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Objective Rational emotive behavior therapy (REBT), introduced by Albert Ellis in the late 1950s, is one of the main pillars of cognitive-behavioral therapy. Existing reviews on REBT are overdue by 10 years or more. We aimed to summarize the effectiveness and efficacy of REBT since its beginnings and investigate the alleged mechanisms of change. Method Systematic search identified 84 articles, out of which 69 provided data for between-group analyses and 39 for within-group analyses. Results We found a medium effect size of REBT compared to other interventions on outcomes (d = 0.58) and on irrational beliefs (d = 0.70), at posttest. For the within-group analyses, we obtained medium effects for both outcomes (d = 0.56) and irrational beliefs (d = 0.61). Several significant moderators emerged. Conclusion REBT is a sound psychological intervention. Directions for future studies are outlined, stemming from the limitations of existing ones.

OBJECTIVE To compare the efficacy of cognitive evolutionary therapy (CET) with cognitive therapy (CT) for depression. METHODS Ninety-seven participants (78 females/19 males) were randomized to a single-blinded controlled trial (CET: n = 51 vs. CT: n = 46). Assessments were conducted at baseline, Sessions 4 and 8, posttreatment, and 3-month follow-up. Clinical diagnoses were made with Structured Clinical Interview for DSM-IV (SCID) and self-reports for depression and secondary outcomes. RESULTS Although both groups showed significant reductions in depressive symptomatology, the overall Time × Treatment group interaction in the intent to treat analysis was not significant (p = .770, posttreatment: d = 0.39). However, CET was superior to CT at increasing engagement in social and enjoyable activities (p = .040, posttreatment: d = 0.83, p = .040) and showed greater reductions than the CT group in behavioral inhibition/avoidance (p = .047, d = 0.62). The between-group differences generally diminished at the 3-month follow-up. CONCLUSIONS CET is a novel therapy for depression that may add therapeutic benefits beyond those of CT.

The definition published by the National Society of Genetic Counselors’ Task Force states that genetic counseling is the process of facilitating people’s understanding and adaptation to the medical, psychological, and familial collateral consequences of genetic diseases. Although the definition of genetic counseling practice goes beyond giving medical information, the great majority of studies, which tested the efficacy of a genetic counseling intervention, focused mainly on providing medical information and seemed to have given less attention to more specific psychological interventions, which could have addressed emotional distress and significant behavioral change relevant to the medical outcomes. Although most genetic counseling theorists recognize the complex emotional, behavioral, and family contexts in which the counselees find themselves during this process, very few studies have investigated the role of specific psychological interventions in the genetic counseling package. Cognitive-behavioral therapy (CBT) is the counseling framework with the most empirical support for a wide range of psychological problems. Consequently, we propose an evidence-based system of psychological interventions CBT that could be added to the genetic counseling paradigm in helping clients deal with specific difficult life situations and the emotional distress associated with them.

In order to promote the improvement of evidence-based psychological treatments (EBPT) and/or the integration of EBPT and bio-medical treatments, we propose a change in direction in cognitive neurogenetics (CNG)—from cognitive neurogenic to cognitive behavioral-based neurogenetics—starting from a top-down analysis: from symptoms and clinical-relevant cognitions to their implementation (brain, protein, genes). To illustrate our proposal, we specifically focus trans-diagnostically on symptoms of depression and anxiety, and consider the next underlying/interrelated mechanisms: (1) specific cognitions related to EBPT clinical theory/practice (cognitions/cognitive biases); (2) involved brain areas; (3) variability in protein expression; and (4) genetic polymorphisms. The proposed CBT-based neurogenetics framework rectifies the limitations of the classical CNG paradigm, and guides a more ecological and integrative approach in CNG. We argue that using large datasets, comparative methods of data analysis, and complex modelling techniques the CNG paradigm can be transcended. Our approach offers the framework for targeting key questions that have been previously disregarded, but which could revolutionize our understanding of the human mind and mental disorders: (Q1) do biological and psychological variables reflect different things in different “realities” or in the same reality?; (Q2) are biological and psychological variables different descriptions, at the same or at a different level of the same thing?; (Q3) if they are different descriptions at different levels of the same thing, are they reducible to each other or are there some emergent properties at more abstract levels?; (Q4) if they are different descriptions at the same level of the same thing, does it make sense to use both of them? Based on the innovative multi-/inter-/trans-disciplinary paradigm we propose, we should answer these questions.

Recent etiopathogenic theories of gastrointestinal conditions state that information processing biases can be a possible major factor involved in the aetiology and maintenance of these conditions. This exploratory study investigated the role of attention biases (AB) towards symptoms-related cues in gastrointestinal patients with respect to symptom maintenance, simultaneously taking into consideration the role of irrational beliefs. We included 32 patients diagnosed with gastrointestinal conditions. Patients completed a battery of psychological tests and an experimental task aimed to measure the preferential attention processing of linguistic stimuli related to gastrointestinal symptoms when they compete for attention resources with neutral stimuli. AB was positively related to irrational beliefs [r(31) = .376, p = .037] and analgesics use [r(32) = .518, p = .002], but not to self-report gastrointestinal symptoms [r(30) = −.165, p = .382]. Irrational beliefs correlated with pain catastrophizing [r(31) = .373, p = .039], but not to gastrointestinal symptoms, pain intensity, visceral sensitivity or negative emotions; however, pain catastrophizing correlated with all of these. Taken together, our results suggest that core irrational beliefs action as general vulnerability factors that trigger specific implicit and explicit cognitive mechanisms (i.e., AB, pain catastrophizing) involved in the onset and maintenance of symptoms. Future experimental studies should test the robustness of these results in larger samples and aim to further advance our understanding of how cognitive factors interact and potentiate each other in generating and maintaining debilitating suffering.

In this chapter, we will introduce the principles and structure of a group-delivered REBT treatment protocol designed for depressed children and adolescents. The protocol was already tested in a clinical trial, comparing group REBT, medication (i.e., sertraline), and their combination in treating youth depression by considering multiple levels of analysis (i.e., cognitive, subjective, and biological – serum serotonin and norepinephrine), and the results have already been published (Iftene, Predescu, Stefan, & David, 2015).

This chapter presents an REBT protocol used for treating MDD (a previous version of this protocol can be found here: http://albertellis.org/pdf_files/rebt_depression.pdf). The protocol follows the descriptions and techniques presented in well-established theoretical and clinical guidelines for rational-emotive behavioral therapy (e.g., Ellis & Grieger, 1977; Walen, DiGiuseppe, & Dryden, 1992). This intervention was tested in a randomized control trial (David, Szentagotai, Lupu, & Cosman, 2008) and was found to be equally effective as cognitive therapy (CT) and pharmacotherapy (a detailed description will be offered in the next section).

People with anxiety disorders often exhibit an attentional bias for threat. Attention bias modification (ABM) procedure may reduce this bias, thereby diminishing anxiety symptoms. In ABM, participants respond to probes that reliably follow non-threatening stimuli (e.g., neutral faces) such that their attention is directed away from concurrently presented threatening stimuli (e.g., disgust faces). Early studies showed that ABM reduced anxiety more than control procedures lacking any contingency between valenced stimuli and probes. However, recent work suggests that no-contingency training and training toward threat cues can be as effective as ABM in reducing anxiety, implying that any training may increase executive control over attention, thereby helping people inhibit their anxious thoughts. Extending this work, we randomly assigned participants with DSM-IV diagnosed social anxiety disorder to either training toward non-threat (ABM), training toward threat, or no-contingency condition, and we used the attention network task (ANT) to assess all three components of attention. After two training sessions, subjects in all three conditions exhibited indistinguishably significant declines from baseline to post-training in self-report and behavioral measures of anxiety on an impromptu speech task. Moreover, all groups exhibited similarly significant improvements on the alerting and executive (but not orienting) components of attention. Implications for ABM research are discussed.

Background Depression has become one of the leading contributors to the global disease burden. Evidence-based treatments for depression are available, but access to them is still limited in some instances. As technology has become more integrated into mental health care, computerized cognitive behavioral therapy (CBT) protocols have become available and have been recently transposed to mobile environments (e.g., smartphones) in the form of “apps.” Preliminary research on some depression apps has shown promising results in reducing subthreshold or mild to moderate depressive symptoms. However, this small number of studies reports a low statistical power and they have not yet been replicated. Moreover, none of them included an active placebo comparison group. This is problematic, as a “digital placebo effect” may explain some of the positive effects documented until now. The aim of this study is to test a newly developed mobile app firmly grounded in the CBT theory of depression to determine whether this app is clinically useful in decreasing moderate depressive symptoms when compared with an active placebo. Additionally, we are interested in the app’s effect on emotional wellbeing and depressogenic cognitions. Methods/design Romanian-speaking adults (18 years and older) with access to a computer and the Internet and owning a smartphone are included in the study. A randomized, three-arm clinical trial is being conducted (i.e., active intervention, placebo intervention and delayed intervention). Two hundred and twenty participants with moderate depressive symptoms (i.e., obtaining scores >9 and ≤16 on the Patient Health Questionnaire, PHQ-9) will be randomized to the three conditions. Participants undergoing therapy, presenting serious mental health problems, or legal or health issues that would prevent them from using the app, as well as participants reporting suicidal ideation are excluded. Participants randomized to the active and placebo interventions will use the smartphone app for 6 weeks. A short therapist check-in via phone will take place every week. Participants in the delayed-intervention condition will be given access to the app after 6 weeks from randomization. The primary outcome is the level of depressive symptomatology. The intervention delivered through the app to the active condition includes psychoeducational materials and exercises based on CBT for depression, while the placebo intervention uses a sham version of the app (i.e., similar structure of courses and exercises). Discussion To our knowledge, this study protocol is the first to test the efficacy of a smartphone app for depressive symptomatology in the form of a randomized controlled trial (RCT) that includes an active placebo condition. As such, this can substantially add to the body of evidence supporting the use of apps designed to decrease depression. Trial registration ClinicalTrials.gov, identifier: NCT03060200. Registered on 1 February 2017. The first participant was enrolled on 17 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1960-1) contains supplementary material, which is available to authorized users.

Context Attentional bias modification (ABM) treatment is a promising intervention tool for a variety of clinical conditions. Objectives This study provides an updated review of the clinical effect of ABM by employing standard meta-analytic procedures to (a) estimate the average effect size of ABM in reducing both attention bias (AB) and symptoms, (b) estimate the average effect size for different conditions (e.g., anxiety, depression, and substance abuse), (c) test possible variables that may moderate the effect sizes, and (d) investigate the relationship between preexistent AB and the reduction in AB and symptoms. Method We included 43 controlled trials with a total of 2,268 participants providing 47 group comparisons (i.e., training vs. control condition). Inclusion criteria were as follows: AB was specifically targeted to reduce symptomatology and emotional vulnerability; participants were randomized to the experimental conditions; a control condition (defined as sham training) existed; symptoms were assessed at least postintervention; sufficient data were provided to allow effect size estimation. Results We obtained a small overall effect size on symptoms postintervention, g = 0.160, 95% confidence interval (CI) = [0.055, 0.265], driven by anxiety studies, g = 0.260, 95% CI = [0.132, 0.388], and studies conducted in healthy participants, g = 0.211, 95% CI = [0.046, 0.375]; no significant effect sizes were found postintervention for other symptom categories. Conclusion The therapeutic benefit of ABM is rather small for anxiety, while the amount of data for other symptom categories is limited. We argue that more efficient, psychometrically sound procedures are needed for assessing and modifying AB.

It has been shown recently that a specific intervention designed to modify the overgeneralization bias [i.e., concreteness training (CNT)] can decrease depressive symptoms. The intervention, however, involves multiple components (e.g., relaxation, problem solving), so it is not clear if the increase in concrete processing is the crucial mechanism in ameliorating depressive symptoms. Using a dismantling design, this online study examined whether targeting only concrete processing in the absence of a therapeutic context reduces depressive symptoms. Forty-two stable dysphoric participants were randomly allocated to either a waiting list or a 7-days concreteness training condition. Compared with the control group, concrete processing training resulted in a significant increase in the concreteness of thinking. No significant differences in autobiographical memory specificity, depressive symptoms, or rumination, however, were obtained post-intervention between the two groups. These findings suggest that concrete processing can be trained, but training effects may not generalize to untrained cognitive contents. The effectiveness of CNT as a standalone treatment for depression may be limited.

The REC (2) the SAD diagnosis is secondary to another axis III diagnosis; (3) personality disorders predisposing patients to confusions between the real and virtual realities (paranoid, schizoid, schizotypal, borderline, antisocial personality disorders); or (4) suffered anytime during the past 6 months of panic disorder with or without agoraphobia. Participants included in some concurrent form of psychotherapy or receiving medication are also excluded.

Cognitive–Behavioral Therapies (CBT) are currently considered (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012) effective treatments for child and adolescent psychopathology. The very first form of CBT is Rational–Emotive and Cognitive–Behavior Therapy (RE Ellis, 1962).

Generalized anxiety disorder (GAD) is defined by the experience of pervasive and uncontrollable worry, in combination with other symptoms related to prolonged physical arousal, like restlessness, irritability, or difficulty sleeping (DSM-5, American Psychiatric Association, 2013). Worry, the core diagnosis feature of GAD, refers to “a chain of thoughts and images, negatively affect-laden and relatively uncontrollable” (Borkovec, Robinson, Pruzinsky, & DePree, 1983, p. 10), with reference to a wide range of domains, like health, financial status, education, family, and so on. While mild and transient worry is a common process in normal population, pathological worry is experienced as pervasive, uncontrollable, and dangerous (Holaway, Heimberg, & Coles, 2006).

Anxiety is transmitted from parents to children both genetically and environmentally (Creswell, Murray, Stacey, & Cooper, 2011). On the one hand, biologic vulnerability to anxiety explains up to 30–40 % of anxiety variability, while environmental factors account for the rest (Barlow, 2002). On the other hand, the way parents conduct exposure to the environment, the way they react to new, uncertain, or ambiguous stimuli, and the reinforcements and punishments they apply, all can model anxious emotional responses and behaviors. While inborn personality features such as neuroticism favor anxious responses, fear is learned in the environment, and there are several mechanisms which can explain how a child learns to be afraid of particular stimuli and situations

Background and objectives Across three experiments we investigated transfer effects of single-session attention bias modification via dot-probe training. Methods In experiment 1, participants received training either toward or away from negative images or no-training, and transfer to an affective task-switching task was examined. In two other experiments, participants were trained to orient attention toward either positive or negative words (experiment 2a) or facial expressions (experiment 2b), and transfer to an interpretation bias task was examined. Results In all experiments, the dot-probe training procedure did not effectively modify biases in attention allocation at the training condition level, but produced a large variability in individual attention bias acquisition within and across conditions. Individual differences in pre-training attention bias and attention bias acquisition were not related to performance on the affective task-switching task or the interpretation tasks. Limitations The present investigations are limited by the lack of effectiveness of ABM at the condition level, the order in which transfer tasks were administered, and the restricted range of affective symptoms that could moderate training and transfer effects. Conclusions The findings from three experiments provided no evidence for single-session dot-probe ABM procedures to effectively manipulate attention bias toward negative, away from negative, or toward positive stimuli at a training condition level. At the individual differences level of analysis, again no evidence was found for transfer of attention training. The observations invite further empirical scrutiny into factors that moderate attentional plasticity in response to dot-probe ABM procedures to optimize the conditions for effective implementation and transfer of training.

Depression is estimated to become the leading cause of disease burden globally by 2030. Despite existing efficacious treatments (both medical and psychotherapeutic), a large proportion of patients do not respond to therapy. Recent insights from evolutionary psychology suggest that, in addition to targeting the proximal causes of depression (for example, targeting dysfunctional beliefs by cognitive behavioral therapy), the distal or evolutionary causes (for example, inclusive fitness) should also be addressed. A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression, and to compare its efficacy against standard cognitive therapy for depression. Romanian-speaking adults (18 years or older) with elevated Beck Depression Inventory (BDI) scores (>13), current diagnosis of major depressive disorder or major depressive episode (MDD or MDE), and MDD with comorbid dysthymia, as evaluated by the Structured Clinical Interview for DSM-IV (SCID), are included in the study. Participants are randomized to one of two conditions: 1) evolutionary-driven cognitive therapy (ED-CT) or 2) cognitive therapy (CT). Both groups undergo 12 psychotherapy sessions, and data are collected at baseline, mid-treatment, post-treatment, and the 3-month follow-up. Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment. This randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression. To our knowledge, this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner. This study can thus add substantially to the body of knowledge on validated treatments for depression. Current Controlled Trials ISRCTN64664414 The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.