J Consult Clin Psychol [JOURNAL]
Sun
200 papers
Democratizing access to psychological therapies: Innovations and the role of psychologists.
Singla DR, Schleider JL, Patel V
J Consult Clin Psychol · 2023 Nov · PMID 37782248 · Publisher ↗
Psychological therapies are highly effective interventions for a range of mental health conditions and often preferred by many patients over medication. Unfortunately, most people who could benefit from these therapies d...
Psychological therapies are highly effective interventions for a range of mental health conditions and often preferred by many patients over medication. Unfortunately, most people who could benefit from these therapies do not receive them. This is true even in the United States, which enjoys relatively high numbers of mental health professionals. The lack of access is further compounded by structural inequities, such as income, geography, and race. The low and inequitable access to one of the most effective interventions for mental health conditions is, arguably, one of the most significant barriers to addressing the growing burden of mental health conditions globally. There are several reasons which might contribute to this inequity, notably the historical reliance on complex treatment protocols designed in settings which serve a nonrepresentative group of persons with mental health problems and, consequently, an emphasis on specialist providers and in-person protocols. These factors lead to long and expensive training, variable quality of delivery, and enhanced costs and challenges to patient engagement. In contrast to medication, the lack of a commercial incentive to promote psychological therapies means that there are no market forces which fuel their scaling up. Given there will never be enough psychologists to serve the large unmet and growing mental health needs in the population, we consider stepped and collaborative models that leverage the range of expertise offered by diverse providers, to offer a pathway to scale up a person-centered approach for psychological treatments. In this article, we highlight three innovations that address some barriers and the potential roles of clinical psychologists to broaden the reach of psychological therapies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Randomized controlled trial of a web-based program for preventing anxiety and depression in university students.
Rith-Najarian LR, Gong-Guy E, Flournoy JC … +1 more , Chavira DA
J Consult Clin Psychol · 2024 Jan · PMID 37768633 · Publisher ↗
OBJECTIVE: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) exam...
OBJECTIVE: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) examined the effectiveness of such a prevention program. METHOD: StriveWeekly is a web-based intervention designed with weekly self-guided skill modules (e.g., behavioral activation) that are synchronously delivered to all users. Student participants ( = 1,607) were recruited from one large public university, and 65.4% had no prior mental health service use. Participants were randomly assigned to 8 weeks of StriveWeekly ( = 804) or a waitlist condition ( = 803). Participants completed web-based surveys at baseline, posttest, and 3-month follow-up. The primary outcome was the self-reported Depression Anxiety and Stress Scale-21. RESULTS: Piecewise linear mixed-effect models found significant group by time interactions for depression ( = -3.05, = .002), anxiety ( = -3.01, = .003), and total symptoms ( = -3.34, < .001). Relative to the waitlist, students assigned to StriveWeekly improved more from baseline to posttest (between-group = 0.18-0.21). These small effects were maintained through follow-up, and subsequently replicated by the original waitlist. The intervention was initiated by 73.0% of students in the StriveWeekly condition (modules completed: = 3.72), and 71.6% of all posttest respondents rated the intervention highly. CONCLUSION: Findings supported StriveWeekly's effectiveness for large scale indicated prevention of anxiety and depression symptoms in university students. However, further development and research are still needed, as not all students used the intervention, reported satisfaction, or experienced improvement. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Intervention format and therapist-child agreement associated with therapeutic alliance and outcomes.
Lochman JE, Laird RD, McDaniel HL … +4 more , Boxmeyer CL, Braun SS, Powell NP, Qu L
J Consult Clin Psychol · 2024 Jan · PMID 37768632 · Full text
OBJECTIVE: The study examined the effects of therapeutic alliance (TA; relational bond, task collaboration) on externalizing behavior outcomes, how TA can operate differently when children are seen in individual versus g...
OBJECTIVE: The study examined the effects of therapeutic alliance (TA; relational bond, task collaboration) on externalizing behavior outcomes, how TA can operate differently when children are seen in individual versus group sessions, and how therapist-child disagreement in perceptions of TA affects outcomes. METHOD: Three hundred sixty children (Ages 9.2-11.8; 65% male; 78.1% Black) identified as having high rates of aggressive behavior by the fourth-grade teachers, and their 20 elementary schools were randomized to group versus individual delivery of the cognitive behavioral intervention, Coping Power. TA ratings were collected from children and therapists at mid and end of intervention using the Therapeutic Alliance Scale for Children. Teacher ratings of children's externalizing and internalizing behavior problems were collected prior to intervention and at 1-year follow-up after intervention using the Behavior Assessment System for Children. RESULTS: Children receiving the intervention individually reported significantly higher trait-like levels of task collaboration than did children seen in groups. Independent of intervention format, higher trait-like levels of therapist-rated bond and task collaboration predicted reduced levels of externalizing problems, and higher trait-like levels of child- and therapist-rated task-collaboration and therapist-rated bond predicted reduced levels of internalizing problems. Differences between therapist and child reports of bond predicted weaker reductions in internalizing behavior for children seen in groups. CONCLUSIONS: It is essential to train therapists to develop and assess for TA by midintervention with children with aggressive behavior problems, especially if they are seen in small groups, and to determine if therapists may misperceive the strength of TA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Revealing subgroup-specific mechanisms of change via moderated mediation: A meditation intervention example.
Webb CA, Hirshberg MJ, Gonzalez O … +2 more , Davidson RJ, Goldberg SB
J Consult Clin Psychol · 2024 Jan · PMID 37768631 · Full text
OBJECTIVE: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their benefi...
OBJECTIVE: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their beneficial effects. We know many treatments work, but we know relatively little about they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation. METHOD: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees ( = 662), we previously developed a "Personalized Advantage Index" (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores. RESULTS: A significant index of moderated mediation (IMM = 1.22, 95% CI [0.30, 2.33]) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app. CONCLUSIONS: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Emotional and cognitive processes in psychotherapy are associated with different aspects of the therapeutic relationship.
Finsrud I, Nissen-Lie HA, Ulvenes PG … +3 more , Vrabel K, Melsom L, Wampold B
J Consult Clin Psychol · 2024 Sep · PMID 37768630 · Publisher ↗
OBJECTIVE: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors ("Confidence in the therapist" and "Confi...
OBJECTIVE: In this naturalistic study we aimed to investigate the relationships between two central change processes (affective and cognitive) and two common relationship factors ("Confidence in the therapist" and "Confidence in the treatment"), which have been shown to impact outcomes in a clinical context. We also investigated whether these interrelationships varied across treatment orientations (i.e., cognitive or psychodynamic focused). METHOD: The sample consisted of 631 patients with a primary anxiety or depressive disorder who were admitted to an inpatient program and treated with psychotherapy. The data consisted of weekly measures of cognitive (i.e., "rumination") and affective (i.e., "problems with emotional clarity") change processes as well as scores on Confidence in the therapist and Confidence in the treatment and symptom distress. A multivariate version of the latent curve model with structured residuals was used to investigate the of week-to-week changes in all variables. RESULTS: Initial analyses established that both problems with emotional clarity and rumination predicted symptom distress. Further, we found that higher Confidence in the therapist predicted higher emotional clarity (but not lower rumination) whereas higher Confidence in the treatment predicted lower rumination (but did not affect emotional clarity). Post hoc analyses found that these interrelationships varied across treatment orientation (i.e., cognitive vs. psychodynamic). DISCUSSION: The results indicate that patients' experience of the therapist is associated with change processes, and that patients' experience of the coherence and meaningfulness of treatment, on the other hand, is associated with change processes. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Predictors of mental health outcomes of three refugee groups in an advocacy-based intervention: A precision medicine perspective.
Blackwell MA, Goodkind JR, Yeater EA … +1 more , Van Horn ML
J Consult Clin Psychol · 2024 Jan · PMID 37768629 · Full text
OBJECTIVE: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial fa...
OBJECTIVE: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes. METHOD: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention. Emotional distress symptoms were measured prior to intervention, midintervention (3 months), postintervention (6 months), and follow-up (6 months after the end of intervention). Number of traumatic events, resource access, social support, and English proficiency were tested for potential predictive effects on intervention outcome. RESULTS: Multilevel generalized linear models revealed that Afghans' ( = -0.259, = 0.108, = .013), and Great Lakes Africans' ( = -0.116, = 0.057, = .042) emotional distress symptoms improved as a function of the intervention, while Iraqis and Syrians showed no intervention effects. For Afghans, English proficiency ( = -0.453, = 0.157, < .01) and social support ( = -0.179, = 0.086, = .037) were most strongly correlated to emotional distress, while for Africans, resource access ( = -0.483, = 0.082, < .001) and social support ( = -0.100, = 0.048, = .040) were the strongest predictors of emotional distress. CONCLUSIONS: Response to advocacy-based interventions and active ingredients may be influenced by culture; findings have implications for refugees and precision medicine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Reducing suicidal ideation in African American adolescents: A randomized controlled clinical trial.
Robinson WL, Whipple CR, Keenan K … +3 more , Flack CE, Lemke S, Jason LA
J Consult Clin Psychol · 2024 Feb · PMID 37768628 · Full text
OBJECTIVE: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with...
OBJECTIVE: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design. METHOD: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention. RESULTS: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition. CONCLUSION: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Clinical science and practice in the age of large language models and generative artificial intelligence.
Schueller SM, Morris RR
J Consult Clin Psychol · 2023 Oct · PMID 37732988 · Publisher ↗
In this article, Schueller and Morris discuss the recent advances made from large language models (LLMs) and generative artificial intelligence (AI). These advances include supporting humans to provide better interventio...
In this article, Schueller and Morris discuss the recent advances made from large language models (LLMs) and generative artificial intelligence (AI). These advances include supporting humans to provide better interventions, understanding processes in clinical interventions, and providing ethical considerations for the use of generative AI in clinical research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Treatment for graduate students: Blunting the emotional toll of postgraduate education.
Prakash N, Votta CM, Deldin PJ
J Consult Clin Psychol · 2023 Dec · PMID 37732972 · Publisher ↗
OBJECTIVES: Graduate students are at greater risk of developing mental health concerns than other adults in their age group. Despite the need for care within this population, there is a lack of literature on accessible i...
OBJECTIVES: Graduate students are at greater risk of developing mental health concerns than other adults in their age group. Despite the need for care within this population, there is a lack of literature on accessible interventions designed specifically to meet the needs of graduate students. The present study examines the efficacy of a novel intervention: Mood Lifters for Graduate Students (ML-GS). METHOD: This study is a clinical trial with randomization. The sample size consisted of 131 participants. The average age was 25.95 years, and the sample was 88.5% women, 61.8% White, and 65.6% straight or heterosexual. Participants completed the same survey before and after participating in ML-GS, as well as 1-month after completing ML-GS. Three measures from those surveys were examined in this study: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale. Two-way mixed-design analyses of variance (ANOVAs) and repeated measures ANOVAs were used to analyze these data. RESULTS: Results indicated that participants enrolled in ML-GS experienced significant, clinically meaningful reductions in depression, anxiety, and stress, when compared to their waitlist counterparts. The changes made during the ML-GS program were also maintained at the 1-month follow-up. CONCLUSIONS: These findings suggest that ML-GS is effective in reducing depression, anxiety, and stress among graduate students. It may be a good solution for the large demand for mental health support in that population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
The role of therapy delivery and clinic organizational factors in explaining therapist effects for trauma-focused psychotherapies in the Veterans Health Administration.
Sayer NA, Wiltsey Stirman S, Rosen CS … +6 more , Kehle-Forbes S, Spoont MR, Eftekhari A, Chard KM, Kaplan A, Nelson DB
J Consult Clin Psychol · 2023 Nov · PMID 37668578 · Full text
OBJECTIVE: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational fac...
OBJECTIVE: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs. METHOD: Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample ( = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs. RESULTS: Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (s < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% ( < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% ( = .140) when therapists' mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery. CONCLUSIONS: Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Ground-up approach to understanding the impacts of historical trauma in one reserve-dwelling first nations community.
Weiss NH, Spillane NS, Goldstein SC … +7 more , Kiefer R, Raudales AM, Nalven T, Egan A, Trinh CD, Moore RS, Gone JP
J Consult Clin Psychol · 2023 Dec · PMID 37650826 · Full text
OBJECTIVE: First Nations peoples experience disproportionate health inequities compared to most non-Indigenous populations. Historical trauma is one factor that has received growing attention in relation to health inequi...
OBJECTIVE: First Nations peoples experience disproportionate health inequities compared to most non-Indigenous populations. Historical trauma is one factor that has received growing attention in relation to health inequities among First Nations populations. The goal of the present study was to improve understanding of the specific forms, impacts, and mechanisms of transmission of events that lead to historical trauma and the historical trauma response in First Nations peoples. METHOD: Five focus groups were conducted among adult members of one First Nations community in Canada ( = 34; 70.4% female). RESULTS: Conventional content analysis revealed the numerous forms that historical trauma take in this First Nations community; individual-, familial-, community-, and societal-level impacts of historical trauma; and ways in which historical trauma has been transmitted in this community. Loss of culture, alcohol use, and parenting were major themes identified across these domains. CONCLUSIONS: Findings provide important information on the experience of historical trauma in one First Nations community, highlighting the roles of loss of culture; alcohol use; and parenting in the forms, impacts, and transmission of historical trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Examining engagement effects in an adaptive preventive intervention for college student drinking.
Patrick ME, Sur A, Arterberry B … +3 more , Peterson S, Morrell N, Vock DM
J Consult Clin Psychol · 2023 Nov · PMID 37650825 · Full text
OBJECTIVE: This study determined the characteristics of engagement and whether engagement in an adaptive preventive intervention (API) was associated with reduced binge drinking and alcohol-related consequences. METHOD:...
OBJECTIVE: This study determined the characteristics of engagement and whether engagement in an adaptive preventive intervention (API) was associated with reduced binge drinking and alcohol-related consequences. METHOD: Incoming students were recruited for a sequential multiple assignment randomized trial (SMART; = 891, 62.4% female, 76.8% non-Hispanic White) with an assessment-only control group. The API occurred during the first semester of college, with outcomes assessed at the end of the semester. The API involved two stages. Stage 1 included universal intervention components (personalized normative feedback [PNF] and self-monitoring). Stage 2 bridged heavy drinkers to access additional resources. We estimated the effect of engagement in Stage 1 only and in the whole API (Stages 1 and 2) among the intervention group, and the effect of the API versus control had all students assigned an API engaged, on alcohol-related outcomes. RESULTS: Precollege binge drinking, intention to pledge a fraternity/sorority, and higher conformity motives were most associated with lower odds of Stage 1 engagement. Action (readiness to change) and PNF engagement were associated with Stage 2 engagement. API engagement was associated with significant reductions in alcohol-related consequences among heavy drinkers. Compared to the control, we estimated the API would reduce the relative increase in alcohol-related consequences from baseline to follow-up by 25%, had all API students engaged. CONCLUSIONS: Even partial engagement in each component of the "light-touch" API rendered benefits. Analyses suggested that had all students in the intervention group engaged, the API would significantly reduce the change in alcohol-related consequences over the first semester in college. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
The prognostic role of emotion regulation dynamics in the treatment of major depressive disorder.
Bar-Sella A, Nof A, Baucom BR … +5 more , Goldstein P, Romanov S, Shpakouskaya I, Kaplun D, Zilcha-Mano S
J Consult Clin Psychol · 2023 Dec · PMID 37616125 · Publisher ↗
OBJECTIVE: The potential prognostic role of emotion regulation in the treatment of major depressive disorder (MDD) has been highlighted by transtheoretical literature and supported by promising empirical findings. The ma...
OBJECTIVE: The potential prognostic role of emotion regulation in the treatment of major depressive disorder (MDD) has been highlighted by transtheoretical literature and supported by promising empirical findings. The majority of the literature is based on self-report observations at a single snapshot, thus little is known about the prognostic value of moment-to-moment dynamic evolvement of emotion. The present study is the first to examine the prognostic value of both intra- and interpersonal, moment-to-moment emotion regulation dynamics, and the potential moderating effect of the type of treatment. METHOD: To assess the prognostic value of emotion regulation dynamics, we focused on the first session, using 6,780 talk-turns within 52 patient-therapist dyads. Emotion regulation dynamics were measured using fundamental frequencies of the voice and were calculated using empirical Bayes residuals of the actor-partner interdependence model. Symptomatic change was measured using the Hamilton Rating Scale for Depression across 16 weeks of supportive treatment (ST) or supportive-expressive treatment (SET). RESULTS: Findings suggest that patients who show less regulated intrapersonal dynamics during the first session show less reduction of symptoms throughout treatment (β = .26, = .019). Findings further suggest that this association is mitigated when these patients receive SET, as opposed to ST (β = .72, = .020). CONCLUSIONS: The findings demonstrate the ability of first-session emotion regulation dynamics to serve as a prognostic variable. The findings further suggest that the adverse effect of emotion regulation dynamics on the patient's prognosis can be mitigated by explicit work on changing maladaptive emotional patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Evaluating the effectiveness of concurrent sessions and counselors' attention allocation in online counseling.
Xu Y, Chan CS, Tsang C … +3 more , Cheung F, Chan E, Yip PSF
J Consult Clin Psychol · 2023 Nov · PMID 37616124 · Publisher ↗
OBJECTIVE: With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is , that is, each counsel...
OBJECTIVE: With its anonymity and accessibility, text-based online counseling has shown great potential in reaching people with mental health needs. One strategy adopted to meet the service gap is , that is, each counselor attending to more than one client at a time. To date, there is no reported evidence supporting its rationality and effectiveness. This study investigated the potential opportunities, effectiveness, and caveats in concurrent service delivery and identified the optimal cutoff number of concurrent sessions while maintaining the quality of service at or above a set threshold. METHOD: We analyzed the transcript of 54,716 online counseling sessions from Open Up, a free, 24/7 text-based counseling service, to develop an attention score that measures the attention allocation of counselors and examined the impact of the counselor's attention allocation on client satisfaction and service outcomes. RESULTS: On average, compared to nonconcurrent sessions, concurrent sessions were longer, more likely to end prematurely, and had lower client satisfaction. We also identified an of approximately 0.4 (out of 1.0, which denotes full attention), which translates to two to three concurrent sessions. CONCLUSIONS: This study provides empirical evidence for the feasibility of conducting multiple text-based sessions concurrently without compromising service quality and client experience. Our method of measuring the counselor attention allocation offers a way to systematically assess and evaluate concurrent sessions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
A framework for neurodiversity-affirming interventions for autistic individuals.
Lerner MD, Gurba AN, Gassner DL
J Consult Clin Psychol · 2023 Sep · PMID 37578755 · Full text
Despite being targets of intervention practice and research for over 60 years, autistic people have been left out of the conversation. Until recently, nearly no research or implementation work has sought the input of aut...
Despite being targets of intervention practice and research for over 60 years, autistic people have been left out of the conversation. Until recently, nearly no research or implementation work has sought the input of autistic people in regard to the design of interventions and, more importantly, how the goals for such interventions are prioritized and determined. This reframe has profound implications for autism-focused interventions and research, most of which have aimed to reduce or eliminate autism symptoms, with variable empirical support (Bottema-Beutel, 2023). These outcomes are practically and ethically incompatible with a neurodiversity perspective. Most prominently, applied behavior analysis (ABA), which was the first intervention approach widely applied to autistic people, has come under increasing scrutiny and criticism for failing to include autistic people in the design of intervention elements and consideration of goals; moreover, autistic people are increasingly identifying iatrogenic effects they have experienced when receiving ABA (Bottema-Beutel, 2023), with these concerns often being met with minimization rather than an endorsement of their validity and willingness to hear them out. Thus, there is a pressing need for a neurodiversity-affirming interventions (NAI) framework for autism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Novel treatment based on acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized comparative effectiveness trial in women veterans.
Martin JL, Carlson GC, Kelly MR … +13 more , Song Y, Mitchell MN, Josephson KR, McGowan SK, Culver NC, Kay MA, Erickson AJ, Saldana KS, May KJ, Fiorentino L, Alessi CA, Washington DL, Yano EM
J Consult Clin Psychol · 2023 Nov · PMID 37535521 · Full text
OBJECTIVE: This randomized comparative effectiveness trial evaluated a novel insomnia treatment using acceptance and commitment therapy (ACT) among women veterans. Participants received either the acceptance and the beha...
OBJECTIVE: This randomized comparative effectiveness trial evaluated a novel insomnia treatment using acceptance and commitment therapy (ACT) among women veterans. Participants received either the acceptance and the behavioral changes to treat insomnia (ABC-I) or cognitive behavioral therapy for insomnia (CBT-I). The primary objectives were to determine whether ABC-I was noninferior to CBT-I in improving sleep and to test whether ABC-I resulted in higher treatment completion and adherence versus CBT-I. METHOD: One hundred forty-nine women veterans with insomnia disorder ( = 48.0 years) received ABC-I or CBT-I. The main sleep outcomes were Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and sleep efficiency (SE) by actigraphy (objective) and sleep diary (subjective). Measures were collected at baseline, immediate posttreatment, and 3-month posttreatment follow-up. Treatment completion and adherence were assessed during the interventions. RESULTS: Both interventions improved all sleep outcomes from baseline to immediate posttreatment and 3-month posttreatment follow-up. At immediate posttreatment, ABC-I was statically noninferior for sleep diary SE and objective SE, but noninferiority was not statistically confirmed for ISI or PSQI total scores. At 3-month posttreatment follow-up, ABC-I was noninferior for all four of the key outcome variables. There was not a statistically significant difference between the number of participants who discontinued CBT-I (11%) versus ABC-I (18%; = .248) before completing treatment. ABC-I was superior to CBT-I for some adherence metrics. CONCLUSIONS: Overall, ABC-I was similar in effectiveness compared to CBT-I for the treatment of insomnia and may improve adherence to some behavioral elements of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Treatment length and symptom improvement in prolonged exposure and present-centered therapy for posttraumatic stress disorder: Comparing dose-response and good-enough level models in two manualized interventions.
Thompson-Hollands J, Lunney CA, Sloan DM … +2 more , Wiltsey Stirman S, Schnurr PP
J Consult Clin Psychol · 2023 Oct · PMID 37471022 · Full text
OBJECTIVE: The dose-response model of change in psychotherapy posits that each session of therapy is incrementally beneficial across patients. The contrasting good-enough level model suggests that patients improve at dif...
OBJECTIVE: The dose-response model of change in psychotherapy posits that each session of therapy is incrementally beneficial across patients. The contrasting good-enough level model suggests that patients improve at different rates in therapy and discontinue treatment when they are satisfied with their improvement. Support for each theory has been mixed, and many prior studies have relied on samples of patients receiving unstructured treatment approaches. We conducted this study to compare these two theories across two manualized treatments for posttraumatic stress disorder (PTSD). METHOD: Two hundred eighty-four female veterans and military service members with PTSD ( = 44.79; 54.6% White non-Hispanic, 6.7% Black non-Hispanic, 37% other) were randomized to receive 10 sessions of prolonged exposure (PE), a trauma-focused therapy, or present-centered therapy (PCT), a non-trauma-focused therapy. Participants completed the PTSD Checklist (PCL) at even-numbered treatment sessions, and the timing of dropout/treatment completion was monitored. RESULTS: The point of highest risk for dropout differed between the treatments, with risk in PE corresponding to the beginning of imaginal exposures. In the PE condition, but not in PCT, a higher number of sessions completed increased the likelihood of achieving reliable clinically significant improvement. Across treatments, the rate of change in PTSD symptoms did not differ according to the number of sessions completed ( = 0.06, = .687). CONCLUSIONS: Findings support the dose-response model of change in psychotherapy. There were notable differences in dropout across the treatment conditions, including rates, timing, and implications for outcomes. These differences likely reflect differences in content between the protocols. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Mediators of change in online mindfulness-based cognitive therapy: A secondary analysis of a randomized trial of mindful mood balance.
Dimidjian S, Gallop R, Levy J … +2 more , Beck A, Segal ZV
J Consult Clin Psychol · 2023 Aug · PMID 37458610 · Publisher ↗
OBJECTIVE: Digital delivery of mindfulness-based cognitive therapy through the Mindful Mood Balance (MMB) program is clinically effective (Segal et al., 2020); however, the mechanisms through which this program delivers...
OBJECTIVE: Digital delivery of mindfulness-based cognitive therapy through the Mindful Mood Balance (MMB) program is clinically effective (Segal et al., 2020); however, the mechanisms through which this program delivers its benefits have not been established. METHOD: This study investigates the differential impact of the MMB program paired with usual depression care (UDC) compared to UDC alone on the putative targets of self-reported mindfulness, decentering, and rumination and the extent to which change in these targets mediates subsequent depressive relapse among a sample of predominantly White, female participants, with residual depressive symptoms. RESULTS: The MMB program relative to UDC was associated with a significantly greater rate of change in decentering (t = 4.94, p < .0001, d = 0.46), mindfulness (t = 6.04, p < .0001, d = 0.56), and rumination (t = 3.82, p < .0001, d = 0.36). Subsequent depressive relapse also was mediated by prior change in these putative targets, with a significant natural indirect effect for decentering, χ2(1) = 7.25, p < .008, OR = 0.57; mindfulness, χ2(1) = 9.99, p < .002, OR = 0.50; and rumination, χ2(1) = 12.95, p < .001, OR = 0.35. CONCLUSIONS: These findings suggest the mechanisms of MMB are consistent with the conceptual model for mindfulness-based cognitive therapy and depressive relapse risk and that such processes can be modified through digital delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.
Chan MS, Liu S, White B … +10 more , Zhang A, Zhou Y, Leung M, Dai W, Liu X, Durantini M, Ye Q, Palmese L, O'Keefe D, Albarracín D
J Consult Clin Psychol · 2023 Oct · PMID 37410398 · Full text
OBJECTIVE: Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV...
OBJECTIVE: Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). METHOD: This meta-analysis of 331 reports (clusters; number of effect sizes [] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. RESULTS: Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. CONCLUSIONS: Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations.
Webb CA, Murray L, Tierney AO … +1 more , Gates KM
J Consult Clin Psychol · 2024 Aug · PMID 37276084 · Full text
OBJECTIVE: Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly be...
OBJECTIVE: Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly beneficial for adolescents with prominent anhedonia, a predictor of poor treatment response and common residual symptom. We applied group iterative multiple model estimation (GIMME) to ecological momentary assessment (EMA) treatment data to investigate common and person-specific processes during BA for anhedonic adolescents. METHOD: Thirty-nine adolescents ( = 15.7 years old, 67% female, 81% White) with elevated anhedonia (Snaith-Hamilton Pleasure Scale) were enrolled in a 12-week BA trial, with weekly anhedonia assessments. EMA surveys were triggered every other week (2-3 surveys per day) throughout treatment assessing current positive affect (PA) and negative affect (NA), engagement in pleasurable activities and social interactions, anticipatory pleasure, rumination, and recent pleasurable and stressful experiences. RESULTS: A multilevel model revealed significant decreases in anhedonia, (25.5) = -4.76, < .001, over the 12-week trial. GIMME results indicated substantial heterogeneity in variable networks across patients. PA was the variable with the greatest number (22% of all paths vs. 11% for NA) of predictive paths to other symptoms (i.e., highest out-degree). Higher PA (but not NA) out-degree was associated with greater anhedonia improvement, (25.8) = -2.22, = .035. CONCLUSIONS: Results revealed substantial heterogeneity in variable relations across patients, which may obscure the search for common processes of change in BA. PA may be a particularly important treatment target for anhedonic adolescents in BA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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