Showing papers in "Journal of Clinical Psychology in 2011"

Stages of change

Abstract: The transtheoretical model, in general, and the stages of change, in particular, have proven useful in adapting or tailoring treatment to the individual. We define the stages and processes of change and then review previous meta-analyses on their interrelationship. We report an original meta-analysis of 39 studies, encompassing 8,238 psychotherapy patients, to assess the ability of stages of change and related readiness measures to predict psychotherapy outcomes. Clinically significant effect sizes were found for the association between stage of change and psychotherapy outcomes (d = .46); the amount of progress clients make during treatment tends to be a function of their pretreatment stage of change. We examine potential moderators in effect size by study outcome, patient characteristics, treatment features, and diagnosis. We also review the large volume of behavioral health research, but scant psychotherapy research, that demonstrates the efficacy of matching treatment to the patient's stage of change. Limitations of the extant research are noted, and practice recommendations are advanced.

Evaluating the psychometric properties of the mental health Continuum-Short Form (MHC-SF)

Abstract: There is a growing consensus that mental health is not merely the absence of mental illness, but it also includes the presence of positive feelings (emotional well-being) and positive functioning in individual life (psychological well-being) and community life (social well-being). We examined the structure, reliability, convergent validity, and discriminant validity of the Mental Health Continuum-Short Form (MHC-SF), a new self-report questionnaire for positive mental health assessment. We expected that the MHC-SF is reliable and valid, and that mental health and mental illness are 2 related but distinct continua. This article draws on data of the LISS panel of CentERdata, a representative panel for Longitudinal Internet Studies for the Social Sciences (N = 1,662). Results revealed high internal and moderate test-retest reliability. Confirmatory factor analysis (CFA) confirmed the 3-factor structure in emotional, psychological, and social well-being. These subscales correlated well with corresponding aspects of well-being and functioning, showing convergent validity. CFA supported the hypothesis of 2 separate yet related factors for mental health and mental illness, showing discriminant validity. Although related to mental illness, positive mental health is a distinct indicator of mental well-being that is reliably assessed with the MHC-SF

Religion and spirituality.

Abstract: Many clients highly value religious and spiritual (R/S) commitments, and many psychotherapists have accommodated secular treatments to R/S perspectives. We meta-analyzed 51 samples from 46 studies (N = 3,290) that examined the outcomes of religious accommodative therapies and nonreligious spirituality therapies. Comparisons on psychological and spiritual outcomes were made to a control condition, an alternate treatment, or a subset of those studies that used a dismantling design (similar in theory and duration of treatment, but including religious contents). Patients in R/S psychotherapies showed greater improvement than those in alternate secular psychotherapies both on psychological (d =.26) and on spiritual (d = .41) outcomes. Religiously accommodated treatments outperformed dismantling-design alternative treatments on spiritual (d = .33) but not on psychological outcomes. Clinical examples are provided and therapeutic practices are recommended.

Pain and emotion: a biopsychosocial review of recent research.

Abstract: Pain is the most common symptom reported to health care providers, is a driving force of health care utilization and lost productivity, and exacts a substantial toll on the afflicted, their loved ones, and society in general. Pain is a prevalent symptom not only in primary medical care and specialty pain clinics, but also in mental health and substance dependence treatment settings. Thus, it is vital that psychologists remain abreast of recent theory and research that informs and directs case conceptualization, assessment, and intervention among patients experiencing pain.

Mindfulness-based approaches: are they all the same?

Abstract: Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems Such approaches include ancient Buddhist mindfulness meditations such as Vipassana and Zen meditations, modern group-based standardized meditations, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, and further psychological interventions, such as dialectical behavioral therapy and acceptance and commitment therapy We review commonalities and differences of these interventions regarding philosophical background, main techniques, aims, outcomes, neurobiology and psychological mechanisms In sum, the currently applied mindfulness-based interventions show large differences in the way mindfulness is conceptualized and practiced The decision to consider such practices as unitary or as distinct phenomena will probably influence the direction of future research

The moderation of mindfulness-based stress reduction effects by trait mindfulness: Results from a randomized controlled trial

Abstract: Mindfulness-based stress reduction (MBSR) has shown effectiveness for a variety of mental health conditions. However, it is not known for whom the intervention is most effective. In a randomized controlled trial (N = 30), we explored whether individuals with higher levels of pretreatment trait mindfulness would benefit more from MBSR intervention. Results demonstrated that relative to a control condition (n = 15), MBSR treatment (n = 15) had significant effects on several outcomes, including increased trait mindfulness, subjective well-being, and empathy measured at 2 and 12 months after treatment. However, relative to controls, MBSR participants with higher levels of pretreatment mindfulness showed a larger increase in mindfulness, subjective well-being, empathy, and hope, and larger declines in perceived stress up to 1 year after treatment.

What works for whom: Tailoring psychotherapy to the person.

Abstract: This article introduces the issue of the Journal of Clinical Psychology: In Session devoted to evidencebased means of adapting psychotherapy to the patient’s (transdiagnostic) characteristics. Practitioners have long realized that treatment should be tailored to the individuality of the patient and the singularity of his or her context, but only recently has sufficient empirical research emerged to reliably guide practice. This article reviews the work of an interdivisional task force and its dual aims of identifying elements of effective therapy relationships (what works in general) and identifying effective methods of adapting treatment to the individual patient (what works in particular). The task force judged four patient characteristics (reactance/resistance, preferences, culture, religion/spirituality) to be demonstrably effective in adapting psychotherapy and another two (stages of change, coping style) as probably effective. Two more patient facets (expectations, attachment style) were related to psychotherapy outcome but possessed insufficient research as a means of adaptation. This special issue provides research-supported methods of individualizing psychotherapy to the person, in addition to his or her

Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans.

Abstract: Objectives: The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans. Design: Two postdeployment time points were used in combination with structural equation modeling to examine the relative strength of two possible directions of prediction: insomnia as a predictor of psychological symptoms, and psychological symptoms as a predictor of insomnia. Participants were active duty soldiers (N 5 659) in a brigade combat team who were assessed 4 months after their return from a 12-month deployment to Iraq, and then again eight months later. Results: Although both insomnia and psychological symptoms were associated at both time periods and across time periods, insomnia at 4 months postdeployment was a significant predictor of change in depression and PTSD symptoms at 12 months postdeployment, whereas depression and PTSD symptoms at 4 months postdeployment were not significant predictors of change in insomnia at 12 months postdeployment. Conclusions: Results support the role of insomnia in the development of additional psychological problems and highlight the clinical implications for combat veterans, to include the importance of longitudinal assessment and monitoring of sleep disturbances, and the need for early intervention. & 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1240‐1258, 2011.

The effectiveness of a trauma focused spiritually integrated intervention for veterans exposed to trauma

Abstract: Building Spiritual Strength (BSS) is an 8-session, spiritually integrated group intervention designed to address religious strain and enhance religious meaning making for military trauma survivors. It is based upon empirical research on the relationship between spirituality and adjustment to trauma. To assess the intervention's effectiveness, veterans with histories of trauma who volunteered for the study were randomly assigned to a BSS group (n = 26) or a wait-list control group (n = 28). BSS participants showed statistically significant reductions in PTSD symptoms based on self-report measures as compared with those in a wait-list control condition. Further research on spiritually integrated interventions for trauma survivors is warranted.

Shared and unique predictors of post-traumatic growth and distress.

Abstract: This prospective longitudinal study compared pretraumatic, peritraumatic, and post-traumatic predictors of post-traumatic growth (PTG) and post-traumatic stress disorder (PTSD). A total of 103 Israeli former prisoners of the Yom Kippur War were followed over 30 years. Sociodemographic variables, trauma exposure, reactions in captivity, world assumptions, social support, and personality factors were assessed in 1991, and PTG and PTSD symptoms in 2003. Hierarchical regression modeling showed that although some predictors, namely, loss of control and active coping during captivity, predicted both PTG and PTSD, others predicted one outcome and not the other. Self-controllability predicted PTG while sociodemographic factors predicted PTSD when controlling for PTSD and PTG, respectively. The findings indicate that salutary and pathogenic trauma outcomes share some but not all precursors, underscoring their multifaceted relationship.

Confirmatory factor and measurement invariance analyses of the emotion regulation questionnaire.

Abstract: Emotion regulation is widely studied in many areas of psychology and the number of publications on emotion regulation has increased exponentially over the past few decades. Additionally, interest in the relationships between emotion dysregulation processes and psychopathology has drastically increased in recent years. The Emotion Regulation Questionnaire (ERQ) was developed to measure two specific constructs related to emotion control: reappraisal and suppression (Gross & John, 2003). In its initial validation study and subsequent analyses, the instrument was shown to possess sound psychometric properties, but, to date, inquiry regarding the measure's characteristics has been limited. Factor analytic examinations of commonly used instruments are recommended to validate the properties of a given measure and increase researchers understanding of the measured constructs. The current study examined the psychometric properties of the ERQ in a sample of 1,188 undergraduates through confirmatory factor analysis. Additionally, tests of measurement invariance were employed in order to examine potential structural differences based on gender and ethnicity. The current study supported the original structure of the measure with all demographic groups and exceptional fit was demonstrated. Additional normative data for gender and ethnic groups are included. Results support the use of the instrument in future research. © 2011 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:1–11, 2011.

The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel.

Abstract: Perceived burdensomeness (PB) and thwarted belongingness (TB) are important indicators of suicide risk; however, limited research has investigated applicability to military populations, and no efforts have been initiated to translate these constructs into easily implemented clinical tools. The current study examined the structure and validity of a brief self-report survey of PB and TB, the 10-item Interpersonal Needs Questionnaire (INQ-10), among a sample of 219 deployed military personnel. Factor analysis confirmed that PB and TB are distinct, and are correlated with psychiatric symptomatology. Receiver operating characteristic analyses indicated the most useful cutoff scores were PB=1 and TB=3.2. Both scales significantly improved the ability to rule-in and rule-out current suicide ideation among deployed service members.

Resistance/Reactance Level

Abstract: Psychotherapists from all professions and perspectives periodically struggle to effectively manage a patient's resistance to change. This article provides definitions and examples of patient-treatment matching applied to patient resistance or reactance. We report the results from an original meta-analysis of 12 select studies (N = 1,102) on matching therapist directiveness to patient reactance. Our findings support the hypothesis that patients exhibiting low levels of trait-like resistance respond better to directive types of treatment, while patients with high levels of resistance respond best to nondirective treatments (d = .82). Limitations of the research reviewed are noted, and practice recommendations are advanced.

Posttraumatic stress and growth among Tibetan refugees: the mediating role of cognitive‐emotional regulation strategies

Abstract: This study examined posttraumatic stress (PTS) and posttraumatic growth (PTG) among 226 Tibetan refugees across two generations. Additional objectives were to (i) examine the sex and generation differences on the scores of trauma, PTS, and PTG, (ii) explore the relationship between traumatic experiences, PTS and PTG, and (iii) investigate the mediating effect of cognitive-emotional regulation strategies between the traumatic experiences and PTS as well as PTG. Females scored higher on trauma, PTS, and PTG. The trauma, PTS, and PTG scores of the two generations were significantly different. Acceptance and putting into perspective partially mediated the relationship between traumatic experience and PTS. Positive refocusing, refocus on planning, putting into perspective, and catastrophisizing partially mediated the relationship between traumatic experiences and PTG.

A systematic review of measures of therapeutic engagement in psychosocial and psychological treatment.

Abstract: This article reports a systematic review of engagement measures for psychosocial therapy. MEDLINE, EMBASE, and PsycINFO databases were searched to identify English-language studies (published 1980 to February 2010) that reported on an instrument/rating scale to measure engagement in psychosocial treatment for mental health difficulties. Forty-seven studies were identified, reporting information on 40 measures of treatment engagement. Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess, they also reveal that there is little consensus in the definition of engagement employed. Few measures are generalizable across treatment settings and clinical populations, and limited information is reported on the indices of reliability and validity. It is concluded that further work is required to develop adequate measures of therapeutic engagement.

Characterizing the magnitude of the relation between self-reported childhood parentification and adult psychopathology: a meta-analysis.

Abstract: Several decades of research have shown that people who experience parentification in childhood are at an increased risk of experiencing psychopathology in adulthood. A meta-analysis was conducted to examine the magnitude of the relation between self-reported parentification experienced in childhood and psychopathology evidenced in adulthood. Results from 12 nonoverlapping studies (N = 2,472), which were conducted between 1984 and 2010, revealed a small significant but reliable effect (r = .14; 95% confidence interval = .10 to .18). Moderator analyses were performed to explore possible explanations for the variance evidenced between parentification and psychopathology. Moderators that were examined include population factors, methodological factors, and type of psychopathology. The present findings indicate that four factors-types of psychopathology, type of sample, race, and parentification measure used-moderated the relation between parentification and psychopathology. The meta-analytic findings that emerged highlight the need for additional empirical research. Possible explanations and clinical

Utilization of personal therapy by psychotherapists: a practice-friendly review and a new study.

Abstract: This article offers both a practice-friendly review of research on therapists' personal therapy and a new study of personal psychotherapy among 3,995 psychologists, counselors, social workers, psychiatrists, and nurses in 6 English-speaking countries. The prevalence of personal therapy as it relates to professional discipline, theoretical orientation, gender, and career level are studied. Findings showed that 87% of the overall sample embarked on personal therapy at least once: 94% of analytic/psychodynamic therapists, 91% of humanistic therapists, 73% of cognitive-behavioral therapists, 82% of the novice therapists to 89% of senior therapists. Both the existing research and this new study demonstrate the extraordinary commonality of personal therapy among psychotherapists, and encourage further use for professional training, clinical practice, and therapist self-care.

Forgiveness, depression, and suicidal behavior among a diverse sample of college students

Abstract: Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.

“Why do they have to grow up so fast?” Parental separation anxiety and emerging adults' pathology of separation‐individuation

Abstract: This study examined associations between parental separation anxiety, controlling parenting, and difficulties in the separation-individuation process, as manifested in separation-individuation pathology. In a sample of emerging adults involved in the process of home leaving (N = 232) and their parents, it was found that parental separation anxiety is positively related to separation-individuation pathology in emerging adults. Dependency-oriented controlling parenting served as an intervening variable in the relationship between parents' feelings of separation anxiety and pathology of the separation-individuation process in emerging adults. These associations were not moderated by emerging adults' residential status (i.e., living with parents or (semi-)independently), suggesting that parental characteristics and behaviors remain important antecedents of separation-individuation pathology even when one no longer lives in the parental household.

Dispositional optimism buffers combat veterans from the negative effects of warzone stress on mental health symptoms and work impairment

Abstract: The study examined dispositional optimism s role in buffering the effect of warzone stress on mental health symptoms and mental health symptoms on work impairment. A total of 2,439 soldiers from an active-duty brigade combat team were surveyed following a 12-month deployment to Iraq. Posttraumatic stress disorder (PTSD) symptoms, depression symptoms, combat exposure, deployment demands, and work impairment were measured. Soldiers higher in dispositional optimism showed weaker relationships between combat exposure and PTSD symptoms, and between deployment demands and PTSD and depression symptoms. Dispositional optimism also buffered mental health symptom effects on work impairment. Dispositional optimism may protect soldiers from warzone stress and mental health symptoms. Potential mechanisms explaining how dispositional optimism may serve as a protective factor are discussed.

The role of weight stigmatization in cumulative risk for binge eating

Abstract: Previous research supports a positive association between weight stigmatization experiences and binge eating. However, the extent to which weight stigmatization accounts for binge eating in the context of other risk factors requires further investigation. Using a cumulative risk model, we examine previously studied risk factors (environmental stress, psychological functioning, negative coping, body dissatisfaction) as well as weight stigmatization as predictors of binge eating bariatric patients and undergraduate students. Results show a unique contribution of weight stigmatization. Analyses by sample indicated that this was only the case for the undergraduate student sample. Results support weight stigmatization as a meaningful predictor of binge eating and highlight the need for further work investigating how these experiences work to promote eating pathology.

Evaluation of the psychometric properties of the Interpersonal Needs Questionnaire-12 in samples of men and women.

Abstract: This study analyzed the psychometric properties of the Interpersonal Needs Questionnaire-12 (INQ-12; Van Orden, Witte, Gordon, Bender, & Joiner, 2008a), designed to test Joiner’s interpersonalpsychological theory of suicide. Study participants included 785 U.S. undergraduates (58.6% female; 77.2% White; ages 18–25). Confirmatory bifactor analyses discerned a general factor for overall distress, while also supporting separate subfactors for perceived burdensomeness and thwarted belongingness. The scale’s factor structure did not vary by gender, and internal consistency reliability was strong among the male and female samples. Correlational analyses supported the scale’s content validity. Overall, the analyses preliminarily support continued use of the INQ-12. & 2011 Wiley Periodicals, Inc. J Clin Psychol 67:609–623, 2011.

Effects of stress, depression, and their interaction on heart rate, skin conductance, finger temperature, and respiratory rate: sympathetic-parasympathetic hypothesis of stress and depression†

Abstract: We examined effects of stress, depression, and their interaction on sympathetic-parasympathetic responses, including percentage heart rate (PHR), percentage skin conductance (PSC), percentage finger temperature (PTEMP), and percentage respiratory rate (PRESPR). Participants were categorized into normal, low-risk, and high-risk depression groups under stress or no-stress by measuring psychophysiological responses. Stress increased PHR and PSC and decreased PTEMP. Depression negatively correlated with PHR and PTEMP. PSC and PTEMP were significantly dependent on and positively correlated with depression. PTEMP was significantly affected by the stress and depression interaction. Stress affects sympathetic, rather than parasympathetic, activity. Depression and the interaction between stress and depression initially associated with the sympathetic division and are then correlated with parasympathetic activity. A sympathetic-parasympathetic hypothesis and its clinical implications are discussed. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–12, 2011.

The Meaning In Life Questionnaire: psychometric properties with individuals with serious mental illness in an inpatient setting.

Abstract: Objectives: This study examined the psychometric properties of the Meaning in Life Questionnaire (MLQ) with individuals with serious mental illness (SMI) in an inpatient setting (N = 96). The 10-item MLQ comprises Presence (perceived meaning) and Search (motivation to discover meaning) scales. Design: This study focused on the reliability and validity of the MLQ, reporting a range of data, including correlations and regression (predicting scores on a measure of psychopathology, the Brief Symptom Inventory). Results: Both MLQ scales yielded reliable scores. The current sample tended to report greater Presence, whereas Search means tended to be similar to those reported in other studies. The association between Presence and the Brief Symptom Inventory was not statistically significant. As for Search, people reporting greater motivation to discover meaning tended to report greater degrees of symptoms. The Presence and Search scales correlated at r =.12, which was unexpected given that most studies note an inverse relationship. However, this finding is considered in light of an interaction effect between Presence and Search when predicting psychological distress. Conclusions: The current findings are supportive of the MLQ's utility with individuals with SMI. Limitations and directions for research are offered. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–10, 2011.

Preferences for Relational Style with Mental Health Clinicians: A Qualitative Comparison of African American, Latino and Non-Latino White Patients

Abstract: The goal of this study is to analyze preferences for relational styles in encounters with mental health providers across racial and ethnic groups. Four primary themes describe what patients want from a mental health provider: listening, understanding, spending time, and managing differences. However, using contextual comparative analysis, the findings explicate how these themes are described differently across African Americans, Latinos, and non-Latino Whites, uncovering important qualitative differences in the meaning of these themes across the groups. The article suggests that closer attention to qualitative preferences for style of interaction with providers may help address disparities in mental health care for racial and ethnic minorities.

Assessment of hoarding.

Abstract: Various questionnaires and interviews have been created over the years to assess compulsive hoarding. In this article, we summarize existing measures, offer practice-friendly suggestions for assessment of hoarding, and address frequent problems in its clinical evaluation. Existing measures for hoarding can be divided into those that are subscales of general measures of obsessive-compulsive disorder (e.g., Obsessive-Compulsive Inventory and Yale-Brown Obsessive-Compulsive Scale) and those that were developed specifically for hoarding and related phenomena. The former were largely developed without the benefit of research identifying the nature of hoarding, while the latter capture the specific dimensions of hoarding and are recommended for clinical use. We provide a case illustration and additional clinical considerations in the assessment of hoarding as well.

Beliefs about the causes of depression and treatment preferences.

Abstract: The relation between patients' beliefs about the causes of their depression, treatment preferences, and demographic variables was studied in a sample of 156 patients in a randomized controlled trial for depression (supportive-expressive psychotherapy vs. medication vs. placebo). No gender differences were found in beliefs or preferences. Racial differences were found for causes endorsed, but not preferences. Treatment experience predicted endorsement of characterological and biological causes. Psychotherapy experience predicted preference for medication. Finally, patients preferring psychotherapy endorsed childhood and complex causes more than those preferring medication, but the groups did not differ in other reasons endorsed. Implications of findings are discussed.

Reexperiencing symptoms and the interpersonal-psychological theory of suicidal behavior among deployed service members evaluated for traumatic brain injury.

Abstract: Recent evidence suggests that military suicide rates now exceed those of the general public. Numerous recent efforts to address this growing concern have focused on the interpersonal psychological theory of suicidal behavior (IPTS). In the current study, we explored the relationships among reexperiencing symptoms of posttraumatic stress disorder and the three components of the IPTS in a sample of deployed military personnel examined for traumatic brain injury. Results indicated that reexperiencing symptoms were directly related to the acquired capability for suicide, but their relationships to perceived burdensomeness and thwarted belongingness were statistically explained by general mental health distress. Results indicate that mental rehearsal of painful and provocative experiences may have an impact on suicide risk. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1-10, 2011. Language: en

Intolerance of uncertainty, depression, and anxiety: the moderating and mediating roles of rumination†

Abstract: Objectives: This study examined rumination as a moderator and mediator between intolerance of uncertainty (IU) and depression and anxiety symptoms. Designs: The study was a cross sectional study. Survey data were collected from 332 undergraduate students at a large Midwestern university. Results: The results from hierarchical analyses supported the moderator role of rumination. A high level of rumination enhanced the association between IU and depression symptoms. In addition, both high and low levels of rumination strengthened the relation between IU and anxiety symptoms. Results from structural equation modeling analyses indicated that rumination fully mediated the relation between IU and depression symptoms, but only partially mediated the association between IU and anxiety symptoms. Conclusions: The results supported rumination as a moderator and mediator in the association between IU and depression and anxiety symptoms. Future research and practical implications are discussed. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–20, 2011.

Understanding and treating hoarding: a biopsychosocial perspective.

Abstract: This article offers a practice-friendly review of conceptualizing and treating hoarding based on biological and psychological research. Although hoarding has commonly been conceptualized as a variant of obsessive-compulsive disorder, research suggests a more complex pattern of overlap with attention deficit-hyperactivity disorder, organic brain disease, depression, anxiety, personality disorders, and impulsivity. The phenomenon of hoarding is discussed in terms of familial and environmental vulnerabilities, maladaptive cognitive process, maladaptive cognitive content, and maladaptive behavioral patterns. The article concludes with a summary of treatment efficacy and 10 promising clinical practices.