Showing papers in "Journal of Consulting and Clinical Psychology in 2003"
TL;DR: A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors, and results did not support the efficacy of AMIs for smoking or HIV-risk behaviors.
Abstract: A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.
1,535 citations
TL;DR: Results generally support the hypothesis that exposure to interpersonal violence increases the risk of these disorders and of diagnostic comorbidity.
Abstract: With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12–17, this study provides prevalence, comorbidity, and risk-factor data for posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D). Roughly 16% of boys and 19% of girls met criteria for at least 1 diagnosis. Six-month PTSD prevalence was 3.7% for boys and 6.3% for girls, 6-month MDE prevalence was 7.4% for boys and 13.9% for girls, and 12-month SA/D prevalence was 8.2% for boys and 6.2% for girls. PTSD was more likely to be comorbid than were MDE and SA/D. Results generally support the hypothesis that exposure to interpersonal violence (i.e., physical assault, sexual assault, or witnessed violence) increases the risk of these disorders and of diagnostic comorbidity. Limited information exists about the prevalence and comorbidity of posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D) among probability samples of adolescents. The extent to which interpersonal violence increases risk of these disorders also remains understudied. We examined these issues using data from the National Survey of Adolescents (NSA). In addition to presenting national prevalence and comorbidity data for these three disorders, we tested the hypothesis that exposure to interpersonal violence increases risk of each disorder and of comorbidity. To date, the best estimates of these mental health problems and their comorbidity among younger age groups at the national level come from the National Comorbidity Survey (NCS; Kessler et al., 1994; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kessler
1,511 citations
TL;DR: This meta-analysis examined 118 studies of the psychosocial outcomes of children exposed to interparental violence and found similar effects were found across a range of outcomes, with slight evidence for greater risk among preschoolers.
Abstract: This meta-analysis examined 118 studies of the psychosocial outcomes of children exposed to interparental violence. Correlational studies showed a significant association between exposure and child problems (d = -0.29). Group comparison studies showed that witnesses had significantly worse outcomes relative to nonwitnesses (d = -0.40) and children from verbally aggressive homes (d = -0.28). but witnesses' outcomes were not significantly different from those of physically abused children (d = 0.15) or physically abused witnesses (d = 0.13). Several methodological variables moderated these results. Similar effects were found across a range of outcomes, with slight evidence for greater risk among preschoolers. Recommendations for future research are made, taking into account practical and theoretical issues in this area.
1,419 citations
TL;DR: In this article, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use, finding that gay-bisexual men exhibited higher prevalence of depression, panic attacks, and psychological distress than heterosexual men.
Abstract: Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.
1,023 citations
TL;DR: In this article, an unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents, maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner.
Abstract: An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.
1,006 citations
TL;DR: Cluster analysis of proportion days abstinent (PDA) revealed 3 groups: high PDA at intake and follow-up (3, 6, 9, 12 months; maintainers); low intake PDA/high follow- up PDA (changers); and low intakePDA/low to moderate follow-ups (stragglers).
Abstract: Client language from a motivational interview (MI) and drug use outcome were investigated. Interview videotapes of 84 drug abusers were coded for frequency and strength of utterances expressing commitment, desire, ability, need, readiness, and reasons to change or maintain their habit. Cluster analysis of proportion days abstinent (PDA) revealed 3 groups: high PDA at intake and follow-up (3, 6, 9, 12 months; maintainers); low intake PDA/high follow-up PDA (changers); and low intake PDA/low to moderate follow-up PDA (stragglers). Distinct group patterns emerged for commitment strength (CS) during MI. Clients dishonest in checklist self-report exhibited CS similar to stragglers. CS for client evaluation of a change plan predicted outcome PDA. CS was predicted by strength of desire, ability, need, and reasons, but more strongly predicted outcome PDA, suggesting CS is a pathway for their influence on behavior.
704 citations
TL;DR: Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy.
Abstract: Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship– outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.
677 citations
TL;DR: Research on the effectiveness of school-based programs for preventing or reducing aggressive behavior was synthesized with a meta-analysis and higher risk youth showed greater reductions in aggressive behavior, poorly implemented programs produced smaller effects, and different types of programs were generally similar in their effectiveness.
Abstract: Research on the effectiveness of school-based programs for preventing or reducing aggressive behavior was synthesized with a meta-analysis. Changes in aggressive behavior between pretest and posttest were analyzed for developmental patterns and characteristics associated with differential effects. Control groups showed little change in aggressive behavior, but there were significant reductions among intervention groups. Most studies were conducted on demonstration programs; the few studies of routine practice programs showed much smaller effects. Among demonstration programs, positive outcomes were associated with a variety of study, subject, and intervention characteristics. Most notably, higher risk youth showed greater reductions in aggressive behavior, poorly implemented programs produced smaller effects, and different types of programs were generally similar in their effectiveness, other things equal.
594 citations
TL;DR: Comparisons of current, past, and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD.
Abstract: Two studies of assault victims examined the roles of (a) disorganized trauma memories in the development of posttraumatic stress disorder (PTSD), (b) peritraumatic cognitive processing in the development of problematic memories and PTSD, and (c) ongoing dissociation and negative appraisals of memories in maintaining symptomatology. In the cross-sectional study (n = 81), comparisons of current, past, and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD. Ongoing dissociation and negative appraisals served to maintain PTSD symptoms. The prospective study (n = 73) replicated these findings longitudinally. Cognitive and memory assessments completed within 12-weeks postassault predicted 6-month symptoms. Assault severity measures explained 22% of symptom variance; measures of cognitive processing, memory disorganization, and appraisals increased prediction accuracy to 71%.
542 citations
TL;DR: Cognitive therapy remained superior to FLU + SE and PLA + SE at the end of the booster period and at 12-month follow-up, and on general mood measures, there were few differences between the treatments.
Abstract: Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for generalized social phobia were assigned to cognitive therapy (CT), fluoxetine plus self-exposure (FLU + SE), or placebo plus self-exposure (PLA + SE). At posttreatment (16 weeks), the medication blind was broken. CT and FLU + SE patients then entered a 3-month booster phase. Assessments were at pretreatment, midtreatment, posttreatment, end of booster phase, and 12-month follow-up. Significant improvements were observed on most measures in all 3 treatments. On measures of social phobia, CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment. FLU + SE and PLA + SE did not differ. CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up. On general mood measures, there were few differences between the treatments
529 citations
TL;DR: Compared with EMDR and relaxation training, exposure therapy produced significantly larger reductions in avoidance and reexperiencing symptoms, and tended to be faster at reducing avoidance and yield a greater proportion of participants who no longer met criteria for PTSD after treatment.
Abstract: The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.
TL;DR: A controlled trial on the Internet-driven treatment of posttraumatic stress and grief in a group of people who manifested mild to relatively severe trauma symptoms, with the highest percentages being found for depression and avoidance.
Abstract: Online therapy offers many advantages over face-to-face therapy. Interapy includes psychoeducation, screening, effect measures, and a protocol-driven treatment via the Internet for people suffering from posttraumatic stress. The present article reports the results of a controlled trial on the Internet-driven treatment of posttraumatic stress and grief in a group of people who manifested mild to relatively severe trauma symptoms. Participants in the treatment condition (n=69) improved significantly more than participants in the waiting-list control condition (n=32) on trauma-related symptoms and general psychopathology. The effect sizes were large. On most subscales, more than 50% of the treated participants showed reliable change and clinically significant improvement, with the highest percentages being found for depression and avoidance.
TL;DR: Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts, and response to cognitive-behavioral therapy across symptom categories was compared, finding poorer outcomesamong patients with hoarding symptoms compared with those with other symptom themes.
Abstract: Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N=132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate consideration to mental compulsions. Five patient clusters were identified: harming, contamination, hoarding, unacceptable thoughts, and symmetry. Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts. In the 2nd study, they compared response to cognitive-behavioral therapy across symptom categories, finding poorer outcomes among patients with hoarding symptoms compared with those with other symptom themes.
TL;DR: Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over-time and support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence.
Abstract: This study evaluated a community-based intervention to help at-risk teens develop healthy, nonabusive relationships with dating partners. Participants were 158 14-16-year-olds with histories of child maltreatment who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed measures of abuse and victimization with dating partners, emotional distress, and healthy relationship skills at bimonthly intervals when dating someone. Intervention consisted of education about healthy and abusive relationships, conflict resolution and communication skills, and social action activities. Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over-time. Findings support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence. Language: en
TL;DR: Sexual attitudes and activities of sexually abused and comparison women were assessed 10 years after disclosure, indicating that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.
Abstract: The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth control efficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.
TL;DR: Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment.
Abstract: This study evaluated a parent problem-solving (PPS) intervention designed to augment the effects of evidence-based therapy for children referred to treatment for aggressive and antisocial behavior All children (N = 127, ages 6-14 years) and their families received problem-solving skills training (PSST), and parents received parent management training (PMT) Families were randomly assigned to receive or not to receive an additional component (PPS) that addressed parental stress over the course of treatment Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment The implications of the findings for improving evidence-based treatment as well as the limitations of adding components to treatment are detailed Language: en
TL;DR: In this paper, the likelihood of partner physical aggression on days of male partners' alcohol consumption, during a 5-month period, was examined for men entering a domestic violence treatment program and domestically violent men entering an alcoholism treatment program.
Abstract: The likelihood of partner physical aggression on days of male partners' alcohol consumption, during a 5-month period, was examined for men entering a domestic violence treatment program (n = 137) and domestically violent men entering an alcoholism treatment program (n = 135). For men entering the domestic violence treatment program (alcoholism treatment program odds in parentheses), the odds of any male-to-female physical aggression were more than 8 times (11 times) higher on days when men drank than on days of no alcohol consumption. The odds of severe male-to-female physical aggression were more than 11 times (11 times) higher on days of men's drinking than on days of no drinking. These findings support the proximal effect model of alcohol use and partner violence.
TL;DR: An experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16, indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest.
Abstract: This article presents an experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16. The program involved separate groups for caregivers, adolescents, and children, which were designed to change potentially modifiable risk and protective factors for bereaved children. The evaluation involved random assignment of 156 families (244 children and adolescents) to the FBP or a self-study condition. Families participated in assessments at pretest, posttest, and 11-month follow-up. Results indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest. At follow-up, the FBP led to reduced internalizing and externalizing problems, but only for girls and those who had higher problem scores at baseline.
TL;DR: It is suggested that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder.
Abstract: Recently hospitalized bipolar, manic patients (N = 53) were randomly assigned to a 9-month, manual-based, family-focused psychoeducational therapy (n = 28) or to an individually focused patient treatment (n = 25). All patients received concurrent treatment with mood-stabilizing medications. Structured follow-up assessments were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up. Compared with patients in individual therapy, those in family-focused treatment were less likely to be rehospitalized during the 2-year study period. Patients in family treatment also experienced fewer mood disorder relapses over the 2 years, although they did not differ from patients in individual treatment in their likelihood of a first relapse. Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder.
TL;DR: Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.
Abstract: A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.
TL;DR: It is suggested that providing CR in combination with IE may enhance treatment gains and lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder.
Abstract: This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.
TL;DR: Patients who received PST along with their significant other reported lower levels of psychological distress as compared with members of the PST-alone condition on approximately half of the outcome measures, and effects were further maintained 1-year posttreatment.
Abstract: The efficacy of problem-solving therapy (PST) to reduce psychological distress was assessed among a sample of 132 adult cancer patients. A second condition provided PST for both the patient and a significant other. At posttreatment, all participants receiving PST fared significantly better than waiting list control patients. Further, improvements in problem solving were found to correlate significantly with improvements in psychological distress and overall quality of life. No differences in symptom reduction were identified between the 2 treatment protocols. At a 6-month follow-up, however, patients who received PST along with their significant other reported lower levels of psychological distress as compared with members of the PST-alone condition on approximately half of the outcome measures. These effects were further maintained 1-year posttreatment.
TL;DR: Meta-analytic procedures used to test one possible factor contributing to the attenuation of effects: structural inequalities between placebo and active treatments indicate that comparisons between active treatments and structurally inequivalent placebos produced larger effects than comparisons between Active treatments andStructurally equivalent placebos.
Abstract: Placebo treatments in psychotherapy cannot adequately control for all common factors, which thereby attenuates their effects vis-a`-vis active treatments. In this study, the authors used meta-analytic procedures to test one possible factor contributing to the attenuation of effects: structural inequalities between placebo and active treatments. Structural aspects of the placebo included number and duration of sessions, training of therapist, format of therapy, and restriction of topics. Results indicate that comparisons between active treatments and structurally inequivalent placebos produced larger effects than comparisons between active treatments and structurally equivalent placebos; moreover, the latter comparison produced negligible effects, indicating that active treatments were not demonstrably superior to well-designed placebos. Psychotherapy treatment outcome studies have used the doubleblind randomized placebo control design to rule out the effects of various common factors (Goldfried & Wolfe, 1996). This design was originally developed in the United States and the United Kingdom in the 1930s (Gehan & Lemak, 1994; Shapiro & Shapiro, 1997; Wampold, 2001a) for the purpose of holding constant all factors except the medication’s active ingredient. Scientific medicine researchers sought to adapt the concept of randomized clinical trials to establish that the benefits of medications were due to physiochemical properties rather than to patients’ expectations, hopes, or other psychological processes. The placebo pill, used in the medical double-blind randomized placebo control design as the typical way of controlling all factors incidental to the treatment, is designed to be indistinguishable from the active medication—in appearance, taste, and smell. In this design, it is necessary that the patient, the administrator of the treatment, and the evaluator be unaware of the patient’s treatment condition because the design is intended to rule out psychological factors that are incidental to the purported active ingredient. Clearly, for instance, if the patient were aware that he or she was receiving a pill with no active ingredients, the expectation for improvement would be attenuated. As noted by Shapiro and Shapiro (1997): Gold [who developed the design in the United States] advocated a comparison between “an allegedly potent agent and a blank of such physical properties as to render a distinction between the two impossible except through some pharmacologic potency which may exist ... [the recommended] double-blind procedure which calls for an investigation in which neither the patient nor the doctor is aware of the identity of the two agents until the results are in and analyzed. This is imperative to avoid the influence of subconscious bia s... ”(Gold, 1954, p. 724). The statement by Gold culminated twenty years of pioneering study of methods with which to reliably and validly evaluate the effectiveness of new drugs. (p. 148) Shortly after the randomized double-blind placebo control group design was adopted in medicine, Rosenthal and Frank (1956) suggested that the design be used in psychotherapy research to rule out factors that are incidental to ingredients specified by the treatment protocol (i.e., to control for the common factors in therapy):
TL;DR: It is suggested that abbreviated PCIT may be of benefit for families with young conduct problem children and posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children.
Abstract: Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment; and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children.
TL;DR: The early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics, and neither early level nor change in symptoms predicted the subsequent level or course of the alliance.
Abstract: Although many studies report that the therapeutic alliance predicts psychotherapy outcome, few exclude the possibility that this association is accounted for by 3rd variables, such as prior improvement and prognostically relevant patient characteristics. The authors treated 367 chronically depressed patients with the cognitive-behavioral analysis system of psychotherapy (CBASP), alone or with medication. Using mixed effects growth-curve analyses, they found the early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics. In contrast, neither early level nor change in symptoms predicted the subsequent level or course of the alliance. Patients receiving combination treatment reported stronger alliances with their psychotherapists than patients receiving CBASP alone. However, the impact of the alliance on outcome was similar for both treatment conditions.
TL;DR: More details were elicited from older than from younger children in response to all types of prompts, but there were no age differences in the proportion of details elicited using invitations or cued invitations.
Abstract: To elucidate age differences in responses to free-recall prompts (i.e., invitations and cued invitations) and focused recognition prompts (i.e., option-posing and suggestive utterances), the authors examined 130 forensic interviews of 4- to 8-year-old alleged victims of sexual abuse. There were age differences in the total number of details elicited as well as in the number of details elicited using each of the different types of prompts, especially invitations. More details were elicited from older than from younger children in response to all types of prompts, but there were no age differences in the proportion of details (about 50%) elicited using invitations. Cued invitations elicited 18% of the total details, and the number of details elicited using cued invitations increased with age. Action-based cues consistently elicited more details than other types of cues.
TL;DR: Findings suggest recovery from PTSD is significantly influenced by perceived social support, and combat exposure predicted PTSD course more strongly than any other risk factor.
Abstract: Risk factors affecting the course of posttraumatic stress disorder (PTSD) are poorly understood. As part of a larger study on characterizing exposure to herbicides in Vietnam, the authors investigated this issue in a random sample of 1,377 American Legionnaires who had served in Southeast Asia during the Vietnam War and were followed over a 14-year period. High combat exposure, perceived negative community attitudes at homecoming, minority race, depression symptoms at Time 1, and more anger at Time 1 predicted a more chronic course. Community involvement at Time 1 was protective and associated with decreased risk at Time 2. Discomfort in disclosing Vietnam experiences was associated with an increased risk for developing PTSD but did not predict its course. Combat exposure predicted PTSD course more strongly than any other risk factor. Findings suggest recovery from PTSD is significantly influenced by perceived social support.
TL;DR: In this paper, a longitudinal study of 270 4th-to 11th-grade children (mean age = 12.9 years, SD = 2.23) was conducted to investigate the relationship between positive affect and negative affect.
Abstract: The tripartite model of anxiety and depression has been studied with adults; however, support is still emerging with children concerning measurement and relations between positive (PA) and negative (NA) affect and psychopathology. In this longitudinal study of 270 4th- to 11th-grade children (mean age = 12.9 years, SD = 2.23). confirmatory factor analysis supported a 2-factor orthogonal model of children's self-reported affect and revealed that the concurrent relations of NA and PA to anxiety and depression symptoms were consistent with the tripartite model. Structural equation modeling demonstrated moderate cross-time stability of trait PA and NA, consistent with a temperament view of these factors, as well as partial support for the role of NA and PA in the development of anxiety and depression symptoms in children.
TL;DR: Examination of outcome predictors and moderators in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder found parental depressive symptoms and severity of child ADHD were associated with decreased rates of excellent response; when these 2 characteristics were present, below-average child IQ was an additional moderator.
Abstract: Using receiver operating characteristics, the authors examined outcome predictors (variables associated with outcome regardless of treatment) and moderators (variables identifying subgroups with differential treatment effectiveness) in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD; MTA). Treatment response was determined using parent- and teacher-reported ADHD and oppositional defiant symptoms, with levels near or within the normal range indicating excellent response. Among 9 baseline child and family characteristics, none predicted but 3 moderated treatment response. In medication management and combined treatments, parental depressive symptoms and severity of child ADHD were associated with decreased rates of excellent response; when these 2 characteristics were present, below-average child IQ was an additional moderator. No predictors or moderators emerged for behavioral and community comparison treatments. The authors discuss conceptual and clinical implications of research on treatment moderators.
TL;DR: Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group.
Abstract: This study evaluated the effectiveness of the Problem Solving For Life program as a universal approach to the prevention of adolescent depression. Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group. Low-risk participants who received the intervention reported a small but significant decrease in depression scores over the intervention period, whereas the low-risk controls reported an increase in depression scores. The low-risk group reported a significantly greater increase in problem-solving scores over the intervention period compared with low-risk controls. These results were not maintained, however, at 12-month follow-up.