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  Subjects -> PSYCHOLOGY (Total: 943 journals)
Showing 1 - 174 of 174 Journals sorted alphabetically
Acción Psicológica     Open Access   (Followers: 3)
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: 23)
ADHD Report The     Full-text available via subscription   (Followers: 10)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44)
Advances in Mental Health     Hybrid Journal   (Followers: 75)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 5)
Advances in Physiotherapy     Hybrid Journal   (Followers: 61)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31)
African Journal of Cross-Cultural Psychology and Sport Facilitation     Full-text available via subscription   (Followers: 5)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 440)
Aggressive Behavior     Hybrid Journal   (Followers: 17)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 41)
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3)
Aletheia     Open Access   (Followers: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 19)
American Imago     Full-text available via subscription   (Followers: 3)
American Journal of Applied Psychology     Open Access   (Followers: 43)
American Journal of Community Psychology     Hybrid Journal   (Followers: 28)
American Journal of Health Behavior     Full-text available via subscription   (Followers: 23)
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: 33)
American Psychologist     Full-text available via subscription   (Followers: 190)
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: 74)
Annual Review of Organizational Psychology and Organizational Behavior     Full-text available via subscription   (Followers: 33)
Annual Review of Psychology     Full-text available via subscription   (Followers: 239)
Anuario de investigaciones (Facultad de Psicología. Universidad de Buenos Aires)     Open Access   (Followers: 1)
Anuario de Psicología / The UB Journal of Psychology     Open Access   (Followers: 1)
Anuario de Psicología Jurídica     Open Access   (Followers: 1)
Anxiety, Stress & Coping: An International Journal     Hybrid Journal   (Followers: 21)
Applied and Preventive Psychology     Hybrid Journal   (Followers: 16)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 75)
Applied Neuropsychology : Adult     Hybrid Journal   (Followers: 40)
Applied Neuropsychology : Child     Hybrid Journal   (Followers: 21)
Applied Psycholinguistics     Hybrid Journal   (Followers: 22)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21)
Applied Psychology     Hybrid Journal   (Followers: 164)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 52)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 8)
Archive for the Psychology of Religion / Archiv für Religionspychologie     Hybrid Journal   (Followers: 23)
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: 1)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 9)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3)
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: 9)
Assessment     Hybrid Journal   (Followers: 12)
Attachment: New Directions in Psychotherapy and Relational Psychoanalysis     Full-text available via subscription   (Followers: 14)
Attention, Perception & Psychophysics     Full-text available via subscription   (Followers: 13)
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: 20)
Australian Journal of Rehabilitation Counseling     Full-text available via subscription   (Followers: 4)
Australian Psychologist     Hybrid Journal   (Followers: 12)
Autism Insights     Open Access   (Followers: 13)
Autism Research     Hybrid Journal   (Followers: 41)
Autism Research and Treatment     Open Access   (Followers: 25)
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: 20)
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: 9)
Behavior Analysis: Research and Practice     Full-text available via subscription   (Followers: 3)
Behavior Analyst     Hybrid Journal   (Followers: 4)
Behavior Modification     Hybrid Journal   (Followers: 10)
Behavior Research Methods     Hybrid Journal   (Followers: 19)
Behavior Therapy     Hybrid Journal   (Followers: 51)
Behavioral Development Bulletin     Full-text available via subscription  
Behavioral Interventions     Hybrid Journal   (Followers: 12)
Behavioral Neuroscience     Full-text available via subscription   (Followers: 55)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 25)
Behavioral Sleep Medicine     Hybrid Journal   (Followers: 7)
Behaviormetrika     Hybrid Journal  
Behaviour     Hybrid Journal   (Followers: 12)
Behaviour Change     Full-text available via subscription   (Followers: 13)
Behaviour Research and Therapy     Hybrid Journal   (Followers: 20)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 138)
Behavioural Processes     Hybrid Journal   (Followers: 8)
Biofeedback     Hybrid Journal   (Followers: 4)
BioPsychoSocial Medicine     Open Access   (Followers: 7)
BMC Psychology     Open Access   (Followers: 17)
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: 152)
British Journal of Developmental Psychology     Full-text available via subscription   (Followers: 37)
British Journal of Educational Psychology     Hybrid Journal   (Followers: 35)
British Journal of Health Psychology     Full-text available via subscription   (Followers: 46)
British Journal of Mathematical and Statistical Psychology     Full-text available via subscription   (Followers: 20)
British Journal of Psychology     Full-text available via subscription   (Followers: 61)
British Journal of Psychotherapy     Hybrid Journal   (Followers: 69)
British Journal of Social Psychology     Full-text available via subscription   (Followers: 34)
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: 15)
Canadian Psychology / Psychologie canadienne     Full-text available via subscription   (Followers: 13)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 1)
Castalia : Revista de Psicología de la Academia     Open Access  
Cendekia : Jurnal Kependidikan dan Kemasyarakatan     Open Access  
Child Development Perspectives     Hybrid Journal   (Followers: 30)
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: 12)
Clinical Psychological Science     Hybrid Journal   (Followers: 11)
Clinical Psychologist     Hybrid Journal   (Followers: 18)
Clinical Psychology & Psychotherapy     Hybrid Journal   (Followers: 73)
Clinical Psychology and Special Education     Open Access   (Followers: 3)
Clinical Psychology Review     Hybrid Journal   (Followers: 42)
Clinical Psychology: Science and Practice     Hybrid Journal   (Followers: 22)
Clinical Schizophrenia & Related Psychoses     Full-text available via subscription   (Followers: 9)
Coaching : Theorie & Praxis     Open Access   (Followers: 1)
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: 17)
Cognitive Neuropsychology     Hybrid Journal   (Followers: 35)
Cognitive Psychology     Hybrid Journal   (Followers: 73)
Cognitive Research : Principles and Implications     Open Access   (Followers: 3)
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: 5)
Contemporary Educational Psychology     Hybrid Journal   (Followers: 28)
Contemporary School Psychology     Hybrid Journal   (Followers: 4)
Contextos Clínicos     Open Access  
Counseling et spiritualité / Counselling and Spirituality     Full-text available via subscription   (Followers: 1)
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 12)
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: 27)
Counselling and Values     Hybrid Journal   (Followers: 5)
Counselling Psychology Quarterly     Hybrid Journal   (Followers: 13)
Couple and Family Psychoanalysis     Full-text available via subscription   (Followers: 1)
Couple and Family Psychology : Research and Practice     Full-text available via subscription   (Followers: 7)
Creativity Research Journal     Hybrid Journal   (Followers: 24)
Creativity. Theories - Research - Applications     Open Access   (Followers: 5)
Criminal Justice Ethics     Hybrid Journal   (Followers: 10)
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: 17)
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: 59)
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 4)
Current Opinion in Psychology     Hybrid Journal   (Followers: 8)
Current Psychological Research     Hybrid Journal   (Followers: 14)
Current Psychology     Hybrid Journal   (Followers: 14)
Current psychology letters     Open Access   (Followers: 2)
Current Research in Psychology     Open Access   (Followers: 17)
Cyberpsychology, Behavior, and Social Networking     Hybrid Journal   (Followers: 16)
Decision     Full-text available via subscription   (Followers: 5)
Depression and Anxiety     Hybrid Journal   (Followers: 24)
Depression Research and Treatment     Open Access   (Followers: 13)
Development and Psychopathology     Hybrid Journal   (Followers: 9)
Developmental Cognitive Neuroscience     Open Access   (Followers: 18)
Developmental Neuropsychology     Hybrid Journal   (Followers: 20)
Developmental Psychobiology     Hybrid Journal   (Followers: 9)
Developmental Psychology     Full-text available via subscription   (Followers: 47)
Diagnostica     Hybrid Journal   (Followers: 2)
Dialectica     Hybrid Journal   (Followers: 2)
Discourse     Full-text available via subscription   (Followers: 10)
Diversitas : Perspectivas en Psicologia     Open Access  

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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  [3163 journals]
  • Improved Perceptions of Emotion Regulation and Reflective Functioning in
           Parents: Two Additional Positive Outcomes of Parent–Child Interaction
           Therapy
    • 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).
       
  • Have Phobias, Will Travel: Addressing One Barrier to the Delivery of an
           Evidence-Based Treatment
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Thomas H. Ollendick, Sarah M. Ryan, Nicole N. Capriola-Hall, Kristin E. Austin, Maria Fraire Although a host of evidence-based treatments exist for youth with anxiety disorders, less than 30% of youth and their families receive these treatments. One of the main barriers to receiving these treatments is the lack of access to care, due largely to the absence of mental health professionals who have expertise in the delivery of these treatments in certain geographic locales. The current study examined whether a brief intensive treatment for specific phobias (SPs), Augmented One-Session Treatment (OST-A), would result in comparable treatment gains for families who traveled a considerable distance to receive this treatment when compared to families who resided in our local community. Participants included 76 youth with a clinically confirmed diagnosis of SP (38 local families and an age- and sex-matched sample of 38 nonlocal families). Although SP severity at pretreatment was significantly greater for the nonlocal youth than the local youth, both nonlocal and local youth showed commensurate improvement and maintenance of treatment gains over a 6-month period across several clinical outcome measures. Findings from this study show that OST-A is effective when families choose to travel for treatment, addressing at least one of the barriers to use of this evidence-based treatment.
       
  • Predictive Relationship Between Parental Beliefs and Accommodation of
           Pediatric Anxiety
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Johanna M. Meyer, Joshua D. Clapp, Stephen P. Whiteside, Julie Dammann, Kathryn D. Kriegshauser, Lisa R. Hale, David M. Jacobi, Bradley C. Riemann, Brett J. Deacon Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.
       
  • Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment
           Outcomes for Children With ADHD-Predominantly Inattentive Presentation
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Yuanyuan Jiang, Lauren M. Haack, Kevin Delucchi, Mary Rooney, Stephen P. Hinshaw, Keith McBurnett, Linda J. Pfiffner We investigated treatment effects on parenting self-efficacy and parent cognitive errors, and whether these parent cognitions are related to short- and long-term outcomes in parenting behaviors in psychosocial treatment for youth with attention-deficit/hyperactivity disorder, predominantly inattentive presentation (ADHD-I). In a randomized controlled trial across two sites (University of California, San Francisco, and University of California, Berkeley), 199 children between the ages of 7 and 11 were randomized to the Child Life and Attention Skills (CLAS; n = 74) program, parent-focused treatment (PFT; n = 74), or treatment as usual (TAU; n = 51). Parents reported on self-efficacy, cognitive errors, positive parenting, and negative parenting prior to treatment, immediately after treatment, and in the next school year at follow-up. Compared to TAU, CLAS and PFT had higher posttreatment parenting self-efficacy, and CLAS alone had lower posttreatment parent cognitive errors. At follow-up, only CLAS had improved parent cognitive errors compared to TAU. No other between-group differences were found in parenting self-efficacy or cognitive errors. Improved parenting self-efficacy was associated with improved posttreatment negative parenting outcomes for PFT and CLAS, and improved parent cognitive errors were also related to improvements in positive and negative posttreatment parenting outcomes for CLAS. Posttreatment parenting self-efficacy mediated follow-up negative parenting outcomes for CLAS and posttreatment parent cognitive errors mediated improved follow-up positive and negative parenting outcomes for CLAS. PFT and CLAS led to enhanced parenting self-efficacy, and CLAS appears especially robust in improving parent cognitive errors both in the short and long term. Pathways provide support for the possibility of parent cognitions as mediators of treatment effects on parenting; clinical focus on such cognitions may be useful.
       
  • Economic Impact of the Statewide Implementation of an Evidence-Based
           Treatment: Multisystemic Therapy in New Mexico
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Alex R. Dopp, Anita Saranga Coen, Allison B. Smith, Jessica Reno, David H. Bernstein, Suzanne E.U. Kerns, Deborah Altschul Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.
       
  • Group CBT for Externalizing Disorders in Urban Schools: Effect of Training
           Strategy on Treatment Fidelity and Child Outcomes
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Ricardo Eiraldi, Jennifer A. Mautone, Muniya S. Khanna, Thomas J. Power, Andrew Orapallo, Jaclyn Cacia, Billie S. Schwartz, Barry McCurdy, Jacqueline Keiffer, Cynthia Paidipati, Rebecca Kanine, Manju Abraham, Shelby Tulio, Lauren Swift, Shannon N. Bressler, Beatriz Cabello, Abbas F. Jawad Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.
       
  • A Method for Tracking Implementation Strategies: An Exemplar Implementing
           Measurement-Based Care in Community Behavioral Health Clinics
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Meredith R. Boyd, Byron J. Powell, David Endicott, Cara C. Lewis Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.’s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled “communication.” There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC—however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.
       
  • A Mixed Methods Study of the Stages of Implementation for an
           Evidence-Based Trauma Intervention in Schools
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Erum Nadeem, Lisa Saldana, Jason Chapman, Holle Schaper A mixed methods study was conducted to examine the implementation process of 26 urban school-based mental health clinics that took part in a training and implementation support program for an evidence-based school trauma intervention. Implementation process was observed using the Stages of Implementation Completion (SIC) measure. Qualitative interviews were conducted with clinic leaders in order to gain insight into clinic processes related to the SIC. Results showed that almost all of the clinics engaged in some activities related to pre-implementation (engagement, feasibility, and readiness), but only 31% of the sites formally started delivering the program to youth. Completing more pre-implementation activities, particularly those related to readiness, predicted program start-up. Qualitative analysis comparing those that implemented the program to those that did not revealed critical differences in decision-making processes, leadership strategies, and the presence of local champions for the program. This study documented the patterns of clinic behavior that occurs as part of large-scale training efforts, suggests some unique challenges that occur in schools, and highlights the importance of engaging in particular implementation activities (i.e., readiness planning, stakeholder consensus and planning meetings) as part of program start-up. Findings indicate that pre-implementation and readiness-related consultation should be employed as part of broad-scale implementation and training efforts.
       
  • Teacher Job Stress and Satisfaction in Urban Schools: Disentangling
           Individual-, Classroom-, and Organizational-Level Influences
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Rachel R. Ouellette, Stacy L. Frazier, Elisa S. Shernoff, Elise Cappella, Tara G. Mehta, Ané Maríñez-Lora, Grace Cua, Marc S. Atkins Schools remain among the most frequent providers of children’s mental health services, particularly in low-income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers’ work-related stress or satisfaction is not well understood. Six urban, high-poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers’ work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.
       
  • Supervision in Community Mental Health: Understanding Intensity of EBT
           Focus
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Leah Lucid, Rosemary Meza, Michael D. Pullmann, Nathaniel Jungbluth, Esther Deblinger, Shannon Dorsey The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision.
       
  • The Intersection of Implementation Science and Behavioral Health: An
           Introduction to the Special Issue
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Courtney Benjamin Wolk, Rinad S. Beidas
       
  • Does Traumatic Brain Injury Attenuate the Exposure Therapy Process'
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Katie A. Ragsdale, Michael A. Gramlich, Deborah C. Beidel, Sandra M. Neer, Emily G. Kitsmiller, Krystal I. Morrison Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.
       
  • Emotion Regulation of Events Central to Identity and Their Relationship
           With Concurrent and Prospective Depressive Symptoms
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Adriana del Palacio-Gonzalez, Dorthe Berntsen Dispositional emotion regulation is related to the severity and maintenance of depressive symptoms. However, whether emotion regulation specific to an event highly central for an individual’s identity is predictive of depressive symptoms has not been examined. Nonclinical participants (N = 220) reported the extent to which they employed a selection of emotion regulation strategies when recalling low- and high-centrality events. Dispositional emotion regulation and depressive symptoms were also assessed. A 7-week follow-up was conducted. High-centrality events were associated with more emotion regulation efforts. Greater brooding and expressive suppression in relation to high-centrality memories predicted concurrent depressive symptoms after controlling for event valence and dispostional emotion regulation. Effects were absent for low-centrality memories. Emotion regulation in response to high-centrality memories did not predict depressive symptoms at follow-up beyond baseline depressive symptoms. Overall, the findings showed that maladaptive emotion regulation in response to memories of high-centrality events is important for explaining depressive symptomatology.
       
  • Acceptability, Feasibility, and Effectiveness of Internet-Based
           Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York
           
    • Abstract: Publication date: July 2018Source: Behavior Therapy, Volume 49, Issue 4Author(s): Sapana R. Patel, Michael G. Wheaton, Erik Andersson, Christian Rück, Andrew B. Schmidt, Christopher N. La Lima, Hanga Galfavy, Olivia Pascucci, Robert W. Myers, Lisa B. Dixon, Helen Blair Simpson Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.
       
  • 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.
       
  • Presidential Address: Team Science Across Disciplines: Advancing CBT
           Research and Practice on Hoarding
    • Abstract: Publication date: Available online 18 May 2018Source: Behavior TherapyAuthor(s): Gail Steketee This presidential address focuses on the recent history of research and practice on hoarding disorder (HD) as a potential model for coordinating interdisciplinary teams of professionals within and outside mental health fields to advance scientific efforts to understand and resolve mental health problems. To identify, assess, and intervene with clients who have HD, psychologists, social workers, psychiatrists, and other service professionals are needed, including those in public health, housing, medicine, aging and protective services, fire, safety, and animal protection. Research findings and practice methods developed by many of my colleagues highlight the various skills of these diverse disciplines and fields. Of particular interest are multimethod assessments and CBT interventions that span individual, group, and family treatments, delivered in the office, at home and via the web by mental health and other professionals, as well as peers. Outcomes are positive, but there remains much work to do to improve understanding and intervention outcomes.
       
  • New Directions in the Cognitive-Behavioral Treatment of OCD: Theory,
           Research, and Practice
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Jonathan S. Abramowitz, Shannon M. Blakey, Lillian Reuman, Jennifer L. Buchholz The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.
       
  • The Long-Term Effects of Group-Based Psychological Interventions for
           Children With Tourette Syndrome: A Randomized Controlled Trial
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Julia Dabrowski, John King, Katie Edwards, Rachel Yates, Isobel Heyman, Sharon Zimmerman-Brenner, Tara Murphy This randomized controlled trial examined the long-term effects of group-based psychological interventions on measures of tic severity, self-reported quality of life (QOL), and school attendance. Children (n = 28) with Tourette syndrome (TS) were assessed 12 months after completing a course of either group-based Habit Reversal Training (HRT) or Education.Both groups demonstrated long-term improvement in tic severity and QOL, which included significant continued improvement during the follow-up (FU) period. Both groups also showed significant posttreatment improvement in school attendance. Further research is required to explore potential therapeutic mechanisms, independent or mutual, which may underlie long-term symptom improvements.
       
  • Changes in Problematic Anger, Shame, and Disgust in Anxious and Depressed
           Adults Undergoing Treatment for Emotion Dysregulation
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Andrada D. Neacsiu, Joscelyn Rompogren, Jeremy W. Eberle, Kibby McMahon Emotion dysregulation, the pervasive difficulty managing negative emotions, is a core problem across mood and anxiety disorders. Anger, shame, and disgust are particularly problematic emotions, impacting both disorder severity and treatment outcome. We previously found that a 16-week dialectical behavior therapy skills training group (DBT-ST) was superior to an activities-based support group (ASG) in decreasing emotion dysregulation in 44 adults with high emotion dysregulation who met diagnostic criteria for an anxiety or depressive disorder. We presently examine these participants’ changes in anger, shame, disgust, and distress using self-reports collected over 6 months during and after treatment. Hierarchical linear modeling analyses show that DBT-ST was superior to ASG in decreasing anger suppression (d = 0.93) and distress (d = 1.04). Both conditions significantly reduced shame, disgust propensity, and disgust sensitivity, but neither was superior for these outcomes. The treatments did not significantly reduce anger expression. Mediation analyses suggest that condition indirectly influenced 4-month anger suppression, shame, and distress through its effect on 2-month emotion dysregulation. These findings suggest that DBT-ST is efficacious for certain problematic emotions and distress in depressed and anxious adults and that common factors may account for some, but not all, of its benefits.
       
  • The Use of Acceptance and Commitment Therapy to Promote Mental Health and
           School Engagement in University Students: A Multisite Randomized
           Controlled Trial
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Simon Grégoire, Lise Lachance, Thérèse Bouffard, Frédérick Dionne The aim of this multisite randomized controlled trial was to determine whether an intervention based on Acceptance and Commitment Therapy (ACT) was efficacious in improving university students’ psychological flexibility, mental health, and school engagement. Students were recruited in four Canadian universities and randomly assigned to an intervention (n = 72) or a wait-list control group (n = 72). Students in the intervention group took part in four 2.5-hour workshops during a 4-week period and were asked to do exercises at home (e.g., meditation, observation grids). Wait-list students received the intervention soon after the post measurements. MANCOVAs and ANCOVAs revealed that students in the intervention group showed greater psychological flexibility at postintervention than those in the control group. They also reported greater well-being and school engagement, and lower stress, anxiety, and depression symptoms. Taken together, results of this study suggest that an ACT-based intervention offers a valuable way to promote mental health and school engagement in postsecondary settings.
       
  • Social Anxiety and the Quality of Everyday Social Interactions: The
           Moderating Influence of Alcohol Consumption
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Fallon R. Goodman, Melissa C. Stiksma, Todd B. Kashdan Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one’s ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.
       
  • Body Image–Acceptance and Action Questionnaire–5: An Abbreviation
           Using Genetic Algorithms
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Geetanjali Basarkod, Baljinder Sahdra, Joseph Ciarrochi Body image concerns are typically linked with negative outcomes such as disordered eating and diminished well-being, but some people can exhibit psychological flexibility and remain committed to their valued goals despite being dissatisfied about their bodies. Such flexibility is most frequently measured by the Body Image–Acceptance and Action Questionnaire (BI-AAQ). This study used a recently validated, fully automated method based on genetic algorithms (GAs) on data from an American community sample (N1 = 538, 71.5% female, Age: M = 40.87, SD = 13.5) to abbreviate the 12-item BI-AAQ to a 5-item short form, BI-AAQ-5. Validation tests were conducted on data from an independent community sample (N2 = 762, 44.6% female, Age: M = 40.65, SD = 13.06). The short form performed comparably to the long form in terms of its factor structure and correlations with theoretically relevant constructs, including body image dissatisfaction, stigma, internalization of societal norms of appearance, self-compassion, and poor mental health. Further, preliminary analyses using structural equation modeling showed that body image flexibility, as measured by either the long or short form, was associated with almost all the criterion variables, even while controlling for a highly related construct of body image dissatisfaction. These results demonstrate the potential discriminant validity of both the long and short form of the BI-AAQ, and show that the BI-AAQ-5 is a suitable alternative to its long form. We discuss how psychological flexibility with respect to body image dissatisfaction can be conducive to positive functioning.
       
  • A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and
           Depression: Findings From a Diverse Sample of Young Adults
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Megan E. Renna, Jean M. Quintero, Ariella Soffer, Martin Pino, Leslie Ader, David M. Fresco, Douglas S. Mennin Emotion regulation therapy (ERT) for generalized anxiety disorder (GAD) and accompanying major depressive disorder (MDD) is a theoretically derived, evidence-based treatment that integrates principles from traditional and contemporary cognitive-behavioral and experiential approaches with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding self-referential regulatory characteristics. Preliminary evidence supports the efficacy of a 20-session version of ERT. However, previous trials of ERT and other traditional and contemporary cognitive-behavioral therapies have often utilized relatively homogeneous samples. Various contextual and demographic factors may be associated with challenges that increase risk for negative mental and social outcomes for young adults ages 18–29, particularly for individuals from diverse backgrounds. The aim of this pilot study was to examine the effectiveness of a briefer 16-session version of ERT in a racially and ethnically diverse sample of young adults. Participants (N = 31) were enrolled at an urban-based, commuter college who consented to treatment for anxiety, worry, or depression at an on-campus counseling center. Open-trial results demonstrate strong ameliorative changes in worry, rumination, self-reported and clinician-rated GAD and MDD severity, social disability, quality of life, attentional flexibility, decentering/distancing, reappraisal, trait mindfulness, and negative emotionality from pre- to posttreatment. These gains were maintained throughout a 3- and 9-month follow-up. These findings provide preliminary evidence for the efficacy of ERT in treating a racially and ethnically heterogeneous population. Further, this study highlights comparable effectiveness of a briefer 16-session version of ERT.
       
  • Working Memory and Motor Activity: A Comparison Across
           Attention-Deficit/Hyperactivity Disorder, Generalized Anxiety Disorder,
           and Healthy Control Groups
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Sarah E. Lea, R. Matt Alderson, Connor H.G. Patros, Stephanie J. Tarle, Elaine F. Arrington, DeMond M. Grant Converging findings from recent research suggest a functional relationship between attention-deficit/hyperactivity disorder (ADHD)-related hyperactivity and demands on working memory (WM) in both children and adults. Excessive motor activity such as restlessness and fidgeting are not pathognomonic symptoms of ADHD, however, and are often associated with other diagnoses such as generalized anxiety disorder (GAD). Further, previous research indicates that anticipatory processing associated with anxiety can directly interfere with storage and rehearsal processes of WM. The topographical similarity of excessive motor activity seen in both ADHD and anxiety disorders, as well as similar WM deficits, may indicate a common relationship between WM deficits and increased motor activity. The relationship between objectively measured motor activity (actigraphy) and PH and visuospatial WM demands in adults with ADHD (n = 21), adults with GAD (n = 21), and healthy control adults (n = 20) was examined. Although all groups exhibited significant increases in activity from control to WM conditions, the ADHD group exhibited a disproportionate increase in activity, while activity exhibited by the GAD and healthy control groups was not different. Findings indicate that ADHD-related hyperactivity is uniquely related to WM demands, and appear to suggest that adults with GAD are no more active relative to healthy control adults during a cognitively demanding laboratory task.
       
  • Experiential Avoidance: An Examination of the Construct Validity of the
           AAQ-II and MEAQ
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Catherine Rochefort, Austin S. Baldwin, Michael Chmielewski Experiential avoidance (also referred to as acceptance or psychological flexibility) is a core construct of third-wave behavior therapies. It is the tendency to avoid uncomfortable thoughts or feelings, even when doing so has negative long-term consequences. In order for developments in experiential avoidance and third-wave behavior therapies to continue, it is imperative to examine the construct validity of the most widely used measures of this construct, the Acceptance and Action Questionnaire–II (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ). In Amazon’s Mechanical Turk (N = 1,052) and college (N = 364) samples, we evaluated the construct validity of these measures. The AAQ-II demonstrated suboptimal patterns of convergent and discriminant validity with measures of neuroticism/negative affect (Big Five Inventory, Big Five Aspects Scale, Positive and Negative Affect Schedule), the MEAQ, and mindfulness (Five Factor Mindfulness Questionnaire). In contrast, the MEAQ demonstrated optimal convergent and discriminant validity. Factor analyses at the scale, subscale, and item levels demonstrated that the AAQ-II loads with indicators of neuroticism/negative affect and not with other constructs at the core of third-wave behavior therapies. In contrast, the MEAQ loads on factors with mindfulness or forms its own factors. These findings suggest the AAQ-II functions as a measure of neuroticism/negative affect, whereas the MEAQ functions as an indicator of experiential avoidance. These findings have substantial implications for research on experiential avoidance and third-wave behavior therapies. Therefore, in order to improve the theory, research, and practice of third-wave behavior therapies, we recommend using the MEAQ to assess experiential avoidance.
       
  • Safety Behavior After Extinction Triggers a Return of Threat Expectancy
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Sophie L. van Uijen, Arne Leer, Iris M. Engelhard Safety behavior is involved in the maintenance of anxiety disorders, presumably because it prevents the violation of negative expectancies. Recent research showed that safety behavior is resistant to fear extinction. This fear conditioning study investigated whether safety behavior after fear extinction triggers a return of fear in healthy participants. Participants learned that two stimuli (A and C) were followed by an aversive loud noise (“threat”), and one stimulus (B) was not. Participants then learned to use safety behavior that prevented the loud noise. Next, A and C were no longer followed by the loud noise, which typically led to extinction of threat expectancy. Safety behavior then became available again for C, but not for A and B. All participants used safety behavior on these C trials. In a final test phase, A, B, and C were presented once without the availability to use safety behavior. At each stimulus presentation, participants rated threat expectancy by indicating to what extent they expected that the loud noise would follow. Compared with the last extinction trial, threat expectancy increased for C in the test phase, whereas it did not increase for A and B. Hence, safety behavior after the extinction of classically conditioned fear caused a partial return of fear. The findings suggest that safety behavior may be involved in relapse after exposure-based therapy for anxiety disorders.
       
  • The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive
           eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized
           Controlled Trials
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Martin O’Connor, Anita Munnelly, Robert Whelan, Louise McHugh eHealth is an innovative method of delivering therapeutic content with the potential to improve access to third-wave behaviural and cognitive therapies. This systematic review and meta-analysis aimed to determine the efficacy and acceptability of third-wave eHealth treatments in improving mental health outcomes. A comprehensive search of electronic bibliographic databases including PubMed, PsycINFO, Web of Science, and CENTRAL was conducted to identify randomized controlled trials of third-wave treatments in which eHealth was the main component. Twenty-one studies were included in the review. Meta-analyses revealed that third-wave eHealth significantly outperformed inactive control conditions in improving anxiety, depression, and quality-of-life outcomes and active control conditions in alleviating anxiety and depression with small to medium effect sizes. No statistically significant differences were found relative to comparison interventions. Findings from a narrative synthesis of participant evaluation outcomes and meta-analysis of participant attrition rates provided preliminary support for the acceptability of third-wave eHealth.Third-wave eHealth treatments are efficacious in improving mental health outcomes including anxiety, depression, and quality of life, but not more so than comparison interventions. Preliminary evidence from indices of participant evaluation and attrition rates supports the acceptability of these treatments.
       
  • 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.
       
  • A Multimethod Examination of the Effect of Insomnia Symptoms on Anxious
           Responding to a Social Stressor
    • Abstract: Publication date: May 2018Source: Behavior Therapy, Volume 49, Issue 3Author(s): Nicole A. Short, Norman B. Schmidt A growing number of studies identify insomnia symptoms as a potential risk factor for the development of anxiety disorders. However, little research has examined potential mechanisms through which insomnia could confer increased risk for anxiety. A separate line of literature suggests sleep is necessary for adaptive emotional and behavioral responding to stressors, a potential mechanism linking insomnia symptoms to anxiety risk. To test whether insomnia symptoms affect emotional and behavioral responding to an anxiety-relevant stressor, the current study recruited a sample of 99 undergraduates with varying levels of insomnia symptoms. Participants completed self-report and psychophysiological measures before, during, and after an impromptu speech task. Results indicated that, after covarying for negative affectivity, increased insomnia symptoms were significantly associated with elevated anticipatory anxiety and skin conductance response prior to the speech, and increased skin conductance response, emotion regulation difficulties, and safety aid use during the speech. Taken together, results provide evidence for the notion that insomnia symptoms are associated with maladaptive emotional and behavioral responding to an anxiety-relevant stressor.
       
  • 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
           Disorder
    • 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
           Disorder
    • 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
           States
    • 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.
       
  • Using a Learning Collaborative Model to Disseminate Cognitive Processing
           Therapy to Community-Based Agencies
    • Abstract: Publication date: Available online 20 March 2018Source: Behavior TherapyAuthor(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.
       
  • Assessing Social Affiliative Behavior: A Comparison of In Vivo and Video
           Tasks
    • 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.
       
  • Mental Contamination in Obsessive-Compulsive Disorder: Associations With
           Contamination Symptoms and Treatment Response
    • Abstract: Publication date: Available online 16 March 2018Source: Behavior TherapyAuthor(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.
       
  • 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.
       
  • Effects of Intensive Behavioral Treatment for Children With Varying Levels
           of Conduct Problems and Callous-Unemotional Traits
    • Abstract: Publication date: Available online 8 March 2018Source: Behavior TherapyAuthor(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.
       
  • 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
           Setting
    • 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
           Change
    • 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.
       
  • Relapse/Recurrence Prevention in Major Depressive Disorder: 26-Month
           
    • Abstract: Publication date: Available online 8 February 2018Source: Behavior TherapyAuthor(s): Amanda J. Shallcross, Emily C. Willroth, Aaron Fisher, Sona Dimidjian, James J. Gross, Pallavi D. Visvanathan, Iris B. Mauss We conducted a 26-month follow-up of a previously reported 12-month study that compared mindfulness-based cognitive therapy (MBCT) to a rigorous active control condition (ACC) for depressive relapse/recurrence prevention and improvements in depressive symptoms and life satisfaction. Participants in remission from major depression were randomized to an 8-week MBCT group (n = 46) or the ACC (n = 46). Outcomes were assessed at baseline; postintervention; and 6, 12, and 26 months. Intention-to-treat analyses indicated no differences between groups for any outcome over the 26-month follow-up. Time to relapse results (MBCT vs. ACC) indicated a hazard ratio = .82, 95% CI [.34, 1.99]. Relapse rates were 47.8% for MBCT and 50.0% for ACC. Piecewise analyses indicated that steeper declines in depressive symptoms in the MBCT vs. the ACC group from postintervention to 12 months were not maintained after 12 months. Both groups experienced a marginally significant rebound of depressive symptoms after 12 months but were still improved at 26 months compared to baseline (b = –4.12, p
       
  • Predictors and Outcomes of Sudden Gains and Sudden Regressions in
           Cognitive Behavioral Therapy for Youth Anxiety
    • Abstract: Publication date: Available online 2 February 2018Source: Behavior TherapyAuthor(s): Phoebe H. Durland, Christopher M. Wyszynski, Brian C. Chu Sudden gains (SGs), referring to large, stable symptom improvement occurring between consecutive treatment sessions, have been associated with improved outcomes among adults with various psychological disorders. Little research exists on SGs or sudden symptom worsening (i.e., sudden regressions [SRs]) during treatment for youth disorders. The current study examined predictors and outcomes of SGs/SRs via multiple informants in youth anxiety treatment. Participants were 118 youth (age M = 11.6, SD = 2.5; 53.8% female) and their caregivers receiving a cognitive-behavioral therapy protocol for a principal anxiety disorder. Anxiety symptom severity was assessed weekly via the State-Trait Anxiety Inventory for Children–Trait–Child/Parent versions. SGs and SRs occurred in 45.8 and 31.3% of youth, respectively. SRs were more common among youth with comorbid mood or externalizing disorders, while SGs occurred more often among youth with greater pretreatment anxiety symptom severity. SGs were not associated with posttreatment outcomes, but SRs predicted significantly higher posttreatment internalizing symptoms based on child report (β = .23, p = .03) and externalizing symptoms based on child (β = .15, p = .04) and parent report (β = .16, p = .03), controlling for overall magnitude of symptom change. SRs among youth receiving cognitive-behavioral therapy for anxiety are associated with pretreatment clinical complexity and poorer posttreatment outcomes and may serve as a warning sign to clinicians of possible treatment failure.
       
  • Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents
           With ADHD Using a Randomized Controlled Trial
    • Abstract: Publication date: Available online 31 January 2018Source: Behavior TherapyAuthor(s): Bianca Boyer, Kelsey J. MacKay, Bryce D. McLeod, Saskia van der Oord Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents’ reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.
       
  • A Cross-Lagged Panel Approach to Understanding Social Support and Chronic
           Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality
           Matters
    • Abstract: Publication date: Available online 31 January 2018Source: Behavior TherapyAuthor(s): Matthew J. Woodward, Sandra B. Morissette, Nathan A. Kimbrel, Eric C. Meyer, Bryann B. DeBeer, Suzy B. Gulliver, J. Gayle Beck Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.
       
  • Changes in Decentering Across Cognitive Behavioral Group Therapy for
           Social Anxiety Disorder
    • Abstract: Publication date: Available online 31 January 2018Source: Behavior TherapyAuthor(s): Sarah A. Hayes-Skelton, Carol S. Lee To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.
       
 
 
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