Michelle Rozenman

Bio: Michelle Rozenman is an academic researcher from University of Denver. The author has contributed to research in topics: Anxiety & Cognitive behavioral therapy. The author has an hindex of 14, co-authored 55 publications receiving 1027 citations. Previous affiliations of Michelle Rozenman include Semel Institute for Neuroscience and Human Behavior & University of California, San Diego.

Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis

Abstract: Importance Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health care in the United States and incentivizing integrated medical-behavioral health care as a strategy for improving access to high-quality care for behavioral health conditions, enhancing patient outcomes, and containing costs. Objective To conduct a systematic meta-analysis of randomized clinical trials to evaluate whether integrated medical-behavioral health care for children and adolescents leads to improved behavioral health outcomes compared with usual primary care. Data Sources Search of the PubMed, MEDLINE, PsycINFO, and Cochrane Library databases from January 1, 1960, through December 31, 2014, yielded 6792 studies, of which 31 studies with 35 intervention-control comparisons and 13 129 participants met the study eligibility criteria. Study Selection We included randomized clinical trials that evaluated integrated behavioral health and primary medical care in children and adolescents compared with usual care in primary care settings that met prespecified methodologic quality criteria. Data Extraction and Synthesis Two independent reviewers screened citations and extracted data, with raw data used when possible. Magnitude and direction of effect sizes were calculated. Main Outcomes and Measures Meta-analysis with a random effects model were conducted to examine an overall effect across all trials, and within intervention and prevention trials. Subsequent moderator analyses for intervention trials explored the relative effects of integrated care type on behavioral health outcomes. Results Meta-analysis with a random-effects model indicated a significant advantage for integrated care interventions relative to usual care on behavioral health outcomes ( d = 0.32; 95% CI, 0.21-0.44; P d = 0.42; 95% CI, 0.29-0.55; P d = 0.07; 95% CI, −0.13 to 0.28; P = .49). The probability was 66% that a randomly selected youth would have a better outcome after receiving integrated medical-behavioral treatment than a randomly selected youth after receiving usual care. The strongest effects were seen for treatment interventions that targeted mental health problems and those that used collaborative care models. Conclusions and Relevance Our results, demonstrating the benefits of integrated medical-behavioral primary care for improving youth behavioral health outcomes, enhance confidence that the increased incentives for integrated health and behavioral health care in the US health care system will yield improvements in the health of children and adolescents.

Core components of therapy in youth: do we know what to disseminate?

Abstract: Bridging the gap between lab and clinic has become a rallying cry for a generation of treatment researchers, and identifying and overcoming barriers to successful dissemination of best-practice treatment has become a major public mental health priority. In this review, the authors argue that a key limit to accomplishing this goal may be found back in the original research laboratories where these treatments were developed. Despite 50 years of research and 1,500 clinical trials, there are surprisingly little data on what makes youth psychotherapy therapeutic. To illustrate the problem this poses for dissemination, the adolescent depression literature is reviewed in terms of (a) critical core components of intervention and (b) basic processes through which these techniques operate. Process-outcome relationships in cognitive-behavioral, interpersonal, and family therapy models are examined with descriptive meta-analytic techniques. Discussion of treatment dissemination follows, focusing on the value of basic research on core psychotherapeutic techniques and processes.

Behavior Therapy for Tics in Children: Acute and Long-Term Effects on Psychiatric and Psychosocial Functioning:

Abstract: Children (n = 126) ages 9 to 17 years with chronic tic or Tourette disorder were randomly assigned to receive either behavior therapy or a control treatment over 10 weeks. This study examined acute effects of behavior therapy on secondary psychiatric symptoms and psychosocial functioning and long-term effects on these measures for behavior therapy responders only. Baseline and end point assessments conducted by a masked independent evaluator assessed several secondary psychiatric symptoms and measures of psychosocial functioning. Responders to behavior therapy at the end of the acute phase were reassessed at 3-month and 6-month follow-up. Children in the behavior therapy and control conditions did not differentially improve on secondary psychiatric or psychosocial outcome measures at the end of the acute phase. At 6-month posttreatment, positive response to behavior therapy was associated with decreased anxiety, disruptive behavior, and family strain and improved social functioning. Behavior therapy is a tic-specific treatment for children with tic disorders.

Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial.

Abstract: Importance Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. Objective To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care. Design, Setting, and Participants This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse, intellectual disability, or unstable serious physical illness. Interventions The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master’s-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master’s-level coordinators. Main Outcomes and Measures The primary outcome was clinically significant improvement on the Clinical Global Impression–Improvement scale (score ≤2). Secondary outcomes included the Pediatric Anxiety Rating Scale, Children's Depression Rating Scale–Revised, and functioning. Results A total of 185 patients were enrolled in the study (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n = 95), compared with those in the ARC group (n = 90), had significantly higher rates of clinical improvement (56.8% vs 28.2%; χ 2 1 = 13.09, P 2,146 = 5.72; P = .004; Cohen f = 0.28), and better functioning (mean [SD], 68.5 [10.7] vs 61.9 [11.9]; t 156 = 3.64; P d = 0.58). Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%) (χ 2 1 = 14.90; P Conclusions and Relevance A pediatric-based brief behavioral intervention for anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care. Trial Registration clinicaltrials.gov Identifier:NCT01147614

Cognitive bias modification approaches to anxiety.

Abstract: Clinical anxiety disorders and elevated levels of anxiety vulnerability are characterized by cognitive biases, and this processing selectivity has been implicated in theoretical accounts of these conditions. We review research that has sought to evaluate the causal contributions such biases make to anxiety dysfunction and to therapeutically alleviate anxiety using cognitive-bias modification (CBM) procedures. After considering the purpose and nature of CBM methodologies, we show that variants designed to modify selective attention (CBM-A) or interpretation (CBM-I) have proven capable of reducing anxiety vulnerability and ameliorating dysfunctional anxiety. In addition to supporting the causal role of cognitive bias in anxiety vulnerability and dysfunction and illuminating the mechanisms that underpin such bias, the findings suggest that CBM procedures may have therapeutic promise within clinical settings. We discuss key issues within this burgeoning field of research and suggest future directions CBM research should take to maximize its theoretical and applied value.

Cognitive Bias Modification and Cognitive Control Training in Addiction and Related Psychopathology: Mechanisms, Clinical Perspectives, and Ways Forward

Abstract: The past decade has witnessed a surge in research on training paradigms aimed at directly influencing cognitive processes in addiction and other psychopathology. Broadly, two avenues have been explored: In the first, the aim was to change maladaptive cognitive motivational biases (cognitive bias modification); in the second, the aim was to increase general control processes (e.g., working memory capacity). These approaches are consistent with a dual-process perspective in which psychopathology is related to a combination of disorder-specific impulsive processes and weak general abilities to control these impulses in view of reflective longer-term considerations. After reviewing the evidence for dual-process models in addiction, we discuss a number of critical issues, along with suggestions for further research. We argue that theoretical advancement, along with a better understanding of the underlying neurocognitive processes, is crucial for adequately responding to recent criticisms on dual-process models and for optimizing training paradigms for use in clinical practice.