Trichotillomania is a debilitating and chronic condition involving repeated hair pulling from various areas of the body. Trichotillomania often begins in childhood, suggesting that the development and understanding of treatments for trichotillomania in youth are of utmost importance, especially for successful early intervention. While habit reversal training (HRT) is considered the gold standard treatment for trichotillomania in young people, this article reviews a nascent treatment approach for trichotillomania in youth, acceptance-enhanced behavior therapy (AEBT). AEBT combines HRT and acceptance and commitment therapy skills. Each component of AEBT is described and reviewed. A detailed case exemplar of the 10-session protocol is presented. Future research directions and important clinical considerations are discussed.

The clinical literature encourages further exploration of the relationship between anxiety and paranoid ideation with the overall objective of identifying processes that mitigate such relationship, thus establishing targets for cognitive intervention. Empirical studies demonstrate that increased levels of anxiety precede the emergence of paranoid cognitions. Yet, possible mediators are still to be investigated. In all, 273 adults completed a battery of standardized questionnaires, and collated data were analyzed statistically. Generalized anxiety was positively associated with paranoid ideation, for both ideas of reference and persecutory beliefs. Although the relationship was not mediated by cognitive flexibility in its entirety, perceived control over internal experiences and external events, an essential constituent of cognitive flexibility, acted as a significant mediator. The results highlight the importance of increasing adaptive perceptions of control among individuals experiencing generalized anxiety, which would likely reduce the co-occurrence of paranoid ideation and lower the risk of transitioning into clinical levels of paranoia.

Pediatric obsessive-compulsive disorder (OCD) affects approximately .25%-3% of children, and if left untreated, can cause significant impairment for the child and family. Cognitive behavioral therapy with exposure and response prevention (ERP) is the gold-standard treatment for pediatric OCD. When using ERP with children and adolescents, it is essential to assess and target family factors in treatment in order to help the youth make therapeutic progress. The following case study illustrates the successful implementation of family-based ERP in a young female with contamination OCD. It further highlights strategies for targeting family accommodation and family conflict within the course of treatment.

This study aimed to examine the psychometric properties of the Chinese version of the family accommodation scale for obsessive-compulsive disorder (OCD) patient version (FAS-PV). A total of 171 adult OCD patients and 145 family members were enrolled in the present study. The majority of the adult OCD patients (89.5%) reported engaging in at least one accommodating behavior in the past week. The FAS-PV comprised three components that included (a) direct participation and facilitation, (b) provision of reassurance and assumption, and (c) modification of routines and avoidance. The FAS-PV demonstrated excellent internal consistency. The correlation between the total FAS-PV score and the criteria measure demonstrated excellent convergent validity when assessing the OCD symptom severity, global functioning, family functioning, and functioning impairment. The findings supported that the FAS-PV could be used widely in evaluating and identifying the accommodating behavior both in clinical and in research settings, especially in adult OCD patients who usually present to the clinic alone.

This clinical case assessed the efficacy of cognitive behavioral therapy (CBT) in treating major depressive disorder in a 26-year-old female, Sara, attributing her depression to pregnancy, financial constraints, parental duties, and emotional stress. Sara had eight sessions of CBT, during which her symptoms were measured using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-Second Edition (BDI-II). Sara's depressive symptoms dramatically decreased after the intervention, moving her HAM-D and BDI-II scores from moderate to mild depression and from clinically depressed to mild, respectively. The assessment showed improved interest, concentration, energy levels, and a more positive self-perception. Integrating Malaysian cultural elements into CBT, emphasizing family support, community engagement, and spirituality positively impacted Sara. This study emphasizes the value of culturally appropriate CBT for depression as it can help with symptom management, challenging negative thoughts, and bolstering self-esteem. This method identifies and addresses cultural impacts on mental health, recommending the incorporation of cultural aspects in therapy, enhancing relapse prevention and quality of life for Malaysians experiencing depression.

The comparative incremental validity of five self-as-context measures in predicting psychological distress and satisfaction with life, after controlling for relevant demographic variables and other psychological flexibility processes, was evaluated in a college student sample ( = 315). All of the measures except the self-as-context subscale of the Multidimensional Psychological Flexibility Inventory (Rolffs et al., 2018) separately accounted for a significant increase in variability in psychological distress. The centering subscale of the Self-as-Context Scale (Zettle et al., 2018) was the only measure to also display incremental predictive validity in accounting for significant variance in life satisfaction. The conceptual and clinical implications of the findings in the context of study limitations are discussed.

Mental health concerns among young adult populations have increased in recent years, with standard treatment approaches presenting many undue barriers (e.g., time and cost constraints and limited availability of therapists). Single-session interventions (SSIs) have been explored as an alternative, scalable intervention to address these barriers to care. We evaluated the acceptability and feasibility of a SSI in a real-world setting and found promising effects of the SSI on symptoms of depression in a young adult population. Given these findings, we offer support for the SSI as an accessible treatment alternative to perhaps be integrated into tiered care treatment models or settings with limited access to care.

Research suggests that metacognitions could be important in explaining symptoms of body dysmorphic disorder (BDD), but the effect of metacognitive therapy (MCT) on BDD is unknown. The aim of this consecutive case series was to explore MCT for BDD, delivered individually within a public mental health setting. Treatment was based on MCT manuals for obsessive-compulsive disorder and generalized anxiety disorder. Of 11 eligible participants, 2 declined treatment, 8 completed treatment, and 1 dropped out. MCT for BDD was associated with significant reductions in BDD symptoms, comorbid symptoms of depression and anxiety, and metacognitions. All treatment completers were characterized as treatment responders (i.e., >30% improvement), and improvements were maintained at 3-month follow-up. MCT could be a promising treatment for BDD. Future studies should explore MCT for BDD in controlled trials and explore how to motivate individuals with BDD for psychological treatment.

Childhood maltreatment (CM) is associated with elevated depression and anxiety in young adulthood; however, there is a dearth of research identifying the intermediary pathways that link CM to these phenomena. The present study investigated two psychological factors-, sensitivity to and avoidance of sudden negative emotional shifts, and , the fear of arousal-related body sensations-as potential mediators of the relationship between CM and psychological distress in young adulthood. Our sample consisted of 280 undergraduate students who completed self-report measures of childhood maltreatment, anxiety sensitivity, contrast avoidance (i.e., the Contrast Avoidance Questionnaire), and psychological distress. We constructed a series of parallel mediation models to test whether contrast avoidance and anxiety sensitivity mediate the relationships between child maltreatment and psychological distress. CM was related to anxiety and stress indirectly through both contrast avoidance and anxiety sensitivity but was related to depression only through contrast avoidance. There were no significant differences in the magnitude of the indirect effects between contrast avoidance and anxiety sensitivity for the models predicting anxiety and stress. Contrast avoidance and anxiety sensitivity both appear to play important roles in understanding how early experiences of CM relate to psychological distress in young adulthood. Theoretical and clinical implications are discussed.

There is emerging interest in understanding positive affect dysfunction in relation to anxiety, including worry. This set of two studies examined the association between the inhibition of affect expression (general affect expressivity in Study 1, positive affect expressivity in Study 2) and worry, with a particular interest in the moderating role of proneness to experience positive affect. Subjects were US-residing adults (Study 1 = 502, Study 2 = 250) who were recruited through a crowdsourcing website and completed self-report measures of study variables. Moderated regression was used to examine study predictions that affect expression would negatively correlate with worry when coupled with diminished positive affect. Proneness toward negative affect was included as a covariate within multivariate analyses. An interactive effect between affect expressivity and positive affect was supported in Study 2 (positive affect expressivity) but not Study 1 (general affect expressivity) in relation to worry. A diminished tendency to express positive affect was associated with greater worry when coupled with less positive affect. Study results and future directions are discussed in terms of the potential emotion-regulatory functions of positive affect expressivity as it relates to worry.

This study aimed to examine the mediating role of self-compassion and social anxiety in the relationship between cognitive distortions and emotional eating. The research was carried out on 406 adult individuals between the ages of 18-25 living in different regions of Turkey. To measure research variables, Liebowitz social anxiety, thought types, self-sensitivity, and Turkish emotional eating scale were used. The scales were distributed to the participants online. The data were analyzed through the SPSS program. In the study, it was determined that self-compassion predicted emotional eating negatively and social anxiety predicted emotional eating positively. According to the results of the serial mediation analysis, it was determined that self-compassion and social anxiety mediated the relationship between cognitive distortions and emotional eating separately.

Following a period of social isolation from the COVID-19 pandemic, social interactions may be particularly complicated for individuals with elevated levels of social anxiety. One potential implication relates to the use of face masks. Face masks have been used as an effective tool to prevent the transmission of COVID-19. However, for individuals with elevated social anxiety, face masks may be a form of avoidance and type of safety behavior and discontinued use of face masks may be associated with increases in social anxiety. In response to these possibilities, the purpose of this study was to develop a measure to assess potential anxiety-related reactions to face masks. Participants were 564 nonreferred young adults who completed a measure developed for this study to assess behaviors and reactions to face masks (Reaction to Face Masks Questionnaire), including anxiety and avoidance behaviors. Measures of social anxiety, more general avoidance, and safety behaviors were also included. Based on an exploratory factor analysis, a two-factor model was retained. Safety-Seeking and Avoidance (SSA) measures reductions in social anxiety derived from a feeling of safety when wearing a face mask, and Social Interference measures increases in social anxiety symptoms related to the interference/inhibition of social interactions related to wearing masks. Both subscales were found to be associated with general measures of social anxiety, more general avoidance, and safety behaviors; however, the correlations were more robust for the SSA subscale. Based on the current findings, general social anxiety and common correlates of social anxiety, including safety-seeking behaviors, were found to be associated with face mask anxiety and avoidance. Implications for future research and potential clinical practice are discussed.

Increased emphasis has been placed on elucidating the contribution of client variables, such as treatment preference, to optimize evidence-based practice. This analog study sought to better understand variables associated with treatment preference using a convenience sample of college students ( = 54) who read brief descriptions of three interventions for negative thoughts-defusion, noticing, and restructuring. They rated each on acceptability and practicality and completed measures of cognitive fusion, emotional distress, and experiential avoidance as possible moderating variables. Restructuring was overwhelmingly preferred and rated as more acceptable than the two alternatives by both the overall sample and a distressed subsample. Preference for defusion or noticing was not predicted by ratings of acceptability or practicality but by elevated levels of cognitive fusion and emotional distress consistent with a compensation model. Limitations of the study and its implications for further research on psychotherapy preference and its integration within evidence-based practice are discussed.

Children with autism spectrum disorder (ASD) exhibit significant deficits in social communication and emotion regulation skills. While cognitive behavioral therapy (CBT) applications appear promising, trials to date have largely excluded social communication skill development and have not been designed to include a wider range of emotional challenges. To our knowledge, the present study is the first to pilot a uniquely modified CBT program targeting emotion regulation, including social communication training, and explicitly focusing on the child's areas of circumscribed interest in order to teach skills and promote generalization. Forty participants were randomly assigned to either the CBT group or a waitlist control (WLC) group, resulting in 20 school-aged children in each group. The treatment approach was determined to be feasible and acceptable, and therapy engagement and attendance were reasonably high. Caregivers expressed high satisfaction with the program, qualitatively citing gains in skills such as social problem-solving, emotion identification, and identifying and processing cognitive distortions. The primary outcome of postintervention changes was not significantly different between the groups (CBT vs. WLC). The mean Social Skills Improvement System score decreased by 0.44 points (95% confidence interval [CI]: -5.04, 4.15) in the CBT group and increased by 0.41 points (95% CI: -4.23, 5.04) in the WLC group, and the postintervention changes were not significantly different between the groups (difference: -0.85; 95% CI: -7.29, 5.60; = .79). The estimated rate of emotional dysregulation episodes decreased by a factor of 0.94 (95% CI: 0.57, 1.56) in the CBT group and increased by a factor of 1.07 (95% CI: 0.51, 2.24) for WLC ( = .74). Among those who reported emotional dysregulation episodes, the mean duration decreased by 1.39 minutes (95% CI: -3.90, 6.67) less for CBT than waitlist ( = .60). Although satisfaction, acceptability, and emotional dysregulation outcome results from this preliminary CBT treatment for ASD are promising, sample size and measurement limitations will be important considerations to inform future trials.

Acceptance and commitment therapy (ACT) for obsessive-compulsive disorder (OCD) has been found efficacious in randomized clinical trials (RCTs), but the two widely known RCTs were conducted within the United States with predominantly White samples. Research that evaluates treatments like ACT for OCD outside the typical Western cultures is needed. The current scoping review summarizes the key characteristics and findings from 18 RCTs that evaluated ACT for OCD in Iran. These RCTs are largely unknown in the broader scientific literature despite representing the vast majority of ACT for OCD trials, in part because the majority are published in Persian. The preponderance of RCTs treated participants in groups, and most protocols did not include exposure exercises. Of 18 trials, 5 were single sex. Use of selective serotonin reuptake inhibitors (SSRIs) was common with all participants on stable doses at pretreatment in many of the trials. Methodological quality was low to medium. ACT was inconsistent against nontraditional comparison conditions, slightly favorable to empirically validated treatments, and favorable compared with the waitlist and SSRIs. The process of change data indicated that ACT increased the psychological flexibility more than cognitive behavior therapy or SSRIs. These results highlight that findings on ACT for OCD from Western populations replicate and generalize to individuals in Iran. These findings also offer insights gained from studying ACT in Iran and significantly expand the literature based on ACT for OCD that can be integrated into scholarship by all researchers.

While exposure therapy is the most effective psychological treatment for obsessive-compulsive disorder (OCD), anxiety, and traumatic stress-related disorders, it is not universally effective, indicating a need for further treatment optimization. This study investigated a shift in approach to exposure therapy with 29 treatment-refractory adults in an OCD clinic not responding to standard treatment, comprising habituation-based exposure therapy. Participants completed standard exposure as a continuation of standard clinic treatment, followed by an acceptance and commitment therapy (ACT) consultation session to assess psychological inflexibility processes interfering with treatment progress, and then an ACT-based exposure targeting behavior change through increasing psychological flexibility. After each exposure, participants and independent raters reported levels of psychological flexibility, rituals, distress, treatment engagement, and treatment perceptions. We observed that the shift to ACT-based exposure was associated with greater psychological flexibility, treatment engagement, treatment acceptability, and treatment preference. These findings suggest that there may be situations where ACT-based exposure has particular utility.

A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample ( = 91), with moderate obsessive-compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.

Emerging research suggests that psychological inflexibility may be a factor contributing to the development and maintenance of insomnia. However, less is known about the potential cognitive pathways that may explain this relationship. In this study, we investigated the serial mediating effects of psychological inflexibility and daytime insomnia-related rumination on the association between dysfunctional beliefs and attitudes about sleep (DBAS) and insomnia symptoms. The sample included 490 college students who underwent assessments at two time points over a 1-month period. The results of our mediational tests yielded significant indirect effects, supporting the prediction that psychological inflexibility and daytime insomnia rumination serially mediate the relationship between DBAS and insomnia. The study provides insights into potential mechanisms for insomnia, emphasizing the role of psychological inflexibility in perpetuating maladaptive cognitive processes associated with insomnia. Future researchers should explore other maladaptive responses to insomnia-related concerns and distress, such as worry and safety behaviors, and replicate findings in clinically elevated insomnia samples.

This study aims to examine the relative contribution of anger cognitions and anger rumination in predicting externalizing and internalizing problems among 180 adolescents (aged 11-18 years) using correlational and linear regression analysis. Our findings showed that anger rumination predicted both externalizing (aggressive behaviors) and internalizing problems (anxious, depressive, and somatic symptoms). In contrast, biased anger cognitions did not appear to meaningfully predict either externalizing or internalizing symptoms, with the only exception of the hostile verbal labels and catastrophic cognitive attributions, a factor that was significantly associated with both rule-breaking behaviors (ß = .339, < .01) and aggressive behaviors (ß = .238, < .05). Anger rumination accounted for a higher rate of variance of psychopathology compared with anger cognitions and should be addressed in interventions for either externalizing or internalizing symptoms in adolescence.

A problem in psychotherapy is the limited availability of psychotherapists. This can not only delay the start of therapy but also curtail the number of sessions and the therapeutic dosage. An option to extend the therapeutic dose without an increase in therapist time may be to combine group psychotherapy with a self-help group. The goal of the present study is to investigate how patients judge this treatment mode and to what degree the contents of a regular group treatment are pursued in a parallel self-help group. Seventy-two psychosomatic inpatients participated in cognitive behavior group therapy and parallel self-help group, which was monitored by the therapist during the regular group therapy sessions. Patients in both groups filled in a questionnaire that asked for the content of the group session, how patients had experienced the interaction, and what they had taken from the group. Patients reported that in the self-help group, they discussed similar topics as in the regular group therapy, like how to deal with anxiety or sadness, how to interact with other people, and how to cope with their mental disorder and problems at work, in the family, or with friends. Patients indicated that there was more relaxed chatting in the self-help group, whereas learning new behavior was reported more frequently for the regular group therapy. In the regular group therapy and the guided self-help group, similar topics were discussed, which suggests that a combination of both can extend the therapeutic process and increase the therapeutic dosage without costs for the therapist or the institution.

Cognitive fusion occurs when people experience their thoughts as literally true and allow them to dictate behavior. Fusion has been shown to be associated with increased symptoms of post-traumatic stress disorder (PTSD) and depression; however, the association between change in cognitive fusion, PTSD, and depression symptoms has been relatively uninvestigated. Our study aims to examine the associations between PTSD, depression symptoms, and cognitive fusion in Canadian veterans from pre- to post-treatment. Clients ( = 287) completed measures of PTSD symptom severity, depression symptom severity, and cognitive fusion at pre- and post-treatment. Our results supported that pretreatment PTSD and depression symptom severity were found to be negatively associated with changes in pre- to post-treatment cognitive fusion, while pretreatment cognitive fusion was not associated with changes in depression or PTSD symptoms. Furthermore, pretreatment depression symptoms predicted pre- to post-treatment changes in PTSD symptoms. However, pretreatment PTSD symptoms did not predict changes in depression symptoms. These findings highlight the importance of understanding the bidirectional associations between PTSD, depression, and cognitive fusion. Furthermore, our results are indicative of PTSD and depression symptoms playing a role in the change in cognitive fusion (e.g., defusion) and of depression playing a larger role in the maintenance of PTSD symptoms. Theoretical and practical implications are discussed.

The Department of Veteran Affairs established Readjustment Counseling Service (RCS) to meet the mental health needs of active-duty service members, veterans, and their families. A diverse therapeutic skill set is needed to serve this complex population. To assess training needs, a national mixed-methods needs assessment consisting of a survey for RCS counselors and focus groups among counselors, RCS educational trainers, and national leadership was conducted. Survey results ( = 681) showed that RCS counselors were most interested in trainings on moral injury, acceptance and commitment therapy, and military sexual trauma (MST). Desired trainings aligned with populations served. Themes from focus groups revealed the need for foundational trainings so that all RCS counselors are adept in treating MST, moral injury, and posttraumatic disorder and proficient in caring for couples. Additionally, counselors desired advanced trainings tailored to individual counselors' needs. RCS counselors identified multiple trainings to help them treat those they serve.

Existing research suggests that Acceptance and Commitment Therapy (ACT) training is beneficial for healthcare workers' professional practice and personal well-being. This review aimed to further understanding of healthcare workers' experiences of ACT training by synthesizing existing qualitative studies. A systematic literature review identified papers published up until April 2022 using the Embase, Ovid MEDLINE, and PsycINFO databases as well as relevant studies within the gray literature. Nine studies were included in the review, which were analyzed using Thematic Synthesis (Thomas & Harden, 2008). Three analytical themes were identified through the thematic synthesis: I am both the patient and the professional; a powerful and empowering experience; and it is not always comfortable. This review has highlighted the importance of experiential learning. The training was a powerful experience for staff, but as such, it was not always comfortable. Recommendations for the future delivery of ACT training are made.

Research suggests that individuals with obsessive-compulsive and related disorders (OCRDs) with lower insight show a poorer response to cognitive behavioral therapy and might benefit from alternative treatments. However, there are inconsistencies in the literature regarding the definition and measurement of insight. This study endeavored to evaluate the psychometric properties of the Cognitive Obsessional Insight Scale (COGINS), a novel self-report measure of cognitive insight in OCRDs. The sample comprised 166 participants with a diagnosis of obsessive-compulsive disorder or body dysmorphic disorder enrolled in clinical trials. Participants completed the COGINS and a questionnaire battery at baseline and posttreatment. The COGINS demonstrated good internal consistency, test-rest reliability, convergent validity with other OCRD-specific measures of insight, positive associations with OCRD symptomatology, and had a moderating effect on treatment response. The COGINS is a valid and reliable practical tool to measure cognitive insight in OCRDs and might help toward clarifying the role of cognitive insight in this population.

Social anxiety disorder (SAD) models highlight maladaptive attention as a maintaining factor of SAD, potentially negatively impacting how individuals with SAD engage with cognitive behavioral therapy (CBT) content in a therapist's presence. Emotional working memory training (eWMT) has been shown to improve affective attentional control. This pilot study assessed the proposed methodology for a randomized controlled trial (RCT) to determine whether eWMT, by improving attentional control prior to internet-based CBT (iCBT), results in better CBT outcomes. The RCT would be considered feasible if the pilot study achieved rates ≥80% for eligible participants recruited, study measures completion, intervention completion, and participant retention. Results from 10 randomized participants showed rates ≥80% for recruitment of eligible participants and iCBT intervention completion. Completion of study measures, eWMT and Placebo training interventions, and participant retention were <80%. Results highlight the need to consider strategies to improve the methodology prior to the RCT.

In social cognitive theory, belief in the ability to manage emotions renders these emotions less aversive. Reduced emotional reactions to stress and greater self-regulation have been linked to lower neuroticism. The purpose of this study was to ascertain whether self-efficacy for regulation of distress/despondency (SEDes) and anger (SEAng) and self-efficacy for experiencing and expressing positive emotions (SEPos) predicted lower subsequent neuroticism. A second purpose was to determine whether these forms of self-efficacy buffered the relationship between perceived stress and subsequent neuroticism. Among 251 university students in the United States, perceived stress predicted 8% of the variance, and SEAng negatively predicted 2% of the variance, in time 2 neuroticism over 3-4 weeks. Contrary to hypotheses, high SEDes and SEPos did not protect against higher time 2 neuroticism when stress was high, but low levels of these forms of self-efficacy were risk factors for modestly higher time 2 neuroticism when stress was low.

Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experiences. Accordingly, the present study aimed to examine the effect of ACT+ERP on appraisals of intrusive thoughts, relative to standard ERP. Forty-eight adults who received 16 treatment sessions as part of a randomized controlled trial comparing standard ERP to ACT+ERP completed the Interpretation of Intrusions Inventory (III) at pre-treatment, post-treatment, and follow-up. Results showed a significant main effect of time for all III subscales, suggesting that appraisals of intrusive thoughts shift over the course of treatment. The effect of the condition × time interaction, however, differed between the III subscales. Specifically, a significant interaction emerged for the control of thoughts subscale, such that individuals who received ACT+ERP experienced greater reductions in beliefs about the need to control thoughts. The interaction term was not significant for importance of thoughts or responsibility subscales. Findings suggest that augmenting ERP with ACT enhances change in beliefs about the need to control thoughts, but not in beliefs about responsibility and the importance of thoughts. Clinical implications and future research directions will be discussed.

A mental health treatment gap exists in which individuals who would benefit from evidence-based psychotherapies (EBPs) do not receive them. It is critical to take effective actions so that individuals with unmet mental health needs feel empowered to seek treatment. Direct-to-consumer (DTC) marketing meets this objective. DTC marketing is an effective, patient-centered approach that creates patient demand for a product or service by influencing patient behaviors, attitudes, and preferences. While primarily used in the United States and New Zealand to promote prescription drugs, uses and practices for DTC marketing with nonpharmaceutical EBPs are less established. This article highlights the value of leveraging this marketing approach to increase awareness and use of EBPs. Additionally, an illustrative example is presented that describes the use of social marketing and marketing mix principles to develop effective DTC marketing campaigns in psychotherapy practice.

The metacognitive model of generalized anxiety disorder (GAD) considers Type II worry, which represents one's tendency to negatively appraise worry, as a defining feature of GAD, and negative metacognitive beliefs are central to eliciting Type II worry during worry episodes. Extant research has found that individuals experiencing GAD report elevated Type II worry, and that negative metacognitive beliefs correlate with Type II worry. However, because of how Type II worry was assessed in existing studies, it remains unclear if negative metacognitive beliefs relate to state Type II worry specifically during a worry episode. This study sought to fill that gap in the existing literature among a sample of individuals experiencing elevated GAD symptom severity ( = 106). Participants completed an assessment of GAD symptom severity and metacognitive beliefs, while later attending an in-person study session where they completed a worry induction and state Type II worry, as conceptualized as the strength of negative appraisals of worry, which was then assessed. Metacognitive beliefs generally positively correlated with state Type II worry, with negative metacognitive beliefs being the only metacognitive belief domain that correlated with state Type II worry in multivariate analyses. Implications for how these results support the metacognitive model of GAD and treatment implications are discussed.