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  Subjects -> SOCIAL SCIENCES (Total: 1374 journals)
    - BIRTH CONTROL (20 journals)
    - CHILDREN AND YOUTH (244 journals)
    - FOLKLORE (28 journals)
    - MATRIMONY (16 journals)
    - MEN'S INTERESTS (17 journals)
    - MEN'S STUDIES (91 journals)
    - SEXUALITY (52 journals)
    - SOCIAL SCIENCES (701 journals)
    - WOMEN'S INTERESTS (42 journals)
    - WOMEN'S STUDIES (163 journals)

SOCIAL SCIENCES (701 journals)                  1 2 3 4     

Showing 1 - 136 of 136 Journals sorted alphabetically
3C Empresa     Open Access   (Followers: 3)
A contrario     Full-text available via subscription   (Followers: 3)
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
Abant İzzet Baysal Üniversitesi Sosyal Bilimler Enstitüsü Dergisi     Open Access   (Followers: 1)
Abordajes : Revista de Ciencias Sociales y Humanas     Open Access   (Followers: 1)
Aboriginal and Islander Health Worker Journal     Full-text available via subscription   (Followers: 14)
About Performance     Full-text available via subscription   (Followers: 12)
Academicus International Scientific Journal     Open Access   (Followers: 3)
Access     Full-text available via subscription   (Followers: 26)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 10)
ACCORD Occasional Paper     Open Access   (Followers: 4)
Accountability in Research: Policies and Quality Assurance     Hybrid Journal   (Followers: 18)
Acta Academica     Full-text available via subscription   (Followers: 6)
Acta Scientiarum. Human and Social Sciences     Open Access   (Followers: 7)
Acta Universitatis Sapientiae, Philologica     Open Access   (Followers: 1)
Adelphi series     Hybrid Journal   (Followers: 15)
Adıyaman Üniversitesi Sosyal Bilimler Enstitüsü Dergisi     Open Access  
Administrative Science Quarterly     Full-text available via subscription   (Followers: 165)
Administrative Theory & Praxis     Full-text available via subscription   (Followers: 6)
Adultspan Journal     Hybrid Journal  
Advances in Appreciative Inquiry     Hybrid Journal  
Advocate: Newsletter of the National Tertiary Education Union     Full-text available via subscription   (Followers: 1)
África     Open Access   (Followers: 1)
Africa Spectrum     Open Access   (Followers: 11)
African Affairs     Hybrid Journal   (Followers: 60)
African Renaissance     Full-text available via subscription   (Followers: 2)
African Research Review     Open Access   (Followers: 5)
African Social Science Review     Open Access   (Followers: 9)
Afyon Kocatepe Üniversitesi Sosyal Bilimler Dergisi     Open Access  
Ágora : revista de divulgação científica     Open Access  
Akademik İncelemeler Dergisi     Open Access   (Followers: 1)
Akademika : Journal of Southeast Asia Social Sciences and Humanities     Open Access   (Followers: 6)
Al-Mabsut : Jurnal Studi Islam dan Sosial     Open Access   (Followers: 1)
Alliage     Free  
Alteridade     Open Access  
American Communist History     Hybrid Journal   (Followers: 19)
ANALES de la Universidad Central del Ecuador     Open Access   (Followers: 2)
Anales de la Universidad de Chile     Open Access  
Analysis     Full-text available via subscription   (Followers: 4)
Andamios. Revista de Investigacion Social     Open Access  
Anemon Muş Alparslan Üniversitesi Sosyal Bilimler Dergisi     Open Access  
Annals of Humanities and Development Studies     Open Access   (Followers: 5)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 45)
Annuaire de l’EHESS     Open Access  
Anthropocene Review     Hybrid Journal   (Followers: 6)
Anthurium : A Caribbean Studies Journal     Open Access   (Followers: 6)
Approches inductives : Travail intellectuel et construction des connaissances     Full-text available via subscription  
Apuntes : Revista de Ciencias Sociales     Open Access   (Followers: 1)
Apuntes de Investigación del CECYP     Open Access  
Arbor     Open Access  
Argomenti. Rivista di economia, cultura e ricerca sociale     Open Access   (Followers: 3)
Argumentos. Revista de crítica social     Open Access  
Around the Globe     Full-text available via subscription   (Followers: 1)
Arquivos do CMD : Cultura, Memória e Desenvolvimento     Open Access  
Articulo - Journal of Urban Research     Open Access   (Followers: 4)
Asia Pacific Journal of Sport and Social Science     Hybrid Journal   (Followers: 6)
Asian Journal of Quality of Life     Open Access  
Asian Journal of Social Science     Hybrid Journal   (Followers: 12)
Asian Journal of Social Sciences and Management Studies     Open Access   (Followers: 6)
Asian Social Science     Open Access   (Followers: 6)
Astrolabio     Open Access  
Atatürk Dergisi     Open Access  
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 10)
Australian and Aotearoa New Zealand Psychodrama Association Journal     Full-text available via subscription  
Australian Journal of Emergency Management     Full-text available via subscription   (Followers: 8)
Australian Journal on Volunteering     Full-text available via subscription   (Followers: 1)
Austrian Journal of South-East Asian Studies     Open Access  
Balkan Journal of Social Sciences     Open Access   (Followers: 3)
Bandung : Journal of the Global South     Open Access   (Followers: 1)
BARATARIA. Revista Castellano-Manchega de Ciencias sociales     Open Access  
Basic and Applied Social Psychology     Hybrid Journal   (Followers: 37)
Basic Income Studies     Hybrid Journal   (Followers: 9)
Bayero Journal of Pure and Applied Sciences     Open Access  
Berkeley Undergraduate Journal     Full-text available via subscription   (Followers: 1)
Big Data & Society     Open Access   (Followers: 35)
Bildhaan : An International Journal of Somali Studies     Open Access   (Followers: 2)
BMC Medical Ethics     Open Access   (Followers: 18)
Bodhi : An Interdisciplinary Journal     Open Access   (Followers: 1)
Body Image     Hybrid Journal   (Followers: 13)
BOGA : Basque Studies Consortium Journal     Open Access   (Followers: 2)
Boletín Cultural y Bibliográfico     Open Access   (Followers: 2)
Border Crossing : Transnational Working Papers     Open Access   (Followers: 2)
Brain and Cognition     Hybrid Journal   (Followers: 34)
Brasiliana - Journal for Brazilian Studies     Open Access   (Followers: 1)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 3)
Bulletin de l’Institut Français d’Études Andines     Open Access   (Followers: 1)
Caderno CRH     Open Access   (Followers: 1)
California Italian Studies Journal     Full-text available via subscription   (Followers: 5)
Caminho Aberto : Revista de Extensão do IFSC     Open Access  
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Caribbean Studies     Full-text available via subscription   (Followers: 11)
Carl Beck Papers in Russian and East European Studies     Full-text available via subscription   (Followers: 5)
Catalan Social Sciences Review     Open Access  
Catalyst : A Social Justice Forum     Open Access   (Followers: 9)
Catholic Social Science Review     Open Access   (Followers: 3)
CBU International Conference Proceedings     Open Access   (Followers: 1)
Cemoti, Cahiers d'études sur la méditerranée orientale et le monde turco-iranien     Open Access   (Followers: 2)
Challenges     Open Access   (Followers: 1)
China Journal of Social Work     Hybrid Journal   (Followers: 1)
Chinese Studies     Open Access   (Followers: 6)
Ciencia e Interculturalidad     Open Access   (Followers: 1)
Ciencia y Sociedad     Open Access   (Followers: 1)
Ciencia, Cultura y Sociedad     Open Access  
Ciencias Holguin     Open Access   (Followers: 1)
Ciências Sociais Unisinos     Open Access   (Followers: 2)
Ciencias Sociales y Educación     Open Access   (Followers: 2)
Ciencias Sociales y Humanidades     Open Access   (Followers: 1)
CienciaUAT     Open Access  
Citizen Science : Theory and Practice     Open Access  
Citizenship Teaching & Learning     Hybrid Journal   (Followers: 6)
Ciudad Paz-ando     Open Access  
Civilizar Ciencias Sociales y Humanas     Open Access   (Followers: 1)
Civitas - Revista de Ciências Sociais     Open Access   (Followers: 1)
Claroscuro     Open Access   (Followers: 1)
CLIO América     Open Access   (Followers: 1)
Cogent Social Sciences     Open Access   (Followers: 3)
Cognitive and Behavioral Practice     Hybrid Journal   (Followers: 11)
Colección Académica de Ciencias Sociales     Open Access  
Colonial Academic Alliance Undergraduate Research Journal     Open Access   (Followers: 3)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 2)
Compendium     Open Access   (Followers: 1)
Comprehensive Therapy     Hybrid Journal   (Followers: 3)
Comuni@cción     Open Access  
Comunitania : Revista Internacional de Trabajo Social y Ciencias Sociales     Open Access   (Followers: 1)
Confluenze Rivista di Studi Iberoamericani     Open Access  
Contemporary Journal of African Studies     Full-text available via subscription   (Followers: 3)
Contemporary Social Science     Hybrid Journal   (Followers: 15)
Contribuciones desde Coatepec     Open Access  
Convergencia     Open Access   (Followers: 1)
Corporate Reputation Review     Hybrid Journal   (Followers: 4)
CRDCN Research Highlight / RCCDR en évidence     Open Access  
Creative and Knowledge Society     Open Access   (Followers: 10)
Creative Approaches to Research     Full-text available via subscription   (Followers: 12)
Critical Psychology     Hybrid Journal   (Followers: 6)
Critical Studies     Full-text available via subscription   (Followers: 10)
Critical Studies on Terrorism     Hybrid Journal   (Followers: 26)
Crossing the Border : International Journal of Interdisciplinary Studies     Open Access   (Followers: 4)
CTheory     Open Access  
Cuadernos de la Facultad de Humanidades y Ciencias Sociales - Universidad Nacional de Jujuy     Open Access   (Followers: 1)
Cuadernos Interculturales     Open Access  
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Cultural Trends     Hybrid Journal   (Followers: 17)
Culturales     Open Access   (Followers: 2)
Culturas. Revista de Gestión Cultural     Open Access  
Culture Mandala : The Bulletin of the Centre for East-West Cultural and Economic Studies     Open Access  
Culture Scope     Full-text available via subscription   (Followers: 2)
De Prácticas y Discursos. Cuadernos de Ciencias Sociales     Open Access  
Debats. Revista de cultura, poder i societat     Open Access  
Demographic Research     Open Access   (Followers: 11)
Derecho y Ciencias Sociales     Open Access   (Followers: 1)
Desacatos     Open Access   (Followers: 1)
Desafios     Open Access  
Desenvolvimento em Questão     Open Access  
Developing Practice : The Child, Youth and Family Work Journal     Full-text available via subscription   (Followers: 20)
Development     Hybrid Journal   (Followers: 16)
Diálogo     Open Access   (Followers: 1)
DIFI Family Research and Proceedings     Open Access   (Followers: 1)
Discourse & Society     Hybrid Journal   (Followers: 67)
Distinktion : Scandinavian Journal of Social Theory     Hybrid Journal   (Followers: 8)
Doct-Us Journal     Open Access  
Drustvena istrazivanja     Open Access   (Followers: 2)
Dynamics of Asymmetric Conflict: Pathways toward terrorism and genocide     Hybrid Journal   (Followers: 15)
E-Dimas : Jurnal Pengabdian Kepada Masyarakat     Open Access   (Followers: 1)
e-Gnosis     Open Access  
e-Hum : Revista das Áreas de Humanidade do Centro Universitário de Belo Horizonte     Open Access   (Followers: 1)
E-Journal of Cultural Studies     Open Access   (Followers: 1)
Eastern Africa Social Science Research Review     Full-text available via subscription   (Followers: 5)
Eat, Sleep, Work     Open Access  
Économie et Solidarités     Full-text available via subscription   (Followers: 1)
Education, Business and Society : Contemporary Middle Eastern Issues     Hybrid Journal  
Égypte - Monde arabe     Open Access   (Followers: 4)
Éire-Ireland     Full-text available via subscription   (Followers: 9)
Electoral Studies     Hybrid Journal   (Followers: 31)
Electronic Journal of Radical Organisation Theory     Full-text available via subscription   (Followers: 3)
Empiria. Revista de metodología de ciencias sociales     Open Access   (Followers: 1)
Encuentros Multidisciplinares     Open Access  
Enseñanza de las Ciencias Sociales     Open Access  
Entramado     Open Access  
Equality, Diversity and Inclusion : An International Journal     Hybrid Journal   (Followers: 14)
Equidad y Desarrollo     Open Access  
Espace populations sociétés     Open Access   (Followers: 1)
EspacesTemps.net     Open Access  
Estudios Avanzados     Open Access  
Estudios Fronterizos     Open Access   (Followers: 1)
Estudios Sociales     Open Access   (Followers: 2)
Estudios Sociales     Open Access  
Ethics and Social Welfare     Hybrid Journal   (Followers: 20)
Ethiopian Journal of the Social Sciences and Humanities     Full-text available via subscription   (Followers: 8)
Ethnic and Racial Studies     Hybrid Journal   (Followers: 42)
Ethnobotany Research & Applications : a journal of plants, people and applied research     Open Access   (Followers: 6)
eTropic : electronic journal of studies in the tropics     Open Access  
Études canadiennes / Canadian Studies     Open Access   (Followers: 1)
Études rurales     Open Access   (Followers: 2)
Eureka Street     Full-text available via subscription   (Followers: 4)
European Journal of Futures Research     Open Access   (Followers: 1)
European Journal of Social Psychology     Hybrid Journal   (Followers: 32)
European Online Journal of Natural and Social Sciences     Open Access   (Followers: 11)
European Review of Latin American and Caribbean Studies - Revista Europea de Estudios Latinoamericanos y del Caribe     Open Access   (Followers: 5)

        1 2 3 4     

Journal Cover Cognitive and Behavioral Practice
  [SJR: 0.859]   [H-I: 41]   [11 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1077-7229
   Published by Elsevier Homepage  [3123 journals]
  • Dialectical Behavior Therapy With Prolonged Exposure for Adolescents:
           Rationale and Review of the Research
    • Abstract: Publication date: Available online 10 February 2018
      Source:Cognitive and Behavioral Practice
      Author(s): Colleen M. Lang, Amanda J. Edwards, Melissa A. Mittler, Lauren Bonavitacola
      Among adolescents, interpersonal trauma has been associated with severe post-traumatic stress disorder (PTSD) and impairments across multiple domains of functioning (e.g., Derosa, Amaya-Jackson & Layne, 2013; Ford, Courtois, Steele, van der Hart, & Nijenhuis, 2005; van der Kolk, 2005). Such difficulties can include high-risk behaviors such as active suicidality (Middlebrooks & Audage, 2008) and nonsuicidal self-injurious behavior (NSSI; Hu, Taylor, Li, & Glauert, 2017). While there have been many advances in the treatment of trauma, treatment dropout for adolescents seeking trauma-informed treatment is predicted by diagnostic comorbidity and complexity (Sprang et al., 2013), as well as the number of traumatic events endorsed (Wamser-Nanney & Steinzor, 2016). Many traumatized adolescents with high-risk behaviors are referred to Dialectical Behavior Therapy (DBT-A). However, DBT-A does not yet include a specific, evidence-based protocol for treating PTSD, without which treatment gains may not be sustained for traumatized adolescents (Harned, Korslund, & Linehan, 2014). While Prolonged Exposure (PE) is indicated as the gold-standard treatment for PTSD and has proven effective for adolescents (PE-A; Foa, McLean, Capaldi, & Rosenfield, 2013), it has not yet been validated with adolescents who are actively suicidal. However, PE has successfully been integrated within DBT for adults with co-occurring Borderline Personality Disorder and PTSD (e.g., DBT-PE; Harned et al., 2014). Based upon this model, the current paper proposes the integration of DBT-A and PE-A to treat adolescents with interpersonal trauma who also present with high-risk behaviors. The paper discusses anticipated complications related to adapting this model for adolescents and provides direction for future research.

      PubDate: 2018-02-14T17:55:24Z
       
  • Cross-Cultural Supervision in Cognitive-Behavioral Therapy: A Case Study
    • Abstract: Publication date: Available online 9 February 2018
      Source:Cognitive and Behavioral Practice
      Author(s): Yang Fahui, Keith Dobson, Li Xiaomiao, Adam Hennebury, Gao Ying, Tang Xinfeng, Qi Le
      This article provides a thorough description of a representative case of online cross-cultural supervision by interviewing all parties involved in the supervision (the supervisor, the supervisee, and the translator). This study provides evidence about the benefits and challenges of online cross-cultural supervision and the feasibility of such a training modality. A cross-cultural supervision competence model and culturally adapted treatment stage model are proposed, and the article provides suggestions for future supervisors, supervisees, and translators.

      PubDate: 2018-02-14T17:55:24Z
       
  • Correcting Misperceptions About Cognitive Processing Therapy to Treat
           Moral Injury: A Response to Gray and Colleagues (this issue)
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Jennifer Schuster Wachen, Katherine A. Dondanville, Patricia A. Resick
      We respond to the commentary by Gray, Nash, and Litz (this issue) regarding the use of cognitive processing therapy (CPT) to address moral injury as described in our previous publication (Wachen et al., 2016). In their commentary, Gray et al. posit that CPT is inappropriate when applied to the treatment of war-related traumas involving “real moral and ethical transgressions” (i.e., moral injuries). However, Gray and colleagues’ assertions are centered on a premise that is incorrect, namely that CPT is based on the idea that “self-blame and guilt are inherently illogical or inaccurate,” and that CPT assumes that all beliefs associated with moral injury are erroneous. On the contrary, we acknowledge that self-blame and guilt may be accurate responses to warzone trauma, yet disagree that CPT is not suitable in these situations. This response serves to clarify some of the inaccurate interpretations of the treatment as stated by Gray and colleagues, and reiterates the position of CPT on many of the issues that were raised. Specifically, we discuss the use of Socratic questioning within CPT to address the issue of moral injury. Furthermore, we highlight the strong evidence base for the use of CPT in treating veterans and active military. Until it has been determined through empirical study, it is premature to assert that CPT is insufficient in addressing moral injury in combat personnel.

      PubDate: 2018-02-14T17:55:24Z
       
  • Optimizing Contingency Management With Methamphetamine-Using Men Who Have
           Sex With Men
    • Abstract: Publication date: Available online 11 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Walter Gómez, David Olem, Rick Andrews, Michael V. Discepola, Patricia Ambrose, Samantha E. Dilworth, Adam W. Carrico
      Among men who have sex with men (MSM), methamphetamine use is associated with multiple, overlapping syndemic conditions including increased risk for HIV seroconversion and onward HIV transmission. Contingency management (CM) is an evidence-based behavioral intervention implemented to curb methamphetamine use and optimize HIV/AIDS prevention among MSM in San Francisco since 2003. We conducted a program evaluation to document the evolution of this 12-week CM program to include delivery of brief, individual counseling incorporating motivational interviewing and behavioral skills. A drop-in group delivered concurrently with CM urine-screening visits also provides peer support as well as referrals for other social and medical services. From December 2011–October 2013, a total of 131 clients enrolled in the CM program and provided a median of 22 urine samples (Interquartile Range = 10–34) that were nonreactive for methamphetamine. Findings support the feasibility and acceptability of integrating individual and group counseling with community-based CM for methamphetamine-using MSM.

      PubDate: 2018-02-14T17:55:24Z
       
  • Adapting Parent–Child Interaction Therapy for Deaf Families That
           Communicate via American Sign Language: A Formal Adaptation Approach
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Lori A. Day, Elizabeth Adams Costa, Danielle Previ, Colleen Caverly
      While our field has made positive strides in adapting psychotherapeutic interventions for diverse groups of people, considerable work is still needed in this area. We present our formal adaptation procedure for parent–child interaction therapy (PCIT) with Deaf persons. This includes a review of the cultural adaptation process for psychological interventions, including PCIT, as well as an introduction to Deaf culture. Details regarding the specific adaptation of PCIT for Deaf persons are outlined. We found that the utilization of a clear framework to guide the cultural adaptation process facilitated careful consideration of the numerous linguistic and cultural variables involved, while maintaining integrity of the treatment model. While the current focus was on adapting PCIT for Deaf families who communicate via American Sign Language, this framework can also be applied to other populations and/or interventions.

      PubDate: 2018-02-05T17:27:42Z
       
  • Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for
           Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical
           Illness (DBT-CMI)
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Becky H. Lois, Alec L. Miller
      Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence. DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.

      PubDate: 2018-02-05T17:27:42Z
       
  • Activating Veterans Toward Sources of Reward: A Pilot Report on
           Development, Feasibility, and Clinical Outcomes of a 12-Week Behavioral
           Activation Group Treatment
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Rachel Hershenberg, Rachel Vickers Smith, Jason T. Goodson, Michael E. Thase
      This pilot study evaluates a 12-week group Behavioral Activation protocol adapted to meet the needs of a Veteran population seeking treatment in an outpatient mental health clinic at a Veteran Affairs Medical Center. In a detailed Method we describe the treatment structure. Acceptability and feasibility are addressed by providing data on referral sources, treatment retention, attendance, and patient satisfaction. Initial clinical outcomes are presented, focusing on symptom reduction, improved quality of life, and changes in the hypothesized mechanism of treatment: improving motivated behavior to pursue rewards (decisional anhedonia). Finally, feedback from individual exit interviews is presented. We conclude with implementation tips and challenges in the service of continuing to improve our evidence-based interventions in Veteran Affairs facilities.

      PubDate: 2018-02-05T17:27:42Z
       
  • Use of Internet Resources to Support Prolonged Exposure for Combat-Related
           PTSD
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Peter D. Yeomans
      In vivo exposure as part of Prolonged Exposure (PE) requires the patient and therapist to generate a list of cues that are reminiscent of the trauma and generative of distress. In contrast to civilian trauma, it can be more challenging to build a robust in vivo hierarchy for a combat-related index trauma. Internet resources such as databases that list casualties from different wars, memorial pages of those who died in theater, and lists of unit association memberships and reunions are useful sources for in vivo hierarchies. These materials can provide opportunities for exposure to additional cues reminiscent of the traumatic event, provide information about the traumatic event that the veteran had been unable to recall, and create opportunities for veterans to reestablish relationships with veteran peers. Case illustrations are provided and reasons for caution are discussed.

      PubDate: 2018-02-05T17:27:42Z
       
  • Delivering Acceptance and Commitment Therapy for Weight Self-Stigma
           Through Guided Self-Help: Results From an Open Pilot Trial
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Michael E. Levin, Sarah Potts, Jack Haeger, Jason Lillis
      Weight self-stigma is a promising target for innovative interventions seeking to improve outcomes among overweight/obese individuals. Preliminary research suggests acceptance and commitment therapy (ACT) may be an effective approach for reducing weight self-stigma, but a guided self-help version of this intervention may improve broad dissemination. This pilot open trial sought to evaluate the potential acceptability and efficacy of a guided self-help ACT intervention, included coaching and a self-help book, with a sample of 13 overweight/obese individuals high in weight self-stigma. Results indicated a high degree of program engagement (77% completed the intervention) and satisfaction. Participants improved on outcomes over time including weight self-stigma, emotional eating, weight management behaviors, health-related quality of life, and depression. Although not a directly targeted outcome, participants improved on objectively measured weight, with an average of 4.18 pounds lost over 7 weeks, but did not improve on self-reported weight at 3-month follow-up. Processes of change improved over time, including psychological inflexibility, valued action and reasons to lose weight. Coaching effects indicated greater retention and improvements over time with one coach vs. the other, suggesting characteristics of coaching can affect outcomes. Overall, these results provide preliminary support for the acceptability and efficacy of a guided self-help ACT program for weight self-stigma. Implications of these results and how to address clinical challenges with guided self-help are discussed.

      PubDate: 2018-02-05T17:27:42Z
       
  • A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication
           Adherence Among Persons Living With HIV/AIDS
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Charles P. Brandt, Daniel J. Paulus, Monica Garza, Chad Lemaire, Peter J. Norton, Michael J. Zvolensky
      Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.

      PubDate: 2018-02-05T17:27:42Z
       
  • A Couple-Based Psychological Treatment for Chronic Pain and Relationship
           Distress
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Annmarie Cano, Angelia M. Corley, Shannon M. Clark, Sarah C. Martinez
      Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.

      PubDate: 2018-02-05T17:27:42Z
       
  • Implementing Group CBT for Depression Among Latinos in a Primary Care
           Clinic
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Adrian Aguilera, Emma Bruehlman-Senecal, Nancy Liu, Julia Bravin
      Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.

      PubDate: 2018-02-05T17:27:42Z
       
  • Interoceptive Exposure: An Overlooked Modality in the Cognitive-Behavioral
           Treatment of OCD
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Shannon M. Blakey, Jonathan S. Abramowitz
      Accumulated research implicates anxiety sensitivity (AS) as a transdiagnostic construct important to the maintenance of OCD. Yet despite the clinical implications of targeting fears of body-related sensations during treatment, interoceptive exposure (IE) is an often-overlooked therapeutic procedure in the cognitive-behavioral treatment of OCD. In this article, we discuss the rationale for—and procedures of—addressing AS during treatment for OCD. We provide two case examples, illustrating how a clinician might approach clinical assessment, case formulation, and treatment planning with each of these patients. We conclude by discussing future research directions to better understand if (and how) targeting AS during therapy might enhance OCD treatment outcome.

      PubDate: 2018-02-05T17:27:42Z
       
  • Intensive Outpatient Comprehensive Behavioral Intervention for Tics: A
           Clinical Replication Series
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Tabatha H. Blount, Jeslina J. Raj, Alan L. Peterson
      Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious behavioral treatment for Tourette’s disorder. In its standard format, CBIT is completed in 8 sessions over a 10-week period. Unfortunately, significant obstacles (e.g., not having a provider nearby; inability to attend weekly sessions) prevent many individuals from participating in standard outpatient CBIT. An intensive outpatient program that compresses CBIT into a week may help overcome many of these barriers. The present clinical replication series examines treatment outcomes in 5 individuals with Tourette’s disorder. Importantly, 4 out of the 5 participants reported clinically meaningful tic reductions on the Yale Global Tic Severity Scale (YGTSS) at the posttreatment assessment, with an average decrease of 11.5 points across those 4 participants. This represents a 28% decrease in the average posttreatment YGTSS score from the average baseline YGTSS score. Of the 3 participants who completed the 1-month follow-up assessment, 2 participants continued to endorse reductions in their baseline tic severity on the YGTSS and were rated as having a positive response on the Clinician Global Impressions–Improvement subscale. Clinical implications are discussed.

      PubDate: 2018-02-05T17:27:42Z
       
  • A Single-Subject Evaluation of the Treatment of Morphing Fear
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1
      Author(s): Eva Zysk, Roz Shafran, Tim I. Williams
      We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.

      PubDate: 2018-02-05T17:27:42Z
       
  • Acknowledgment to 2017 Reviewers
    • Abstract: Publication date: February 2018
      Source:Cognitive and Behavioral Practice, Volume 25, Issue 1


      PubDate: 2018-02-05T17:27:42Z
       
  • An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for
           Children and Adolescents
    • Abstract: Publication date: Available online 1 February 2018
      Source:Cognitive and Behavioral Practice
      Author(s): Joseph F. McGuire, Eric A. Storch
      Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.

      PubDate: 2018-02-05T17:27:42Z
       
  • Hope for the Worst: Occasional Reinforced Extinction and Expectancy
           Violation in the Treatment of OCD
    • Abstract: Publication date: Available online 31 January 2018
      Source:Cognitive and Behavioral Practice
      Author(s): Jason W. Krompinger, Nathaniel P. Van Kirk, Lauryn E. Garner, Sriramya I. Potluri, Jason A. Elias
      An inhibitory learning conceptualization of treatment mechanisms in exposure-based therapy appears to better account for durability of symptom reduction and index overall learning. Presented here is an overview of two core elements of inhibitory learning, expectancy violation and occasional reinforced extinction, as they are thought to function in exposure and response prevention (ERP) for OCD. The overview is then followed by case examples illustrating these processes at work in a naturalistic clinical setting. Implications for treatment are broadly discussed.

      PubDate: 2018-02-05T17:27:42Z
       
  • Enhancing Inhibitory Learning: The Utility of Variability in Exposure
    • Abstract: Publication date: Available online 31 January 2018
      Source:Cognitive and Behavioral Practice
      Author(s): Kelly A. Knowles, Bunmi O. Olatunji
      Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered.

      PubDate: 2018-02-05T17:27:42Z
       
  • Evaluating Triple P Online: A Digital Parent Training Program for Child
           Behavior Problems
    • Abstract: Publication date: Available online 6 December 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Amit Baumel, Keren Faber
      Triple P Online (i.e., TPOL; www2.tripleponline.net) is an online self-help parent training program aimed at reducing child behavior problems through “positive parenting practices”—available at time of review for $79.95. TPOL is comprised of 8 video-based modules that also incorporate in-session activities and homework. Randomized control trials have shown that TPOL effectively reduces child behavior problems. The program’s main strengths include very high-quality content with an abundance of relevant and easily locatable resources, an easy-to-use interface, and a professional look and feel. The program’s main weakness lies in its lack of monitoring and adaptation to the user’s state (e.g., child’s and parent’s behaviors), and real-time reminders for desired actions. Altogether, TPOL is an extremely valuable and important resource for families seeking evidence-based treatment for child behavior problems.

      PubDate: 2017-12-13T01:04:08Z
       
  • Striving Towards Empowerment and Medication Adherence (STEP-AD): A
           Tailored Cognitive Behavioral Treatment Approach for Black Women Living
           With HIV
    • Abstract: Publication date: Available online 5 December 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Sannisha K. Dale, Steven A. Safren
      In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.

      PubDate: 2017-12-13T01:04:08Z
       
  • A Multilevel Approach for Reducing Mental Health and Substance Use
           Disparities Affecting Bisexual Individuals
    • Abstract: Publication date: Available online 24 November 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Brian A. Feinstein, Christina Dyar, John E. Pachankis
      Despite bisexual individuals being at increased risk for mental health and substance use problems, clinicians’ ability to provide affirmative and competent care to bisexual clients is limited by their lack of bisexual-specific training. To address this common gap in training, this article provides a brief review of bisexual health disparities and the factors that influence them. Then, we describe a multi-level approach for improving the health and well-being of bisexual individuals. This approach addresses factors that influence health at the micro-level (e.g., strategies that clinicians can use to help bisexual clients cope with stigma-related stressors), mezzo-level (e.g., adaptations to clinical environments and training programs that promote bisexual-affirmative care), and macro-level (e.g., advocating for political change and implementing strategies to reduce prejudice against bisexual individuals at the population-level). Specifically, we describe how clinicians can adapt evidence-based interventions to tailor them to the needs of their bisexual clients. Additionally, we discuss the need for bisexual-affirmative clinical training and provide recommendations for how clinical training can be adapted to prepare clinicians to work effectively with bisexual clients. Finally, we describe how population-level interventions can be used to reduce prejudice against bisexual individuals in order to reduce bisexual health disparities. Given the striking health disparities affecting bisexual individuals, there is a critical need to develop, test, and disseminate interventions to improve the health of this population and to prepare clinicians to provide bisexual-affirmative care.

      PubDate: 2017-12-13T01:04:08Z
       
  • Treatment of Maternal Depression With In-Home Cognitive Behavioral Therapy
           Augmented by a Parenting Enhancement: A Case Report
    • Abstract: Publication date: Available online 21 November 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Erica Pearl Messer, Robert T. Ammerman, Angelique R. Teeters, Amy L. Bodley, Jessica Howard, Judith B. Van Ginkel, Frank W. Putnam
      Depression is prevalent among mothers who participate in home visitation programs. This case study describes In-Home Cognitive Behavioral Therapy (IH-CBT), an empirically based treatment for depressed mothers that is strongly integrated with ongoing home visitation. The use of a Parenting Enhancement for Maternal Depression (PEMD) module was added to address parenting difficulties in a depressed mother. This case describes issues and challenges encountered in delivering treatment in the home with low-income, depressed mothers. Issues involving engagement, adaptation to the setting, responding to the unique needs of low-income mothers, and partnership with concurrent home visiting to optimize outcomes are considered. Long-term follow-up (18 months after the end of treatment) permits examination of sustainability of gains. Implications for treating this high-risk population are discussed.

      PubDate: 2017-12-13T01:04:08Z
       
  • Treating Transgender Individuals in Inpatient and Residential Mental
           Health Settings
    • Abstract: Publication date: Available online 10 November 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Heather M. Walton, Sharon L. Baker
      This article describes the need for specific guidelines regarding how to manage inpatient and residential mental health programming with respect to transgender individuals. The article discusses what is known about transgender mental health and how it is related to sociopolitical factors, how inpatient and residential programs can address the impact of sociopolitical factors on transgender individuals and send a welcoming message to prospective consumers, how programs can attend to policies and procedures in ways that create the best milieu for an inpatient or residential unit that provides care for one or more transgender individuals, and how providers and interdisciplinary teams can meet the unique clinical needs of transgender individuals. These guidelines are designed to assist providers in creating a safe environment that affords quality inpatient and residential mental health care to transgender individuals.

      PubDate: 2017-11-15T19:18:56Z
       
  • Multimedia Field Test: Digitalizing Better Sleep Using the Sleepio Program
    • Abstract: Publication date: Available online 8 November 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Jennifer Cowie, Joanne L. Bower, Rogelio Gonzalez, Candice A. Alfano
      The promise of online cognitive behavioral therapy for insomnia (CBT-I) and other sleep-related problems as an alternative to traditional face-to-face treatment rests upon the accessibility, ease-of-use, and effectiveness of these approaches. Here we provide a review of Sleepio, a digitalized, state-of-the-art CBT-I program for adults, informed by our personal experience with the program, available research, and information provided at the Sleepio website. The 6-week treatment program can be completed flexibly via web-based or mobile platform. Initial assessment of individual goals and baseline sleep patterns is used to build a personalized account comprised of four sections: Sleep Diary, Case File, Library, and Community. Sleepio uses evidence-based principles and practices, engaging content, and an easy-to-follow format. Unique features of the program including synchronization with compatible sleep tracking devices, multiple built-in user supports, and a 14-day money-back guarantee. Both statistical and clinically meaningful sleep improvements have been found in a large randomized controlled trial. Overall, Sleepio represents a model program for online CBT-I delivery.

      PubDate: 2017-11-15T19:18:56Z
       
  • Addressing Weight Suppression to Improve Treatment Outcome for Bulimia
           Nervosa
    • Abstract: Publication date: Available online 29 October 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Adrienne Juarascio, Elin L. Lantz, Alexandra F. Muratore, Michael R. Lowe
      Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.

      PubDate: 2017-11-15T19:18:56Z
       
  • Using Prolonged Exposure and Cognitive Processing Therapy to Treat
           Veterans With Moral Injury-Based PTSD: Two Case Examples
    • Abstract: Publication date: Available online 13 October 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Philip Held, Brian J. Klassen, Michael B. Brennan, Alyson K. Zalta
      Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.

      PubDate: 2017-10-14T04:15:27Z
       
  • Usability of a Smartphone Application to Support the Prevention and Early
           Intervention of Anxiety in Youth
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Ryan D. Stoll, Armando A. Pina, Kevin Gary, Ashish Amresh
      Mental, emotional, and behavioral disorders are common in youth with anxiety problems being among the most prevalent, typically failing to spontaneously remit, and placing some youth at risk for additional difficulties. Mobile health (mHealth) might be a novel avenue to strengthen prevention efforts for child anxiety, since program effects are generally small. However, although a significant number of mHealth tools have been developed, few have been evaluated in terms of usability (or even clinical effectiveness). Usability testing is the first level of evaluation in responsible mHealth efforts as it is one of the main barriers to usage and adoption. As such, the objective of this research was to evaluate the usability of a smartphone application (app) corresponding to an indicated prevention and early intervention targeting youth anxiety. To accomplish this, 132 children (M age =9.65, 63% girls) and 45 service providers (M age =29.13, 87% female) rated our app along five established dimensions of usability (ease of use, ease of learning, quality of support information, satisfaction, and stigma). Findings showed that the app was highly and positively rated by youth and providers, with some variations (lower ratings when errors occurred). Path analyses also showed that system understanding was significantly related to greater system satisfaction, but that such relation occurred through the quality of support information offered by the app. Together, this has research and clinical implications as it highlights avenues for advancing youth care via mHealth usability evaluation, including prior to establishing effectiveness.

      PubDate: 2017-10-12T04:02:10Z
       
  • A Dialectical Behavior Therapy Skills Group Case Study on Mothers With
           Severe Emotion Dysregulation
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Christina Gamache Martin, Leslie E. Roos, Maureen Zalewski, Nicole Cummins
      Parenting is an emotionally demanding endeavor, which can be particularly challenging for parents who struggle with psychopathology and lack the regulation skills to manage their own emotional lability. Although dialectical behavior therapy (DBT) is an effective treatment that directly targets emotion dysregulation, little is known about whether DBT might also improve parenting behaviors. A DBT skills group was employed to examine whether DBT skills are utilized by mothers in their parenting and whether skill use improves parenting. Four mothers with severe emotion dysregulation who met diagnostic criteria for at least one Axis I disorder were part of a case study, in which they completed a DBT skills group for mothers, and two of the mothers participated in an in-depth exit interview regarding their use of DBT skills in their parenting. The mothers reported substantial changes in their parenting during the exit interview and modest improvements were found for parenting in pre- to posttreatment parenting assessments. This paper describes the various parenting contexts in which DBT skills were used and discusses maternal emotion regulation as a potential pathway from DBT skills to improved parenting.

      PubDate: 2017-10-12T04:02:10Z
       
  • Treating Depression Among Adolescent Perinatal Women With a Dialectical
           Behavior Therapy–Informed Skills Group
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Blair Vinson Kleiber, Jennifer N. Felder, Bethany Ashby, Stephen Scott, Janet Dean, Sona Dimidjian
      Depression is a prevalent and impairing problem affecting both women and offspring during the perinatal (pregnancy and the postpartum) period. Despite this, few studies have examined treatments for perinatal adolescents with depressive symptoms. The present study examined the feasibility and preliminary outcomes of a dialectical behavioral therapy (DBT) informed skills group among depressed adolescent perinatal women (N =25) recruited from both a public health parent education program and an adolescent obstetric clinic. A brief composite case example is included to illustrate how DBT skills were taught, practiced, and applied. Findings suggest the intervention was credible, acceptable, and associated with improvement in depression. Challenges with feasibility of enrolling and retaining adolescent perinatal women were evident, as approximately half of the enrolled participants did not complete the study. This study provides preliminary evidence that a DBT-informed skills group may be a promising intervention for depressed adolescent perinatal women and points to important directions for clinical practice and research, including treatment engagement and retention.

      PubDate: 2017-10-12T04:02:10Z
       
  • A Cultural Adaptation of Dialectical Behavior Therapy in Nepal
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Megan K. Ramaiya, Devika Fiorillo, Upasana Regmi, Clive J. Robins, Brandon A. Kohrt
      Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.

      PubDate: 2017-10-12T04:02:10Z
       
  • Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Jessica Maura, Amy Weisman de Mamani
      Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.

      PubDate: 2017-10-12T04:02:10Z
       
  • Culturally Sensitive Adaptations to Evidence-Based Cognitive Behavioral
           Treatment for Social Anxiety Disorder: A Case Paper
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Jessica R. Graham-LoPresti, Speshal Walker Gautier, Shannon Sorenson, Sarah A. Hayes-Skelton
      Cognitive Behavioral Group Therapy (CBGT), which involves restructuring maladaptive thoughts and exposures in social contexts in a group format, is an empirically supported treatment for social anxiety disorder (SAD). However, research on applying these skills to experiences of discrimination that may contribute to social anxiety in marginalized populations is limited. A case description is presented to demonstrate the ways in which culturally sensitive adaptations of CBGT were applied to treat social anxiety related to issues of discrimination. The case example includes outcome data from one individual diagnosed with SAD who experienced clinical improvement in symptoms of SAD after receiving CBGT as a part of a larger treatment trial for SAD. Specifically, this paper focuses on the way in which SAD manifested for a Latina woman based on a history, and current context of race-based and gender-based discrimination. We present strategies to address SAD related to experiences of discrimination within the context of CBGT as well as clinical implications related to the integration of multicultural principles and traditional cognitive behavioral therapies for SAD more generally.

      PubDate: 2017-10-12T04:02:10Z
       
  • The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment
           
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Nicholas S. Perry, Shannon D. Chaplo, Katherine J.W. Baucom
      For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.

      PubDate: 2017-10-12T04:02:10Z
       
  • A Case Study of Individually Delivered Mindfulness-Based Cognitive
           Behavioral Therapy for Severe Health Anxiety
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Christina M. Luberto, Jessica F. Magidson, Aaron J. Blashill
      Health anxiety involves persistent worry about one's physical health, despite medical reassurance. Cognitive-behavioral therapy (CBT) is currently the most widely used, evidence-based treatment for health anxiety. Mindfulness-based cognitive therapy (MBCT) is an evidence-based cognitive-behavioral treatment approach that may be useful for health anxiety due to its focus on nonjudgmental awareness and acceptance of physical and emotional events. MBCT has largely been evaluated in a group format; however, the majority of outpatient CBT providers rely also on individual treatments. No research to date has examined the utility of MBCT delivered as an individual therapy for patients with health anxiety. The purpose of the current case study is to describe the delivery, acceptability, and effects of an individually delivered mindfulness-based cognitive-behavioral intervention on health anxiety symptoms for a young woman with severe health anxiety referred to outpatient behavioral medicine by her primary care provider. The treatment was a 16-session, patient-centered intervention largely delivered using MBCT techniques, supplemented by traditional cognitive-behavioral techniques. The patient completed a validated self-report measure of health anxiety symptoms (SHAI) at the beginning of each session. The treatment was found to be acceptable, as evidenced by high treatment attendance and patient feedback. The patient reported significant cognitive, affective, and behavioral improvements, including a 67% reduction in medial visits. Health anxiety scores on the SHAI showed a 52% decrease from the first to last session, reliable change index score of 12.11, and fell below the clinical cutoff at the final session, demonstrating clinical significance. These results suggest that it is feasible to adapt MBCT for the individual treatment of health anxiety, and that controlled trials of individual MBCT are warranted.

      PubDate: 2017-10-12T04:02:10Z
       
  • Development and Refinement of a Targeted Sexual Risk Reduction
           Intervention for Women With a History of Childhood Sexual Abuse
    • Abstract: Publication date: November 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 4
      Author(s): Theresa E. Senn, Amy Braksmajer, Heidi Hutchins, Michael P. Carey
      Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age=34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age=33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.

      PubDate: 2017-10-12T04:02:10Z
       
  • Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and
           Aggression in Veterans: A Pilot Study
    • Abstract: Publication date: Available online 29 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Heidi M. Zinzow, Johnell O. Brooks, Patrick Rosopa, Stephanie Jeffirs, Casey Jenkins, Julia Seeanner, Alyssa McKeeman, Larry F. Hodges
      Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.

      PubDate: 2017-10-05T03:57:09Z
       
  • Optimizing Exposure Therapy for Pathological Health Anxiety:
           Considerations From the Inhibitory Learning Approach
    • Abstract: Publication date: Available online 29 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Maria Gropalis, Michael Witthöft, Josef Bailer, Florian Weck
      Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.

      PubDate: 2017-10-05T03:57:09Z
       
  • The Development of a Brief Distress Reduction Intervention for Individuals
           Recently Diagnosed With HIV in China
    • Abstract: Publication date: Available online 17 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Joyce P. Yang, Jane M. Simoni, Sapna Cheryan, Cheng-shi Shiu, Weiti Chen, Hongxin Zhao, Hongzhou Lu
      In China, where there are few mental health resources, the majority of HIV-related efforts have focused on medical treatment and transmission prevention rather than psychosocial support. Yet people living with HIV/AIDS (PLWHA) report high levels of psychological distress, especially upon first receiving their HIV diagnosis. We conducted mixed methods research of a qualitative study with (N = 31) individual interviews and 3 focus groups (n = 6 in each group) of HIV-affected participants, and a quantitative survey (N = 200) with individuals living with HIV in Shanghai and Beijing, China. Our qualitative data revealed major themes of forms of distress experienced and types of psychosocial support that our participants wished they could have accessed upon diagnosis as well as suggestions for intervention structure that would be most feasible and acceptable. Our quantitative surveys provided further evidence of the high degree of psychosocial distress among recently diagnosed PLWHA. Our findings informed the development of the Psychology Toolbox intervention, a brief CBT skills-based intervention comprising cognitive restructuring, behavioral activation, and paced breathing, designed to be integrated into primary care for recently diagnosed PLWHA. This study describes the intervention development process and contents of each session. Future research should evaluate the intervention for efficacy as well as examine best strategies for eventual implementation and dissemination.

      PubDate: 2017-09-22T11:10:10Z
       
  • Guided Recovery: An Interpretative Phenomenological Analysis of Service
           Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating
           Disorders
    • Abstract: Publication date: Available online 9 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Carolyn Rose Plateau, Faye A. Brookes, Matthew Pugh
      The efficacy of Cognitive Behavioral Therapy–based Guided Self-Help for mild to moderate bulimia and binge eating disorders has been well supported. However, limited research has explored in-depth individual experiences of this treatment approach. In-depth semistructured interviews were conducted with 4 individuals who had completed Cognitive Behavioral Therapy–based Guided Self-Help (CBT-GSH) for bulimic or binge eating disorders. The interviews were transcribed verbatim and subsequently analyzed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged: Autonomy and volition; A dynamic relationship: the guided and the guide; and The unwanted friend. The reciprocal nature of the guide/guided relationship was identified as integral to the success of the therapeutic approach. However, participants expressed initial uncertainty towards the therapeutic process, and experienced an uncomfortable dissonance between a lack of volition in therapy seeking and the need to continually self-prescribe CBT-GSH. The findings affirm the central role of the guide in promoting motivation to engage with therapy and highlight the potential benefits of in-session weighing. However, it may be necessary to provide additional support on commencing CBT-GSH to address concerns about the therapeutic approach in this group.

      PubDate: 2017-09-11T19:18:42Z
       
  • Development and Feasibility of a Group Cognitive-Behavioral Therapy for
           Fear of Cancer Recurrence
    • Abstract: Publication date: Available online 5 September 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Josée Savard, Marie-Hélène Savard, Aude Caplette-Gingras, Lucie Casault, Caroline Camateros
      This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session. Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment. These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach. This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.

      PubDate: 2017-09-06T13:54:48Z
       
  • Family-Focused Treatment for Childhood Depression: Model and Case
           Illustrations
    • Abstract: Publication date: August 2017
      Source:Cognitive and Behavioral Practice, Volume 24, Issue 3
      Author(s): Martha C. Tompson, David A. Langer, Jennifer L. Hughes, Joan R. Asarnow
      Although the evidence base for treatment of depressive disorders in adolescents has strengthened in recent years, less is known about the treatment of depression in middle to late childhood. A family-based treatment may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase, particularly given data indicating that attributes of the family environment predict recovery versus continuing depression among depressed children. Family-Focused Treatment for Childhood Depression (FFT-CD) is designed as a 15-session family treatment with both the youth and parents targeting two putative mechanisms involved in recovery: (a) enhancing family support, specifically decreasing criticism and increasing supportive interactions; and (b) strengthening specific cognitive-behavioral skills within a family context that have been central to CBT for depression, specifically behavioral activation, communication, and problem solving. This article describes in detail the FFT-CD protocol and illustrates its implementation with three depressed children and their families. Common themes/challenges in treatment included family stressors, comorbidity, parental mental health challenges, and inclusion/integration of siblings into sessions. These three children experienced positive changes from pre- to posttreatment on assessor-rated depressive symptoms, parent- and child-rated depressive symptoms, and parent-rated internalizing and externalizing symptoms. These changes were maintained at follow-up evaluations 4 and 9months following treatment completion.

      PubDate: 2017-07-24T16:41:28Z
       
  • Development and Preliminary Feasibility Study of a Brief Behavioral
           Activation Mobile Application (Behavioral Apptivation) to be used in
           Conjunction with Ongoing Therapy
    • Abstract: Publication date: Available online 6 June 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Jennifer Dahne, Jacob Kustanowitz, C.W. Lejuez
      Depressive symptoms are the most frequently treated psychiatric condition in the United States. Brief behavioral activation treatment for depression (BATD) is a popular, evidence-based psychotherapy with strong research support for the treatment of depression. In this paper, we describe the development and initial pilot feasibility testing of a BATD mobile application (Behavioral Apptivation) to be used by patients and therapists in conjunction with BATD therapy. We present information regarding the app development process as well as results from a small open-label feasibility trial of the app utilized in conjunction with individual BATD. We include a case series from the open-label trial highlighting how Behavioral Apptivation can be utilized in clinical practice.

      PubDate: 2017-06-26T15:07:04Z
       
  • Self-Acceptance Group Therapy: A Transdiagnostic, Cognitive-Behavioral
           Treatment for Shame
    • Abstract: Publication date: Available online 2 June 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Michelle Schoenleber, Kim L. Gratz
      Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.

      PubDate: 2017-06-04T16:49:33Z
       
  • Updating the Textbook: A Novel Approach to Training Graduate Students in
           Evidence-Based Youth Practices
    • Abstract: Publication date: Available online 11 May 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Ziv Bell, Ilana Seager, Tiffany Shader, Mary A. Fristad
      Despite the ever-improving base of evidence-based practices (EBPs) for the treatment of childhood disorders, a gap between EBP research and their use in community settings continues to exist. An exciting opportunity to close this gap exists in the form of graduate student training; however, at present, several roadblocks exist. In this paper, we review the current state of graduate training in delivering EBPs and obstacles involved in training future community clinicians (i.e., graduate students) in EBPs. Next, we describe in detail our initiative to develop a curriculum that addresses these challenges. This innovative course empowered graduate students to receive training in the delivery of youth EBPs in community settings through reviews of the research literature, active learning techniques (e.g., discussions of case conceptualizations, role-playing case studies), and a written, publication-quality review of EBPs. Finally, we offer recommendations for other educators of mental health professionals (e.g., psychologists, social workers, counselors) to improve upon this curriculum in their training of graduate students in the theory and application of EBPs for treating childhood disorders.

      PubDate: 2017-05-15T14:46:11Z
       
  • A Brief Alcohol Intervention During Inpatient Psychiatric Hospitalization
           for Suicidal Adolescents
    • Abstract: Publication date: Available online 11 May 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Kimberly H. McManama O’Brien, Laika D. Aguinaldo, Erina White, Christina M. Sellers, Anthony Spirito
      Alcohol use and suicide-related thoughts and behaviors are common in psychiatrically hospitalized adolescents and each problem can exacerbate the other. Despite knowledge about the functional relationship between alcohol use and suicide-related thoughts and behaviors, inpatient psychiatric units only cursorily address alcohol use because suicide risk is considered primary. In this paper we provide theoretical and empirical rationale for the inclusion of brief motivational interventions for alcohol use in inpatient treatment settings for suicidal adolescents. We give a case example of the brief intervention in practice, including when and how to use specific techniques. Following the case example, we discuss the flexibility of this intervention and how it can be adapted for adolescents with varying risk profiles. We conclude with recommendations for future research, including the development and testing of technology-based boosters following hospital discharge.

      PubDate: 2017-05-15T14:46:11Z
       
  • When Self-Blame Is Rational and Appropriate: The Limited Utility of
           Socratic Questioning in the Context of Moral Injury: Commentary on Wachen
           et al. (2016)
    • Abstract: Publication date: Available online 18 April 2017
      Source:Cognitive and Behavioral Practice
      Author(s): Matt J. Gray, William P. Nash, Brett T. Litz
      In this commentary, we argue that a generally sound therapeutic technique—Socratic questioning—is ill-suited to address a common variant of combat-related emotional and psychological distress. Specifically, moral injury is a term used to describe a syndrome of shame, self-handicapping, anger, and demoralization that occurs when deeply held beliefs and expectations about moral and ethical conduct are transgressed. Importantly, moral injury can and often does result from instances of intentional perpetration. We contend that challenging the accuracy of self-blame in such cases is conceptually problematic and potentially harmful. Such an approach is based on a questionable premise—i.e., that self-blame and resulting guilt are inherently illogical or inaccurate. Though this is often the case, it is not invariably so. We briefly describe an alternate approach—Adaptive Disclosure—that allows for accurate and legitimate self-blame when warranted but also promotes the possibilities of self-forgiveness, compassion, and moral reparation.

      PubDate: 2017-05-06T13:54:02Z
       
 
 
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