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

Journal of Consulting and Clinical Psychology - Vol 85, Iss 8



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: Wed, 26 Jul 2017 04:00:47 GMT

 



Motivational interviewing and the clinical science of Carl Rogers.

Thu, 20 Jul 2017 04:00:00 GMT

The clinical method of motivational interviewing (MI) evolved from the person-centered approach of Carl Rogers, maintaining his pioneering commitment to the scientific study of therapeutic processes and outcomes. The development of MI pertains to all 3 of the 125th anniversary themes explored in this special issue. Applications of MI have spread far beyond clinical psychology into fields including health care, rehabilitation, public health, social work, dentistry, corrections, coaching, and education, directly impacting the lives of many people. The public relevance and impact of clinical psychology are illustrated in the similarity of MI processes and outcomes across such diverse fields and the inseparability of human services from the person who provides them, in that both relational and technical elements of MI predict client outcomes. Within the history of clinical psychology MI is a clear product of clinical science, arising from the seminal work of Carl Rogers whose own research grounded clinical practice in empirical science. As with Rogers’ work 70 years ago, MI began as an inductive empirical approach, observing clinical practice to develop and test hypotheses about what actually promotes change. Research on MI bridges the current divide between evidence-based practice and the well-established importance of therapeutic relationship. Research on training and learning of MI further questions the current model of continuing professional education through self-study and workshops as a way of improving practice behavior and client outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



From efficacy to effectiveness to broad implementation: Evolution of the Body Project.

Thu, 20 Jul 2017 04:00:00 GMT

Objective: At the turn of the millennium, eating disorders (EDs) prevention was largely nonexistent. No program had reduced future onset of EDs in even a single trial, and most had not reduced ED symptoms. Sixteen years later, the ED prevention field has translated basic risk factor research into interventions, with demonstrated efficacy and effectiveness in reducing ED risk factors and symptoms, as well as future ED onset in some trials. This article reviews the aforementioned progress focusing on a model intervention (i.e., the Body Project [BP]). Method: The article is a qualitative review of the existing BP literature. Results: Although clinical psychology has struggled with bridging the research practice gap and translating efficacy and effectiveness research into clinical implementation, researchers, clinicians, and community stakeholders working with the BP have made significant progress in addressing barriers to scalability, large-scale implementation, and sustainability, reaching 3.5 million girls and young women in 125 countries. Conclusion: The successful evolution of the BP from basic research to traversing the efficacy-to-effectiveness-to-dissemination/implementation continuum has yielded significant public health impact and is thus a fitting case for this special issue commemorating the 125th anniversary of the American Psychological Association. The BP example may help others broadly implement efficacious interventions for other mental health problems. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis.

Thu, 01 Jun 2017 04:00:00 GMT

Objective: Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarize difficulties in conducting randomized clinical trials (RCTs). Method: We systematically identified RCTs of psychological therapies with mental health outcomes in prisoners (37 studies). Effect sizes were calculated and meta-analyzed. Eligible studies were assessed for quality. Subgroup and metaregression analyses were conducted to examine sources of between-study heterogeneity. Thematic analysis reviewed difficulties in conducting prison RCTs. Results: In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials. Conclusions: CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Mon, 26 Jun 2017 04:00:00 GMT

Objective: To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy—panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)—would be more effective for particular patients. Method: Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS). Results: Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = −1.05, CI95% [−1.50, −0.60]), and later age of onset (d = −0.65, CI95% [−0.98, −0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Conclusions: Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



A randomized controlled trial of an online, modular, active learning training program for behavioral activation for depression.

Thu, 20 Jul 2017 04:00:00 GMT

Objective: This randomized-controlled trial assessed the efficacy of a trainer-led, active-learning, modular, online behavioral activation (BA) training program compared with a self-paced online BA training with the same modular content. Method: Seventy-seven graduate students (M = 30.3 years, SD = 6.09; 76.6% female) in mental health training programs were randomly assigned to receive either the trainer-led or self-paced BA training. Both trainings consisted of 4 weekly sessions covering 4 core BA strategies. Primary outcomes were changes in BA skills as measured by an objective role-play assessment and self-reported use of BA strategies. Assessments were conducted at pre-, post-, and 6-weeks after training. A series of longitudinal mixed effect models assessed changes in BA skills and a longitudinal model implemented with generalized estimating equations assessed BA use over time. Results: Significantly greater increases in total BA skills were found in the trainer-led training condition. The trainer-led training condition also showed greater increases in all core BA skills either at posttraining, follow-up, or both. Reported use of BA strategies with actual clients increased significantly from pre- to posttraining and maintained at follow-up in both training conditions. Conclusions: This trial adds to the literature on the efficacy of online training as a method to disseminate BA. Online training with an active learning, modular approach may be a promising and accessible implementation strategy. Additional strategies may need to be paired with the online BA training to assure the long-term implementation and sustainability of BA in clinical practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



“Great powers and great responsibilities”: A brief comment on “A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials” (Franklin et al., 2016).

Thu, 20 Jul 2017 04:00:00 GMT

Online and mobile mental health applications (apps) herald exciting new opportunities for the treatment and prevention of self-injurious thoughts and behaviors (SITBs). With such rapid technological advances, it is paramount that health care innovation not be achieved to the detriment of intervention quality. Franklin et al.’s (2016) therapeutic evaluative conditioning (TEC) app is a novel and timely addition to the mobile health landscape; uncommonly for such apps, it is evidence based. There are, however, several crucial challenges to be surmounted for TEC to be successful; arguably, interventions ought to build lasting skills that can be subsequently and consciously recruited to manage distress beyond the intervention period. Furthermore, SITBs are a coping mechanism (albeit maladaptive); thus, extinguishing SITBs via TEC must be bolstered by the development of alternative coping strategies, particularly if the psychological distress that underlies SITBs is not addressed therapeutically. Stigma exacerbates the psychological distress of those engaging in SITBs; therefore, we question whether the types of stimuli employed in TEC may further add to this stigma, potentially affecting future help seeking. One solution may be to explore a positive-only TEC; enhancing positive self-worth may provide a more sustainable and meaningful treatment target, particularly when used as an adjunct to therapy or as a waiting list intervention. Mobile interventions for SITBs bring unique ethical challenges, including individuals’ right to be fully informed about potentially distressing stimuli. This commentary aims to highlight the methodological and ethical challenges faced by TEC and encourage further discussion around this topic. (PsycINFO Database Record (c) 2017 APA, all rights reserved)



Understanding the context of novel interventions for self-injurious thoughts and behaviors: A reply to Nielsen et al.

Thu, 20 Jul 2017 04:00:00 GMT

In this response to the commentary by Nielsen, Kirtley, & Townsend (in press), the authors note several points of agreement related to further testing of therapeutic evaluative conditioning (TEC) for self-injurious thoughts and behaviors (SITBs), navigating logistical and ethical issues surrounding mobile interventions, and integrating such interventions into traditional practice. They also note a common mission held by Nielsen et al., themselves, and the SITB research community more broadly: the large-scale reduction of SITBs. Given that national rates of SITBs have never declined appreciably and have been on the rise in recent decades, there is an urgent need for progress toward this goal. However, they also highlight several unsupported or inaccurate assumptions and specific points made by Nielsen et al. that are important to correct for the sake of accuracy and progress in the prediction and prevention of SITBs. These include an overly narrow conceptualization of what constitutes an intervention; an unsupported model of the causes of SITBs and how to best prevent them; an erroneous belief about the iatrogenic effects of SITB stimulus exposure; and inaccuracies in their description of the development, testing, and release of TEC. The authors hope that this brief discussion of the evidence will facilitate progress toward the mission of large-scale reductions in SITBs. (PsycINFO Database Record (c) 2017 APA, all rights reserved)