Changes in Cognitions, Emotions, and Behaviors in Depressed Patients and Their Spouses Following Marital Cognitive Therapy, Traditional Cognitive Therapy, Pharmacotherapy, and No Intervention

This study evaluated specific influences of a cognitive marital treatment (CMT) for depression based on an integration of cognitive theory of depression and systems theory. The effects of CMT on variables representing cognitions, emotions, and behaviors were compared with the effects of traditional cognitive therapy (CT), pharmacotherapy (PT), and no treatment (NT). Subjects were Major Depression Disorder and Dysthymic outpatients and their spouses. The changes considered were for pre–post treatment and pre-treatment–follow-up. CMT affected a wider range of variables than other treatments. In most instances it was also superior to the NT condition. Most of the gains were manifested at termination and lasted through follow-up. The variables affected by CMT were patients' and spouses' cognitions and emotions. PT had best effects on patients' emotions. CT affected patients' cognitions, but did not achieve superiority on any of the compared variables. None of the treatments produced significant changes in behaviors.     

„Intention to treat“ oder „treatment as received“ – Umgang mit Abbrechern in der Forschung zur Straftäterbehandlung

Lack of internal validity is a frequent problem in evaluation studies of offender treatment, as randomized controlled trials are difficult to implement and comparison groups in quasi-experimental studies are often not completely equivalent. Special matching procedures or statistical control of selection bias by using potentially interfering variables as covariates can provide a solution to some of these problems; however, a high dropout rate from offender treatment programs presents another problem, as the variables that cause attrition are often risk factors for reoffending. It is argued that a treatment-as-received (TR) approach which compares treatment completers with the comparison group may confound genuine treatment effects with selection effects. Particularly high recidivism rates in dropouts may be due to negative effects of attrition (e.g. stigmatization) but may more likely reflect a higher a priori risk for reoffending. Using data from some recent treatment studies, the authors show that alleged positive effects often disappear when a more adequate intention-to-treat (ITT) approach is used in which dropouts are retained in the treatment sample.     

INTERACTION EFFECTS IN MULTIELEMENT DESIGNS: INEVITABLE,DESIRABLE, AND IGNORABLE

A single-subject design often used to compare the effectiveness of two or more independent variables (like treatment programs) is the multielement (alternating treatments or simultaneous treatments) design. Variants of this design approximate the concurrent comparison of the effects of two or more variables (or levels of variables) by programming the variables (or levels) in rapid alternation, typically across or within daily sessions. Properly combined with conventional reversal designs, these designs can also display a variety of interaction effects, some of them worrisome, others highly desirable for the future development of the field. A worrisome model is the possibility that when Treatment B alternates rapidly with Treatment C, the effects of each will not be the same as when each is the only treatment used. A desirable model is the use of the multielement design as a fast-paced component of an otherwise conventional reversal design examining contextual control of some relationship: the possibility that some behavior responds differently to Controlling Variables A and B in Context X than in Context Y. This second possibility opens single-subject designs to the more efficient examination of all interactive effects and is highly desirable, considering the prevalence and importance of interactions in determining the limits and the generality of currently understood behavioral phenomena.     

The Use of Propensity Scores in Mediation Analysis

Mediation analysis uses measures of hypothesized mediating variables to test theory for how a treatment achieves effects on outcomes and to improve subsequent treatments by identifying the most efficient treatment components. Most current mediation analysis methods rely on untested distributional and functional form assumptions for valid conclusions, especially regarding the relation between the mediator and outcome variables. Propensity score methods offer an alternative whereby the propensity score is used to compare individuals in the treatment and control groups who would have had the same value of the mediator had they been assigned to the same treatment condition. This article describes the use of propensity score weighting for mediation with a focus on explicating the underlying assumptions. Propensity scores have the potential to offer an alternative estimation procedure for mediation analysis with alternative assumptions from those of standard mediation analysis. The methods are illustrated investigating the mediational effects of an intervention to improve sense of mastery to reduce depression using data from the Job Search Intervention Study (JOBS II). We find significant treatment effects for those individuals who would have improved sense of mastery when in the treatment condition but no effects for those who would not have improved sense of mastery under treatment.     

Evaluating the Effectiveness of a Group CBT for Parents of ADHD Children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26–58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and 3-month follow-up. Data were analysed using 2?×?3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children.     

Neuropsychological Features of Lesion-related Epilepsy in Adults: An Overview

Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.     

Consistent Treatment of Variables and Causation Poses a Challenge for Behavioral Research Methods: A Commentary on Nesselroade and Molenaar (2016)

Nesselroade and Molenaar presented the ideographic filter as a proposal for analyzing lawful regularities in behavioral research. The proposal highlights an inconsistency that poses a challenge for behavioral research more generally. One can distinguish a broadly Humean approach from a broadly non-Humean approach as they relate to variables and to causation. Nesselroade and Molenaar rejected a Humean approach to latent variables that characterizes them as nothing more than summaries of their manifest indicators. By contrast, they tacitly accepted a Humean approach to causes characterized as nothing more than summaries of their manifest causal effects. A non-Humean treatment of variables coupled with a Humean treatment of causation creates a theoretical tension within their proposal. For example, one can interpret the same model elements as simultaneously representing both variables and causes. Future refinement of the ideographic filter proposal to address this tension could follow any of a number of strategies.     

Disorder-specific Effects of CBT for Anxious and Depressed Youth: A Meta-analysis of Candidate Mediators of Change

The commonalities between anxiety and depression have been discussed before, but few have delineated the potentially different mechanisms through which treatments work for these populations. The current study conducted a comprehensive review of child and adolescent randomized clinical trials that tested cognitive-behavioral therapy (CBT) for anxiety or depression. All studies were required to have assessed both treatment outcomes and at least one theory-specific process target, including behavioral, physiological, cognitive, and coping variables. Using a meta-analytic approach, CBT demonstrated positive treatment gains across anxiety, depression, and general functioning outcomes. CBT for anxiety also produced moderate to large effects across behavioral, physiological, cognitive, and coping processes, with behavioral targets demonstrating potentially the greatest change. CBT for depression produced small effects for cognitive processes but nonsignificant effects for behavioral and coping variables. Findings were generally consistent with CB theory but suggest potentially different mediators in the treatment of anxiety and depression. Results are discussed in terms of implications for mechanisms research, theories of change, and treatment development.     

Objective measurement of the independent variable: A neglected methodological aspect in community-based behavioral research

The importance of adequately measuring independent as well as dependent variables in studies evaluating therapeutic services provided to antisocial children is indicated. Data were obtained from a study in which 139 antisocial children were stratified according to age and then randomly placed into 14 groups. The children were randomly assigned to either of 2 treatment strategies or to a control treatment strategy. The effect of the treatments was evaluated by 2 pre-post selfrating scales, by a prepost inventory completed by therapists, and by behavioral observations of both children and their therapists. Measurements of the children's and therapists' behaviors were secured at each weekly 2-hr, meeting for approximately 30 weeks. Very few significant differences occurred between the treatment and control groups on the dependent variables. The findings indicated that independent checks are necessary to insure that therapeutic strategies are actually being implemented, thus providing for an adequate test of their effects on the dependent variables.     

The EffectLiteR Approach for Analyzing Average and Conditional Effects

We present a framework for estimating average and conditional effects of a discrete treatment variable on a continuous outcome variable, conditioning on categorical and continuous covariates. Using the new approach, termed the EffectLiteR approach, researchers can consider conditional treatment effects given values of all covariates in the analysis and various aggregates of these conditional treatment effects such as average effects, effects on the treated, or aggregated conditional effects given values of a subset of covariates. Building on structural equation modeling, key advantages of the new approach are (1) It allows for latent covariates and outcome variables; (2) it permits (higher order) interactions between the treatment variable and categorical and (latent) continuous covariates; and (3) covariates can be treated as stochastic or fixed. The approach is illustrated by an example, and open source software EffectLiteR is provided, which makes a detailed analysis of effects conveniently accessible for applied researchers.     

Treatment Choice and Placebo Expectation Effects

Placebo expectations can have a strong influence on physical and mental health outcomes. In prior research examining placebo expectation effects, participants have been assigned placebo treatments rather than being actively involved in selecting their treatment. In modern health care, however, individuals are often involved in health care decisions. We review relevant literature regarding choice and placebo expectation effects and conclude that exercising choice over a treatment should strengthen placebo effects. Data relevant to this hypothesis is reviewed. Next, we provide a framework for understanding the key variables involved in mediating and moderating the influence of treatment choice on placebo expectation effects. Finally, theoretical and practical issues revolving around treatment choice in the context of placebo effects are raised.     

Health beliefs,optimism, and health‐related decisions: A study with Hong Kong Chinese

T he Health Belief Model (HBM; Rosenstock, 1966) is the most widely used psychological theory of health‐related behaviours but its applicability to non‐Western, especially Asian, populations has not been systematically studied. The main objective of the current study was to examine the effects of components of the HBM and dispositional optimism on preventive intention in two separate samples of 220 Hong Kong Chinese adults and 340 Hong Kong Chinese adolescents. Two HBM variables, benefits and barriers, were experimentally manipulated for an imaginary flu outbreak and a hypothetical vaccine. Optimism in the two samples was assessed using the Chinese revised Life Orientation Test (Lai et al., 1998). Participants indicated their intention to take the hypothetical vaccine after reading information for each of the treatment combinations defined by the two HBM variables. The order of the presentation of each of the six treatment conditions was counterbalanced. Results of ANOVA showed that the effects of the two HBM variables were similar in the two groups. Higher benefits and lower barriers were associated with stronger behavioural intention to take the vaccine. The two HBM variables interacted significantly in the adolescent but not the adult sample. Among the adolescents, the difference in intention scores between low and high barriers became larger when the benefits of taking the vaccine increased. In addition, optimism had significant effect on preventive intention only among the adolescents. These findings suggest that age may be an important factor moderating the effects of HBM components as well as optimism on preventive intention in Hong Kong Chinese. Implications of these findings to future research among Chinese were discussed.     

An information processing system for the psychiatric emergency room

An information processing system for a psychiatric emergency room is described. Several studies are presented that show the utility of the system. In the first study, variables involved in diagnosis are explicated. The second study attempts to determine the characteristics that distinguish recidivists from nonrecidivists at an emergency room. The third study attempts to find patient variables related to success in short-term treatment programs. The final study is aimed at discovering whether there are psychopathological effects related to the use of inhalants. Together, these studies show the potential of a mental health information system for learning more about the nature of mental disorders and their treatment.     

State-trace analysis: A method of testing simple theories of causation

An independent variable measures some aspect of a treatment applied to a person; a dependent variable measures some aspect of the treatment's effect upon the person. Two dependent variables will often covary with each other because they are affected by a common independent variable. A state trace is a graph which plots the value of one dependent variable as a function of another. (Thus, a state trace is a generalization of the yes-no receiver-operating-characteristic curve.) By appropriately analyzing state traces, it is possible to test theories concerning (a) the mechanisms by which independent variables affect dependent variables and (b) how these mechanisms differ from one population of persons to another. As an illustration, a study of long-term memory in normal persons, schizophrenics, and persons with organic brain syndrome is presented. The effects of number of word presentations and length of retention interval upon probability of word recall and recognition were investigated. The results were analyzed by state-trace analysis.     

Duration of flooding sessions in the treatment of obsessive-compulsive patients

This study investigated the duration effect of flooding ‘in vivo’ and ‘in fantasy’ in twelve obsessive-compulsive patients treated in a balanced Latin square design. Clinical assessments regarding twenty one clinical variables were carried out before and after each treatment condition. Long practice sessions proved significantly superior to other treatment conditions. Short and long sessions ‘in fantasy’ did not diner significantly. Long fantasy sessions appear to have potentiating effects on in vivo practice sessions. The order effect and the intercorrelation of the variables prior to treatment and to the outcome, are also presented. Some prognostic factors and the follow-up findings 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.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.     

Effects of a Self-Efficacy Intervention on Exercise: The Moderating Role of Diabetes and Cardiovascular Diseases

The paper examines the influence of a brief tailored intervention on exercise levels and self-efficacy beliefs in the context of participants' health status. We hypothesised that the effects of a self-efficacy intervention targeting more frequent exercise would be larger among people with diabetes or cardiovascular diseases (CVD), compared to the effects of the intervention among individuals without such diseases. The treatment was tailored to participants' self-efficacy and was delivered by e-mail. Data from 187 adults were collected at two measurement points, with a 6-month follow-up. Participants reported their exercise frequency and self-efficacy scores, along with several social-cognitive variables, such as risk perception and intentions. Besides the influence of the intervention on exercise and self-efficacy, we found that the treatment effects were moderated by diabetes or CVD: Participants with those illnesses benefited from the intervention, compared to people without such diagnosis. Among participants with CVD or diabetes the effects of the intervention on behavior were mediated by changes in efficacy beliefs. The results indicated that a parsimonious treatment may contribute to change in exercise over the longer term, in particular among individuals with a disease related to the respective behavior. Changes in behavior may be explained by changes in respective beliefs.     

Time-Varying Treatments in Observational Studies: Marginal Structural Models of the Effects of Early Grade Retention on Math Achievement

One of the main objectives of many empirical studies in the social and behavioral sciences is to assess the causal effect of a treatment or intervention on the occurrence of a certain event. The randomized controlled trial is generally considered the gold standard to evaluate such causal effects. However, for ethical or practical reasons, social scientists are often bound to the use of nonexperimental, observational designs. When the treatment and control group are different with regard to variables that are related to the outcome, this may induce the problem of confounding. A variety of statistical techniques, such as regression, matching, and subclassification, is now available and routinely used to adjust for confounding due to measured variables. However, these techniques are not appropriate for dealing with time-varying confounding, which arises in situations where the treatment or intervention can be received at multiple timepoints. In this article, we explain the use of marginal structural models and inverse probability weighting to control for time-varying confounding in observational studies. We illustrate the approach with an empirical example of grade retention effects on mathematics development throughout primary school.