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  Subjects -> PSYCHOLOGY (Total: 990 journals)
Showing 1 - 174 of 174 Journals sorted alphabetically
Acción Psicológica     Open Access   (Followers: 4)
Acta Colombiana de Psicología     Open Access   (Followers: 5)
Acta Comportamentalia     Open Access   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Psychologica     Hybrid Journal   (Followers: 27)
Activités     Open Access   (Followers: 1)
Actualidades en Psicologia     Open Access   (Followers: 2)
Ad verba Liberorum : Journal of Linguistics & Pedagogy & Psychology     Open Access   (Followers: 9)
Addictive Behaviors Reports     Open Access   (Followers: 8)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 25)
ADHD Report The     Full-text available via subscription   (Followers: 11)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 48)
Advances in Mental Health     Hybrid Journal   (Followers: 82)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 8)
Advances in Physiotherapy     Hybrid Journal   (Followers: 63)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34)
African Journal of Cross-Cultural Psychology and Sport Facilitation     Full-text available via subscription   (Followers: 5)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 470)
Aggressive Behavior     Hybrid Journal   (Followers: 19)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 44)
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3)
Aletheia     Open Access   (Followers: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 21)
American Imago     Full-text available via subscription   (Followers: 3)
American Journal of Applied Psychology     Open Access   (Followers: 47)
American Journal of Community Psychology     Hybrid Journal   (Followers: 29)
American Journal of Health Behavior     Full-text available via subscription   (Followers: 24)
American Journal of Orthopsychiatry     Hybrid Journal   (Followers: 5)
American Journal of Psychoanalysis     Hybrid Journal   (Followers: 21)
American Journal of Psychology     Full-text available via subscription   (Followers: 36)
American Psychologist     Full-text available via subscription   (Followers: 226)
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: 81)
Annual Review of Organizational Psychology and Organizational Behavior     Full-text available via subscription   (Followers: 38)
Annual Review of Psychology     Full-text available via subscription   (Followers: 279)
Anuario de investigaciones (Facultad de Psicología. Universidad de Buenos Aires)     Open Access   (Followers: 1)
Anuario de Investigaciones de la Facultad de Psicología     Open Access  
Anuario de Psicología / The UB Journal of Psychology     Open Access   (Followers: 1)
Anuario de Psicología Jurídica     Open Access   (Followers: 1)
Anuario Pilquen : Sección Divulgación Científica     Open Access  
Anxiety, Stress & Coping: An International Journal     Hybrid Journal   (Followers: 22)
Applied and Preventive Psychology     Hybrid Journal   (Followers: 17)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 74)
Applied Neuropsychology : Adult     Hybrid Journal   (Followers: 41)
Applied Neuropsychology : Child     Hybrid Journal   (Followers: 25)
Applied Psycholinguistics     Hybrid Journal   (Followers: 23)
Applied Psychological Measurement     Hybrid Journal   (Followers: 22)
Applied Psychology     Hybrid Journal   (Followers: 190)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 54)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 8)
Archive for the Psychology of Religion / Archiv für Religionspychologie     Hybrid Journal   (Followers: 25)
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: 3)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 10)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4)
Asian American Journal of Psychology     Full-text available via subscription   (Followers: 5)
Asian Journal of Behavioural Studies     Open Access  
Asian Journal of Business Ethics     Hybrid Journal   (Followers: 10)
Assessment     Hybrid Journal   (Followers: 15)
Attention, Perception & Psychophysics     Full-text available via subscription   (Followers: 14)
Australasian Journal of Organisational Psychology     Hybrid Journal   (Followers: 9)
Australian and Aotearoa New Zealand Psychodrama Association Journal     Full-text available via subscription  
Australian Educational and Developmental Psychologist, The     Full-text available via subscription   (Followers: 8)
Australian Journal of Psychology     Hybrid Journal   (Followers: 20)
Australian Journal of Rehabilitation Counseling     Full-text available via subscription   (Followers: 4)
Australian Psychologist     Hybrid Journal   (Followers: 11)
Autism Research     Hybrid Journal   (Followers: 44)
Autism Research and Treatment     Open Access   (Followers: 29)
Autism's Own     Open Access   (Followers: 4)
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: 42)
Behavior Analysis in Practice     Full-text available via subscription   (Followers: 13)
Behavior Analysis: Research and Practice     Full-text available via subscription   (Followers: 5)
Behavior Analyst     Hybrid Journal   (Followers: 6)
Behavior Modification     Hybrid Journal   (Followers: 11)
Behavior Research Methods     Hybrid Journal   (Followers: 21)
Behavior Therapy     Hybrid Journal   (Followers: 52)
Behavioral Development Bulletin     Full-text available via subscription  
Behavioral Interventions     Hybrid Journal   (Followers: 15)
Behavioral Neuroscience     Full-text available via subscription   (Followers: 57)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 28)
Behavioral Sleep Medicine     Hybrid Journal   (Followers: 9)
Behaviormetrika     Hybrid Journal  
Behaviour     Hybrid Journal   (Followers: 13)
Behaviour Change     Full-text available via subscription   (Followers: 13)
Behaviour Research and Therapy     Hybrid Journal   (Followers: 20)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 168)
Behavioural Processes     Hybrid Journal   (Followers: 9)
Biofeedback     Hybrid Journal   (Followers: 4)
BioPsychoSocial Medicine     Open Access   (Followers: 8)
BMC Psychology     Open Access   (Followers: 19)
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: 174)
British Journal of Developmental Psychology     Full-text available via subscription   (Followers: 40)
British Journal of Educational Psychology     Hybrid Journal   (Followers: 35)
British Journal of Health Psychology     Full-text available via subscription   (Followers: 47)
British Journal of Mathematical and Statistical Psychology     Full-text available via subscription   (Followers: 20)
British Journal of Psychology     Full-text available via subscription   (Followers: 64)
British Journal of Psychotherapy     Hybrid Journal   (Followers: 68)
British Journal of Social Psychology     Full-text available via subscription   (Followers: 36)
Buletin Psikologi     Open Access  
Burnout Research     Open Access   (Followers: 8)
Cadernos de psicanálise (Rio de Janeiro)     Open Access  
Cadernos de Psicologia Social do Trabalho     Open Access  
Canadian Art Therapy Association     Hybrid Journal  
Canadian Journal of Behavioural Science     Full-text available via subscription   (Followers: 5)
Canadian Journal of Experimental Psychology     Full-text available via subscription   (Followers: 18)
Canadian Psychology / Psychologie canadienne     Full-text available via subscription   (Followers: 14)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 3)
Castalia : Revista de Psicología de la Academia     Open Access  
Cendekia : Jurnal Kependidikan dan Kemasyarakatan     Open Access  
Child Development Perspectives     Hybrid Journal   (Followers: 32)
Child Development Research     Open Access   (Followers: 18)
Ciencia Cognitiva     Open Access   (Followers: 2)
Ciencia e Interculturalidad     Open Access   (Followers: 3)
Ciências & Cognição     Open Access  
Ciencias Psicológicas     Open Access  
Clínica y Salud     Open Access  
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Practice & Epidemiology in Mental Health     Open Access  
Clinical Practice in Pediatric Psychology     Full-text available via subscription   (Followers: 11)
Clinical Psychological Science     Hybrid Journal   (Followers: 12)
Clinical Psychologist     Hybrid Journal   (Followers: 19)
Clinical Psychology & Psychotherapy     Hybrid Journal   (Followers: 80)
Clinical Psychology and Special Education     Open Access   (Followers: 4)
Clinical Psychology Review     Hybrid Journal   (Followers: 47)
Clinical Psychology: Science and Practice     Hybrid Journal   (Followers: 24)
Clinical Schizophrenia & Related Psychoses     Full-text available via subscription   (Followers: 10)
Clocks & Sleep     Open Access   (Followers: 1)
Coaching : Theorie & Praxis     Open Access   (Followers: 2)
Coaching Psykologi - The Danish Journal of Coaching Psychology     Open Access   (Followers: 2)
Cogent Psychology     Open Access  
Cógito     Open Access  
Cognition & Emotion     Hybrid Journal   (Followers: 43)
Cognitive Behaviour Therapist     Hybrid Journal   (Followers: 13)
Cognitive Behaviour Therapy     Hybrid Journal   (Followers: 18)
Cognitive Neuropsychology     Hybrid Journal   (Followers: 36)
Cognitive Psychology     Hybrid Journal   (Followers: 73)
Cognitive Research : Principles and Implications     Open Access   (Followers: 3)
Community Psychology in Global Perspective     Open Access  
Consciousness and Cognition     Hybrid Journal   (Followers: 32)
Construção Psicopedagógica     Open Access  
Consulting Psychology Journal : Practice and Research     Full-text available via subscription   (Followers: 4)
Contagion : Journal of Violence, Mimesis, and Culture     Full-text available via subscription   (Followers: 7)
Contemporary Educational Psychology     Hybrid Journal   (Followers: 27)
Contemporary School Psychology     Hybrid Journal   (Followers: 4)
Contextos Clínicos     Open Access  
Counseling et spiritualité / Counselling and Spirituality     Full-text available via subscription   (Followers: 2)
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 12)
Counseling Psychologist     Hybrid Journal   (Followers: 17)
Counseling Psychology and Psychotherapy     Open Access   (Followers: 13)
Counselling and Psychotherapy Research : Linking research with practice     Hybrid Journal   (Followers: 26)
Counselling and Values     Hybrid Journal   (Followers: 5)
Counselling Psychology Quarterly     Hybrid Journal   (Followers: 13)
Couple and Family Psychology : Research and Practice     Full-text available via subscription   (Followers: 7)
Creativity Research Journal     Hybrid Journal   (Followers: 25)
Creativity. Theories ? Research ? Applications     Open Access   (Followers: 5)
Criminal Justice Ethics     Hybrid Journal   (Followers: 11)
Cuadernos de Marte     Open Access  
Cuadernos de Neuropsicología     Open Access   (Followers: 1)
Cuadernos de Psicologia del Deporte     Open Access  
Cuadernos de Psicopedagogía     Open Access  
Cultural Diversity and Ethnic Minority Psychology     Full-text available via subscription   (Followers: 18)
Cultural-Historical Psychology     Open Access   (Followers: 2)
Culturas Psi     Open Access  
Culture and Brain     Hybrid Journal   (Followers: 4)
Current Addiction Reports     Hybrid Journal   (Followers: 12)
Current Behavioral Neuroscience Reports     Hybrid Journal   (Followers: 2)
Current Directions In Psychological Science     Hybrid Journal   (Followers: 65)
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 8)
Current Opinion in Psychology     Hybrid Journal   (Followers: 14)
Current Psychological Research     Hybrid Journal   (Followers: 15)
Current Psychology     Hybrid Journal   (Followers: 14)
Current psychology letters     Open Access   (Followers: 2)
Current Research in Psychology     Open Access   (Followers: 19)
Cyberpsychology, Behavior, and Social Networking     Hybrid Journal   (Followers: 18)
Decision     Full-text available via subscription   (Followers: 6)
Depression and Anxiety     Hybrid Journal   (Followers: 27)
Depression Research and Treatment     Open Access   (Followers: 15)
Development and Psychopathology     Hybrid Journal   (Followers: 9)
Developmental Cognitive Neuroscience     Open Access   (Followers: 18)
Developmental Neuropsychology     Hybrid Journal   (Followers: 21)
Developmental Psychobiology     Hybrid Journal   (Followers: 9)
Developmental Psychology     Full-text available via subscription   (Followers: 48)
Diagnostica     Hybrid Journal   (Followers: 3)

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Similar Journals
Journal Cover
Behavior Therapy
Journal Prestige (SJR): 1.686
Citation Impact (citeScore): 3
Number of Followers: 52  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0005-7894
Published by Elsevier Homepage  [3161 journals]
  • Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive
           Behavioral Therapy for Childhood Anxiety Disorders
    • Abstract: Publication date: Available online 14 May 2019Source: Behavior TherapyAuthor(s): Jennifer S. Silk, Gede Pramana, Stefanie L. Sequeira, Oliver Lindhiem, Philip C. Kendall, Dana Rosen, Bambang Parmanto Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40–50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9–14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At post-treatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at two-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to post-treatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders.
  • Internet-based Cognitive Behavior Therapy for Loneliness: A Pilot
           Randomized Controlled Trial
    • Abstract: Publication date: Available online 11 May 2019Source: Behavior TherapyAuthor(s): Anton Käll, Sofia Jägholm, Hugo Hesser, Frida Andersson, Aleksi Mathaldi, Beatrice Tiger Norkvist, Roz Shafran, Gerhard Andersson Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on Cognitive Behavioral Therapy (CBT) have shown positive effects. The current study investigated the efficacy of an eight-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pre-treatment and post-treatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohen’s d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at post-assessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.
  • A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on
           Sleep, Secondary Outcomes, and Populations with Co-occurring Mental Health
    • Abstract: Publication date: Available online 3 May 2019Source: Behavior TherapyAuthor(s): Elizaveta Bourchtein, Joshua M. Langberg, Hana-May Eadeh Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including five studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically-developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.
  • The Role of Intrusive Imagery in Hoarding Disorder
    • Abstract: Publication date: Available online 2 May 2019Source: Behavior TherapyAuthor(s): Nick A.J. Stewart, Chris R. Brewin, James D. Gregory Despite the incidence of trauma in the histories of people with Hoarding Disorder (HD), re-experiencing symptoms, namely intrusive images, have not been investigated in the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about (1) their everyday experiences of intrusive imagery, and (2) the unexpected images they experience when discarding high and low value possessions. Compared to CCs, everyday images described by the HD group were more frequent, had a greater negative valence, and were associated with greater interference in everyday life and attempts to avoid the imagery. With regard to discard-related imagery, a MANOVA followed up with mixed ANOVAs showed that HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD and CC participants both experienced positive imagery when discarding high value objects. CC participants reported greater avoidance of imagery in the high value object condition, but imagery did not change between conditions for HD participants. The findings are discussed, particularly in relation to the therapeutic implications the potential of imagery-based interventions for HD.
  • Effects of Rumination and Worry on Sleep
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Olivia H. Tousignant, Nicholas D. Taylor, Michael K. Suvak, Gary D. Fireman Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought—rumination and worry—are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.
  • Sudden Gains: How Important Are They During Exposure and Response
           Prevention for Obsessive-Compulsive Disorder'
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Jennifer L. Buchholz, Jonathan S. Abramowitz, Shannon M. Blakey, Lillian Reuman, Michael P. Twohig Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.
  • The Effect of a Brief Mindfulness Training on Distress Tolerance and
           Stress Reactivity
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Joseph K. Carpenter, Jenny Sanford, Stefan G. Hofmann Poor distress tolerance (DT) is considered an underlying facet of anxiety, depression, and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance or nonjudgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the nonjudge and nonreact facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.
  • Is Heightened Disgust Propensity Truly a Risk Factor for
           Contamination-Related Obsessive-Compulsive Disorder'
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Gabriele Melli, Andrea Poli, Carlo Chiorri, Bunmi O. Olatunji Disgust propensity (DP) has been conceptualized as a stable personality trait that confers risk for contamination-related OCD (C-OCD). However, the extent to which DP leads to the subsequent development of C-OCD is unclear. In fact, the presence of C-OCD might lead to an increase in DP rather than the inverse. The present study was aimed to test this hypothesis in a large clinical sample of OCD patients (≥ 21 years of age) with (C-OCD; n = 56) and without (NC-OCD; n = 103) contamination-related symptoms that completed measures of OCD symptoms, depression, anxiety, and DP. DP was assessed twice, in reference to the present situation (T1) and to when the participant was 18 years old (T0). The two groups did not significantly differ in DP at T0. However, C-OCD participants reported higher DP scores than NC-OCD at T1. Furthermore, the T1 vs T0 difference in DP was significant only in the C-OCD group. Subsequent analyses also showed that T1 DP levels, but not T0 levels, significantly predicted contamination-related symptoms. Despite study limitations, these findings question the role of DP as a risk factor for C-OCD.
  • Sleep-Related Problems in Pediatric Obsessive-Compulsive Disorder and
           Intensive Exposure Therapy
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Natalja A. Nabinger de Diaz, Lara J. Farrell, Allison M. Waters, Caroline Donovan, Harry W. McConnell Limited research has examined sleep-related problems (SRPs) among children and adolescents with obsessive-compulsive disorder (OCD). The present study addresses this gap by investigating preliminary associations between SRPs, demographic factors (gender and age), family variables (family accommodation and parental stress), and clinical factors (medication status, internalizing and externalizing symptoms, OCD severity, OCD-related impairment), and treatment outcomes in a sample of 103 youth (aged 7 to 17 years; 53% female) with a primary diagnosis of OCD. Clinician, parent, and child measures were used to assess demographic, family, and clinical predictors. SRPs were assessed using an 8-item measure comprising items of the Child Behaviour Checklist, Child Depression Inventory, and Multidimensional Anxiety Scale for Children as used in previous studies. Results showed that SRPs were highly prevalent among this sample and that more SRPs were associated with younger age, internalizing problems, and functional impairment. However, SRPs were not an independent predictor of OCD severity, impairment, or treatment response. Preliminary findings suggest that SRPs among youth with OCD may be more strongly associated with broader internalizing symptoms than with OCD itself. Future longitudinal research is warranted to further explore the complexity of SRPs when co-occurring with pediatric OCD.
  • Cognitive and Behavioral Differences Between Subtypes in Refractory
           Irritable Bowel Syndrome
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Sula Windgassen, Rona Moss-Morris, Hazel Everitt, Alice Sibelli, Kimberley Goldsmith, Trudie Chalder Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.
  • Examining the Effects of Exercise on Pattern Separation and the Moderating
           Effects of Mood Symptoms
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Emily E. Bernstein, Richard J. McNally Aerobic exercise has broad cognitive benefits. One target of interest is enhanced memory. The present study explored pattern separation as a specific memory process that could be sensitive to acute and regular exercise and clinically significant for disorders (e.g., depression) characterized by cognitive-affective deficits and hippocampal impairment. In a within-subjects design, participants (N = 69) attended two visits during which they repeated a behavioral pattern separation task at rest and after an activity (cycling, stretching). Regular exercise habits, demographics, mood and anxiety symptoms, and recognition memory capacity were also measured. More regular exercise predicted better resting pattern separation, t(62) = 2.13, b = 1.74, p = .037. Age moderated this effect, t(61) = 2.35, b = .25, p = .02; exercise most strongly predicted performance among middle-age participants. There was no main effect of activity condition on post-activity performance, t(61) = .67, p = .51. However, with significant heterogeneity in reported mood symptoms and regular exercise habits, there was a three-way interaction between condition, regular exercise, and depression, t(55) = 2.08, b = .22, p = .04. Relative to stretching, cycling appears to have enhanced the benefit of regular exercise for pattern separation performance; however, this was evident among participants with mild to no symptoms of depression, but absent among participants with moderate to severe symptoms. Results have implications for how exercise might protect against declines in pattern separation. Future research should explore exercise’s potential as a prevention tool or early intervention for pattern separation and related clinical outcomes.
  • Repetitive Thinking in Social Anxiety Disorder: Are Anticipatory
           Processing and Post-Event Processing Facets of an Underlying
           Unidimensional Construct'
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Quincy J.J. Wong, Peter M. McEvoy, Ronald M. Rapee Existing literature suggests that anticipatory processing and post-event processing—two repetitive thinking processes linked to social anxiety disorder (SAD)—might be better conceptualized as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomized controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = .43 to .47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = .16 to .27) and was not related to life interference (r = .11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD.
  • Predictors of Symptom Outcome in Interpretation Bias Modification for
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Hillary L. Smith, Katherine A. McDermott, Corinne N. Carlton, Jesse R. Cougle Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.
  • Infant Language Production and Parenting Skills: A Randomized Controlled
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Dainelys Garcia, Gabriela M. Rodriquez, Ryan M. Hill, Nicole E. Lorenzo, Daniel M. Bagner The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the child-directed interaction phase of parent–child interaction therapy, on infant language production. Participants were 60 infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers, who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the infant behavior program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers’ use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.
  • Impulsivity and Behavior-Dependent Life Events Mediate the Relationship of
           Reward Sensitivity and Depression, but Not Hypomania, Among at-Risk
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Corinne P. Bart, Lyn Y. Abramson, Lauren B. Alloy Both reward sensitivity and impulsivity are related to the development and course of bipolar spectrum disorders (BSDs) and have been implicated in other disorders and negative functional outcomes such as substance abuse, obesity, suicidal behaviors, and risk-taking. Furthermore, according to the transactional component of the Behavioral Approach System (BAS)/reward hypersensitivity theory of BSDs, people with reward hypersensitivity should experience more BAS-relevant events, and thus, are more vulnerable to mood symptoms and episodes via stress generation. Impulsivity may exacerbate stress generation in individuals at risk for BSDs based on exhibiting reward hypersensitivity. The current study examined whether impulsivity explained the generation of stress and subsequent mood symptoms beyond what is explained by reward sensitivity alone. Participants were 131 Moderate BAS and 216 High BAS sensitivity adolescents (M = 18.43 years, SD = 1.40), who completed baseline measures of reward sensitivity and impulsivity, as well as follow-up measures of life events and mood symptoms. Results from linear regression analyses indicated that higher baseline impulsivity predicted behavior-dependent, but not behavior-independent, life events. Furthermore, path analyses suggested that the effect of BAS group on depression symptoms at next follow-up was partly explained via the indirect effect of impulsivity and negative behavior-dependent life events. We did not find these effects for behavior-independent or positive-dependent events or for prediction of hypomanic symptoms. The findings suggest that impulsivity may account for stress generation of negative events that precede depression.
  • Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based
           Psychiatric Hospital Program
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Courtney Beard, Lara S. Rifkin, Alexandra L. Silverman, Thröstur Björgvinsson Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word–sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.
  • Trajectories of Change in a Group Behavioral Activation Treatment for
           Severe, Recurrent Depression
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Heather A. O’Mahen, Nicholas J. Moberly, Kimberly A. Wright Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen’s d = 1.25. Although 34% (26 of the 77 who provided outcome data) of individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.
  • Individuals Intolerant of Uncertainty: The Maintenance of Worry and
           Distress Despite Reduced Uncertainty
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Rachel M. Ranney, Evelyn Behar, Gregory Bartoszek The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.
  • Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Fredrik Santoft, Sigrid Salomonsson, Hugo Hesser, Elin Lindsäter, Brjánn Ljótsson, Mats Lekander, Göran Kecklund, Lars-Göran Öst, Erik Hedman-Lagerlöf Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.
  • Emotion Regulation Strategies in Cognitive Behavioral Therapy for Panic
    • Abstract: Publication date: May 2019Source: Behavior Therapy, Volume 50, Issue 3Author(s): Asher Y. Strauss, Yogev Kivity, Jonathan D. Huppert Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.
  • A further validation of the cognitive bias modification effect on trust in
           middle childhood
    • Abstract: Publication date: Available online 26 April 2019Source: Behavior TherapyAuthor(s): Guy Bosmans, Martine Verhees, Simon De Winter Recent middle childhood research suggests that children's trust in maternal support can be manipulated using Cognitive Bias Modification (CBM) aimed at changing children's interpretation of ambiguous maternal support-related behavior. The current study with 60 children (40 girls, Mage = 10.62, SDage = 1.20) aimed to replicate previous research and to test whether the CBM effect is specific to trust or generalizes to other child evaluations of maternal behavior. More specifically, CBM effects on children's evaluation of parenting behavior were tested. Trust and maternal parenting behaviors were assessed using children's self-report. Results largely replicated previous findings, including the positive effect of CBM on children's trust in maternal support. Suggesting that this effect was specific for trust, the CBM manipulation did not affect children's appraisal of maternal parenting behavior. This finding supports the validity of CBM effects.
  • Repeated exposure to perceptual illusion challenges reduces anxiety
           sensitivity cognitive concerns: Evidence from a randomized clinical trial.
    • Abstract: Publication date: Available online 26 April 2019Source: Behavior TherapyAuthor(s): Brian J. Albanese, Brian W. Bauer, Alexa M. Raudales, Daniel W. Capron, Norman B. Schmidt
  • “Cold” Cognitive Control and Attentional Symptoms in Anxiety:
           Perceptions versus Performance
    • Abstract: Publication date: Available online 23 April 2019Source: Behavior TherapyAuthor(s): Lauren S. Hallion, David F. Tolin, Amber L. Billingsley, Susan N. Kusmierski, Gretchen J. Diefenbach Clinically significant anxiety is associated with an array of attentional symptoms (e.g., difficulty concentrating; unwanted thought) that are subjectively experienced as severe. However, neuropsychological findings are mixed with respect to the presence of cognitive deficits that can account for these symptoms. Contextualizing predictions from established clinical theories (e.g., Attentional Control Theory) within contemporary, neurobiologically-derived models of cognitive control (Dual Mechanisms of Control Theory), the present study investigated the relationship between “cold” proactive and reactive cognitive control, task effort, and subjective attentional symptoms (difficulty concentrating; unwanted thought) in a mixed clinical sample of individuals with generalized anxiety disorder (GAD) and/or obsessive–compulsive disorder (OCD) and a comparison sample of healthy controls. Clinical status moderated the relationship between attentional symptoms (attentional focusing and trait worry) and proactive cognitive control response time. Clinical status also moderated the relationship between trait worry and task effort. Higher trait worry was associated with slower proactive control and lower effort in healthy participants, but faster proactive control in clinical participants. Self-reported attentional focusing showed differential validity vis-à-vis proactive control response time in clinical versus healthy participants. Post-hoc conditional effects analysis suggested more accurate self-appraisals in healthy controls, but was not significant after correction for multiple comparisons. Preliminary evidence suggested that differences in task effort in anxious versus healthy adults may relate to subjective attentional symptoms in GAD and OCD.
  • Trans Collaborations Clinical Check-In (TC3): Initial Validation of a
           Clinical Measure for Transgender and Gender Diverse Adults Receiving
           Psychological Services
    • Abstract: Publication date: Available online 11 April 2019Source: Behavior TherapyAuthor(s): Natalie R. Holt, Terrence Z. Huit, Grant P. Shulman, Jane L. Meza, Jolene D. Smyth, Nathan Woodruff, Richard Mocarski, Jae A. Puckett, Debra A. Hope One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement based care given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in healthcare. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18 item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC3 (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC3 as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC3 across multiple time points to determine utility as a progress monitoring measure. The TC3 should also be further validated with more culturally diverse samples.
  • Trauma-Related Cognitions and Cognitive Emotion Regulation as Mediators of
           PTSD Change Among Treatment-Seeking Active Duty Military Personnel with
    • Abstract: Publication date: Available online 5 April 2019Source: Behavior TherapyAuthor(s): Carmen P. McLean, Yinyin Zang, Thea Gallagher, Noah Suzuki, Jeffrey S. Yarvis, Brett T. Litz, Jim Mintz, Stacey Young-McCaughan, Alan L. Peterson, Edna B. Foa, for the STRONG STAR Consortium Trauma-related cognitions about the self and the world have been identified as a mediator of posttraumatic stress disorder (PTSD) change during prolonged exposure (PE) therapy. However, the extent to which negative cognitions mediate PTSD change in other PTSD treatments is unclear. In addition, previous studies have not tested alternate mediators of PTSD change during PE. In a sample of 216 treatment-seeking active duty military personnel with PTSD, the present study examined the specificity of the negative cognition mediation effect in both PE and present-centered therapy (PCT). In addition, we examined another possible mediator, cognitive emotion regulation. Lagged mediational analyses indicated that negative cognitions about the self and world and the unhelpful cognitive emotion regulation strategy of catastrophizing each significantly mediated change in PTSD from baseline to 6-month follow-up. In a combined model, the mediating effect of catastrophizing was greater than negative cognitions about the world, and similar to negative cognitions about the self. Moderated mediation analyses revealed that the effect of catastrophizing was greater in PE than in PCT. Findings show that trauma-related cognitions and, to a greater degree, the emotion regulation strategy catastrophizing, both mediate PTSD change. Further research is needed to determine whether these mediating variables represent mechanisms of therapeutic change.
  • A Daily Diary Investigation of the Defective Self Model Among College
           Students with Recent Self-injury
    • Abstract: Publication date: Available online 1 April 2019Source: Behavior TherapyAuthor(s): Mary K. Lear, Carolyn M. Pepper The Defective Self Model of self-injury (Hooley, Ho, Slater, & Lockshin, 2010) asserts that individuals choose to self-injure to gratify the desire for self-punishment associated with a self-critical cognitive style. Specifically, self-injury is used to regulate negative self-directed thoughts and emotions and is made accessible via the belief that the individual deserves punishment. This study sought to test primary assumptions of the Defective Self Model using a two-week daily diary protocol. It was hypothesized that trait self-criticism would predict daily self-injury urge intensity and behaviors directly, as well as indirectly, through daily thoughts about deserving punishment. We also posited that guilt would predict self-injury urge intensity and behaviors beyond sadness, hostility, and fear. Support for primary hypotheses was mixed. Self-criticism did not directly predict self-injury outcomes, but did indirectly predict urge intensity through daily thoughts about punishment. Daily guilt predicted self-injury urge intensity beyond daily sadness, hostility and fear and was the only type of negative affect associated with self-injury behavior. Results are primarily contextualized through a social cognitive lens in which self-injury urge is precipitated by the activation of a self-critical schema in daily life. Alternatively, self-criticism may serve as a gateway to initial self-injury but lack the sensitivity to predict individual self-injury episodes. Treatments designed to reduce self-critical thoughts and bolster self-compassion may decrease self-injury urge intensity, thereby affecting the frequency of self-injury episodes.
  • The authors declare that they have no conflict of interest.
    • Abstract: Publication date: Available online 23 March 2019Source: Behavior TherapyAuthor(s): Funding Imagery rescripting (IR) and imaginal exposure (IE) are two efficacious treatments for nightmare disorder, but their discrete underlying mechanism(s) remain largely unknown. We therefore examined mediators of the treatment effects of IR and IE in a randomized wait-list controlled trial (N = 104). Therapeutic outcomes were assessed at pre- and post-assessment, and mediator assessment took place in between treatment sessions to establish a temporal relationship between mediators and nightmare symptoms (i.e., frequency and distress). In line with the hypothesis, enhanced mastery (or self-efficacy) of the nightmare content mediated the therapeutic efficacy of IR. Furthermore, the treatment effects of IE were mediated by increased tolerability of the negative emotions elicited by nightmares. Even though IR and IE for nightmares seem to produce similar therapeutic effects, the results of this study suggest that IR and IE tap into different underlying processes.
  • Examining the interrelation among change processes: Decentering and
           anticipatory processing across cognitive behavioral therapy for social
           anxiety disorder
    • Abstract: Publication date: Available online 23 March 2019Source: Behavior TherapyAuthor(s): Sarah A. Hayes-Skelton, Stephanie Marando-Blanck As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.
  • CBT-I & subjective-objective sleep discrepancy
    • Abstract: Publication date: Available online 23 March 2019Source: Behavior TherapyAuthor(s): Tatjana Crönlein, Astrid Lehner, Petra Schüssler, Peter Geisler, Rainer Rupprecht, Thomas C. Wetter Discrepancy between objective and subjective sleep parameters is a frequent symptom in persons suffering from insomnia. Since it has an impairing effect on daytime well-being and neglects possible positive objective improvements, it would be useful if it was treated. Apart from hypnotics, cognitive behavior therapy (CBT-I) is the therapy of choice for chronic forms of insomnia. However, there is limited information about whether CBT-I can also improve subjective-objective sleep discrepancy. We investigated a large sample of patients showing chronic forms of insomnia regarding their subjective-objective sleep discrepancy pre and post CBT-I. Objective sleep data were obtained from three nights (two baseline nights and one night after therapy) using polysomnography in our sleep laboratory. All 92 patients participated in a 14-day inpatient program with CBT-I including psychoeducation about subjective-objective sleep discrepancy. Repeated measures analyses showed an improvement in subjective-objective sleep discrepancy parameters after CBT-I. Those parameters were also correlated with perceived quality of sleep. We conclude that CBT-I is a useful tool to improve subjective-objective sleep discrepancy in patients showing chronic forms of insomnia.
  • Modeling hierarchical versus random exposure schedules in Pavlovian fear
           extinction: No evidence for differential fear outcomes
    • Abstract: Publication date: Available online 14 March 2019Source: Behavior TherapyAuthor(s): Sara Scheveneels, Yannick Boddez, Bram Vervliet, Dirk Hermans In exposure therapy, the client can either be confronted with the fear-eliciting situations in a hierarchical way or in a random way. In the current study we developed a procedure to investigate the effects of hierarchical versus random exposure on long-term fear responding in the laboratory. Using a fear conditioning procedure, one stimulus (CS +) was paired with an electric shock (US), whereas another stimulus was not paired with the shock (CS-). The next day, participants underwent extinction training including presentations of the CS-, CS + and a series of morphed stimuli between the CS- and CS +. In the hierarchical extinction condition (HE; N = 32), participants were first presented with the CS-, subsequently with the morph most similar to the CS-, then with the morph most similar to that one, and so forth, until reaching the CS +. In the random extinction condition (RE; N = 32), the same stimuli were presented but in a random order. Fear responding to the CS +, CS- and a new generalization stimulus (GS) was measured on the third day. Higher expectancy violation (t(62) = -2.67, p = .01), physiological arousal (t(62) = -2.08, p = .04) and variability in US-expectancy ratings (t(62) = -2.25, p = .03) were observed in the RE condition compared to the HE condition, suggesting the validity of this novel procedure. However, no differences between the RE and HE condition were found in fear responding as tested one day later, F(1, 62) < 1. In conclusion, we did not find evidence for differential long-term fear responding in modeling hierarchical versus random exposure in Pavlovian fear extinction.
  • A Clinician’s Primer for Idiographic Research: Considerations and
    • Abstract: Publication date: Available online 1 March 2019Source: Behavior TherapyAuthor(s): Marilyn L. Piccirillo, Emorie D. Beck, Thomas L. Rodebaugh Theorists and clinicians have long noted the need for idiographic (i.e., individual-level) designs within clinical psychology. Results from idiographic work may provide a possible resolution of the therapist’s dilemma – the problem of treating an individual using information gathered via group-level research. Due to advances in data collection and time series methodology, there has been increasing interest in using idiographic designs to answer clinical questions. Although time series methods have been well-studied outside the field of clinical psychology, there is limited direction on how clinicians can use such models to inform their clinical practice. In this primer, we collate decades of published and word-of-mouth information on idiographic designs, measurement, and modeling. We aim to provide an initial guide on the theoretical and practical considerations that we urge interested clinicians to consider before conducting idiographic work of their own.
  • Negative Emotional Action Termination (NEAT): Support for a cognitive
           mechanism underlying negative urgency in nonsuicidal self-injury
    • Abstract: Publication date: Available online 14 February 2019Source: Behavior TherapyAuthor(s): Kenneth J.D. Allen, Jill M. Hooley Negative urgency, the self-reported tendency to act impulsively when distressed, increases risk for nonsuicidal self-injury (NSSI). NSSI is also associated with impaired negative emotional response inhibition (NERI), specifically negative emotional action termination (NEAT), a cognitive process theoretically related to negative urgency. We previously found that adults with NSSI history had difficulty inhibiting behavioral responses to affective images depicting negative content (but not positive or neutral images) in an Emotional Stop-Signal Task. We sought to replicate this finding, determine whether this deficit extends to negative emotional action suppression (NEAS; an earlier stage of NERI), and explore whether impairment in these two stages of emotional response inhibition helps explain the relationship between negative urgency and NSSI. 88 adults with NSSI history (n = 45) and healthy control participants (n = 43) without NSSI history or psychopathology completed a clinical interview, symptom inventories, an impulsivity questionnaire, and behavioral assays of early and late NERI (NEAS and NEAT, respectively). The NSSI group had worse NEAT than the control group in the Emotional Stop-Signal Task, but no group differences in NEAS were observed in an Emotional Go/No-go task. However, both early and late stages of NERI accounted for independent variance in negative urgency. We additionally found that NEAT explained variance in the association between negative urgency and NSSI. These results suggest that impulsive behavior in NSSI may involve specifically impaired inhibitory control over initiated negative emotional impulses. This deficit in late response inhibition to negative emotional stimuli might reflect a cognitive mechanism or pathway to elevated negative urgency among people who self-injure.Graphical Unlabelled Image
  • Exploring Mechanisms of Action in Exposure-Based Cognitive Behavioral
           Therapy for Eating Disorders: The Role of Eating-Related Fears and
           Body-Related Safety Behaviors
    • Abstract: Publication date: Available online 12 February 2019Source: Behavior TherapyAuthor(s): Nicholas R. Farrell, Leigh C. Brosof, Irina A. Vanzhula, Caroline Christian, Owen R. Bowie, Cheri A. Levinson Evidence-based cognitive behavioral therapy for eating disorders includes a component of exposure therapy, which involves patients confronting feared eating and body-related stimuli while preventing safety behaviors. With recent research demonstrating that eating-related fears and safety behaviors are central to eating disorder pathology, there is increased emphasis on improving the efficacy of exposure therapy in eating disorders. Doing so will require a better understanding of important mechanisms of action in this treatment. The present study explored how changes during treatment in eating-related fears and avoidance as well as body-related safety behaviors influence overall treatment outcomes. Individuals with eating disorders (N = 71) receiving exposure-based treatment completed measures of global eating disorder severity at admission and discharge. Hypothesized mechanisms of action were also assessed at admission and discharge as well as at a two-week time point after beginning treatment. Path modeling analyses showed that decreased eating-related cognitions (feared concerns about eating) and emotions (anxiety about eating) at the two-week time point were prospectively predictive of lowered global eating disorder symptom severity at discharge. Additionally, reduced body checking and avoidance behaviors after two weeks of treatment were also associated with lower eating disorder severity at discharge. These findings highlight the importance of exposure-based therapy in eating disorders and the need to uniquely address eating-related fears and safety behaviors.
  • Changes in Hypothesized Mechanisms of Change Before and After Initiating
           Abstinence in Cognitive-Behavioral Therapy for Women with Alcohol Use
    • Abstract: Publication date: Available online 8 February 2019Source: Behavior TherapyAuthor(s): Kevin A. Hallgren, Elizabeth E. Epstein, Barbara S. McCrady Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d =-0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.
  • Residual Insomnia and Nightmares Post-Intervention Symptom Reduction Among
           Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms
    • Abstract: Publication date: Available online 1 February 2019Source: Behavior TherapyAuthor(s): Cristina M. López, Cynthia L. Lancaster, Allison Wilkerson, Daniel F. Gros, Kenneth J. Ruggiero, Ron Acierno While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment non-response. More specifically, predicting effects of residual insomnia and nightmares on post-intervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion, and if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.
  • Acceptability and Efficacy of Group Behavioral Activation for Depression
           among Adults: A Meta-Analysis
    • Abstract: Publication date: Available online 29 January 2019Source: Behavior TherapyAuthor(s): Mel Simmonds-Buckley, Stephen Kellett, Glenn Waller The evidence base for behavioral activation (BA) as a frontline treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at post-treatment/follow-up, recovery and drop-out rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes post-group BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k = 13, N = 461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k = 15, N = 526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The drop-out rate for group BA (14%) was no different to other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
  • Goal Achievement and Goal-related Cognitions in Behavioral Activation
           Treatment for Depression
    • Abstract: Publication date: Available online 25 January 2019Source: Behavior TherapyAuthor(s): Keegan Knittle, Paul Gellert, Clair Moore, Natalie Bourke, Victoria Hull This study investigates the extent to which achieving goals during behavioral activation (BA) treatment predicts depressive symptom improvement, and whether goal-related cognitions predict goal achievement or treatment response. Patients (n = 110, mean age 37.6, 54% female) received low-intensity cognitive behavioral therapy for depression, which included setting up to three behavioral goals in each of three BA-focused sessions (i.e. 9 goals per patient). Patients completed items from the Self-Regulation Skills Battery to assess goal-related cognitions and goal achievement for these goals, and depressive symptoms were assessed weekly with the PHQ-9. Multi-level models investigated the relationships between goal-related cognitions, goal achievement and depressive symptoms. Depressive symptoms improved curve-linearly during treatment (B = 0.12, p 
  • Intervening on Thwarted Belongingness and Perceived Burdensomeness to
           Reduce Suicidality among Veterans: Subanalyses from a Randomized
           Controlled Trial
    • Abstract: Publication date: Available online 24 January 2019Source: Behavior TherapyAuthor(s): Nicole A. Short, Lauren Stentz, Amanda M. Raines, Joseph W. Boffa, Norman B. Schmidt Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensomeness and thwarted belongingness, or participate in a repeated contact control condition. Results indicated a direct effect of the intervention on both perceived burdensomeness and thwarted belongingness. Temporal mediation analyses also revealed an indirect effect of condition on suicidality at Month-1 follow-up via reductions in perceived burdensomeness. The current results are the first to indicate that factors from the interpersonal theory of suicide can be reduced among veterans, and to demonstrate that these reductions in perceived burdensomeness lead to reductions in suicidality. Because of the brevity and computer delivery system, this intervention could be widely and rapidly disseminated among military veterans to reduce the public health burden of suicide in this population.
  • Recent Developments in the Treatment of Depression
    • Abstract: Publication date: Available online 17 January 2019Source: Behavior TherapyAuthor(s): Steven D. Hollon, Zachary D. Cohen, Daisy R. Singla, Paul Andrews The cognitive and behavioral interventions can be as efficacious as antidepressant medications and more enduring, but some patients will be more likely to respond to one than the other. Recent work has focused on developing sophisticated selection algorithms using machine-learning approaches that answer the question “What works best for whom”. Moreover, the vast majority of people suffering from depression reside in low and middle-income countries where access to either psychotherapy or medications is virtually nonexistent. Great strides have been made in training non-specialist providers (known as task-sharing) to overcome this gap. Finally, recent work growing out of evolutionary psychology suggests that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode so as to increase the risk of relapse whenever someone tries to stop. We address each of these developments and their cumulative implications.
  • Perceptions of Cognitive-Behavioural Therapy and Antidepressant Medication
    • Abstract: Publication date: Available online 11 January 2019Source: Behavior TherapyAuthor(s): Shadi Beshai, Lisa M. Watson, Tyler J.S. Meadows, Joelle N. Soucy The majority of people with depression in the United States either never seek treatment or gravitate exclusively to Antidepressant Medication (ADM), despite the existence of other effective treatments, such as Cognitive Behavioral Therapy (CBT). Reluctance to use psychotherapy is partly due to lack of appropriate mental health literacy and perceptions of low treatment acceptability (appropriateness for a given problem) and credibility (treatment logicalness, and whether the patient expects improvement). In the current investigation, we examined whether providing psychoeducation about CBT for depression would change participant perceptions of the treatment's acceptability and credibility. We recruited 554 (female n = 314; 57%) participants across two online studies, and assessed their baseline perceptions of CBT and ADM using modified Treatment Acceptability (TAAS) and Treatment Credibility and Expectancy (CEQ) scales. Participants were subsequently presented with evidence-based, expert-vetted psychoeducational materials describing CBT and ADM, and were asked to re-complete the TAAS and CEQ. In Study 1, participants endorsed significantly higher CBT-CEQ (Credibility/Expectancy) scores post-psychoeducation. In Study 2, participants endorsed significantly lower CBT-TAAS (Acceptability), and among those with no exposure to depression treatments, endorsed significantly higher CBT-CEQ scores post-psychoeducation. In both studies, there were no perceptual changes of ADM after the psychoeducation. Finally, in Study 2, endorsement of a biological model of depression and depressive symptoms were negatively predictive of CBT's acceptability and credibility and expectancy post-psychoeducation. Perceptions of credibility and expectancy of CBT for depression appear malleable even after exposure to brief psychoeducation, whereas shifting perceptions of CBT's acceptability may require more extensive intervention.
  • Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic
    • Abstract: Publication date: Available online 10 January 2019Source: Behavior TherapyAuthor(s): Jennifer L. Greenberg, Katharine A. Phillips, Gail Steketee, Susanne S. Hoeppner, Sabine Wilhelm Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits. We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18–22 weeks. Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at post-treatment. Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.
  • Changes in decentering and reappraisal temporally precede symptom
           reduction during Emotion Regulation Therapy for generalized anxiety
           disorder with and without co-occurring depression
    • Abstract: Publication date: Available online 4 January 2019Source: Behavior TherapyAuthor(s): Mia S. O'Toole, Megan E. Renna, Douglas S. Mennin, David M. Fresco Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was non-significant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well.
  • Improving Couples' Relationship Functioning Leads to Improved Coparenting:
           A Randomized Controlled Trial with Rural African American Couples
    • Abstract: Publication date: Available online 4 January 2019Source: Behavior TherapyAuthor(s): Justin A. Lavner, Allen W. Barton, Steven R.H. Beach Family-centered prevention programs for couples with children are being increasingly disseminated, with the hope that improving couples' romantic relationships will lead to other benefits for families. To date, however, it is unclear whether these interventions do in fact yield these benefits. The current study addressed this gap by examining whether post-intervention improvements in couples' relationship functioning following family-centered prevention predicted longer-term change in coparenting, and whether post-intervention improvements in coparenting predicted longer-term change in relationship functioning. We used four waves of data collected over 2 years from 346 rural African American couples with an early adolescent child who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, an intervention designed to promote strong couple, coparenting, and parent–child relationships in two-parent African American families. Results indicated that ProSAAF had significant short-term positive effects on both romantic relationship functioning and coparenting and that these effects did not differ in magnitude. Over time, however, only romantic relationship functioning post-intervention was positively associated with long-term changes in coparenting; coparenting post-intervention was not associated with long-term changes in relationship functioning and this association was significantly weaker than the other pathway. These findings support a key premise underlying relationship enhancement programs for parents, indicating that improving couples' romantic relationship functioning can have longer-term benefits for the coparenting relationship as well. Further research examining long-term parent, child, and family outcomes following family-centered prevention for couples and the mechanisms of change underlying these outcomes is needed.
  • Group Differences in Facial Emotion Expression in Autism: Evidence for the
           Utility of Machine Classification
    • Abstract: Publication date: Available online 21 December 2018Source: Behavior TherapyAuthor(s): Nicole N. Capriola-Hall, Andrea Trubanova Wieckowski, Deanna Swain, Sherin Aly, Amira Youssef, A. Lynn Abbott, Susan W. White Effective social communication relies, in part, on accurate nonverbal expression of emotion. To evaluate the nature of facial emotion expression (FEE) deficits in children with Autism Spectrum Disorder (ASD), we compared 20 youth with ASD to a sample of typically developing (TD) youth (n = 20) using a machine-based classifier of FEE. Results indicate group differences in FEE for overall accuracy across emotions. In particular, a significant group difference in accuracy of FEE was observed when participants were prompted by a video of a human expressing an emotion, F(2, 36) = 4.99, p = .032, η2 = 0.12. Specifically, youth with ASD made significantly more errors in FEE relative to TD youth. Findings support continued refinement of machine-based approaches to assess and potentially remediate FEE impairment in youth with ASD.
  • Symptom Severity at Week Four of Cognitive Behavior Therapy Predicts
           Depression Remission
    • Abstract: Publication date: Available online 12 December 2018Source: Behavior TherapyAuthor(s): Jacqueline B. Persons, Cannon Thomas Early response has been shown to predict psychotherapy outcome. We examined the strength of the relationship between early response and remission in 82 patients who received naturalistic cognitive behavior therapy in a private practice setting, and 158 patients who received protocol cognitive therapy in a research setting. We predicted that the relationship between early response and remission would be substantial enough to guide clinical decision-making in both samples, and that a simple model of severity at week four of treatment would predict remission as effectively as a more complex change score. Logistic regressions showed that a simple model based on week four Beck Depression Inventory (BDI) score was as predictive of remission as more complex models of early change. A receiver operating characteristics (ROC) analysis showed that BDI score at week four was substantially predictive of remission in both the naturalistic and research protocol samples; the area under the curve was 0.80 and 0.84 in the naturalistic and protocol samples respectively. To guide clinical decision-making, we identified threshold scores on the BDI corresponding to various negative predictive values (probability of non-remission when non-remission is predicted). Our results indicate that depressed patients who remain severely depressed at week four of cognitive therapy are unlikely to reach remission at the end of relatively brief (maximum 20 sessions) treatment. We discuss implications of our findings for clinical decision-making and treatment development.
  • Reducing Test Anxiety in School Settings: A Controlled Pilot Study
           Examining a Group Format Delivery of the Attention Training Technique
           among Adolescent Students
    • Abstract: Publication date: Available online 11 December 2018Source: Behavior TherapyAuthor(s): Thomas A. Fergus, Christine A. Limbers Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined if a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed post-intervention study measures on the final day of the intervention and completed follow-up study measures approximately three weeks following the intervention. As predicted, students receiving ATT reported less post-intervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed.
  • Could Treatment Matching Patients' Beliefs about Depression Improve
    • Abstract: Publication date: Available online 8 December 2018Source: Behavior TherapyAuthor(s): Jeffrey R. Vittengl, Lee Anna Clark, Michael E. Thase, Robin B. Jarrett Patients' beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of (a) biochemical causes and (b) need for medication), and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients' biological beliefs about depression could increase CT efficacy.
  • A latent structure analysis of cognitive vulnerability to depression in
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): Richard T. Liu, Brae Anne McArthur, Taylor A. Burke, Jessica L. Hamilton, Naoise Mac Giollabhui, Jonathan P. Stange, Elissa J. Hamlat, Lyn Y. Abramson, Lauren B. Alloy Whether cognitive vulnerability to depression exists along a continuum of severity or as a qualitatively discrete phenomenological entity has direct bearing on theoretical formulations of risk for depression and clinical risk assessment. This question is of particular relevance to adolescence, given that cognitive vulnerability appears to coalesce and rates of depression begin to rise markedly during this period of development. Although a dimensional view is often assumed, it is necessary to submit this assumption to direct empirical evaluation. Taxometric analysis is a family of statistical techniques developed directly to test such assumptions. The present study applied taxometric methods to address this question in a community sample of early adolescents (n = 485), drawing on three indices of cognitive vulnerability to depression (i.e., negative inferential style, ruminative response style, self-referent information processing). The results of three taxometric analyses (i.e., mean above minus below a cut [MAMBAC], maximum eigenvalue [MAXEIG], and latent mode [L-Mode]) were consistent in unambiguously supporting a dimensional conceptualization of this construct. The latent structure of the tested indices of cognitive vulnerability to depression in adolescence appears to exist along a continuum of severity rather than as a discrete clinical entity.
  • Prevention of Initial Depressive Disorders among “At-Risk”
           Portuguese Adolescents
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): A. Paula Matos, M. do Rosário Pinheiro, José J. Costa, M. do Céu Salvador, Eirikur Ö. Arnarson, W. Edward Craighead This study evaluated whether Arnarson and Craighead's (2009, 2011) developmentally-based behavioral and cognitive program that prevented the initial episode of depressive disorders among Icelandic adolescents could be adapted to prevent depressive disorders among “at-risk” Portuguese adolescents. One hundred sixty-eight Portuguese mid-adolescents (primarily 14–15-years-old), who had subsyndromal symptoms of depression but who had never met criteria for a depressive disorder, were identified by classroom screening with the CDI and subsequent K-SADS-PL interview. All 168 adolescents were offered participation in the 14-week prevention program; 70 agreed to participate in the program, and 98 agreed to participate only in an assessment control group. Psychological disorders were evaluated at baseline, 6-, 12-, 18-, and 24-month assessments. During the 2-year follow-up period, 12 students in the assessment-only group experienced an initial depressive disorder versus 2 in the prevention group. Survival analyses indicated a significantly lower rate of initial episodes of depressive disorders (χ2(1) = 4.261, p = .039) among the prevention group participants compared to the assessment only comparison group. The hazard ratio was 0.207, and the NNT was 11. Survival analyses indicated no significant differences between the prevention condition and the assessment only condition in the occurrence of other psychiatric disorders (χ2(1) = 1.080, p = .299). The findings indicate the program can be successfully adapted for use in Portuguese schools, and they provide a preliminary indication that those “at-risk” adolescents who chose to participate in the program, compared to those who chose to participate only in the assessments, developed fewer initial episodes of depressive disorders over the course of 24 months. The program effects were similar to the outcomes of the prior study of this program in Iceland. As in the Icelandic version of the program, its effects appeared to be specific to the depressive disorders for which the program was designed.
  • The Role of Dyadic Discord in Outcomes in Acute Phase Cognitive Therapy
           for Adults with Recurrent Major Depressive Disorder
    • Abstract: Publication date: Available online 6 December 2018Source: Behavior TherapyAuthor(s): Joseph M. Trombello, Jeffrey R. Vittengl, Wayne H. Denton, Abu Minhajuddin, Michael E. Thase, Robin B. Jarrett Major depressive disorder (MDD) and relationship discord between cohabiting partners frequently co-occur, with bidirectional effects established. As relationship quality influences understanding and treatment of MDD, the current analyses clarified the relations of pretreatment dyadic discord with outcomes during and at the end of acute phase cognitive therapy (CT) for adults with recurrent MDD. Married or cohabiting patients (n = 219) completed the Dyadic Adjustment Scale (DYS) before and after a 16–20 session, 12–14 week CT protocol. Lower levels of dyadic adjustment indicated higher levels of dyadic discord. Response to CT was defined as the absence of a major depressive episode and ≤ 12 on the 17-item Hamilton Rating Scale for Depression. Pre-treatment dyadic discord, whether defined as a continuous or categorical variable (using DYS cutoff score of 97), was not associated with treatment completion or response but was positively associated with levels of depressive symptoms at the end of acute phase CT. Furthermore, CT was associated with declines in dyadic discord, with 23.3% of initially-discordant couples moving to nondiscordant status at the end of CT. Depressive symptoms did not significantly mediate changes in dyadic discord. Finally, pre- (but not mid-) treatment dyadic discord was associated with subsequent changes in depressive symptoms, suggesting limited mediation. These findings replicate prior research indicating that individual CT is associated with reductions in depressive symptoms and dyadic discord while clarifying that lower pre-treatment dyadic discord may predict initial improvement in depressive symptoms.
  • A Sequential Analysis of Clinician Skills and Client Change Statements in
           Brief Motivational Intervention for Young Adult Heavy Drinking
    • Abstract: Publication date: Available online 29 November 2018Source: Behavior TherapyAuthor(s): Justin Walthers, Tim Janssen, Nadine R. Mastroleo, Ariel Hoadley, Nancy P. Barnett, Suzanne M. Colby, Molly Magill This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians' use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice) and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians' use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.
  • Negative interpretation biases precede the onset of psychosis
    • Abstract: Publication date: Available online 23 November 2018Source: Behavior TherapyAuthor(s): Jenny Yiend, Paul Allen, Natalie Lopez, Irina Falkenberg, Huai-Hsuan Tseng, Philip McGuire This study investigated whether a negative interpretation bias was present in people at high risk for psychosis. People with an At Risk Mental State (ARMS) (n = 21), patients with First Episode Psychosis (FEP) (n = 20), and healthy controls (n = 20) performed three tasks, each of which was designed to measure interpretation bias. Both ARMS and FEP participants showed an attenuated positive bias compared to controls. These findings extend previous results investigating interpretation bias in psychosis by showing that interpretative biases are present before the onset of psychosis, and could therefore contribute to its development. Biased interpretation mechanisms could be a new target for clinical intervention in the early phase of psychosis.
  • The fixed mindset of anxiety predicts future distress: A longitudinal
    • Abstract: Publication date: Available online 14 November 2018Source: Behavior TherapyAuthor(s): Hans S. Schroder, Courtney P. Callahan, Allison E. Gornik, Jason S. Moser Mindsets, or beliefs about the malleability of self-attributes such as intelligence and personality, have been linked to a wide range of outcomes in educational and social psychology. There has been recent interest in exploring this construct in clinical psychological contexts. To that end, research has shown that the fixed mindset of anxiety– the belief that anxiety is fixed and unchangeable- is related to a variety of psychological distress symptoms, emotion regulation strategies, and treatment preferences. One outstanding question is whether the fixed mindset of anxiety predicts future psychological symptoms. To address this question, the current longitudinal study assessed weekly distress and anxiety mindset across five weeks. We found that fixed mindset of anxiety is predictive of future weekly distress, even after controlling for the previous week's distress, sex, socioeconomic status, baseline depression symptoms, and presence of psychiatric diagnosis. These findings add evidence to an emerging conceptual framework in which the fixed mindset of anxiety represents an important risk factor for the onset of future psychological problems.
  • Self-Help for Social Anxiety: Randomized Controlled Trial comparing a
           Mindfulness and Acceptance-based Approach with a Control Group
    • Abstract: Publication date: Available online 4 November 2018Source: Behavior TherapyAuthor(s): Nancy L. Kocovski, Jan E. Fleming, Rebecca A. Blackie, Meagan B. MacKenzie, Alison L. Rose There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from 0.74 to 0.79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.
  • A direct observational measure of family functioning for a low-resource
           setting: Adaptation and feasibility in a Kenyan sample
    • Abstract: Publication date: Available online 20 August 2018Source: Behavior TherapyAuthor(s): Ali M. Giusto, Bonnie N. Kaiser, David Ayuku, Eve S. Puffer Family interactions are recognized as highly influential for youth development of psychopathology. Key challenges for assessing family functioning include cross-cultural variability in functioning and self-report measurement challenges. Observational measures –adapted to cultural context – provide an approach to addressing challenges. This study aimed to adapt a direct observational tool for assessing family interaction patterns in Kenya, to outline a replicable adaptation process, and to explore tool feasibility and acceptability. We reviewed existing tools to assess their adaptability based on compatibility with context-specific data. After initial modifications, the measure was iteratively adapted through pilot testing and collaborative discussions between US and Kenyan collaborators that drove changes and further piloting. The measure was administered to 26 families. The Family Problem Solving Code was chosen for adaptation. The tool's activity structure was feasible to administer, but activity content showed low acceptability, requiring new content. Final activities included (a) a hands-on problem-solving task, (b) a discussion of marital conflict with couples, and (c) a structured discussion of family hopes. Codes were adapted to reflect culturally-congruent descriptions of behavior, expressions, and interactions; including an emphasis on non-verbal interactions. The scoring system was modified to facilitate training and consistent rating among trainees with limited experience. Observational tool findings were consistent with those of an interview assessing family functioning, rated by clinical and non-clinical raters. Adaptation resulted in a culturally-relevant tool assessing family functioning that proved feasible and acceptable. The adaptation process also proved feasible and efficient in a low-resource setting, suggesting its utility for other contexts.
  • An Internet-Based Compassion-Focused Intervention for Increased
           Self-Criticism: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 17 August 2018Source: Behavior TherapyAuthor(s): Tobias Krieger, Fabienne Reber, Barbara von Glutz, Antoine Urech, Christian T. Moser, Ava Schulz, Thomas Berger Increased levels of self-criticism and a lack of self-compassion have been associated with the development and maintenance of a range of psychological disorders. In the current study, we tested the efficacy of an online version of a compassion-focused intervention, mindfulness-based compassionate living (MBCL), with guidance on request. A total of 122 self-referred participants with increased levels of self-criticism were randomly assigned to care as usual (CAU) or the intervention group (CAU + online intervention). Primary endpoints were self-reported depressive, anxiety and distress symptoms (DASS-21) and self-compassion (SCS) at 8-weeks. Secondary endpoints were self-criticism, mindfulness, satisfaction with life, fear of self-compassion, self-esteem and existential shame. At post-treatment, the intervention group showed significant changes with medium to large effect sizes compared to the control group regarding primary outcomes (Cohen's d: 0.79 [DASS] and − 1.21 [SCS]) and secondary outcomes (Cohen's ds: between 0.40 and 0.94 in favor of the intervention group). The effects in the intervention group were maintained at six-months post-randomization. Adherence measures (number of completed modules, self-reported number of completed exercises per week) predicted post-intervention scores for self-compassion but not for depressive, anxiety, and distress symptoms in the intervention group. The current study shows the efficacy of an online intervention with a transdiagnostic intervention target on a broad range of measures, including depressive and anxiety symptoms and self-compassion.
  • Dissemination and Implementation of Cognitive Behavioral Therapy for
           Depression in the Kaiser Permanente Health Care System: Evaluation of
           Initial Training and Clinical Outcomes
    • Abstract: Publication date: Available online 16 August 2018Source: Behavior TherapyAuthor(s): Bradley E. Karlin, Gregory K. Brown, Shari Jager-Hyman, Kelly L. Green, Michi Wong, Diane S. Lee, Andrew Bertagnolli, Thekla Brumder Ross Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, Cognitive Behavioral Therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.
  • The Struggle of Behavioral Therapists With Exposure: Self-Reported
           Practicability, Negative Beliefs, and Therapist Distress About
           Exposure-Based Interventions
    • Abstract: Publication date: Available online 3 August 2018Source: Behavior TherapyAuthor(s): Andre Pittig, Roxana Kotter, Jürgen Hoyer Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
  • Self-Criticism Impacts Emotional Responses to Pain
    • Abstract: Publication date: Available online 1 August 2018Source: Behavior TherapyAuthor(s): Kathryn R. Fox, Isabel M. O'Sullivan, Shirley B. Wang, Jill M. Hooley Nonsuicidal self-injury (NSSI) is associated with numerous negative outcomes (e.g., suicide attempts), making it a focus of great clinical concern. Yet, mechanisms reinforcing NSSI remain unclear. The Benefits and Barriers Model proposes that NSSI engagement is determined by both benefits of and barriers to NSSI. Benefits include mood improvement, a function reported by most who engage in NSSI; barriers include a desire to avoid pain and bodily harm. Self-criticism is generally understood as a trait lowering desire to avoid pain and bodily harm, thus decreasing that specific barrier. However, recent research demonstrated that self-criticism may also increase NSSI benefits. Highly self-critical people may view NSSI and pain in the context of feeling deserving of pain and punishment; thus, pain may improve mood for self-critical individuals. We tested whether self-criticism impacted emotional responding to pain among adult females with (n = 44) and without (n = 65) NSSI histories. After a negative mood induction, participants rated their moods before, during, and after self-administered pain. In participants with and without NSSI histories, self-criticism was positively correlated with mood improvements during pain. Thus, regardless of NSSI history, self-criticism impacted emotional responses to pain. Together, results suggest that self-criticism may not only decrease an important NSSI barrier but also enhance NSSI benefits, specifically leading to more mood improvement during pain.
  • Testing an app-assisted treatment for suicide prevention in a randomized
           controlled trial: Effects on suicide risk and depression
    • Abstract: Publication date: Available online 30 July 2018Source: Behavior TherapyAuthor(s): Mia Skytte O'Toole, Mikkel B. Arendt, Christian M. Pedersen Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. 129 participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU + APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., “LifeApp'tite”). Suicide risk and symptoms of depression were assessed pre and post therapy, and at 4-month follow-up.The TAU + APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was only the case at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.
  • Different disgust domains specifically relate to mental and contact
           contamination fear in obsessive–compulsive disorder: evidence from a
           path analytic model in an Italian clinical sample
    • Abstract: Publication date: Available online 29 July 2018Source: Behavior TherapyAuthor(s): Andrea Poli, Gabriele Melli, Adam S. Radomsky Both contact contamination (CC) and mental contamination (MC) fears – which combined represent the most common manifestation of obsessive–compulsive disorder (OCD) - have been widely associated with disgust propensity (DP). However, extant research explored this relationship using measures assessing only pathogen-related disgust, not taking into account the potential role played by sexual and moral disgust, despite literature about MC suggesting that this might be particularly relevant. In Study 1 the psychometric properties of the Italian version of the Three Domains of Disgust Scale (TDDS) were assessed in a large Italian community sample. Exploratory and confirmatory factor analyses confirmed the three-factor structure of the TDDS. The scale also showed good internal consistency and construct validity. In Study 2, the differential patterns of relationships between CC and MC and the three disgust domains were explored in an Italian clinical OCD sample using a path analytic approach. The TDDS-Pathogen subscale was a unique predictor of CC while the TDDS-Sexual subscale was a unique predictor of MC, after controlling for anxiety and depression. Surprisingly, the TDDS-Moral subscale was not a predictor of either domain of contamination fear. Limitations and clinical implications are discussed.
  • Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care
           in Child Mental Health Treatment
    • Abstract: Publication date: Available online 27 July 2018Source: Behavior TherapyAuthor(s): Tatiana M. Davidson, Brian E. Bunnell, Benjamin E. Saunders, Rochelle Hanson, Carla K. Danielson, Danna Cook, Brian Chu, Shannon Dorsey, Zachary W. Adams, Arthur R. Andrews, Jesse Walker, Kathryn E. Soltis, Judith Cohen, Esther Deblinger, Kenneth J. Ruggiero Mental health systems need scalable solutions that can reduce the efficacy-effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high quality care are providers' fidelity to evidence-based treatment models and children's and caregivers' engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio-recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.Technology-Based Tools to Enhance Quality of Care in Mental Health Treatment;; NCT01915160.
  • Patient-Informed Treatment Development of Behavioral Smoking Cessation for
           People with Schizophrenia
    • Abstract: Publication date: Available online 27 July 2018Source: Behavior TherapyAuthor(s): Sarah M. Wilson, Alexandra C. Thompson, Emily D. Currence, Shaun P. Thomas, Eric A. Dedert, Angela C. Kirby, Eric B. Elbogen, Scott D. Moore, Patrick S. Calhoun, Jean C. Beckham The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semi-structured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multi-component mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the StayQuit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at post-treatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.
  • Improved Perceptions of Emotion Regulation and Reflective Functioning in
           Parents: Two Additional Positive Outcomes of Parent–Child Interaction
    • Abstract: Publication date: Available online 12 July 2018Source: Behavior TherapyAuthor(s): Melanie J. Zimmer-Gembeck, Jessica Kerin, Haley J. Webb, Alex Gardner, Shawna Campbell, Kellie Swan, Susan G. Timmer The purpose of this study was to test whether Parent–Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of pre-mentalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, pre-mentalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.
  • The relative effects of abstract versus concrete processing on proactivity
           in depression
    • Abstract: Publication date: Available online 11 July 2018Source: Behavior TherapyAuthor(s): Shanta Dey, Ben R. Newell, Michelle L. Moulds Low levels of proactivity are characteristic of individuals with depression. Two studies were conducted to compare the relative effects of abstract versus concrete processing on proactivity in high dysphoric individuals. In Study 1, participants read information about an upcoming research study and were then randomly allocated to a writing task that induced them to think about participating in that study in either an abstract (e.g., why you would participate in the study'; n = 25) or concrete (e.g., how you will participate in the study'; n = 25) way. Participants were then asked to indicate whether they would sign-up to the study. As expected, more participants indicated that they would take part in the study in the concrete condition (76%) than in the abstract condition (36%). In Study 2, high dysphoric participants were asked to identify their ideal part-time job and were then randomly allocated to a writing task that induced them to think about applying for the job in an abstract (n = 26) or concrete (n = 25) way. There was no difference between conditions in self-reported intentions of proactivity. However, significantly more participants in the concrete condition opted to look at an employment assistance website and returned to the lab to collect a job application package. Overall, these findings suggest that abstract processing could contribute to low levels of proactivity in depression, and that facilitating the use of concrete processing could help to alleviate this problem. Our results also point to the need for greater conceptual clarification of the distinction between concrete processing about proactive behaviour and implementation intentions (identifying specific steps for completing an action/goal).
  • Defining Treatment Outcomes in Pediatric Obsessive–Compulsive Disorder
           Using a Self-report Scale
    • Abstract: Publication date: Available online 22 June 2018Source: Behavior TherapyAuthor(s): Joseph F. McGuire, Daniel A. Geller, Tanya K. Murphy, Brent J. Small, Arianna Unger, Sabine Wilhelm, Eric A. StorchABSTRACTThis study examined benchmarks of treatment response and clinical remission on the Obsessive Compulsive Inventory-Child Version (OCI-CV) for youth with obsessive–compulsive disorder (OCD). Participants were 91 youth who enrolled in a randomized controlled trial that examined the benefit of augmenting cognitive behavior therapy (CBT) with either d-cycloserine or placebo. Youth completed the OCI-CV at baseline, Week 4 (prior to initiating exposure therapy), and post-treatment. Receiver operator curve (ROC) analyses examined optimal benchmarks for treatment response and clinical remission as identified by independent evaluators at the post-treatment assessment using the Clinical Global Impression (CGI) scales of Improvement (CGI-Improvement), Severity (CGI-Severity), and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Optimal benchmarks for treatment response were a 20–25% reduction in the OCI-CV total score. Meanwhile, optimal benchmarks for remission were a 55–65% reduction in the OCI-CV total score and a post-treatment total score ≤ 6–8. OCI-CV benchmarks exhibited moderate agreement with the CY-BOCS for treatment response and clinical remission. Meanwhile, fair agreement was observed for response and remission with CGI scales. A lower pre-treatment OCI-CV total score was associated with less agreement between classification approaches. Findings provide benchmarks for classifying treatment response and clinical remission in an efficient manner. Given the moderate agreement between the CY-BOCS and OCI-CV benchmarks, the OCI-CV may serve as a useful alternative when clinician-rated scales cannot be administered due to limited resources (e.g., time, training). Thus, evidence-based measurement can be incorporated to monitor therapeutic response and remission in clinical practice.
  • 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.
  • 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.
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