Trauma exposure among youth in the United States is a common event. Although the number of individuals who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) is only a small percentage of those exposed to trauma, many individuals who do not meet full criteria for PTSD continue to experience problematic posttraumatic stress symptomology. Acceptance and commitment therapy (ACT) is an empiricallybased psychological intervention that has shown effectiveness in the treatment of a number of concerns among both adults and adolescents. ACT has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating adolescent posttraumatic stress is currently unknown. Using a multiple-baseline design, the present study investigated the effectiveness of a 10-week ACT protocol to treat adolescents experiencing posttraumatic stress. Seven individuals between the ages of 12 and 17 participated in the treatment, four of who were from a community sample and three who were in residential care to treat comorbid eating disorders. Structured interviews were completed at pretreatment and individuals reported baseline data for anywhere from 7 to 66 days before engaging in treatment. Symptom and process measures were completed at each session. Postassessment was completed one week following the final session. Results revealed a decrease in posttraumatic stress symptomology across both samples, with a 73.7% mean reduction in self-reported posttraumatic stress symptomology and a mean reduction of 58.8% on clinician-rated measures of PTSD. Overall results provide preliminary support for ACT as an effective treatment for adolescent posttraumatic stress. Empirical and clinical implications of results as well as limitations and future directions are discussed.

This research project demonstrates the importance of the use of Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder and its relationship to the frequency of suicidal thoughts in veterans through the use of the positivist paradigm. The correlation that was found showing that Cognitive Behavioral Therapy does reduce the frequency of suicide ideation through the collection of quantitative data, and the understanding of Cognitive Learning Theory it is this study offers clinicians another tool to combat suicide in veterans.

The purpose of the current study was to evaluate changes in attentional biases following CBT for Social Phobia. It was found that 1.) consistent with previous investigations, the overall sample displayed vigilance toward threatening facial stimuli prior to receiving treatment, and 2.) participants’ pattern of responding to threatening facial stimuli changed following treat-ment, but only when the sample was divided into those who were vigilant and those who were avoidant prior to treatment. Findings provide support for the presence of two distinct sub-groups with differing attentional styles, one with a tendency for vigilance toward social threats, and a second with a tendency to avoid threat cues. These findings have important implications for how individuals may differentially respond to treatment and may help explain some of the mixed findings in the extant literature on Social Phobia and attention bias.

Schizophrenia is a complex and pervasive brain disorder that effects millions of people in the United States. There are three tiers of symptoms associated with the disorder, they include: positive symptoms, negative symptoms and thought disorders. The most common method of treatment for this disorder involves the use of antipsychotic medications, and while these medications have been shown to be effective in treating certain positive symptoms of the disorder, they have a tendency to be less effective in treating the negative cluster of symptoms and the thought disorders that can be highly debilitating for patients. The aim of this review was to determine the level of effectiveness of psychosocial treatments for the disorder, and in particular to look in to Cognitive- Behavioral Therapy (CBT) as an adjunctive method of treatment to be used in conjunction with medication. By performing searches using the PsycInfo, ERIC, EBSCO and Medline databases, the researcher was able to draw the conclusion that while there are some complications and areas of improvement in study construction, CBT can indeed be a helpful method of treatment for many patients. Importantly, CBT tends to be a very flexible treatment that can accommodate many different combinations of symptoms at varying levels or severity and stages of the illness. A discussion of a possible model of treatment that uses CBT was also undertaken to provide readers with a practical example of how this form of treatment can be used. / text

Previous research indicates that cognitive-behavioral therapy (CBT) is helpful in reducing depression in youth. However, little research exists into what specific components within CBT treatment protocols are associated with decreases in depression. Furthermore, little is known about how components within CBT treatment protocols reduce depression. Cognitive theories suggest that interventions targeted at negative cognitions reduce depression. Research has provided initial support for this position, although these studies did not utilize clinically depressed youth. Research has also shown that the therapeutic ingredients of therapist relational behaviors and group cohesion are important general factors in treatment; however, research exploring these variables in youth depression is lacking. Cognitive theories of depression suggest depressogenic thinking mediates the relationship between interventions and depression. However, no research exists exploring depressogenic thinking as a mediator between specific components of CBT treatment protocols and youth depression. The purpose of the current study was to investigate the association between specific components of a CBT treatment protocol and depression. The current study also sought to investigate depressogenic thinking as a mediator between the components of interest and depression. Participants were 42 girls, aged 9 to 14, who completed a manualized CBT group treatment protocol for depression. Participants completed a diagnostic interview for depression and completed self-report measures of depressogenic thinking. Group therapy sessions were coded for cognitive interventions, therapist relational behaviors, and group cohesion. The results of the main hypotheses indicated no significant associations between cognitive interventions, therapist relational behaviors, group cohesion and depression. Furthermore, tests of depressogenic thinking as a mediator could not be conducted based on the aforementioned results. However, post-hoc power analysis revealed extremely low power for the analyses. To further investigate the data, an exploratory analysis was conducted, with steps taken to increase power. Results from the exploratory analysis indicated the therapist relational behaviors measure consisted of two factors, both of which were significantly associated with post-treatment depression. Furthermore, the exploratory analysis revealed a significant association between cognitive interventions and post-treatment depression. Finally, no significant association was found between group cohesion and post-treatment depression. Implications, limitations, and recommendations for further areas of research are presented. / text

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering. To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV). Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity. / Tinnitus är upplevelsen av ljud i frånvaro av en extern ljudkälla och är ett vanligt, långvarigt och svårbehandlat hälsotillstånd. Kognitiv beteendeterapi (KBT) har det starkaste forskningsstödet för att behandla de negativa konsekvenserna av tinnitus. Detta till trots svarar inte en stor andel på KBT-baserade behandlingar för tinnitus. Behandlingsutvecklingen av KBT försvåras som konsekvens av att teorier som behandlingen vilar på är dåligt utvecklade, effekten av isolerade tekniker har inte bevisats, och att förändringsmekanismer är till största del okända. Föreliggande avhandling avsåg att adressera några av ovanstående problem genom att tillämpa en induktiv, flermetod, principstyrd vetenskaplig strategi baserad på pragmatisk kontextuell filosofi. Det övergripande syftet med avhandlingen var att undersöka användbarheten i en funktionell processdimension vid tinnitus: upplevelsemässigt undvikande—upplevelsemässig acceptans (EA). EA definieras som benägenheten att undvika eller förändra frekvensen, durationen eller intensiteten av icke-önskade inre sensationer som tankar, känslor och fysiologiska sensationer. Avhandlingen är baserad på experimentella studier (Studie II, VI), process och mediationsstudier (Studie I, III, V) och randomiserade kontrollerade studier (Studie III, IV). Tre övergripande fynd bekräftade användbarheten av EA vid tinnitus. För det första kunde det påvisas i randomiserade, kontrollerade studier att en acceptans-baserad behandling (Acceptance and Commitment Therapy, ACT) hade effekt på tinnitusbesvär. Studie III fann stöd för att ACT var mer effektiv än en väntelistekontroll och en habitueringsfokuserad ljudterapi. Studie IV fann stöd för att internet-förmedlad ACT var mer effektiv än en aktiv kontrollbetingelse (internet-diskussionsforum) och lika effektiv som en etablerad internet-förmedlad KBT-behandling. För det andra kunde processforskning (Studie I, III, V) påvisa att teoretiskt viktiga processer var relaterade till specifika tekniker i ACT och att dessa processer var i sin tur associerade med behandlingsutfall. Exempelvis kunde Studie V styrka att minskning i individers benägenhet att tränga undan tankar och känslor i relation till tinnitus var unikt associerat med behandlingsutfall i ACT i jämfört med KBT. För det tredje påvisade experimentella manipulationer av acceptans- och undvikande-processer användbarheten av EA (Studie II, VI). Studie II fann stöd för att kontroll över maskeringsljud var associerad med minskad kognitiv prestationsförmåga och ökade besvära av tinnitus över upprepade experimentella manipulationer i jämfört med att inte ha kontroll över maskeringsljudet. Slutligen visade Studie VI att bland normalhörande kunde experimentellt inducerad mindfulness motverka minskad förmåga att hålla ut i en mentalt krävande uppgift i närvaro av ett tinnitusliknande ljud till följd av initial suppression av samma ljud. Den övergripande konklusionen av vetenskapliga arbeten som sammanfattas i avhandlingen var att en principstyrd och kontextuell vetenskaplig strategi kan vara en framkomlig väg för att utveckla psykologiska behandlingar för tinnitusbesvär.

xvi, 90 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Empirical support for the efficacy of CBT in treating depression suggests that the majority of clients will respond to this intervention. However, the more nuanced, and clinically relevant, question of "Which clients will respond to CBT for depression?" has been difficult to answer. Research efforts have focused on two different approaches to this question. One approach focuses on trajectories of symptom change within the first weeks of treatment to identify clients who are most likely to achieve response. A second approach looks to pretreatment client variables such as hopelessness and dysfunctional attitudes to identify clients who are more likely to respond. The current study is the first to simultaneously compare these two approaches to the prediction of treatment outcome. The sample consists of 222 clients (65.32% female, 92.79% Caucasian), ages 18 through 64 (M =27.85, SD = 11.28), receiving treatment for mood and anxiety disorders (59% met criteria for comorhid disorders) in a CBT oriented psychology training clinic. Results suggest that the rate of change in depressive symptoms over the first five treatment sessions significantly and consistently predicted outcome over and above the majority of pretreatment variables, except for precontemplation stages of change scores and initial severity of depression and anxiety symptoms. Similarly, rate of change in anxiety symptoms significantly predicted outcome on two of the three measures over and above the majority of pretreatment variables, except for hopelessness and initial severity of anxiety symptoms. Post hoc analyses revealed different predictors of outcome when trajectories of change and pretreatment variables were examined separately. Both rates of change and a number of pretreatment variables predicted outcome. Finally, pretreatment predictors of rate of early symptom change such as a contemplative orientation to change and therapist experience, were identified which may suggest that therapists should target these factors to potentially maximize rapid early symptom change, and in turn outcome. The findings are discussed in terms of their implications regarding methodological approaches to treatment outcome research and treatment planning for adults with comorbidities. / Committee in charge: Anne Simons, Chairperson, Psychology; Philip Fisher, Member, Psychology; Hyoun Kim, Member, Not from U of O; Jane Mendle, Member, Psychology; Jeff Todahl, Outside Member, Counseling; Psychology and Human Services

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.