Neuroscience-based Cognitive Therapy: New Methods for Assessment, Treatment and Self-Regulation
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Ideally, clients complete the first part of the SYA form in session with the client as a way to troubleshoot potential internal i. Clients then complete the second part of the form after attempting to engage the action between sessions, and bring the completed form back with them to the next session to discuss the outcome with their clinician.
Lores has many potential candidate planned proactions. Given the strong pulls toward both security and reward in regards to her job and taking the CFA exam, an optimal planned action between sessions would be for her to officially register for her exam. Given that she sees great importance in furthering herself at work i. A potentially less anxiety-provoking action could be researching information on registering for the CFA exam or going to the bookstore and purchase a prep book to aid in her studying.
In thinking about the significant burden that she endures as the caretaker and provider of her family, an additional proaction that may be explored in these sessions may involve self-care, and establishing activities that will provide her with a sense of joy and release that she would not typically pursue.
The ultimate goal of this exercise with Lores is to have her gain self-efficacy through her ability and determination to complete these actions outside of session, and complete larger actions over time in an effort to ultimately live consistently with her expressed values. The final sessions of Phase II sessions 14—16 focus on the termination of the therapeutic relationship and assisting the client in becoming more independent in her or his ability to take larger steps toward a proactive life following the end of ERT.
For Lores, these final sessions will specifically focus on goal-setting in further envisioning her life if she could overcome anxiety and a strong pull toward security as well as ways to reduce her tendency to ruminate and the mood variations that she is prone to experiencing. During these final meetings, Lores and her clinician strategize about the skills that she can use when her emotions become intense. At this point, clients and therapists reflect together on the progress that has been made throughout the course of ERT in reviewing the ERT Toolbox and identifying points throughout the treatment where they have noticed change within themselves in an effort to further establish self-efficacy.
Finally, ERT therapists and clients say their goodbyes, with the goal of the client continuing to utilize their ERT skills following the termination of treatment. To date, ERT has been administered in university-based clinics and counseling centers serving both community members and students. ERT is delivered by doctoral students in clinical psychology who have been trained and supervised by the third and fourth authors. ERT was well tolerated by clients, as evidenced by low rates of attrition in the course of treatment. These gains were maintained for 9 months following the end of treatment Mennin et al.
Similar to the OT findings, these gains were maintained for 9 months following the end of treatment Mennin et al. These findings offer substantial preliminary evidence for the effectiveness of the treatment, but these samples were relatively limited to a largely homogeneous sample of Caucasian, middle-aged participants with middle- to upper-class socioeconomic backgrounds.
This sample is relatively diverse, with many participants from various cultural and socioeconomic backgrounds throughout a large, urban commuter college campus who were seeking treatment in the college-counseling center for mood and anxiety issues. Specifically in regards to race, this sample consisted of individuals of whom Although findings from this study offers evidence for ERT reducing symptoms associated with anxiety and depressive disorders in a diverse young adult sample population, future work that includes a waitlist control is still needed to make any conclusions about efficacy in this young adult population.
We have also examined whether these treatment outcomes are the result of changes in the outlined target mechanisms by assessing changes in performance on lab-based computerized behavioral tasks across three time points within the previous session version of ERT: pre-treatment, mid-treatment, and post-treatment. One promising preliminary finding is related to emotional conflict adaptation Etkin et al.
Particularly, participants were instructed to respond to a tone as quickly as possible following viewing of neutral and negative images. Further, this change in attentional flexibility from pre to mid treatment significantly predicted reductions in anxiety and worry at post-treatment as well as decreases in social disability and emotional reactivity Renna et al. We also developed an Approach-Avoidance variant of the Implicit Association Task AAIAT and administered this task to a subset of patients to examine changes in implicit associations related to security- and reward-related processing throughout ERT.
Further, these mid-to-post changes were strongly associated with changes in emotional clarity, negative emotionality, and quality of life Quintero et al. We have also assessed heart rate variability HRV , an index of parasympathetic flexibility Porges, ; Thayer et al. At pre-treatment, clients displayed a flattened response throughout the experimental period suggesting reduced cardiac flexibility and across this period demonstrated lower levels of HRV compared to a normal control comparison group.
At mid-treatment, clients displayed a quadratic pattern of vagal withdrawal i. Clients who showed the greatest increases in parasympathetic flexibility from pre- to mid-treatment showed the greatest pre- to post-treatment gains in diagnostic severity, anxiety, and mood symptoms. Despite these promising mechanistic findings, the exclusion of a control treatment diminishes the ability to attribute treatment change to specific components of ERT. Despite this limitation, taken together, these preliminary data are supportive of our hypotheses that ERT may, in part, exert its therapeutic impact through normalization of emotion regulatory mechanisms.
Further, individuals with distress disorders tend to perseverate in a maladaptive attempt to respond to motivationally relevant distress and often utilize these self-referential processes e. Despite the success of cognitive behavioral therapies CBT for emotional disorders, a sizable subgroup of patients with distress disorders fail to evidence adequate treatment response. ERT is a theoretically derived, evidence based, treatment that integrates principles from traditional and contemporary therapies with findings from basic and translational affective science to offer a framework for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with high levels of chronic distress.
Ongoing trials are examining more nuanced demographic information of this sample of participants, such as primary language, personal and family income, sexual orientation, and parental education level. Additionally, a current trial of ERT is testing its transdiagnostic efficacy by requiring inclusionary criteria of high emotionality and inordinate negative self-referential processing but can be diagnostically heterogenous American Psychiatric Association, Data on skills usage and mindfulness practice from past and current trials of ERT are also currently being analyzed to assess whether or not the use of these skills following the acute period of ERT is associated with maintenance of symptom improvement and mechanistic gains throughout the 3- and 9-month follow-up periods.
An additional empirical question that we seek to examine in ERT is a question of dosing, i. With this aim in mind, a current trial of ERT is underway that examines the effectiveness of traditional session ERT versus a more abbreviated 8-session version. The 8-session version of the treatment has been established in an effort to maintain treatment fidelity from previous versions of ERT, while potentially providing the treatment to a larger number of individuals, thereby reducing patient burden.
The establishment of the effectiveness of 8-session ERT permits us to disseminate the treatment to a wider and more diverse group of individuals, and therefore, further advance the general understanding of the treatment. Accordingly, other investigators have recently begun to examine this briefer version of ERT with caregivers of those with cancer who are highly ruminative or worried given that this population has demonstrated a poor response to psychosocial treatments including CBT Mennin and Fresco, Although ERT has established preliminary efficacy as an intervention to treat generalized anxiety and co-occurring depression, due to its multiple mechanisms and treatment components, it is difficult to identify which aspects of the intervention are promoting symptom reduction and mechanistic change.
We recently argued that all cognitive behavioral treatments share common core emotion-related principles Mennin et al. Indeed, there have been a number of recent treatments that target emotions more directly and have improved our ability to treat anxiety and mood disorders including dialectical behavior therapy Linehan, , acceptance and commitment therapy Hayes et al. Although ERT utilizes similar treatment components and techniques to these approaches, ERT derives from a separate conceptual model. In particular, ERT represents an intervention that incorporates common underlying mechanisms of traditional and third-wave CBTs that reflect both basic research and affect science.
We also plan to use a dismantling approach to identify the way that specific skills in ERT may contribute to improvements in the purported mechanisms by examining whether briefer and more targeted intervention components can more precisely and specifically target the purported mechanisms of action. This work will allow us to better hone the treatment in identifying the way in which specific ERT skills, in isolation, promote changes in each purported mechanism. Additionally, future research may benefit from utilizing a control treatment to isolate gains made throughout treatment that may specifically be attributed to components of ERT.
Finally, current research on ERT is examining neural underpinnings of the purported mechanisms associated with the treatment.
Tullio Scrimali, M.D.
Building upon the preliminary findings from the behaviorally based tasks, participants in our current trials are completing a number of computer-based tasks while undergoing functional magnetic resonance imaging fMRI at different points throughout treatment. Further, ERT should continue to be honed in an effort to reach a wider group of individuals through greater efforts for treatment personalization including addressing specific contextual challenges of diverse groups in terms of race, culture, and socioeconomic status.
Despite the need for these future steps, ERT demonstrates a novel approach for treating distress disorders in an effort to promote stronger long-term ameliorative changes for the individuals suffering from these conditions. All subjects in studies referenced were given full study consent prior to any research procedures. All authors listed, have made substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Schmaling, K. Response styles among patients with minor depression and dysthymia in primary care. Segal, Z. The workshop is focused in demonstrating and discussing the important topic concerning how some recent developments of Neuroscience can be today used in order to better the intervention in any educational environments. During the workshop two methods, coming from Neuroscience Laboratories will be illustrated and explained.
Such parameters can be today easily monitorized thanks to some new hardware and software which are inexpensive and that can be easily used, after a short training in the educational setting. Basic information will be given concerning how to use such new methods when working with students. More detailed information will be given about Quantitative Monitoring of Electrodermal Activity , a new methods that Tullio Scrimali developed and experimented for many years.
This method is the simplest to be put into practice in Cognitive Therapy an it is also the less expensive.