Subscribe: Journal of Consulting and Clinical Psychology - Vol 77, Iss 6
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Journal of Consulting and Clinical Psychology - Vol 85, Iss 4

The Journal of Consulting and Clinical Psychology publishes original contributions on the following topics: (a) the development, validity, and use of techniques of diagnosis, treatment, and prevention of disordered behavior; (b) studies of populations of

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Copyright: Copyright 2017 American Psychological Association

Randomized controlled trial of Triple P for parents of children with asthma or eczema: Effects on parenting and child behavior.


Objective: Parents play an important role in children’s illness management, in promoting child adjustment and reducing behavior problems. Little research has focused on the evaluation of parenting interventions in the context of childhood chronic illness. The aim of this study was to test the efficacy of a brief, group parenting intervention (Healthy Living Triple P) in improving parenting skills and parent adjustment, and reducing child behavioral and emotional difficulties in the context of childhood asthma and eczema. Method: One hundred seven parents of children with a diagnosis of asthma and/or eczema were randomly assigned to intervention (n = 52) or care as usual (CAU; n = 55). Parents completed self-report measures of their child’s behavioral and emotional adjustment, their own parenting, and their own level of adjustment at pre- and postintervention and at 6-month follow-up. Parent–child interactions were observed and coded at each time point. The intervention consisted of 2 group sessions of 2 hr each delivered by trained, accredited practitioners. Results: Attrition was low, with T2 and T3 assessment completed by 84.6% and 80.8% of intervention families and 92.7% and 81.8% of CAU families, respectively. Intention-to-treat analyses indicated that overall parent-reported ineffective parenting as well as parental overreactivity reduced as a result of intervention. Parent report of child behavior problems also decreased, but there were no changes in children’s emotional adjustment. No changes in observed parent or child behavior were found. Stress reduced for parents in the intervention group compared to the CAU group, but there were no changes in parental anxiety or depression. Effects showed evidence of reliable and clinical change and were maintained at 6-month follow-up. Conclusions: The intervention shows promise as an addition to clinical services for children with asthma and eczema and may have broader application to other chronic health conditions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Characterizing spouse/partner depression and alcohol problems over the course of military deployment.


Objective: Spouse/partners of military personnel demonstrate elevated levels of distress during military deployments, yet there is insufficient information about courses of adjustment over time. The current study identified trajectories of depression and alcohol use problems and predictors of those trajectories across the deployment cycle. Method: National Guard soldiers (N = 1973) and spouses/intimate partners (N = 1020) completed assessments of risk/protective factors and baseline measures of mental health functioning 2 to 5 months prior to soldiers’ 1-year deployments (Time 1) to Kuwait/Iraq in support of Operation New Dawn or Afghanistan in support of Operation Enduring Freedom. Partners’ mental health was reassessed at 4 months (Time 2) and 8 months (Time 3) after soldiers deployed, and both spouses/partners and soldiers were reassessed 2–3 months postdeployment (Time 4). Results: Latent class growth modeling of partner depression symptoms over time revealed 4 groups: Resilience (79.9%), Deployment Distress (8.9%), Anticipatory Distress (8.4%), and Post-Deployment Distress (2.7%). Three alcohol misuse trajectories were identified: Resilience (91.3%), Deployment Onset (5.4%), and Deployment Desistance (3.3%). Predeployment predictors of partners’ depression symptom trajectories varied by group and included soldier reports of stressors and social support and partner levels of neuroticism, introversion, disconstraint, and reported stressors. Predeployment predictors of alcohol misuse trajectories varied by group, and included soldier levels of alcohol misuse as well as partner neuroticism, disconstraint, and family readiness. Conclusions: Delineating and predicting trajectories of partner adjustment can allow for better targeted interventions toward those most at risk for heightened distress or alcohol problems over the deployment cycle. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

A randomized clinical trial of behavioral couples therapy versus individually-based treatment for drug-abusing women.


Objective: Behavioral couples therapy (BCT) is more efficacious than individually-based therapy (IBT) for substance and relationship outcomes among substance use disorder patients. This study compared BCT with IBT for drug-abusing women. Method: Sixty-one women, mostly White, late 30s, with primary substance use disorder other than alcohol (74% opioid), and male partners were randomized to 26 sessions over 13 weeks of BCT plus 12-step-oriented IBT (i.e., BCT + IBT) or IBT. Substance-related outcomes were percentage days abstinent (PDA), percentage days drug use (PDDU), Inventory of Drug Use Consequences. Relationship outcomes were Dyadic Adjustment Scale (DAS), days separated. Data were collected at baseline, posttreatment, and quarterly for 1-year follow-up. Results: On PDA, PDDU, and substance-related problems, both BCT + IBT and IBT patients showed significant (p .8 for most time periods). BCT + IBT showed a significant (p .47). On relationship outcomes, compared to IBT, BCT + IBT had significantly higher male-reported Dyadic Adjustment Scale (p < .001, d = .57) and fewer days separated (p = .01, d = −.47) throughout 1-year follow-up. Conclusion: BCT + IBT for drug-abusing women was more efficacious than IBT in improving relationship satisfaction and preventing relationship breakup. On substance use and substance-related problems, women receiving both treatments substantially improved, and women receiving BCT + IBT had fewer substance-related problems than IBT. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Effects of multisystemic therapy on caregivers of serious juvenile offenders: A 20-year follow-up to a randomized clinical trial.


Objective: Caregivers of serious juvenile offenders often hold favorable attitudes about criminality and frequently have histories of involvement in antisocial behaviors themselves. In the present study, the authors examined the long-term criminal and noncriminal outcomes for caregivers of serious juvenile offenders who had participated two decades earlier in a randomized clinical trial of multisystemic therapy (MST; Borduin et al., 1995). Method: Participants were 276 caregivers of serious juvenile offenders who were originally randomized to MST or individual therapy (IT). Criminal and civil suit data for caregivers were obtained during a 20.7-year follow-up when caregivers were on average 61.5 years old. Results: Caregivers in the MST condition had 94% fewer felonies and 70% fewer misdemeanors than did caregivers in the IT condition. In addition, caregivers in the IT condition were sentenced to 92% more days of incarceration and had 50% more family-related civil suits. Moreover, the favorable long-term effects of MST on caregiver criminality and civil suits were mediated by improved family relations during treatment. Conclusion: The present study represents the only follow-up to date of caregivers in an MST clinical trial and demonstrates the broader clinical benefits of a family-based treatment for serious juvenile offenders. Implications of the findings for policymakers and researchers are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Family-based treatments for serious juvenile offenders: A multilevel meta-analysis.


Objective: Researchers have identified several family-based treatments that hold considerable promise in reducing serious juvenile offending; however, these treatments remain underutilized by youth service systems. In the present study, we used meta-analysis to summarize the findings of research on family-based treatments for serious juvenile offenders. Method: We conducted a multilevel meta-analysis that modeled dependencies between multiple effect sizes from the same study. The meta-analysis synthesized 324 effect sizes from 28 studies that met inclusion criteria. Potential moderators (e.g., characteristics of samples, treatments, methods, and measures) were entered as fixed effects in the meta-analytic model. Results: Across studies, family-based treatments produced modest, yet long-lasting, treatment effects (mean d = 0.25 for antisocial behavior, 0.24 overall) relative to comparison conditions. Furthermore, certain characteristics moderated the magnitude of treatment effects; for example, measures of substance use showed the largest effects and measures of peer relationships showed the smallest effects. Conclusions: Policymakers, administrators, and treatment providers may find it useful to consider the effects of family-based treatments for serious juvenile offenders in their selection of treatments for this population. In addition, investigators who seek to develop and study such treatments may wish to consider the current findings in their future research efforts. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Mom-net: Evaluation of an internet-facilitated cognitive behavioral intervention for low-income depressed mothers.


Objective: Evaluate an Internet-facilitated cognitive–behavioral treatment intervention for depression, tailored to economically disadvantaged mothers of young children. Method: Economically disadvantaged mothers (N = 266) of preschool aged children, who reported elevated levels of depressive symptoms, were randomized to either the 8-session, Internet-facilitated intervention (Mom-Net) or to Motivational Interviewing and Referral to Services (MIRS). Outcomes were measured using the Patient Health Questionnaire 9 (PHQ-9; Spitzer et al., 1999), the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revised (DSM–IV–TR) Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 2002), and the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960). Results: Relative to participants in the MIRS condition, participants in Mom-Net demonstrated significantly greater reduction in depression as indexed by self-report questionnaire (primary outcome), interviewer-rated symptoms, and diagnostic outcomes. Conclusions: Results suggest that the Mom-Net intervention is effective as a remotely delivered intervention for economically disadvantaged mothers. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Effectiveness of an internet intervention (Deprexis) for depression in a united states adult sample: A parallel-group pragmatic randomized controlled trial.


Objective: To examine the effectiveness of an Internet intervention for depression with a randomized, controlled trial in a large sample of adults recruited from the United States. Method: The current study examines the effectiveness of Deprexis, an Internet treatment for depression that was provided with relatively minimal support. There were 376 treatment-seeking adults (mean age = 32 years; 74% female; 77% Caucasian, 7% Asian, 7% multiple races, 4% African American, and 11% Hispanic/Latino) with elevated depression (Quick Inventory of Depressive Symptoms-Self-Report [QIDS-SR] > = 10) who were randomized to receive an 8-week course of treatment immediately (n = 285) or after an 8-week delay (n = 91; i.e., waitlist control). Results: Intention-to-treat analyses indicated that treatment was associated with greater reduction in self-reported symptoms of depression (effect size d = .80) and 12 times greater likelihood of experiencing at least 50% symptom improvement compared with waitlist control. Similar effects were observed for several secondary outcomes, such as interviewer-rated depression symptoms, well-being, and depression-related disability. Treatment effects for symptoms of social anxiety, panic, and traumatic intrusions were relatively small. Conclusion: Results suggest that Deprexis can produce symptomatic improvement among depressed adults recruited from the United States. Additional research is needed that examines whether improvements are maintained over time and who is particularly likely to respond to this form of treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Self-control depletion and nicotine deprivation as precipitants of smoking cessation failure: A human laboratory model.


Objective: The need to understand potential precipitants of smoking relapse is exemplified by relapse rates as high as 95%. The Self-Control Strength model, which proposes that self-control is dependent upon limited resources and susceptible to fatigue, may offer insight into relapse processes. The current study tested the hypothesis that self-control depletion (SCD), produced from engagement in emotional suppression, would serve as a novel antecedent for cessation failure, as indexed by a validated laboratory analogue of smoking lapse and relapse. We also examined whether SCD effects interacted with those of a well-established relapse precipitant (i.e., nicotine deprivation). Craving and behavioral economic indices (delay discounting and demand) were tested as hypothesized mechanisms for increased cessation failure. Ultimately, a moderated mediation model was used to test nicotine deprivation as a hypothesized moderator of SCD effects. Method: We used a 2 × 2 (12-hr deprivation vs. no deprivation; SCD vs. no SCD) factorial between-subjects design (N = 128 smokers). Results: The primary hypothesis of the study was supported, as SCD increased lapse behavior (p = .04). Nicotine deprivation significantly increased craving, cigarette demand, delay discounting, and lapse behavior. No main effects were found for SCD on putative mediators (i.e., craving, demand, and discounting), but the SCD and deprivation manipulations interacted upon craving (p = .04). The moderated mediation model was significant. SCD was found to increase craving among nicotine deprived smokers, which mediated effects on lapse behavior. Conclusions: SCD appears to play an important role in smoking relapse and may be a viable target for intervention. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors.


Objective: Mindfulness meditation reduces psychological distress among individuals with cancer. However, mechanisms for intervention effects have not been fully determined. This study tested emotion regulation strategies as mediators of intervention effects in a sample of younger women treated for breast cancer, a group at risk for psychological distress. We focused on two distinct strategies targeted by the intervention—rumination and self-kindness—and further examined the broader construct of mindfulness as a potential mediator. Method: Women (n = 71) with Stage 0-III breast cancer diagnosed at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week mindfulness intervention or wait-list control group. Assessments occurred at study entry, postintervention, and a 3-month follow-up. Results: In single mediator analyses, increases in self-kindness (CIB [−7.83, −1.93]), decreases in rumination (CIB [−5.05, −.31]), and increases in mindfulness (CIB [−6.58, −.82]) each mediated reductions in depressive symptoms from pre- to postintervention. Increases in self-kindness also mediated reductions in perceived stress (CIB [−5.37, −.62]) from pre- to postintervention, and increases in self-kindness (CIB [−5.67, −.22]) and in mindfulness (CIB [−5.51, −.16]) each mediated intervention effects on perceived stress from preintervention to 3-month follow-up. In multiple mediator analysis, only self-kindness mediated intervention effects on depressive symptoms from pre- to postintervention (CIB [−6.41, −.61]), and self-kindness and mindfulness together mediated intervention effects on perceived stress from preintervention to follow-up (CIB [−6.77, −.35]). Conclusions: Self-kindness played a consistent role in reducing distress in younger women with breast cancer. The efficacy of this understudied emotion regulation strategy should be evaluated in other clinical populations. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Health care contact and suicide risk documentation prior to suicide death: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).


Objective: Prior research has shown that a substantial portion of suicide decedents access health care in the weeks and months before their death. We examined whether this is true among soldiers. Method: The sample included the 569 Regular Army soldiers in the U.S. Army who died by suicide on active duty between 2004 and 2009 compared to 5,690 matched controls. Analyses examined the prevalence and frequency of health care contacts and documentation of suicide risk (i.e., the presence of prior suicidal thoughts and behaviors) over the year preceding suicide death. Predictors of health care contact and suicide risk documentation were also examined. Results: Approximately 50% of suicide decedents accessed health care in the month prior to their death, and over 25% of suicide decedents accessed health care in the week prior to their death. Mental health encounters were significantly more prevalent among suicide decedents (4 weeks: 27.9% vs. 7.9%, χ2 = 96.2, p < .001; 52 weeks: 59.4% vs. 33.7%, χ2 = 120.2, p < .001). Despite this, risk documentation was rare among suicide decedents (4 weeks: 13.8%; 52 weeks: 24.5%). Suicide decedents who were male, never married, and non-Hispanic Black were less likely to access care prior to death. Number of mental health encounters was the only predictor of suicide risk documentation among decedents at 4 weeks (OR = 1.14) and 52 weeks (OR = 1.05) prior to their death. Conclusions: Many soldiers who die by suicide access health care shortly before death, presenting an opportunity for suicide prevention. However, in most cases, there was no documentation of prior suicidal thoughts or behaviors, highlighting the need for improvements in risk detection and prediction. Increasing the frequency, scope, and accuracy of risk assessments, especially in mental health care settings, may be particularly useful. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)