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Journal of Consulting and Clinical Psychology - Vol 85, Iss 1



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
 



Editorial.

2017-01-02

Joanne Davila introduces herself as the new Editor of the Journal of Consulting and Clinical Psychology ( JCCP ). She believes it is important to continue to publish articles that reflect the best possible science in terms of both theory and methods, as well as shape the field. Davila discusses her plans for the future of the journal including: stability, growth, and inclusiveness. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Education and job-based interventions for unmarried couples living with low incomes: Benefit or burden?

2016-10-24

Objective: Government initiatives undertaken to improve the earning potential of disadvantaged unmarried parents assume that job training and additional schooling will strengthen these families, yet alternative models predict that these same interventions could overwhelm couples’ limited resources, undermining family stability. Method: We use 3 waves of dyadic data and propensity score analysis to test these competing perspectives by examining the effects of job-related and school-related interventions on 3-year marriage rates. The sample consists of unmarried new parents averaging $20,475 in household income, 52% of whom are African American and 20% of whom are Hispanic/Latino. Results: Marriage rates decreased, from 17% to 10%, for couples in which men participated in school-related interventions. Mediation analyses indicate that school-related interventions reduce the amount of time men spend with their child and the amount of money they contribute to their household, reducing marriage rates in turn. Marriage rates were unaffected by women’s participation in school-related interventions, and by men’s and women’s participation in job-related interventions. Conclusion: Implementing economic interventions that increase income while minimizing demands on the limited resources of economically distressed couples may prove necessary for strengthening society’s most vulnerable families. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress.

2016-08-22

Objective: This study reports outcomes from a randomized effectiveness trial testing modular treatment versus multiple community-implemented evidence-based treatments for youth. Method: An ethnoracially diverse sample of 138 youth ages 5 to 15 (62 girls, 76 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, disruptive behavior, and/or traumatic stress were treated by community therapists randomly assigned to 1 of 2 conditions: (a) modular treatment, which involved a single modular protocol (i.e., modular approach to therapy for children; MATCH) that allowed flexible selection and sequencing of procedures to fit the chosen treatment focus in the context of measurement feedback, and (b) community-implemented treatment (CIT), which was a county-supported implementation of multiple evidence-based practices for youth. Results: Youth treated with MATCH showed significantly faster rates of improvement over time on clinical and functional outcomes relative to youth in the CIT condition and required significantly fewer sessions delivered over significantly fewer days. Caregiver-reported clinical improvement rates were significantly greater for MATCH (60%) versus CIT (36.7%). Further, youth in the CIT condition were significantly more likely to receive additional psychosocial treatment services and were significantly more likely to use a variety of psychotropic medications during the active treatment phase. Conclusions: These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence-based treatments. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women.

2017-01-02

Objective: Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned with pregnant women’s preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). Method: Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. Results: Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p = .04) and higher remission (56.3% vs. 30.3%, p = .003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p < .0002) and environmental reward (d = 0.54, p < .003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. Conclusions: BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Perceived criticism predicts outcome of psychotherapy for panic disorder: Replication and extension.

2017-01-02

Objective: We tested the relation of perceived criticism (PC) from a parent or spouse/romantic partner to outcome of psychotherapy for panic disorder (PD). Method: Participants were 130 patients with PD (79% with agoraphobia) who received 24 twice-weekly sessions of panic-focused psychodynamic psychotherapy, cognitive-behavioral therapy, or applied relaxation therapy. Patients were predominantly White (75%), female (64%), and non-Hispanic (85%). At baseline, Week 5 of treatment, termination, and at 6- and 12-month follow-up, patients rated PC from the relative with whom they lived. Independent evaluators assessed the severity of PD at baseline, Weeks 1, 5, and 9 of treatment, termination, and the 2 follow-up points. Data were analyzed with piecewise (treatment phase, follow-up phase) latent growth curve modeling. Results: The latent intercept for PC at baseline predicted the latent slope for panic severity in the follow-up (p = .04) but not the active treatment phase (p = .50). In contrast, the latent intercept for PD severity at baseline did not predict the latent slope on PC in either phase (ps ≥ .29). Nor did the slopes of PC and PD severity covary across treatment (p = .31) or follow-up (p = .13). Indeed, PC did not change significantly across treatment (p = .45), showing the stability of this perception regardless of significant change in severity of patients’ PD (p < .001). Conclusions: Because PC predicts worse long-term treatment outcome for PD, study findings argue for interventions to address perceived criticism in treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Advancement in the maturing science of cultural adaptations of evidence-based interventions.

2017-01-02

Objective: Concerns about the maturing science of cultural adaptation of evidence-based interventions (EBIs) have encompassed deficient standardization of theoretical frameworks and inefficiencies adapting multiple EBIs for multiple ethnic groups. Others argue that original EBIs applied with fidelity address universal processes applicable across ethnicity without adaptation. Study goals were to (1) establish a unifying data-driven framework for culturally adapting mental health EBIs for ethnic minorities, and (2) provide information for the fidelity debate by examining the extent to which fidelity to core EBI components is achieved in the cultural adaptation process. Method: A systematic review of primary research was conducted utilizing an inductive approach via thematic synthesis to code 20 years of cultural EBI adaptation studies for mental health problems in ethnic minorities. Studies were coded for adapted EBI components and extent of EBI modification. Results: Results yielded the Cultural Treatment Adaptation Framework (CTAF), an overarching data-driven framework providing common concepts and language for adapted treatment components that unifies cultural adaption science. Findings also demonstrated patterns of adapted components. All adapted EBIs (100%) yielded changes in peripheral (engagement and treatment delivery) components. In contrast, only 11.11% of culturally adapted EBIs yielded core therapeutic component modifications. Instead, 60.0% required core additions that address sociocultural, cultural skill, and psychoeducation needs. Conclusion: Fidelity to core components is largely preserved in cultural adaptation, but core component addendums, delivery, and contextualization are substantially changed. The CTAF and its patterns represent a key step in advancement of a maturing cultural adaptation science. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Examining the impact of differential cultural adaptation with Latina/o immigrants exposed to adapted parent training interventions.

2017-01-02

Objective: There is a dearth of empirical studies aimed at examining the impact of differential cultural adaptation of evidence-based clinical and prevention interventions. This prevention study consisted of a randomized controlled trial aimed at comparing the impact of 2 differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTOR). Method: The sample consisted of 103 Latina/o immigrant families (190 individual parents). Each family was allocated to 1 of 3 conditions: (a) a culturally adapted PMTO (CA), (b) culturally adapted and enhanced PMTO (CE), and (c) a wait-list control. Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3). Results: Multilevel growth modeling analyses indicated statistically significant improvements on parenting skills for fathers and mothers (main effect) at 6-month follow-up in both adapted interventions, when compared with the control condition. With regard to parent-reported child behaviors, child internalizing behaviors were significantly lower for both parents in the CE intervention (main effect), compared with control at 6-month follow-up. No main effect was found for child externalizing behaviors. However, a Parent × Condition effect was found indicating a significant reduction of child externalizing behaviors for CE fathers compared with CA and control fathers at posttest and 6-month follow-up. Conclusion: Present findings indicate the value of differential cultural adaptation research designs and the importance of examining effects for both mothers and fathers, particularly when culturally focused and gender variables are considered for intervention design and implementation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Omitted data in randomized controlled trials for anxiety and depression: A systematic review of the inclusion of sexual orientation and gender identity.

2016-06-16

Objective: The current study examined the frequency with which randomized controlled trials (RCTs) of behavioral and psychological interventions for anxiety and depression include data pertaining to participant sexual orientation and nonbinary gender identities. Method: Using systematic review methodology, the databases PubMed and PsycINFO were searched to identify RCTs published in 2004, 2009, and 2014. Random selections of 400 articles per database per year (2,400 articles in total) were considered for inclusion in the review. Articles meeting inclusion criteria were read and coded by the research team to identify whether the trial reported data pertaining to participant sexual orientation and nonbinary gender identities. Additional trial characteristics were also identified and indexed in our database (e.g., sample size, funding source). Results: Of the 232 articles meeting inclusion criteria, only 1 reported participants’ sexual orientation, and zero articles included nonbinary gender identities. A total of 52,769 participants were represented in the trials, 93 of which were conducted in the United States, and 43 acknowledged the National Institutes of Health as a source of funding. Conclusions: Despite known mental health disparities on the basis of sexual orientation and nonbinary gender identification, researchers evaluating interventions for anxiety and depression are not reporting on these important demographic characteristics. Reporting practices must change to ensure that our interventions generalize to lesbian, gay, bisexual, and transgender persons. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



Temporal precedence in the identification of mediators of change: A brief comment on “Mediators of change in the child/adolescent multimodal treatment study” (Kendall et al., 2016).

2017-01-02

Objective: Comment on the issue of temporal precedence and the implications for interpreting the results of the mediation analyses in the Child/Adolescent Multimodal Treatment Study. Method: Review of Kendall et al. (2016). Results: Kendall et al. reported that residualized (baseline to posttreatment) change in coping efficacy, but not anxious self-talk, mediated residualized (baseline to follow-up) change in anxiety symptoms in cognitive–behavior therapy (CBT), sertraline (SRT), and CBT + SRT compared to placebo. Because the measure of anxiety symptoms included data from follow-up, it was concluded that “the gains being referred to can be viewed as ‘change following treatment’” (p. 8) and, therefore, the analyses captured “true temporal precedence” (p. 3). However, the anxiety scores represented an amalgam of change occurring within and after treatment, and available data suggest much of the anxiety change occurred during the treatment, the time when the change in coping occurred. Conclusions: Given the measurement timeline, a clear and unambiguous claim of demonstrating temporal precedence is not justified. Nonetheless, these results remain important for other reasons when interpreted in the context of the broad cognitive–behavioral conceptual model of anxiety that led to the selection of these mediators for examination. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)



On the importance of temporal precedence in mediational analyses.

2017-01-02

This response to the commentary by Gaynor (in press) (a) underscores the importance of defining terms (predictor, moderator, and mediator variables) used in psychological treatment outcome research, (b) notes the improvements in mediation analyses using treatment of youth anxiety as the illustration, and (c) encourages continued advancement in the methodology for mediation analyses. We agree with Gaynor (in press) both on the importance of temporal precedence and on the use of cautious language with regard to interpreting mediational analyses. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)