Existential Approaches and Cognitive Behavior Therapy: Challenges and Potential.

Existential concerns such as death, responsibility, meaninglessness, and isolation not only are the hallmark of existential psychotherapy but also are frequently encountered by CBT therapists-nevertheless, due to epistemological and ideological differences, existential and CBT approaches to psychotherapy had little overlap historically. During recent years, existential issues are increasingly discussed in empirical clinical psychology, e.g., the potential role of the fear of death for a variety of mental disorders by Iverach et al. (Clinical Psychology Review, 34(7), 580-593, 2014), and there is increasing experimental evidence for a causal rather than correlational role of death anxiety discussed by Menzies and Dar-Nimrod (Journal of Abnormal Psychology, 126(4), 367-377, 2017). Further, existential concerns are common themes in CBT discussed by Grober et al. (Psychotherapeut, 61(3), 229-236, 2016) and may play an important role in the training of CBT therapists discussed by Worrell et al. (Journal of Psychotherapy and Counselling Psychology Reflections, 3(1), 9-16, 2018) as well as in personal therapy and supervision.

Couple-based Intervention for Depression: An Effectiveness Study in the National Health Service in England.

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple-based treatment for depression (BCT-D) provided in London services that are part of the "Improving Access to Psychological Therapies" (IAPT) program in England. Twenty-three therapists in community clinics were trained in BCT-D during a 5-day workshop, followed by monthly group supervision for 1 year. The BCT-D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT-D. Eighty-five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT-D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT-D, although they were not the focus of treatment. BCT-D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT-D in routine clinical settings.

Dupuytren's disease.

Dupuytren's disease is a benign contractile disorder of the hand. The condition commonly affects older men of Celtic descent. Although fibroproliferation and collagen alteration play a role in its etiology, defining a cause remains elusive. Nonoperative intervention for advanced disease has shown only short-term benefit. Therefore, open fasciectomy has become the mainstay of treatment. Associated morbidity and recurrence have prompted investigation into less invasive techniques, including needle aponeurotomy and enzymatic fasciotomy. Data from phase III studies using injectable collagenase are changing treatment algorithms. Postoperative rehabilitation includes nighttime splinting and immediate active range of motion exercises to facilitate return to function.

The use of therapist self-disclosure: clinical psychology trainees' experiences.

This qualitative study examined clinical psychology trainees' experiences of using, or not using, therapist self-disclosure and their experience of training and supervision on this issue. Fourteen trainees were interviewed and their accounts analyzed using interpretative phenomenological analysis, yielding nine themes organized into two domains. The first domain ("the decision in the moment") concerned participants' struggle with decision making about disclosure; the second ("the developing therapist") reflected their evolving ideas about disclosure over training and within the wider philosophical context of therapy. The dilemmas surrounding disclosure seemed to distill some central issues associated with participants' developing professional therapist identity. Working out one's position on self-disclosure is a challenge that trainee therapists may require support in mastering.

Challenging Hofmann's negative thoughts: A rebuttal.

In his commentary on Longmore and Worrell [Longmore, R., & Worrell, M. (2007) Do we need to challenge thoughts in Cognitive Behavioural Therapy? Clinical Psychology review, 27, 173-187], Hofmann [Hofmann, S. G. (2008-this issue). Common misconceptions about cognitive mediation of treatment change: A commentary to Longmore and Worrell (2007). Clinical Psychology Review, doi:10.1016/j.cpr.2007.03.003] argues that the paper shows a range of errors, biases, and misconceptions that have led to incorrect interpretations of the literature and general conclusions. Hofmann discusses recent developments in the methodological criteria for mediation studies in support of his contentions. In this rebuttal it is demonstrated that Hofmann has in fact misrepresented the primary focus and arguments of Longmore and Worrell (2007). Additionally, it is shown that the arguments and research findings that Hofmann discusses do not constitute a significant challenge to the conclusions drawn as a result of the original review.

Do we need to challenge thoughts in cognitive behavior therapy?

Cognitive behavior therapy (CBT) emphasizes the primacy of cognition in mediating psychological disorder. It aims to alleviate distress by modifying cognitive content and process, realigning thinking with reality. Recently, various authors have questioned the need for CBT therapists to use logico-rational strategies to directly challenge maladaptive thoughts. Hayes [Hayes, S.C. (2004). Acceptance and commitment therapy and the new behavior therapies. In S.C. Hayes, V.M. Follette, & M.M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition. (pp. 1-29). New York: Guilford] has identified three empirical anomalies in the research literature. Firstly, treatment component analyzes have failed to show that cognitive interventions provide significant added value to the therapy. Secondly, CBT treatments have been associated with a rapid symptomatic improvement prior to the introduction of specific cognitive interventions. Thirdly, there is a paucity of data that changes in cognitive mediators instigate symptomatic change. This paper critically reviews the empirical literature that addresses these significant challenges to CBT. A comprehensive review of component studies finds little evidence that specific cognitive interventions significantly increase the effectiveness of the therapy. Although evidence for the early rapid response phenomenon is lacking, there is little empirical support for the role of cognitive change as causal in the symptomatic improvements achieved in CBT. These findings are discussed with reference to the key question: Do we need to challenge thoughts in CBT?