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Consistent uptake and implementation of evidence-based CBT (EB-CBT) in clinical practice remains challenging. Understanding key barriers and facilitators experienced by CBT therapists is essential for developing effective implementation strategies to enhance adoption of EB-CBT practices. This study applies the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to provide a theoretically driven exploration of perceived barriers and facilitators to implementing EB-CBT reported by CBT therapists. A cross-sectional survey design incorporating qualitative open-ended questions was used to gather in-depth insights from 228 UK-based CBT therapists. Data were analysed using reflexive thematic analysis. Inductive analysis identified ten barriers and eight facilitators, which were deductively mapped onto the COM-B and TDF to identify key determinants affecting practice at the individual therapist or broader organisational level. At the therapist level, barriers identified were understanding of evidence-based decision making, scepticism about EB-CBT as being rigid, based on flawed evidence, and lacking client centredness, and a preference for intuitive eclecticism. Therapist facilitators included skills in research literacy and formulation, guided self-reflection as a behaviour regulation strategy, and reinforcement through positive outcomes. Organisational barriers were limited or complex research/guidelines, difficulty accessing knowledge, lack of training/supervision, and service constraints. Organisational facilitators consisted of external monitoring as a behavioural regulation strategy, fostering communities of practice, gaining knowledge through resources, and access to training/supervision. Key perceptions as well as misconceptions around using EB-CBT in practice were identified, highlighting the need for multi-level strategies addressing both individual and organisational factors to enhance therapists’ capability, motivation, and opportunity to adopt EB-CBT practices.
Key learning aims
As a result of reading this paper, readers should:
(1) Understand the key barriers UK therapists perceive as hindering the implementation of evidence-based CBT practices.
(2) Understand the key factors UK therapists perceive as facilitating and enhancing the implementation evidence-based CBT practices.
(3) Be able to use the COM-B and TDF model to map key determinants affecting adoption of evidence-based CBT practice at both the individual therapist and broader organisational level.
(4) Consider theoretically driven implementation interventions which could be used to target identified individual and organisational factors to improve sustained adoption of EB-CBT.
This study longitudinally examined associations between parent and peer relationships, childhood maltreatment, and adolescents’ psychopathology. We expected lower perceived parental relationship quality to predict greater symptomatology and higher perceived friendship quality to buffer this association, with greater buffering effects for maltreated participants. We assessed 545 participants (295 maltreated, 250 non-maltreated; 60.2% male; 52.8% Black, 27.5% White, 12.8% Bi-racial, 13.4% Latin@) across two timepoints (Wave 1, Mage = 13.8 years, Wave 2,Mage = 16.2 years). Department of Human Services records indicated maltreatment status prior to Wave 1. Adolescents self-reported Wave 1 parental relationship and friendship quality and Wave 2 internalizing/externalizing symptoms. Parental relationship quality did not predict psychopathology, and this association did not differ by maltreatment status. We found a significant three-way interaction between maternal relationship quality, maltreatment, and friendship quality on internalizing (β = .10, p = .037) and externalizing (β = .12, p = .010) symptoms. For non-maltreated adolescents, parental relationships and friendship quality differentially predicted symptomatology. Maltreated adolescents with low maternal relationship and friendship quality exhibited the most symptoms, whereas those with low maternal relationship quality and high friendship quality exhibited the least. Findings invite inquiry into parent and peer relationships’ differential roles in adolescents’ psychopathology.
This study examined three neurocognitive patterns or “clinical pearls” historically viewed as evidence for executive dysfunction in Parkinson disease (PD): 1) letter < category fluency; 2) word list < story delayed recall; 3) word list delayed recall < recognition. The association between intraindividual magnitudes of each neuropsychological pattern and individual performance on traditional executive function tests was examined.
Methods:
A clinical sample of 772 individuals with PD underwent neuropsychological testing including tests of verbal fluency, word list/story recall, recognition memory, and executive function. Raw scores were demographically normed (Heaton) and converted to z-scores for group-level analyses.
Results:
Letter fluency performance was worse than category fluency (d = −0.12), with 28% of participants showing a discrepancy of ≥ −1.0 SD. Delayed recall of a list was markedly poorer than story recall (d = −0.86), with 52% of the sample exhibiting ≥ −1.0 SD deficits. Lastly, delayed free recall was worse than recognition memory (d = −0.25), with 24% showing a discrepancy of ≥ −1.0 SD. These patterns did not consistently correlate with executive function scores. The word list < story recall pattern was more common in earlier than later PD stages and durations.
Conclusion:
Among the three pearls, the most pronounced was stronger memory performance on story recall than word lists, observed in more than half the sample. Only ¼ the participants exhibited all three neurocognitive patterns simultaneously. The variability in patterns across individuals highlights the heterogeneity of cognitive impairment in PD and suggests that intra-individual comparisons may offer a more nuanced insight into cognitive functioning.
Our aim is to illuminate the persistent problem of evidence in cases of sexual violence in conflict zones by investigating the relationship between archival practices and processes of legal redress. This special issue consists of six essays, with contributors drawn from the disciplines of history and law. In temporal terms, the cases range from the seventeenth century to the late twentieth century; spatially, they address conflicts in Africa, Asia, Europe, and the United States. The case studies each offer an overview of “their archive,” explain its creation and limitations, and address its political logic and uses. As we interrogate archives, where evidence of sexual violence is located, it is critical that we note three things. First, to understand the nature and political construction of the archive. Second, to use this insight to interpret and assess the nexus of power relations within which historical and contemporary actors operate. Finally, to remember the inescapable limits of the evidence that shape the pursuit of justice, past or present.
Despite recent attention to the increased risk of cognitive impairment in older adults with essential tremor (ET), there are only limited data on the trajectories of cognitive change in ET or the demographic and motor predictors of such change.
Method:
This study included 148 cognitively normal individuals with ET (mean age = 76.7 ± 9.7 years) at baseline and had at least one follow-up evaluation (mean years of observation = 5.2 ± 1.6). Generalized Estimating Equations examined rates of change in six composite cognitive outcomes as a function of time, as well as demographic (age, sex, and education) and motor predictors (tremor severity, age of tremor onset, presence of rest tremor, cranial tremor, intention tremor, tandem gait) of rates of change. Demographics, medication use, and mood symptoms at baseline were covariates for all models.
Results:
Participants evidenced a decline in global cognition, executive function, and attention (prange = <0.001–0.044) over time. Older age predicted faster decline in all cognitive outcomes except attention (prange=<0.001–0.025). Tremor severity predicted faster decline in executive function (p = 0.011). Rest tremor predicted faster decline in executive function and attention (p = 0.033, 0.017). Tandem gait missteps predicted faster decline in memory and visuospatial ability (p = 0.026, 0.028).
Conclusions:
Results point to a dissociation in the predictive value of different motor features for specific aspects of cognitive decline. These results shed light on the earliest manifestations of cognitive impairment in older adults with ET and implicate different pathways by which heterogeneous cognitive changes emerge.
We report a rare case of a 3-month-old male infant with Down syndrome, severe pulmonary arterial hypertension (a large patent ductus arteriosus, an atrial septal defect, and a giant hepatic arteriovenous malformation). Initial treatment involved hepatic arteriovenous malformation embolisation using 17 Azur® CX Peripheral Coils, resulting in clinical improvement. However, persistent pulmonary arterial hypertension led to patent ductus arteriosus closure using an 8-mm Lifetech Cera™ vascular plug after a successful balloon occlusion test. Post-intervention, the patient showed symptomatic relief, reduced right ventricular overload, and atrial septal defect shunting shifted to left to right. This is the first reported paediatric case combining these features successfully managed through a multidisciplinary and stepwise treatment approach, eliminating the need for liver transplantation.
Thomas Aquinas argues that ‘Old Law’, comprised of the precepts found in the Hebrew Bible, should be divided into three types: moral, ceremonial and judicial. His system is meant to be instructive for Christian ethics, distinguishing between eternally, universally binding precepts relevant to Christians and other irrelevant or even forbidden ones. But Aquinas derives this threefold division from a mistranslated Vulgate passage from Deuteronomy where a singular noun, mitzvah, is translated as a plural noun: praecepta. Based on the original Hebrew, the verse actually supports a twofold division, not a threefold one. Aquinas’ system also runs into issues when it comes to sorting the precepts. To fix the sorting, retain the instructive benefit, and shed the biblical tension, we ought to keep Aquinas’ understanding of ‘moral law’, but discard the judicial and ceremonial categories in favour of one ‘cultural law’ category, in line with the popular Jewish philosophical division between chukim and mishpatim.
This study provides a comprehensive analysis of the morphology and genetics of Raillietiella gigliolii, an endoparasitic pentastomid found in amphisbaenians. The research was based on specimens deposited in the Universidade Regional do Cariri (URCA), as well as newly collected individuals from the Brazilian Caatinga. Detailed morphological descriptions were carried out, including measurements of the hooks, cephalothorax, tail, buccal cadre, and the copulatory spicule in males. In parallel, the first molecular characterisation of this species was performed, targeting the mitochondrial COI gene (barcode region). All specimens exhibited consistent morphotypes, particularly in the shape of the hooks, with no observable variation between males and females, nor between individuals parasitising different hosts (Amphisbaena alba and A. vermicularis). Molecular analyses revealed a well-supported monophyletic clade, with no detectable genetic divergence among individuals, confirming both the morphological stability and genetic delimitation of the species. These findings support the recognition of R. gigliolii as a clearly delineated species, currently restricted to amphisbaenians, which does not exhibit significant morphological variability, in contrast to other congeners.
The global transformation of the economy towards a digital one has fundamentally restructured business operations, economic models, and tax practices. With digital technologies and electronic communications embedded within industries, the digital economy has fostered innovative business models, transformed user behaviors, and increased operational efficiency. However, such a revolution has come at the price of exposing the limitations of traditional international tax models based on physical presence and tangible properties. The entry of borderless, intangible, and platform-based economic activities necessitates urgent tax redesign, especially amid digital businesses, which increasingly interact across borders yet leave no traditional physical presence.
This research describes the revolutionary influence of the digital economy on cross-border taxation, deconstructs the traditional conceptualization of the permanent establishment (PE), and evaluates the emergent principle of “tax where value is generated” based on recent literature as well as emerging global reform approaches.
To fully understand resilience and to inform resilience-promoting interventions, it is important to explore how resilience develops and the factors that influence it. Using a multidimensional approach that considers both well-being resilience (higher than expected wellbeing after adversity) and depression resilience (lower than expected depression after adversity), this study examined resilience trajectories among Chinese 0adolescents and the associations of gratitude and perceived stress with resilience trajectories. Data from a four-wave longitudinal study were analyzed from 563 Chinese adolescents (mean age at Time 1 = 12.83 years, 51.87% boys). Parallel-process latent class growth modeling identified four distinct trajectories of resilience development: flourishing resilience (increasing resilience; 21.67%), increasing wellbeing resilience but decreasing depression resilience (28.24%), declining resilience (29.48%), and increasing depression resilience but decreasing wellbeing resilience (20.61%). Gratitude was associated with greater odds of being in the flourishing resilience group. Furthermore, perceived stress was associated with lower odds of being in the flourishing resilience group and higher odds of being in the declining resilience group. The findings suggest that resilience is a dynamic and multidimensional construct with highly heterogeneous developmental trajectories. Gratitude and perceived stress may be effective targets for interventions to enhance adolescent resilience.
With a larger and more diverse set of countries than Cuzán and Heggen (2023a) studied, this article completes a general path of incumbencies that was partially traced by their “cruise and crash” model of the cost of ruling. The missing piece is a bump in the share of the vote in the party’s first reelection. The electoral “bonus” holds more or less steadily until the crash, at which point the vote plunges about 20% below the original win. The analysis suggests that the path of the vote in long-term incumbencies follows a general pattern that is shaped like an inverted asymmetrical letter U or W.
Emergency supply kits (ESKs) may support disaster-related self-sufficiency and may be important for people with chronic health conditions (CHCs). However, evidence of ESK’s effectiveness in supporting self-sufficiency is lacking. This study examined associations between households possessing ESKs and 1) household members leaving home for medicine and 2) individuals with CHCs seeking medical care.
Methods
Data were collected through a survey distributed to southwest Florida after Hurricane Ian’s impact (n = 1342). Associations were assessed using logistic regression models.
Results
ESK possession was more common among households with members with CHCs (63%) than households without such members (56%). Overall, regression models revealed no clear association between ESK possession and leaving home for medicine (adjusted Odds Ratio (aOR)=1.27; CI = 0.81-2.02). Analyses restricted to households with individuals with CHCs revealed no clear associations between ESK possession and leaving the home for medicine (aOR= 1.35; CI = 0.81-2.25) or seeking medical care (aOR = 1.07; CI = 0.68-1.68).
Conclusions
This study did not provide evidence that ESKs promote medical self-sufficiency. However, it did not characterize the medication in households’ ESKs or the type, duration, and severity of CHCs, and could have had uncontrolled confounding. Characterization of such factors would be important in future studies of ESKs and self-sufficiency among people with CHCs.