An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students

Objective

Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.

Method

Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.

Results

Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.

Conclusions

This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.     

Implementing Dialectical Behavior Therapy Skills Training With at-Risk Male Youth in a Military-Style Residential Program

Recent calls to action rightly emphasize the need for early and preventative intervention for youth at risk for or currently exhibiting borderline personality disorder (BPD) features, nonsuicidal self-injury (NSSI), and/or suicidality. However, there is a lack of information in both the research literature and clinical practice guidelines about the acceptability and effectiveness of such interventions for male youth, particularly those who have dropped out of high school and, thus, are at even greater risk for a multitude of adverse psychological and functional outcomes. The current study aims to address this gap by examining the acceptability and pilot efficacy of a modified Dialectical Behavior Therapy for Adolescents (DBT-A) skills training group intervention among a sample of 73 non-treatment-seeking male youth (aged 16–18) with borderline personality features, self-harm, or suicidal ideation who had dropped out of high school and were enrolled in a military-style residential program (relative to youth participating in the residential program alone). Both quantitative and qualitative feedback from youth point to the high acceptability of DBT-A skills training with this population. Within-subjects and between-groups comparisons support the preliminary efficacy of DBT-A skills training with this population. At posttreatment, participants reported statistically significant decreases in emotion regulation (ER) difficulties (d = 0.43) and increases in distress tolerance (d = -0.50). Further, compared to a similar group of male youth who did not receive DBT-A skills training, those who received skills training showed greater improvements in ER difficulties, albeit not distress tolerance. Data from this pilot trial provide preliminary support for the efficacy of brief, stand-alone DBT-A skills training in improving ER difficulties in a high-risk group of male youth.     

Behavioral and Psychophysiological Effects of a Yoga Intervention on High-Risk Adolescents: A Randomized Control Trial

The purpose of this study was to conduct a pilot randomized control trial to test whether a mindful yoga intervention had a beneficial impact on substance use and its psychological and psychophysiological correlates in high-risk adolescents. Research on yoga has generated growing evidence for its positive effects on physical and emotional health. However, most studies are conducted with adults, with few controlled studies conducted with youth. We designed a 20-session mindful yoga intervention for adolescents attending a school for students at high-risk for dropping out. The 50-min classes were offered three times a week. The participants (mean age = 16.7 years) were randomly assigned to control and intervention groups. Multi-rater (student, teacher), multi-method (survey, cognitive, psychophysiological) data were collected before and after the yoga curriculum. At post-test, students in the yoga condition, as compared to control students, exhibited trends toward decreased alcohol use and improved teacher-rated social skills (p < .10); and showed a non-significant increase in arousal in response to relevant stimuli as measured in skin conductance. Significant effects were not found on hypothesized proximal measures of self-regulation, mood, mindfulness, or involuntary engagement coping. Future research is needed to replicate and expand upon our findings. Studies are also needed with larger samples to further investigate potential mediators and moderators of yoga’s effects.     

Impact of Youth Strengths and Objective Strain on the Experiences of Subjective Strain Among Caregivers of Youth with Behavioral Health Conditions

Caregivers of youth with behavioral health conditions often experience significant and chronic caregiving strain. Caregiving strain is thought to consist of three dimensions: objective strain (observable negative events), subjective internalized strain (negative feelings directed inwardly), and subjective externalized strain (negative feelings directed outwardly). Based on a modified stress process model, the aims of this study were to: (1) examine whether the association between youth emotional-behavioral problem severity (measured with the Child Behavior Checklist/6–18) and subjective internalized and subjective externalized caregiving strain is mediated by objective strain for caregivers, and; (2) identify other predictors of subjective internalized and subjective externalized strain, particularly related to youth emotional-behavioral strengths as measured by the Behavioral and Emotional Rating Scale-Parent Rating Scale. We also explored the extent to which the association between youth emotional-behavioral problem severity and subjective internalized and subjective externalized strain may be moderated by perceived youth emotional-behavioral strengths. One-hundred and eighty-five (N = 185) caregivers of youth served by a community-based system of care participated in structured survey interviews at program enrollment. Regression analyses indicated that objective strain was found to fully mediate the association between youth emotional-behavioral problem severity and subjective externalized strain. Greater youth strengths related to family involvement were also associated with lower subjective externalized strain. Higher caregiver age, lower education, biological parent relationship to youth, greater youth emotional-behavioral problem severity, higher objective strain, and lower youth strengths related to school functioning were associated with higher subjective internalized strain. A significant interaction was found between youth problem severity, youth affective strengths, and subjective internalized strain such that caregivers who reported higher levels of youth affective strengths experienced stronger effects from youth emotional-behavioral problem severity on subjective internalized strain. These findings shed light upon the complex set of circumstances that may lead caregivers of youth with behavioral health conditions to experience subjective internalized and subjective externalized strain.     

The Impact of Youth Risk on Mentoring Relationship Quality: Do Mentor Characteristics Matter?

Although mentoring is a widely used intervention strategy, effect sizes for at‐risk youth remain modest. Research is therefore needed to maximize the impact of mentoring for at‐risk youth who might struggle to benefit from mentoring relationships. This study tested the hypothesis that different types of youth risk would have a negative impact on mentoring relationship quality and duration and explored whether mentor characteristics exacerbated or mitigated these negative effects. Results showed that elevated environmental stress at a youth's home and/or school predicted shorter match duration, and elevated rates of youth behavioral problems, such as poor academic performance or misconduct, predicted greater youth dissatisfaction and less positive mentor perceptions of relationship quality. Mentors with greater self‐efficacy and more previous involvement with youth in their communities were able to buffer the negative effects of environmental stress on match duration. Similarly, mentors' previous involvement with youth buffered the negative effects of youth behavioral problems on mentor perceptions of relationship quality. Findings have important implications for the matching of mentors and at‐risk youth in a way that improves mentoring outcomes.     

Negative life events and substance use moderate cognitive behavioral adolescent depression prevention intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n?=?173) in which adolescents (M age =?15.5, SD =?1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Effectiveness of a trauma/grief-focused group intervention: a qualitative study with war-exposed Bosnian adolescents

The effectiveness and impacts of a school-based, trauma/grief-focused group treatment program for war-exposed youth in Bosnia and Herzegovina were investigated using semistructured focus groups, conducted separately for students and their school counselor group leaders. Overall, students' and leaders' evaluations of the groups were generally positive. General themes of outcomes and impacts perceived by students and group leaders include: acquisition of coping skills and attitudes, willingness to advocate for peers, improved interpersonal relationships, negative impacts, general positive impacts, impacts in the schools, impacts on the group and logistics of the program, and broader impacts on the perception of mental health in the community. The broad positive impacts of this program suggest that trauma/grief-focused group treatment intervention programs targeting trauma-exposed youth may be effective on multiple levels with war-exposed youth and their communities.     

Spirituality Development for Homeless Youth: A Mindfulness Meditation Feasibility Pilot

Few resilience enhancement interventions are available to help homeless youth at high risk for mental health problems and substance abuse. Mindfulness meditation has demonstrated effectiveness in persons who deal with some of these issues. Our purpose was to examine the feasibility of delivering a spirituality development class—a minimally modified version of Yale University’s 8-session Spiritual Self-Schema (3-S) program—to homeless youth in a shelter in an urban center in the Southeastern United States. We used a quasi-experimental, one group, pre- and post-intervention design with standardized self-report measures of impulsiveness, resilience, spirituality, mental wellness, and psychological symptoms. Seventy-one youth enrolled in the study; 39 of the youth attended at least four sessions of the class and completed the posttest. The spirituality development class was well received by the youth and, overall, participants demonstrated improvement on measures of spirituality, mental wellness, psychological symptoms, and resilience on the posttest. There were no statistically meaningful changes in impulsiveness scores. We concluded that mindfulness meditation programs are feasible for this population. Future studies of high-risk youth should use a randomized controlled trial design to examine the long-term impact of such training on psychological status and behavioral outcomes such as educational path, work attainment, and drug and alcohol abuse.     

Negative Life Events and Substance Use Moderate Cognitive Behavioral Adolescent Depression Prevention Intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Multiple peer victimization among elementary school students: relations with social-emotional problems

Research has indicated that children exposed to multiple risks often report worse mental health and academic performance than those experiencing only one risk. The present research examines whether exposure to more than one form of peer victimization (multiple peer victimization) at school is related to reports of negative outcomes. Eighty-six fourth and fifth grade students self-reported exposure to peer victimization and social-emotional problems. MANCOVAs indicated that children who experienced multiple peer victimization reported higher depressive symptoms, lower self-esteem, and self-blame attributions for their own victimization, than those who experienced victimization in only one form or none at all. Peer victimization to/from school was also investigated. While peer victimization was found to occur on the way to/from school, adding this to victimization at school did not show the same cumulative effects. Implications for schools are discussed.     

Preventing conduct problems, promoting social competence: a parent and teacher training partnership in head start

Studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the "highest risk" at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.     

Counseling Outcomes From 1990 to 2008 for School‐Age Youth With Depression: A Meta‐Analysis

Clinical trials exploring the effectiveness of counseling and psychotherapy in treatment of depression in school‐age youth composed this meta‐analysis. Results were synthesized using a random effects model for mean difference and mean gain effect size estimates. No effects of moderating variables were evident. Counseling and psychotherapy are effective for treatment of depression in school‐age youth both at termination and follow‐up, and in school and nonschool settings.     

Improved Parent Cognitions Relate to Immediate and Follow-Up Treatment Outcomes for Children With ADHD-Predominantly Inattentive Presentation

We investigated treatment effects on parenting self-efficacy and parent cognitive errors, and whether these parent cognitions are related to short- and long-term outcomes in parenting behaviors in psychosocial treatment for youth with attention-deficit/hyperactivity disorder, predominantly inattentive presentation (ADHD-I). In a randomized controlled trial across two sites (University of California, San Francisco, and University of California, Berkeley), 199 children between the ages of 7 and 11 were randomized to the Child Life and Attention Skills (CLAS; n = 74) program, parent-focused treatment (PFT; n = 74), or treatment as usual (TAU; n = 51). Parents reported on self-efficacy, cognitive errors, positive parenting, and negative parenting prior to treatment, immediately after treatment, and in the next school year at follow-up. Compared to TAU, CLAS and PFT had higher posttreatment parenting self-efficacy, and CLAS alone had lower posttreatment parent cognitive errors. At follow-up, only CLAS had improved parent cognitive errors compared to TAU. No other between-group differences were found in parenting self-efficacy or cognitive errors. Improved parenting self-efficacy was associated with improved posttreatment negative parenting outcomes for PFT and CLAS, and improved parent cognitive errors were also related to improvements in positive and negative posttreatment parenting outcomes for CLAS. Posttreatment parenting self-efficacy mediated follow-up negative parenting outcomes for CLAS and posttreatment parent cognitive errors mediated improved follow-up positive and negative parenting outcomes for CLAS. PFT and CLAS led to enhanced parenting self-efficacy, and CLAS appears especially robust in improving parent cognitive errors both in the short and long term. Pathways provide support for the possibility of parent cognitions as mediators of treatment effects on parenting; clinical focus on such cognitions may be useful.     

Risky Behavior in Affluent Youth: Examining the Co-occurrence and Consequences of Multiple Problem Behaviors

Children of affluent parents are often excluded in psychological research as they are considered to be at “low risk”; however, research is beginning to suggest that this previously under-studied population may be at risk for developing multiple problem behaviors, including substance use and externalizing problems. The current study aimed to extend the application of Problem Behavior Theory (PBT) to a sample of affluent adolescents by examining the extent to which these behaviors co-occurred and were associated with negative outcomes. Data were collected from 1,147 high school students living in an affluent community via anonymous questionnaires regarding their engagement in various problem behaviors. PBT was supported in this sample, and youth who engaged in multiple problem behaviors reported experiencing more negative outcomes than youth who did not engage in these behaviors. The findings of this study support the generalizability of PBT and also highlight the importance of continuing to study affluent youth in addition to traditionally high-risk populations.     

PEER TUTORING WITH OR WITHOUT HOME-BASED REINFORCEMENT,FOR READING REMEDIATION

An operant-based corrective reading program was established to study effectiveness of peer tutoring in the school, for reading deficient children. Sixty-nine second to fourth grade students were matched on measures of initial reading ability and level of reading retardation, and randomly assigned to three groups: Peer Tutoring Only, Peer Tutoring with Home Based Reinforcement, and Control. SRA materials were used in training for the experimental groups, supplemented with additional reading materials. The program continued for 15 weeks, in seven public schools. Changes in oral reading accuracy and comprehension were assessed. Both reading and comprehension were significantly increased by peer tutoring, relative to the control group. The addition of home-based reinforcement doubled this increase. The measured gain in oral reading, based upon standardized testing, was 0.19 years for the controls and 1.27 years for peer tutoring with home-based reinforcement. Internal measures of gain showed similar results, and comprehension gains were also comparable. A high rate of compliance with the tutoring program was maintained by the tutors. High ratings of satisfaction were obtained for the program, from all groups of participants. The feasibility of the program for application in the school system is discussed.     

Character Development within Youth Development Programs: Exploring Multiple Dimensions of Activity Involvement

We examined links among three dimensions of youth involvement (intensity, duration, and engagement) in Boy Scouts of America (BSA), an international out‐of‐school time (OST) youth development program designed to promote moral and performance character in boys. Using data from 737 youth and their parents who participated in one of 40 BSA program sites (commonly referred to as “packs”), we first considered how individual‐ and pack‐level measures of program involvement were differentially linked with character development. Next, we examined whether pack‐level involvement characteristics moderate individual‐level involvement characteristics, hypothesizing that highly involved packs would serve to further enhance the positive effects of high levels of individual involvement. Results indicated engagement was the strongest, most frequent predictor of increases in both moral and performance character. Although there were no direct effects of pack‐level intensity, duration, or engagement, the effects of individual‐level engagement were moderated by pack‐level engagement, suggesting that the largest increases in moral and performance character occurred among highly engaged youth who were enrolled in highly engaged packs. These results highlight the need to examine multiple dimensions of OST program involvement simultaneously, and suggest that strengthening youth engagement in programming may provide a means for enhancing the positive effects of high‐quality youth programming.     

Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD,Predominantly Inattentive Presentation

We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.     

Bullying,Cyberbullying, Student Life Satisfaction and the Community of Chilean Adolescents

Feeling support from the community is a vital aspect of adolescents’ quality of life. Negative experiences at school, such as bullying and cyberbullying can have an adverse impact on adolescents’ life satisfaction that can expand to different domains of their lives including community variables. The goal of the present study was to examine the association between peer victimization, life satisfaction and community support among Chilean adolescents. We used a sample of 497 youths enrolled in grades 9 to 12 of public and private schools in different Chilean districts. Results indicate a negative association between bullying and cyberbullying behavior on community support through life satisfaction. Peer victimization can have negative consequences for youths at a personal level on their assessments of life satisfaction, which can expand to feeling less support from the community. Feeling less support from the community can be detrimental to healthy youth development and adolescents’ quality of life. Community prevention efforts can thus provide emotional support for youth victims of bullying and cyberbullying.

     

Activity involvement among suicidal and nonsuicidal high-risk and typical adolescents

The purpose of this study was to compare weekly activities among four groups of randomly selected high-risk and typical high school students: (1) potential dropouts at suicide risk, (2) typical youth at suicide risk, (3) potential dropouts not at suicide risk, and (4) typical youth not at suicide risk. Of the 1,286 participants, 39.4% of the high-risk and 30.1% of typical high school students screened in at suicide risk. Weekly activity comparisons across the four groups showed that suicide-risk adolescents, regardless of potential dropout status, engaged in more solitary activities on weekdays and weekends than did their nonsuicide risk peers. High-risk potential dropout youth engaged in less homework and more social activities during weekdays and weekends than did the typical high school students. These results provide important insight into the weekly activity involvement of at-risk youth while helping to gain a better understanding of suicide-risk adolescents. Implications of these findings are discussed for identifying youth at risk for suicidal behavior and for prevention programming.     

Changing Parent’s Mindfulness,Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial

We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.