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  Subjects -> PSYCHOLOGY (Total: 972 journals)
Showing 1 - 174 of 174 Journals sorted alphabetically
Acción Psicológica     Open Access   (Followers: 4)
Acta Colombiana de Psicología     Open Access   (Followers: 5)
Acta Comportamentalia     Open Access   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Psychologica     Hybrid Journal   (Followers: 27)
Activités     Open Access   (Followers: 1)
Actualidades en Psicologia     Open Access   (Followers: 2)
Ad verba Liberorum : Journal of Linguistics & Pedagogy & Psychology     Open Access   (Followers: 9)
Addictive Behaviors Reports     Open Access   (Followers: 8)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 25)
ADHD Report The     Full-text available via subscription   (Followers: 11)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46)
Advances in Mental Health     Hybrid Journal   (Followers: 80)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 7)
Advances in Physiotherapy     Hybrid Journal   (Followers: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34)
African Journal of Cross-Cultural Psychology and Sport Facilitation     Full-text available via subscription   (Followers: 5)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 465)
Aggressive Behavior     Hybrid Journal   (Followers: 19)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 43)
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3)
Aletheia     Open Access   (Followers: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 20)
American Imago     Full-text available via subscription   (Followers: 3)
American Journal of Applied Psychology     Open Access   (Followers: 46)
American Journal of Community Psychology     Hybrid Journal   (Followers: 29)
American Journal of Health Behavior     Full-text available via subscription   (Followers: 24)
American Journal of Orthopsychiatry     Hybrid Journal   (Followers: 5)
American Journal of Psychoanalysis     Hybrid Journal   (Followers: 21)
American Journal of Psychology     Full-text available via subscription   (Followers: 35)
American Psychologist     Full-text available via subscription   (Followers: 218)
Anales de Psicología     Open Access   (Followers: 2)
Análise Psicológica     Open Access   (Followers: 1)
Análisis y Modificación de Conducta     Open Access   (Followers: 2)
Analitika : Jurnal Magister Psikologi Uma     Open Access  
Analysis     Full-text available via subscription   (Followers: 3)
Annual Review of Clinical Psychology     Full-text available via subscription   (Followers: 79)
Annual Review of Organizational Psychology and Organizational Behavior     Full-text available via subscription   (Followers: 36)
Annual Review of Psychology     Full-text available via subscription   (Followers: 264)
Anuario de investigaciones (Facultad de Psicología. Universidad de Buenos Aires)     Open Access   (Followers: 1)
Anuario de Investigaciones de la Facultad de Psicología     Open Access  
Anuario de Psicología / The UB Journal of Psychology     Open Access   (Followers: 1)
Anuario de Psicología Jurídica     Open Access   (Followers: 1)
Anuario Pilquen : Sección Divulgación Científica     Open Access  
Anxiety, Stress & Coping: An International Journal     Hybrid Journal   (Followers: 22)
Applied and Preventive Psychology     Hybrid Journal   (Followers: 17)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 74)
Applied Neuropsychology : Adult     Hybrid Journal   (Followers: 41)
Applied Neuropsychology : Child     Hybrid Journal   (Followers: 24)
Applied Psycholinguistics     Hybrid Journal   (Followers: 22)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21)
Applied Psychology     Hybrid Journal   (Followers: 179)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 54)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 8)
Archive for the Psychology of Religion / Archiv für Religionspychologie     Hybrid Journal   (Followers: 24)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30)
Archives of Scientific Psychology     Open Access   (Followers: 4)
Arquivos Brasileiros de Psicologia     Open Access   (Followers: 1)
Art Therapy Online     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 10)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4)
Asian American Journal of Psychology     Full-text available via subscription   (Followers: 5)
Asian Journal of Behavioural Studies     Open Access  
Asian Journal of Business Ethics     Hybrid Journal   (Followers: 10)
Assessment     Hybrid Journal   (Followers: 13)
Attachment: New Directions in Psychotherapy and Relational Psychoanalysis     Full-text available via subscription   (Followers: 14)
Attention, Perception & Psychophysics     Full-text available via subscription   (Followers: 14)
Australasian Journal of Organisational Psychology     Hybrid Journal   (Followers: 9)
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: 8)
Australian Journal of Psychology     Hybrid Journal   (Followers: 21)
Australian Journal of Rehabilitation Counseling     Full-text available via subscription   (Followers: 4)
Australian Psychologist     Hybrid Journal   (Followers: 12)
Autism Insights     Open Access   (Followers: 14)
Autism Research     Hybrid Journal   (Followers: 42)
Autism Research and Treatment     Open Access   (Followers: 27)
Autism's Own     Open Access   (Followers: 3)
Autism-Open Access     Open Access   (Followers: 6)
Avaliação Psicológica     Open Access  
Avances en Psicologia Latinoamericana     Open Access   (Followers: 1)
Aviation Psychology and Applied Human Factors     Hybrid Journal   (Followers: 21)
Balint Journal     Hybrid Journal   (Followers: 2)
Barbaroi     Open Access  
Basic and Applied Social Psychology     Hybrid Journal   (Followers: 41)
Behavior Analysis in Practice     Full-text available via subscription   (Followers: 13)
Behavior Analysis: Research and Practice     Full-text available via subscription   (Followers: 5)
Behavior Analyst     Hybrid Journal   (Followers: 6)
Behavior Modification     Hybrid Journal   (Followers: 11)
Behavior Research Methods     Hybrid Journal   (Followers: 20)
Behavior Therapy     Hybrid Journal   (Followers: 51)
Behavioral Development Bulletin     Full-text available via subscription  
Behavioral Interventions     Hybrid Journal   (Followers: 14)
Behavioral Neuroscience     Full-text available via subscription   (Followers: 55)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 28)
Behavioral Sleep Medicine     Hybrid Journal   (Followers: 8)
Behaviormetrika     Hybrid Journal  
Behaviour     Hybrid Journal   (Followers: 13)
Behaviour Change     Full-text available via subscription   (Followers: 13)
Behaviour Research and Therapy     Hybrid Journal   (Followers: 20)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 159)
Behavioural Processes     Hybrid Journal   (Followers: 9)
Biofeedback     Hybrid Journal   (Followers: 4)
BioPsychoSocial Medicine     Open Access   (Followers: 7)
BMC Psychology     Open Access   (Followers: 18)
Body, Movement and Dance in Psychotherapy: An International Journal for Theory, Research and Practice     Hybrid Journal   (Followers: 11)
Boletim Academia Paulista de Psicologia     Open Access  
Boletim de Psicologia     Open Access  
Brain Informatics     Open Access  
British Journal of Clinical Psychology     Full-text available via subscription   (Followers: 168)
British Journal of Developmental Psychology     Full-text available via subscription   (Followers: 40)
British Journal of Educational Psychology     Hybrid Journal   (Followers: 35)
British Journal of Health Psychology     Full-text available via subscription   (Followers: 47)
British Journal of Mathematical and Statistical Psychology     Full-text available via subscription   (Followers: 20)
British Journal of Psychology     Full-text available via subscription   (Followers: 64)
British Journal of Psychotherapy     Hybrid Journal   (Followers: 69)
British Journal of Social Psychology     Full-text available via subscription   (Followers: 36)
Buletin Psikologi     Open Access  
Burnout Research     Open Access   (Followers: 8)
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: 17)
Canadian Psychology / Psychologie canadienne     Full-text available via subscription   (Followers: 15)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 2)
Castalia : Revista de Psicología de la Academia     Open Access  
Cendekia : Jurnal Kependidikan dan Kemasyarakatan     Open Access  
Child Development Perspectives     Hybrid Journal   (Followers: 32)
Child Development Research     Open Access   (Followers: 18)
Ciencia Cognitiva     Open Access   (Followers: 2)
Ciencia e Interculturalidad     Open Access   (Followers: 3)
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: 11)
Clinical Psychological Science     Hybrid Journal   (Followers: 12)
Clinical Psychologist     Hybrid Journal   (Followers: 19)
Clinical Psychology & Psychotherapy     Hybrid Journal   (Followers: 77)
Clinical Psychology and Special Education     Open Access   (Followers: 4)
Clinical Psychology Review     Hybrid Journal   (Followers: 44)
Clinical Psychology: Science and Practice     Hybrid Journal   (Followers: 23)
Clinical Schizophrenia & Related Psychoses     Full-text available via subscription   (Followers: 10)
Coaching : Theorie & Praxis     Open Access   (Followers: 2)
Coaching Psykologi - The Danish Journal of Coaching Psychology     Open Access   (Followers: 2)
Cogent Psychology     Open Access  
Cógito     Open Access  
Cognition & Emotion     Hybrid Journal   (Followers: 43)
Cognitive Behaviour Therapist     Hybrid Journal   (Followers: 13)
Cognitive Behaviour Therapy     Hybrid Journal   (Followers: 18)
Cognitive Neuropsychology     Hybrid Journal   (Followers: 36)
Cognitive Psychology     Hybrid Journal   (Followers: 73)
Cognitive Research : Principles and Implications     Open Access   (Followers: 3)
Community Psychology in Global Perspective     Open Access  
Consciousness and Cognition     Hybrid Journal   (Followers: 32)
Construção Psicopedagógica     Open Access  
Consulting Psychology Journal : Practice and Research     Full-text available via subscription   (Followers: 4)
Contagion : Journal of Violence, Mimesis, and Culture     Full-text available via subscription   (Followers: 7)
Contemporary Educational Psychology     Hybrid Journal   (Followers: 26)
Contemporary School Psychology     Hybrid Journal   (Followers: 4)
Contextos Clínicos     Open Access  
Counseling et spiritualité / Counselling and Spirituality     Full-text available via subscription   (Followers: 2)
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 13)
Counseling Psychologist     Hybrid Journal   (Followers: 17)
Counseling Psychology and Psychotherapy     Open Access   (Followers: 12)
Counselling and Psychotherapy Research : Linking research with practice     Hybrid Journal   (Followers: 26)
Counselling and Values     Hybrid Journal   (Followers: 5)
Counselling Psychology Quarterly     Hybrid Journal   (Followers: 13)
Couple and Family Psychology : Research and Practice     Full-text available via subscription   (Followers: 7)
Creativity Research Journal     Hybrid Journal   (Followers: 25)
Creativity. Theories ? Research ? Applications     Open Access   (Followers: 5)
Criminal Justice Ethics     Hybrid Journal   (Followers: 11)
Cuadernos de Marte     Open Access  
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: 18)
Cultural-Historical Psychology     Open Access   (Followers: 2)
Culturas Psi     Open Access  
Culture and Brain     Hybrid Journal   (Followers: 4)
Current Addiction Reports     Hybrid Journal   (Followers: 12)
Current Behavioral Neuroscience Reports     Hybrid Journal   (Followers: 2)
Current Directions In Psychological Science     Hybrid Journal   (Followers: 60)
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 4)
Current Opinion in Psychology     Hybrid Journal   (Followers: 9)
Current Psychological Research     Hybrid Journal   (Followers: 15)
Current Psychology     Hybrid Journal   (Followers: 14)
Current psychology letters     Open Access   (Followers: 2)
Current Research in Psychology     Open Access   (Followers: 19)
Cyberpsychology, Behavior, and Social Networking     Hybrid Journal   (Followers: 17)
Decision     Full-text available via subscription   (Followers: 6)
Depression and Anxiety     Hybrid Journal   (Followers: 27)
Depression Research and Treatment     Open Access   (Followers: 15)
Desde el Jardín de Freud Revista de Psicoanálisis     Open Access   (Followers: 1)
Development and Psychopathology     Hybrid Journal   (Followers: 9)
Developmental Cognitive Neuroscience     Open Access   (Followers: 18)
Developmental Neuropsychology     Hybrid Journal   (Followers: 21)
Developmental Psychobiology     Hybrid Journal   (Followers: 9)
Developmental Psychology     Full-text available via subscription   (Followers: 48)

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Journal Cover
Behavior Therapy
Journal Prestige (SJR): 1.686
Citation Impact (citeScore): 3
Number of Followers: 51  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0005-7894
Published by Elsevier Homepage  [3161 journals]
  • Exploring Mechanisms of Action in Exposure-Based Cognitive Behavioral
           Therapy for Eating Disorders: The Role of Eating-Related Fears and
           Body-Related Safety Behaviors
    • Abstract: Publication date: Available online 12 February 2019Source: Behavior TherapyAuthor(s): Nicholas R. Farrell, Leigh C. Brosof, Irina A. Vanzhula, Caroline Christian, Owen R. Bowie, Cheri A. Levinson Evidence-based cognitive behavioral therapy for eating disorders includes a component of exposure therapy, which involves patients confronting feared eating and body-related stimuli while preventing safety behaviors. With recent research demonstrating that eating-related fears and safety behaviors are central to eating disorder pathology, there is increased emphasis on improving the efficacy of exposure therapy in eating disorders. Doing so will require a better understanding of important mechanisms of action in this treatment. The present study explored how changes during treatment in eating-related fears and avoidance as well as body-related safety behaviors influence overall treatment outcomes. Individuals with eating disorders (N = 71) receiving exposure-based treatment completed measures of global eating disorder severity at admission and discharge. Hypothesized mechanisms of action were also assessed at admission and discharge as well as at a two-week time point after beginning treatment. Path modeling analyses showed that decreased eating-related cognitions (feared concerns about eating) and emotions (anxiety about eating) at the two-week time point were prospectively predictive of lowered global eating disorder symptom severity at discharge. Additionally, reduced body checking and avoidance behaviors after two weeks of treatment were also associated with lower eating disorder severity at discharge. These findings highlight the importance of exposure-based therapy in eating disorders and the need to uniquely address eating-related fears and safety behaviors.
  • Changes in Hypothesized Mechanisms of Change Before and After Initiating
           Abstinence in Cognitive-Behavioral Therapy for Women with Alcohol Use
    • Abstract: Publication date: Available online 8 February 2019Source: Behavior TherapyAuthor(s): Kevin A. Hallgren, Elizabeth E. Epstein, Barbara S. McCrady Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d =-0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.
  • Residual Insomnia and Nightmares Post-Intervention Symptom Reduction Among
           Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms
    • Abstract: Publication date: Available online 1 February 2019Source: Behavior TherapyAuthor(s): Cristina M. López, Cynthia L. Lancaster, Allison Wilkerson, Daniel F. Gros, Kenneth J. Ruggiero, Ron Acierno While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment non-response. More specifically, predicting effects of residual insomnia and nightmares on post-intervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion, and if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.
  • Acceptability and Efficacy of Group Behavioral Activation for Depression
           among Adults: A Meta-Analysis
    • Abstract: Publication date: Available online 29 January 2019Source: Behavior TherapyAuthor(s): Mel Simmonds-Buckley, Stephen Kellett, Glenn Waller The evidence base for behavioral activation (BA) as a frontline treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at post-treatment/follow-up, recovery and drop-out rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes post-group BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k = 13, N = 461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k = 15, N = 526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The drop-out rate for group BA (14%) was no different to other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
  • Goal Achievement and Goal-related Cognitions in Behavioral Activation
           Treatment for Depression
    • Abstract: Publication date: Available online 25 January 2019Source: Behavior TherapyAuthor(s): Keegan Knittle, Paul Gellert, Clair Moore, Natalie Bourke, Victoria Hull This study investigates the extent to which achieving goals during behavioral activation (BA) treatment predicts depressive symptom improvement, and whether goal-related cognitions predict goal achievement or treatment response. Patients (n = 110, mean age 37.6, 54% female) received low-intensity cognitive behavioral therapy for depression, which included setting up to three behavioral goals in each of three BA-focused sessions (i.e. 9 goals per patient). Patients completed items from the Self-Regulation Skills Battery to assess goal-related cognitions and goal achievement for these goals, and depressive symptoms were assessed weekly with the PHQ-9. Multi-level models investigated the relationships between goal-related cognitions, goal achievement and depressive symptoms. Depressive symptoms improved curve-linearly during treatment (B = 0.12, p 
  • Intervening on Thwarted Belongingness and Perceived Burdensomeness to
           Reduce Suicidality among Veterans: Subanalyses from a Randomized
           Controlled Trial
    • Abstract: Publication date: Available online 24 January 2019Source: Behavior TherapyAuthor(s): Nicole A. Short, Lauren Stentz, Amanda M. Raines, Joseph W. Boffa, Norman B. Schmidt Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month-1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.
  • Recent Developments in the Treatment of Depression
    • Abstract: Publication date: Available online 17 January 2019Source: Behavior TherapyAuthor(s): Steven D. Hollon, Zachary D. Cohen, Daisy R. Singla, Paul Andrews The cognitive and behavioral interventions can be as efficacious as antidepressant medications and more enduring, but some patients will be more likely to respond to one than the other. Recent work has focused on developing sophisticated selection algorithms using machine-learning approaches that answer the question “What works best for whom”. Moreover, the vast majority of people suffering from depression reside in low and middle-income countries where access to either psychotherapy or medications is virtually nonexistent. Great strides have been made in training non-specialist providers (known as task-sharing) to overcome this gap. Finally, recent work growing out of evolutionary psychology suggests that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode so as to increase the risk of relapse whenever someone tries to stop. We address each of these developments and their cumulative implications.
  • Using a Learning Collaborative Model to Disseminate Cognitive Processing
           Therapy to Community-Based Agencies
    • Abstract: Publication date: January 2019Source: Behavior Therapy, Volume 50, Issue 1Author(s): Stefanie T. LoSavio, Kirsten H. Dillon, Robert A. Murphy, Karen Goetz, Falesha Houston, Patricia A. Resick Although effective treatments for posttraumatic stress disorder exist, their use in community settings is disappointingly low. Training alone does not necessarily lead to adoption. To address this problem, we trained community clinicians in cognitive processing therapy, an evidence-based treatment for posttraumatic stress disorder, using a Learning Collaborative, an intensive training methodology focused on both clinical training and developing sustainability. Sixty clinicians within 18 agencies began the year-long, team-based Learning Collaborative. Clinicians attended three in-person Learning Sessions, received weekly consultation, and submitted audio-recorded sessions to be rated for fidelity. Clinicians were rostered as approved treatment providers if they completed all training requirements. Additionally, we engaged leadership from each agency to build a sustainable practice. Clinicians trained through the Learning Collaborative demonstrated a high degree of fidelity to the treatment (average competence ratings “satisfactory” to “good”), and most (68%) were rostered as approved treatment providers. Patients treated by clinician trainees exhibited significant symptom reductions (d = 1.68 and 1.28 for posttraumatic stress and depression symptoms, respectively, among treatment completers). At a 6-month follow-up, 95% of rostered clinicians and 100% of agencies with rostered clinicians were still providing the treatment. These results suggest that the Learning Collaborative model is a promising approach for the dissemination and implementation of evidence-based treatments for adult posttraumatic stress disorder.
  • Mental Contamination in Obsessive-Compulsive Disorder: Associations With
           Contamination Symptoms and Treatment Response
    • Abstract: Publication date: January 2019Source: Behavior Therapy, Volume 50, Issue 1Author(s): Brittany M. Mathes, Katherine A. McDermott, Sarah A. Okey, Ana Vazquez, Ashleigh M. Harvey, Jesse R. Cougle The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.
  • Effects of Intensive Behavioral Treatment for Children With Varying Levels
           of Conduct Problems and Callous-Unemotional Traits
    • Abstract: Publication date: January 2019Source: Behavior Therapy, Volume 50, Issue 1Author(s): Pevitr S. Bansal, Daniel A. Waschbusch, Sarah M. Haas, Dara E. Babinski, Sara King, Brendan F. Andrade, Michael T. Willoughby The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, Mage = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.
  • Acknowledgment to 2018 Reviewers
    • Abstract: Publication date: January 2019Source: Behavior Therapy, Volume 50, Issue 1Author(s):
  • Perceptions of Cognitive-Behavioural Therapy and Antidepressant Medication
    • Abstract: Publication date: Available online 11 January 2019Source: Behavior TherapyAuthor(s): Shadi Beshai, Lisa M. Watson, Tyler J.S. Meadows, Joelle N. Soucy The majority of people with depression in the United States either never seek treatment or gravitate exclusively to Antidepressant Medication (ADM), despite the existence of other effective treatments, such as Cognitive Behavioral Therapy (CBT). Reluctance to use psychotherapy is partly due to lack of appropriate mental health literacy and perceptions of low treatment acceptability (appropriateness for a given problem) and credibility (treatment logicalness, and whether the patient expects improvement). In the current investigation, we examined whether providing psychoeducation about CBT for depression would change participant perceptions of the treatment's acceptability and credibility. We recruited 554 (female n = 314; 57%) participants across two online studies, and assessed their baseline perceptions of CBT and ADM using modified Treatment Acceptability (TAAS) and Treatment Credibility and Expectancy (CEQ) scales. Participants were subsequently presented with evidence-based, expert-vetted psychoeducational materials describing CBT and ADM, and were asked to re-complete the TAAS and CEQ. In Study 1, participants endorsed significantly higher CBT-CEQ (Credibility/Expectancy) scores post-psychoeducation. In Study 2, participants endorsed significantly lower CBT-TAAS (Acceptability), and among those with no exposure to depression treatments, endorsed significantly higher CBT-CEQ scores post-psychoeducation. In both studies, there were no perceptual changes of ADM after the psychoeducation. Finally, in Study 2, endorsement of a biological model of depression and depressive symptoms were negatively predictive of CBT's acceptability and credibility and expectancy post-psychoeducation. Perceptions of credibility and expectancy of CBT for depression appear malleable even after exposure to brief psychoeducation, whereas shifting perceptions of CBT's acceptability may require more extensive intervention.
  • Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic
    • Abstract: Publication date: Available online 10 January 2019Source: Behavior TherapyAuthor(s): Jennifer L. Greenberg, Katharine A. Phillips, Gail Steketee, Susanne S. Hoeppner, Sabine Wilhelm Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits. We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18–22 weeks. Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at post-treatment. Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.
  • Changes in decentering and reappraisal temporally precede symptom
           reduction during Emotion Regulation Therapy for generalized anxiety
           disorder with and without co-occurring depression
    • Abstract: Publication date: Available online 4 January 2019Source: Behavior TherapyAuthor(s): Mia S. O'Toole, Megan E. Renna, Douglas S. Mennin, David M. Fresco Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was non-significant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well.
  • Improving Couples' Relationship Functioning Leads to Improved Coparenting:
           A Randomized Controlled Trial with Rural African American Couples
    • Abstract: Publication date: Available online 4 January 2019Source: Behavior TherapyAuthor(s): Justin A. Lavner, Allen W. Barton, Steven R.H. Beach Family-centered prevention programs for couples with children are being increasingly disseminated, with the hope that improving couples' romantic relationships will lead to other benefits for families. To date, however, it is unclear whether these interventions do in fact yield these benefits. The current study addressed this gap by examining whether post-intervention improvements in couples' relationship functioning following family-centered prevention predicted longer-term change in coparenting, and whether post-intervention improvements in coparenting predicted longer-term change in relationship functioning. We used four waves of data collected over 2 years from 346 rural African American couples with an early adolescent child who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, an intervention designed to promote strong couple, coparenting, and parent–child relationships in two-parent African American families. Results indicated that ProSAAF had significant short-term positive effects on both romantic relationship functioning and coparenting and that these effects did not differ in magnitude. Over time, however, only romantic relationship functioning post-intervention was positively associated with long-term changes in coparenting; coparenting post-intervention was not associated with long-term changes in relationship functioning and this association was significantly weaker than the other pathway. These findings support a key premise underlying relationship enhancement programs for parents, indicating that improving couples' romantic relationship functioning can have longer-term benefits for the coparenting relationship as well. Further research examining long-term parent, child, and family outcomes following family-centered prevention for couples and the mechanisms of change underlying these outcomes is needed.
  • Group Differences in Facial Emotion Expression in Autism: Evidence for the
           Utility of Machine Classification
    • Abstract: Publication date: Available online 21 December 2018Source: Behavior TherapyAuthor(s): Nicole N. Capriola-Hall, Andrea Trubanova Wieckowski, Deanna Swain, Sherin Aly, Amira Youssef, A. Lynn Abbott, Susan W. White Effective social communication relies, in part, on accurate nonverbal expression of emotion. To evaluate the nature of facial emotion expression (FEE) deficits in children with Autism Spectrum Disorder (ASD), we compared 20 youth with ASD to a sample of typically developing (TD) youth (n = 20) using a machine-based classifier of FEE. Results indicate group differences in FEE for overall accuracy across emotions. In particular, a significant group difference in accuracy of FEE was observed when participants were prompted by a video of a human expressing an emotion, F(2, 36) = 4.99, p = .032, η2 = 0.12. Specifically, youth with ASD made significantly more errors in FEE relative to TD youth. Findings support continued refinement of machine-based approaches to assess and potentially remediate FEE impairment in youth with ASD.
  • Symptom Severity at Week Four of Cognitive Behavior Therapy Predicts
           Depression Remission
    • Abstract: Publication date: Available online 12 December 2018Source: Behavior TherapyAuthor(s): Jacqueline B. Persons, Cannon Thomas Early response has been shown to predict psychotherapy outcome. We examined the strength of the relationship between early response and remission in 82 patients who received naturalistic cognitive behavior therapy in a private practice setting, and 158 patients who received protocol cognitive therapy in a research setting. We predicted that the relationship between early response and remission would be substantial enough to guide clinical decision-making in both samples, and that a simple model of severity at week four of treatment would predict remission as effectively as a more complex change score. Logistic regressions showed that a simple model based on week four Beck Depression Inventory (BDI) score was as predictive of remission as more complex models of early change. A receiver operating characteristics (ROC) analysis showed that BDI score at week four was substantially predictive of remission in both the naturalistic and research protocol samples; the area under the curve was 0.80 and 0.84 in the naturalistic and protocol samples respectively. To guide clinical decision-making, we identified threshold scores on the BDI corresponding to various negative predictive values (probability of non-remission when non-remission is predicted). Our results indicate that depressed patients who remain severely depressed at week four of cognitive therapy are unlikely to reach remission at the end of relatively brief (maximum 20 sessions) treatment. We discuss implications of our findings for clinical decision-making and treatment development.
  • Reducing Test Anxiety in School Settings: A Controlled Pilot Study
           Examining a Group Format Delivery of the Attention Training Technique
           among Adolescent Students
    • Abstract: Publication date: Available online 11 December 2018Source: Behavior TherapyAuthor(s): Thomas A. Fergus, Christine A. Limbers Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined if a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed post-intervention study measures on the final day of the intervention and completed follow-up study measures approximately three weeks following the intervention. As predicted, students receiving ATT reported less post-intervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed.
  • Could Treatment Matching Patients' Beliefs about Depression Improve
    • Abstract: Publication date: Available online 8 December 2018Source: Behavior TherapyAuthor(s): Jeffrey R. Vittengl, Lee Anna Clark, Michael E. Thase, Robin B. Jarrett Patients' beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of (a) biochemical causes and (b) need for medication), and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients' biological beliefs about depression could increase CT efficacy.
  • A latent structure analysis of cognitive vulnerability to depression in
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): Richard T. Liu, Brae Anne McArthur, Taylor A. Burke, Jessica L. Hamilton, Naoise Mac Giollabhui, Jonathan P. Stange, Elissa J. Hamlat, Lyn Y. Abramson, Lauren B. Alloy Whether cognitive vulnerability to depression exists along a continuum of severity or as a qualitatively discrete phenomenological entity has direct bearing on theoretical formulations of risk for depression and clinical risk assessment. This question is of particular relevance to adolescence, given that cognitive vulnerability appears to coalesce and rates of depression begin to rise markedly during this period of development. Although a dimensional view is often assumed, it is necessary to submit this assumption to direct empirical evaluation. Taxometric analysis is a family of statistical techniques developed directly to test such assumptions. The present study applied taxometric methods to address this question in a community sample of early adolescents (n = 485), drawing on three indices of cognitive vulnerability to depression (i.e., negative inferential style, ruminative response style, self-referent information processing). The results of three taxometric analyses (i.e., mean above minus below a cut [MAMBAC], maximum eigenvalue [MAXEIG], and latent mode [L-Mode]) were consistent in unambiguously supporting a dimensional conceptualization of this construct. The latent structure of the tested indices of cognitive vulnerability to depression in adolescence appears to exist along a continuum of severity rather than as a discrete clinical entity.
  • Prevention of Initial Depressive Disorders among “At-Risk”
           Portuguese Adolescents
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): A. Paula Matos, M. do Rosário Pinheiro, José J. Costa, M. do Céu Salvador, Eirikur Ö. Arnarson, W. Edward Craighead This study evaluated whether Arnarson and Craighead's (2009, 2011) developmentally-based behavioral and cognitive program that prevented the initial episode of depressive disorders among Icelandic adolescents could be adapted to prevent depressive disorders among “at-risk” Portuguese adolescents. One hundred sixty-eight Portuguese mid-adolescents (primarily 14–15-years-old), who had subsyndromal symptoms of depression but who had never met criteria for a depressive disorder, were identified by classroom screening with the CDI and subsequent K-SADS-PL interview. All 168 adolescents were offered participation in the 14-week prevention program; 70 agreed to participate in the program, and 98 agreed to participate only in an assessment control group. Psychological disorders were evaluated at baseline, 6-, 12-, 18-, and 24-month assessments. During the 2-year follow-up period, 12 students in the assessment-only group experienced an initial depressive disorder versus 2 in the prevention group. Survival analyses indicated a significantly lower rate of initial episodes of depressive disorders (χ2(1) = 4.261, p = .039) among the prevention group participants compared to the assessment only comparison group. The hazard ratio was 0.207, and the NNT was 11. Survival analyses indicated no significant differences between the prevention condition and the assessment only condition in the occurrence of other psychiatric disorders (χ2(1) = 1.080, p = .299). The findings indicate the program can be successfully adapted for use in Portuguese schools, and they provide a preliminary indication that those “at-risk” adolescents who chose to participate in the program, compared to those who chose to participate only in the assessments, developed fewer initial episodes of depressive disorders over the course of 24 months. The program effects were similar to the outcomes of the prior study of this program in Iceland. As in the Icelandic version of the program, its effects appeared to be specific to the depressive disorders for which the program was designed.
  • The Role of Dyadic Discord in Outcomes in Acute Phase Cognitive Therapy
           for Adults with Recurrent Major Depressive Disorder
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): Joseph M. Trombello, Jeffrey R. Vittengl, Wayne H. Denton, Abu Minhajuddin, Michael E. Thase, Robin B. Jarrett Major depressive disorder (MDD) and relationship discord between cohabiting partners frequently co-occur, with bidirectional effects established. As relationship quality influences understanding and treatment of MDD, the current analyses clarified the relations of pretreatment dyadic discord with outcomes during and at the end of acute phase cognitive therapy (CT) for adults with recurrent MDD. Married or cohabiting patients (n = 219) completed the Dyadic Adjustment Scale (DYS) before and after a 16–20 session, 12–14 week CT protocol. Lower levels of dyadic adjustment indicated higher levels of dyadic discord. Response to CT was defined as the absence of a major depressive episode and ≤ 12 on the 17-item Hamilton Rating Scale for Depression. Pre-treatment dyadic discord, whether defined as a continuous or categorical variable (using DYS cutoff score of 97), was not associated with treatment completion or response but was positively associated with levels of depressive symptoms at the end of acute phase CT. Furthermore, CT was associated with declines in dyadic discord, with 23.3% of initially-discordant couples moving to nondiscordant status at the end of CT. Depressive symptoms did not significantly mediate changes in dyadic discord. Finally, pre- (but not mid-) treatment dyadic discord was associated with subsequent changes in depressive symptoms, suggesting limited mediation. These findings replicate prior research indicating that individual CT is associated with reductions in depressive symptoms and dyadic discord while clarifying that lower pre-treatment dyadic discord may predict initial improvement in depressive symptoms.
  • A Sequential Analysis of Clinician Skills and Client Change Statements in
           Brief Motivational Intervention for Young Adult Heavy Drinking
    • Abstract: Publication date: Available online 29 November 2018Source: Behavior TherapyAuthor(s): Justin Walthers, Tim Janssen, Nadine R. Mastroleo, Ariel Hoadley, Nancy P. Barnett, Suzanne M. Colby, Molly Magill This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians' use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice) and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians' use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.
  • Negative interpretation biases precede the onset of psychosis
    • Abstract: Publication date: Available online 23 November 2018Source: Behavior TherapyAuthor(s): Jenny Yiend, Paul Allen, Natalie Lopez, Irina Falkenberg, Huai-Hsuan Tseng, Philip McGuire This study investigated whether a negative interpretation bias was present in people at high risk for psychosis. People with an At Risk Mental State (ARMS) (n = 21), patients with First Episode Psychosis (FEP) (n = 20), and healthy controls (n = 20) performed three tasks, each of which was designed to measure interpretation bias. Both ARMS and FEP participants showed an attenuated positive bias compared to controls. These findings extend previous results investigating interpretation bias in psychosis by showing that interpretative biases are present before the onset of psychosis, and could therefore contribute to its development. Biased interpretation mechanisms could be a new target for clinical intervention in the early phase of psychosis.
  • The fixed mindset of anxiety predicts future distress: A longitudinal
    • Abstract: Publication date: Available online 14 November 2018Source: Behavior TherapyAuthor(s): Hans S. Schroder, Courtney P. Callahan, Allison E. Gornik, Jason S. Moser Mindsets, or beliefs about the malleability of self-attributes such as intelligence and personality, have been linked to a wide range of outcomes in educational and social psychology. There has been recent interest in exploring this construct in clinical psychological contexts. To that end, research has shown that the fixed mindset of anxiety– the belief that anxiety is fixed and unchangeable- is related to a variety of psychological distress symptoms, emotion regulation strategies, and treatment preferences. One outstanding question is whether the fixed mindset of anxiety predicts future psychological symptoms. To address this question, the current longitudinal study assessed weekly distress and anxiety mindset across five weeks. We found that fixed mindset of anxiety is predictive of future weekly distress, even after controlling for the previous week's distress, sex, socioeconomic status, baseline depression symptoms, and presence of psychiatric diagnosis. These findings add evidence to an emerging conceptual framework in which the fixed mindset of anxiety represents an important risk factor for the onset of future psychological problems.
  • Self-Help for Social Anxiety: Randomized Controlled Trial comparing a
           Mindfulness and Acceptance-based Approach with a Control Group
    • Abstract: Publication date: Available online 4 November 2018Source: Behavior TherapyAuthor(s): Nancy L. Kocovski, Jan E. Fleming, Rebecca A. Blackie, Meagan B. MacKenzie, Alison L. Rose There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from 0.74 to 0.79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.
  • Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic
    • Abstract: Publication date: Available online 16 October 2018Source: Behavior TherapyAuthor(s): Asher Y. Strauss, Yogev Kivity, Jonathan D. Huppert Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or post-treatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.
  • Sudden Gains: How Important Are They During Exposure and Response
           Prevention for Obsessive–Compulsive Disorder'
    • Abstract: Publication date: Available online 16 October 2018Source: Behavior TherapyAuthor(s): Jennifer L. Buchholz, Jonathan S. Abramowitz, Shannon M. Blakey, Lillian Reuman, Michael P. Twohig Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive–compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at post-treatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.
  • Feasibility of Automated Training for Facial Emotion Expression and
           Recognition in Autism
    • Abstract: Publication date: November 2018Source: Behavior Therapy, Volume 49, Issue 6Author(s): Susan W. White, Lynn Abbott, Andrea Trubanova Wieckowski, Nicole N. Capriola-Hall, Sherin Aly, Amira Youssef Impairment in facial emotion recognition (FER) and facial emotion expression (FEE), often documented in autism spectrum disorder (ASD), are believed to contribute to the observed core social-communication disability that characterizes this disorder. Moreover, impaired FER and FEE are frequently seen in other disorders and problem behaviors. We describe the development of a novel system to detect and give real-time feedback on these processes, termed facial emotion expression training (FEET), an automated, gamelike system that is based on 3-dimensional sensing (Kinect) technology. A sample of 40 children (n = 20 ASD, n = 20 typically developing) interacted with our prototype system, which presented audiovisual stimuli and assessed responses of participants. Overall, consumer satisfaction ratings were high, and youth with ASD reported enjoying interacting with the system more than did the typical youth. Results suggest that new technology-based interventions are acceptable to consumers and viable for use in remediation of transdiagnostic processes, such as FER and FEE. Implications for future technology-based intervention to target transdiagnostic processes are discussed.
  • Volume Author Index
    • Abstract: Publication date: November 2018Source: Behavior Therapy, Volume 49, Issue 6Author(s):
  • Development and Preliminary Evaluation of a Positive Emotion Regulation
           Augmentation Module for Anxiety and Depression
    • Abstract: Publication date: November 2018Source: Behavior Therapy, Volume 49, Issue 6Author(s): Jenna R. Carl, Matthew W. Gallagher, David H. Barlow Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. Many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to disorder severity and prevent full recovery, and these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of adding a novel brief intervention module for enhancing positive emotion in anxiety and depressive disorders to existing evidence-based treatment. This intervention was evaluated in nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment, utilizing a multiple baseline experimental-across-participants design. Results indicated that the intervention was effective in improving positive emotion regulation skills for five of nine participants. The intervention was also associated with further improvements in anxiety and depressive symptoms, positive and negative emotion, functioning, quality of life, and well-being. Participants reported high acceptability and satisfaction with the study intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.
  • Predictors of symptom outcome in interpretation bias modification for
    • Abstract: Publication date: Available online 9 October 2018Source: Behavior TherapyAuthor(s): Hillary L. Smith, Katherine A. McDermott, Corinne N. Carlton, Jesse R. Cougle Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pre-treatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.
  • The Effect of a Brief Mindfulness Training on Distress Tolerance and
           Stress Reactivity
    • Abstract: Publication date: Available online 9 October 2018Source: Behavior TherapyAuthor(s): Joseph K. Carpenter, Jenny Sanford, Stefan G. Hofmann Distress tolerance (DT) is considered an underlying facet of anxiety, depression and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance non-judgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the non-judge and non-react facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.
  • Is heightened disgust propensity truly a risk factor for
           contamination-related obsessive–compulsive disorder'
    • Abstract: Publication date: Available online 9 October 2018Source: Behavior TherapyAuthor(s): Gabriele Melli, Andrea Poli, Carlo Chiorri, Bunmi O. OlatunjiABSTRACTDisgust propensity (DP) has been conceptualized as a stable personality trait that confers risk for contamination-related OCD (C-OCD). However, the extent to which DP leads to the subsequent development of C-OCD is unclear. In fact, the presence of C-OCD might lead to an increase in DP rather than the inverse. The present study was aimed to test this hypothesis in a large clinical sample of OCD patients (≥ 21 years of age) with (C-OCD; n = 56) and without (NC-OCD; n = 103) contamination-related symptoms that completed measures of OCD symptoms, depression, anxiety, and DP. DP was assessed twice, in reference to the present situation (T1) and to when the participant was 18 years old (T0). The two groups did not significantly differ in DP at T0. However, C-OCD participants reported higher DP scores than NC-OCD at T1. Furthermore, the T1 vs T0 difference in DP was significant only in the C-OCD group. Subsequent analyses also showed that T1 DP levels, but not T0 levels, significantly predicted contamination-related symptoms. Despite study limitations, these findings question the role of DP as a risk factor for C-OCD.
  • Sleep-Related Problems in Paediatric Obsessive–Compulsive Disorder and
           Intensive Exposure Therapy
    • Abstract: Publication date: Available online 28 September 2018Source: Behavior TherapyAuthor(s): Natalja A. Nabinger de Diaz, Lara J. Farrell, Allison M. Waters, Caroline Donovan, Harry W. McConnell Limited research has examined sleep-related problems (SRPs) among children and adolescents with Obsessive–Compulsive Disorder (OCD). The present study addresses this gap by investigating preliminary associations between SRPs, demographic factors (gender and age), family variables (family accommodation and parental stress) and clinical factors (medication status, internalising and externalising symptoms, OCD severity, OCD-related impairment), and treatment outcomes in a sample of 103 youth (aged 7 to 17 years; 53% female) with a primary diagnosis of OCD. Clinician, parent, and child measures were used to assess demographic, family, and clinical predictors. SRPs were assessed using an 8-item measure comprising items of the Child Behaviour Checklist, Child Depression Inventory, and Multidimensional Anxiety Scale for Children as used in previous studies. Results showed that SRPs were highly prevalent among this sample and that more SRPs were associated with younger age, internalising problems, and functional impairment. However, SRPs were not an independent predictor of OCD severity, impairment, or treatment response. Preliminary findings suggest that SRPs among youth with OCD may be more strongly associated with broader internalising symptoms than with OCD itself. Future longitudinal research is warranted to further explore the complexity of SRPs when co-occurring with paediatric OCD.
  • Cognitive And Behavioral Differences Between Subtypes In Refractory
           Irritable Bowel Syndrome
    • Abstract: Publication date: Available online 21 September 2018Source: Behavior TherapyAuthor(s): Sula Windgassen, Rona Moss-Morris, Hazel Everitt, Alice Sibelli, Kimberley Goldsmith, Trudie Chalder Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C) and alternating (IBS-A). This paper aimed to identify whether (1) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes (2) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, severity and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.
  • Examining the effects of exercise on pattern separation and the moderating
           effects of mood symptoms
    • Abstract: Publication date: Available online 21 September 2018Source: Behavior TherapyAuthor(s): Emily E. Bernstein, Richard J. McNally Aerobic exercise has broad cognitive benefits. One target of interest is enhanced memory. The present study explored pattern separation as a specific memory process that could be sensitive to acute and regular exercise and clinically significant for disorders (.e.g., depression) characterized by cognitive-affective deficits and hippocampal impairment. In a within-subjects design, participants (N = 69) attended two visits during which they repeated a behavioral pattern separation task at rest and after an activity (cycling, stretching). Regular exercise habits, demographics, mood and anxiety symptoms, and recognition memory capacity were also measured. More regular exercise predicted better resting pattern separation, t(62) = 2.13, b = 1.74, p = .037. Age moderated this effect, t(61) = 2.35, b = 0.25, p = .02; exercise most strongly predicted performance among middle-age participants. There was no main effect of activity condition on post-activity performance, t(61) = 0.67, p = .51. However, with significant heterogeneity in reported mood symptoms and regular exercise habits, there was a three-way interaction between condition, regular exercise, and depression, t(55) = 2.08, b = 0.22, p = .04. Relative to stretching, cycling appears to have enhanced the benefit of regular exercise for pattern separation performance; however, this was evident among participants with mild to no symptoms of depression, but absent among participants with moderate to severe symptoms. Results have implications for how exercise might protect against declines in pattern separation. Future research should explore exercise's potential as a prevention tool or early intervention for pattern separation and related clinical outcomes.
  • Repetitive thinking in social anxiety disorder: Are anticipatory
           processing and post-event processing facets of an underlying
           unidimensional construct'
    • Abstract: Publication date: Available online 18 September 2018Source: Behavior TherapyAuthor(s): Quincy J.J. Wong, Peter M. McEvoy, Ronald M. Rapee Existing literature suggests that anticipatory processing and post-event processing - two repetitive thinking processes linked to social anxiety disorder (SAD) – might be better conceptualised as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomised controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = 0.43 to 0.47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = 0.16 to 0.27) and was not related to life interference (r = 0.11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD.
  • Effects of Rumination and Worry on Sleep
    • Abstract: Publication date: Available online 18 September 2018Source: Behavior TherapyAuthor(s): Olivia H. Tousignant, Nicholas D. Taylor, Michael K. Suvak, Gary D. Fireman Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought—rumination and worry—are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of two weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.
  • Infant Language Production and Parenting Skills: A Randomized Controlled
    • Abstract: Publication date: Available online 11 September 2018Source: Behavior TherapyAuthor(s): Dainelys Garcia, Gabriela M. Hungerford, Ryan M. Hill, Nicole E. Barroso, Daniel M. Bagner The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the Child-Directed Interaction phase of Parent–Child Interaction Therapy, on infant language production. Participants were sixty infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers' use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.
  • Translating CBM-I into real world settings: Augmenting a CBT-based
           psychiatric hospital program
    • Abstract: Publication date: Available online 11 September 2018Source: Behavior TherapyAuthor(s): Courtney Beard, Lara S. Rifkin, Alexandra L. Silverman, Thröstur Björgvinsson Cognitive Bias Modification for interpretation bias (CBM-I) is an appealing augmentation to CBT because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the Word-Sentence Association Paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% non-binary) to either CBM-I or a control group (Phase 1: Neutral WSAP task; Phase 2: Treatment as usual (TAU)). CBM-I comprised daily sessions (10-minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = .378), but no group differences on depression outcomes (d = .008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.
  • Impulsivity and Behavior-Dependent Life Events Mediate the Relationship of
           Reward Sensitivity and Depression, but not Hypomania, Among at-Risk
    • Abstract: Publication date: Available online 11 September 2018Source: Behavior TherapyAuthor(s): Corinne P. Bart, Lyn Y. Abramson, Lauren B. Alloy Both reward sensitivity and impulsivity are related to the development and course of bipolar spectrum disorders (BSDs) and have been implicated in other disorders and negative functional outcomes such as substance abuse, obesity, suicidal behaviors, and risk-taking. Furthermore, according to the transactional component of the Behavioral Approach System(BAS)/reward hypersensitivity theory of BSDs, people with reward hypersensitivity should experience more BAS-relevant events, and thus, are more vulnerable to mood symptoms and episodes via stress generation. Impulsivity may exacerbate stress generation in individuals at risk for BSDs based on exhibiting reward hypersensitivity. The current study examined whether impulsivity explained the generation of stress and subsequent mood symptoms beyond what is explained by reward sensitivity alone. Participants were 131 Moderate BAS and 216 High BAS sensitivity adolescents (M = 18.43 years, SD = 1.40), who completed baseline measures of reward sensitivity and impulsivity, as well as follow-up measures of life events and mood symptoms. Results from linear regression analyses indicated that higher baseline impulsivity predicted behavior-dependent, but not behavior-independent life events. Furthermore, path analyses suggested that the effect of BAS group on depression symptoms at next follow-up was partly explained via the indirect effect of impulsivity and negative behavior-dependent life events. We did not find these effects for behavior-independent or positive-dependent events or for prediction of hypomanic symptoms. The findings suggest that impulsivity may account for stress generation of negative events that precede depression.
  • Trajectories of Change in a Group Behavioral Activation Treatment for
           Severe, Recurrent Depression
    • Abstract: Publication date: Available online 31 August 2018Source: Behavior TherapyAuthor(s): Heather A. O’Mahen, Nicholas J. Moberly, Kimberly A. Wright Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to post-treatment was large, Cohen's d = 1.25. Although 34% (26 of the 77 who provided outcome data) individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted post-treatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.
  • Individuals Intolerant of Uncertainty: The Maintenance of Worry and
           Distress Despite Reduced Uncertainty
    • Abstract: Publication date: Available online 23 August 2018Source: Behavior TherapyAuthor(s): Rachel M. Ranney, Evelyn Behar, Gregory Bartoszek The intolerance of uncertainty model (IUM) of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but there few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.
  • A direct observational measure of family functioning for a low-resource
           setting: Adaptation and feasibility in a Kenyan sample
    • Abstract: Publication date: Available online 20 August 2018Source: Behavior TherapyAuthor(s): Ali M. Giusto, Bonnie N. Kaiser, David Ayuku, Eve S. Puffer Family interactions are recognized as highly influential for youth development of psychopathology. Key challenges for assessing family functioning include cross-cultural variability in functioning and self-report measurement challenges. Observational measures –adapted to cultural context – provide an approach to addressing challenges. This study aimed to adapt a direct observational tool for assessing family interaction patterns in Kenya, to outline a replicable adaptation process, and to explore tool feasibility and acceptability. We reviewed existing tools to assess their adaptability based on compatibility with context-specific data. After initial modifications, the measure was iteratively adapted through pilot testing and collaborative discussions between US and Kenyan collaborators that drove changes and further piloting. The measure was administered to 26 families. The Family Problem Solving Code was chosen for adaptation. The tool's activity structure was feasible to administer, but activity content showed low acceptability, requiring new content. Final activities included (a) a hands-on problem-solving task, (b) a discussion of marital conflict with couples, and (c) a structured discussion of family hopes. Codes were adapted to reflect culturally-congruent descriptions of behavior, expressions, and interactions; including an emphasis on non-verbal interactions. The scoring system was modified to facilitate training and consistent rating among trainees with limited experience. Observational tool findings were consistent with those of an interview assessing family functioning, rated by clinical and non-clinical raters. Adaptation resulted in a culturally-relevant tool assessing family functioning that proved feasible and acceptable. The adaptation process also proved feasible and efficient in a low-resource setting, suggesting its utility for other contexts.
  • Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout
    • Abstract: Publication date: Available online 20 August 2018Source: Behavior TherapyAuthor(s): Fredrik Santoft, Sigrid Salomonsson, Hugo Hesser, Elin Lindsäter, Brjánn Ljótsson, Mats Lekander, Göran Kecklund, Lars-Göran Öst, Erik Hedman-Lagerlöf Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators, i.e., sleep quality, behavioral activation, perceived competence and therapeutic alliance, and outcome, i.e., symptoms of burnout, were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = − 0.017, 95% CIasymmetric [− 0.037, − 0.002], and increase in perceived competence, ab = − 0.037, 95% CIasymmetric [− 0.070, − 0.010]. Behavioral activation, ab = − 0.004 [− 0.016, 0.007], and therapeutic alliance, ab = 0.002 [− 0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.
  • An Internet-Based Compassion-Focused Intervention for Increased
           Self-Criticism: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 17 August 2018Source: Behavior TherapyAuthor(s): Tobias Krieger, Fabienne Reber, Barbara von Glutz, Antoine Urech, Christian T. Moser, Ava Schulz, Thomas Berger Increased levels of self-criticism and a lack of self-compassion have been associated with the development and maintenance of a range of psychological disorders. In the current study, we tested the efficacy of an online version of a compassion-focused intervention, mindfulness-based compassionate living (MBCL), with guidance on request. A total of 122 self-referred participants with increased levels of self-criticism were randomly assigned to care as usual (CAU) or the intervention group (CAU + online intervention). Primary endpoints were self-reported depressive, anxiety and distress symptoms (DASS-21) and self-compassion (SCS) at 8-weeks. Secondary endpoints were self-criticism, mindfulness, satisfaction with life, fear of self-compassion, self-esteem and existential shame. At post-treatment, the intervention group showed significant changes with medium to large effect sizes compared to the control group regarding primary outcomes (Cohen's d: 0.79 [DASS] and − 1.21 [SCS]) and secondary outcomes (Cohen's ds: between 0.40 and 0.94 in favor of the intervention group). The effects in the intervention group were maintained at six-months post-randomization. Adherence measures (number of completed modules, self-reported number of completed exercises per week) predicted post-intervention scores for self-compassion but not for depressive, anxiety, and distress symptoms in the intervention group. The current study shows the efficacy of an online intervention with a transdiagnostic intervention target on a broad range of measures, including depressive and anxiety symptoms and self-compassion.
  • Dissemination and Implementation of Cognitive Behavioral Therapy for
           Depression in the Kaiser Permanente Health Care System: Evaluation of
           Initial Training and Clinical Outcomes
    • Abstract: Publication date: Available online 16 August 2018Source: Behavior TherapyAuthor(s): Bradley E. Karlin, Gregory K. Brown, Shari Jager-Hyman, Kelly L. Green, Michi Wong, Diane S. Lee, Andrew Bertagnolli, Thekla Brumder Ross Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, Cognitive Behavioral Therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.
  • Introduction to the Special Issue: Integration of Technological Advances
           in Cognitive-Behavior Therapy
    • Abstract: Publication date: Available online 9 August 2018Source: Behavior TherapyAuthor(s): Dean McKay A wide range of technological approaches has been adopted in assessment and intervention using cognitive-behavior therapy (CBT). The articles that comprise this special issue cover a diversity of areas, ranging from assessment including: motion-tracking devices, ecological momentary assessment, facial recognition software to provide rapid feedback, audio and tablet-based CBT administered procedures, web-based acceptance program for stress-reduction, and videoconferencing for delivery of anxiety treatment in youth. It is expected that technological advances will continue to lead to additional advances in CBT delivery.
  • The Struggle of Behavioral Therapists With Exposure: Self-Reported
           Practicability, Negative Beliefs, and Therapist Distress About
           Exposure-Based Interventions
    • Abstract: Publication date: Available online 3 August 2018Source: Behavior TherapyAuthor(s): Andre Pittig, Roxana Kotter, Jürgen Hoyer Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
  • I did OK, but did I Like it' Using Ecological Momentary Assessment to
           Examine Perceptions of Social Interactions Associated With Severity of
           Social Anxiety and Depression
    • Abstract: Publication date: Available online 3 August 2018Source: Behavior TherapyAuthor(s): Emily C. Geyer, Karl C. Fua, Katharine E. Daniel, Philip I. Chow, Wes Bonelli, Yu Huang, Laura E. Barnes, Bethany A. Teachman Socially anxious and depressed individuals tend to evaluate their social interactions negatively, but little is known about the specific real-time contributors to these negative perceptions. The current study examined how affect ratings during social interactions predict later perceptions of those interactions, and whether this differs by social anxiety and depression severity. Undergraduate participants (N = 60) responded to a smartphone application that prompted participants to answer short questions about their current affect and social context up to six times a day for two weeks. At the end of each day, participants answered questions about their perceptions of their social interactions from that day. Results indicated that the link between negative affective experiences reported during social interactions and the end-of-day report of enjoyment (but not effectiveness) of those experiences was more negative when social anxiety was more severe. The link between negative affective experiences rated during social interactions and the end-of-day report of effectiveness (but not enjoyment) during those social encounters was more negative when depression was more severe. These findings demonstrate the importance of examining self-perceptions of social interactions based both on the extent to which individuals think that they met the objective demands of an interaction (i.e., effectiveness, mastery) and the extent to which they liked or disliked that interaction (i.e., enjoyment, pleasure). These findings also highlight how real-time assessments of daily social interactions may reveal the key experiences that contribute to negative self-evaluations across disorders, potentially identifying critical targets for therapy.
  • Self-Criticism Impacts Emotional Responses to Pain
    • Abstract: Publication date: Available online 1 August 2018Source: Behavior TherapyAuthor(s): Kathryn R. Fox, Isabel M. O'Sullivan, Shirley B. Wang, Jill M. Hooley Nonsuicidal self-injury (NSSI) is associated with numerous negative outcomes (e.g., suicide attempts), making it a focus of great clinical concern. Yet, mechanisms reinforcing NSSI remain unclear. The Benefits and Barriers Model proposes that NSSI engagement is determined by both benefits of and barriers to NSSI. Benefits include mood improvement, a function reported by most who engage in NSSI; barriers include a desire to avoid pain and bodily harm. Self-criticism is generally understood as a trait lowering desire to avoid pain and bodily harm, thus decreasing that specific barrier. However, recent research demonstrated that self-criticism may also increase NSSI benefits. Highly self-critical people may view NSSI and pain in the context of feeling deserving of pain and punishment; thus, pain may improve mood for self-critical individuals. We tested whether self-criticism impacted emotional responding to pain among adult females with (n = 44) and without (n = 65) NSSI histories. After a negative mood induction, participants rated their moods before, during, and after self-administered pain. In participants with and without NSSI histories, self-criticism was positively correlated with mood improvements during pain. Thus, regardless of NSSI history, self-criticism impacted emotional responses to pain. Together, results suggest that self-criticism may not only decrease an important NSSI barrier but also enhance NSSI benefits, specifically leading to more mood improvement during pain.
  • Testing an app-assisted treatment for suicide prevention in a randomized
           controlled trial: Effects on suicide risk and depression
    • Abstract: Publication date: Available online 30 July 2018Source: Behavior TherapyAuthor(s): Mia Skytte O'Toole, Mikkel B. Arendt, Christian M. Pedersen Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. 129 participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU + APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., “LifeApp'tite”). Suicide risk and symptoms of depression were assessed pre and post therapy, and at 4-month follow-up.The TAU + APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was only the case at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.
  • Different disgust domains specifically relate to mental and contact
           contamination fear in obsessive–compulsive disorder: evidence from a
           path analytic model in an Italian clinical sample
    • Abstract: Publication date: Available online 29 July 2018Source: Behavior TherapyAuthor(s): Andrea Poli, Gabriele Melli, Adam S. Radomsky Both contact contamination (CC) and mental contamination (MC) fears – which combined represent the most common manifestation of obsessive–compulsive disorder (OCD) - have been widely associated with disgust propensity (DP). However, extant research explored this relationship using measures assessing only pathogen-related disgust, not taking into account the potential role played by sexual and moral disgust, despite literature about MC suggesting that this might be particularly relevant. In Study 1 the psychometric properties of the Italian version of the Three Domains of Disgust Scale (TDDS) were assessed in a large Italian community sample. Exploratory and confirmatory factor analyses confirmed the three-factor structure of the TDDS. The scale also showed good internal consistency and construct validity. In Study 2, the differential patterns of relationships between CC and MC and the three disgust domains were explored in an Italian clinical OCD sample using a path analytic approach. The TDDS-Pathogen subscale was a unique predictor of CC while the TDDS-Sexual subscale was a unique predictor of MC, after controlling for anxiety and depression. Surprisingly, the TDDS-Moral subscale was not a predictor of either domain of contamination fear. Limitations and clinical implications are discussed.
  • Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care
           in Child Mental Health Treatment
    • Abstract: Publication date: Available online 27 July 2018Source: Behavior TherapyAuthor(s): Tatiana M. Davidson, Brian E. Bunnell, Benjamin E. Saunders, Rochelle Hanson, Carla K. Danielson, Danna Cook, Brian Chu, Shannon Dorsey, Zachary W. Adams, Arthur R. Andrews, Jesse Walker, Kathryn E. Soltis, Judith Cohen, Esther Deblinger, Kenneth J. Ruggiero Mental health systems need scalable solutions that can reduce the efficacy-effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high quality care are providers' fidelity to evidence-based treatment models and children's and caregivers' engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio-recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.Technology-Based Tools to Enhance Quality of Care in Mental Health Treatment;; NCT01915160.
  • Patient-Informed Treatment Development of Behavioral Smoking Cessation for
           People with Schizophrenia
    • Abstract: Publication date: Available online 27 July 2018Source: Behavior TherapyAuthor(s): Sarah M. Wilson, Alexandra C. Thompson, Emily D. Currence, Shaun P. Thomas, Eric A. Dedert, Angela C. Kirby, Eric B. Elbogen, Scott D. Moore, Patrick S. Calhoun, Jean C. Beckham The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semi-structured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multi-component mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the StayQuit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at post-treatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.
  • Improved Perceptions of Emotion Regulation and Reflective Functioning in
           Parents: Two Additional Positive Outcomes of Parent–Child Interaction
    • Abstract: Publication date: Available online 12 July 2018Source: Behavior TherapyAuthor(s): Melanie J. Zimmer-Gembeck, Jessica Kerin, Haley J. Webb, Alex Gardner, Shawna Campbell, Kellie Swan, Susan G. Timmer The purpose of this study was to test whether Parent–Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of pre-mentalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, pre-mentalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.
  • The relative effects of abstract versus concrete processing on proactivity
           in depression
    • Abstract: Publication date: Available online 11 July 2018Source: Behavior TherapyAuthor(s): Shanta Dey, Ben R. Newell, Michelle L. Moulds Low levels of proactivity are characteristic of individuals with depression. Two studies were conducted to compare the relative effects of abstract versus concrete processing on proactivity in high dysphoric individuals. In Study 1, participants read information about an upcoming research study and were then randomly allocated to a writing task that induced them to think about participating in that study in either an abstract (e.g., why you would participate in the study'; n = 25) or concrete (e.g., how you will participate in the study'; n = 25) way. Participants were then asked to indicate whether they would sign-up to the study. As expected, more participants indicated that they would take part in the study in the concrete condition (76%) than in the abstract condition (36%). In Study 2, high dysphoric participants were asked to identify their ideal part-time job and were then randomly allocated to a writing task that induced them to think about applying for the job in an abstract (n = 26) or concrete (n = 25) way. There was no difference between conditions in self-reported intentions of proactivity. However, significantly more participants in the concrete condition opted to look at an employment assistance website and returned to the lab to collect a job application package. Overall, these findings suggest that abstract processing could contribute to low levels of proactivity in depression, and that facilitating the use of concrete processing could help to alleviate this problem. Our results also point to the need for greater conceptual clarification of the distinction between concrete processing about proactive behaviour and implementation intentions (identifying specific steps for completing an action/goal).
  • Defining Treatment Outcomes in Pediatric Obsessive–Compulsive Disorder
           Using a Self-report Scale
    • Abstract: Publication date: Available online 22 June 2018Source: Behavior TherapyAuthor(s): Joseph F. McGuire, Daniel A. Geller, Tanya K. Murphy, Brent J. Small, Arianna Unger, Sabine Wilhelm, Eric A. StorchABSTRACTThis study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory-Child Version (OCI-CV) for youth with obsessive–compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and post-treatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the post-treatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20–25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55–65% reduction in the OCI-CV total score and a post-treatment total score ≤ 6–8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pre-treatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.
  • Audio and Computer Cognitive Behavioral Therapy for Depressive Symptoms in
           Older Adults: A Pilot Randomized Controlled Trial
    • Abstract: Publication date: Available online 21 June 2018Source: Behavior TherapyAuthor(s): Avani Shah, Martin Morthland, Forrest Scogin, Andrew Presnell, Elizabeth A. DiNapoli, Jamie DeCoster, Thomas Yang The purpose of this study was to develop and explore the feasibility of audio-based (ACBT) and computer-based (CCBT) cognitive behavioral therapies for older adults with depressive symptoms. The audio program consisted of eight compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: identifying and changing unhelpful thoughts, addressing feelings, relaxation, engaging in pleasant events, assertiveness, and problem-solving. Fifty-one older adults were recruited from medical settings and rural communities. Participants were randomly assigned to immediate treatment (ACBT or CCBT) or delayed treatment control condition. Analyses were conducted to examine change on interviewer-based and self-reported depression. A significant interaction effect between time and condition was found on the interviewer-based depression scale. This suggests that both types of treatments decreased depressive symptoms over time when compared to a delayed treatment control. Computer-based and audio-based cognitive behavioral treatments may be valuable low-cost modalities to deliver psychotherapy to older adults with depressive symptoms.
  • Does Motivation Impact OCD Symptom Severity' An Exploration of
           Longitudinal Effects
    • Abstract: Publication date: Available online 19 June 2018Source: Behavior TherapyAuthor(s): Gabriella Ponzini, Nathaniel Van Kirk, Meghan Schreck, Jacob A. Nota, Casey A. Schofield, Christina Gironda, Jason Elias Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.
  • Surviving and Thriving During Stress: A Randomized Clinical Trial
           Comparing a Brief Web-Based Therapist-Assisted Acceptance-Based Behavioral
           Intervention Versus Waitlist Control for College Students
    • Abstract: Publication date: Available online 5 June 2018Source: Behavior TherapyAuthor(s): Elizabeth H. Eustis, Sarah A. Hayes-Skelton, Susan M. Orsillo, Lizabeth Roemer The high rates of anxiety in college students and the many barriers to accessing evidence-based care in communities and on campuses indicate a clear need to explore ways to increase access to evidence-based treatments. Web-based interventions and preventions are one way to bridge this gap; they hold the potential to decrease mental health disparities and enhance student functioning. The current RCT examined the acceptability and efficacy of a 3-session web-based therapist-assisted acceptance-based behavioral intervention targeting anxiety (Surviving and Thriving During Stress) for college students versus a waitlist (WL) control condition, in a sample of racially and ethnically diverse college students. Overall, participants rated the program as helpful and acceptable. Mixed-effects regression models (MRMs) were run in SPSS to examine the effects of time, condition, and Condition × Time on outcomes and hypothesized mechanisms. Significant Condition × Time interactions for general anxiety, depression, and quality of life (QOL) emerged, suggesting that SATDS participants reported significantly greater changes on these outcomes from pre- to posttreatment versus WL. However, interaction effects were nonsignificant for anxious arousal and social anxiety. MRMs examining hypothesized mechanisms revealed significant Condition × Time interactions for experiential avoidance, decentering, and values-based living. However, interaction effects were nonsignificant for mindfulness. All significant gains were maintained at 1-month follow-up, with the exception of QOL. Results contribute to the growing literature on the acceptability and efficacy of web-based approaches, and suggest these approaches can be effective for diverse college students, and may provide a unique platform to increase access to evidence-based care.
  • The “Brightening” Effect: Reactions to Positive Events in the Daily
           Lives of Individuals With Major Depressive Disorder and Generalized
           Anxiety Disorder
    • Abstract: Publication date: Available online 5 June 2018Source: Behavior TherapyAuthor(s): Gabriela Kattan Khazanov, Ayelet Meron Ruscio, Joel Swendsen Depressed individuals are less reactive than healthy individuals to positive stimuli in the laboratory, but accumulating evidence suggests that they are more emotionally reactive to positive events in their daily lives. The present study probed the boundaries of this curious “mood brightening” effect and investigated its specificity to major depressive disorder (MDD) vis-à-vis generalized anxiety disorder (GAD), its closest boundary condition. We used ecological momentary assessment to measure reactions to positive events over one week in individuals with MDD (n = 38), GAD (n = 36), comorbid MDD-GAD (n = 38), and no psychopathology (n = 33). Depressed individuals responded to positive events with larger changes in affect, cognition, reported withdrawal (but not approach) behavior, and symptoms than healthy controls. More severe depression assessed before the sampling week predicted greater brightening. Altered reactivity to positive events was relatively specific to MDD when compared with GAD, similar to patterns found for other positive emotional processes. The robustness, scope, and relative specificity of the brightening effect highlights the need to resolve conflicting findings across laboratory and non-laboratory studies to advance understanding of altered reactivity in emotional disorders.
  • A Propensity Score Analysis of Homework Adherence-Outcome Relations in
           Cognitive Behavioral Therapy for Depression
    • Abstract: Publication date: Available online 5 June 2018Source: Behavior TherapyAuthor(s): Judith A. Callan, Nikolaos Kazantzis, Seo Young Park, Charity G. Moore, Michael E. Thase, Abu Minhajuddin, Sander Kornblith, Greg J. Siegle Little is known about whether or not a consistently high level of homework adherence over the course of therapy benefits patients. This question was examined in two samples of patients who were receiving individual Cognitive Behavioral Therapy (CBT) for depression (Ns = 128 [Sequenced Treatment Alternatives to Relieve Depression: STAR-D] and 183 [Continuation Phase Cognitive Therapy Relapse Prevention: C-CT-RP]). Logistic and linear regression and propensity score models were used to identify whether or not clinician assessments of homework adherence differentiated symptom reduction and remission, as assessed by the Hamilton Depression Rating Scale-17 (HDRS-17), the Quick Inventory of Depressive Symptomatology–Self-Reported Scale (QIDS-SR), and the QIDS–Clinician Scale (QIDS-C). CBT-related response and remission were equally likely between both high and low homework adherers in both studies and in all models. But in propensity adjusted models that adjusted for session attendance, for both the STAR-D and C-CT-RP samples, greater homework adherence was significantly associated with greater response and remission from depression in the first and last 8 sessions of CBT. Our results suggest that homework adherence can account for response and remission early and late in treatment, with adequate session attendence.
  • Durability of Cognitive Behavioral Therapy Effects for Youth and
           Adolescents With Anxiety, Depression, or Traumatic Stress:A Meta-Analysis
           on Long-Term Follow-Ups
    • Abstract: Publication date: Available online 1 June 2018Source: Behavior TherapyAuthor(s): Leslie R. Rith-Najarian, Bita Mesri, Alayna L. Park, Michael Sun, Denise A. Chavira, Bruce F. Chorpita Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.
  • Social Anxiety Disorder and Perceived Criticism in Intimate Relationships:
           Comparisons With Normal and Clinical Control Groups
    • Abstract: Publication date: Available online 1 June 2018Source: Behavior TherapyAuthor(s): Eliora Porter, Dianne L. Chambless, John R. Keefe, Kelly M. Allred, Moriah J. Brier Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in socially anxious individuals’ relationships. In the present study, we compared levels of perceived, expressed, and observed criticism and reactions to criticism among individuals with SAD and their partners (n = 21), individuals with other anxiety disorders and their partners (n = 35), and couples free of psychopathology (n = 30). Participants rated both global criticism and criticism during a 10-minute problem-solving task, which was also coded for criticism by observers. Individuals with anxiety disorders showed elevated levels of interaction-specific perceived criticism, expressed criticism, and upset and stress due to criticism relative to normal controls; they also reported that the interaction was more stressful. However, there were no group differences on global measures of criticism, and the two anxious groups did not differ on any measures. Findings suggest that the high levels of criticism anxious individuals perceive and their corresponding negative reactions to criticism, though not specific to SAD, may account for some of the relationship difficulties that have been identified in SAD. Results also indicate that anxious individuals may contribute to their relationship difficulties by being highly critical themselves. Overall, our findings point to the need for a clinical focus on decreasing perceived criticism among individuals with anxiety disorders.
  • Does Exposure and Response Prevention Behaviorally Activate Patients With
           Obsessive-Compulsive Disorder' A Preliminary Test
    • Abstract: Publication date: Available online 1 June 2018Source: Behavior TherapyAuthor(s): Shannon M. Blakey, Jonathan S. Abramowitz, Rachel C. Leonard, Bradley C. Riemann Exposure and response prevention (ERP) and behavioral activation (BA) are effective treatments for obsessive-compulsive disorder (OCD) and depression, respectively. Patients with OCD often exhibit depression; furthermore, ERP for OCD is associated with reduced depressive symptoms. To our knowledge, no study has examined whether ERP itself functions to behaviorally activate patients with concurrent OCD and depressive symptoms. This prospective study was designed to test the hypotheses that (a) OCD exposure hierarchy completion, increased BA, and depressive symptom reduction would all be related, and (b) pre- to posttreatment changes in BA would mediate the direct effect of OCD hierarchy completion on posttreatment depressive symptoms, even after controlling for pretreatment depressive symptoms, pretreatment BA, pre- to posttreatment reductions in OCD symptoms, treatment duration, and antidepressant medication use. Patients (N = 90) with a primary diagnosis of OCD who received residential ERP for OCD completed a self-report battery at pre- and posttreatment. Exposure hierarchy completion, increases in BA, and decreases in depression were all significantly correlated (rs ranged .33 to .44). The effect of hierarchy completion on posttreatment depressive symptoms was fully mediated by pre- to posttreatment changes in BA. Findings highlight the potential for ERP to exert antidepressant effects by behaviorally activating patients. Limitations, clinical implications, and future directions are discussed.
  • The Relationship Between Dropout and Outcome in Naturalistic Cognitive
           Behavior Therapy
    • Abstract: Publication date: Available online 20 May 2018Source: Behavior TherapyAuthor(s): Garret G. Zieve, Jacqueline B. Persons, Lisa Ann D. Yu Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.
  • Internet-Delivered Exposure-Based Cognitive-Behavioral Therapy for
           Adolescents With Functional Abdominal Pain or Functional Dyspepsia: A
           Feasibility Study
    • Abstract: Publication date: Available online 19 May 2018Source: Behavior TherapyAuthor(s): Marianne Bonnert, Ola Olén, Maria Lalouni, Erik Hedman-Lagerlöf, Josefin Särnholm, Eva Serlachius, Brjánn Ljótsson Functional abdominal pain (FAP) and functional dyspepsia (FD) are common in adolescents and associated with low quality of life. Exposure-based cognitive-behavioral therapy (CBT) is efficient for adult and adolescent irritable bowel syndrome (IBS), but has never been evaluated for adolescent FAP/FD. The aim of this study was to evaluate the feasibility and potential efficacy of a novel disorder-specific Internet-delivered CBT (Internet-CBT) for adolescents with FAP or FD, using an uncontrolled open pilot including 31 adolescents. The Internet-CBT consisted of 10 weekly online modules, which focused mainly on exposure to abdominal symptoms. Parents received modules to help them reduce unhelpful parental behaviors. Participants reported the treatment to be credible, and an overall satisfaction with the treatment. Data attrition rate was low (7%) and adherence to treatment was acceptable. We saw a significant and large effect on the primary outcome, pain intensity, at posttreatment (d = 1.20, p < .001) that was further improved after 6 months (d = 1.69, p < .001). Participants also made significant and large improvements on gastrointestinal symptoms (d = 0.84, p < .001) and quality of life (d = 0.84, p < .001) that were sustained or further improved at follow-up 6 months after treatment. This study demonstrated that exposure-based Internet-CBT, tailored for adolescents with FAP or FD, is a feasible treatment that potentially improves pain intensity, gastrointestinal symptoms, and quality of life.
  • Long-term Outcome of a Cluster-Randomized Universal Prevention Trial
           Targeting Anxiety and Depression in School Children
    • Abstract: Publication date: Available online 19 May 2018Source: Behavior TherapyAuthor(s): Johan Ahlen, Fabian Lenhard, Ata Ghaderi The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child's anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and non-random attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.
  • Using Motion Tracking to Measure Avoidance in Children and Adults:
           Psychometric Properties, Associations With Clinical Characteristics, and
           Treatment-Related Change
    • Abstract: Publication date: Available online 1 May 2018Source: Behavior TherapyAuthor(s): Eli R. Lebowitz, Bernard François Avoidance is implicated in many areas of psychopathology, particularly anxiety and its disorders. Accurate, reliable, valid, and objective measurement of avoidance behavior poses methodological challenges. Two key technological advances, increased computing power and the advent of motion-tracking technology, offer novel solutions to these challenges. We describe a series of three studies using a novel motion-tracking system to measure avoidance in children and adults. The first study examined behavioral avoidance of spider stimuli in large samples of children and adults (N = 200 each; the adults were the mothers of the children). Behavioral avoidance was associated with self-rated fear of spiders and increased state anxiety from before to after the task. The second study examined avoidance of threat faces in children and adults (N = 35 each; the adults were the mothers of the children) and test-retest reliability in the adults. Avoidance of threat faces was associated with broadband anxiety symptom severity. Test-retest correlations in behavioral avoidance measured 6 weeks apart was high and significant. The third study examined behavioral avoidance of spiders in clinically anxious children (N = 25) before and after cognitive-behavioral therapy for childhood anxiety disorders. Behavioral avoidance was significantly reduced following cognitive-behavioral therapy and reduction in behavioral avoidance correlated significantly with improvement in child-rated anxiety symptoms. Taken together, these studies provide strong support for the promise of motion-tracking technology to enable a new phase of behavioral avoidance research with sensitive, valid, reliable, and cost- and time-effective measurement of behavioral avoidance across the lifespan.
  • Using Explicit Case Formulation to Improve Cognitive Processing Therapy
           for PTSD
    • Abstract: Publication date: Available online 18 April 2018Source: Behavior TherapyAuthor(s): Reginald D.V. Nixon, Danielle Bralo We investigated the utility of explicit case formulation (CF) within Cognitive Processing Therapy (CPT) for individuals with posttraumatic stress disorder (PTSD). An uncontrolled pre-posttreatment design was used. Participants attended 12–16 weekly sessions of CPT with explicit CF, where CF guided treatment length and treatment components. Treatment was completed by 19 of the 23 participants who started therapy. Results revealed significant reductions in PTSD and depression severity as well as unhelpful PTSD-related beliefs from pre- to posttreatment (ds between 1.10 – 1.92) and treatment gains were maintained at 3-month follow-up. Of the participants available at posttreatment for assessment, 69% (n = 11/16) met good end-state functioning for PTSD and 62% (n = 8/13) did so at follow-up. Finally, 72% (n = 13/18) of those interviewed at posttreatment no longer met criteria for PTSD and this was found for 93% of those assessed at follow-up (n = 14/15). Treatment, and CF in particular, was found to be acceptable by participants. Explicit case formulation did not interfere with positive outcomes of Cognitive Processing Therapy for PTSD. Further clinical implications and future directions for research are discussed.
  • Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for
           OCD: A Patient-Level Mega-Analysis of Eight Sites
    • Abstract: Publication date: Available online 18 April 2018Source: Behavior TherapyAuthor(s): Gail Steketee, Jedidiah Siev, Iftah Yovel, Keith Lit, Sabine Wilhelm Cognitive (CT) and behavioral treatments (BT) for OCD are efficacious separately and in combination. Tailoring treatment to patient-level predictors and moderators of outcome has the potential to improve outcomes. The present study combined data from eight treatment clinics to examine the benefits of BT (n = 125), CT (n = 108), and CBT (n = 126), and study predictors across all treatments and moderators of outcome by treatment type. All three methods led to large benefits for OCD and depression symptoms. Residual gain scores for OCD symptoms were marginally smaller for BT compared to treatments containing CT. For depression, significantly more gains were evident for CBT than BT, and CT did not differ from either. Significantly fewer BT participants (36%) achieved clinically significant improvement compared to CT (56%), and this was marginally evident for CBT (48%). For all treatments combined, no predictors were identified in residual gain analyses, but clinically improved patients had lower baseline depression and stronger beliefs about responsibility/threat and importance/control of thoughts. Moderator analyses indicated that higher baseline scores on depression adversely affected outcomes for BT but not CT or CBT, and lower OCD severity and more education were associated with positive outcomes for CT only. A trend was evident for higher responsibility/threat beliefs to moderate clinical improvement outcomes for those receiving cognitive (CT and CBT), but not behavioral (BT) treatment. Medication status and comorbidity did not predict or moderate outcomes. Findings are discussed in light of models underlying behavioral and cognitive treatments for OCD.
  • Attention Bias Modification Treatment for Adolescents With Social Anxiety
    • Abstract: Publication date: Available online 17 April 2018Source: Behavior TherapyAuthor(s): Thomas H. Ollendick, Susan W. White, John Richey, Jungmeen Kim-Spoon, Sarah M. Ryan, Andrea Trubanova Wieckowski, Marika C. Coffman, Rebecca Elias, Marlene V. Strege, Nicole N. Capriola-Hall, Maria Smith Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.
  • Predictors and Trajectories of Response to the Homework, Organization, and
           Planning Skills (HOPS) Intervention for Adolescents with ADHD
    • Abstract: Publication date: Available online 10 April 2018Source: Behavior TherapyAuthor(s): Rosanna P. Breaux, Joshua M. Langberg, Stephen Molitor, Melissa R. Dvorsky, Elizaveta Bourchtein, Zoe Smith, Cathrin D. Green The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; Mage = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students' acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills post-intervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.ADHDattention-deficit/hyperactivity disorderGPAgrade point averageOTMPorganization, time-management, and planningHOPSHomework, Organization, and Planning SkillsSMHschool mental health
  • What Drives OCD Symptom Change During CBT Treatment' Temporal
           Relationships Among Obsessions and Compulsions
    • Abstract: Publication date: Available online 6 April 2018Source: Behavior TherapyAuthor(s): Judith M. Laposa, Lance L. Hawley, Kevin J. Grimm, Danielle E. Katz, Neil A. Rector Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.
  • Early Change Trajectories in Cognitive-Behavioral Therapy for Binge-Eating
    • Abstract: Publication date: Available online 5 April 2018Source: Behavior TherapyAuthor(s): Anja Hilbert, Stephan Herpertz, Stephan Zipfel, Brunna Tuschen-Caffier, Hans-Christoph Friederich, Andreas Mayr, Ross D. Crosby, Martina de Zwaan Rapid response is considered the most well-established outcome predictor across treatments of binge-eating disorder (BED), including cognitive-behavioral therapy (CBT). This study sought to identify latent trajectories of early change in CBT and compare them to common rapid response classifications. In a multicenter randomized trial, 86 adults with BED (DSM-IV) or subsyndromal BED provided weekly self-reports of binge eating over the first 4 weeks of CBT, which were analyzed to predict binge eating, depression, and body mass index at posttreatment, 6-, and 18-month follow-up. Using latent growth mixture modeling, three patterns of early change—including moderate and low decreasing—as well as low stable binge eating were identified, which significantly predicted binge-eating remission at 6-month follow-up. Other classifications of rapid response based on Receiver Operating Characteristics curve analyses or on the literature (≥ 10% reduction in binge eating at week 1, ≥ 70% reduction in binge eating at week 4) only predicted posttreatment remission or overall depression, respectively. Latent change trajectories, but not other rapid response classifications, predicted binge-eating frequency over time. A fine-grained analysis of change over the first 4 weeks of CBT for BED revealed different trajectories of early change in binge eating that led to an improved prediction of binge-eating outcome, compared to that of common rapid response classifications. Thorough monitoring of early change trajectories during treatment may have clinical utility.
  • “Teaching Moments” in Psychotherapy: Addressing Emergent Life Events
           Using Strategies From a Modular Evidence-Based Treatment
    • Abstract: Publication date: Available online 5 April 2018Source: Behavior TherapyAuthor(s): Karen Guan, Maya M. Boustani, Bruce F. Chorpita Emergent life events (ELEs) are unexpected, acute client stressors reported in psychotherapy sessions that are associated with reduced evidence-based treatment (EBT) integrity and client progress. As a potential solution, this study examined the extent to which ELEs could be appropriately addressed using existing EBT strategies. Participants were 34 low-income youth (ages 5–15, 50% male, 85% Latino) seen by 18 therapy providers in the modular EBT condition (MATCH) of a community effectiveness trial. MATCH experts rated descriptions of 75 ELEs from therapy sessions on how well they might be addressed clinically by any of MATCH’s 33 strategies for youth anxiety, depression, trauma, or conduct problems (i.e., “addressability”). MATCH-expert ratings were compared with observationally coded provider responses to ELEs. Results revealed that when assuming the presence of youth and caregiver in session, two-thirds of ELEs were identified as fully addressable and nearly all ELEs (96%) were partially addressable. ELEs related to family issues were most common but least likely to be addressable. Problem Solving and Relaxation skills could address the greatest percentage (87%) of ELEs. The most common supplemental content not explicitly prescribed in MATCH, but identified as necessary to fully address ELEs, was “assessing and empathic listening.” Provider responses were often incongruent with MATCH-expert raters regarding which strategies to use for which ELEs. In summary, most ELEs reported in a diverse community sample could be theoretically harnessed as “teaching moments” for skills within an existing, multi-problem EBT. However, providers may benefit from development of a structured resource to guide them in choosing the most effective response when these unexpected events arise.
  • Maintenance of Gains in Relationship and Individual Functioning Following
           the Online OurRelationship Program
    • Abstract: Publication date: Available online 28 March 2018Source: Behavior TherapyAuthor(s): Brian D. Doss, McKenzie K. Roddy, Kathryn M. Nowlan, Karen Rothman, Andrew Christensen In the United States, more than 40% of marriages end in divorce and more than one third of intact marriages are distressed. Unfortunately, only a minority of couples seek couple therapy to improve their relationships. Online interventions, with their increased reach and reduced costs, offer the potential to improve relationships nationwide. The online OurRelationship program has been shown in previous nationwide studies to improve relationship and individual functioning. The present study examined whether initial gains in the OurRelationship program were maintained in the following year and whether the extent of maintenance varied across important demographic and individual factors. In this study, 151 distressed heterosexual couples (302 individuals) who were randomized to the OurRelationship program were assessed 3 and 12 months following the intervention. Initial gains in relationship satisfaction, relationship confidence, and negative relationship quality were maintained through 12 months; positive relationship quality significantly improved over follow-up. Furthermore, couples maintained their initial gains in depressive symptoms, perceived health, work functioning, and quality of life; anxious symptoms continued to significantly decrease over follow-up. Finally, there was no evidence that historically underserved groups – racial/ethnic minorities, lower income couples, or rural couples – experienced greater deterioration. In fact, Hispanic couples reported continued improvement in relationship confidence and negative relationship quality in the 12 months following the program. The ability of the OurRelationship program – an eight-hour, primarily self-help program – to create long-lasting improvements in distressed relationships.indicates it may have the potential to improve the lives of distressed couples on a broad scale.
  • The Links Between Social Anxiety Disorder, Insomnia Symptoms, and Alcohol
           Use Disorders: Findings From a Large Sample of Adolescents in the United
    • Abstract: Publication date: Available online 26 March 2018Source: Behavior TherapyAuthor(s): Heidemarie Blumenthal, Daniel J. Taylor, Renee M. Cloutier, Catherine Baxley, Heather Lasslett Social anxiety disorder (SAD) is associated with increased risk of developing an alcohol use disorder (AUD). Most of the current literature has focused on the role of acute stress responding in this relation; however, both SAD and AUDs also are linked to insomnia symptoms (i.e., difficulty falling or staying asleep). As adolescence is a sensitive period for the onset of these disorders, the present study examined if insomnia symptoms might partially account for the SAD-AUD link in a large sample of adolescents. Data from the National Comorbidity Survey–Adolescent Supplement were examined. Participants (N = 10,140) completed interviews to assess past 12-month SAD and AUD diagnostic status as well as insomnia symptoms. Analyses tested whether insomnia symptoms accounted for a significant proportion of the SAD-AUD relation. Results indicated that insomnia symptoms were positively related to both SAD and AUD status, and the relation between SAD and AUD status was significantly reduced when insomnia symptoms were included in the model. Findings remained significant after controlling for the effects of age, gender, posttraumatic stress disorder, major depressive disorder, and other drug dependence status. Experimental examination and intensive longitudinal assessment of these relationships are needed before strong conclusions can be inferred about causality and temporal relationships. The current findings do indicate insomnia may be an important indirect and stigma-free treatment target to address in prevention and treatment efforts for SAD, AUDs, and their co-occurrence.
  • Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal
           Behavior: A Meta-Analysis
    • Abstract: Publication date: Available online 22 March 2018Source: Behavior TherapyAuthor(s): Christopher R. DeCou, Katherine Anne Comtois, Sara J. Landes Dialectical Behavior Therapy (DBT) prioritizes suicidal behavior and other self-directed violence as the primary treatment targets, and has been demonstrated to reduce self-directed violence in clinical trials. This paper synthesizes findings from controlled trials that assessed self-directed violence and suicidality, including suicide attempts, non-suicidal self-injury (NSSI), suicidal ideation, and accessing psychiatric crisis services. Eighteen controlled trials of DBT were identified. Random effects meta-analyses demonstrated that DBT reduced self-directed violence (d = -.324, 95% CI = -.471 to -.176), and reduced frequency of psychiatric crisis services (d = -.379, 95% CI = -.581 to -.176). There was not a significant pooled effect of DBT with regard to suicidal ideation (d = -.229, 95% CI = -.473 to .016). Our findings may reflect the prioritization of behavior over thoughts within DBT, and offer implications for clinical practice and future research concerning the implementation of DBT for acute suicidality.
  • Alcohol-Induced Amnesia and Personalized Drinking Feedback: Blackouts
           Predict Intervention Response
    • Abstract: Publication date: Available online 21 March 2018Source: Behavior TherapyAuthor(s): Mary Beth Miller, Angelo M. DiBello, Ellen Meier, Eleanor L.S. Leavens, Jennifer E. Merrill, Kate B. Carey, Thad R. Leffingwell Alcohol-induced amnesia (“blackout”) is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days.
  • Assessing Social Affiliative Behavior: A Comparison of In Vivo and Video
    • Abstract: Publication date: Available online 19 March 2018Source: Behavior TherapyAuthor(s): Cristina P. Garcia, Lauren T. Catalano, Kristen R. Dwyer, Julie M. McCarthy, Melanie E. Bennett, Jack J. Blanchard Social affiliation, or engagement in positive social interactions, is often profoundly impaired in individuals with schizophrenia. Valid measures of social affiliation are needed to understand these impairments and their symptom and functional correlates; however, such measures are limited and have not been validated. This pilot study evaluated one such measure—the video-based Social Affiliation Interaction Task (SAIT)—and a novel in vivo behavioral measure, the Affiliative Conversation Task (ACT). Twenty participants with schizophrenia or schizoaffective disorder (SZ) and 35 non-psychiatric controls (CT) completed both tasks and measures of negative symptoms and functioning. We explored group differences in social affiliation skills; convergent validity between social affiliation skill ratings from the two tasks; and concurrent validity with social affiliation skill ratings, negative symptoms, and functioning. SZ evidenced lower affiliation skill ratings than CT on the video SAIT, but not on the ACT, and the tasks displayed moderate convergent validity for affiliation skill ratings. Less affiliation skill in the SAIT was correlated with more negative symptoms and less functioning in the SZ group with medium effects, though the results were not significant. Findings suggest that the SAIT may be more sensitive to individual differences in skill level. Future research should continue to examine the SAIT for use in measuring affiliation skills.
  • Do Parents Benefit From Help When Completing a Self-Guided Parenting
           Program Online' A Randomized Controlled Trial Comparing Triple P
           Online With and Without Telephone Support
    • Abstract: Publication date: Available online 9 March 2018Source: Behavior TherapyAuthor(s): Jamin J. Day, Matthew R. Sanders In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.
  • Preextinction Stress Prevents Context-Related Renewal of Fear
    • Abstract: Publication date: Available online 8 March 2018Source: Behavior TherapyAuthor(s): Shira Meir Drexler, Christian J. Merz, Oliver T. Wolf Extinction learning, which creates new safety associations, is thought to be the mechanism underlying exposure therapy, commonly used for the treatment of anxiety disorders and posttraumatic stress disorder. The relative strength and availability for retrieval of both the fear and safety memories determine the response in a given situation. While the fear memory is often context-independent and may easily generalize, extinction memory is highly context-specific. “Renewal” of the extinguished fear memory might thus occur following a shift in context. The aim of the current work was to create an enhanced and generalized extinction memory to a discrete stimulus using stress exposure before extinction learning, thereby preventing renewal. In our contextual fear conditioning paradigm, 40 healthy men acquired (Day 1), retrieved and extinguished (Day 2) the fear memories, with no differences between the stress and the control group. A significant difference between the groups emerged in the renewal test (Day 3). A renewal effect was seen in the control group (N = 20), confirming the context-dependency of the extinction memory. In contrast, the stress group (N = 20) showed no renewal effect. Fear reduction was generalized to the acquisition context as well, suggesting that stress rendered the extinction memory more context-independent. These results are in line with previous studies that showed contextualization disruption as a result of pre-learning stress, mediated by the rapid effects of glucocorticoids on the hippocampus. Our findings support research investigating the use of glucocorticoids or stress induction in exposure therapy and suggest the right timing of administration in order to optimize their effects.
  • Working From Home: An Initial Pilot Examination of Videoconferencing-Based
           Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home
    • Abstract: Publication date: Available online 5 March 2018Source: Behavior TherapyAuthor(s): Aubrey L. Carpenter, Donna B. Pincus, Jami M. Furr, Jonathan S. Comer Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.
  • Development of a Distance-Based Effect Size Metric for Single-Case
           Research: Ratio of Distances
    • Abstract: Publication date: Available online 21 February 2018Source: Behavior TherapyAuthor(s): Michael T. Carlin, Mack S. Costello This article describes the development of an effect size measure called Ratio of Distances (RD). The goal was to develop a measure of level change for single case experimental research that met several practical requirements: (a) the measure is adaptable to designs with varying numbers of observations per, and across, phases; (b) the measure is adaptable to situations in which slope does and does not exist; (c) the measure has no ceiling, as is the limitation with commonly used overlap-based measures of effect size; and (d) the measure is computationally transparent and easily computed using widely available analysis tools (e.g., Microsoft Excel). The measure is applicable to single cases and meta-analyses.
  • Enhancing the Efficacy of Cognitive Bias Modification for Social Anxiety
    • Abstract: Publication date: Available online 18 February 2018Source: Behavior TherapyAuthor(s): Elizabeth S. Stevens, Evelyn Behar, Alexander A. Jendrusina Cognitive bias modification for interpretation (CBM-I) is a promising treatment modality for social anxiety disorder, but effect sizes are relatively small across investigations (Hallion & Ruscio, 2011). Additionally, the extent to which CBM-I impacts other cognitive, emotional, and behavioral outcomes is unclear. This study investigated whether two empirically supported treatment components for anxiety disorders, imaginal exposure (IE) and relaxation, augment the effects of CBM-I and increase the extent to which the effects of CBM-I generalize to behavioral and affective outcomes. We randomly assigned 111 undergraduate students with social anxiety to undergo IE, relaxation, or neutral thinking prior to CBM-I, then measured their interpretation biases, as well as their speaking time, anxiety, and subjective evaluations of performance during a speech task. Results indicated that individuals who received IE prior to CBM-I evidenced more adaptive interpretation biases and less behavioral avoidance during the speech task than did individuals who engaged in relaxation or neutral thinking. However, they did not report differential anxiety, habituation, or evaluations of their performance on the speech task. These findings suggest that the combination of CBM-I with adjunct components that target behavioral, rather than cognitive, mechanisms can facilitate transfer of the effects of CBM-I to reducing behavioral avoidance.
  • A Two-Session Hierarchy for Shaping Successive Approximations of Speech in
           Selective Mutism: Pilot Study of Mobile Apps and Mechanisms of Behavior
    • Abstract: Publication date: Available online 16 February 2018Source: Behavior TherapyAuthor(s): Brian E. Bunnell, Franklin Mesa, Deborah C. Beidel Selective mutism (SM) is an anxiety disorder marked by withdrawal of speech in particular social situations. Treatment is often difficult, requiring attention to several characteristics particular to the disorder. Therapeutic tools and activities such as games and mobile applications (apps) may be particularly advantageous to behavioral therapy for SM. A 2-session hierarchy for shaping successive approximations of speech in SM was piloted with 15 children, 5 to 17 years old, who were randomly assigned to shaping while using mobile apps, other therapeutic tools/activities, and reinforcement alone. Very strong treatment gains were observed: 13 of 15 (88.7%) children completed the hierarchy during the first session and 14 (93.3%) did so during the second session, with the final child completing all but the final step (i.e., to ask and respond to at least 5 open-ended questions). Moreover, all 15 children spoke to the clinician within 59 minutes of treatment (M = 17 minutes), and 14 (93.3%) children held five, 5-minute conversations with additional unknown adults during the second session. This occurred regardless of the inclusion of therapeutic tools/activities, although preliminary patterns of responding were observed such that children shaped while using mobile apps tended to show less self-reported and physiologically measured anxious distress. The utility of therapeutic activities and mobile apps when treating SM is discussed as well as areas for future research.
  • Behavioral Versus Nonbehavioral Guided Self-Help for Parents of Children
           With Externalizing Disorders in a Randomized Controlled Trial
    • Abstract: Publication date: Available online 13 February 2018Source: Behavior TherapyAuthor(s): Christopher Hautmann, Christina Dose, Karin Duda-Kirchhof, Lisa Greimel, Martin Hellmich, Stephanie Imort, Josepha Katzmann, Julia Pinior, Kristin Scholz, Stephanie Schürmann, Tanja Wolff Metternich-Kaizman, Manfred Döpfner Self-help interventions for parents, which have a behavioral basis, are considered to be an effective treatment option for children with externalizing disorders. Nonbehavioral approaches are widely used but have little empirical evidence. The main objective of this trial was to compare the efficacy of a behavioral and a nonbehavioral guided self-help program for parents. Families of children (aged 4–11 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) were randomized to either a behavioral or a nonbehavioral guided self-help program including 8 parenting booklets and 10 counseling telephone calls. The analyses considered the ratings of 5 informants: blinded clinician, therapist, participant, (her or his) partner, and teacher. Of the 149 families randomized to treatment (intention-to-treat sample [ITT]), 110 parents completed the intervention (per-protocol sample [PP]). For the 4 primary outcome measures (blinded clinician- and participant-rated ADHD and ODD) at post-assessment, the analysis revealed a treatment advantage for the behavioral group in blinded clinician-rated ODD symptoms (ITT: d = 0.37; PP: d = 0.35). Further treatment differences, all in favor of the behavioral group (ITT and PP), were detected in therapist ratings (i.e., ODD) and participant ratings (e.g., parental self-efficacy [only PP], negative parenting behavior, parental stress). In both samples, no differences were found at post-assessment for ratings of the partner and the teacher, or at the 12-month follow-up (only participant ratings available). Behavioral guided self-help shows some treatment advantage in the short term. No superiority over nonbehavioral therapy was detected 12 months after treatment termination.
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