One-year follow-up of the effectiveness and mediators of cognitive behavioural therapy among adults with attention-deficit/hyperactivity disorder: secondary outcomes of a randomised controlled trial.

BACKGROUND: The long-term effectiveness of cognitive behavioural therapy (CBT) in medicated attention-deficit/hyperactivity disorder (ADHD) adults with residual symptoms needs to be verified across multiple dimensions, especially with respect to maladaptive cognitions and psychological quality of life (QoL). An exploration of the mechanisms underlying the additive benefits of CBT on QoL in clinical samples may be helpful for a better understanding of the CBT conceptual model and how CBT works in medicated ADHD. METHODS: We conducted a secondary analysis of a randomised controlled trial including 98 medicated ADHD adults with residual symptoms who were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M)-only group. Outcomes included ADHD-core symptoms (ADHD Rating Scale), depression symptoms (Self-rating Depression Scale), maladaptive cognitions (Automatic Thoughts Questionnaire and Dysfunctional Attitude Scale), and psychological QoL (World Health Organization Quality of Life-Brief Version-psychological domain). Mixed linear models (MLMs) were used to analyse the long-term effectiveness at one-year follow-up, and structural equation modeling (SEM) was performed to explore the potential mechanisms of CBT on psychological QoL. RESULTS: ADHD patients in the CBT + M group outperformed the M-only group in reduction of ADHD core symptoms (d = 0.491), depression symptoms (d = 0.570), a trend of reduction of maladaptive cognitions (d = 0.387 and 0.395, respectively), and improvement of psychological QoL (d = - 0.433). The changes in above dimensions correlated with each other (r = 0.201 ~ 0.636). The influence of CBT on QoL was mediated through the following four pathways: 1) changes in ADHD core symptoms; 2) changes in depressive symptoms; 3) changes in depressive symptoms and then maladaptive cognitions; and 4) changes firstly in depressive symptoms, maladaptive cognitions, and then ADHD core symptoms. CONCLUSIONS: The long-term effectiveness of CBT in medicated ADHD adults with residual symptoms was further confirmed. The CBT conceptual model was verified in clinical samples, which would be helpful for a deeper understanding of how CBT works for a better psychological QoL outcome. TRIAL REGISTRATION: ChiCTR1900021705 (2019-03-05).

Bidirectional associations between maladaptive cognitions and emotional symptoms, and their mediating role on the quality of life in adults with ADHD: a mediation model.

Background/objectives: Adults with attention-deficit/hyperactivity disorder (ADHD) have more maladaptive cognitions, emotional problems and a poorer quality of life (QoL). A verification of the psychological model in clinical samples is needed for a better understanding of the mechanisms of ADHD diagnosis on QoL via maladaptive cognitions, emotional symptoms, and their interactions. Methods: 299 ADHD participants and 122 healthy controls were recruited. ADHD core symptoms, maladaptive cognitions, emotional symptoms and psychological QoL were rated. Pearson's correlation and structural equation modeling were analyzed to explore the relationship and influence of ADHD diagnosis on QoL. Results: More maladaptive cognitions, emotional symptoms, and poorer QoL were found in the ADHD group, and the dysfunctional attitudes were on par between ADHD with or without medication (p = 0.368). Moderate to strong correlations were found between emotional symptoms, maladaptive cognitions and QoL, and ADHD core symptoms presented correlations among the above scores (r = 0.157 ~ 0.416, p < 0.01) in ADHD participants. The influence of ADHD diagnosis on QoL was mediated through maladaptive cognitions, emotional symptoms, and their bidirectional interactions (p < 0.05), especially those with stable medication. Conclusion: Our study is the first to verify the psychological model in adults with ADHD in China. The findings determined the direct influence of ADHD diagnosis on QoL and the indirect influence through maladaptive cognitions, emotional symptoms, and their interactions, emphasizing the importance of interventions for emotional symptoms and maladaptive cognitions for ADHD patients both with or without medication for a better QoL outcome.

Association Between Child Abuse Experience and Pathological Internet Use Among Chinese University Students: The Mediating Roles of Security and Maladaptive Cognitions.

Research has revealed that child abuse experience can increase pathological Internet use; however, few studies have focused on the influence of child abuse experience on pathological Internet use. This study examined the mediating roles of security and maladaptive cognitions in the association between child abuse and pathological Internet use. A total of 918 Chinese university students participated in the study, with measurements of child abuse, security, maladaptive cognitions, and pathological Internet use being employed. Structural equation modeling results indicated that child abuse could positively predict (i) pathological Internet use, (ii) pathological Internet use through the mediating role of security, (iii) pathological Internet use through the mediating role of maladaptive cognitions, and (iv) pathological Internet use through the chain mediating role of security and maladaptive cognitions. These results indicated that security and maladaptive cognitions were the primary factors in the association between child abuse and pathological Internet use.

Predicting Adolescent Internet Gaming Addiction from Perceived Discrimination, Deviant Peer Affiliation and Maladaptive Cognitions in the Chinese Population: A Two-Year Longitudinal Study.

A robust positive association between perceived discrimination and Internet gaming addiction (IGA) among adolescents has been demonstrated by existing research; however, the mediating mechanisms underlying this relationship remain largely unknown. This study, grounded in the cognitive-behavioral and social development models, examined whether deviant peer affiliation and maladaptive cognitions mediated the predictive effect of perceived discrimination on adolescent IGA. Six-hundred-and-sixty students (Meanage = 13.43 years; 367 female participants) recruited from southern China participated in four assessments (fall 7th grade, spring 7th grade, fall 8th grade, spring 8th grade). Participants completed a self-administered questionnaire that assessed their demographics, as well as questionnaire measures of perceived discrimination, deviant peer affiliation, maladaptive cognitions, and IGA. The structural equation model showed that fall 7th grade's perceived discrimination positively predicted spring 7th grade's deviant peer affiliation, which, in turn, increased fall 8th grade's maladaptive cognitions, ultimately increasing spring 8th grade's IGA. Moreover, the indirect effect of fall 7th grade's perceived discrimination on spring 8th grade's IGA via spring 7th grade's deviant peer affiliation was also significant. The results suggested deviant peer affiliation and maladaptive cognitions as potential mediating mechanisms linking perceived discrimination to adolescent IGA. These findings have important implications for the prevention and intervention of adolescent IGA.

Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder.

Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes.Trial registration: ClinicalTrials.gov identifier: NCT01244295.

Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders.

BACKGROUND: Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal. METHODS: 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal. RESULTS: Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal. CONCLUSION: Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive-behavioral treatment is warranted.

Associations Among the Big Five Personality Traits, Maladaptive Cognitions, and Internet Addiction Across Three Time Measurements in 3 Months During the COVID-19 Pandemic.

The present study examined the longitudinal association among the Big Five personality traits, maladaptive cognitions, and Internet addiction during the COVID-19 pandemic. A total of 481 Chinese university students (247 men; mean age = 20.31 years) were surveyed three times (interval of 1 month) by using the Chinese version of the Big Five Personality Traits Scale, Maladaptive Cognitions Scale, and Internet Addiction Scale. The results of a cross-lagged panel analysis highlighted that (i) extraversion, agreeableness, conscientiousness, and openness were negatively associated with maladaptive cognitions and Internet addiction, whereas neuroticism was found to be positively associated with maladaptive cognitions and Internet addiction across time; (ii) associations among the Big Five personality traits, maladaptive cognitions, and Internet addiction were dynamic and bidirectional; and (iii) maladaptive cognitions played mediating roles in extraversion, agreeableness, conscientiousness, openness, and Internet addiction across time. The Big Five personality traits, maladaptive cognitions, and Internet addiction predicted each other across time, and maladaptive cognitions were likely to be the key mediating factor in the associations between the Big Five personality traits and Internet addiction, which supported and expanded the Davis' cognitive-behavioral model.

Evaluating schema modes and cognitive distortions in borderline personality disorder: A mixed-method approach.

OBJECTIVES: Cognitive processes, such as schema modes and cognitive distortions, may play a role in the genesis and maintenance of affective, interpersonal, and behavioral difficulties in individuals with Borderline Personality Disorder (BPD). This study aimed at exploring the schema modes and cognitive distortions in individuals with BPD. METHODS: Using a mixed-method approach, 30 individuals with BPD and 30 healthy participants were assessed on the Borderline Personality Questionnaire, the Schema Mode Inventory, the Cognitive Distortions Scale, and a semi-structured interview schedule. RESULTS: The BPD group had higher scores than the control group on all the maladaptive schema modes and cognitive distortions subscales. The child modes were the commonest and were also the strongest correlate of BPD symptomatology. Qualitative analysis of the content of the semi-structured interview also corroborated these findings. CONCLUSIONS: There could be many schema modes and cognitive distortions operating behind the diverse psychopathology seen in BPD.

How maladaptive cognitions contribute to the development of problematic social media use.

The current study investigates the effects of perfectionism discrepancies (PD) and social hopelessness (SH) on problematic social media use as conceptualized by the cognitive-behavioral model. METHODS: A sample of 400 university students (52.3% women; mean age = 22.01 ± 1.99) completed measures assessing PD, SH, and problematic social media use. RESULTS: Structural equation modeling showed that both social hopelessness and feeling discrepant from personal and prescribed standards predicted the preference for online social interactions (POSI). POSI predicted the motivation to use online social media as a means of alleviating distressing feelings, the inability to regulate social media use and the negative outcomes resulting from use of SNS. CONCLUSIONS: In line with the cognitive-behavioral model of problematic Internet use, the present study suggests the primary importance of maladaptive cognitions about the self (i.e. perfectionism discrepancies) and the world (i.e. social hopelessness) for the development of a preference for online social interactions. In particular, the present study shows that individuals are likely to opt for online social interactions as a function of their pessimistic social expectancies and the sense of inadequacy that comes from perceptions of falling short of expectations.

Psychological Distress and Problematic Mobile Phone Use Among Adolescents: The Mediating Role of Maladaptive Cognitions and the Moderating Role of Effortful Control.

Previous studies have documented that psychological distress is related to problematic mobile phone use (PMPU), and sporadic research has investigated the potential mechanisms underlying the association. Based on the cognitive-behavioral model of pathological Internet use (PIU), the self-control theory, and the problem-behavior theory, this study aimed to examine the mediating role of maladaptive cognitions toward mobile phones and the moderating role of effortful control between psychological distress and PMPU. Data were collected from 1,799 secondary school students (45.1% male; M age = 14.07, SD = 1.69) using four self-reported questionnaires. The results revealed that maladaptive cognitions toward mobile phones partially mediated the relationship between psychological distress and PMPU. In addition, effortful control as a protective factor attenuated the indirect effect from psychological distress to PMPU. These findings advanced the understanding of the etiology of PMPU and the need to develop effective strategies for prevention, suggesting that schools and families should pay additional attention to students with psychological distress. Targeted interventions for integrating online and offline worlds and effortful control training programs may help to prevent adolescents from engaging in PMPU.

The role of school connectedness and maladaptive cognitions in the association between stress and Internet addiction: A serial mediation model.

PURPOSE: To explore the mediating effect of school interest and maladaptive cognitions in the relationship between stress and Internet addiction. DESIGN AND METHODS: A total of 2271 high school students were recruited from a Chinese high school. Serial mediation model was used. RESULTS: School interest and maladaptive cognitions had 0.03 and 0.13 indirect effects in the association between stress and Internet addiction, and accounting for 7.9% and 34.2% of the total effect, respectively. The serial indirect effect of school interest and maladaptive cognition was 0.05, accounting for 13.2% of the total effect. PRACTICE IMPLICATIONS: The present study highlights the need of reducing stress and increasing school interest among high school students to prevent and intervene the occurrence of Internet addiction.

The relative contribution of motives and maladaptive cognitions to levels of Internet Gaming Disorder.

This study aimed at determining whether motives and/or maladaptive cognitions would predict levels of Internet Gaming Disorder independently of negative affect and problematic Internet use. Seventy-nine Internet gamers completed the following questionnaires: Ten-Item Internet Gaming Disorder Test, Problematic Internet Use Questionnaire Short Form, Depression Anxiety and Stress Scale 21, Motives for Online Gaming Questionnaire, and Maladaptive Gaming-Related Cognitions Scale. Results showed that all variables were positively and significantly correlated with levels of Internet Gaming Disorder with the exception of motives relating to recreation. Furthermore, a hierarchical linear regression analysis showed that motives relating to coping and skills development and maladaptive cognitions relating to overvaluing of game rewards were the only significant predictors of levels of Internet Gaming Disorder when controlling for negative affect and problematic Internet use. The implications of these findings are discussed.

Validation of the Chinese Version of the Revised Internet Gaming Cognition Scale among Adolescents in China: Maladaptive Cognitions as Potential Determinants of Internet Gaming Disorder.

Maladaptive gaming cognitions are important determinants of Internet gaming disorder (IGD). Based on a systematic review, a 4-factor Internet gaming cognition scale (IGCS) was previously developed and cross-cultural validation of IGCS is warranted. The present study assesses the validation of the IGCS and its revised version, the Chinese version of Revised IGCS (C-RIGCS), among adolescents in China. Altogether, 755 students were recruited from junior middle schools in Guangzhou and Chengdu, China. The psychometric properties of the C-RIGCS were assessed by using appropriate statistical methods. The 4-factor model of the original IGCS was not supported by confirmatory factor analysis (CFA). In the split-half sub-samples, exploratory factor analysis suggested a 3-factor model for C-RIGCS, which was confirmed by CFA. The C-RIGCS and its three subscales showed satisfactory internal reliability, test-retest reliability, content validity, and absence of ceiling and floor effects (except on one case). Besides, the C-RIGCS and its three subscales were significantly correlated with external variables including IGD, gaming time, impulsivity, and self-control, and perceptions that Internet gaming is the primary source of self-esteem and social acceptance. The C-RIGCS proposed a new 3-factor model that showed satisfactory psychometric properties. It can be applied to understand maladaptive gaming cognitions of adolescent IGD.

Personality and Problematic Internet Use Among Chinese College Students: The Mediating Role of Maladaptive Cognitions Over Internet Use.

The previous research on personality and problematic Internet use (PIU) has predominantly, if not exclusively, focused on their direct associations with cross-sectional designs. Based on four annual waves of data from 2,516 Chinese college students, this study examined the mediating role of maladaptive cognitions over Internet use in the associations between personality traits (i.e., neuroticism, extraversion, and psychoticism) and PIU. Results indicated that these personality traits assessed at year 2 (i.e., the second college year) were indirectly associated with PIU at year 4 via maladaptive cognitions over Internet use at year 3. The indirect associations were robust after controlling for PIU at year 2, depression and anxiety at year 4, and a series of demographic covariates at year 1. Such findings highlight various personality traits as critical antecedents of PIU. Furthermore, identifying maladaptive cognitions over Internet use as a mechanism explaining the associations between personality traits and PIU may facilitate more targeted and effective intervention efforts.

Relation between coping and posttrauma cognitions on PTSD in a combat-trauma population.

Individual differences in cognitive processes and coping behaviors play a role in the development and maintenance of posttraumatic stress disorder (PTSD). Given the large numbers of combat-exposed service members returning from the Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) conflicts, exploring individual differences in cognitive-affective processes is important for informing our understanding of PTSD etiology and early intervention in military samples. The present study examined the unique main and interactive effects of negative posttrauma cognitions (i.e., negative beliefs about self [NS], the world [NW], and self-blame [SB]) and coping strategies (i.e., positive behavioral, positive cognitive, avoidant coping, and social and emotional coping) on PTSD diagnosis within 155 (Mage = 30.7, SD = 4.48) OEF/OIF/OND combat trauma-exposed veterans recruited from an ongoing study examining the effects of combat trauma and stress reactivity. In the final, stepwise logistic regression analysis, avoidant coping, but no other coping strategy, was significantly positively related to PTSD diagnosis in the initial step. Higher levels of NS, but not NW, were significantly associated with having a PTSD diagnosis, while SB was associated with decreased likelihood of PTSD, above and beyond coping strategies. A significant interaction effect was found between NS and positive cognitive coping, such that greater positive cognitive coping weakened the relationship between NS and PTSD. Examining and addressing coping behaviors and negative thoughts of self jointly may benefit assessment and intervention approaches in a combat-trauma population.

Therapeutic mechanisms of Mindfulness-Oriented Recovery Enhancement for internet gaming disorder: Reducing craving and addictive behavior by targeting cognitive processes.

Background: Internet gaming disorder (IGD) is characterized by signs and symptoms similar to substance use and gambling disorders, and associated with psychosocial impairments. Research suggests that maladaptive gaming-related cognitions and coping may be implicated in IGD; therefore, interventions for IGD need to target these underlying mechanisms. Mindfulness-based treatment is effective in changing maladaptive cognitive processes and increasing adaptive coping among people with addictions. Aims: This study used data from an RCT of Mindfulness-Oriented Recovery Enhancement (MORE) for IGD to further examine changes in maladaptive gaming-related cognitions and positive reappraisal as mediators of the effects of MORE on IGD signs/symptoms. Methods: Participants (N = 30, Age M = 25.0, SD  = 5.4) were randomized to 8-weekly sessions of MORE or a support group (SG) control condition. IGD severity, levels of craving for video game playing, maladaptive gaming-related cognitions, and positive reappraisal were measured at pre-and posttreatment, and 3-month follow-up. Results: Multivariate path analyses revealed that effects of MORE in reducing IGD and craving were statistically mediated by changes in maladaptive gaming-related cognitions. Though changes in positive reappraisal did not significantly mediate effects of MORE on IGD or craving, MORE enhanced positive reappraisal to a significantly greater extent than the SG at posttreatment. Discussion: Findings suggest that effects of mindfulness treatment in reducing maladaptive gaming-related cognitions might lead to reductions in IGD severity and cravings for video game playing. This cognitive mechanism should be evaluated in a future, full-scale RCT.

Beyond "Facebook Addiction": The Role of Cognitive-Related Factors and Psychiatric Distress in Social Networking Site Addiction.

The use of social networking sites (SNSs) is rapidly increasing as billions of individuals use SNS platforms regularly to communicate with other users, follow the news, and play browser games. Given the widespread use of SNS platforms, investigating the potential predictors of addictive SNS use beyond Facebook use has become paramount given that most studies so far focused on "Facebook addiction." In this study, a total of 511 English-speaking SNS users (58.1% young adults aged 20-35 years; 64.6% female) were recruited online and asked to complete a battery of standardized psychometric tools assessing participants' sociodemographic characteristics, SNS preferences and patterns of use, SNS addiction, preference for online social interaction, maladaptive cognitions, fear of missing out (FoMo), dysfunctional emotion regulation, and general psychiatric distress. Overall, about 4.9% (n = 25) of all participants could be classed as having a high SNS addiction risk profile. Moreover, the results further indicated that FoMo (ß = 0.38), maladaptive cognitions (ß = 0.25), and psychiatric distress (ß = 0.12) significantly predicted SNS addiction (i.e., p < 0.0001) and accounted for about 61% of the total variance in SNS addiction, with FoMo providing the strongest predictive contribution over and above the effects of sociodemographic variables and patterns of SNS use. The implications of the present findings were discussed in light of extant literature on behavioral addictions and Facebook addiction and further considerations were provided regarding the potential clinical implications for cognitive-based psychological treatment approaches to SNS addiction.

Resisting temptation: alcohol specific self-efficacy mediates the impacts of compensatory health beliefs and behaviours on alcohol consumption.

Awareness of health risks linked with excessive alcohol consumption appears to have little influence on how much some people drink. Compensatory health beliefs (CHBs), in which the consequences of unhealthy behaviour are considered to be neutralised by additional healthy behaviours, are one way of justifying poor health choices. Currently, the role of CHBs within the context of drinking behaviour is not well understood. This research examined associations between alcohol specific compensatory health beliefs (ACH-Beliefs) and behaviours (ACH-Behaviours), alcohol consumption and alcohol specific self-efficacy (ASE), via an online survey completed by 249 participants, aged 18 + years (63.1% female; M age = 41.62 years; SD = 14.80). Higher ACH-Beliefs were associated with increases in ACH-Behaviours. While both predicted alcohol consumption, a greater proportion of variance was explained by ACH-Behaviours. ASE was a significant mediator of those relationships, suggesting that those with higher ASE may be better equipped to regulate drinking behaviour. Recommendations for future research include measuring both CHBs and behaviours within an experimental design, and further investigation of related cognitions such as compensatory behaviour intentions. Alcohol misuse interventions may wish to consider the potential roles of CHBs and behaviours in facilitating maladaptive coping strategies, and how addressing these may reduce harms.

Maladaptive Core Beliefs and their Relation to Generalized Anxiety Disorder.

Research has demonstrated that individuals with generalized anxiety disorder (GAD) hold unhelpful beliefs about worry, uncertainty, and the problem-solving process. Extant writings (e.g., treatment manuals) also suggest that other types of maladaptive beliefs may characterize those with GAD. However, these other beliefs have received limited empirical attention and are not an explicit component of cognitive theories of GAD. The present study examined the extent to which dysfunctional attitudes, early maladaptive schemas, and broad self-focused and other-focused beliefs explain significant variance in GAD symptoms, over and above negative and positive beliefs about worry, negative beliefs about uncertainty, and negative beliefs about problems. N = 138 participants classified into Probable GAD and Non-GAD groups completed self-report measures. After controlling for trait anxiety and depressive symptoms, only beliefs about worry, negative beliefs about uncertainty, and schemas reflecting unrelenting standards (e.g., "I must meet all my responsibilities all the time"), the need to self-sacrifice (e.g., "I'm the one who takes care of others"), and less positive views of other people and their intentions (e.g., lower endorsement of views such as "other people are fair"), were unique correlates of Probable GAD versus Non-GAD or GAD severity. Theoretical and clinical implications are discussed.

What is the best time point to identify patients at risk of developing persistent low back pain?

BACKGROUND: Early identification of patients at risk of developing persistent low back pain (LBP) is crucial. OBJECTIVE: Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified. METHODS: Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic regression analysis was performed for all time points. RESULTS: The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive. CONCLUSIONS: Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.