Showing papers in "Journal of Clinical Psychology in 2007"

Evidence-based practice in psychology.

Abstract: Evidence-based practice is a growing topic of interest in the field of psychology. In 2006, the American Psychological Association (APA) developed a formal policy statement on evidence-based practice in psychology (EBPP). It is now important for the profession to come to a better understanding about what EBPP is (and is not), and to develop a skill set associated with EBPP. The next seven articles explore the history of EBPP, elaborate the definition and present uses of the term, and provide information relevant to the skill set regarding a practice consistent with the evidence-based approach. Many of the articles were derived from the 2007 midwinter meeting of the Council of University Directors of Clinical Psychology, where the program topic was "Evidence-based Practice: What it is, Why It's Important, and What you Need to Know."

Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review.

Abstract: The construct of experiential avoidance has become more frequently used by clinical researchers. Experiential avoidance involves the unwillingness to remain in contact with private experiences such as painful thoughts and emotions and is often proposed to be critical to the development and maintenance of psychopathology. This review summarizes the empirical studies on experiential avoidance as a factor in the etiology of maladaptive behavior and its relationship to specific diagnostic categories. Although some of the current literature suggests that experiential avoidance may be implicated in various forms of psychopathology, a fundamental limitation of this research is the lack of theoretical integration and refinement with regard to operationalizing and assessing experiential avoidance. Future studies should attempt to understand the core processes involved in experiential avoidance better, and then clearly operationalize the construct and determine its incremental validity relative to other constructs. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 871–890, 2007.

Self-injury: a research review for the practitioner.

Abstract: Non-suicidal self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. In this practice-friendly review, the authors summarize the empirical research on who self-injures, why people self-injure, and what treatments have demonstrated effectiveness. Self-injury is more common in adolescents and young adults as compared to adults. Common forms include cutting, severe scratching, burning, and banging or hitting; most individuals who self-injure have used more than one method. Although diagnostically heterogeneous, self-injurers typically exhibit two prominent characteristics: negative emotionality and self-derogation. Self-injury is most often performed to temporarily alleviate intense negative emotions, but may also serve to express self-directed anger or disgust, influence or seek help from others, end periods of dissociation or depersonalization, and help resist suicidal thoughts. Psychotherapies that emphasize emotion regulation, functional assessment, and problem solving appear to be most effective in treating self-injury.

Seeking help from a mental health professional: The influence of one's social network

Abstract: The decision to seek psychological help may be hindered or facilitated by many factors. Two potential factors that might facilitate help seeking are having a relationship with someone (a) who recommends seeking help or (b) who themselves have sought help. In two studies (N = 780, N = 746), we explored the relationship between these factors and intentions to seek mental health services. In Study 1, being prompted to seek help and knowing someone who had sought help were both related to positive expectations about mental health services. In Study 2, being prompted to seek help and knowing someone who had sought help were related to more positive attitudes toward help seeking. Also, knowing someone who had sought help was related to the intention to seek help. Of those who sought psychological help, approximately 75% had someone recommend that they seek help and about 94% knew someone who had sought help.

Evidence-based practice in clinical psychology: what it is, why it matters; what you need to know.

Abstract: The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.

Alexithymia and interpersonal problems.

Abstract: This study examines whether alexithymia relates to specific interpersonal problems, based on data collected in a sample of mental health outpatients (N = 404) and a student sample (N = 157). Linear regression analysis, in which the effects of group, gender, and age were controlled, indicated that two interpersonal problems were significantly and reliably related to alexithymia: cold/distant and nonassertive social functioning. The theoretical relevance of the results for attachment and psychoanalytic theory is indicated, as well as implications of the findings for clinical practice.

Targeting emotion dysregulation in the treatment of self-injury.

Abstract: Clinically useful definitions of emotion regulation with respect to deliberate self-harm (referred to here as self-injury) focus on adaptive ways of responding to emotional distress rather than on the control of emotions or dampening of emotional arousal. According to one such definition, emotion regulation is a multifaceted construct involving a) the awareness, understanding, and acceptance of emotions; b) ability to engage in goal-directed behaviors, and inhibit impulsive behaviors, when experiencing negative emotions; c) the flexible use of situationally appropriate strategies to modulate the intensity and/or duration of emotional responses rather than to eliminate emotions entirely; and d) willingness to experience negative emotions as part of pursuing meaningful activities in life (Gratz & Roemer, 2004). This article addresses the role of emotion dysregulation in self-injury and discusses two treatments for self-injury that explicitly focus on increasing emotion regulation. These treatments are based on the premise that the reduction of emotion dysregulation will decrease the need for maladaptive behaviors that function to regulate emotions, such as self-injury. A case illustration describing how one of these treatments (an acceptance-based, emotion regulation group therapy) is used to treat self-injury is provided.

Does psychotherapy research inform treatment decisions in private practice

Abstract: Psychologists in independent practice (N = 591) were surveyed regarding their approach to treatment decisions, specifically the use of research on empirically supported treatments (ESTs) to inform practice. All participants received a case study of a patient with panic disorder, and half were randomly assigned to receive a research summary on evidence-based treatments for panic disorder (cognitive-behavioral therapy and pharmacotherapy). Practitioners reported that they rely primarily on clinical experiences to inform treatment decisions, although they often consult EST literature. Those who received the research summary were significantly more likely to report they would use an EST. These results indicate that providing information about ESTs can impact practice. Although this sample was more positive about EST research than clinicians are often depicted to be, this study indicates an enduring research-practice gap in clinical psychology.

The efficacy of cognitive–behavioral therapy and the problem of drop-out

Abstract: Treatment drop-out is a common problem in the everyday practice of psychotherapy. In the cognitive-behavioral psychology literature, there are scant data on drop-out from therapy and the data available vary widely according to the definition of drop-out and the intensity of treatment. This study presents results obtained in the Behavioural Therapy Unit of the University of Barcelona. Of the 203 patients seen in the unit, 89 (43.8%) dropped out, mostly in the early stages of the intervention. The most common reasons for this were low motivation and/or dissatisfaction with the treatment or the therapist (46.7%), external difficulties (40%), and patients' feeling of improvement (13.3%). Patients who dropped out differed from those who continued; they more often presented affective or eating disorders or problems with impulse control. The observed drop-out rate is in line with figures reported for psychotherapy in general and by those studies which have considered cognitive-behavioral therapy in particular.

Relational spirituality and depression in adolescent girls.

Abstract: This study examines the possibility that relational spirituality may be inversely associated with the relatively higher rates of adolescent depression found in girls as compared with boys. Subjects were 615 adolescents, representing a diverse range of religious, ethnic, and socioeconomic backgrounds. Overall spirituality and depression were measured using The Brief-Multidimensional Measure of Religiosity/Spirituality and the Beck Depression Inventory, respectively. Overall, both level of depression and level of relational spirituality were higher in girls as compared with boys. Regression analyses conducted independently for boys and girls revealed that daily spiritual experiences, forgiveness, and religious coping were associated with less-depressive symptomatology exclusively in girls. This pattern in the findings suggests that uniquely in girls, depression may be associated with disruptions in a relational form of spirituality.

Barriers and facilitators of evidence‐based practice perceived by behavioral science health professionals

Abstract: Progress in implementing evidence-based behavioral practices has been slow. A qualitative study was performed to characterize the major facilitators and barriers to evidence-based practice (EBP) perceived by behavioral professionals. Members of professional e-mail listservs were queried and 84 barriers and 48 facilitators were nominated by 37 respondents. Thematic analysis revealed seven themes to describe both barriers and facilitators: (a) training, (b) attitudes, (c) consumer demand, (d) logistical considerations, (e) institutional support, (f) policy, and (g) evidence. Most frequently cited barriers included negative attitudes about EBP and lack of training. Barriers also reflected confusion between EBP and the products of EBP (i.e., empirically supported treatments [ESTs]). Main facilitators included a growing evidence base. Results suggest that uptake of EBP may be facilitated by education and training.

Florida Obsessive-Compulsive Inventory: development, reliability, and validity.

Abstract: The Florida Obsessive-Compulsive Inventory (FOCI) is a new self-report questionnaire that has separate scales for symptom enumeration (The Checklist) and evaluation of symptom severity (Severity Scale). The present research investigated the FOCI in a sample of 113 patients with obsessive-compulsive disorder (OCD). The results indicated that the FOCI Severity Scale is internally consistent (α = .89) and highly correlated with the total score from the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989a). The correlations of the FOCI Severity Scale with measures of depression and global severity of psychopathology were similar to those obtained with the Y-BOCS Total Severity Score. The FOCI Symptom Checklist had adequate reliability (K-R 20 = .83) and moderate correlations (rs < .45) with the FOCI Severity Scale, the Y-BOCS scales, and measures of depression and severity of psychopathology. These findings imply concurrent validity for the FOCI Severity Scale. A strength of the FOCI is that it offers a quick evaluation of both presence and severity of OCD symptoms. An important limitation is that the FOCI does not assess the severity of individual symptoms. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 851–859, 2007.

Non-suicidal self-injury: an introduction.

Abstract: This issue of Journal of Clinical Psychology: In Session is devoted to the assessment and treatment of non-suicidal self-injury (henceforth self-injury). In this introductory article, the author describes the scope of behaviors referenced by the term self-injury, establishes the historical and current relevance of self-injury for clinical practice, and summarizes the articles that appear in this issue. Self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. This issue addresses many aspects of self-injury, including its prevalence, functions, assessment, and treatment. The articles feature case illustrations and treatment recommendations, and all have direct implications for clinical practice. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1039–1043, 2007.

A longitudinal study of perceived parental psychological control and psychological well-being in Chinese adolescents in Hong Kong.

Abstract: On two occasions separated by one year, Chinese adolescents (N = 2,758) responded to instruments measuring their perceived parental psychological control and psychological well-being, including hopelessness, mastery, life satisfaction, and self-esteem. Pearson correlation analyses revealed that perceived parental psychological control was concurrently related to adolescent psychological well-being at Time 1 and Time 2. Multiple regression analyses demonstrated that the relationships between perceived parental psychological control and adolescent psychological well-being over time were bidirectional in nature. Regarding the differential contribution of paternal and maternal psychological control to adolescent psychological well-being over time, paternal psychological control at Time 1 predicted changes in adolescent life satisfaction at Time 2, particularly for adolescent girls. On the other hand, maternal psychological control at Time 1 predicted changes in adolescent self-esteem at Time 2. Relative to those conditions in which one or none of the adolescents' parents was perceived to display high psychological control at Time 1, the psychological well-being of adolescents at Time 2 was poorer under the condition in which both parents were perceived to display high levels of psychological control at Time 1. The clinical implications of these findings and directions for future research are discussed. © 2006 Wiley Periodicals, Inc. J Clin Psychol 63: 1–22, 2007.

The voices acceptance and action scale (VAAS): Pilot data.

Abstract: Acceptance and mindfulness methods that emphasise the acceptance rather than control of symptoms are becoming more central to behavioural and cognitive therapies. Acceptance and Commitment Therapy (ACT) is the most developed of these methods; recent applications of ACT to psychosis suggest it to be a promising therapeutic approach. However, investigation of the mechanisms of therapy within this domain is difficult because there are no acceptance-based measures available specifically for psychotic symptoms. This paper describes the preliminary evaluation of a self-report instrument designed to assess acceptance-based attitudes and actions in relation to auditory and command hallucinations. Following initial scale development, a 56-item version of the Voices Acceptance and Action Scale (VAAS) was administered to 43 participants with command hallucinations as part of their baseline assessment in a larger trial. Measures of symptoms, quality of life, and depression were also administered. The scale was examined for reliability using corrected item total statistics. Based on this method, 31 items were retained. Internal consistency and test-retest reliability for the 31-item VAAS were acceptable. Subsequent examination of construct validity showed the VAAS to correlate significantly in the expected directions with depression, quality of life, and coping with command hallucinations. It also discriminated compliance from non-compliance with harmful command hallucinations. Although these results are preliminary and subject to a number of limitations, the VAAS shows promise as a useful aid in the assessment of the psychological impact of voices.

The internet and self‐injury: What psychotherapists should know

Abstract: The Internet affords information gathering and sharing previously impossible. For individuals who practice self-injury, this capacity allows rapid identification of others with shared history, experience, and practices. For many of those who self-injure, the ability to find others like themselves reduces the isolation and loneliness that so often characterizes the behavior. For others, however, active participation in online communities may effectively substitute for the real work required to develop positive coping and healthy relationships. Our experience suggests that regular assessment of self-injury Internet use is uncommon in therapeutic settings. Proliferation of self-injury message boards, informational Web sites, blogs, and YouTube posts is a clinical challenge. In this article, we review the research on self-injury and Internet use and then make a series of recommendations for clinicians.

Clinical assessment of self-injury: a practical guide.

Abstract: In this article, the author provides a practice-friendly guide to the psychological assessment of self-injury, such as self-inflicted cutting, burning, hitting, and excoriation of wounds. The crucial distinction between self-injury and suicide is emphasized. The author presents a structure for the assessment of self-injury that focuses first on the therapeutic relationship, and thereafter on the history and specifics of the behavior, its intrapersonal and interpersonal functions, and its antecedents and consequences. Types of self-injury that are atypical, and especially alarming, are identified. A case example illustrates both the style and content of a thorough assessment.

Interpersonal profiles in major depressive disorder.

Abstract: Although patients with mood disorders report interpersonal difficulties in addition to depression or anxiety, few studies have examined interpersonal patterns in those patients. Here the authors' goals were to (a) identify the interpersonal pattern in patients with major depressive disorder (MDD), (b) determine interpersonal differences between subgroups of MDD patients, and (c) examine the interpersonal patterns of comorbid MDD patients. One- hundred forty-one MDD adults participated in an ongoing randomized clinical trial of treatments for depression. Interpersonal profiles revealed that MDD patients were significantly more distressed by interpersonal problems than normative samples. Furthermore, MDD patients with depressive personality disorder reported more interpersonal distress than MDD-only patients report and were more likely to have interpersonal problems related to dominance and control than submissiveness.

Integrating spirituality and psychotherapy: ethical issues and principles to consider.

Abstract: Professional and scientific psychology appears to have rediscovered spirituality and religion during recent years, with a large number of conferences, seminars, workshops, books, and special issues in major professional journals on spirituality and psychology integration. The purpose of this commentary is to highlight some of the more compelling ethical principles and issues to consider in spirituality and psychology integration with a focus on psychotherapy. This commentary will use the American Psychological Association's (2002) Ethics Code and more specifically, the RRICC model of ethics that readily applies to various mental health ethics codes across the world. The RRICC model highlights the ethical values of respect, responsibility, integrity, competence, and concern. Being thoughtful about ethical principles and possible dilemmas as well as getting appropriate training and ongoing consultation can greatly help the professional better navigate these challenging waters.

Past and recent deliberate self-harm: emotion and coping strategy differences.

Abstract: Only limited information on nonsuicidal deliberate self-harm behavior among nonclinical populations is available, and it is unclear whether coping and emotional difficulties remain among those with a past history of self-harm behavior. The purpose of this study is to examine emotions and coping strategies among three nonclinical groups with a recent, past, and no history of nonsuicidal deliberate self-harm behavior. College students completed self-report measures of self-harm behavior, suicidal thoughts, emotional dispositions, and coping strategies. Contrary to expectations, there were few differences in coping strategies among the three groups ( p > .0033). Those with a recent history (n = 23; in the last 12 months) and past history (n = 32; more than 12 months ago) of self-harm behavior reported greater levels of negative emotion (e.g., hostility, guilt, sadness) than those who have never self-harmed (n = 161; p 12 months ago), negative emotion differences were present, and both recent and past self-harmers merit concern in managing their negative emotions to lower their risk for future difficulties.

God's will, God's punishment, or God's limitations? Religious coping strategies reported by young adults living with serious mental illness.

Abstract: Qualitative research has demonstrated that religious meaning-making coping, defined as attributions of a stressful life event that involve the sacred, is particularly relevant to persons with serious mental illness. However, recent research advances in the study of religious coping have yet to be employed in clinical samples. This longitudinal study examines religious meaning-making coping in a sample of 48 young adults diagnosed with schizophrenia or bipolar disorder over a one-year period. Young adults with mental illness generally reported using religious meaning-making coping in levels comparable to nonpsychiatric samples. Reports of benevolent religious reappraisals were associated with perceptions of positive mental health, whereas punishing God reappraisals and reappraisals of God's power were associated with self-reported distress and personal loss. Religious coping variables accounted for variation in adults' reports of psychiatric symptoms and personal loss one year later over and above demographic and global religious variables. Implications of findings for clinical practice are discussed.

Interpersonal and social rhythm therapy: a means of improving depression and preventing relapse in bipolar disorder.

Abstract: Interpersonal and social rhythm therapy (IPSRT) was designed to directly address the major pathways to recurrence in bipolar disorder, namely medication nonadherence, stressful life events, and disruptions in social rhythms. The efficacy of IPSRT has been supported by two large studies examining it in conjunction with pharmacotherapy in patients with bipolar illness. In this article, the author discusses the advantages of IPSRT as both an acute intervention and a prophylactic treatment for bipolar depression. The author outlines the four phases of IPSRT, indicating the appropriate focus and duration for each, and discusses IPSRT as a modular treatment. The article concludes with a case example that further illustrates the basic therapeutic methods and processes of IPSRT.

Introduction to the special issue on spirituality and psychotherapy.

Abstract: Religion and spirituality have been topics of interest to psychologists since the inception of the field, and this special issue devoted to spirituality and psychotherapy reflects the maturation of decades of research. Psychotherapy clients would like to discuss religious or spiritual issues with therapists, but therapists feel poorly prepared to do so. This special issue hopefully represents a step towards bridging the needs of clients and the expertise of providers. The seven articles in this issue reflect the progress psychologists have made toward understanding religion and spirituality, and they represent state-of-the-art attempts at integrating these dimensions into treatment. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 903–907, 2007.

When religion and obsessive-compulsive disorder collide: treating scrupulosity in Ultra-Orthodox Jews.

Abstract: Evidence-based practice suggests that clinicians should integrate the best available research with clinical judgment and patient values. Treatment of religious patients with scrupulosity provides a paradigmatic example of such integration. The purpose of this study is to describe potential adaptations to make exposure and response prevention, the first-line treatment for obsessive–compulsive disorder, acceptable and consistent with the values of members of the Ultra-Orthodox Jewish community. We believe that understanding these challenges will enhance the clinician's ability to increase patient motivation and participation in therapy and thereby provide more effective treatment for these and other religious patients. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 925–941, 2007.

Psychological treatment of self-injury among adolescents.

Abstract: Self-injury is a dangerous and pervasive behavior problem among adolescents. Clinical trials testing the effectiveness of psychological treatments for this behavior problem among adolescents are lacking; however, several treatments have shown promise, such as those focused on teaching emotion regulation, distress tolerance, and interpersonal skills. The authors provide a case illustration of the use of dialectical behavior therapy, which is one of the most promising treatments for adolescent self-injury. They then discuss several important considerations in the treatment of self-injury, such as the use of strategies to increase treatment participation and the assessment of self-injury and related target behaviors over the course of treatment to determine its effectiveness and to manage risk of self-injury.

An initial evaluation of a mindful parenting program.

Abstract: A growing number of children are experiencing marital transition. The effects of divorce on children have typically been considered deleterious, although factors can buffer the difficulty of postdivorce adjustment. One of these factors is a positive relationship with a parental figure. Unfortunately, divorce often overwhelms parents with a series of changes that compromise their parenting skills. One new approach to improving parenting after divorce is mindful parenting, which aims to enhance interpersonal and emotional connection in the parent-child relationship. This program is intended to facilitate parents' self-awareness, their mindfulness, and their intentionality in responding to their child's needs. The present study reports on the implementation of the Mindful Parenting Program, delivered in two groups to 12 recently divorced parents with preschool-aged children. Program effectiveness was conducted on two levels. First, mindfulness measured by the Toronto Mindfulness Scale revealed significant increases over the intervention and posttest period. Second, in-home behavioral observations conducted pre- and postintervention revealed no changes in parent-child relationships. These findings are discussed within the larger context of facilitating effective parenting postdivorce.

Stability of negative self‐structures: A longitudinal comparison of depressed, remitted, and nonpsychiatric controls

Abstract: To be considered a vulnerability marker for depression, a variable should, in addition to demonstrating sensitivity and specificity, also show evidence of temporal stability (i.e., remain present in the absence of depressive symptomatology). Although many cognitive factors are associated with depression, the majority of them appear to be episode rather than vulnerability markers. This study examined cognitive organization of positive and negative interpersonal and achievement content in clinically depressed, remitted, and nonpsychiatric controls. At initial assessment, a sample of 54 clinically depressed individuals and 37 never-depressed controls completed self-report measures of positive and negative automatic thoughts and two cognitive organizational tasks. They were retested 6 months later when half of the depressed group no longer met diagnostic criteria for major depression. Negative automatic thoughts decreased and positive automatic thoughts increased significantly in individuals who had improved clinically. The organization of negative interpersonal content remained stable despite symptom amelioration, but negative achievement content was less interconnected at follow-up in those patients who had improved. The structure of relational schemas, in particular, appears to be stable and may be an important cognitive vulnerability factor for depression.

The relationships of antisocial behavior with attachment styles, autonomy‐connectedness, and alexithymia

Abstract: The present study was aimed at investigating the relationships among attachment styles, autonomy-connectedness (self-awareness, sensitivity to others, and capacity for managing new situations), alexithymia, and antisocial behavior among 202 college students (67 men and 135 women). We were particularly interested in sex differences in the levels of these variables as well as their associations. Sex differences were expected in types of insecure attachment styles, patterns of autonomy-connectedness, and levels of self-reported antisocial and passive-aggressive behavior. All expected sex differences were indeed found. Furthermore, the model that we hypothesized was partly confirmed: For men, anxious attachment had a stronger direct and positive effect on antisocial behavior than for women, and the positive effect of anxious attachment on passive-aggressive behavior was smaller for women than for men. Interestingly, capacity for managing new situations had a main and mediating effect on antisocial behavior. Sensitivity to others appeared as a mediator between anxious attachment style and passive-aggressive behavior. Contrary to expectations, fantasizing (a component of alexithymia) had a strong, negative association with antisocial behavior. The results are discussed against the background of other recent findings concerning alexithymia and autonomy- connectedeness. © 2007 Wiley Periodicals, Inc. J Clin Psychol.

Spiritual interventions in psychotherapy: evaluations by highly religious clients.

Abstract: Spiritual and religious interventions in psychotherapy have increasingly received research attention, particularly with highly religious clients This study examined client opinions about and experiences with religious interventions in psychotherapy A sample of 152 clients at a counseling center of a university sponsored by the Church of Jesus Christ of Latter-Day Saints (LDS) completed a survey with ratings of specific religious interventions concerning appropriateness, helpfulness, and prevalence Out-of-session religious interventions were considered more appropriate by clients than in-session religious interventions, but in-session interventions were rated as more helpful Specific interventions considered both appropriate and helpful by the LDS participants included referencing scriptural passages, teaching spiritual concepts, encouraging forgiveness, involving religious community resources, and conducting assessments of client spirituality Some religious interventions were perceived as inappropriate or not helpful, and clients provided explanations for why religious interventions can be either effective or ineffective in psychotherapy

A preliminary study of spiritual self‐schema (3‐S+) therapy for reducing impulsivity in HIV‐positive drug users

Abstract: The purpose of this study was twofold. First, pretreatment correlations are presented among impulsivity, intoxicant use, HIV risk behavior, spirituality, and motivation in a sample of 38 HIV-positive drug users. Second, treatment outcomes are presented from a preliminary study of spiritual self-schema (3-S(+)) therapy - a manual-guided psychotherapy integrating cognitive and Buddhist psychologies - for increasing motivation for abstinence, HIV prevention, and medication adherence. Impulsivity was negatively correlated with spiritual practices and motivation for recovery, and was positively related to intoxicant use and HIV risk behavior. Relative to a standard care comparison condition, patients completing 3-S(+) therapy reported greater decreases in impulsivity and intoxicant use, and greater increases in spiritual practices and motivation for abstinence, HIV prevention, and medication adherence.