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Background: Exposure tasks—where an individual confronts a feared stimulus or situation—are known to be a key element of the treatment for youth anxiety. However, optimal therapist behaviors during these exposure tasks and the specifics of how therapist should conduct exposure tasks have not been determined. The current study examined the relationship between therapist behaviors that (a) increased, (b) decreased or (c) maintained the youth’s anxiety during exposures and treatment outcomes. Methods: Participants were youth (N = 107) ages 7 to 17 who received cognitive behavioral therapy for anxiety. Youth and their primary caregiver(s) completed a diagnostic interview and self- and parent-report measures pre- and post-treatment. Exposure session videos were rated by observers trained to reliability on a coding system evaluating therapist behaviors. Hierarchical regression analyses examined the role of therapist behaviors in predicting treatment outcomes. Logistic regression assessed the ability of therapist behaviors to predict treatment responder status (i.e., being a treatment responder versus a non-responder). Exploratory analyses examined the relationship between the individual therapist behaviors (within the three overall categories of behaviors) and treatment outcomes. Results: Youth showed significant improvement over the course of treatment. The three categories of therapist behaviors used during exposure tasks (increase, decrease and maintain the youth’s anxiety) were not associated with treatment outcomes. Discussion: Findings indicate that so long as exposure tasks are conducted, the therapist behaviors during the exposures may not be as important for predicting outcomes. Clinical implications, study limitations, and future directions are discussed. / Psychology

Effective intervention programs play a fundamental role in reducing rates of juvenile delinquency. Cognitive behavioral therapy (CBT) is an evidence-based psychotherapy that is strongly supported by research (ACT, 2010). Moral Kombat (MK) is an intervention that combines character-building and CBT concepts in programs for at-risk and delinquent juveniles with the goal to change their belief systems, thus improving their behaviors (Marchant, 2009). The purpose of the study was to evaluate the extent to which MK incorporates the principles identified in the literature as necessary for a CBT program to be successful. The occurrences of the 11 CBT principles identified in the literature found in the MK participant manuals were counted. MK appears to be a structurally sound program that has the potential to help participants but includes barriers to success such as resistance due to compelled attendance, social factors, costs, and inability to meet participant-specific therapy needs.

Provoked vulvodynia (PVD) is a disorder characterized by intense vulvar pain, most often reported as raw, burning, or stinging tissue. Current treatment options for PVD are insufficient and narrow in focus, as they predominantly address the physical pain associated with the disorder. Current publications regarding cognitive behavioral therapy and mindfulness treatment indicate that both therapies are highly effective. Mindfulness and cognitive behavioral therapies are noninvasive, efficacious long term, and provide a comprehensive biopsychosocial approach. The aim of this study is to educate nurse practitioners regarding these treatment options, which manage the physical as well as psychosocial aspects of PVD.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

Objective: Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method:Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals (n = 11) and patients with bothersome tinnitus (n = 8). Results:Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions:Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.

Objectives: Although tinnitus is one of the most commonly-reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related accessibility of care, and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence- based interventions are necessary. This presentation focuses on the adaptation of an Internet-based Cognitive Behavioral Therapy (ICBT) intervention, originally used in Sweden and in the UK, for individuals with tinnitus in the United States. Elements of the ICBT program requiring consideration included (a) adaptations to the platform’s features and functionalities, (b) translation into Spanish to extend the reach of the program (c) user acceptability and satisfaction of the program, (d) outcomes from a pilot trial from which it was hypothesized that patients would demonstrate a reduction in tinnitus distress and associated difficulties as measures using standardized self-reported outcome measures, and (e) discussion of the relative merits and appropriateness of the intervention. Design: The iTerapi platform developed in Sweden was adopted for use in the US. The platform required functional and security features modifications to confirm its compliance with both institutional and governmental regulations, and to ensure it was suitable for the US population. Acceptability and suitability of the materials were evaluated by both hearing healthcare professionals (n=11) andindividuals with tinnitus (n=8). A pilot study followed as adults with bothersome tinnitus completed the 8-week program (n=30). Results: Cultural adaptations included word substitutions, adapting counseling examples for a US population, and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured the suitability of the chapters. Literacy level analysis confirmed all chapters were within the guidelines to be below the 6th grade level for readability. Healthcare professionals and individuals with tinnitus reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability and exercises provided in the ICBT platform. Preliminary analyses of pilot data indicated a reduction in tinnitus distress and associated difficulties (i.e., anxiety, depression, insomnia) and an improvement in quality of life. Conclusions: Ensuring that the ePlatform offers the appropriate features and functionalities for the intended population is an essential part of developing Internet-based intervention. The user evaluations and pilot trial outcomes indicated that clinical trials can be performed to assess the effectiveness of ICBT for tinnitus in the US.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24131号 / 医博第4871号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 阪上 優, 教授 佐藤 俊哉, 教授 小杉 眞司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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