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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (25 March 2022) | Viewed by 40604

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Special Issue Editors

Prof. Dr. Louise Mchugh

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Guest Editor

School of Psychology, University College Dublin, D04 F6X4 Dublin, Ireland
Interests: process-based therapy; acceptance and commitment therapy; relational frame theory; chronic conditions; ecological momentary assessment

Dr. Rhonda Merwin

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Guest Editor

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27712, USA
Interests: acceptance and mindfulness interventions; ecological momentary assessment and intervention; psychological flexibility; eating disorders; interoceptive awareness; type 1 diabetes and related conditions

Special Issue Information

Dear Colleagues,

The last thirty years have seen significant advances in cognitive and behavior psychotherapies and their application in health care/clinical practices. These include the integration of acceptance/mindfulness and neurobiological findings in theory and practice, greater orientation to processes of change, and the use of mobile technology and digital and just-in-time interventions. The Journal of Clinical Medicine is planning a Special Issue on new advances in cognitive and behavior psychotherapies. Appropriate submissions are empirical papers relevant to new advances in cognitive or cognitive behavior therapy or theory and may include clinical outcome studies, studies of the dynamic interplay of influential factors (e.g., personalized medicine, processes of change research, lab-based research relevant to clinical interventions), and systematic literature reviews. For this Special Issue, we encourage submissions that discuss the current state of the art and address ongoing knowledge gaps, controversies, and cutting edge advances in theory and practice related to the field of clinical medicine.

Prof. Dr. Louise Mchugh
Dr. Rhonda Merwin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cognitive behavior psychotherapy
evidence-based practice
process-based therapy
processes of change
personalized medicine

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Published Papers (10 papers)

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Editorial

Jump to: Research, Review

4 pages, 174 KiB

Open AccessEditorial

Editors Introduction to the Special Issue on Advances in Cognitive and Behaviour Therapies and Applications in Health Practices

by Louise McHugh and Rhonda M. Merwin

J. Clin. Med. 2022, 11(18), 5269; https://doi.org/10.3390/jcm11185269 - 7 Sep 2022

Viewed by 1313

Abstract

The last thirty years have seen significant advances in cognitive and behavioural psychotherapies and their application in health care/clinical practices [...] Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

Research

Jump to: Editorial, Review

16 pages, 577 KiB

Open AccessArticle

A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD

by Megan M. Kelly, Erin D. Reilly, Victoria Ameral, Stephanie Richter and Seiya Fukuda

J. Clin. Med. 2022, 11(12), 3482; https://doi.org/10.3390/jcm11123482 - 17 Jun 2022

Cited by 10 | Viewed by 3660

Abstract

Veterans with PTSD often have substantial interpersonal difficulties and low levels of social support, which puts them at increased risk of mortality, but few treatments address global social impairment for veterans with PTSD. This study is a pilot randomized trial of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (ACT-SS), a psychotherapy that targets social avoidance and eroded social relationships, compared to Person-Centered Therapy (PCT), a non-directive psychotherapy. Participants were randomized to twelve sessions of either ACT-SS (n = 21) or PCT (n = 19). The results showed that veterans with PTSD had high ratings of satisfaction for both treatments. Contrary to the PCT group, participants in the ACT-SS group showed a significant improvement in the quality of social relationships, engagement in social and leisure activities, and PTSD symptoms from the baseline assessment to the end of treatment and a three-month follow-up. Veterans in the ACT-SS group, but not the PCT group, also showed significant improvements in mindfulness and valued living and a reduction in experiential avoidance from baseline to the end of treatment, with sustained improvements in valued living at the three-month follow-up. Overall, the present study demonstrated the feasibility, acceptability, and positive preliminary outcomes of ACT-SS for veterans with PTSD. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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11 pages, 737 KiB

Open AccessArticle

What the Body Reveals about Lay Knowledge of Psychological Flexibility

by Neal Falletta-Cowden, Patrick Smith, Steven C. Hayes, Sandra Georgescu and Seyed Ali Kolahdouzan

J. Clin. Med. 2022, 11(10), 2848; https://doi.org/10.3390/jcm11102848 - 18 May 2022

Cited by 8 | Viewed by 5760

Abstract

The embodied knowledge of psychological flexibility processes was tested by examining the ability of raters to score whole body pictures based on the degree to which they were open, aware, and engaged. Participants’ best and worst physical posture was photographed when asked to think of a difficult psychological matter. Naïve and untrained raters (n = 16) showed excellent reliability while rating the postures of 82 persons from the general population in Reno and Chicago in the USA and recent Iranian immigrants in the Maryland/DC area. Participants showed embodied knowledge of psychological flexibility concepts across all three locations (though significantly less among those recently from Iran). Thus, experience alone appears to teach people that psychological flexibility is helpful, even if they are unable to express this knowledge in words. Implications for psychotherapeutic work is considered. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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18 pages, 2372 KiB

Open AccessArticle

Development and Initial Feasibility of a Hospital-Based Acceptance and Commitment Therapy Intervention to Improve Retention in Care for Out-of-Care Persons with HIV: Lessons Learned from an Open Pilot Trial

by Lilian Dindo, Ethan Moitra, McKenzie K. Roddy, Chelsea Ratcliff, Christine Markham and Thomas Giordano

J. Clin. Med. 2022, 11(10), 2827; https://doi.org/10.3390/jcm11102827 - 17 May 2022

Cited by 1 | Viewed by 1962

Abstract

Roughly 40% of persons with HIV (PWH) are not consistently involved in HIV care in the US. Finding out-of-care PWH is difficult, but hospitalization is common and presents an opportunity to re-engage PWH in outpatient care. The aims of this study were to (1) develop an Acceptance and Commitment Therapy (ACT)-based intervention for hospitalized, out-of-care PWH who endorse avoidance-coping to improve HIV treatment engagement; (2) examine the intervention’s initial feasibility and acceptability; and (3) to revise the study protocol (including the intervention), based on stakeholder feedback, in preparation for a randomized controlled trial (RCT) comparing ACT to treatment as usual. Therapists and HIV care experts developed a four-session ACT-based intervention to be delivered during hospitalization. Fifteen hospitalized patients with poorly controlled HIV enrolled in the open trial, eight completed four sessions, two completed three sessions, and seven provided qualitative feedback. Patients universally liked the intervention and the holistic approach to mental health and HIV care. Refinements included repeating key concepts, including representative graphics, and translating to Spanish. Among the patients who attended ≥3 ACT sessions, 5/10 attended a HIV-care follow-up visit and 5/7 who had labs had a viral load <20 2-months post-intervention. Next steps include conducting a randomized clinical trial exploring the impact of the refined intervention to treatment as usual on retention in care and viral load. ClinicalTrials.gov Identifier: NCT04481373. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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34 pages, 2144 KiB

Open AccessArticle

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies

by Joseph Lavelle, Darragh Storan, Varsha Eswara Murthy, Noemi De Dominicis, Hugh E. Mulcahy and Louise McHugh

J. Clin. Med. 2022, 11(10), 2757; https://doi.org/10.3390/jcm11102757 - 13 May 2022

Cited by 14 | Viewed by 4648

Abstract

Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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15 pages, 975 KiB

Open AccessArticle

Randomized Clinical Trial Evaluating AcceptME—A Digital Gamified Acceptance and Commitment Early Intervention Program for Individuals at High Risk for Eating Disorders

by Maria Karekla, Patrisia Nikolaou and Rhonda M. Merwin

J. Clin. Med. 2022, 11(7), 1775; https://doi.org/10.3390/jcm11071775 - 23 Mar 2022

Cited by 14 | Viewed by 3110

Abstract

Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evaluating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high risk for an ED. Participants (n = 92; Mage = 15.30 years, SD = 2.15) received either AcceptME (n = 62) or a waitlist control (n = 30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score < 52) in the AcceptME at end-of-intervention (57.1%) compared to controls (7.1%), with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symptomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at risk for developing an ED. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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18 pages, 313 KiB

Open AccessArticle

Effects of Integrated Moral Reasoning Development Intervention for Management of Violence in Schizophrenia: A Randomized Controlled Trial

by Mei-Chi Hsu and Wen-Chen Ouyang

J. Clin. Med. 2022, 11(5), 1169; https://doi.org/10.3390/jcm11051169 - 22 Feb 2022

Cited by 2 | Viewed by 2106

Abstract

Moral cognition is an important and multidimensional, but often overlooked, determinant of violence. Very few interventions have systematically examined the role of moral reasoning, anger management and problem-solving together in violence. A randomized controlled trial was conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning Development Intervention (MRDI) in the management of repetitive violence in schizophrenia. This study placed special emphasis on essential components related to moral reasoning and violence in patients with schizophrenia. Evaluations, including measures of violence, moral reasoning, ethical valuation and judgement, decision-making, conflict management style, and personality traits, were performed at baseline, end of intervention, and 1-month follow-up after intervention. We found that MRDI was superior to treatment-as-usual, in improving moral reasoning and related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning, with decreased levels of violent behaviors. The MRDI participants also experienced significantly greater improvements or changes (p < 0.05) in their ethical valuation and judgement, decision-making style and preferences, and conflict management style. Our findings provide important implications for risk assessment and violence management and prevention. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

16 pages, 1090 KiB

Open AccessArticle

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

by Mirian Santamaría-Peláez, Jerónimo Javier González-Bernal, Juan Carlos Verdes-Montenegro-Atalaya, Luis Ángel Pérula-de Torres, Ana Roldán-Villalobos, Esperanza Romero-Rodríguez, Nur Hachem Salas, Rosa Magallón Botaya, Teresa de Jesús González-Navarro, Raquel Arias-Vega, Francisco Javier Valverde, María Jiménez-Barrios, Luis Alberto Mínguez, Benito León-del-Barco, Raúl Soto-Cámara and Josefa González-Santos

J. Clin. Med. 2021, 10(24), 5941; https://doi.org/10.3390/jcm10245941 - 17 Dec 2021

Cited by 8 | Viewed by 4943

Abstract

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η² = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η² = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η² = 0.071—F (2.79) = 2.874; p = 0.049; η² = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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Review

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34 pages, 1311 KiB

Open AccessReview

The Impact of Group Emotion Regulation Interventions on Emotion Regulation Ability: A Systematic Review

by Rebekah Moore, David Gillanders and Simon Stuart

J. Clin. Med. 2022, 11(9), 2519; https://doi.org/10.3390/jcm11092519 - 29 Apr 2022

Cited by 13 | Viewed by 5416

Abstract

Emotional regulation (ER) as a concept is not clearly defined, and there is a lack of clarity about how individuals can improve their ability to regulate emotions. Nevertheless, there is increasing evidence of the importance of ER as a transdiagnostic treatment target across mental health problems. This review examines the impact of ER group interventions on ER ability compared with no intervention, other comparable group interventions, or control conditions. A systematic review was conducted, in which 15 studies were included. Although types of ER intervention were mixed, the interventions had a considerable overlap in skills taught and how ER was measured. In all but one study, the ER intervention improved ER ability. ER interventions were superior to waitlist or treatment as usual, but there was limited evidence to suggest they were superior to other active treatments. Data from some studies suggest that improved ER was sustained at follow-up. Across the studies, there was generally poor linking of theory to practice, which hampers understanding of how interventions were constructed and why different skills were included. Although the results need to be interpreted with caution due to issues with methodological quality with the included papers, there is promising evidence that ER group interventions significantly improve ER ability. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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22 pages, 731 KiB

Open AccessReview

Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review

by Carmen M. Galvez-Sánchez, Casandra I. Montoro, María Moreno-Padilla, Gustavo A. Reyes del Paso and Pablo de la Coba

J. Clin. Med. 2021, 10(12), 2706; https://doi.org/10.3390/jcm10122706 - 19 Jun 2021

Cited by 28 | Viewed by 5898

Abstract

Objectives: Acceptance and commitment therapy (ACT) is considered by the American Psychological Association as an evidence-based treatment for a variety of disorders, including chronic pain. The main objective of the present systematic review was to determine the effectiveness of ACT in patients with central pain sensitization syndromes (CPSS). Methods: This systematic review was conducted according to the guidelines of the Cochrane Collaboration and PRISMA statements. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. Results: The literature search identified 21 studies (including investigations of fibromyalgia syndrome, irritable bowel syndrome, and migraine) eligible for the systematic review. There were no studies regarding the effectiveness of ACT for chronic tension-type headache (CTTH), interstitial cystitis (IC), or temporomandibular disorder (TMD). The evaluation of ROB showed that 12 of the selected studies were of low quality, 5 were of moderate quality, and 4 were high quality. ACT reduces some clinical symptoms, such as anxiety, depression, and pain. This positive effect of ACT might be mediated by pain acceptance, psychological flexibility, optimism, self-efficacy, or adherence to values. ACT showed better results in comparison to non-intervention (e.g., “waiting list”) conditions, as well as pharmacological and psychoeducational interventions. It is not entirely clear whether extended ACT treatments are more advantageous than briefer interventions. Conclusions: There are few studies about the effectiveness of ACT on CPSS. However, ACT seems to reduce subjective CPSS symptoms and improve the health-related quality of life of these patients. The absence of studies on the effectiveness of ACT in CTTH, IC, and TMD, indicate the pressing need for further ACT studies in these CPSS. Full article

(This article belongs to the Special Issue New Advances in Cognitive and Behavior Psychotherapies)

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