Subscribe: Journal of Consulting and Clinical Psychology - Vol 77, Iss 6
Added By: Feedage Forager Feedage Grade B rated
Language: English
based  database record  drinking  home  psycinfo database  randomized  results  session  strength home  training  treatment 
Rate this Feed
Rate this feedRate this feedRate this feedRate this feedRate this feed
Rate this feed 1 starRate this feed 2 starRate this feed 3 starRate this feed 4 starRate this feed 5 star

Comments (0)

Feed Details and Statistics Feed Statistics
Preview: Journal of Consulting and Clinical Psychology - Vol 77, Iss 6

Journal of Consulting and Clinical Psychology - Vol 84, Iss 11

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

Last Build Date: Thu, 27 Oct 2016 17:00:30 EST

Copyright: Copyright 2016 American Psychological Association

Home-based telebehavioral health for U.S. military personnel and veterans with depression: A randomized controlled trial.


Objective: Evidence of feasibility, safety, and effectiveness of home-based telebehavioral health (HBTBH) needs to be established before adoption of HBTBH in the military health system can occur. The purpose of this randomized controlled noninferiority trial was to compare the safety, feasibility, and effectiveness of HBTBH to care provided in the traditional in-office setting among military personnel and veterans. Method: One hundred and twenty-one U.S. military service members and veterans were recruited at a military treatment facility and a Veterans Health Administration hospital. Participants were randomized to receive 8 sessions of behavioral activation treatment for depression (BATD) either in the home via videoconferencing (VC) or in a traditional in-office (same room) setting. Participants were assessed at baseline, midtreatment (4 weeks), posttreatment (8 weeks), and 3 months posttreatment. Results: Mixed-effects modeling results with Beck Hopelessness Scale and Beck Depression Inventory II scores suggested relatively strong and similar reductions in hopelessness and depressive symptoms for both groups; however, noninferiority analyses failed to reject the null hypothesis that in-home care was no worse than in-office treatment based on these measures. There were not any differences found between treatment groups in regards to treatment satisfaction. Safety procedures were successfully implemented, supporting the feasibility of home-based care. Conclusion: BATD can be feasibly delivered to the homes of active duty service members and veterans via VC. Small-group differences suggest a slight benefit of in-person care over in-home telehealth on some clinical outcomes. Reasons for this are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Strength at Home Couples program to prevent military partner violence: A randomized controlled trial.


Objective: We evaluated the efficacy of Strength at Home Couples, a cognitive–behavioral trauma-informed intimate partner violence (IPV) preventive intervention for married or partnered military service members or veterans. No prior randomized controlled trial had supported the efficacy of such an intervention in this population. Method: Participants included 69 male service members or veterans and their female partners. Recruitment was conducted from February 2010 through August 2013, and participation occurred within 2 Department of Veterans Affairs hospitals. All couples completed an initial assessment including diagnostic interviews and measures of physical and psychological IPV and were randomized by cohort to a supportive prevention couples group or Strength at Home Couples. All couples were reassessed at postintervention and at 6 and 12 months follow-ups. Results: Both service members or veterans and their female partners engaged in fewer acts of reported physical and psychological IPV in the Strength at Home Couples condition relative to supportive prevention, and relative risk of physical violence was lower for both members of the dyad in Strength at Home Couples at follow-up assessments (male service member or veteran IPV relative risk [RR] = .53; female IPV RR = .43). Those in Strength at Home Couples evidenced significantly greater program completion than did those in supportive prevention (RR = 1.73; 95% confidence interval [1.00, 2.99]). Exploratory analyses did not find differences between groups on relationship satisfaction. Conclusion: Results provide support for the efficacy of Strength at Home Couples in preventing physical IPV and reducing psychological IPV. These results have important implications for preventing violence and associated physical and mental health problems. Clinical Trials Registration: Trial Registry Name: Strength at Home Couples Program; Registration Number: NCT00827879; URL: (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).


Objective: Prolonged exposure (PE) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD) but there is limited research with active-duty military populations. Virtual reality exposure (VRE) has shown promise but randomized trials are needed to evaluate efficacy relative to existing standards of care. This study evaluated the efficacy of VRE and PE for active duty soldiers with PTSD from deployments to Iraq and Afghanistan. Method: Active-duty soldiers (N = 162) were randomized to 10-sessions of PE, VRE, or a minimal attention waitlist (WL). Blinded assessors evaluated symptoms at baseline, halfway through treatment, at posttreatment, and at 3- and 6-month follow-ups using the Clinician Administered PTSD Scale (CAPS). Results: Intent-to-treat analyses found that both PE and VRE resulted in significant reductions in PTSD symptoms relative to those in the WL. The majority of patients demonstrated reliable change in PTSD symptoms. There was no difference between PE and VRE regarding treatment drop out before completing 10 sessions (44 and 41% for VRE and PE, respectively). Contrary to hypotheses, analyses at posttreatment did not show that VRE was superior to PE. Post hoc analyses found that PE resulted in significantly greater symptom reductions than VRE at 3- and 6-month follow-up. Both treatments significantly reduced self-reported stigma. Conclusions: PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Evaluating postdeployment training for coping with intrusive cognition: A comparison of training approaches.


Objective: Although intrusive cognition (IC) is remarkably common in soldiers postdeployment and successful coping with ICs may predict better long-term psychological health, few elements of current programmatic postdeployment trainings have directly addressed adaptive strategies for managing intrusive deployment-related cognitions. The current study explored the efficacy of a brief acceptance-based skills training for coping with ICs relative to a change-based skills training, a psychoeducation-only training, or training as usual. Method: Participants were 1,524 (1,372 men) active-duty U.S. Army soldiers between 3 and 12 months’ postdeployment. Results: Soldiers who received acceptance-based training demonstrated larger reductions in distress and impairment related to ICs about deployment at 1 month follow-up and larger reductions in symptoms of PTSD and general psychopathology relative to other training conditions. In contrast, participants in the change-oriented skills training showed relatively fewer benefits than did those in the acceptance-based training. In addition, soldiers who received the psychoeducation-only training showed no benefits relative to training as usual. Conclusions: Results suggest that brief trainings focused on postdeployment ICs may have benefits for soldiers up to 1 month later and may be a useful addition to a broader postdeployment transition program. Findings also indicate that an acceptance-based training approach may be more beneficial than a change-oriented approach for helping soldiers manage ICs and that psychoeducation alone may be insufficient for helping soldiers manage these cognitions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Therapeutic alliances predict session by session drinking behavior in the treatment of alcohol use disorders.


Objective: The therapeutic alliance is recognized as an important contributor to treatment outcomes. In this study, the session-to-session interplay of the alliance (as perceived by the patient) and alcohol involvement (drinking days and heavy drinking days between successive treatment sessions) was examined. The analyses also tested the extent to which pretreatment changes in drinking altered these interrelationships. Method: Participants (N = 63) seeking treatment for an alcohol use disorder received 12 weeks of CBT for alcohol dependence and completed weekly assessments of the alliance. Results: Higher session alliance scores at a given session significantly predicted lower alcohol involvement (both drinking days and heavy drinking days) in the period until the next treatment session, controlling for previous alcohol involvement. This relationship was further moderated by pretreatment change (changes in drinking before the first treatment session). Among those who demonstrated low pretreatment change, alliances continued to predict alcohol involvement. In contrast, alliances were not associated with alcohol involvement among those who significantly reduced their drinking before the first treatment session (high pretreatment changers). Finally, alcohol involvement during the period preceding a treatment session did not significantly predict alliance ratings. Conclusions: These data demonstrate that more positive patient ratings of the alliance at any given treatment session are associated with less alcohol involvement during the period until the next treatment session, most particularly among patients who have not initiated reductions in their drinking before the first treatment session. For such patients, efforts to maximize therapeutic alliances may be warranted and productive. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Augmenting brief interventions for adolescent marijuana users: The impact of motivational check-ins.


Objective: Brief interventions for adolescent marijuana users offered in schools reach users who would not otherwise present for treatment. The current study builds on previous trials of a school-based, 2-session motivational enhancement therapy (MET) intervention by adding periodic, brief motivational check-ins to reinforce gains and bolster motivation. Method: Adolescent participants were randomly assigned to a motivational check-in (MCI; n = 128) or assessment-only check-in (ACI; n = 124) comparison condition. Both conditions received 2 sessions of MET. Participants in the MCI condition then attended 3 MET-based check-in sessions at 4, 7, and 10 months after baseline, whereas the ACI condition participants attended assessment-only check-ins at the same time points. Optional cognitive behavior therapy (CBT) sessions were available as needed for 12 months from baseline in both conditions. Results: Outcomes were assessed at 6, 9, 12, and 15 months after baseline. Participants (59% Caucasian; 68% male; mean age = 15.84) reported using marijuana on an average of 37 of the last 60 days, and 70% met diagnostic criteria for a marijuana use disorder. Both conditions were associated with reduced use and negative consequences that were sustained throughout the 15 months of follow-up. The MCI condition resulted in greater reductions at the 6 months follow-up, but differences between conditions were not found at later follow-ups, and MCI participation did not increase engagement in CBT as predicted. Conclusions: Results replicated the efficacy of the brief intervention for adolescent marijuana use and provided mixed evidence on the utility of adding repeated check-in sessions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Motivational interviewing improves depression outcome in primary care: A cluster randomized trial.


Objective: To examine the effects of Motivational Interviewing (MI) conducted by primary care providers on rates of improvement over time for depressive symptoms and remission among low-income patients with newly diagnosed Major Depressive Disorder. Method: Ten care teams were randomized to MI with standard management of depression (MI-SMD; 4 teams, 10 providers, 88 patients) or SMD alone (6 teams, 16 providers, 80 patients). Patients were assessed at 6, 12 and 36 weeks with the Patient Health Questionnaire-9 (PHQ-9). Treatment receipt was ascertained through patient inquiry and electronic records. Audio-recorded index encounters were evaluated for mediators of improved depressive symptoms (providers’ MI ability and patient language favoring participating in treatment or other depression related mood-improving behaviors). Results: In Intention-To-Treat analyses, MI-SMD was associated with a more favorable trajectory of PHQ-9 depressive symptom scores than SMD alone (randomization group × time interaction estimate = 0.13, p = .018). At 36 weeks, MI-SMD was associated with improved depressive symptoms (Cohen’s d = 0.41, 95% CI [0.11, 0.72]) and remission rate (Success Rate Difference = 14.53 [1.79, 27.26]) relative to SMD alone. MI-SMD was not associated with a significant group x time interaction for remission, or with increased receipt of antidepressant medication or specialty mental health counseling. The providers’ ability to direct clinical discussions toward treating depression, and the patients’ language favoring engagement in mood-improving behaviors, mediated the effects of MI-SMD on depressive symptoms (ps < .05). Discussion: Training providers to frame discussions about depression using MI may improve upon standard management for depression. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Randomized controlled trial of a very brief, multicomponent web-based alcohol intervention for undergraduates with a focus on protective behavioral strategies.


Objective: Tertiary Health Research Intervention via Email (THRIVE), a very brief, freely available, multicomponent Web-based alcohol intervention originally developed and tested among students in Australia and New Zealand, was tested in the United States. We also evaluated effects of systematically varying the protective behavioral strategies (PBS) component of the intervention to include shorter, focused lists of direct (e.g., alternating alcoholic with nonalcoholic drinks) or indirect (e.g., looking out for friends) strategies. Method: Undergraduates with past-month heavy drinking (N = 208) were randomized to education/assessment control or one of three U.S.-THRIVE variants, including direct PBS only, indirect PBS only, or full (direct and indirect PBS). Results: After 1 month, compared to the control condition, full condition participants reported fewer drinks per week (rate ratio [RR] = .62) and lower peak drinking (RR = .74). The indirect-only condition reported reduced peak drinking (RR = .74) and a trend toward fewer drinks per week (RR = .78). Changes in drinking relative to control were significant through 6 months for the full and indirect-only conditions. There were no significant differences between the direct-only and control conditions. U.S.-THRIVE was not associated with decreased heavy drinking or alcohol-related problems relative to control. Conclusions: To our knowledge, this was the first study to systematically vary the types of PBS provided in an intervention. Initial results suggest U.S.-THRIVE is efficacious. Compared to control, presenting indirect PBS only as part of U.S.-THRIVE was associated with lower drinks per week and peak past 30-day drinking. Targeting indirect PBS may be more appropriate for non-treatment-seeking young adults receiving a brief intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)

Treatment moderators and effectiveness of Engagement and Counseling for Latinos intervention on worry reduction in a low-income primary care sample.


Objective: We conducted a secondary analysis of randomized controlled trial data to determine if the Engagement and Counseling for Latinos (ECLA) intervention, a brief, evidence-based, and culturally adapted cognitive–behavioral intervention specifically designed for and effective at treating depression, also reduced co-occurring worry symptoms. We also explored whether delivery modality (telephone, face-to-face) and sociodemographic patient characteristics moderated treatment effectiveness. Method: Between May 2011 and September 2012, low-income Latino primary care patients (N = 257) with depression from Boston and San Juan were randomized to usual care (n = 86), face-to-face ECLA (n = 84), or telephone ECLA (n = 87) and completed a psychosocial assessment at baseline and 4 months after randomization. We used intention-to-treat analyses with linear regression models with change in worry (4 months from randomization) as the primary outcome and treatment condition as the primary predictor. Results: Patients in ECLA experienced significant reductions in worry at 4 months from randomization than those in usual care (PSWQΔ = −3.28, p < .05). Among patients receiving ECLA, those in the telephone condition exhibited greater worry reductions than those in the face-to-face condition (telephone: M = −7.83, SD = 11.45; face-to-face: M = −6.73, SD = 12.23; p < .05). Employment status was the only significant treatment moderator. Unemployed patients did not exhibit any changes in worry irrespective of condition, whereas employed patients exhibited the greatest worry reductions across conditions. Conclusions: Although worry was not a treatment target in ECLA, it also reduced worry among low-income Latinos, which suggests ECLA may have transdiagnostic clinical implications. Telephone-delivered ECLA might hold promise for increasing the uptake of mental health care among employed low-income Latinos. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)