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  Subjects -> PSYCHOLOGY (Total: 875 journals)
Showing 1 - 174 of 174 Journals sorted alphabetically
Acción Psicológica     Open Access   (Followers: 2)
Acta Colombiana de Psicología     Open Access   (Followers: 4)
Acta Comportamentalia     Open Access   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Psychologica     Hybrid Journal   (Followers: 22)
Activités     Open Access   (Followers: 1)
Actualidades en Psicologia     Open Access   (Followers: 1)
Ad verba Liberorum : Journal of Linguistics & Pedagogy & Psychology     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 5)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 20)
ADHD Report The     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 39)
Advances in Mental Health     Hybrid Journal   (Followers: 69)
Advances in Physiotherapy     Hybrid Journal   (Followers: 50)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29)
African Journal of Cross-Cultural Psychology and Sport Facilitation     Full-text available via subscription   (Followers: 3)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 391)
Aggressive Behavior     Hybrid Journal   (Followers: 15)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 33)
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3)
Aletheia     Open Access   (Followers: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 15)
American Imago     Full-text available via subscription   (Followers: 3)
American Journal of Applied Psychology     Open Access   (Followers: 34)
American Journal of Community Psychology     Hybrid Journal   (Followers: 24)
American Journal of Health Behavior     Full-text available via subscription   (Followers: 23)
American Journal of Orthopsychiatry     Hybrid Journal   (Followers: 4)
American Journal of Psychoanalysis     Hybrid Journal   (Followers: 21)
American Journal of Psychotherapy     Full-text available via subscription   (Followers: 34)
American Psychologist     Full-text available via subscription   (Followers: 163)
Anales de Psicología     Open Access   (Followers: 2)
Análise Psicológica     Open Access   (Followers: 1)
Análisis y Modificación de Conducta     Open Access   (Followers: 2)
Analysis     Full-text available via subscription   (Followers: 4)
Annual Review of Clinical Psychology     Full-text available via subscription   (Followers: 66)
Annual Review of Organizational Psychology and Organizational Behavior     Full-text available via subscription   (Followers: 26)
Annual Review of Psychology     Full-text available via subscription   (Followers: 203)
Anuario de Psicología / The UB Journal of Psychology     Open Access   (Followers: 1)
Anuario de Psicología Jurídica     Open Access   (Followers: 1)
Anxiety, Stress & Coping: An International Journal     Hybrid Journal   (Followers: 22)
Applied and Preventive Psychology     Hybrid Journal   (Followers: 13)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 66)
Applied Neuropsychology : Adult     Hybrid Journal   (Followers: 32)
Applied Neuropsychology : Child     Hybrid Journal   (Followers: 18)
Applied Psychological Measurement     Hybrid Journal   (Followers: 17)
Applied Psychology     Hybrid Journal   (Followers: 128)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 47)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 6)
Archive for the Psychology of Religion / Archiv für Religionspychologie     Hybrid Journal   (Followers: 16)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26)
Archives of Scientific Psychology     Open Access   (Followers: 3)
Arquivos Brasileiros de Psicologia     Open Access   (Followers: 1)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3)
Asian American Journal of Psychology     Full-text available via subscription   (Followers: 5)
Asian Journal of Business Ethics     Hybrid Journal   (Followers: 7)
Assessment     Hybrid Journal   (Followers: 9)
At-Tajdid : Jurnal Ilmu Tarbiyah     Open Access   (Followers: 2)
Attachment: New Directions in Psychotherapy and Relational Psychoanalysis     Full-text available via subscription   (Followers: 16)
Attention, Perception & Psychophysics     Full-text available via subscription   (Followers: 10)
Australian and Aotearoa New Zealand Psychodrama Association Journal     Full-text available via subscription  
Australian Educational and Developmental Psychologist, The     Full-text available via subscription   (Followers: 6)
Australian Journal of Psychology     Hybrid Journal   (Followers: 16)
Australian Psychologist     Hybrid Journal   (Followers: 11)
Autism Research     Hybrid Journal   (Followers: 31)
Autism Research and Treatment     Open Access   (Followers: 29)
Autism's Own     Open Access  
Autism-Open Access     Open Access   (Followers: 5)
Avaliação Psicológica     Open Access  
Avances en Psicologia Latinoamericana     Open Access   (Followers: 1)
Aviation Psychology and Applied Human Factors     Hybrid Journal   (Followers: 18)
Balint Journal     Hybrid Journal   (Followers: 3)
Barbaroi     Open Access  
Basic and Applied Social Psychology     Hybrid Journal   (Followers: 32)
Behavior Analysis in Practice     Full-text available via subscription   (Followers: 6)
Behavior Analysis: Research and Practice     Full-text available via subscription   (Followers: 2)
Behavior Analyst     Hybrid Journal   (Followers: 2)
Behavior Modification     Hybrid Journal   (Followers: 9)
Behavior Research Methods     Hybrid Journal   (Followers: 17)
Behavior Therapy     Hybrid Journal   (Followers: 45)
Behavioral Development Bulletin     Full-text available via subscription  
Behavioral Interventions     Hybrid Journal   (Followers: 7)
Behavioral Neuroscience     Full-text available via subscription   (Followers: 50)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 21)
Behavioral Sleep Medicine     Hybrid Journal   (Followers: 6)
Behaviour     Hybrid Journal   (Followers: 12)
Behaviour Research and Therapy     Hybrid Journal   (Followers: 17)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 115)
Behavioural Processes     Hybrid Journal   (Followers: 6)
Biofeedback     Hybrid Journal   (Followers: 4)
BioPsychoSocial Medicine     Open Access   (Followers: 6)
BMC Psychology     Open Access   (Followers: 15)
Body, Movement and Dance in Psychotherapy: An International Journal for Theory, Research and Practice     Hybrid Journal   (Followers: 9)
Boletim Academia Paulista de Psicologia     Open Access  
Boletim de Psicologia     Open Access  
Brain Informatics     Open Access   (Followers: 1)
British Journal of Clinical Psychology     Full-text available via subscription   (Followers: 125)
British Journal of Developmental Psychology     Full-text available via subscription   (Followers: 35)
British Journal of Educational Psychology     Hybrid Journal   (Followers: 32)
British Journal of Health Psychology     Full-text available via subscription   (Followers: 42)
British Journal of Mathematical and Statistical Psychology     Full-text available via subscription   (Followers: 20)
British Journal of Psychology     Full-text available via subscription   (Followers: 58)
British Journal of Psychotherapy     Hybrid Journal   (Followers: 66)
British Journal of Social Psychology     Full-text available via subscription   (Followers: 32)
Burnout Research     Open Access   (Followers: 7)
Cadernos de psicanálise (Rio de Janeiro)     Open Access  
Cadernos de Psicologia Social do Trabalho     Open Access  
Canadian Art Therapy Association     Hybrid Journal  
Canadian Journal of Behavioural Science     Full-text available via subscription   (Followers: 5)
Canadian Journal of Experimental Psychology     Full-text available via subscription   (Followers: 11)
Canadian Psychology / Psychologie canadienne     Full-text available via subscription   (Followers: 11)
Cendekia : Jurnal Kependidikan dan Kemasyarakatan     Open Access  
Child Development Perspectives     Hybrid Journal   (Followers: 26)
Child Development Research     Open Access   (Followers: 14)
Ciencia Cognitiva     Open Access   (Followers: 2)
Ciencia e Interculturalidad     Open Access  
Ciências & Cognição     Open Access  
Ciencias Psicológicas     Open Access  
Clínica y Salud     Open Access  
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Practice in Pediatric Psychology     Full-text available via subscription   (Followers: 10)
Clinical Psychological Science     Hybrid Journal   (Followers: 11)
Clinical Psychologist     Hybrid Journal   (Followers: 15)
Clinical Psychology & Psychotherapy     Hybrid Journal   (Followers: 67)
Clinical Psychology and Special Education     Open Access   (Followers: 1)
Clinical Psychology Review     Hybrid Journal   (Followers: 33)
Clinical Psychology: Science and Practice     Hybrid Journal   (Followers: 20)
Clinical Schizophrenia & Related Psychoses     Full-text available via subscription   (Followers: 8)
Coaching Psykologi - The Danish Journal of Coaching Psychology     Open Access   (Followers: 1)
Cogent Psychology     Open Access  
Cógito     Open Access  
Cognition & Emotion     Hybrid Journal   (Followers: 35)
Cognitive Behaviour Therapy     Hybrid Journal   (Followers: 14)
Cognitive Neuropsychology     Hybrid Journal   (Followers: 27)
Cognitive Psychology     Hybrid Journal   (Followers: 60)
Cognitive Research : Principles and Implications     Open Access  
Consciousness and Cognition     Hybrid Journal   (Followers: 26)
Construção Psicopedagógica     Open Access  
Consulting Psychology Journal : Practice and Research     Full-text available via subscription   (Followers: 3)
Contagion : Journal of Violence, Mimesis, and Culture     Full-text available via subscription   (Followers: 8)
Contemporary Educational Psychology     Hybrid Journal   (Followers: 21)
Contemporary School Psychology     Hybrid Journal   (Followers: 4)
Contextos Clínicos     Open Access  
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 10)
Counseling Psychologist     Hybrid Journal   (Followers: 14)
Counseling Psychology and Psychotherapy     Open Access   (Followers: 7)
Counselling and Psychotherapy Research : Linking research with practice     Hybrid Journal   (Followers: 20)
Counselling and Values     Hybrid Journal   (Followers: 2)
Counselling Psychology Quarterly     Hybrid Journal   (Followers: 10)
Couple and Family Psychoanalysis     Full-text available via subscription   (Followers: 1)
Couple and Family Psychology : Research and Practice     Full-text available via subscription   (Followers: 4)
Creativity Research Journal     Hybrid Journal   (Followers: 20)
Creativity. Theories - Research - Applications     Open Access   (Followers: 1)
Criminal Justice Ethics     Hybrid Journal   (Followers: 8)
Cuadernos de Neuropsicología     Open Access   (Followers: 1)
Cuadernos de Psicologia del Deporte     Open Access  
Cuadernos de Psicopedagogía     Open Access  
Cultural Diversity and Ethnic Minority Psychology     Full-text available via subscription   (Followers: 12)
Cultural-Historical Psychology     Open Access  
Culturas Psi     Open Access  
Culture and Brain     Hybrid Journal   (Followers: 4)
Current Addiction Reports     Hybrid Journal   (Followers: 9)
Current Behavioral Neuroscience Reports     Hybrid Journal   (Followers: 2)
Current Directions In Psychological Science     Hybrid Journal   (Followers: 47)
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Current Opinion in Psychology     Hybrid Journal   (Followers: 4)
Current Psychological Research     Hybrid Journal   (Followers: 14)
Current Psychology     Hybrid Journal   (Followers: 15)
Current psychology letters     Open Access   (Followers: 2)
Current Research in Psychology     Open Access   (Followers: 21)
Cyberpsychology, Behavior, and Social Networking     Hybrid Journal   (Followers: 14)
Decision     Full-text available via subscription   (Followers: 2)
Depression and Anxiety     Hybrid Journal   (Followers: 14)
Depression Research and Treatment     Open Access   (Followers: 13)
Developmental Cognitive Neuroscience     Open Access   (Followers: 16)
Developmental Neuropsychology     Hybrid Journal   (Followers: 15)
Developmental Psychobiology     Hybrid Journal   (Followers: 9)
Developmental Psychology     Full-text available via subscription   (Followers: 44)
Diagnostica     Hybrid Journal   (Followers: 2)
Dialectica     Hybrid Journal   (Followers: 1)
Discourse     Full-text available via subscription   (Followers: 8)
Diversitas: Perspectivas en Psicologia     Open Access  
Drama Therapy Review     Hybrid Journal   (Followers: 1)
Dreaming     Full-text available via subscription   (Followers: 11)
Drogues, santé et société     Full-text available via subscription  
Dynamics of Asymmetric Conflict: Pathways toward terrorism and genocide     Hybrid Journal   (Followers: 12)
E-Journal of Applied Psychology     Open Access   (Followers: 7)
Ecopsychology     Hybrid Journal   (Followers: 6)
ECOS - Estudos Contemporâneos da Subjetividade     Open Access  
Educational Psychology Review     Hybrid Journal   (Followers: 25)
Educational Psychology: An International Journal of Experimental Educational Psychology     Hybrid Journal   (Followers: 46)
Educazione sentimentale     Full-text available via subscription  
Electronic Journal of Research in Educational Psychology     Open Access   (Followers: 6)
Elpis - Czasopismo Teologiczne Katedry Teologii Prawosławnej Uniwersytetu w Białymstoku     Open Access  
Emotion     Full-text available via subscription   (Followers: 32)
Emotion Review     Hybrid Journal   (Followers: 17)
En-Claves del pensamiento     Open Access   (Followers: 1)
Enseñanza e Investigacion en Psicologia     Open Access  
Epiphany     Open Access   (Followers: 3)

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Journal Cover Behavior Therapy
  [SJR: 1.929]   [H-I: 80]   [45 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0005-7894
   Published by Elsevier Homepage  [3031 journals]
  • Anticipatory Processing, Maladaptive Attentional Focus, and Postevent
           Processing for Interactional and Performance Situations: Treatment
           Response and Relationships With Symptom Change for Individuals With Social
           Anxiety Disorder
    • Authors: Quincy J.J. Wong; Bree Gregory; Lauren F. McLellan; Maria Kangas; Maree J. Abbott; Leigh Carpenter; Peter M. McEvoy; Lorna Peters; Ronald M. Rapee
      Pages: 651 - 663
      Abstract: Publication date: September 2017
      Source:Behavior Therapy, Volume 48, Issue 5
      Author(s): Quincy J.J. Wong, Bree Gregory, Lauren F. McLellan, Maria Kangas, Maree J. Abbott, Leigh Carpenter, Peter M. McEvoy, Lorna Peters, Ronald M. Rapee
      Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2017.03.004
  • Gender Difference in Attentional Bias Toward Negative and Positive Stimuli
           in Generalized Anxiety Disorder
    • Authors: Kerry L. Kinney; Joseph W. Boffa; Nader Amir
      Pages: 277 - 284
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Kerry L. Kinney, Joseph W. Boffa, Nader Amir
      Females are two times as likely as males to develop generalized anxiety disorder (GAD; Steiner et al., 2005; Vesga-López et al., 2008). Moreover, the clinical presentation of GAD is different across genders. One explanation for these differences may be the role of cognitive biases involved in GAD between genders. In the present study, we used an exogenous spatial cueing task to examine gender differences in attentional bias for negative and positive information in 118 individuals with a primary diagnosis of GAD. Males and females did not differ in their attentional bias for idiographically selected negative or neutral words. However, women showed a significantly larger attentional bias for positive words than did men. Results suggest that developing gender-specific treatments for GAD could improve treatment response rates.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.06.002
  • The Role of Social Support in Cognitive-Behavioral Conjoint Therapy for
           Posttraumatic Stress Disorder
    • Authors: Philippe Shnaider; Iris Sijercic; Sonya G. Wanklyn; Michael K. Suvak; Candice M. Monson
      Pages: 285 - 294
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Philippe Shnaider, Iris Sijercic, Sonya G. Wanklyn, Michael K. Suvak, Candice M. Monson
      The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.05.003
  • Aggression Protects Against the Onset of Major Depressive Episodes in
           Individuals With Bipolar Spectrum Disorder
    • Authors: Tommy H. Ng; Rachel D. Freed; Madison K. Titone; Jonathan P. Stange; Rachel B. Weiss; Lyn Y. Abramson; Lauren B. Alloy
      Pages: 311 - 321
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Tommy H. Ng, Rachel D. Freed, Madison K. Titone, Jonathan P. Stange, Rachel B. Weiss, Lyn Y. Abramson, Lauren B. Alloy
      A growing body of research suggests that bipolar spectrum disorders (BSDs) are associated with high aggression. However, little research has prospectively examined how aggression may affect time to onset of hypomanic/manic versus major depressive episodes. In a longitudinal study, we tested the hypothesis that aggression would prospectively predict a shorter time to the onset of hypomanic/manic episodes and a longer time to the onset of major depressive episodes, based on the behavioral approach system theory of BSDs. Young adults (N = 120) diagnosed with cyclothymia, bipolar II disorder, or bipolar disorder not otherwise specified were followed every 4 months for an average of 3.55 years. Participants completed measures of depressive and manic symptoms, family history of mood disorder, impulsivity, and aggression at baseline and were followed prospectively with semistructured diagnostic interview assessments of hypomanic/manic and major depressive episodes and treatment seeking for mood problems. Cox proportional hazard regression analyses indicated that overall, physical, and verbal aggression predicted a longer time to major depressive episode onset, even after controlling for baseline depressive and manic symptoms, family history of mood disorder, treatment seeking for mood problems, and impulsivity. Aggression, however, did not significantly predict time to onset of hypomanic/manic episodes, controlling for the same covariates. The findings suggest that approach-related behaviors may be utilized to delay the onset of major depressive episodes among people with BSDs.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.08.005
  • Daily Stress, Coping, and Negative and Positive Affect in Depression:
           Complex Trigger and Maintenance Patterns
    • Authors: David M. Dunkley; Maxim Lewkowski; Ihno A. Lee; Kristopher J. Preacher; David C. Zuroff; Jody-Lynn Berg; J. Elizabeth Foley; Gail Myhr; Ruta Westreich
      Pages: 349 - 365
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): David M. Dunkley, Maxim Lewkowski, Ihno A. Lee, Kristopher J. Preacher, David C. Zuroff, Jody-Lynn Berg, J. Elizabeth Foley, Gail Myhr, Ruta Westreich
      Major depressive disorder is characterized by emotional dysfunction, but mood states in daily life are not well understood. This study examined complex explanatory models of daily stress and coping mechanisms that trigger and maintain daily negative affect and (lower) positive affect in depression. Sixty-three depressed patients completed perfectionism measures, and then completed daily questionnaires of stress appraisals, coping, and affect for 7 consecutive days. Multilevel structural equation modeling (MSEM) demonstrated that, across many stressors, when the typical individual with depression perceives more criticism than usual, he/she uses more avoidant coping and experiences higher event stress than usual, and this is connected to daily increases in negative affect as well as decreases in positive affect. In parallel, results showed that perceived control, less avoidant coping, and problem-focused coping commonly operate together when daily positive affect increases. MSEM also showed that avoidant coping tendencies and ongoing stress, in combination, explain why people with depression and higher self-critical perfectionism maintain daily negative affect and lower positive affect. These findings advance a richer and more detailed understanding of specific stress and coping patterns to target in order to more effectively accomplish the two predominant therapy goals of decreasing patients’ distress and strengthening resilience.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.06.001
  • Characterizing Interpersonal Difficulties Among Young Adults Who Engage in
           Nonsuicidal Self-Injury Using a Daily Diary
    • Authors: Brianna J. Turner; Matthew A. Wakefield; Kim L. Gratz; Alexander L. Chapman
      Pages: 366 - 379
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Brianna J. Turner, Matthew A. Wakefield, Kim L. Gratz, Alexander L. Chapman
      Compared to people who have never engaged in nonsuicidal self-injury (NSSI), people with a history of NSSI report multiple interpersonal problems. Theories propose that these interpersonal difficulties play a role in prompting and maintaining NSSI. The cross-sectional nature of most studies in this area limits our understanding of how day-to-day interpersonal experiences relate to the global interpersonal impairments observed among individuals with NSSI, and vice versa. This study compared young adults with (n =60) and without (n =56) recent, repeated NSSI on baseline and daily measures of interpersonal functioning during a 14-day daily diary study. Groups differed in baseline social anxiety, excessive reassurance seeking, and use of support seeking relative to other coping strategies, but did not differ in self-perceived interpersonal competence. In terms of day-to-day functioning, participants with (vs. without) NSSI had significantly less contact with their families and friends, perceived less support following interactions with friends, and were less likely to seek support to cope, regardless of level of negative affect. With the exception of contact with family members, these group differences in daily interpersonal functioning were accounted for by baseline levels of social anxiety and use of support seeking. Contrary to expectations, participants with NSSI had more frequent contact with their romantic partners, did not differ in perceptions of support in romantic relationships, and did not report more intense negative affect following negative interpersonal interactions. This study provides a novel test of recent interpersonal theories of NSSI using daily reports.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.07.001
  • Perfectionism and Contingent Self-Worth in Relation to Disordered Eating
           and Anxiety
    • Authors: Anna M. Bardone-Cone; Stacy L. Lin; Rachel M. Butler
      Pages: 380 - 390
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Anna M. Bardone-Cone, Stacy L. Lin, Rachel M. Butler
      Perfectionism has been proposed as a transdiagnostic risk factor linked to eating disorders and anxiety. In the current study, we examine domains of contingent self-worth as potential moderators of the relationships between maladaptive perfectionism and disordered eating and anxiety using two waves of data collection. Undergraduate females (N = 237) completed online surveys of the study’s core constructs at two points separated by about 14 months. At a bivariate level, maladaptive perfectionism was positively associated with disordered eating and anxiety. Maladaptive perfectionism and both appearance and relationship contingent self-worth interacted to predict increases in disordered eating. Neither of the interactive models predicted change in anxiety. Findings highlight maladaptive perfectionism as a transdiagnostic construct related to both disordered eating and anxiety. Interactive findings suggest that targeting maladaptive perfectionism and contingent self-worth (appearance, relationship) in prevention and treatment efforts could mitigate risk for the development or increase of disordered eating.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.05.006
  • Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial
    • Authors: Erik Andersson; Erik Hedman; Olle Wadström; Julia Boberg; Emil Yaroslav Andersson; Erland Axelsson; Johan Bjureberg; Timo Hursti; Brjánn Ljótsson
      Pages: 391 - 402
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Erik Andersson, Erik Hedman, Olle Wadström, Julia Boberg, Emil Yaroslav Andersson, Erland Axelsson, Johan Bjureberg, Timo Hursti, Brjánn Ljótsson
      Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure-based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers (defined as > 56 on the Penn State Worry Questionnaire [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d = 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.07.003
  • Randomized Controlled Trial of a Computerized Interactive Media-Based
           Problem Solving Treatment for Depression
    • Authors: Luis R. Sandoval; Jay C. Buckey; Ricardo Ainslie; Martin Tombari; William Stone; Mark T. Hegel
      Pages: 413 - 425
      Abstract: Publication date: May 2017
      Source:Behavior Therapy, Volume 48, Issue 3
      Author(s): Luis R. Sandoval, Jay C. Buckey, Ricardo Ainslie, Martin Tombari, William Stone, Mark T. Hegel
      This study evaluated the efficacy of an interactive media-based, computer-delivered depression treatment program (imbPST) compared to a no-treatment control condition (NTC) in a parallel-group, randomized, controlled trial conducted in an outpatient psychiatric research clinic. 45 adult participants with major depressive disorder or dysthymia were randomized to receive either 6 weekly sessions of imbPST or no treatment (No Treatment Control; NTC). The primary outcome measure was the Beck Depression Inventory II (BDI-II). There was a significant Group x Time interaction effect [F (1.73, 43)= 58.78; p<.001; η2=.58, Cohens d=1.94], such that the patients receiving imbPST had a significantly greater reduction in depressive symptoms compared to the patients in the NTC condition. Participants in the imbPST group improved their depression symptoms significantly from moderate (BDI-II=21.9±4.20) to mild levels of depression (BDI-II=17.9±4.0) after receiving 3 weekly sessions of imbPST (p<0.001), and progressed to still milder levels of depression after six weekly sessions (BDI-II=14.5±3.7, p<0.001). NTC participants showed no significant reduction in BDI-II scores (BDI-II=21.8±4.2 pre, BDI-II=21.5±5.2 post, N.S.). Additionally, 40% of the imbPST group showed a clinically significant and reliable change in depression levels while none of the NTC group met this criterion. imbPST participants rated the program highly usable on the system usability scale (SUS) after the first session (SUS Session 1=74.6±7.2) and usability scores increased significantly by the last session (SUS Session 6=85.4±5.6). We conclude that imbPST is an effective, engaging, and easily used depression treatment program that warrants further evaluation with heterogeneous depressed populations in a stand-alone, self-administered fashion.
      Graphical abstract image

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2016.04.001
  • Treating PTSD: Innovations and Understanding Processes of Change
    • Authors: Reginald D.V. Nixon; Denise M. Sloan
      Pages: 143 - 146
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Reginald D.V. Nixon, Denise M. Sloan

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.06.003
  • Investigating Relationships Between PTSD Symptom Clusters Within Virtual
           Reality Exposure Therapy for OEF/OIF Veterans
    • Authors: Jessica L. Maples-Keller; Matthew Price; Sheila Rauch; Maryrose Gerardi; Barbara O. Rothbaum
      Pages: 147 - 155
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Jessica L. Maples-Keller, Matthew Price, Sheila Rauch, Maryrose Gerardi, Barbara O. Rothbaum
      Several cognitive behavioral therapeutic approaches have been demonstrated to be effective in reducing post-traumatic stress disorder (PTSD) symptoms (Foa, Keane, Friedman, & Cohen, 2008). The bulk of PTSD treatment research has relied on pre-post designs, which are limited in their ability to investigate the therapeutic process over time. The present study investigated the relations between PTSD symptom clusters using symptom assessment at pretreatment, midtreatment, and posttreatment using cross-lagged panel design over the course of Virtual Reality Exposure (VRE) treatment. Participants were 156 Iraq and/or Afghanistan veterans who met DSM-IV criteria for PTSD due to military trauma. Using structural equation modeling, the final reexperiencing model demonstrated good fit, χ2(34)=39.95, p =.22; RMSEA=.034, 90% CI: [0.00, 0.07], CFI=.993, and results suggested that reexperiencing at pretreatment demonstrated a significant effect on numbing, avoidance, hyperarousal at midtreatment, and reexperiencing symptoms at midtreatment demonstrate a significant effect on each of the three symptom clusters at posttreatment. These findings suggest that reexperiencing symptoms are indeed a key aspect of the therapeutic process within exposure therapy for PTSD. Additional research examining the impact of reexperiencing-focused intervention strategies on treatment outcomes is warranted.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.02.011
  • Temporal Sequencing of Change in Posttraumatic Cognitions and PTSD Symptom
           Reduction During Prolonged Exposure Therapy
    • Authors: Mandy J. Kumpula; Kimberly Z. Pentel; Edna B. Foa; Nicole J. LeBlanc; Eric Bui; Lauren B. McSweeney; Kelly Knowles; Hannah Bosley; Naomi M. Simon; Sheila A.M. Rauch
      Pages: 156 - 165
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Mandy J. Kumpula, Kimberly Z. Pentel, Edna B. Foa, Nicole J. LeBlanc, Eric Bui, Lauren B. McSweeney, Kelly Knowles, Hannah Bosley, Naomi M. Simon, Sheila A.M. Rauch
      Prolonged exposure (PE) effectively reduces negative cognitions about self, world, and self-blame associated with posttraumatic stress disorder (PTSD), with changes in posttraumatic cognitions being associated with reductions in PTSD symptoms (Foa & Rauch, 2004). Further, recent research has demonstrated that cognitive change is a likely mechanism for PTSD symptom reduction in PE (Zalta et al., 2014). The present study examines temporal sequencing of change in three domains of posttraumatic cognitions (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms during the course of PE. Adult outpatients meeting diagnostic criteria for PTSD were recruited at 4 sites. Participants (N =46) received 8 sessions of PE over 4 to 6weeks. PTSD symptoms and posttraumatic cognitions were assessed at pretreatment and Sessions 2, 4, 6, and 8. PTSD symptom severity and negative cognitions about the self and the world each decreased significantly from pre- to posttreatment, while self-blame cognitions were unchanged. Examination of temporal sequencing of changes during the course of PE via time-lagged mixed effects regression modeling revealed that preceding levels of negative cognitions about the world drove successive severity levels of PTSD symptoms, whereas preceding PTSD symptom severity did not drive subsequent negative cognitions about the world. Reductions in negative cognitions about the self led to subsequent improvement in PTSD. Improvement in PTSD symptoms in prior sessions was related to later reduction in negative cognitions about the self, though the impact of negative cognitions in influencing subsequent symptom change demonstrated a stronger effect. Results support that reductions in negative cognitions about the self and world are mechanisms of change in PE, which may have valuable implications for maximizing treatment effectiveness.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.02.008
  • Constructive and Unproductive Processing of Traumatic Experiences in
           Trauma-Focused Cognitive-Behavioral Therapy for Youth
    • Authors: Adele M. Hayes; Carly Yasinski; Damion Grasso; C. Beth Ready; Elizabeth Alpert; Thomas McCauley; Charles Webb; Esther Deblinger
      Pages: 166 - 181
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Adele M. Hayes, Carly Yasinski, Damion Grasso, C. Beth Ready, Elizabeth Alpert, Thomas McCauley, Charles Webb, Esther Deblinger
      Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the constructive processing of feared experiences, and strengthening new inhibitory learning. We examined variables thought to be associated with unproductive and constructive processing of traumatic experiences in a sample of 81 youth with elevated PTSD symptoms, who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for abuse or traumatic interpersonal loss. Sessions during the trauma narrative phase of TF-CBT were coded for indicators of unproductive processing (overgeneralization, rumination, avoidance) and constructive processing (decentering, accommodation of corrective information), as well as levels of negative emotion. In previous analyses of this trial (Ready et al., 2015), more overgeneralization during the narrative phase predicted less improvement in internalizing symptoms at posttreatment and a worsening of externalizing symptoms over the 12-month follow-up. In contrast, more accommodation predicted improvement in internalizing symptoms and also moderated the negative effects of overgeneralization on internalizing and externalizing symptoms. The current study examined correlates of overgeneralization and accommodation. Overgeneralization was associated with more rumination, less decentering, and more negative emotion, suggesting immersion in trauma-related material. Accommodation was associated with less avoidance and more decentering, suggesting a healthy distance from trauma-related material that might allow for processing and cognitive change. Decentering also predicted improvement in externalizing symptoms at posttreatment. Rumination and avoidance showed important associations with overgeneralization and accommodation, respectively, but did not predict treatment outcomes. This study identifies correlates of overgeneralization and accommodation that might shed light on how these variables relate to unproductive and constructive processing of traumatic experiences.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.06.004
  • Homework “Dose,” Type, and Helpfulness as Predictors of Clinical
           Outcomes in Prolonged Exposure for PTSD
    • Authors: Andrew A. Cooper; Alexander C. Kline; Belinda Graham; Michele Bedard-Gilligan; Patricia G. Mello; Norah C. Feeny; Lori A. Zoellner
      Pages: 182 - 194
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Andrew A. Cooper, Alexander C. Kline, Belinda Graham, Michele Bedard-Gilligan, Patricia G. Mello, Norah C. Feeny, Lori A. Zoellner
      Homework is often viewed as central to prolonged exposure (PE) for posttraumatic stress disorder (PTSD), but its relationship with treatment outcome is not well understood. We evaluated homework type, dose, and patients’ perceptions of helpfulness as predictors of symptom change and posttreatment outcomes in PE. Patients with chronic PTSD received PE in a randomized clinical trial. Independent evaluators assessed PTSD severity at pre- and posttreatment. Patients reported homework adherence and perceived helpfulness at the beginning of each session, separately for in vivo and imaginal exposure assignments. These variables were examined as predictors of change in PTSD symptoms, PTSD remission, and good end-state functioning (GESF; low PTSD, depression, and anxiety) at posttreatment. Higher imaginal homework adherence predicted greater symptom improvement between sessions and across treatment, as well as twice the odds of achieving remission and GESF. Patients who were at least moderately adherent to imaginal homework assignments (two or more times a week) reported more symptom gains than those who were least adherent but did not differ from those who were most adherent. In vivo adherence was not consistently associated with better outcome, perhaps due to heterogeneity in form and function of weekly assignments. Higher ratings of helpfulness of both types of homework predicted greater symptom improvement from pre- to posttreatment and between sessions. Overall, imaginal exposure homework may complement in-session exposures by enhancing key change processes, though perfect adherence is not necessary. Patients’ perceptions of helpfulness may reflect buy-in or perceived match between homework completion and functional impairment. Clinically, in addition to targeting adherence to homework assignments, querying about perceived helpfulness and adjusting assignments appropriately may help augment clinical gains.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.02.013
  • Fidelity to the Cognitive Processing Therapy Protocol: Evaluation of
           Critical Elements
    • Authors: Courtney C. Farmer; Karen S. Mitchell; Kelly Parker-Guilbert; Tara E. Galovski
      Pages: 195 - 206
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Courtney C. Farmer, Karen S. Mitchell, Kelly Parker-Guilbert, Tara E. Galovski
      The contributions of individual therapy elements to the overall efficacy of evidence-based practices for the treatment of posttraumatic stress disorder (PTSD) are not well-understood. This study first examined the extent to which theoretically important treatment components of Cognitive Processing Therapy (CPT; i.e., skill in Socratic questioning; prioritizing assimilation; attention to practice assignments; emphasis on expression of natural affect) were successfully administered across the course of therapy for 68 PTSD-positive survivors of interpersonal trauma. Therapist fidelity in the administration of these four elements was evaluated in 533 taped CPT sessions of study participants included in one of two randomized controlled CPT treatment trials. Second, we examined therapist fidelity to these components as a predictor of session-to-session PTSD and depression symptom change. Third, follow-up analyses examined the influence of high therapist competence for these four components across an entire course of therapy on symptom change from pre- to posttreatment. Results showed consistently high adherence and more variable competence for these four treatment components. There were no significant effects of therapist fidelity on session-to-session symptom change. However, results showed that overall high therapist competence for “skill in Socratic questioning” and “prioritizing assimilation before overaccommodation” were related to greater client improvement in PTSD severity, but “attention to practice assignments” and “emphasis on expression of natural affect” were not. Overall competence ratings for the four components were not significantly associated with improvement in depressive symptoms. Findings contribute to increased understanding of the relationship between the key treatment components of CPT and symptom change.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.02.009
  • A Daily Diary Study of Posttraumatic Stress Symptoms and Romantic Partner
    • Authors: Sarah B. Campbell; Keith D. Renshaw; Todd B. Kashdan; Timothy W. Curby; Sarah P. Carter
      Pages: 222 - 234
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Sarah B. Campbell, Keith D. Renshaw, Todd B. Kashdan, Timothy W. Curby, Sarah P. Carter
      Little is known about the role of romantic partner symptom accommodation in PTSD symptom maintenance. To explore the bidirectional associations of posttraumatic stress disorder (PTSD) symptoms and romantic partner symptom accommodation over time, military servicemen (n =64) with symptoms of PTSD and their cohabiting heterosexual civilian romantic partners (n =64) completed a 2-week daily diary study. Cross-lagged, autoregressive models assessed the stability of men’s PTSD symptoms and partners’ accommodation, as well as the prospective associations of earlier PTSD symptoms with later accommodation and vice versa. Analyses used Bayesian estimation to provide point estimates (b) and Credible Intervals (CIs). In all models, PTSD symptoms (total and individual clusters) were highly stable (b =0.91; CI: 0.88-0.95), and accommodation was moderately stable (b =0.48; CI: 0.40-0.54). In all models, earlier PTSD symptoms (total and clusters) were significantly, positively associated with later accommodation (b =0.04; CI: 0.02-0.07). In contrast, earlier accommodation was significantly associated only with later situational avoidance (b =0.02; CI: 0.00-0.07). Thus, PTSD symptoms may lead to subsequent accommodating behaviors in romantic partners, but partner accommodation seems to contribute only to survivors’ future situational avoidance symptoms. The findings reinforce the notion that PTSD symptoms have an impact on relationship behaviors, and that accommodation from partners may sustain avoidant behaviors in particular. Clinicians should attend to romantic partners’ accommodating behaviors when working with survivors.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.04.006
  • Longitudinal Associations Between PTSD Symptoms and Dyadic Conflict
           Communication Following a Severe Motor Vehicle Accident
    • Authors: Steffany J. Fredman; J. Gayle Beck; Philippe Shnaider; Yunying Le; Nicole D. Pukay-Martin; Kimberly Z. Pentel; Candice M. Monson; Naomi M. Simon; Luana Marques
      Pages: 235 - 246
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Steffany J. Fredman, J. Gayle Beck, Philippe Shnaider, Yunying Le, Nicole D. Pukay-Martin, Kimberly Z. Pentel, Candice M. Monson, Naomi M. Simon, Luana Marques
      There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.05.001
  • Battling on the Home Front: Posttraumatic Stress Disorder and Conflict
           Behavior Among Military Couples
    • Authors: Lynne M. Knobloch-Fedders; Catherine Caska-Wallace; Timothy W. Smith; Keith Renshaw
      Pages: 247 - 261
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Lynne M. Knobloch-Fedders, Catherine Caska-Wallace, Timothy W. Smith, Keith Renshaw
      This study evaluated interpersonal behavior differences among male military service members with and without PTSD and their female partners. Couples (N = 64) completed a 17-minute videotaped conflict discussion, and their interaction behavior was coded using the circumplex-based Structural Analysis of Social Behavior model (SASB; Benjamin, 1979, 1987, 2000). Within couples, the behavior of partners was very similar. Compared to military couples without PTSD, couples with PTSD displayed more interpersonal hostility and control. Couples with PTSD also exhibited more sulking, blaming, and controlling behavior, and less affirming and connecting behavior, than couples without PTSD. Results advance our understanding of the relational impacts of PTSD on military service members and their partners, and underscore the value of couple-based interventions for PTSD in the context of relationship distress.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.08.014
  • Web-Delivered CBT Reduces Heavy Drinking in OEF-OIF Veterans in Primary
           Care With Symptomatic Substance Use and PTSD
    • Authors: Michelle C. Acosta; Kyle Possemato; Stephen A. Maisto; Lisa A. Marsch; Kimberly Barrie; Larry Lantinga; Chunki Fong; Haiyi Xie; Michael Grabinski; Andrew Rosenblum
      Pages: 262 - 276
      Abstract: Publication date: March 2017
      Source:Behavior Therapy, Volume 48, Issue 2
      Author(s): Michelle C. Acosta, Kyle Possemato, Stephen A. Maisto, Lisa A. Marsch, Kimberly Barrie, Larry Lantinga, Chunki Fong, Haiyi Xie, Michael Grabinski, Andrew Rosenblum
      Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems, including posttraumatic stress disorder (PTSD) and hazardous or harmful substance use. Unfortunately, many veterans experience significant barriers to receiving evidence-based treatment, including poor treatment motivation, concerns about stigma, and lack of access to appropriate care. To address this need, the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy (CBT), targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care. Veterans with PTSD/subthreshold PTSD and hazardous substance use were randomized to primary care treatment as usual (TAU; n = 81) or to TAU plus a web-based CBT intervention called Thinking Forward (n = 81). Thinking Forward consisted of 24 sections (approximately 20 minutes each), accessible over 12 weeks. Participants completed baseline and 4-, 8-, 12-, 16-, and 24-week follow-up assessments. Three primary outcomes of PTSD, alcohol and other drug use, and quality of life were examined. Significant treatment effects were found for heavy drinking, but not for PTSD or quality of life. The effect of the intervention on heavy drinking was mediated by intervening increases in coping, social support, self-efficacy, and hope for the future. These results demonstrate the promise of a web-based, self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2016.09.001
  • Honoring the Past, Envisioning the Future: ABCT’s 50th Anniversary
           Presidential Address
    • Authors: Michelle G. Craske
      Abstract: Publication date: Available online 18 May 2017
      Source:Behavior Therapy
      Author(s): Michelle G. Craske
      The theme of our Association for Behavioral and Cognitive Therapy (ABCT) 50th Anniversary was to honor the past and envision the future. From the wisdom, foresight, and determination of the pioneers of our organization, and the continuous upholding of the scientific method over the last fifty years, cognitive behavioral Therapy (CBT) has become the most empirically supported psychological treatment for a wide array of mental health problems. Yet, we still have a long way to go. This address outlines a vision for the future of CBT, which involves greater collaborative science, with all minds working together on the same problem, and greater attention to the risk factors and critical processes that underlie psychopathology and explain treatment change. Such knowledge generation can inform the development of new, more efficient and more effective therapies that are tailored with more precision to the needs of each person. Latest technologies provide tools for a precision focus while at the same time increasing the reach of our treatments to the many for whom traditional therapies are unavailable. Our impact will be greatly enhanced by large samples with common methods and measures that inform a precision approach. We have come a long way since ABCT was founded in 1966, and we are poised to make even larger strides in our mission to enhance health and well-being by harnessing science, our major guiding principle.

      PubDate: 2017-05-21T12:39:50Z
      DOI: 10.1016/j.beth.2017.05.003
  • Multi-Informant Assessments of Adolescent Social Anxiety: Adding Clarity
           by Leveraging Reports from Unfamiliar Peer Confederates
    • Authors: Danielle E. Deros; Sarah J. Racz; Melanie F. Lipton; Tara M. Augenstein; Jeremy N. Karp; Lauren M. Keeley; Noor Qasmieh; Brigitte I. Grewe; Amelia Aldao; Andres De Los Reyes
      Abstract: Publication date: Available online 16 May 2017
      Source:Behavior Therapy
      Author(s): Danielle E. Deros, Sarah J. Racz, Melanie F. Lipton, Tara M. Augenstein, Jeremy N. Karp, Lauren M. Keeley, Noor Qasmieh, Brigitte I. Grewe, Amelia Aldao, Andres De Los Reyes
      Adolescent social anxiety (SA) assessments often include adolescent and parent reports, and low reporting correspondence results in uncertainties in clinical decision-making. Adolescents display SA within non-home contexts such as peer interactions. Yet, current methods for collecting peer reports raise confidentiality concerns, though adolescent SA assessments nonetheless would benefit from context-specific reports relevant to adolescent SA (i.e., interactions with unfamiliar peers). In a sample of 89 adolescents (30 Evaluation-Seeking; 59 Community Control), we collected SA reports from adolescents and their parents, and SA reports from unfamiliar peer confederates who interacted with adolescents during 20-minute mock social interactions. Adolescents and parents completed reports on trait measures of adolescent SA and related concerns (e.g., depressive symptoms), and adolescents completed self-reports of state arousal within mock social interactions. Adolescents’ SA reports correlated with reports on parallel measures from parents in the .30s and with peer confederates in the .40s-to-.50s, whereas reports from parent-confederate dyads correlated in the .07-to-.22 range. Adolescent, parent, and peer confederate SA reports related to reports on trait measures of adolescent SA and depressive symptoms, and distinguished Evaluation-Seeking from Community Control Adolescents. Confederates’ SA reports incrementally predicted adolescents' self-reported SA over-and-above parent reports, and vice versa, with combined Rs ranging from.51-.60. These combined Rs approximate typical correspondence levels between informants who observe adolescents in the same context (e.g., mother-father). Adolescent and peer confederate (but not parent) SA reports predicted adolescents' state arousal in social interactions. These findings have implications for clarifying patterns of reporting correspondence in clinical assessments of adolescent SA.

      PubDate: 2017-05-21T12:39:50Z
      DOI: 10.1016/j.beth.2017.05.001
  • Childhood ADHD and Negative Self-Statements: Important Differences
           Associated with Subtype and Anxiety Symptoms
    • Authors: Peter J. Castagna; Matthew Calamia; Thompson E. Davis
      Abstract: Publication date: Available online 16 May 2017
      Source:Behavior Therapy
      Author(s): Peter J. Castagna, Matthew Calamia, Thompson E. Davis
      The current study examined the role negative self-statements have on the comorbidity between anxious symptomatology and ADHD-combined presentation (ADHD-C) and ADHD-predominantly inattentive (ADHD-I). A total of 114 children and adolescents with ADHD (M age = 10.15; SD = 2.30; range = 7-16) from a clinic-referred sample were grouped based on a semistructured diagnostic interview and consensus approach (ADHD-C, n = 62; ADHD-I, n = 52). Negative self-statements were measured using the Children’s Automatic Thoughts Scale and the total score from the Multidimensional Anxiety Scale for Children was used to measure anxious symptomatology. Findings indicated youth diagnosed with ADHD-C, compared to those diagnosed with ADHD-I, had more frequent personal failure (Cohen's d =.40) and hostile intent negative self-statements (Cohen's d =.47). The association of ADHD subtype and negative self-statements was moderated by anxiety; negative self-statements of personal failure were highest in anxious ADHD-C children (β =.31). A second sample of 137 children and adolescents (M age = 10.61; SD = 2.26; range = 7-16) from a larger clinic referred sample was utilized to replicate our results dimensionally. Results indicated that both hyperactivity/impulsivity (β = .23, p < .01) and the interaction of hyperactivity/impulsivity and anxiety (β = .17, p < .05) were significant predictors of negative self-statements regarding personal failure, while holding child age, child gender, oppositional symptoms, and inattention constant. In all, negative self-statements should be considered in the treatment and assessment of ADHD with particular attention paid to ADHD subtype and internalizing comorbidity.

      PubDate: 2017-05-21T12:39:50Z
      DOI: 10.1016/j.beth.2017.05.002
  • Efficacy of Guided iCBT for Depression and Mediation of Change by
           Cognitive Skill Acquisition
    • Authors: Nicholas R. Forand; Jeffrey G. Barnett; Daniel R. Strunk; Mohammed U. Hindiyeh; Jason E. Feinberg; John R. Keefe
      Abstract: Publication date: Available online 1 May 2017
      Source:Behavior Therapy
      Author(s): Nicholas R. Forand, Jeffrey G. Barnett, Daniel R. Strunk, Mohammed U. Hindiyeh, Jason E. Feinberg, John R. Keefe
      Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale-Self Report and the Behavioral Activation Scale for Depression-Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at post-treatment (Hedge’s g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.

      PubDate: 2017-05-01T09:27:07Z
      DOI: 10.1016/j.beth.2017.04.004
  • Effects of Bias Modification Training in Binge Eating Disorder
    • Authors: Florian Schmitz; Jennifer Svaldi
      Abstract: Publication date: Available online 26 April 2017
      Source:Behavior Therapy
      Author(s): Florian Schmitz, Jennifer Svaldi
      Food-related attentional biases have been identified as maintaining factors in binge eating disorder (BED) as they can trigger a binge episode. Bias modification training may reduce symptoms, as it has been shown to be successful in other appetitive disorders. The aim of this study was to assess and modify food-related biases in BED. It was tested whether biases could be increased and decreased by means of a modified dot-probe paradigm, how long such bias modification persisted, and whether this affected subjective food craving. Participants were randomly assigned to a bias enhancement (attend to food stimulus) group or to a bias reduction (avoid food stimulus) group. Food-related attentional bias was found to be successfully reduced in the bias-reduction group, and effects persisted briefly. Additionally, subjective craving for food was influenced by the intervention, and possible mechanisms are discussed. Given these promising initial results, future research should investigate boundary conditions of the experimental intervention to understand how it could complement treatment of BED.

      PubDate: 2017-05-01T09:27:07Z
      DOI: 10.1016/j.beth.2017.04.003
  • Mental imagery training increases wanting of rewards and reward
           sensitivity and reduces depressive symptoms
    • Authors: Julia Linke; Michèle Wessa
      Abstract: Publication date: Available online 18 April 2017
      Source:Behavior Therapy
      Author(s): Julia Linke, Michèle Wessa
      High reward sensitivity and wanting of rewarding stimuli help to identify and motivate repetition of pleasant activities. This behavioral activation is thought to increase positive emotions. Therefore, both mechanisms are highly relevant for resilience against depressive symptoms. Yet, these mechanisms have not been targeted by psychotherapeutic interventions. In the present study, we tested a mental imagery training comprising eight 10-minute sessions every second day and delivered via the Internet to healthy volunteers (N=30, 21 female, mean age of 23.8 years, caucasian) who were pre-selected for low reward sensitivity. Participants were paired according to age, sex, reward sensitivity, and mental imagery ability. Then, members of each pair were randomly assigned to either the intervention or wait condition. Ratings of wanting and response bias toward probabilistic reward cues (Probabilistic Reward Task) served as primary outcomes. We further tested whether training effects extended to approach behavior (Approach Avoidance Task) and depressive symptoms (Becks Depression Inventory). The intervention led to an increase in wanting (p < .001, η 2 p = .45) and reward sensitivity (p = .004, η 2 p = .27). Further, the training group displayed faster approach toward positive edibles and activities (p = .025, η 2 p = .18) and reductions in depressive symptoms (p = .028, η 2 p = .16). Results extend existing literature by showing that mental imagery training can increase wanting of rewarding stimuli and reward sensitivity. Further, the training appears to reduce depressive symptoms and thus may foster the successful implementation of exsiting treatments for depression such as behavioral activation and could also increase resilience against depressive symptoms.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2017.04.002
  • Mechanisms of change during attention training and mindfulness in high
           trait anxious individuals: A randomized controlled study
    • Authors: Peter M. McEvoy; Rachel Graville; Sarra Hayes; Robert T. Kane; Jonathan K. Foster
      Abstract: Publication date: Available online 13 April 2017
      Source:Behavior Therapy
      Author(s): Peter M. McEvoy, Rachel Graville, Sarra Hayes, Robert T. Kane, Jonathan K. Foster
      The first aim of this study was to compare attention manipulation techniques deriving from metacognitive therapy (the Attention Training Technique, ATT) and mindfulness-based approaches (Mindfulness-Based Progressive Muscle Relaxation, MB-PMR) to a thought wandering control (TWC) condition, in terms of their impact on anxiety and four mechanisms: distancing, present-focused attention, uncontrollability and dangerousness metacognitive beliefs, and cognitive flexibility (Stroop task). The second aim was to test indirect effects of the techniques on anxiety via the mechanism measures. High trait anxious participants (N = 81, M age = 23.60, SD age = 7.66, 80% female) were randomized to receive ATT, MB-PMR or the TWC condition. Measures of cognitive and somatic anxiety, distancing, present-focused attention, metacognitive beliefs, and cognitive flexibility were administered before or after the attention manipulation task. Compared to the TWC group, ATT and MB-PMR were associated with greater changes on cognitive (but not somatic) anxiety, present-focused attention, metacognitive beliefs, and uncorrected errors for threat-related words on the Stroop task. The pattern of means was similar for distancing, but this did not reach statistical significance, and Stroop speed increased equally for all conditions. Indirect effects models revealed significant effects of condition on state anxiety via distancing, metacognitive beliefs, and present-focused attention, but not via Stroop errors. ATT and MB-PMR were associated with changes on anxiety and the mechanism measures, suggesting that the mechanisms of change may be more similar than different across these techniques.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2017.04.001
  • Results of a Pilot Study to Ameliorate Psychological and Behavioral
           Outcomes of Minority Stress among Young Gay and Bisexual Men
    • Authors: Nathan Grant Smith; Trevor A. Hart; Ammaar Kidwai; Julia Vernon; Martin Blais; Barry Adam
      Abstract: Publication date: Available online 4 April 2017
      Source:Behavior Therapy
      Author(s): Nathan Grant Smith, Trevor A. Hart, Ammaar Kidwai, Julia Vernon, Martin Blais, Barry Adam
      Project PRIDE (Promoting Resilience In Discriminatory Environments) is an eight-session small group intervention aimed at reducing negative mental and behavioral health outcomes resulting from minority stress. This study reports the results of a one-armed pilot test of Project PRIDE, which aimed to examine the feasibility and potential for efficacy of the intervention in a sample of 33 gay and bisexual men aged 18 to 25. The intervention appeared feasible to administer in two different sites and all participants who completed post-treatment (n = 22) or follow-up (n = 19) assessments reported high satisfaction with the intervention. Small to large effect sizes were observed for increases in self-esteem; small effect sizes were found for decreases in loneliness and decreases in minority stress variables; and small and medium effect sizes were found for reductions in alcohol use and number of sex partners, respectively. Overall, Project PRIDE appears to be a feasible intervention with promise of efficacy.

      PubDate: 2017-04-24T09:16:13Z
      DOI: 10.1016/j.beth.2017.03.005
  • Emotion Regulation Protects against Recurrence of Depressive Symptoms
           following inpatient care for Major Depressive Disorder
    • Authors: Lisa Hopfinger; Matthias Berking; Claudi L.H. Bockting; David D. Ebert
      Abstract: Publication date: Available online 11 March 2017
      Source:Behavior Therapy
      Author(s): Lisa Hopfinger, Matthias Berking, Claudi L.H. Bockting, David D. Ebert
      Relapse following response in psychotherapy for Major Depressive Disorder (MDD) is a major concern. Emotion regulation (ER) has been discussed as a putative emerging and maintaining factor for depression. The purpose of the present study was to examine whether ER protects against recurrence of depression over and above residual symptoms of depression following inpatient care for MDD. ER skills (ERSQ-ES) and depression (HEALTH-49) were assessed in 193 patients with MDD (age, M=47.4, SD= 9.6, 75.1% female, 100% Caucasian) at treatment discontinuation, 3- and 12-month after treatment. Multiple hierarchical regressions were used to examine general and specific ER as predictors of depressive symptoms at follow ups. Higher general ER predicted lower depression over and beyond residual symptoms of depression at 3-month among treatment responders but not among treatment non-responders. With regard to specific ER skills, readiness to confront and acceptance of undesired emotions predicted lower depressive symptoms beyond residual symptoms of depression twelve months, respectively three- and twelve months after treatment. Findings of the present study indicate that targeting general ER might be more important for remitted and less important for non-remitted patients. Enhancing ER should hence be realized in a sequential treatment design, in which a continuation phase treatment with a specific focus on ER directly follows, once patients sufficiently responded to treatment. Acceptance of undesired emotion and readiness to confront situations that cue these emotions appear to be particularly important for protecting against recurrence of depression. Future research should clarify whether findings can be generalized to outpatient care.

      PubDate: 2017-03-13T03:04:00Z
      DOI: 10.1016/j.beth.2017.03.003
  • Emotion regulation in borderline personality disorder: An experimental
           investigation of the effects of instructed acceptance and suppression
    • Authors: Katherine L. Dixon-Gordon; Brianna J. Turner; M. Zachary Rosenthal; Alexander L. Chapman
      Abstract: Publication date: Available online 11 March 2017
      Source:Behavior Therapy
      Author(s): Katherine L. Dixon-Gordon, Brianna J. Turner, M. Zachary Rosenthal, Alexander L. Chapman
      Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and non-psychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (versus suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.

      PubDate: 2017-03-13T03:04:00Z
      DOI: 10.1016/j.beth.2017.03.001
  • The Effects of Training Contingency Awareness during Attention Bias
           Modification on Learning and Stress Reactivity
    • Authors: Amit Lazarov; Rany Abend; Shiran Seidner; Daniel S. Pine; Yair Bar-Haim
      Abstract: Publication date: Available online 11 March 2017
      Source:Behavior Therapy
      Author(s): Amit Lazarov, Rany Abend, Shiran Seidner, Daniel S. Pine, Yair Bar-Haim
      Current attention bias modification (ABM) procedures are designed to implicitly train attention away from threatening stimuli with the hope of reducing stress reactivity and anxiety symptoms. However, the mechanisms underlying effective ABM delivery are not well understood, with awareness of the training contingency suggested as one possible factor contributing to ABM efficacy. Here, 45 high-anxious participants were trained to divert attention away from threat in two ABM sessions. They were randomly assigned to one of three training protocols: an implicit protocol, comprised of two standard implicit ABM training sessions; an explicit protocol, comprised of two sessions with explicit instruction as to the attention training contingency; and an implicit-explicit protocol, in which participants were not informed of the training contingency in the first ABM session and informed of it at the start of the second session. We examined learning processes and stress reactivity following a stress-induction task. Results indicate that relative to implicit instructions, explicit instructions led to stronger learning during the first training session. Following rest, the explicit and implicit groups exhibited consolidation-related improvement in performance whereas no such improvement was noted for the implicit-explicit group. Finally, although stress reactivity was reduced after training, contingency awareness did not yield a differential effect on stress reactivity measured using both self-reports and skin conductance, within and across sessions. These results suggest that explicit ABM administration leads to greater initial learning during the training protocol while not differing from standard implicit administration in terms of offline learning and stress reactivity.

      PubDate: 2017-03-13T03:04:00Z
      DOI: 10.1016/j.beth.2017.03.002
  • Effects of Tailored and ACT-Influenced Internet-based CBT for Eating
           Disorders and the Relation between Knowledge Acquisition and Outcome: A
           Randomized Controlled Trial
    • Authors: Sandra Weineland Strandskov; Ata Ghaderi; Hedvig Andersson; Nicole Parmskog; Emelie Hjort; Anna Svanberg Wärn; Maria Jannert; Gerhard Andersson
      Abstract: Publication date: Available online 2 March 2017
      Source:Behavior Therapy
      Author(s): Sandra Weineland Strandskov, Ata Ghaderi, Hedvig Andersson, Nicole Parmskog, Emelie Hjort, Anna Svanberg Wärn, Maria Jannert, Gerhard Andersson
      Objectives This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. Design Randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). Intervention The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted eight weeks, and was adapted to the participant's individual needs. A clinician provided support. Main outcome measures Eating disorder symptoms and body shape dissatisfaction. Results Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35-0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r = -0.27 to – r = 0.23). Conclusion The results provide preliminary support for Internet based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology. Trial registration Clinical Trials NCT02700620.

      PubDate: 2017-03-08T02:45:00Z
      DOI: 10.1016/j.beth.2017.02.002
  • Advancing Personalized Medicine: Application of a Novel Statistical Method
           to Identify Treatment Moderators in the Coordinated Anxiety Learning and
           Management Study
    • Authors: Andrea N. Niles; Amanda G. Loerinc; Jennifer L. Krull; Peter Roy-Byrne; Greer Sullivan; Cathy Sherbourne; Alexander Bystritsky; Michelle G. Craske
      Abstract: Publication date: Available online 23 February 2017
      Source:Behavior Therapy
      Author(s): Andrea N. Niles, Amanda G. Loerinc, Jennifer L. Krull, Peter Roy-Byrne, Greer Sullivan, Cathy Sherbourne, Alexander Bystritsky, Michelle G. Craske
      Objective There has been increasing recognition of the value of personalized medicine where the most effective treatment is selected based on individual characteristics. This study used a new method to identify a composite moderator of response to evidence-based anxiety treatment (CALM) compared to Usual Care. Method Eight hundred seventy-six patients diagnosed with one or multiple anxiety disorders were assigned to CALM or Usual Care. Using the method proposed by Kraemer (2013), thirty-five possible moderators were examined for individual effect sizes then entered into a forward-stepwise regression model predicting differential treatment response. K-fold cross validation was used to identify the number of variables to include in the final moderator. Results Ten variables were selected for a final composite moderator. The composite moderator effect size (r = .20) was twice as large as the strongest individual moderator effect size (r = .10). Although on average patients benefitted more from CALM, 19% of patients had equal or greater treatment response in Usual Care. The effect size for the CALM intervention increased from d = .34 to d = .54 when accounting for the moderator. Conclusions Findings support the utility of composite moderators. Results were used to develop a program that allows mental health professionals to prescribe treatment for anxiety based on baseline characteristics (

      PubDate: 2017-02-23T13:12:59Z
      DOI: 10.1016/j.beth.2017.02.001
  • Trait Affect, Emotion Regulation, and the Generation of Negative and
           Positive Interpersonal Events
    • Authors: Jessica L. Hamilton; Taylor A. Burke; Jonathan P. Stange; Evan M. Kleiman; Liza M. Rubenstein; Kate A. Scopelliti; Lyn Y. Abramson; Lauren B. Alloy
      Abstract: Publication date: Available online 8 February 2017
      Source:Behavior Therapy
      Author(s): Jessica L. Hamilton, Taylor A. Burke, Jonathan P. Stange, Evan M. Kleiman, Liza M. Rubenstein, Kate A. Scopelliti, Lyn Y. Abramson, Lauren B. Alloy
      Positive and negative trait affect and emotion regulatory strategies have received considerable attention in the literature as predictors of psychopathology. However, it remains unclear whether individuals’ trait affect is associated with responses to state positive affect (positive rumination and dampening) or negative affect (ruminative brooding), or whether these affective experiences contribute to negative or positive interpersonal event generation. Among 304 late adolescents, path analyses indicated that individuals with higher trait negative affect utilized dampening and brooding rumination responses, whereas those with higher trait positive affect engaged in rumination on positive affect. Further, there were indirect relationships between trait negative affect and fewer positive and negative interpersonal events via dampening, and between trait positive affect and greater positive and negative interpersonal events via positive rumination. These findings suggest that individuals’ trait negative and positive affect may be associated with increased utilization of emotion regulation strategies for managing these affects, which may contribute to the occurrence of positive and negative events in interpersonal relationships.

      PubDate: 2017-02-10T13:07:01Z
      DOI: 10.1016/j.beth.2017.01.006
  • To Do or Not to Do' Task Control Deficit in Obsessive-Compulsive
    • Authors: Eyal Kalanthroff; Avishai Henik; Helen Blair Simpson; Doron Todder; Gideon E. Anholt
      Abstract: Publication date: Available online 23 January 2017
      Source:Behavior Therapy
      Author(s): Eyal Kalanthroff, Avishai Henik, Helen Blair Simpson, Doron Todder, Gideon E. Anholt
      Task control is an executive control mechanism that facilitates goal-directed task selection by suppressing irrelevant automatic “stimulus-driven” behaviors. In the current study, we test the hypothesis that less efficient task control in individuals diagnosed with obsessive-compulsive disorder (OCD) is associated with OCD symptoms, and specifically, with the inability to inhibit unwanted behaviors in OCD. Thirty-five healthy controls, thirty participants with OCD, and twenty-six participants with generalized anxiety disorder (GAD) completed the object-interference (OI) task to measure task control, the stop-signal task to measure response inhibition, and the arrow-flanker task to evaluate executive abilities not contingent upon task control. OCD patients, but not GAD patients or healthy controls, exhibited impaired performance on the OI task. The deficit in task control, but not in response inhibition, correlated with OCD symptom severity. We suggest that reduced task control may be one of the neurocognitive processes that underlie the inability to inhibit unwanted behaviors in OCD.

      PubDate: 2017-01-27T18:06:33Z
      DOI: 10.1016/j.beth.2017.01.004
  • The role of threat level and intolerance of uncertainty (IU) in anxiety:
           An experimental test of IU theory
    • Authors: Mary E. Oglesby; Norman B. Schmidt
      Abstract: Publication date: Available online 22 January 2017
      Source:Behavior Therapy
      Author(s): Mary E. Oglesby, Norman B. Schmidt
      Intolerance of uncertainty (IU) has been proposed as an important transdiagnostic variable within mood- and anxiety-related disorders. The extant literature has suggested that individuals high in IU interpret uncertainty more negatively. Furthermore, theoretical models of IU posit that those elevated in IU may experience an uncertain threat as more anxiety-provoking than a certain threat. However, no research to date has experimentally manipulated the certainty of an impending threat while utilizing an in vivo stressor. In the current study, undergraduate participants (N = 79) were randomized to one of two conditions: certain threat (participants were told that later on in the study they would give a 3-minute speech) or uncertain threat (participants were told that later on in the study they would flip a coin to determine whether or not they would give a 3-minute speech). Participants also completed self-report questionnaires measuring their baseline state anxiety, baseline trait IU, and pre-speech state anxiety. Results indicated that trait IU was associated with greater state anticipatory anxiety when the prospect of giving a speech was made uncertain (i.e., uncertain condition). Further, findings indicated no significant difference in anticipatory state anxiety among individuals high in IU when comparing an uncertain versus certain threat (i.e., uncertain and certain threat conditions, respectively). Furthermore, results found no significant interaction between condition and trait IU when predicting state anticipatory anxiety. This investigation is the first to test a crucial component of IU theory while utilizing an ecologically valid paradigm. Results of the present study are discussed in terms of theoretical models of IU and directions for future work.

      PubDate: 2017-01-27T18:06:33Z
      DOI: 10.1016/j.beth.2017.01.005
  • The Role of Patient Characteristics in the Concordance of Daily and
           Retrospective Reports of PTSD
    • Authors: Sarah B. Campbell; Marketa Krenek; Tracy L. Simpson
      Abstract: Publication date: Available online 14 January 2017
      Source:Behavior Therapy
      Author(s): Sarah B. Campbell, Marketa Krenek, Tracy L. Simpson
      Research has documented discrepancies between daily and retrospective reports of psychological symptoms in a variety of conditions. A limited number of studies have assessed these discrepancies in samples of individuals with posttraumatic stress disorder (PTSD), with even less research addressing potential covariates that may influence such discrepancies. In the current study, 65 individuals with co-occurring PTSD and alcohol use disorder (AUD) completed daily assessments of their PTSD symptoms for one month, followed by a standard retrospective report of PTSD over the same month. Initial analyses explored the mean levels of daily and retrospective PTSD symptoms, while multilevel models assessed the level of agreement between daily and retrospective reports and the role of demographic variables and comorbid psychopathology (e.g., depression) or substance use (e.g., alcohol use) in moderating the association of daily and retrospective reports. Results showed that retrospective reports of arousal and avoidance symptoms were weakly related to daily reports of these symptoms, while reports of re-experiencing and numbing symptoms showed better agreement. Intra-individual alcohol consumption also moderated associations of re-experiencing and avoidance symptoms, such that on days individuals drank more, their daily reports resembled their retrospective reports less well. Future research should explore the degree to which these results generalize to non-dually-diagnosed samples, as well as the role such reporting discrepancies may play in PTSD treatment.

      PubDate: 2017-01-20T06:44:31Z
      DOI: 10.1016/j.beth.2017.01.003
  • From Efficacy to Global Impact: Lessons Learned about What-Not-to-Do in
           Translating our Research to Reach
    • Authors: Carolyn B. Becker
      Abstract: Publication date: Available online 12 January 2017
      Source:Behavior Therapy
      Author(s): Carolyn B. Becker
      Although members of the Association for Behavioral and Cognitive Therapies have made significant strides towards the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician world-wide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include: increased attention towards prevention; use of lower-cost, simplified interventions; task-shifting; train-the-trainer models; community participatory research methodology, and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project and is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.

      PubDate: 2017-01-12T21:07:08Z
      DOI: 10.1016/j.beth.2016.12.007
  • Long-term outcomes of cognitive-behavior therapy for adolescent body
           dysmorphic disorder
    • Authors: Georgina Krebs; Lorena Fernández de la Cruz; Benedetta Monzani; Laura Bowyer; Martin Anson; Jacinda Cadman; Isobel Heyman; Cynthia Turner; David Veale; David Mataix-Cols
      Abstract: Publication date: Available online 10 January 2017
      Source:Behavior Therapy
      Author(s): Georgina Krebs, Lorena Fernández de la Cruz, Benedetta Monzani, Laura Bowyer, Martin Anson, Jacinda Cadman, Isobel Heyman, Cynthia Turner, David Veale, David Mataix-Cols
      Emerging evidence suggests that cognitive-behavior therapy (CBT) is an efficacious treatment for adolescent body dysmorphic disorder (BDD) in the short-term, but longer-term outcomes remain unknown. The current study aimed to follow-up a group of adolescents who had originally participated in a randomized controlled trial of CBT for BDD to determine whether treatment gains were maintained. Twenty-six adolescents (mean age = 16.2, SD = 1.6) with a primary diagnosis of BDD received a course of developmentally tailored CBT and were followed up over 12 months. Participants were assessed at baseline, mid-treatment, post-treatment, two-, six-, and 12-month follow-up. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD. Secondary outcomes included measures of insight, depression, quality of life, and global functioning. BDD symptoms decreased significantly from pre- to post-treatment and remained stable over the 12-month follow-up. At this time-point, 50% of participants were classified as responders and 23% as remitters. Participants remained significantly improved on all secondary outcomes at 12-month follow-up. Neither baseline insight nor baseline depression predicted long-term outcomes. The positive effects of CBT appear to be durable up to 12-month follow-up. However, the majority of patients remained symptomatic and vulnerable to a range of risks at 12-month follow-up, indicating that longer-term monitoring is advisable in this population. Future research should focus on enhancing the efficacy of CBT in order to improve long-term outcomes.

      PubDate: 2017-01-12T21:07:08Z
      DOI: 10.1016/j.beth.2017.01.001
  • Mobile phone-based mood ratings prospectively predict psychotherapy
    • Authors: Emma Bruehlman-Senecal; Adrian Aguilera; Stephen M. Schueller
      Abstract: Publication date: Available online 9 January 2017
      Source:Behavior Therapy
      Author(s): Emma Bruehlman-Senecal, Adrian Aguilera, Stephen M. Schueller
      Objective Psychotherapy non-attendance is a costly and pervasive problem. While prior research has identified stable patient-level predictors of attendance, far less is known about dynamic (i.e., time-varying) factors. Identifying dynamic predictors can clarify how clinical states relate to psychotherapy attendance and inform effective “just-in-time” interventions to promote attendance. The present study examines whether daily mood, as measured by responses to automated mobile phone-based text messages, prospectively predicts attendance in group cognitive-behavioral therapy (CBT) for depression. Method Fifty-six Spanish-speaking Latino patients with elevated depressive symptoms (46 women, mean age = 50.92 years, SD = 10.90 years), enrolled in a manualized program of group CBT, received daily automated mood-monitoring text messages. Patients’ daily mood ratings, message response rate, and delay in responding were recorded. Results Patients’ self-reported mood the day prior to a scheduled psychotherapy session significantly predicted attendance, even after controlling for patients’ prior attendance history and age (OR = 1.33, 95% CI [1.04, 1.70], p = .02). Positive mood corresponded to a greater likelihood of attendance. Conclusions Our results demonstrate the clinical utility of automated mood-monitoring text messages in predicting attendance. These results underscore the value of text messaging, and other mobile technologies, as adjuncts to psychotherapy. Future work should explore the use of such monitoring to guide interventions to increase attendance, and ultimately the efficacy of psychotherapy.

      PubDate: 2017-01-12T21:07:08Z
      DOI: 10.1016/j.beth.2017.01.002
  • Implementing Clinical Research Using Factorial Designs: A Primer
    • Authors: Timothy B. Baker; Stevens S. Smith; Daniel M. Bolt; Wei-Yin Loh; Robin Mermelstein; Michael C. Fiore; Megan E. Piper; Linda M. Collins
      Abstract: Publication date: Available online 7 January 2017
      Source:Behavior Therapy
      Author(s): Timothy B. Baker, Stevens S. Smith, Daniel M. Bolt, Wei-Yin Loh, Robin Mermelstein, Michael C. Fiore, Megan E. Piper, Linda M. Collins
      Factorial experiments have rarely been used in the development or evaluation of clinical interventions. However, factorial designs offer advantages over randomized controlled trial designs, the latter being much more frequently used in such research. Factorial designs are highly efficient (permitting evaluation of multiple intervention components with good statistical power) and present the opportunity to detect interactions amongst intervention components. Such advantages have led methodologists to advocate for the greater use of factorial designs in research on clinical interventions (Collins, Dziak, & Li, 2009). However, researchers considering the use of such designs in clinical research face a series of choices that have consequential implications for the interpretability and value of the experimental results. These choices include: whether to use a factorial design, selection of the number and type of factors to include, how to address the compatibility of the different factors included, whether and how to avoid confounds between the type and number of interventions a participant receives, and how to interpret interactions. The use of factorial designs in clinical intervention research poses choices that differ from those typically considered in randomized clinical trial designs. However, the great information yield of the former encourages clinical researchers’ increased and careful execution of such designs.

      PubDate: 2017-01-12T21:07:08Z
      DOI: 10.1016/j.beth.2016.12.005
  • Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder
    • Authors: Lori Eisner; David Eddie; Rebecca Harley; Michelle Jacobo; Andrew A. Nierenberg; Thilo Deckersbach
      Abstract: Publication date: Available online 6 January 2017
      Source:Behavior Therapy
      Author(s): Lori Eisner, David Eddie, Rebecca Harley, Michelle Jacobo, Andrew A. Nierenberg, Thilo Deckersbach
      There is growing evidence that the capacity for emotion regulation is compromised in individuals with bipolar disorder. Dialectical behavior therapy (DBT), an empirically supported treatment that specifically targets emotion dysregulation, may be an effective adjunct treatment for improving emotion regulation and residual mood symptoms in patients with bipolar disorder. In this open, proof of concept pilot study, 37 participants engaged in a 12-week DBT group skills training program, learning mindfulness, emotion regulation, and distress tolerance skills. Repeated measures mixed models revealed skill acquisition in the areas of mindfulness, emotion regulation and distress tolerance, as well as improved psychological well-being and decreased emotion reactivity. The results of this study support a burgeoning literature that DBT is a feasible adjunct intervention for patients with bipolar disorder.

      PubDate: 2017-01-12T21:07:08Z
      DOI: 10.1016/j.beth.2016.12.006
  • Kindling of Life Stress in Bipolar Disorder: Effects of Early Adversity
    • Authors: Benjamin G. Shapero; Rachel B. Weiss; Taylor A. Burke; Elaine M. Boland; Lyn Y. Abramson; Lauren B. Alloy
      Abstract: Publication date: Available online 26 December 2016
      Source:Behavior Therapy
      Author(s): Benjamin G. Shapero, Rachel B. Weiss, Taylor A. Burke, Elaine M. Boland, Lyn Y. Abramson, Lauren B. Alloy
      Most theoretical frameworks regarding the role of life stress in bipolar disorders (BD) do not incorporate the possibility of a changing relationship between psychosocial context and episode initiation across the course of the disorder. The kindling hypothesis theorizes that over the longitudinal course of recurrent affective disorders, the relationship between major life stressors and episode initiation declines (Post, 1992). The present study aimed to test an extension of the kindling hypothesis in BD by examining the effect of early life adversity on the relationship between proximal life events and prospectively assessed mood episodes. Data from 145 bipolar participants (59.3% female, 75.2% Caucasian, and mean age of 20.19 years; SD = 1.75 years) were collected as part of the Temple-Wisconsin Longitudinal Investigation of Bipolar Spectrum Project (112 Bipolar II; 33 Cyclothymic disorder). Participants completed a self-report measure of early adversity at baseline and interview-assessed mood episodes and life events at regular four-month follow-ups. Results indicate that early childhood adversity sensitized bipolar participants to the effects of recent stressors only for depressive episodes and not hypomanic episodes within BD. This was particularly the case with minor negative events. The current study extends prior research examining the kindling model in BD using a methodologically rigorous assessment of life stressors and mood episode occurrence. Clinicians should assess experiences of early adversity in individuals with BD as it may impact reactivity to developing depressive episodes in response to future stressors.

      PubDate: 2016-12-26T17:40:47Z
      DOI: 10.1016/j.beth.2016.12.003
  • Psychometric Properties of the French adaptation of The Basic
           Documentation for Psycho-Oncology (Po-Bado), a Distress Screening Tool
    • Authors: Nena Stadelmaier; Kamel Gana; Yaël Saada; Odile Duguey-Cachey; Bruno Quintard
      Abstract: Publication date: Available online 13 December 2016
      Source:Behavior Therapy
      Author(s): Nena Stadelmaier, Kamel Gana, Yaël Saada, Odile Duguey-Cachey, Bruno Quintard
      We translated and adapted the French version of the Basic Documentation for Psycho-Oncology (Po-Bado standard version) and we report its psychometric properties. The Po-Bado is a 12-item documentation instrument that measures psychosocial burden in cancer patients (all types and stages). The intensity of a patient’s psychological suffering is evaluated by a health-care professional (e.g. doctor, psychologist, nurse) in a semi-guided interview. Overall, 252 cancer patients (M age = 57 years, SD = 12.8 years) participated, completing the Po-Bado during a supportive care consultation following initial diagnosis. Our results show good reliability of the Po-Bado scores, with high internal consistency and inter-rater coefficients. Low temporal stability indicated that the Po-Bado measures a state-like phenomenon (vs. trait-like). Validity analysis showed significant correlations between cancer-specific psychosocial burden and negative mood (i.e., depression, anxiety) and psychological disturbance as assessed by the GHQ-12. Confirmatory factor analysis validated the Po-Bado’s two-factor structure, i.e., somatic and psychological burdens. A ROC curve determined the optimal cut-off score of 7.5. These results suggest that the Po-Bado is an easily applicable tool for clinicians and researchers to screen effectively for psychosocial burden in oncology.

      PubDate: 2016-12-18T17:30:19Z
      DOI: 10.1016/j.beth.2016.12.001
  • Social Anxiety and Social Support in Romantic Relationships
    • Authors: Eliora Porter; Dianne L. Chambless
      Abstract: Publication date: Available online 13 December 2016
      Source:Behavior Therapy
      Author(s): Eliora Porter, Dianne L. Chambless
      Little is known about the quality of socially anxious individuals’ romantic relationships. In the present study, we examine associations between social anxiety and social support in such relationships. In Study 1, we collected self-report data on social anxiety symptoms and received, provided, and perceived social support from 343 undergraduates and their romantic partners. One year later couples were contacted to determine whether they were still in this relationship. Results indicated that men’s social anxiety at Time 1 predicted higher rates of break-up at Time 2. Men’s and women’s perceived support, as well as men’s provided support, were also significantly predictive of break-up. Social anxiety did not interact with any of the support variables to predict break-up. In Study 2, a subset of undergraduate couples with a partner high (n = 27) or low (n = 27) in social anxiety completed two 10-minute, lab-based, videorecorded social support tasks. Both partners rated their received or provided social support following the interaction, and trained observers also coded for support behaviors. Results showed that socially anxious individuals received less support from their partners during the interaction according to participant- but not observer-report. High and lower social anxiety couples did not differ in terms of the target’s provision of support. Taken together, results suggest that social anxiety is associated with difficulties even in the context of established romantic relationships. Clinical implications are discussed.

      PubDate: 2016-12-18T17:30:19Z
      DOI: 10.1016/j.beth.2016.12.002
  • Generalization of pain-related fear based on conceptual knowledge
    • Authors: Ann Meulders; Kristof Vandael; Johan W.S. Vlaeyen
      Abstract: Publication date: Available online 5 December 2016
      Source:Behavior Therapy
      Author(s): Ann Meulders, Kristof Vandael, Johan W.S. Vlaeyen
      Increasing evidence suggests that pain-related fear is key to the transition from acute to chronic pain. Previous research has shown that perceptual similarity with a pain-associated movement fosters the generalization of fear to novel movements. Perceptual generalization of pain-related fear is adaptive as it enables individuals to extrapolate the threat value of one movement to another without the necessity to learn anew. However, excessive spreading of fear to safe movements may become maladaptive and may lead to sustained anxiety, dysfunctional avoidance behaviors, and severe disability. A hallmark of human cognition is the ability to extract conceptual knowledge from a learning episode as well. Although this conceptual pathway may be important to understand fear generalization in chronic pain, research on this topic is lacking. We investigated acquisition and generalization of concept-based pain-related fear. During acquisition, unique exemplars of one action category (CS+, e.g., opening boxes) were followed by pain, whereas exemplars of another action category (CS-, e.g., closing boxes) were not. Subsequently, spreading of pain-related fear to novel exemplars of both action categories was tested. Participants learned to expect the pain to occur and reported more pain-related fear to the exemplars of the CS+ category compared to those of the CS- category. During generalization, fear and expectancy generalized to novel exemplars of the CS+ category, but not to the CS- category. This pattern was not corroborated in the eyeblink startle measures. This is the first study that demonstrates that pain-related fear can be acquired and generalized based on conceptual knowledge.

      PubDate: 2016-12-11T15:38:41Z
      DOI: 10.1016/j.beth.2016.11.014
  • An experimental investigation of co-rumination, problem solving, and
    • Authors: Kate J. Zelic; Jeffrey A. Ciesla; Kelsey S. Dickson; Laura C. Hruska; Shannon N. Ciesla
      Abstract: Publication date: Available online 1 December 2016
      Source:Behavior Therapy
      Author(s): Kate J. Zelic, Jeffrey A. Ciesla, Kelsey S. Dickson, Laura C. Hruska, Shannon N. Ciesla
      Co-rumination involves excessive dwelling on negative aspects of problems within a dyadic relationship (Rose, 2002). While research has focused on the tendency to co-ruminate within particular relationships, we were interested in examining the behavior of co-rumination outside the context of a pre-existing relationship. Using an experimental manipulation of co-rumination, the primary goal of this study was to experimentally test the effects of co-rumination and examine its associations with negative and positive affectivity. Participants were randomly assigned to one of three interviewing style conditions: a co-ruminative style, a problem solving style, or a distracting style. Results revealed that the co-rumination condition significantly differed from both the distraction and problem solving conditions on overall negative affect, sadness, and anxiety, but not on hostility. There were no significant differences amongst groups on positive affect. In conclusion, this investigation revealed detrimental effects of co-ruminative behavior even between strangers.

      PubDate: 2016-12-05T02:05:42Z
      DOI: 10.1016/j.beth.2016.11.013
  • Compassion-Based Therapy for Trauma-Related Shame and Posttraumatic
           Stress: Initial Evaluation Using a Multiple Baseline Design
    • Authors: Teresa M. Au; Shannon Sauer-Zavala; Matthew W. King; Nicola Petrocchi; David H. Barlow; Brett T. Litz
      Abstract: Publication date: Available online 29 November 2016
      Source:Behavior Therapy
      Author(s): Teresa M. Au, Shannon Sauer-Zavala, Matthew W. King, Nicola Petrocchi, David H. Barlow, Brett T. Litz
      Accumulating research suggests that shame can strongly contribute to the development and maintenance of posttraumatic stress disorder (PTSD). Interventions that promote self-compassion have shown promise for reducing shame related to various clinical problems, but this approach has not been systematically evaluated for traumatized individuals. The aim of this study was to develop a brief compassion-based therapy and assess its efficacy for reducing trauma-related shame and PTSD symptoms. Using a multiple baseline experimental design, the intervention was evaluated in a community sample of trauma-exposed adults (N = 10) with elevated trauma-related shame and PTSD symptoms. Participants completed weekly assessments during a 2-, 4-, or 6-week baseline phase and a 6-week treatment phase, and at 2- and 4-weeks after the intervention. By the end of treatment, 9 of 10 participants demonstrated reliable decreases in PTSD symptom severity, while 8 of 10 participants showed reliable reductions in shame. These improvements were maintained at 2- and 4-week follow-up. The intervention was also associated with improvements in self-compassion and self-blame. Participants reported high levels of satisfaction with the intervention. Results suggest that the intervention may be useful as either a stand-alone treatment or as a supplement to other treatments.

      PubDate: 2016-12-05T02:05:42Z
      DOI: 10.1016/j.beth.2016.11.012
  • Moderation of the alliance-outcome association by prior depressive
           episodes: Differential effects in cognitive-behavioral therapy and
           short-term psychodynamic supportive psychotherapy
    • Authors: Lorenzo Lorenzo-Luaces; Ellen Driessen; Robert J. DeRubeis; Henricus L. Van; John R. Keefe; Mariëlle Hendriksen; Jack Dekker
      Abstract: Publication date: Available online 23 November 2016
      Source:Behavior Therapy
      Author(s): Lorenzo Lorenzo-Luaces, Ellen Driessen, Robert J. DeRubeis, Henricus L. Van, John R. Keefe, Mariëlle Hendriksen, Jack Dekker
      Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N = 282) at week 5 of treatment. Overall, the alliance was a predictor of symptom change (d = 0.33). In SPSP, the alliance was a modest but robust predictor of change irrespective of prior episodes (d = 0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d = 0.86), moderate for those with 1 prior episode (d = 0.49) and small for those with 2+ prior episodes (d = 0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.

      PubDate: 2016-11-27T17:57:01Z
      DOI: 10.1016/j.beth.2016.11.011
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