Imagery rescripting and cognitive restructuring for inpatients with moderate and severe depression - a controlled pilot study.

BACKGROUND: This controlled pilot study investigates the effect of the combined use of cognitive restructuring (CR) and imagery rescripting (IR) compared to treatment as usual among inpatients with moderate and severe depression. Alongside expert ratings and self-report tools, fitness wristbands were used as an assessment tool. METHODS: In addition to the standard inpatient care (SIC) program, 33 inpatients with moderate and severe depression were randomly assigned to an intervention group (two sessions of IR and CR) or an active treatment-as-usual (TAU) control group (two sessions of problem-solving and build-up of positive activity). Depression severity was assessed by the Hamilton Depression Rating Scale-21 (HDRS-21), the Beck Depression Inventory-II (BDI-II), and as a diagnostic adjunct daily step count via the Fitbit Charge 3™. We applied for analyses of HDRS-21 and BDI-II, 2 × 2 repeated-measures analysis of variance (ANOVA), and an asymptotic Wilcoxon test for step count. RESULTS: The main effect of time on both treatments was η2 = .402. Based on the data from the HDRS-21, patients in the intervention group achieved significantly greater improvements over time than the TAU group (η2 = .34). The BDI-II data did not demonstrate a significant interaction effect by group (η2 = .067). The daily hourly step count for participants of the intervention group was significantly higher (r = .67) than the step count for the control group. CONCLUSIONS: The findings support the utilization of imagery-based interventions for treating depression. They also provide insights into using fitness trackers as psychopathological assessment tools for depressed patients. TRIAL REGISTRATION: The trial is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien) under the registration number: DRKS00030809.

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD.

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.

Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.

An experimental examination of neurostimulation and cognitive restructuring as potential components for Misophonia interventions.

Misophonia is a disorder of decreased tolerance to certain aversive, repetitive common sounds, or to stimuli associated with these sounds. Two matched groups of adults (29 participants with misophonia and 30 clinical controls with high emotion dysregulation) received inhibitory neurostimulation (1 Hz) over a personalized medial prefrontal cortex (mPFC) target functionally connected to the left insula; excitatory neurostimulation (10 Hz) over a personalized dorsolateral PFC (dlPFC) target; and sham stimulation over either target. Stimulations were applied while participants were either listening or cognitively downregulating emotions associated with personalized aversive, misophonic, or neutral sounds. Subjective units of distress (SUDS) and psychophysiological measurements (e.g., skin conductance response [SCR] and level [SCL]) were collected. Compared to controls, participants with misophonia reported higher distress (∆SUDS = 1.91-1.93, ps < 0.001) when listening to and when downregulating misophonic distress. Both types of neurostimulation reduced distress significantly more than sham, with excitatory rTMS providing the most benefit (Cohen's dSUDS = 0.53; dSCL = 0.14). Excitatory rTMS also enhanced the regulation of emotions associated with misophonic sounds in both groups when measured by SUDS (dcontrol = 1.28; dMisophonia = 0.94), and in the misophonia group alone when measured with SCL (d = 0.20). Both types of neurostimulation were well tolerated. Engaging in cognitive restructuring enhanced with high-frequency neurostimulation led to the lowest misophonic distress, highlighting the best path forward for misophonia interventions.

Preliminary Efficacy of a Brief Cognitive Restructuring Intervention to Reduce Sexual Coercion Intentions: Roles of Alcohol and Emotion Regulation.

Sexual coercion (SC), the use of nonphysical tactics to obtain sexual contact with a nonconsenting partner, is a prevalent form of sexual misconduct that is associated with several physical and psychological health concerns. Therefore, effective preventative interventions to reduce SC prevalence are needed. Alcohol consumption and difficulties in emotion regulation (ER) are two risk factors that contribute to SC. Cognitive restructuring (CR) has the potential to reduce SC intentions by improving ER through actively challenging one's thoughts to modify emotions. This study represents a secondary data analysis to examine the effectiveness of a brief, web-based CR intervention in reducing SC intentions. To test whether the intervention would remain beneficial in the presence of alcohol, we tested effects among intoxicated versus sober participants. Young, male, heavy episodic drinkers with a history of sexual aggression (N = 137) were randomized into a CR intervention versus control condition as well as alcohol consumption versus no alcohol condition. Then, participants completed a sexual aggression analog scenario. General linear regression analyses showed that intoxicated men reported stronger SC intentions than sober men. Additionally, relative to controls, men in the CR condition who had better preexisting ER cognitive reappraisal skills had significantly lower SC intentions. Our findings provide preliminary support for CR as an effective strategy to reduce SC intentions among sexually aggressive, heavy episodic drinking men with better cognitive reappraisal skills. If findings are replicated, this brief, web-based CR intervention could overcome potential challenges in dissemination and be easily applied in clinical settings.

Differential engagement of the posterior cingulate cortex during cognitive restructuring of negative self- and social beliefs.

Negative self-beliefs are a core feature of psychopathology, encompassing both negative appraisals about oneself directly (i.e. self-judgment) and negative inferences of how the self is appraised by others (i.e. social judgment). Challenging maladaptive self-beliefs via cognitive restructuring is a core treatment mechanism of gold-standard psychotherapies. However, the neural mechanisms underlying the restructuring of these two kinds of negative self-beliefs are poorly understood. Eighty-six healthy participants cognitively restructured self-judgment and social-judgment negative self-belief statements during 7 Tesla functional magnetic resonance imaging scanning. Cognitive restructuring broadly elicited activation in the core default mode network (DMN), salience and frontoparietal control regions. Restructuring self-judgment relative to social-judgment beliefs was associated with comparatively higher activation in the ventral posterior cingulate cortex (PCC)/retrosplenial cortex, while challenging social-judgment statements was associated with higher activation in the dorsal PCC/precuneus. While both regions showed increased functional connectivity with the supplementary and pre-supplementary motor areas during restructuring, the dorsal PCC displayed greater task-dependent connectivity with distributed regions involved in salience, attention and social cognition. Our findings indicate distinct patterns of PCC engagement contingent upon self- and social domains, highlighting a specialized role of the dorsal PCC in supporting neural interactions between the DMN and frontoparietal/salience networks during cognitive restructuring.

Cognitive restructuring and psychotherapy outcome: A meta-analytic review.

Cognitive restructuring (CR) is one method that is hypothesized to play a role in the process of change across many psychotherapies and for a variety of clinical presentations. In this article, we define and illustrate CR. We then present a meta-analysis of four studies (including a total of 353 clients) examining the effect of CR measured within session on psychotherapy outcomes. The overall CR-outcome association was r = .35 (95% CI [.24, .44]; equivalent of d = 0.85). While more research on CR and immediate psychotherapy outcomes is needed, there is accumulating encouraging evidence regarding the therapeutic effect of CR. We conclude by advancing implications for clinical training and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sequencing effects of behavioral activation and cognitive restructuring in an Internet-based intervention for depressed adults are negligible: Results from a randomized controlled trial.

OBJECTIVE: Applying elements of cognitive behavioral therapy (CBT) in internet-based interventions (IBIs) is effective in treating depression. However, CBT-based IBIs differ in which kind of components are applied and the order of their application. Furthermore, it is as yet unknown whether such sequencing matters. Using an IBI for depression, we examined whether the sequence of two major CBT components, behavioral activation (BA) and cognitive restructuring (CR), affect patterns of symptom changes and dropout rates. METHOD: Individuals with moderate to mild depressive symptoms (N = 2,304, 59% female) were randomly assigned to two groups: one group that received BA in Modules 2 and 3 and CR in Modules 4 and 5, and another group with the opposite sequence. The component contents were identical. We investigated group differences in dropout rates, symptom changes, and change trajectories across the intervention. RESULTS: The groups had similar dropout rates and showed similar changes pre- to postassessment, and from pre- to 3-, 6-, and 12-month follow-up assessments. Between-group differences were small enough to be considered equivalent. Three classes of change trajectories emerged in both groups, but they did not differ in shape or size and did not show diverging associations with person-level characteristics. CONCLUSIONS: Results suggest that the sequence of the CBT components BA and CR in IBIs for depression does, on average, not systematically impact how individuals change during and after participation, which provides flexibility in designing CBT-based interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preliminary Efficacy of a Cognitive Restructuring Intervention for Intimate Partner Aggression: Emotional Clarity as a Mechanism of Change.

Despite the fact that intimate partner aggression (IPA) is a widespread public health problem, empirically supported interventions for IPA are limited. Furthermore, existing interventions tend to be resource-intensive and may not adequately address the risk factors that serve to maintain IPA, resulting in challenges to intervention dissemination and implementation. Based on theoretical and empirical findings linking emotional clarity and IPA, this study represents a secondary data analysis to evaluate the preliminary efficacy of a brief web-based cognitive restructuring (CR) intervention to reduce psychological and physical IPA perpetration intentions by increasing emotional clarity skills. In all, 137 men were randomized into a CR intervention versus control condition and subsequently completed an aggression analog scenario. Results of structural equation modeling analyses showed a significant indirect effect of the intervention on psychological IPA intentions via increased emotional clarity. Specifically, men in the CR intervention condition evidenced greater emotional clarity as compared to men in the control condition, which, in turn, was related to lower intentions to perpetrate psychological IPA. The indirect effect from the CR intervention to physical IPA intentions via emotional clarity was not statistically significant. These findings provide promising initial support for the usefulness of the current CR intervention in reducing psychological IPA. Next steps in this line of research include expansion to a randomized controlled trial that tests intervention effects on real-world IPA perpetration across more diverse samples. Importantly, our findings highlight that CR skills can be delivered via a brief web-based intervention, which decreases potential barriers to dissemination and implementation.

Vindicating pollyanna? An experimental test of cognitive restructuring and positive thinking interventions.

OBJECTIVE: Despite its considerable potential, psychotherapy research has made limited use of small-scale experimental study designs to test intervention components. This study employs such a design to test the immediate effects on emotional experience of two approaches to changing negative thoughts, cognitive restructuring and fostering positive thinking. Cognitive restructuring draws on the strategies core to cognitive behavioral therapies. Fostering positive thinking has also received attention, though less so as a psychological intervention. METHOD: We tested the benefits of these strategies over a brief interval by randomizing 230 participants to complete a worksheet introducing one of the two strategies. Participants reported their skills prior to exposure to these worksheets and affect was assessed immediately prior to and following use of worksheets. RESULTS: Participants' negative affect reduced following both strategies. Conditions did not differ significantly in affect change. Analysis of potential moderators showed that, among those with higher levels of cognitive behavioral therapy skills, the positive thinking condition produced greater gains in positive affect than the cognitive restructuring condition. CONCLUSIONS: These results indicate that both forms of brief interventions promote reductions in negative affect. Positive thinking interventions, which are not focused on the accuracy of one's thinking, appear to be particularly effective in promoting positive affect.

Should cognitive restructuring precede imagery rescripting? An experimental pilot study.

BACKGROUND AND OBJECTIVES: Imagery rescripting (ImRs) is a promising therapeutic technique used in treatment for a variety of psychiatric disorders. During an ImRs session, an aversive disorder-related memory, is activated in imagination and rescripted to a more positive outcome. It has been shown to successfully weaken the negative cognitive meaning, so-called encapsulated beliefs of the targeted aversive memory. In many studies, ImRs is preceded by a cognitive restructuring (CR) technique focused on the encapsulated belief of the target memory. It is not clear whether adding such a CR technique is necessary or that ImRs as standalone technique can achieve comparable effects. METHODS: Students with mild psychological distress (N = 53) were randomized over one session of cognitive restructuring plus imagery rescripting (CR + ImRs), a therapist attention placebo plus imagery rescripting (PLA + ImRs) and a double therapist attention placebo (PLA + PLA). Believability of the idiosyncratic encapsulated belief (primary outcome) and quality (vividness, distress and emotional connotation: secondary outcome) of the target memory were assessed at pre, post and at 1-week follow-up. RESULTS: Results indicate that both, CR + ImRs and PLA + ImRs, reduced the believability of the encapsulated beliefs in greater extent than PLA + PLA. No differences appeared between the two ImRs conditions. For the secondary outcomes no differences between the three conditions were found. LIMITATIONS: This study should be seen as a pilot study, moreover a non-clinical sample was used. CONCLUSION: Findings suggest that a CR technique preceding ImRs is redundant. However, this study needs replication in a larger sample.

PsicoQuilombologia: escrevivência de uma psicologia das encruzilhadas em tempos pandêmicos / PsychoQuilombology: writexperience of a psychology of crossroads in pandemic times / PsicoQuilombología: escrivivencia de una psicología de la encrucijada en tiempos pandémicos

O texto é um relato de experiência da participação no Grupo de Estudos psicoQuilombologia ocorrida nos meses de setembro de 2020 a março de 2021, período atravessado pela segunda onda da pandemia de COVID-19 no Brasil. O objetivo do relato é apresentar o conceito-movimento de psicoQuilombologia como uma proposta epistemológica quilombola de agenciamento de cuidado e saúde, com base em uma escuta que se faça descolonial e inspirada no fecundo e ancestral acervo de cuidado dos povos africanos, quilombolas e pretos, preservado e atualizado em nossos quilombos contemporâneos. A metodologia utilizada é a escrevivência, método desenvolvido por Conceição Evaristo que propõe uma escrita em que as vivência e memórias estão totalmente entrelaçadas, imersas e imbricadas com a pesquisa. O resultado das escrevivências dessa pesquisa descortinam que os povos pretos desenvolveram práticas de cuidado e acolhimento às vulnerabilidades do outro, enraizadas no fortalecimento de laços e conexões coletivas de afetos e cuidado mútuos. Práticas de cuidado que articulam memória, ancestralidade, tradição, comunidade, transformação, luta, resistência e emancipação, engendrando modos coletivos de ser e viver. Nas quais cuidar do outro implica tratar suas relações e situar o cuidado como extensão de uma cura que se agencia no coletivo. O trabalho conclui apontando que o cenário pandêmico vigente acentua a pungência de se desenvolver estratégias de cuidado baseadas em epistemologias pretas e quilombolas, valorizando os sentidos de ancestralidade, comunidade, pertencimento e emancipação.(AU)

The text is an experience report of the participation in the psicoQuilombology Study Group that carried out from September 2020 to March 2021, during the second wave of the COVID-19 pandemic in Brazil. The purpose of the report is to introduce the concept-movement of psicoQuilombology as a quilombola epistemological proposal for the development of care and health, based on a decolonial listening and inspired by the rich care collection of African peoples, quilombolas and Blacks, preserved and updated in our contemporary quilombos. The methodology used is writexperience [escrevivências], a method developed by Conceição Evaristo who proposes a writing in that the experiences and memories are totally involved with the research. The result of the writability of this research show that Black people have developed practices of care and acceptance of the other's vulnerabilities, based on the strengthening of ties and collective connections of mutual affection and care. Care practices that mix memory, ancestry, tradition, community, transformation, struggle, resistance and emancipation, outlining collective ways of being and living. The core idea is that taking care of the other means treating your relationships and maintaining care as an extension of a cure that takes place in the collective. The paper concludes by pointing out that the current pandemic scenario demonstrates the urgent need to develop care strategies based on black and quilombola epistemologies, valuing the senses of ancestry, community, belonging and emancipation.(AU)

Este es un reporte de experiencia de la participación en el Grupo de Estudio psicoQuilombología que ocurrió en los meses de septiembre de 2020 a marzo de 2021, periodo en que Brasil afrontaba la segunda ola de la pandemia de la COVID-19. Su propósito es presentar el concepto-movimiento de psicoQuilombología como una propuesta epistemológica quilombola para el desarrollo del cuidado y la salud, basada en una escucha decolonial e inspirada en el rico acervo asistencial de los pueblos africanos, quilombolas y negros, conservado y actualizado en nuestros quilombos contemporáneos. La metodología utilizada es la escrivivencia, un método desarrollado por Conceição Evaristo quien propone una escrita en que las vivencias y los recuerdos están totalmente involucrados con la investigación. El resultado de la escrivivencia muestra que las personas negras han desarrollado prácticas de cuidado y aceptación de las vulnerabilidades del otro, basadas en el fortalecimiento de lazos y conexiones colectivas de afecto y cuidado mutuos. Prácticas de cuidado que mezclan memoria, ascendencia, tradición, comunidad, transformación, lucha, resistencia y emancipación, perfilando formas colectivas de ser y vivir. El cuidar al otro significa tratar sus relaciones y mantener el cuidado como una extensión de una cura que tiene lugar en lo colectivo. El trabajo concluye que el actual escenario pandémico demuestra la urgente necesidad de desarrollar estrategias de atención basadas en epistemologías negras y quilombolas, y que valoren los sentidos de ascendencia, comunidad, pertenencia y emancipación.(AU)

Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial.

BACKGROUND/OBJECTIVES: The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. METHODS: A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. RESULTS: Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. CONCLUSIONS: This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. TRIAL REGISTRATION NUMBER: NCT04571528.

Effectiveness of Cognitive Restructuring on Intensity of Pain in Cancer Patients: A Pilot Study in Oncology Department of Tertiary Care Hospital.

BACKGROUND: Pain is a most feared symptom among cancer patients. It not only affects physical health but it is a psychological burden and affects overall quality of life in cancer patients. it interferes the activity of daily living and treatment outcome. cognitive restructuring is very useful psychological treatment to reduce pain. OBJECTIVES: The purpose of the study was to assess level of pain, evaluate effectiveness of cognitive restructuring on intensity of pain and to find association of pain with demographic variables. METHODS: Quasi experimental  study was conducted in oncology department of SKIMS tertiary care hospital. Purposive sampling technique was used to select 22 patients for study group and 22 patients for control group. CBPS and Numerical rating pain scale was used to measure intensity of pain. Data collected by interview method. RESULTS: The results showed significant difference p<0.05 at only  in anxiety,face and activity on CBPS scores. Mean score of NPRS was 27.27% of moderate pain  and severe pain reduced from 63.64 to  to 0.%  in study group after CR. Results revealed Significant association of pain with age, gender and period of illness. CONCLUSION: Based on findings of the study it is concluded that CR has significant impact in cancer patients  on reducing pain and can ease problems related to pain. CR is an appropriate intervention to reduce the symptoms of cancer patients which has indirect impact on cancer treatment.

Introduction to Cognitive Restructuring for Medical Students.

Introduction: Medical students list stigma and lack of time as reasons to avoid seeking mental health care. Many patients do not receive appropriate mental health care due to a lack of knowledge regarding available treatments among their medical providers. We created this activity to enhance medical student knowledge and well-being by introducing cognitive restructuring principles and skills in a highly interactive module. Methods: We administered a 90-minute learning activity, which included a short videotaped lecture, clinical case vignette, small-group discussion, and application exercise. Immediately following the learning activity, students and faculty completed anonymous evaluations. Results: A total of 139 first-year medical students and 152 second-year medical students completed the activity. For the first-year cohort, upwards of 80% of students and 100% of faculty respondents rated the session either good or excellent. For the second-year cohort, over 80% of students and over 90% of faculty rated the session either good or excellent. Approximately 90% of first- and second-year medical students and 100% of faculty recommended offering the session to future students. Open-ended feedback from students was overwhelmingly positive. Discussion: The resources included in this module allow educators at any institution to implement this learning activity, as no specific content knowledge/expertise is required of faculty. As the activity was well received by students and faculty, the investment of curricular time appears to have been well spent.

[The value of cognitive restructuring of reference ideas in schizophrenia]. / Intérêt de la restructuration cognitive des idées de référence dans la schizophrénie.

The process and results of cognitive restructuring of disabling reference ideas are presented through the study of a case of schizophrenia. The clinical evolution is measured according to an applied behavior analysis protocol that targets psychotic symptomatology and illness awareness. The results are encouraging since we observe a clinically significant decrease in the severity of reference ideas, anxiety and an improvement in illness awareness in only ten sessions.

"With insomnia, nothing is real": The Role of Gender and Cognitive Restructuring in Stress Induced Insomnia and Burnout.

INTRODUCTION: The aim of our study is to provide a theoretical and practical framework to the better under standing of insomnia and its relationship with perceived stress, burnout, cognitive restructuring and gender. The prior findings supported the integration of these constructs into a comprehensive model that helps us identify their complex system. METHODS: In our cross-sectional self-report study, 216 responders participated. The gender ratio was 23.6% (N=51) to 76.4% (N=165) with female dominance. The mean age was 22.5 years (MAge=22.51; SDAge=4.38) between 18 and 54. RESULTS: The applied pathway analysis supported the assumption that insomnia has a mediating role between perceived stress and burnout syndrome with the relevant effects of gender and cognitive restructuring as a way of coping. CONSEQUENCES: The increasing number of empirical findings highlights the relevance of sleep-related problems and the importance of the better understanding them in order to identify those components that could serve as key positions to interventions and preventions.

Is it magic? An exploratory randomized controlled trial comparing imagery rescripting and cognitive restructuring in the treatment of depression.

BACKGROUND AND OBJECTIVES: To investigate whether working with intrusive images and the use of imagery processes would be beneficial to treating depression, an imagery-based intervention (imagery rescripting, IR) was compared with a more commonly used verbal-based technique (cognitive restructuring, CR). The study aimed not only to test the efficacy of IR as a brief modular treatment for depression, but to explore whether such experiential use of imagery would alleviate the abstract-evaluative, verbal processes of rumination and worry. METHODS: Forty-one participants diagnosed with clinical depression and who also reported intrusive images underwent one assessment session of imagery properties before they were randomly assigned to an IR group or to an active control group of CR. They then received three weekly sessions of treatment, and outcomes were measured before and after treatment, as well as at two-month follow-up. RESULTS: The results showed that IR was equally if not more effective than CR in alleviating depression. Significant differential reductions in rumination, worry and experiential avoidance between treatments added support to the technique's experiential nature, and possibly, a defusing out of an abstract-evaluative mode of processing. LIMITATIONS: Only self-report measures were used, with a small number of treatment sessions by one clinician. CONCLUSIONS: The findings support the therapeutic potential of imagery modalities in the treatment of depression, which compared to cognitive restructuring, appear to bring about more significant emotional change with time (clinical trial registered at the Joint CUHK-NTEC CREC Ref. No. 2015.458).

Cognitive Restructuring Before Versus After Exposure: Effect on Expectancy and Outcome in Individuals With Claustrophobia.

Maximizing the discrepancy between expected and actual outcomes during exposure (i.e., expectancy violation) is thought to optimize inhibitory learning. The current study examined Craske et al.'s suggestion that engaging in cognitive restructuring (CR) before exposure prematurely reduces expectancy and mitigates outcomes. Participants (N = 93) with claustrophobia were randomly assigned to either 15 minutes of CR before exposure (CR Before) or 15 minutes of CR after exposure (CR After). Although the CR Before condition experienced greater expectancy reduction before exposure than the CR After condition, both groups experienced similar overall expectancy reduction by the end of the intervention. Groups experienced similar gains, with large significant improvement at posttreatment and follow-up. Results suggest that both cognitive therapy and exposure therapy lead to expectancy reduction, but that the order of these interventions does not impact outcome. Clinicaltrials.org registration #NCT03628105.

Burnout and Commitment to Primary Care: Lessons From the Early Impacts of COVID-19 on the Workplace Stress of Primary Care Practice Teams.

PURPOSE: The COVID-19 pandemic has dramatically affected all areas of health care. Primary care practices are on the front lines for patients seeking health care during this period. Understanding clinical and administrative staff members' strategies for managing the broad-ranging changes to primary care service delivery is important for the support of workforce well-being, burnout, and commitment to primary care. METHODS: Thirty-three staff members from 8 practices within a single health care system completed short, semistructured interviews from May 11, 2020 to July 20, 2020. Interviews were coded using a combination of conventional and directed content analysis. RESULTS: Themes emerged from the data that mapped onto the Job Demands-Control-Social Support model. Participants reported that every aspect of primary care service delivery needed to be adapted for COVID-19, which increased their job demands significantly. Several also described pride in their development of new skills, and in most interviews, they expressed that the experience brought staff together. Staff engaged in active cognitive reframing of events during the interviews as they coped with increased workplace stress. However, as the pandemic changed from an acute stress event to a chronic stressor, staff were more likely to indicate signs of burnout. CONCLUSIONS: Primary care teams absorbed tremendous burdens during COVID-19 but also found that some stress was offset by increased support from management and colleagues, belief in their own necessity, and new development opportunities. Considering high prepandemic strain levels, the ability of primary care teams to persist under these conditions might erode as the crisis becomes an enduring challenge.

Enhancing cognitive restructuring with concurrent fMRI-guided neurostimulation for emotional dysregulation-A randomized controlled trial.

BACKGROUND: Transdiagnostic clinical emotional dysregulation is a key component of many mental health disorders and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot an intervention that combines a one-time teaching and practice of cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted based on functional magnetic resonance imaging (fMRI). METHODS: Thirty-seven clinical adults who self-reported high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the left dlPFC target while practicing CR following emotional induction using recent autobiographical stressors. RESULTS: Receiving active versus sham rTMS led to significantly higher high frequency heart rate variability during regulation, lower regulation duration during the intervention, and higher likelihood to use CR during the week following the intervention. There were no differences between conditions when administering neurostimulation alone without the CR skill and compared to sham. Participants in the sham versus active condition experienced less distress the week after the intervention. There were no differences between conditions at the one-month follow up. CONCLUSION: This study demonstrated that combining active rTMS with emotion regulation training for one session significantly enhances emotion regulation and augments the impact of training for as long as a week. These findings are a promising step towards a combined intervention for transdiagnostic emotion dysregulation.