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Journal of Consulting and Clinical Psychology - Vol 84, Iss 12



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 2016 American Psychological Association
 



Empirical findings from psychotherapy research with indigenous populations: A systematic review.

2016-10-13

Objective: Although the dire mental health needs of Indigenous communities are well established in the literature, the empirical evidence for psychotherapeutic treatment for these populations is perceived to be scant. This review is intended to determine gaps in the literature for this population by asking how much empirical work has been published, what types of research are being conducted, which topics are most prevalent among the existing literature, and what can be concluded about psychotherapy with Indigenous populations based on this literature. Method: A systematic review of empirical psychotherapy research on Indigenous clients of Australia, Canada, New Zealand, and the United States was conducted across 10 databases. Results: A total of 44 studies were found, with just 2 examples of controlled outcome trials. The most common research topic was treatment evaluation, but only 4 treatment evaluation studies examined individual psychotherapy with adults. Looking across all topics, treatment for substance use disorders comprised the majority of studies on specific mental health problems. Conclusions: Moving forward, it will be important for researchers to examine individual psychotherapy for Indigenous clients and to consider treatment for disorders unrelated to substance use. A preference for the inclusion of cultural practices and education in psychotherapy was clear across the literature, but the limited inferences that can be drawn from the existing research make it impossible to come to any conclusions about the specific roles or effects of cultural practices. Overall, empirical research is badly needed for psychotherapy with Indigenous populations at this time. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive–behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents.

2016-10-24

Objective: Sleep problems are a major risk factor for the emergence of mental health problems in adolescence. The aim of this study was to investigate the post intervention effects of a cognitive–behavioral/mindfulness-based group sleep intervention on sleep and mental health among at-risk adolescents. Method: A randomized controlled trial (RCT) was conducted across High schools in Melbourne, Australia. One hundred forty-four adolescents (aged 12–17 years) with high levels of anxiety and sleeping difficulties, but without past or current depressive disorder, were randomized into either a sleep improvement intervention or an active control ‘study skills’ intervention. Both programs consisted of 7 90-min-long group sessions delivered over 7 weeks. One hundred twenty-three participants began the interventions (female = 60%; mean age = 14.48, SD = 0.95), with 60 in the sleep condition and 63 in the control condition. All participants were required to complete a battery of mood and sleep questionnaires, 7 days of wrist actigraphy (an objective measure of sleep), and sleep diary entry at pre- and-post intervention. Results: The sleep intervention condition was associated with significantly greater improvements in subjective sleep (global sleep quality [with a medium effect size], sleep onset latency, daytime sleepiness [with small effect sizes]), objective sleep (sleep onset latency [with a medium effect size]), and anxiety (with a small effect size) compared with the control intervention condition. Conclusion: The SENSE study provides evidence that a multicomponent group sleep intervention that includes cognitive–behavioral and mindfulness-based therapies can reduce sleep initiation problems and related daytime dysfunction, along with concomitant anxiety symptoms, among at-risk adolescents. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



A meta-intervention to increase completion of an HIV-prevention intervention: Results from a randomized controlled trial in the state of Florida.

2016-10-27

Objective: A randomized control trial with 722 eligible clients from a health department in the State of Florida was conducted to identify a simple, effective meta-intervention to increase completion of an HIV-prevention counseling program. Method: The overall design involved 2 factors representing an empowering and instrumental message, as well as an additional factor indicating presence or absence of expectations about the counseling. Completion of the 3-session counseling was determined by recording attendance. Results: A logistic regression analysis with the 3 factors of empowering message, instrumental message, and presence of mediator measures, as well as all interactions, revealed significant interactions between instrumental and empowering messages and between instrumental messages and presence of mediator measures. Results indicated that (a) the instrumental message alone produced most completion than any other message, and (b) when mediators were not measured, including the instrumental message led to greater completion. Conclusions: The overall gains in completion as a result of the instrumental message were 16%, implying success in the intended facilitation of counseling completion. The measures of mediators did not detect any experimental effects, probably because the effects were happening without much conscious awareness. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



In-session caregiver behavior predicts symptom change in youth receiving trauma-focused cognitive behavioral therapy (TF-CBT).

2016-09-12

Objective: Involving caregivers in trauma-focused treatments for youth has been shown to result in better outcomes, but it is not clear which in-session caregiver behaviors enhance or inhibit this effect. The current study examined the associations between caregiver behaviors during Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and youth cognitive processes and symptoms. Method: Participants were a racially diverse sample of Medicaid-eligible youth (ages 7–17) and their nonoffending caregivers (N = 71 pairs) who received TF-CBT through an effectiveness study in a community setting. Caregiver and youth processes were coded from audio-recorded sessions, and outcomes were measured using the Child Behavior Checklist (CBCL) and UCLA PTSD Reaction Index for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM–IV; UPID) at 3, 6, 9, and 12 months postintake. Results: Piecewise linear growth curve modeling revealed that during the trauma narrative phase of TF-CBT, caregivers’ cognitive-emotional processing of their own and their child’s trauma-related reactions predicted decreases in youth internalizing and externalizing symptoms over treatment. Caregiver support predicted lower internalizing symptoms over follow-up. In contrast, caregiver avoidance and blame of the child predicted worsening of youth internalizing and externalizing symptoms over follow-up. Caregiver avoidance early in treatment also predicted worsening of externalizing symptoms over follow-up. During the narrative phase, caregiver blame and avoidance were correlated with more child overgeneralization of trauma beliefs, and blame was also associated with less child accommodation of balanced beliefs. Conclusions: The association between in-session caregiver behaviors and youth symptomatology during and after TF-CBT highlights the importance of assessing and targeting these behaviors to improve clinical outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder.

2016-09-12

Objective: Teenage drivers diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at significant risk for negative driving outcomes related to morbidity and mortality. However, there are few viable psychosocial treatments for teens with ADHD and none focus on the key functional area of driving. The Supporting the Effective Entry to the Roadway (STEER) program was evaluated in a clinical trial to investigate whether it improved family functioning as a proximal outcome and driving behavior as a distal outcome. Method: One hundred seventy-two teenagers with ADHD, combined type, were randomly assigned to STEER or a driver education driver practice program (DEDP). Results: Relative to parents in the DEDP condition, parents in STEER were observed to be less negative at posttreatment and 6-month follow-up but not at 12-month follow-up, and there were no significant differences for observed positive parenting. Relative to teens in the DEDP condition, teens in STEER reported lower levels of risky driving behaviors at posttreatment and 6-month follow-up, but not at 12-month follow-up. Groups did not differ on objective observations of risky driving or citations/accidents. Conclusions: The STEER program for novice drivers with ADHD was effective in reducing observations of negative parenting behavior and teen self-reports of risky driving relative to DEDP; groups did not significantly differ on observations of positive parenting or driving behaviors. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



“Is supervision necessary? Examining the effects of Internet-based CBT training with and without supervision”: Correction to Rakovshik et al. (2016).

2016-11-28

Reports an error in "Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision" by Sarah G. Rakovshik, Freda McManus, Maria Vazquez-Montes, Kate Muse and Dennis Ougrin (Journal of Consulting and Clinical Psychology, 2016[Mar], Vol 84[3], 191-199). In the article, the department and affiliation were misspelled for author Kate Muse. The department and affiliation should have read Psychology Department, University of Worcester. All versions of this article has been corrected. (The following abstract of the original article appeared in record 2016-03513-001.) Objective: To investigate the effect of Internet-based training (IBT), with and without supervision, on therapists’ (N = 61) cognitive–behavioral therapy (CBT) skills in routine clinical practice. Method: Participants were randomized into 3 conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW); (2) Internet-based training with CBT supervision via Skype (IBT-S); and (3) “delayed-training” controls (DTs), who did not receive the training until all data collection was completed. The IBT participants received access to training over a period of 3 months. CBT skills were evaluated at pre-, mid- and posttraining/wait using assessor competence ratings of recorded therapy sessions. Results: Hierarchical linear analysis revealed that the IBT-S participants had significantly greater CBT competence at posttraining than did IBT-CW and DT participants at both the mid- and posttraining/wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training DTs. Conclusions: IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more-traditional “live” methods of training. There was no evidence for a significant effect of IBT without supervision over a nontraining control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



A randomized trial of methods to engage Mexican American parents into a school-based parenting intervention.

2016-09-05

Objective: This study examined the efficacy of motivational strategies for increasing engagement into evidence-based, parenting interventions delivered through schools. Method: Participants were 122 mothers of kindergarten and third grade students attending an urban school that predominantly served Mexican American families living in low-income conditions. At pretest, mothers reported sociocultural characteristics, and teachers rated children’s behavior. Mothers randomly assigned to the experimental condition received a multicomponent engagement package; mothers assigned to the control condition received a brochure plus a nonengagement survey interview. All families were offered a free parenting program delivered at their child’s school. Dependent variables included parenting program enrollment, initiation (i.e., attending at least 1 session), and attendance. Results: Parents in the experimental condition were more likely to initiate compared with those in the control condition if their children had high baseline concentration problems (OR = 8.98, p < .001, 95% CI [2.55, 31.57]). Parents in the experimental condition attended more sessions than did those in the control condition if their children had high baseline concentration problems (p < .01, d = .49, 95% CI [.35, 2.26]) or conduct problems (p < .01, d = .54, 95% CI [.51, 2.56]). Highly acculturated parents attended more sessions if assigned to the experimental condition than the control condition (p < .01, d = .66, 95% CI [.28, 2.57]). Conclusions: The motivational engagement package increased parenting program initiation and attendance for parents of students at-risk for behavior problems. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Does timing matter? Examining the impact of session timing on outcome.

2016-05-23

Objective: First-line treatments for posttraumatic stress disorder (PTSD) are often implemented twice per week in efficacy trials. However, there is considerable variability in the frequency of treatment sessions (e.g., once per week or twice per week) in clinical practice. Moreover, clients often cancel or reschedule treatment sessions, leading to even greater variability in treatment session timing. The goal of the current study is to investigate the impact of PTSD treatment session frequency on treatment outcome. Method: One hundred thirty-six women (Mage = 32.16 [SD = 9.90]) with PTSD were randomized to receive cognitive processing therapy or prolonged exposure. PTSD symptom outcome was measured using the Clinician-Administered PTSD Scale, and session frequency and consistency were measured using dates of treatment session attendance. Session frequency was operationalized using average days between session, and consistency was defined by the standard deviation of the number of days between treatment sessions. Results: Piecewise growth curve modeling revealed that higher average days between sessions was associated with significantly smaller PTSD symptom reduction, with more frequent sessions yielding greater PTSD symptom reduction (p < .001, d = .82). Higher consistency was also associated with significantly greater PTSD symptom reduction (p < .01, d = .48). The substantially larger effect size for frequency suggests that average days between treatment sessions impacts treatment outcome more than consistency. Follow-up analyses revealed a longer time interval between Sessions 4 and 5 was associated with smaller reductions in PTSD treatment outcome. Conclusions: More frequent scheduling of sessions may maximize PTSD treatment outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative.

2016-07-04

Objective: Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. Method: Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians’ work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. Results: Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). Conclusions: Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Therapist–client agreement in assessments of clients’ functioning.

2016-10-24

Objective: We aimed to assess the extent to which therapists’ reports of client functioning track their clients’ changing experience of their own functioning from session to session (temporal congruence) as well as the extent to which they over- or underestimate their clients’ functioning (level or directional bias) and to examine whether these indices predict treatment outcomes. Method: The participants included 384 clients who were treated by 77 therapists. Both clients and therapists rated the clients’ functioning each session. The clients also completed pre- and posttreatment outcome measures. Results: Using multilevel modeling, we found that therapists’ reports regarding their clients’ functioning tended to be temporally congruent from session to session with their clients’ reported functioning. In addition, on average, therapists did not show a level bias (i.e., did not over- or underestimate their clients’ functioning). Finally, temporal congruence (but not level bias) predicted better treatment outcomes. Conclusion: These findings highlight the importance of tracking clients’ fluctuating symptoms over time. Thus, we discuss their implication for the policy and practice of providing session-by-session feedback to therapists. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Change in patients’ interpersonal impacts as a mediator of the alliance-outcome association in treatment for chronic depression.

2016-10-17

Objective: Theories posit that chronically depressed individuals have hostile and submissive interpersonal styles that undermine their interpersonal effectiveness and contribute to the cause and maintenance of their depression. Recent findings support this theory and demonstrate that chronically depressed patients’ interpersonal impacts on their therapist become more adaptive (i.e., less hostile and submissive, and more friendly and assertive) during a targeted chronic depression treatment: cognitive–behavioral analysis system of psychotherapy (CBASP). In this study, the authors examined whether such changes in interpersonal impacts (as rated by clinicians’ experiences of interacting with their patients) mediated the association between early patient-rated alliance quality and final session depression. Method: Data derived from a large trial for chronic depression that compared the efficacy of CBASP, nefazodone, and their combination. The current subsample (N = 220) included patients in the CBASP and combined conditions who completed at least 1 depression assessment and the alliance measure, and whose therapists completed at least 1 interpersonal impacts assessment. Mediation models were fit using a bootstrapping procedure for assessing indirect effects. Results: As hypothesized, results supported a mediating effect; higher early alliance predicted decreases in patient hostile-submissiveness during therapy, which in turn related to lower final session depression (indirect effect B = −.02, 95% confidence interval: −.07, −.001). This indirect effect accounted for 13% of the total effect of alliance on depression. There was no moderating effect of treatment condition on the indirect effect. Conclusions: Results further support CBASP change theory and suggest a candidate mechanism of the alliance’s effect on outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



A randomized controlled trial of the Marriage Checkup adapted for private practice.

2016-09-05

Objective: This study examined the effectiveness of the Marriage Checkup (MC), adapted for independent practice. Method: A total of 233 couples were recruited from 2 metropolitan areas of Denmark and randomized to the MC adapted for independent practice (MC-P, n = 116) or a waitlist condition (WL, n = 117). Self-report measures of relationship health were obtained online at 3 (WL) or 6 (MC-P) time points across 54 weeks. MC-P couples received 2 checkups (Week 7 and 51). WL couples received tickets to a movie night (Week 10). Data were analyzed using multilevel growth models. Results: Following the first checkup, small intervention effects were found on 3 of 4 outcome measures. Between the checkups, the effects on 2 of 3 measures first leveled off then reappeared. Following the second checkup, intervention effects in the small to medium range were found on all 4 measures including the Brief Marital Satisfaction Inventory (Cohen’s d = 0.48), the Couple Satisfaction Index (d = 0.20), the Responsiveness and Attention Scale (d = 0.43), and the Intimate Safety Questionnaire (d = 0.21). Conclusions: Couples receiving 2 annual checkups across 54 weeks experienced small to medium effects on relationship health when compared to controls. These are the first and preliminary results on a model for conducting regular relationship health checkups in a real-world therapeutic setting. Future studies are needed to investigate the comparative and long-term effects of this approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)