Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language

2017 ◽  
Vol 45 (6) ◽  
pp. 577-589
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
Paul Merrick ◽  
Maria Stubbe
Keyword(s):  
Role Play ◽  
Similar Degree ◽  
Behaviour Therapy ◽  
Metaphoric Language ◽  
External Expert ◽  
Cognitive Behaviour ◽  
Before And After ◽  
Case Conceptualizations ◽  
The Difference ◽  
Therapy Sessions

Background:There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this.Aims:This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations.Method:Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play ‘clients’ and an external expert rated the quality of the sessions and of the shared conceptualizations.Results:There were significant increases in some ratings of alliance, based on role play ‘client’ ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and ‘client’ on a measure of preference for producing metaphor, the lower the rating of the session by the ‘client’ on theBondfactor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically.Conclusion:This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.

Recent applications of metaphor research in cognitive behaviour therapy

2020 ◽  
Vol 10 (2) ◽  
pp. 199-213
Author(s):  
Fiona Mathieson ◽  
Jennifer Jordan ◽  
Maria Stubbe
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Self Report ◽  
Therapy Process ◽  
Behaviour Therapy ◽  
Early Therapy ◽  
Metaphoric Language ◽  
Cognitive Behaviour ◽  
Shared Language ◽  
The Impact ◽  
Therapy Sessions

Abstract Metaphors are common in psychotherapy. The last decade has seen increasing interest in the use of metaphor in cognitive behaviour therapy (CBT), with attention to client metaphors being asserted as a way of enhancing CBT. However, prior to this current research there was very little research on the use of metaphor in CBT sessions, and no studies have examined how to train therapists in this skill. This article discusses four studies that provide a preliminary empirical basis for the exploration of metaphors in CBT. The first study evaluated the reliability and utility of an approach to metaphor identification. The second study explored how clients and therapists co-construct metaphors, contributing to development of a shared language in early therapy sessions and identified a range of responses to each other’s metaphors. The third study explored the effect of training CBT therapists to intentionally bring client metaphors into case conceptualisations in terms of building therapeutic alliance and collaboration, along with an exploration of preference for metaphoric language. The fourth study explored the impact of the metaphor training on therapist confidence, awareness and use of metaphors, based on therapist self-report ratings and reflections on their ongoing application of learning over a three month period. These findings suggest that it is possibly to conduct empirical research on metaphor in CBT, with metaphor having potential as an important therapy process1 variable.

Do people with schizophrenia display theory of mind deficits in clinical interactions?

2004 ◽  
Vol 34 (3) ◽  
pp. 401-412 ◽  
Author(s):  
R. McCABE ◽  
I. LEUDAR ◽  
C. ANTAKI
Keyword(s):  
Theory Of Mind ◽  
Mental Health Professionals ◽  
Negative Symptoms ◽  
Experimental Studies ◽  
Chronic Schizophrenia ◽  
Mental States ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Clinical Interactions ◽  
Therapy Sessions

Background. Having a ‘theory of mind’ (ToM) means that one appreciates one's own and others' mental states, and that this appreciation guides interactions with others. It has been proposed that ToM is impaired in schizophrenia and experimental studies show that patients with schizophrenia have problems with ToM, particularly during acute episodes. The model predicts that communicative problems will result from ToM deficits.Method. We analysed 35 encounters (>80 h of recordings) between mental health professionals and people with chronic schizophrenia (out-patient consultations and cognitive behaviour therapy sessions) using conversation analysis in order to identify how the participants used or failed to use ToM relevant skills in social interaction.Results. Schizophrenics with ongoing positive and negative symptoms appropriately reported first and second order mental states of others and designed their contributions to conversations on the basis of what they thought their communicative partners knew and intended. Patients recognized that others do not share their delusions and attempted to reconcile others' beliefs with their own but problems arose when they try to warrant their delusional claims. They did not make the justification for their claim understandable for their interlocutor. Nevertheless, they did not fail to recognize that the justification for their claim is unconvincing. However, the ensuing disagreement did not lead them to modify their beliefs.Conclusions. Individuals with schizophrenia demonstrated intact ToM skills in conversational interactions. Psychotic beliefs persisted despite the realization they are not shared but not because patients cannot reflect on them and compare them with what others believe.

scholarly journals Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial

2015 ◽  
Vol 9 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Bo Karlsson ◽  
Gunilla Burell ◽  
Ulla-Maria Anderberg ◽  
Kurt Svärdsudd
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Control Group ◽  
Behaviour Therapy ◽  
Coping With Stress ◽  
Multidimensional Pain Inventory ◽  
Vital Exhaustion ◽  
Cognitive Behaviour ◽  
Before And After ◽  
Stress Behaviour ◽  
Individual Strategies

AbstractBackground and aimsStress has been pointed out as an important influential factor in the development and maintaining of the fibromyalgia syndrome (FMS) . Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.Methods48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (n = 24) and a waitlist control group (n = 24) . When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-Åsberg Depression rating scale – self-reported. Primary outcome was the MPI-1 dimension ‘life control’, secondary outcomes were the MPI-1 dimensions ‘interference’, ‘affective distress’ and ‘support from spouses or significant others’, the various MPI-2 dimensions, the ‘general activity level’ in the MPI-3 dimension, and ‘vital exhaustion’, ‘stress behaviour’, and ‘depression’. The only tertiary outcome was the MPI-1 dimension ‘pain severity’.ResultsIn the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions ‘life control’, ‘interference from pain’, ‘affective distress’, ‘support from spouses or significant others’, and ‘distracting responses’ and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the ‘vital exhaustion’ and ‘stress behaviour’. ‘Pain severity’ was rated higher after the intervention.ConclusionsCognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.ImplicationsFMS is a disorder with great therapeutic challenges. Total abolishment of pain symptoms is extremely difficult or impossible to achieve. Thus, the development of individual strategies for coping with pain is essential to reduce its impact on daily life. Since stress may worsen the pain experience, coping with stress might be a promising route to accomplishing that goal. In evaluations of interventions for pain it is important to monitor the effect on behaviour responses to pain and not only ratings of pain itself.

scholarly journals Pre-post effect sizes should be avoided in meta-analyses

2016 ◽  
Vol 26 (4) ◽  
pp. 364-368 ◽  
Author(s):  
P. Cuijpers ◽  
E. Weitz ◽  
I. A. Cristea ◽  
J. Twisk
Keyword(s):  
Comparison Group ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Behaviour Therapy ◽  
Natural Processes ◽  
Cognitive Behaviour ◽  
Post Test ◽  
The Difference ◽  
Meta Analyses ◽  
Highly Cited

AimsThe standardised mean difference (SMD) is one of the most used effect sizes to indicate the effects of treatments. It indicates the difference between a treatment and comparison group after treatment has ended, in terms of standard deviations. Some meta-analyses, including several highly cited and influential ones, use the pre-post SMD, indicating the difference between baseline and post-test within one (treatment group).MethodsIn this paper, we argue that these pre-post SMDs should be avoided in meta-analyses and we describe the arguments why pre-post SMDs can result in biased outcomes.ResultsOne important reason why pre-post SMDs should be avoided is that the scores on baseline and post-test are not independent of each other. The value for the correlation should be used in the calculation of the SMD, while this value is typically not known. We used data from an ‘individual patient data’ meta-analysis of trials comparing cognitive behaviour therapy and anti-depressive medication, to show that this problem can lead to considerable errors in the estimation of the SMDs. Another even more important reason why pre-post SMDs should be avoided in meta-analyses is that they are influenced by natural processes and characteristics of the patients and settings, and these cannot be discerned from the effects of the intervention. Between-group SMDs are much better because they control for such variables and these variables only affect the between group SMD when they are related to the effects of the intervention.ConclusionsWe conclude that pre-post SMDs should be avoided in meta-analyses as using them probably results in biased outcomes.

scholarly journals Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

2020 ◽  
Vol 13 ◽  
Author(s):  
Cassie M. Hazell ◽  
Orla Kelly ◽  
Sorcha O’Brien ◽  
Clara Strauss ◽  
Kate Cavanagh ◽  
...  
Keyword(s):  
Patient Experience ◽  
Controlled Trial ◽  
Pilot Trial ◽  
List Type ◽  
Behaviour Therapy ◽  
Hearing Voices ◽  
Self Help ◽  
Cognitive Behaviour ◽  
Therapy Sessions ◽  
Trial Participants

Abstract Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE. Key learning aims (1) To explore participants’ experience of accessing GiVE as part of a trial. (2) To identify what (if any) changes participants noticed over the course of the GiVE trial. (3) To identify what participants attribute these changes to.

Depression, Mastery and Number of Group Sessions Attended Predict Outcome of Patients with Panic and Agoraphobia in a Behavioural/Medication Program

1994 ◽  
Vol 39 (5) ◽  
pp. 283-288 ◽  
Author(s):  
Rudy Bowen ◽  
Maxine South ◽  
Don Fischer ◽  
Terah Looman
Keyword(s):  
Group Therapy ◽  
Cognitive Behaviour Therapy ◽  
Demographic Variables ◽  
Personal Knowledge ◽  
Predictors Of Outcome ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Poor Outcomes ◽  
Therapy Sessions

From a list of 214 patients suffering from panic and agoraphobia and who had been treated with cognitive behaviour therapy, 30 patients who had very good outcomes and 32 who had poor outcomes were selected. The groups were selected by the nurse therapist and psychiatrist on the basis of personal knowledge of the patients. The distinction into good and poor outcome groups was confirmed by the results of a follow-up questionnaire completed by the patient. Of several clinical and demographic variables which had been hypothesized, to be predictors of outcome, only depression, as measured by the Beck Depression Inventory, mastery, as measured by the Pearlin Mastery Scale and the number of group therapy sessions attended predicted outcome. Levels of depression and mastery might be clinically modifiable variables which affect the outcome of treatment for patients with panic and agoraphobia.

GROUP COGNITIVE BEHAVIOUR THERAPY FOR ANGER: A PILOT STUDY

2003 ◽  
Vol 31 (1) ◽  
pp. 69-83 ◽  
Author(s):  
Ronald Siddle ◽  
Freda Jones ◽  
Fairuz Awenat
Keyword(s):  
Randomized Controlled Trial ◽  
Pilot Study ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Behaviour Therapy ◽  
Randomized Controlled ◽  
Cognitive Behaviour ◽  
Initial Appointment ◽  
The Difference ◽  
Group Cbt

Patients referred with anger problems often do not attend for treatment. The aim of this study was to determine if group Cognitive Behaviour Therapy (CBT) was feasible. Patients referred for help with their anger were assessed, given 6 sessions of group CBT and re-assessed. Of 119 patients referred, 49 (41%) did not attend the initial appointment. Patients who attended for interview were invited to participate in the group CBT. Only 11 patients (9%) of those referred for therapy attended for the full course of CBT. Thirty-four patients (29%) were exposed to at least one session of CBT, while 66 patients (56%) did not attend for any therapy. Patients who attended for some or all of the CBT treatment reported reductions in the frequency and intensity of their anger outbursts. There was also a significant reduction in measures of their anger traits. It could be concluded that group CBT is an appropriate way to deliver this therapy to patients with anger problems, but it is clear that many of those referred are ambivalent about therapy and will not attend. Figures are given that will allow the planning of a randomized controlled trial to evaluate the difference between individual and group based CBT for patients with anger problems.

scholarly journals Serotonin tranporter methylation and response to cognitive behaviour therapy in children with anxiety disorders

2014 ◽  
Vol 4 (9) ◽  
pp. e444-e444 ◽  
Author(s):  
S Roberts ◽  
K J Lester ◽  
J L Hudson ◽  
R M Rapee ◽  
C Creswell ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Anxiety Disorders ◽  
Cognitive Behaviour Therapy ◽  
Environmental Influences ◽  
Psychological Therapy ◽  
Behaviour Therapy ◽  
Effective Treatment Option ◽  
Cognitive Behaviour ◽  
Before And After ◽  
Beneficial Response

Abstract Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.

Randomised Controlled Trial on the Use of Acupuncture in Adults with Chronic, Non-Responding Anxiety Symptoms

2015 ◽  
Vol 33 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Nick Errington-Evans
Keyword(s):  
Trait Anxiety ◽  
Controlled Trial ◽  
Anxiety Symptoms ◽  
Waiting List ◽  
Control Group ◽  
Acupuncture Points ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
The Difference ◽  
Randomised Controlled

Background A group of adults can be identified with chronic non-responding anxiety symptoms who have repeatedly accessed treatments through their GP, such as cognitive behaviour therapy, bibliotherapy and medication, but with no effect. These patients make heavy use of health service resources with no beneficial outcome. This study aims to test the effect of an acupuncture formula of three specific acupuncture points, suggested in a previous pilot study. Method 40 participants from a psychiatry waiting list were randomised into one of two groups: group 1 (n=25) received 10 weeks of acupuncture at PC6, HT7 and LR3, and group 2 was a waiting list control group. The waiting list group (n=15) then received acupuncture. Both groups were followed up for 10 weeks after treatment. The outcome measure was the State and Trait Anxiety Inventory. Results 36 patients completed the study, with two dropouts in each group. State anxiety scores in the acupuncture group decreased from 57.7 (SD 13.1) to 38.8 (12.0); scores in the waiting list control group decreased from 61.5 (11.6) to 60.6 (11.7). The difference was highly significant (p<0.0001). Similar changes were seen for trait anxiety scores. The control group showed similar statistically significant improvements when they received acupuncture. The improvements were maintained after 10 weeks of follow-up in each group. Conclusions Acupuncture is a promising intervention for patients with chronic anxiety symptoms that have proven resistant to other forms of treatment.

scholarly journals The Effect of Cognitive Behaviour Therapy on Sleep and Circadian Rhythm in Young College Students

2021 ◽  
pp. 43-47
Author(s):  
Shweta Kanchan ◽  
Sunita Tiwari ◽  
Shweta Singh
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Sleep Time ◽  
Behaviour Therapy ◽  
Circadian Phase ◽  
Dim Light Melatonin Onset ◽  
College Going ◽  
Cognitive Behaviour ◽  
Before And After ◽  
Sleep Parameters ◽  
Dim Light

The present study is to study the effect of cognitive behaviour therapy on various sleep parameters and circadian phase rhythmic in young college going adults. Fifty young college going adults were chosen from the MBBS and BDS students of King George's Medical University Lucknow, their polysomnography was conducted along with it salivary melatonin estimation was conducted to find the time of Dim light melatonin onset (DLMO), the subjects were administered cognitive behaviour therapy (CBT),after completing the sessions of cognitive behaviour therapy another Polysomnographic study and DLMO estimation was conducted, various sleep parameters were compared before and after the CBT. The study showed an improvement in the steep quality, a decrease in daytime sleepiness along with this total sleep time significantly increased, sleep efficiency also improved and there was a decrease in the REM sleep latency. The Dim light melatonin onset advanced for the subjects and the chronotype showed an inclination towards an earlier timings.

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