Positive training’ involved learning to ascribe non-threatening meanings to emotionally ambiguous scenarios. Results suggested this training was successful at inducing interpretation biases to be non-threatening, as indicated by faster responses to positive (versus negative) word fragments, as well as more positive and less negative interpretations of novel scenarios (relative to control conditions). Notwithstanding, the impact of training on subsequent avoidance and fear when presented with a live spider was minimal. No differences across training conditions were found; however, faster responding to positive word fragments predicted less avoidance and fear for participants receiving ‘Positive training’.

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed.

To compare the outcomes of cognitive therapy for depression under controlled and clinically representative conditions, while holding several therapist and clinical assessment factors constant. Treatment outcomes for a sample of 23 adults with a primary diagnosis of Major Depressive Disorder who received cognitive therapy in an outpatient clinic were compared with outcomes of 18 clients who were treated in the cognitive therapy condition of a large, multi-site randomized clinical trial of treatments for depression. All participants had been treated by one of two therapists who served as clinicians in both settings. Individuals in the two samples were diagnostically and demographically similar (approximately 50 % Female, 83 % White). A variety of client characteristics, assessed prior to treatment, as well as the outcomes of treatment, were examined. Significantly superior treatment outcomes were observed in the individuals treated in the research study, relative to clients in the outpatient clinic, and the difference was not accounted for by intake characteristics. Individuals treated by the therapists in the RCT experienced almost three times as much improvement in depressive symptoms as clients seen in the outpatient setting. If replicated, the findings suggest that differences exist between treatment outcomes in research and outpatient settings and that these differences may not simply be due to therapist experience and training, or differences in patient populations. Future research should further examine the impact of fidelity monitoring, treatment expectation and motivation, and the duration and timing of treatment protocols on clinical outcomes.