The Cognitive-Behavioural Theory and Treatment of Bulimia Nervosa: An Examination of Treatment Mechanisms and Future Directions

Enhanced cognitive-behavioural therapy (CBT-E) is the current treatment of choice for bulimia nervosa. While the cognitive-behavioural theoryand treatment of bulimia nervosa have made a substantial contribution to our understanding of the disorder, approximately half of patientstreated with CBT-E fail to achieve remission of binge eating and purging. There is evidence showing that mechanisms proposed by the CBT-Emodel are associated with binge eating and purging symptoms, and therefore likely important targets for treatment. To identify future directionsin improving the efficacy of this treatment, and informed by a model of the client change process, we review the evidence for the hypothesised treatment mechanisms of CBT-E. We conclude that while the proposed treatment mechanisms of CBT-E largely change over the course of treatment, there is limited evidence that the treatment manipulations of CBT-E are responsible for the specific changes in the proposed treatment mechanisms. In addition, given a lack of research in this area, we could find no evidence that changes in the additional treatment mechanisms outlined in CBT-E are associated with changes in the core symptomatology of binge eating and purging. Based on these findings, we recommend that future efforts are directed towards understanding the client change process in CBT-E and outline three clear directions for research

Current perspective on the therapeutic preset for substance-assisted psychotherapy

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective on preconditions and theoretical knowledge that have been identified as valuable in the literature for appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed

Therapeutic Frameworks in Integration Sessions in Substance-Assisted Psychotherapy: A Systematized Review

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration, and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during integration sessions in SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integrations sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE, and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until November 11, 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPTHowever, there is currently an insufficient evidence base to suggest that any type of therapy is most effective for guiding integration sessions. Systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed

Emotion Focused Therapy – Case Conceptualization and Treatment: Adults

This article provides a comprehensive overview of emotion focused therapy (EFT). First, the theoretical foundations are presented highlighting the central tenets of the approach, including the therapeutic relationship, clients' experiencing, emotional processing and self-organization. Subsequently, EFT's trans-diagnostic model of case-conceptualization is presented and its application to a number of different client populations including depression, anxiety, trauma, eating disorders, personality disorders couples and families is described

Emotion-focused therapy for grief and bereavement

We present an Emotion Focused Therapy perspective on working with grief and bereavement. This perspective considers emotions as a fundamentally adaptive signaling system that provides people with important information about their needs and goals. Thus the focus in working with grief and bereavement in EFT is to access and symbolize people’s adaptive grief around their loss. When this grief is blocked by other emotional states, such as lingering resentments, guilt, or fear of emotional pain, it is important for these other emotions to also be accessed and differentiated from the grief. This emotional processing can be facilitated through an empathic relational stance and experiential interventions which are guided by emotion theory and process diagnosis

Approach-alcohol action tendencies can be inhibited by cognitive load

Rationale: Dysregulated alcohol consumption has been attributed to an imbalance between an approach-alcohol action tendency and executive control processes. However, which specific executive control processes are involved is not known. One candidate executive process is interference suppression, which refers to the suppression of task-irrelevant information through the active maintenance of task-relevant information or a cognitive load. Objective: The present study aimed to (1) establish whether alcohol action tendency can be inhibited by interference suppression through the use of cognitive loads and (2) to assess whether individual differences in the degree of interference suppression from cognitive loads is related to individual differences in the ability to regulate alcohol consumption. Method: Two groups of social drinkers (total N = 58) who differed in their ability to regulate their alcohol consumption completed a novel cognitive load variant of the approach avoidance task (AAT) and an alcohol taste test. Results: Results indicated that (1) there was a relationship between alcohol bias on the AAT and alcohol consumption under low load, but not high load, consistent with the hypothesis that the action tendency would be inhibited through interference suppression, and (2) this effect of load was not modified by drinking group, with both groups demonstrating equivalent ability to inhibit the action tendency. Conclusions: The present findings suggest that alcohol action tendency can be inhibited through interference suppression, and that this is effective even for those that have difficulty regulating their alcohol consumption

Research on humanistic-experiential psychotherapies : updated review

We review recent research on humanistic-experiential psychotherapies (HEPs), which include person-centered therapy (PCT), emotion-focused therapy (EFT), gestalt, and psychodrama approaches, along with generic relationship control conditions characterized as supportive or nondirective. A key part of this review is a meta-analysis of 91 studies of the effectiveness/efficacy of HEPs, published between 2009 and 2018, which produced the following results: (1) HEPs were associated with large pre-post client change (d = .86). (2) In controlled studies, clients in HEPs generally showed large gains relative to clients who received no therapy (.88). (3) In comparative outcome studies, HEPs in general were statistically and clinically equivalent in effectiveness to other therapies (-.08). (4) Overall, CBT appeared to have an equivocal advantage over HEPs (-.26). However, these studies were overwhelmingly delivered by CBT researchers in largely non-bona fide versions of HEPs as comparison conditions. Overall, the strongest results were found for EFT, followed by PCT; generic supportive-nondirective approaches were least effective, especially when compared to CBT. HEPs appeared to be most effective with relationship/interpersonal difficulties, self-damaging activities, coping with chronic medical conditions, and psychosis. Findings were more mixed for depression and anxiety. In addition, we offer an updated meta-synthesis of the qualitative outcomes of these therapies, which fell into three main categories: appreciating experiences of self; appreciating experience of self in relationship to others; and changed view of self/others. We also provide narrative reviews of recent qualitative research on helpful and unhelpful factors in HEPs, along with quantitative process-outcome research on HEPs including process-outcome research and work on mediating processes. In an integrative summary we identify a core set of interwoven client change processes involving emotional expression, deepening and transformation, the emergence of new client narratives, and the assimilation of problematic experiences. We conclude with a set of recommendations for research, practice and mental health guideline development

Current perspective on the therapeutic preset for substance-assisted psychotherapy

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective onpreconditions and theoretical knowledge that have been identified as valuable in the literaturefor appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed

Dosing and Therapeutic Conduct in Administration Sessions in Substance-Assisted Psychotherapy: A Systematized Review

While the potential of serotonergic psychedelics and related substances as adjuncts in substance-assisted psychotherapy (SAPT) has been investigated for the treatment of several disorders, evidence for the appropriate therapeutic conduct in administration sessions is sparse. In this article, we discuss the current evidence for best therapeutic practice during administration sessions with serotonergic psychedelics and entactogens as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines. PsycINFO, MEDLINE, and Cochrane Library databases were searched. Clinical trials, treatment manuals, study protocols, qualitative studies, case studies, descriptive studies, opinion papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. The final synthesis included k = 82 sources. Information about substances, dosages, number of administration sessions, issues that are common for clients, different types of experiences, music, and therapeutic conduct was summarized, compared, and critically discussed. The effects different therapeutic models, methods, techniques, and more complex interventions each have on the therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was anecdotal limiting any conclusive statements regarding appropriate therapeutic conduct during administration sessions. Consequently, essential components of therapeutic interventions remain largely tentative, necessitating systematic investigation