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

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

Dynamic models of individual change in psychotherapy process research.


Objective: There is a need for rigorous methods to study the mechanisms that lead to individual-level change (i.e., process-outcome research). We argue that panel data (i.e., longitudinal study of a number of individuals) methods have 3 major advantages for psychotherapy researchers: (1) enabling microanalytic study of psychotherapeutic processes in a clinically intuitive way, (2) modeling lagged associations over time to ensure direction of causality, and (3) isolating within-patient changes over time from between-patient differences, thereby protecting against confounding influences because of the effects of unobserved stable attributes of individuals. However, dynamic panel data methods present a complex set of analytical challenges. We focus on 2 particular issues: (1) how long-term trajectories in the variables of interest over the study period should be handled, and (2) how the use of a lagged dependent variable as a predictor in regression-based dynamic panel models induces endogeneity (i.e., violation of independence between predictor and model error term) that must be taken into account in order to appropriately isolate within- and between-person effects. Method: An example from a study of working alliance in psychotherapy in primary care in Sweden is used to illustrate some of these analytic decisions and their impact on parameter estimates. Results: Estimates were strongly influenced by the way linear trajectories were handled; that is, whether variables were “detrended” or not. Conclusions: The issue of when detrending should be done is discussed, and recommendations for research are provided. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Mechanisms of change in cognitive therapy for major depressive disorder in the community mental health setting.


Objective: This study examined the relation of change in theory-relevant cognitive variables to depressive symptom change over the course of cognitive therapy, as well as the specificity of change mechanisms to cognitive therapy as compared with dynamic therapy. Method: There were 237 adult outpatients who were randomized to either cognitive (n = 119) or dynamic (n = 118) therapy for major depressive disorder in a community mental health setting. Assessments of compensatory skills (Ways of Responding Community Version and Self-Report Version), dysfunctional attitudes (Dysfunctional Attitudes Scale), and depressogenic schemas (Psychological Distance Scaling Task) were obtained at baseline and months 1, 2, and 5 following baseline. Primary outcome was measured using the Hamilton Rating Scale for Depression. Results: Across both therapy conditions, change in all 3 cognitive domains was associated with concurrent change in depressive symptoms. After controlling for other cognitive variables, increased interconnectedness of the positive achievement-related schema was significantly associated with concurrent symptom change in cognitive (rp = .26, p < .001) but not dynamic therapy (rp = .08, p = .29). Increases in positive compensatory skills were associated with subsequent change in depressive symptoms in cognitive therapy (rp = −.36, p = .003), but not in dynamic therapy (rp = .11, p = .386). Conclusions: Results provide support for the compensatory skills model of cognitive therapy (CT) within a community mental health setting. Additional research is necessary to understand other possible mechanisms of change in CT in the community setting. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Does impaired mental health interfere with the outcome of brief alcohol intervention at general hospitals?


Objective: The aim of this study was to test whether the efficacy of in-person and computer delivered brief alcohol intervention (BAI) is moderated by mental health status. Method: General hospital inpatients with at-risk alcohol use aged 18 to 64 years (N = 961, 75% men) were allocated to in-person BAI, computer-based BAI, and assessment only. In-person BAI contained counseling by research staff. Computer-based BAI contained computer-generated individualized feedback letters. BAIs were designed to be delivered at baseline and 1 and 3 months later. Outcome was reduction in alcohol use per day after 6, 12, 18, and 24 months. Latent growth curve models were estimated. Two mental health indicators, the 5-item mental health inventory and routine care diagnosis of mental and behavioral disorders assessed by general hospital physicians, were tested as moderators of BAI efficacy. Results: In all groups, inpatients with better mental health reduced alcohol use after hospitalization (ps < 0.01). While inpatients with impaired mental health did not reduce their drinking significantly following assessment only, those who received any of the 2 BAIs did (ps < 0.05). Conclusions: BAI was particularly efficacious in reducing alcohol use among general hospital inpatients with at-risk alcohol use and impaired mental health, with computer-based delivery being at least as efficacious as in-person delivery. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Depressive symptoms and gestational length among pregnant adolescents: Cluster randomized control trial of CenteringPregnancy® plus group prenatal care.


Objectives: Depressive symptoms are associated with preterm birth among adults. Pregnant adolescents have high rates of depressive symptoms and low rates of treatment; however, few interventions have targeted this vulnerable group. Objectives are to: (a) examine impact of CenteringPregnancy® Plus group prenatal care on perinatal depressive symptoms compared to individual prenatal care; and (b) determine effects of depressive symptoms on gestational age and preterm birth among pregnant adolescents. Method: This cluster-randomized controlled trial was conducted in 14 community health centers and hospitals in New York City. Clinical sites were randomized to receive standard individual prenatal care (n = 7) or CenteringPregnancy® Plus group prenatal care (n = 7). Pregnant adolescents (ages 14–21, N = 1,135) completed the Center for Epidemiologic Studies Depression Scale during pregnancy (second and third trimesters) and postpartum (6 and 12 months). Gestational age was obtained from medical records, based on ultrasound dating. Intention to treat analyses were used to examine objectives. Results: Adolescents at clinical sites randomized to CenteringPregnancy® Plus experienced greater reductions in perinatal depressive symptoms compared to those at clinical sites randomized to individual care (p = .003). Increased depressive symptoms from second to third pregnancy trimester were associated with shorter gestational age at delivery and preterm birth (<37 weeks gestation). Third trimester depressive symptoms were also associated with shorter gestational age and preterm birth. All p < .05. Conclusions: Pregnant adolescents should be screened for depressive symptoms prior to third trimester. Group prenatal care may be an effective nonpharmacological option for reducing depressive symptoms among perinatal adolescents. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Multiple indicators of sexual interest in prepubescent or pubescent children as predictors of sexual recidivism.


Objective: Sexual interest in children is a well-known risk factor for sexual reoffending (recidivism). The present study examined the relationship between sexual interest in prepubescent children (pedophilia) or pubescent children (hebephilia) and sexual recidivism. It extended previous work by using multiple indicators of sexual interest, using a more sensitive phallometric procedure that measures change in penile blood volume, and examining both hebephilia alongside pedophilia, as well as noncontact sexual recidivism. Method: Six hundred fifty-six men who had committed a sexual offense underwent a comprehensive sexological assessment that included multiple sexual interest measures: volumetric phallometry, self-report, and sexual behavior. Criminal record data were acquired to examine recidivism. Offenders were followed for an average of 10 years of opportunity. Results: Indicators of hebephilia and pedophilia were significantly associated with noncontact sexual recidivism, but inconsistently associated with contact recidivism. The relationship with phallometrically assessed pedophilia and contact sexual recidivism was significant after controlling for offender age statistically. Phallometrically assessed sexual arousal to children did not add to risk appraised by an actuarial measure. Conclusion: Both hebephilia and pedophilia were predictive of noncontact sexual recidivism. The results for contact sexual recidivism are discussed, including a potential confound in previous work on the assessment of sexual interest in children. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation.


Objective: Anxiety sensitivity (AS) is a well-established transdiagnostic risk factor for anxiety and mood psychopathology including suicide. A variety of interventions using cognitive–behavioral skills as well as cognitive bias modification (CBM) suggest that AS can be quickly and effectively reduced in nonclinical and nontreatment seeking samples. However, it is unclear whether AS reduction protocols will have efficacy for more severe clinical samples. Moreover, the combination of cognitive–behavioral techniques with CBM focused on changing interpretation bias (CBM-I) related to AS has not been evaluated. Method: A patient sample with co-occurring anxiety psychopathology and active suicidal ideation (N = 74) was randomly assigned to a brief 1-session computerized treatment including: (a) psychoeducation and interoceptive exposure (i.e., cognitive anxiety sensitivity treatment [CAST]) plus CBM-I for AS; or (b) health information condition plus sham CBM for AS. Participants were assessed immediately after the 1-hr intervention as well as at 1- and 4-month follow-ups. Results: Consistent with hypotheses, participants in the active treatment showed significantly greater AS reduction that was maintained through follow-up (effect sizes ranged from medium to large for the overall AS and the AS subscales). Mediation analyses suggested that changes in AS mediated suicide outcomes. Conclusions: In sum, these are the first findings to suggest that brief AS reduction protocols have efficacy both in terms of risk and symptom outcomes in patient samples showing active suicidal ideation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

How much is enough? Examining frequency criteria for NSSI disorder in adolescent inpatients.


Objective: To empirically evaluate the diagnostic relevance of the proposed Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; APA, 2013) Criterion-A frequency threshold for nonsuicidal self-injury (NSSI) disorder. Method: Archival, de-identified, self-reported clinical assessment data from 746 adolescent psychiatric patients (Mage = 14.97; 88% female; 76% White) were used. The sample was randomly split into 2 unique samples for data analyses. Measures included assessments of NSSI, proposed DSM–5 NSSI-disorder criteria, psychopathology, dysfunction, distress, functional impairment, and suicidality. Results: Discriminant-function analyses run with Sample A identified a significant differentiation of groups based on a frequency of NSSI at 25 or more days in the past year, Λ = .814, χ2(54) = 72.59, p25 days), moderate (5–24 days), and low (1–4 days) and compared. The high-NSSI group scored higher on most NSSI features, including DSM–5-proposed Criterion-B and -C symptoms, depression, psychotic symptoms, substance abuse, borderline personality-disorder features, suicidal ideation, and suicide plans, than the moderate- and low-NSSI groups, who did not differ from each other on many of the variables. Conclusion: The currently proposed DSM–5 Criterion-A frequency threshold for NSSI disorder lacks validity and clinical utility. The field needs to consider raising the frequency threshold to ensure that a meaningful and valid set of diagnostic criteria are established, and to avoid overpathologizing individuals who infrequently engage in NSSI. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial.


Objective: Nonsuicidal self-injury (NSSI) is prevalent among young adults and associated with negative medical and psychological consequences, necessitating its treatment. However, few treatments have been developed to treat NSSI specifically, or to treat the behavior among individuals without borderline personality disorder. The purpose of this study was to investigate the Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention specifically developed to treat NSSI among young adults, in a pilot randomized controlled trial (RCT). Method: Young adults (N = 33; age: M = 22.36 years, SD = 3.40) meeting inclusion and exclusion criteria were randomly assigned to the treatment (T-SIB; n = 15) or treatment as usual (n = 18) condition. The sample was 93.9% female, 42.4% Caucasian, and 30.3% Hispanic/Latino. Results: Feasibility and acceptability of the study and intervention were supported, and medium effects were found for decreased NSSI frequency in the T-SIB group using intent-to-treat analyses. Conclusion: Results of this study support the further evaluation of T-SIB in a larger RCT. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury.


Objective: Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. Method: Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. Results: Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. Conclusions: Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)

Sleep the night before and after a treatment session: A critical ingredient for treatment adherence?


Objective: Sleep prepares key neural structures for next-day learning, and sleep obtained after learning promotes subsequent memory consolidation supporting long-term retention. This study examined whether sleep the night before and after a therapy session predicts aspects of treatment adherence. Method: As part of a randomized clinical trial, 188 adults (62.7% female, mean age = 47.5, 80.5% Caucasian) with persistent insomnia received cognitive–behavioral therapy for insomnia. Patients completed a sleep diary before and after treatment sessions. Minutes spent awake during the night (total wake time; TWT) and total sleep time (TST) were used as measures of sleep disturbance. At each treatment session, therapists rated participant understanding of the session and homework compliance from the previous session. Results: Compared to longer TWT, before session shorter TWT was associated with increased treatment understanding the next day. After session shorter TWT was also associated with increased understanding, but not homework compliance the subsequent session compared to participants with longer TWT. Similar results were obtained for TST. Conclusions: Improving sleep may benefit patient adherence to treatment. Sleep may influence processes related to initial learning and subsequent consolidation of treatment information. Future studies should examine whether improved sleep within other psychiatric disorders is also an ingredient to the successful outcome of psychosocial interventions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)(image)