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

Journal of Consulting and Clinical Psychology - Vol 86, Iss 2



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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Compassion-focused therapy as guided self-help for enhancing public mental health: A randomized controlled trial.

Thu, 21 Dec 2017 05:00:00 GMT

Objective: Despite promising results for compassion-focused therapy (CFT) as self-help, larger-scale trials including long-term follow-up data are needed to establish its effectiveness in the context of public mental health. Empirical evidence supporting its effectiveness in improving well-being is lacking. In a randomized controlled trial, the effects of CFT as guided self-help on well-being were evaluated. Method: Adults (mean age = 52.87, SD = 9.99, 74.8% female) with low to moderate levels of well-being were recruited in the Dutch population and randomized to CFT (n = 120) or a waitlist control group (n = 122). Participants completed the Mental Health Continuum–Short Form (well-being), Hospital Anxiety and Depression Scale (depression and anxiety), Perceived Stress Scale (stress), Self-Compassion Scale–Short Form (self-compassion), Forms of Self-Criticizing/Attacking and Reassurance Scale (self-criticism and self-reassurance), Positive and Negative Affect Schedule (positive/negative affect), and Gratitude questionnaire (gratitude) at baseline, postintervention (3 months), 3- and 9-month follow-up. Results: Compared with the waitlist control group, the CFT group showed superior improvement on well-being at postintervention, d = .51, 95% CI [.25, .77], p < .001, and 3-month follow-up, d = .39, 95% CI [.13, .65], p < .001. No significant moderators were found. On all secondary outcome measures but positive affect, the intervention group showed significantly greater improvements up to 3-month follow-up. At 9-month follow-up, improvements on all measures were retained or amplified among CFT participants. Conclusions: CFT as guided self-help shows promise as a public mental health strategy for enhancing well-being and reducing psychological distress. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder.

Thu, 25 Jan 2018 05:00:00 GMT

Objective: Although previous research has suggested that people with a history of using psychiatric crisis services are at higher risk for suicide, it is unclear whether this link is attributable to individual risk factors or iatrogenic effects of service utilization. We examined this question by analyzing data from a randomized controlled trial of dialectical behavior therapy (DBT), a treatment for highly suicidal individuals in which patients took advantage of crisis services less than those in the comparison condition. We hypothesized that crisis-service utilization during a treatment year, rather than pretreatment indicators of suicide risk, would be associated with higher suicide risk after treatment, and that DBT’s treatment effects would be partially attributable to this association. Method: Participants were 101 women (Mage = 29.3, 87% Caucasian) with recent suicidal and self-injurious behaviors meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association [APA], 1994) criteria for borderline personality disorder. We examined relationships between suicidal ideation (using the Suicide Behaviors Questionnaire; Linehan, 1981), number of suicide attempts (using the Suicide Attempt Self-Injury Interview; Linehan, Comtois, Brown, Heard, & Wagner, 2006), and number of psychiatric inpatient admissions and psychiatric emergency-room (ER) visits (using the Treatment History Interview; Linehan & Heard, 1987) from the years prior to, during, and following treatment. Results: Treatment-year psychiatric ER visits were the sole predictor of the number of follow-up year suicide attempts. Treatment condition and pretreatment inpatient admissions predicted treatment-year psychiatric ER visits. Finally, there was evidence that DBT resulted in fewer suicide attempts at follow-up, in part because getting DBT led to fewer psychiatric ER visits. Conclusion: In this population and context, data suggest that crisis-service utilization conveys risk for suicide. DBT may reduce suicide risk in part by reducing use of these services. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



In psychotherapy with severe patients discouraging news may be worse than no news: The impact of providing feedback to therapists on psychotherapy outcome, session attendance, and the alliance.

Thu, 21 Dec 2017 05:00:00 GMT

Objective: Our objective was to assess low-cost and feasible feedback alternatives and compare them to Lambert’s OQ feedback system. We also studied patient, therapist, and process characteristics that could moderate the effect of feedback on outcome, session attendance, and alliance. Method: A total of 547 patients, 75% female, average age 41 (SD = 13), 95% Latino, treated in an outpatient individual psychotherapy setting in Chile were randomly assigned to five feedback conditions: no feedback, feedback on symptomatology, feedback on the alliance, feedback on both symptomatology and alliance, and Lambert’s OQ progress feedback report. The measures included the Outcome Questionnaire and the Working Alliance Inventory. We also had follow-up interviews with therapists. Results: We found through multilevel modeling that feedback had no effect on outcome, session attendance, and alliance. Contrary to previous findings, these results were maintained even when focusing only on patients “not-on-track.” However, patients’ former psychiatric hospitalization history and baseline severity, combined with lack of progress, significantly moderated the impact of feedback. For this more dysfunctional population, “positive feedback” (i.e., low symptomatology) to therapists had a positive impact on therapy outcome, while “negative feedback” (i.e., high symptomatology) had a negative impact. Conclusions: Providing feedback to therapists without offering them tools to improve treatment may be ineffective and even be detrimental. This may be especially the case for patients who suffer more severe mental health issues and whose therapists receive mostly discouraging news as feedback. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

Thu, 21 Dec 2017 05:00:00 GMT

Objective: In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators. Method: A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3,025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change). Results: Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = −.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators. Conclusions: This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Trajectories of in-session change language in brief motivational interventions with mandated college students.

Mon, 27 Nov 2017 05:00:00 GMT

Objective: Brief motivational interventions (BMIs) are currently the most efficacious individual intervention for mandated college students. However, little is known about how BMIs facilitate client language in relation to subsequent changes in alcohol use and problems in mandated student samples. Method: The current study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions (N = 252) from 2 randomized clinical trials that led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers. A proportion of change language was calculated for each decile (1st to 10th) of the BMI sessions. Results: Latent class analyses of in-session speech indicated that there were 3 distinct trajectories of change language over the course of the session: high (n = 59), increasing (n = 122), and low (n = 71). Members of the high trajectory group showed higher rates of alcohol-related problems prior to the BMI and members of the low trajectory group were more likely to be male. Six months following the BMI, members of the high and low trajectory groups demonstrated significant reductions in alcohol use and problems, and members of the increasing trajectory group only reduced alcohol-related problems. Conclusions: Associations among the 3 trajectories of client change language and subsequent reductions in alcohol use and problems partially supported the technical hypothesis of MI efficacy. Client factors as well as the nature of the discussion of personalized feedback may determine the link between in-session client language and subsequent behavior change. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Disentangling the link between posttraumatic stress disorder and violent behavior: Findings from a nationally representative sample.

Mon, 27 Nov 2017 05:00:00 GMT

Objective: Although research using combat veteran samples has demonstrated an association between posttraumatic stress disorder (PTSD) and violence toward others, there has been relatively little research examining this relationship among individuals with no combat history. Method: Data representative of the United States population collected from the two wave National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed to determine the risk factors for violent behavior of individuals reporting no history of active military combat (N = 33,215). Results: In χ2 analyses, participants meeting criteria for lifetime PTSD at Wave 1 reported higher rates of violence between Waves 1 and 2 compared with participants without a history of PTSD (7 vs. 3%). An increase in anger after trauma and use of alcohol to cope with PTSD symptoms were stronger predictors of physically aggressive or violent acts than a lifetime diagnosis of PTSD without anger. When controlling for these and other covariates, PTSD alone no longer significantly predicted any subtype of physical aggression or violence toward others. Conclusions: Results suggest that although PTSD is related to violent behavior, specific sequelae of trauma (specifically, increased anger and self-medicating with alcohol) are more critical than diagnosis per se in predicting violent behavior in the general population. Clinical implications and future research directions are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans.

Thu, 25 Jan 2018 05:00:00 GMT

Objective: Psychiatric service dogs are an emerging complementary treatment for military members and veterans with posttraumatic stress disorder (PTSD). Yet despite anecdotal accounts of their value, there is a lack of empirical research on their efficacy. The current proof-of-concept study assessed the effects of this practice. Method: A nonrandomized efficacy trial was conducted with 141 post-9/11 military members and veterans with PTSD to compare usual care alone (n = 66) with usual care plus a trained service dog (n = 75). The primary outcome was longitudinal change on The PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993), including data points from a cross-sectional assessment and a longitudinal record review. Secondary outcomes included cross-sectional differences in depression, quality of life, and social and work functioning. Results: Mixed-model analyses revealed clinically significant reductions in PTSD symptoms from baseline following the receipt of a service dog, but not while receiving usual care alone. Though clinically meaningful, average reductions were not below the diagnostic cutoff on the PCL. Regression analyses revealed significant differences with medium to large effect sizes among those with service dogs compared with those on the waitlist, including lower depression, higher quality of life, and higher social functioning. There were no differences in employment status, but there was lower absenteeism because of health among those who were employed. Conclusion: The addition of trained service dogs to usual care may confer clinically meaningful improvements in PTSD symptomology for military members and veterans with PTSD, though it does not appear to be associated with a loss of diagnosis. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Follow-up of monotherapy remitters in the PReDICT study: Maintenance treatment outcomes and clinical predictors of recurrence.

Thu, 25 Jan 2018 05:00:00 GMT

Objective: This study followed remitted patients from a randomized controlled trial of adults with major depressive disorder (MDD). The aims were to describe rates of recurrence and to evaluate 3 clinical predictor domains. Method: Ninety-four treatment-naïve patients (50% female; Mage = 38.1 years; 48.9% White; 30.9% Hispanic) with MDD who had remitted to 12-week monotherapy (escitalopram, duloxetine, or cognitive behavior therapy [CBT]) participated in a 21-month maintenance phase (i.e., continued medication or 3 possible CBT booster sessions per year). Recurrence was assessed quarterly, and the clinical predictors were the following: 2 measures of residual depressive symptoms, 1 measure of lifetime depressive episodes, and 2 measures of baseline anxiety. Survival analysis models evaluated recurrence rates, and regression models evaluated the predictors. Results: Among all patients, 15.5% experienced a recurrence, and the survival distributions did not statistically differ among treatments. Residual depressive symptoms on the Hamilton Depression Rating Scale at the end of monotherapy were associated with increased risk for recurrence (hazard ratio = 1.31, 95% confidence interval [CI: 1.02, 1.67], Wald χ2 = 4.41, p = .036), and not having a comorbid anxiety disorder diagnosis at study baseline reduced the risk of recurrence (hazard ratio = .31, 95% CI [.10, .94], Wald χ2 = 4.28, p = .039). Conclusions: The study supported the benefits of maintenance treatment for treatment-naïve patients who remitted to initial monotherapy; nevertheless, remitted patients with a comorbid anxiety disorder diagnosis at the beginning of treatment or residual depressive symptoms after initial treatment were at risk for poorer long-term outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)



Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy.

Thu, 21 Dec 2017 05:00:00 GMT

Objective: Both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Therapy (CT) enhance self-management of prodromal symptoms associated with depressive relapse, albeit through divergent therapeutic procedures. We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT. Decentering and dysfunctional attitudes were assessed as treatment-specific process markers. Method: Participants in remission from Major Depressive Disorder (MDD; N = 166) were randomized to 8 weeks of either MBCT (N = 82) or CT (N = 84) and were followed for 24 months, with process markers measured every 3 months. Attendance in both treatments was high (6.3/8 session) and treatment fidelity and competence were evaluated. Relapse was defined as a return of symptoms meeting the criteria for major depression on Module A of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). Results: Intention-to-treat analyses indicated no differences between MBCT and CT in either rates of relapse to MDD or time to relapse across 24 months of follow up. Both groups experienced significant increases in decentering and participants in CT reported greater reductions in dysfunctional attitudes. Within both treatments, participants who relapsed evidenced lower decentering scores than those who stayed well over the follow up. Conclusions: This is the first study to directly compare relapse prophylaxis following MBCT and CT directly. The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection. These findings lend credence to Teasdale et al.’s (2002) contention that, even though they may be taught through dissimilar methods, CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)