Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient

The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours).The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-Efor BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa

Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder

Background: Improving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment. The current study explores the dynamic temporal associations between theory-driven cognitive and behavioural mechanisms of symptom change both during and following group CBT. Methods: A randomized controlled trial of imagery-enhanced CBT (n = 51) versus traditional verbal CBT (n = 54) for social anxiety was completed in a community mental health clinic setting. This study included data collected from 12-weekly sessions and a 1-month follow-up session. Mixed models were used to assess magnitude of change over the course of treatment. Cross-lagged panel models were fit to the data to examine temporal relationships between mechanisms (social evaluative beliefs, safety behaviours) and social interaction anxiety symptoms. Results: Participants in both CBT groups experienced significant improvements across all cognitive, behavioural, and symptom measures, with no significant differences in the magnitude of changes between treatments. During treatment, greater social-evaluative beliefs (fear of negative evaluation, negative self-portrayals) at one time point (T) were predictive of more severe SAD symptoms and safety behaviours at T+1. Social-evaluative beliefs (fear of negative evaluation, probability and cost of social failure) and safety behaviours measured at post-treatment were positively associated with SAD symptoms at the 1-month follow-up. Conclusions: The current study identifies social-evaluative beliefs that may be important targets for symptom and avoidance reduction during and following CBT. Assessment of these social-evaluative beliefs throughout treatment may be useful for predicting future SAD symptoms and avoidance, and for adapting treatment to promote optimal change for patients

Evidence That the Clinical Impairment Assessment (CIA) Subscales Should Not Be Scored: Bifactor Modelling, Reliability, and Validity in Clinical and Community Samples

Aim: The Clinical Impairment Assessment (CIA 3.0) is the most widely used instrument assessing psychosocial impairment secondary to eating disorder symptoms. However, there is conflicting advice regarding the dimensionality and optimal method of scoring the CIA. We sought to resolve this confusion by conducting a comprehensive factor analytic study of the CIA in a community sample (N = 301) and clinical sample comprising patients with a diagnosed eating disorder (N = 209). Convergent and discriminant validity were also assessed. Method: The CIA and measures of eating disorder symptoms were administered to both samples. Results: Factor analyses indicated there is a general impairment factor underlying all items on the CIA that is reliably measured by the CIA Global score. CIA Global demonstrated good convergent and discriminant validity. Conclusions: CIA Global is a reliable and valid measure of psychosocial impairment secondary to eating disorder symptoms; however, subscale scores should not be computed

Shame in Eating Disorders

JAMOVI and R output files - for access by peer reviewer

Moderation of CBT for Social Anxiety Disorder Treatment Trajectories

R files and output for a project investigating whether a lack of genuine effects or poor methodology is responsible for a failure to identify replicable moderators of CBT for Social Anxiety Disorder

Co-occurring Social Anxiety and Eating Disorders

Files related to a manuscript concerning the impact of co-occurring social anxiety on eating disorder treatment outcome

Does exposure to cigarette health warnings elicit psychological reactance in smokers?

Researchers disagree as to whether cigarette warnings elicit psychological reactance in smokers. We used an experimental design to investigate whether (a) cigarette warnings elicit state reactance; and (b) the degree of reactance elicited by graphic cigarette warnings exceeds that elicited by text-only cigarette warnings. Smokers were exposed to graphic or text-only warnings and then completed reactance measures. Text-only warnings elicited little reactance, whereas over 80% of smokers who were exposed to graphic warnings experienced some reactance. Smokers who were exposed to graphic warnings were more likely to experience elevated and extreme levels of reactance. Our findings are consistent with recent studies indicating that graphic anti-smoking warnings can elicit maladaptive psychological responses

Transportability of imagery-enhanced CBT for social anxiety disorder

Data and R code for the paper "Transportability of imagery-enhanced CBT for social anxiety disorder" by Peter M. McEvoy, David M. Erceg-Hurn, Kevin C. Barber, Jessica R. Dupasquier, & David A. Moscovitc

Transdiagnostic Interventions for Emotional Disorders: Impacts on Positive and Negative Affect

Supplementary materials for a project comparing the impact of transdiagnostic CBTs on positive and negative affec