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COGNITIVE MEDIATION RESEARCH
Testing the Efficacy of Theoretically Derived Improvements in the Treatment of Social Phobia. By Rapee, Ronald M.; Gaston, Jonathan E.; Abbott, Maree J. Journal of Consulting and Clinical Psychology. Vol 77 (2), Apr 2009, 317-327. Key Findings: Enhancing standard cognitive therapy with performance feedback and attention retraining produced superior outcomes on diagnostic severity compared to standard CT. The enhanced CT was associated with greater reductions in perceived cost of negative evaluation and negative views of one's skills and appearance. Changes on these cognitive variables mediated the outcome differences in diagnostic severity. The reduction of anxiety vulnerability through the modification of attentional bias: A real-world study using a home-based cognitive bias modification procedure. By See, J; Macleod, CM; Bridle, R. Journal of Abnormal Psychology, Vol 118(1), Feb 2009, 65–75. Key Finding: Using a home-based computerized attentional modification program, these researchers experimentally induced attentional bias in response to negative emotional material. Half of the subjects were induced to orient their attention toward threat and the other half away from threat. Those who had been induced to attend away from threat subsequently had lower trait anxiety scores and a decreased state anxiety response to a subsequent naturalistic stressor. (PsycINFO Database Record (c) 2009 APA, all rights reserved. Cognitive Mechanisms of social anxiety reduction: An examination of specificity and temporality. By Smits, Jasper A. J.; Rosenfield, David; McDonald, Renee; Telch, Michael J. Journal of Consulting and Clinical Psychology. 2006 Dec Vol 74(6) 1203-1212. Key Finding: Reductions in cognitive biases toward social threat (probability and cost) accounted for significant variance in fear reduction achieved during treatment. CBT PROCESS AND PROCEDURES Measuring the suicidal mind: implicit cognition predicts suicidal behavior. By Kazantzis, N., Whittington, C., & Dattilio, F.. Clinical Psychology: Science and Practice. Volume 17 Issue 2, Pages 144 - 156 Key Finding: Key Finding: This meta-analysis of 46 studies, N = 1,072, examined the impact of homework on outcome in CBT. Results support the conclusion that homework enhances the effect of CBT. Specifically, the researchers found a pre–posttreatment ES of d = 1.08 for standard CBT (with homework) and a smaller d = 0.63 for versions of CBT that did not include homework. Measuring the suicidal mind: implicit cognition predicts suicidal behavior. By Strunk, D. R.; Brotman, M. A.; & DeRubeis, R. J. Behaviour Research and Therapy, Vol 48(7), Jul 2010, 599-606. Key Finding: Key Finding: This study examined therapist and patient contributions to effective cognitive therapy in a sample of 60 patients with moderate to severe depression. Among therapist behaviors, key predictors of improvement over the first five sessions were adherence to cognitive methods and negotiating content/structuring sessions. Among patient behaviors, patients' tendency to facilitate versus inhibit therapist adherence predicted improvement. DEPRESSION Cognitive predictors of symptom return following depression treatment. By Beevers, Christopher G.; Keitner, Gabor I.; Ryan, Christine E.; Miller, Ivan W. Journal of Abnormal Psychology. 2003 Aug Vol 112(3) 488-496. Key finding: Relapse is a common problem in major depressive disorder. In this study, patients who were treated to at least a 50% reduction in depressive symptoms were followed up. Those who showed poor change in dysfunctional attitudes or a poor change in extreme thinking during treatment experienced faster return of depressive symptoms in the year following treatment. Unlinking Negative Cognition and Symptoms of Depression: Evidence of a Specific Treatment Effect for Cognitive Therapy. By Beevers, Christopher G.; Miller, Ivan W. Journal of Consulting and Clinical Psychology. Vol 73(1), Feb 2005, 68-77. Key Finding: Depressed patients were randomly assigned to receive cognitive therapy or family therapy. During the year following treatment, patients who had received cognitive therapy showed weaker associations between negative cognition and symptoms of depression than those who had received family therapy. Findings support the hypothesis that cognitive therapy specifically changes how a person thinks in the presence of dysphoria. Determinants of change in cognitive therapy for depression. By DeRubeis, Robert J.; Feeley, Michael. Cognitive Therapy and Research. 1990 Oct Vol 14(5) 469-482. Key Finding: Concrete, symptom-focused methods of cognitive therapy, predicted subsequent symptom reduction when assessed early in treatment, but not later. Less focused, more abstract discussions, did not predict improvement. Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial. By Dozois, DJ; Bieling, PJ; Patelis-Siotis, I; Hoar, L; Chudzik, S; McCabe, K; & Westra, HA. Journal of Consulting and Clinical Psychology, Vol 77(6), Dec 2009, 1078-88. Key Finding: Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved. Cognitive processes in cognitive therapy: Evaluation of the mechanisms of change in the treatment of depression. By Garratt, Genevieve; Ingram, Rick E.; Rand, Kevin L.; Sawalani, Gita. Clinical Psychology: Science and Practice. 2007 Sep Vol 14(3) 224-239. Key Finding: The current body of research generally supports cognitive mediation in cognitive therapy of depression. Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder. By Kaufman, Noah K.; Rohde, Paul; Seeley, John R.; Clarke, Gregory N.; Stice, Eric Journal of Consulting and Clinical Psychology. 2005 Feb Vol 73(1) 38-46 Key Finding: Adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire appeared to mediate treatment effects on depressive symptoms. Findings suggest that reduction of negative thinking is the primary mechanism for reducing depression in CWD-A. The effects of rumination and negative cognitive styles on depression: A mediation analysis. By Lo, Cola S.L.; Ho, Samuel M.Y.; Hollon, Steven D. Behaviour Research and Therapy. 2008 Vol 46 487-495. Key finding: Research on cognitive models of depression has identified negative cognitive styles and rumination as risk factors for depression. The present study examined the hypothesis that rumination mediates the effect of negative cognitive styles on depression. Specifically, we evaluated the differential effects of two aspects of rumination, characterized by brooding and reflection, on the relationship between negative cognitive styles and level of depressive symptoms. A total of 115 college students and 38 patients suffering from depressive disorders completed a battery of questionnaires measuring levels of depressive symptoms, brooding, reflection, and negative cognitive styles. The results support the notion that there exist two distinct dimensions of rumination and that, of the two, it is brooding and not reflection that mediates the relationship between negative cognitive styles and depression and contributes to its negative outcomes. Brooding and reflection: Rumination predicts suicidal ideation at 1-year follow-up in a community sample. By Miranda, Regina; Nolen-Hoeksema, Susan. Behaviour Research and Therapy. 2007 Vol 45 3088-3095. Key finding: Brooding and reflection were examined as possible predictors of suicidal ideation. After controlling for baseline ideation, both dimensions of rumination predicted thoughts of suicide at 1-year follow-up. Mechanisms of action of cognitive therapy: The relative contributions of technical and interpersonal interventions. By Persons, Jacqueline B.; Burns, David D. Cognitive Therapy and Research. 1985 Oct Vol 9(5) 539-551. Key Finding: Mood changes during sessions of cognitive therapy were related to changes in degree of belief in automatic thoughts and to the quality of patients’ relationship to their therapist. Cognitive aspects of chronic depression. By Riso LP, Blandino JA, Penna S, Dacey S, Grant MM, Toit PL, Duin JS, Pacoe EM, Ulmer CS. Journal of Abnormal Psychology. 2003;112:72-80. Key Findings: This study included 42 outpatients with chronic depression, 27 outpatients with nonchronic major depressive disorder, and 24 controls. A Schema Questionnaire, the Dysfunctional Attitudes Scale, the Attributional Style Questionnaire, and a ruminative response style questionnaire were more strongly related to chronic depression compared to major depressive disorders, even after controlling for mood state and symptoms of personality disorders. Cognitive Reactivity to Sad Mood Provocation and the Prediction of Depressive Relapse. By Segal, Zindel V.; Kennedy, Sidney; Gemar, Michael; Hood, Karyn; Pedersen, Rebecca; Buis, Tom Archives of General Psychiatry. Vol 63(7), Jul 2006, 749-755. Key Finding: Patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. Cognitive reactivity was assessed at the end of both treatments by having patients complete the Dysfunctional Attitudes Scale before and after a sad mood induction. Patients who received CT showed less cognitive reactivity at the end of treatment and patients with lower reactivity had lower relapse rates over the following 18 months. Patients’ Competence in and Performance of Cognitive Therapy Skills: Relation to the Reduction of Relapse Risk Following Treatment for Depression. By Strunk, Daniel R.; DeRubeis, Robert J.; Chiu, Angela W.; Alvarez, Jennifer. Journal Journal of Consulting and Clinical Psychology. Vol 75(4), Aug 2007, 523-530. Key Finding: Many previous studies have found that CT is superior to antidepressant medication for reducing relapse following treatment for depression. This study examined patients’ acquisition and use of CT skills as possible mediators of reduced relapse risk. Among patients who had a positive response to CT, lower risk of relapse in the year following treatment was associated with higher scores on measures of CT coping skills and in-session evidence of the independent implementation of CT material. Immediate effects on depression of cognitive therapy interventions. By Teasdale, John D.; Fennell, Melanie J. Cognitive Therapy and Research. 1982 Sep Vol 6(3) 343-352. Key Finding: Interventions involving targeting, testing, and modifying depressive thoughts consistently produced more change in belief in the thoughts than did interventions involving exploring and obtaining more information relevant to the thoughts. The greater change in belief resulting from Thought Change intervention was consistently accompanied by greater reduction in self-rated depressed mood than was obtained in the Thought Exploration intervention. Rumination reconsidered: A psychometric analysis. By Treynor, Wendy; Gonzalez, Richard; Nolen-Hoeksema, Susan. Cognitive Therapy and Research. 2003 Jun Vol 27(3) 247-259. Key finding: A two factor model of rumination is proposed, (1) reflective pondering (reflection) and (2) brooding. Brooding is found to mediate the gender-depression association. EATING DISORDERS Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change. By Wilson, G. Terence; Fairburn, Christopher C.; Agras, W. Stewart; Walsh, B. Timothy; Kraemer, Helena. Journal of Consulting and Clinical Psychology. 2002 Apr Vol 70(2) 267-274. Key Finding: Increased self-efficacy regarding eating behavior was one of several mediators of reductions in binging and purging achieved during treatment. MIXED DISORDERS Unique and common mechanisms of change across cognitive and dynamic psychotherapies. By Gibbons, Mary Beth Connolly; Crits-Christoph, Paul; Barber, Jacques P.; Wiltsey Stirman, Shannon; Gallop, Robert; Goldstein, Lizabeth A.; Temes, Christina M.; Ring-Kurtz, Sarah Journal of Consulting and Clinical Psychology. Vol 77(5), Oct 2009, 801-813. br> Key Finding: In an analysis of data pooled from 5 different studies on various disorders, improvements in patients’ views of self and compensatory skills (especially decreases in negative compensatory responses or negative thinking) from intake to termination of therapy uniquely predicted status on outcome variables at 6-month follow-up. This was true regardless of whether patients underwent psychodynamic or cognitive therapy.br> NEUROBIOLOGY Amygdala-frontal connectivity during emotion regulation. By Banks, Sarah J.; Eddy, Kamryn T.; Angstadt, Mike; Nathan, Pradeep J.; and Phan, K. Luan. Social Cognitive and Affective Neuroscience. 2007 2(4):303-312. Key Finding: Control or regulation of emotion is mediated by reappraisal. This study shows that the degree or extent of the correction of negative emotion following reappraisal is predicted by connectivity between specific brain areas, the amygdala and prefrontal cortex. Lateral prefrontal cortex mediates the cognitive modification of attentional bias. By Browning, M.; Holmes, E.A.; Murphy, S.E.; Goodwin, G.M.; & Harmer, C.L. Biological Psychiatry, 2010 in press. Key Finding: As in previous studies, attentional bias toward and away from threat was induced in normal subjects using a dot-probe experimental procedure. Subjects subsequently underwent additional experimental procedures while having their brains scanned using fMRI. Findings showed that the previous training had altered activation in the lateral frontal lobes to emotional stimuli. The authors conclude: "This directly supports the proposal that psychological interventions may influence attention via an effect on the prefrontal cortex." (PsycINFO Database Record (c) 2009 APA, all rights reserved. Amygdala reactivity to masked negative faces is associated with automatic judgmental bias in major depression: a 3 T fMRI study. By Dannlowski U, Ohrmann P, Bauer J, Kugel H, Arolt V, Heindel W, Kersting A, Baune BT. Suslow T. J Psychiatry Neurosci 2007;32:423-429. Key Finding: Amygdala hyperreactivity to negative facial emotions was found to be a neural substrate of negative judgmental bias in depressed inpatients. In a sample of 35 inpatients, the presence of negatively biased evaluative processing predicted a more severe disease course. Volition diminishes genetically mediated amygdala hyperreactivity. By Schardt, Dina M.; Erk, Susanne; Nüsser, Corinna; Nöthen, Markus M.; Cichon, Sven; Rietschel, Marcella; Treutlein, Jens; Goschke, Thomas; Walter, Henrik NeuroImage. Dec 5, 2009. Key Finding: Numerous studies have found that individuals who carry the short-allele variety of the serotonin transporter promoter gene (5-HTTLPR) show hyperreactive amygdala responses to negative or threatening stimuli. In this study, the researchers demonstrated that this genetically mediated amygdala hyperreactivity can be modified by the intentional use of cognitive emotion regulation strategies. Subjects' volitional use of cognitive strategies altered their amygdala-prefrontal connectivity, which in turn was associated with reduced amygdala reactivity. Individual differences in typical reappraisal use predict amygdala and prefrontal responses. By By Drabant, Emily M.; McRae, Kateri; Manuck, Stephen B.; Hariri, Ahmad R.; Gross, James J. J Biological Psychiatry Vol 65(5), Mar 2009, 367-373. Key Finding: Greater use of reappraisal in everyday life was related to decreased amygdala activity and increased prefrontal and parietal activity during the processing of negative emotional facial expressions. These associations were not attributable to variation in trait anxiety, neuroticism, or the use of another common form of emotion regulation, namely suppression. Prefrontal-Subcortical Pathways Mediating Successful Emotion Regulation. By Wager, Tor D.; Davidson, Matthew L.; Hughes, Brent L.; Lindquist, Martin A.; and Ochsner, Kevin N. Neuron. 2008 Volume 59, Issue 6, 25 September 2008, Pages 1037-1050 Key Finding: The failure to regulate negative emotions contributes to the development and symptoms of many psychiatric disorders. Brain scan studies have shown the prefrontal cortices are activated when people employ meaning reappraisal strategies to successfully control negative emotional response. This study identified specific subcortical pathways that mediated the relation between prefrontal activation and self-reported emotion following reappraisal. Spatiotemporal dynamics of error processing dysfunctions in major depressive disorder. By Holmes, Avram J. and Pizzagalli, Diego A. Arch Gen Psychiatry. 2008;65(2):179-188. Key Finding: Citing Beck’s theory of “automatically activated cognitive schemata,” this study explored the underlying mechanisms of the negative cognitive biases found in major depression. Using event-related potentials and a modified Stroop task, they found patients with MDD showed larger error-related negativity compared to healthy subjects. The biased cognitive reactions were associated with hyperactivation of rostral anterior cingulate cortex and medial prefrontal cortex areas, and diminished ability to employ dorsolateral prefrontal cortex-based cognitive control. NONSPECIFIC FACTORS Cognitive change and the therapeutic alliance: The role of technical and nontechnical factors in cognitive therapy. By Rector, Neil A.; Zuroff, David C.; Segal, Zindel V. Psychotherapy: Theory, Research, Practice, Training. 1999 Win Vol 36(4) 320-328. Key Findings: (1) Depressed patients who entered treatment with more dysfunctional attitudes had difficulty perceiving that their therapists cared about and liked them. (2) The degree to which patients were in agreement with the goals and tasks of therapy was predictive of subsequent change in dysfunctional attitudes. (3) Changes in dysfunctional attitudes were associated with changes in depression only among patients who perceived that their therapist cared about and liked them. PANIC DISORDER Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis. By Smits, J. A. J., Powers, M. B., Cho, Y., & Telch, M. J. (2004). Journal of Consulting and Clinical Psychology, 72, 646-652. Key Finding: Using regression analyses, pre- and posttreatment of 90 CBT-treated patients and 40 wait-list control participants were compared on reduction of fear of fear measures. Treatment predicted 31% of symptom reduction, and fear of fear mediated changes in global disability. Automatic Associations and Panic Disorder: Trajectories of Change Over the Course of Treatment. By Teachman, Bethany A.; Marker, Craig D.; Smith-Janik, Shannan B. Journal of Consulting and Clinical Psychology. Vol 76(6), Dec 2008, 988-1002. Key Finding: Automatic panic associations decreased over the course of CBT for panic disorder and the degree of change in these associations predicted reduction in panic symptom severity PTSD Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors. By Meiser-Stedman, Richard; Dalgleish, Tim; Glucksman, Ed; Yule, William; Smith, Patrick Journal of Abnormal Psychology. Vol 118(4), Nov 2009, 778-787. Key Finding: A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2–4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved. Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. By Smith, Patrick; Yule, William; Perrin, Sean; Tranah, Troy; Dalgleish, Tim; Clark, David M. Journal of the American Academy of Child & Adolescent Psychiatry. Vol 46(8). Aug 2007, 1051-1061. Key Finding: Among a sample of children and young people (8-18 years old) with PTSD, those who received individual CBT showed significantly greater improvements in symptoms and functioning than did wait-list controls, and their improvements were partially mediated by reductions in maladaptive thinking. SOCIAL PHOBIA Cognitive mediation of treatment change in social phobia. By Hofmann, S. G. (2004). Journal of Consulting and Clinical Psychology, 72, 392-399. Key Finding: In a randomized controlled trial of ninety individuals diagnosed with social phobia, estimated social cost mediated treatment change, both in exposure therapy and in CBT. Exposure without cognitive intervention resulted in less durable improvement. Negative self-focused cognitions mediate the effect of trait social anxiety on state anxiety. By Schulz, Stefan M.; Alpers, Georg W.; Hofmann, Stefan G. Behaviour Research and Therapy. Vol 46(4), Apr 2008, 438-449. Key Findings: In this study, negative self-focused cognitions or relaxation were experimentally induced during anticipation of a public speaking task and a number of anxiety signs and symptoms were assessed. In support of the cognitive model of social phobia, negative self-focused cognitions mediated the effects of trait social anxiety on subjects’ self-reported anxiety and heart rate variability as they anticipated the public speaking task. SOMATIC DISORDERS Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. By Burns, John W.; Kubilus, Amanda; Bruehl, Stephen; Harden, R. Norman; Lofland, Kenneth. Journal of Consulting and Clinical Psychology. 2003 Feb Vol 71(1) 81-91. Key Finding: Early-treatment changes in catastrophizing and helplessness regarding pain predicted late-treatment outcome. SUBSTANCE ABUSE Mediators of outcome of psychosocial treatments for cocaine dependence. By Crits-Christoph, Paul; Gibbons, Mary Beth Connolly; Barber, Jacques P.; Gallop, Robert; Beck, Aaron T.; Mercer, Delinda; Tu, Xin; Thase, Michael E.; Weiss, Roger D.; Frank, Arlene. Journal of Consulting and Clinical Psychology. Vol 71(5), Oct 2003, 918-925. Key Findings: A measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling. |
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