Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST)

This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians’ ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.     

CBT/DBT-Informed Intensive Outpatient Treatment for Anxiety and Depression: A Naturalistic Treatment Outcomes Study

Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p < .001), depression (t = 5.55, p < .001), and suicidality (t = 2.32, p < .05) over the course of the IOP. After completing treatment, 68.1% of participants tapered down to once-weekly treatment. The present study highlights the clinical utility of an IOP and suggests that this approach can be effective for adult patients presenting with severe symptoms of anxiety and/or depression.     

Attachment and behavioral addictions in adolescents: The mediating and moderating role of coping strategies

Gambling, video gaming, and Internet use are typically included as everyday activities that could potentially become behavioral addictions. There is growing evidence that views non‐substance related addictions as coping mechanisms, and considers that attachment styles are likely to play a pivotal role on the development of such addictions, especially on young people. Therefore, the present study aimed to: (1) explore the association between attachment, coping, and behavioral addictions (i.e., gambling disorder, video game addiction, and problematic Internet use); and (2) to analyze the mediating/moderating effect that coping has in the relationship of attachment and these behavioral addictions. A sample consisting of 472 students from secondary education (Mean age = 15.6; SD = 1.33; 51.6% females) was recruited. The findings showed a negative association between attachment and behavioral addictions. Most coping strategies were found to be associated with attachment styles, except for self‐critique and emotional avoidance. In particular, problem avoidance was significantly correlated to all behavioral addictions. In addition, self‐blame and problem solving were significantly correlated to video game addiction and problematic Internet use. Finally, coping was found to act as a mediator and moderator between attachment and video game addiction and problematic Internet use.     

Cognitive-behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: A preliminary study

Abstract

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive–compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Δ = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Δ = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.     

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Reduced autobiographical memory specificity as a mediating factor between general anxiety symptoms and performance on problem‐solving tasks

This study sought to further explain the association between general anxiety symptoms and impaired problem‐solving by testing whether this occurs, in part, through a reduced ability to retrieve event‐level, specific autobiographical memory (AM). Participants (N = 301; M age = 28.2 SD = 7.7, 55.8% female) completed assessments of the retrieval of specific AM, anxiety symptoms, depressive symptoms, and rumination. They then completed the Means‐End Problem Solving Task, which assessed their ability to produce relevant problem‐solving steps. Participants who were higher in anxiety reported a lesser number of relevant problem‐solving steps, and this association was, in part, related to anxiety being associated with reduced AM specificity (after controlling for depressive symptoms). Rumination did not mediate anxiety and problem‐solving, nor anxiety and AM specificity. These findings provide further evidence that elevated anxiety is associated with reduced ability to retrieve specific AM, and a specific cognitive pathway through which anxiety may affect problem‐solving performance.     

Behavioral and Socio-emotional Functioning in Children with Selective Mutism: A Comparison with Anxious and Typically Developing Children Across Multiple Informants

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8.9 years, SD = 3.2 years), and 49 community controls (M = 7.7 years, SD = 2.6 years) on primary caregiver, teacher, and child reports of behavioral and socio-emotional functioning. Children with SM were rated lower than controls on a range of social skills, but the SM and MA groups did not significantly differ on many of the social skills and anxiety measures. However, children with SM were rated higher than children with MA and controls on social anxiety. Findings suggest that SM may be conceptualized as an anxiety disorder, with primary deficits in social functioning and social anxiety. This interpretation supports a more specific classification of SM as an anxiety disorder for future diagnostic manuals than is currently described in the literature. The present findings also have implications for clinical practice, whereby social skills training merits inclusion in intervention for children with anxiety disorders as well as children with SM.     

Personality pathology severity,cluster type and specific therapeutic interventions in outpatient psychotherapy

We explored the relationship between severity of personality pathology, cluster type and therapeutic interventions (psychodynamic–interpersonal [PI] and cognitive–behavioural [CB]) in 76 outpatients across two early sessions (3rd and 9th) of psychodynamic psychotherapy, while accounting for patients' baseline global symptom severity. Pretreatment personality pathology severity was assessed using the Personality Disorder Index (PDI), where DSM‐IV Axis II PD was assigned a value of 2, subclinical traits and features were assigned a 1 and absence of Axis II psychopathology was assigned a 0. Interrater reliability of personality pathology severity was excellent (ICC [1, 1]: 0.85). Interrater agreement for Cluster A (κ = 0.75), Cluster B (κ = 0.92) and Cluster C (κ = 0.70) was high. Interventions were coded with Comparative Psychotherapy Process Scale (CPPS) from videotapes, and reliability was excellent (CPPS‐PI = 0.86; CPPS‐CB = 0.78). Stepwise linear regressions indicated that therapists' focus on mood shift/topic avoidance (B = 0.29, p = .009) and future events (B = ?0.26, p = .020) predicted Axis II severity. Overall use of PI techniques and Cluster A personality disorder (CLA) were positively correlated (r = .312, p = .006). Stepwise binomial logistic regressions indicated that therapists' focus on uncomfortable feelings (B = 1.915, p = .008) and explaining rationale behind approach (B = 1.276, p =. 038) predicted CLA. All results remained significant when controlling for patients' baseline general symptomatology (Brief Symptom Inventory‐Global Severity Index [BSI‐GSI]), except for the relation between explaining rationale and CLA. Discussion highlights how using psychodynamic treatment model, therapists' focus on patient's in‐session affect expression and explaining rationale behind approach are highly relevant when working with CLA patients.     

Body image disturbance and skin bleaching

This study looks at body image disturbance among Jamaicans who bleach their skin. The hypothesis states that there is a positive relationship between skin bleaching and body image disturbance. The study used a convenience sample of 160 participants with a skin bleaching group (n = 80) and a non‐bleaching comparison group (n = 80). The instrument included demographic questions, the body image disturbance questionnaire (BIDQ), and questions about skin bleaching. The results of a t‐test revealed that the skin bleaching group (M = 1.5255, SD = 0.42169) was not significantly different from the non‐bleaching group (M = 1.4938, SD = 0.74217) in terms of body image disturbance, t(158) = 0.333, p = .740. The participants who bleached did not suffer from body image disturbance. Self‐reports revealed that they bleached to acquire beauty, attract a partner, elude the police, and market skin bleaching products. The practice was fashionable and popular and it made some participants feel good, while others were fans of a popular musical artiste who bleached his skin. The majority of participants bleached because of the perceived personal, social, and entrepreneurial benefits of the practice and not because they suffered emotional distress, anxiety, and functional impairment because of their skin colour. However, there was some level of BID among the minority of participants who argued that they bleached because they wanted to be pretty so they were emotionally distressed about there body image and experienced functional impairment.     

Relational aggression in college students: Examining the roles of social anxiety and empathy

This study examined the unique contributions of social anxiety and empathy to relational aggression in 300 19–to–25–year–old (M=21.25; SD=1.32) male (n=97) and female (n=203) college students using hierarchical linear regression analysis. The interactive relations between gender and social anxiety, and between gender and empathy, were also assessed. In addition to the gender and overt aggression covariates, fear of negative evaluation and perspective taking were unique predictors of relational aggression. Males, students who were more overtly aggressive, and those who reported greater fear of negative evaluation were more relationally aggressive than were peers. Students with higher levels of perspective taking reported using less relational aggression than did peers. A gender x empathetic concern interaction indicated that for males only, lower levels of empathetic concern were associated with higher levels of relational aggression. Results are discussed within a social information‐processing perspective. Aggr. Behav. 29:430–439, 2003. © 2003 Wiley‐Liss, Inc.     

Parent Education for Migrant Mothers of Left‐Behind Children in China: A Pilot Randomized Controlled Trial

Although numerous studies have indicated the significance of parental support and parent–child communication in alleviating the adverse effects of parental departure on left‐behind children, researchers have rarely addressed the impact of parent education on migrant parents. On the basis of the results of a pilot randomized controlled trial, the study reported here involved examining the possible outcomes and feasibility of a parent education program for rural‐to‐urban migrant mothers of left‐behind children in China. Informed by an existential–narrative approach to parent education, the program was composed of six 2.5‐hour sessions. The sample included 56 migrant mothers recruited from a social service center in Shenzhen, China, who were randomly assigned to either the immediate group (n = 28, M = 34.82 years, SD = 4.12, aged 23–43) or the waitlist control group (n = 28, M = 34.68 years, SD = 4.53, aged 28–43). The hypotheses of the trial were twofold: that the program would positively affect participants’ parental identity and that it would improve mother–child relationships and parenting practices. The results revealed no significant difference in parental identity between the intervention group and the waitlist control group at the post‐test assessment after ruling out the effects of pretest survey scores. However, significant differences did emerge in parent–child relationships and parenting practices. Overall, the results corroborate the feasibility of examining the current program for migrant mothers in China in a full trial. The findings also offer insights into developing empirically supported parent education programs for migrant parents.     

Obsessive beliefs and uncertainty in obsessive compulsive and related patients

Background/objectiveThe aim of the present study was to examine obsessive beliefs and intolerance of uncertainty differences among patients Obsessive compulsive disoreder (OCD), trichotillomania, excoriation, generalized anxiety disorder (GAD) and a control group healthy.Method130 participants between the ages of 17 and 62 years (Mean = 29.56, SD = 11.81) diagnosed with OCD (n = 36), trichotillomania (n = 18), excoriation (n = 17), GAD (n = 31) and a healthy control group (n = 28) were evaluated by Obsessive Beliefs Spanish Inventory-Revised and Intolerance of Uncertainty Scale.ResultsThe trichotillomania group presented one of the highest obsessive beliefs highlighting over-importance of thoughts, thought action fusion-moral, importance of controlling one's thoughts. The OCD group also had higher scores in inflated responsibility and thought action fusion-likelihood. The GAD group excelled in inhibitory and prospective uncertainty. The level of depression influenced obsessive beliefs while anxiety affected inhibitory and prospective uncertainty.ConclusionsCognitive variables such as obsessive beliefs and Intolerance of Uncertainty should be considered in the prevention and intervention of obsessive and anxiety disorders.     

Findings on the relationship between Internet addiction and psychological symptoms in Brazilian adults

This study evaluated the prevalence of Internet addiction (IA) and its association with negative psychological symptoms in Brazilian adults. A network analysis was conducted to estimate specific variables and their expected influence on IA. In this cross-sectional study, 15,476 adults (M_age = 37.5, SD = 9.59) completed an open web-based survey. Three questionnaires were used: the Internet Addiction Test (IAT), Depression Anxiety and Stress Scale (DASS-21) and Satisfaction With Life Scale (SWLS). Based on IAT scores, participants were classified as No-Risk user (NRU), Low-Risk user (LRU) or High-Risk user (HRU). We observed that 4.8% of the participants were classified in the HRU group. In addition, their risk for severe symptoms of depression was 10 times higher and, for anxiety, seven times higher than that in the NRU group (p < .001). Time spent using smartphones was also significantly higher in the HRU group (M_hours = 5.1, p < .001). The main factors associated with IA were depression, gender and anxiety, but the variable “having children” was the most influential in the IA network. These findings suggest that psychiatric symptoms are the main factors associated with IA among the adult population.     

The buffering role of in‐group identification and intergroup contact on the association between perceived discrimination and mental health

Previous research has shown that disadvantaged group members cope with the negative effects of perceived discrimination (PD) on mental health using various mechanisms. We examined the potential protective role of two processes—in‐group identification and intergroup contact—on the association between PD and mental health (anxiety and depression) among physically disabled adults (N = 269, M_age = 39.13, SD = 13.80). Intergroup contact, but not in‐group identification, had a buffering role on the association between PD and both depression and anxiety. However, this effect was further moderated by in‐group identification such that high levels of intergroup contact had a protective role against PD, only when in‐group identification was low. Findings highlight the importance of evaluating various social–psychological processes interactively in creating a resilient outlook among disadvantaged groups.     

The Effects of Modafinil on Convergent and Divergent Thinking of Creativity: A Randomized Controlled Trial

Modafinil is a drug licensed for the treatment of narcolepsy and sleep apnea. Recently, modafinil has been reported to be used as a pharmacological cognitive enhancer by healthy individuals with no psychiatric disorders. This paper reports on a study that investigated the effects of modafinil on divergent and convergent thinking tasks of creativity. Sixty‐four healthy male (n = 31) and female (n = 33) volunteers participated in a randomized double‐blind placebo‐controlled parallel group design study. For the convergent thinking tasks, modafinil had no significant main effect on the Group Embedded Figures Task and the Remote Associates Task (RAT). However, a median split analysis showed that modafinil participants low in creativity personality trait had significantly higher RAT scores (Mean [M] = 6.85, SD = 3.39; 95% confidence interval [95% CI]: 5.53–8.2) than those high in creativity personality trait (M = 4.27, SD = 3.0; 95% CI: 2.4–6.0). For the divergent thinking tasks, relative to placebo (M = 1.195, SD = 0.28; 95% CI: 1.0–1.3), modafinil (M = 0.77, SD = 0.37; 95% CI: 0.63–0.92) significantly reduced the performance of flexibility scores and marginally reduced the elaboration scores as measured by the Abbreviated Torrance Test for Adults (ATTA). Overall, participants on modafinil (M = 6.3, SD = 2.6; 95% CI: 5.3–7.4) had significantly lower ATTA scores relative to participants on placebo (M = 9.5, SD = 2.3; 95% CI: 8.6–10.4). These results indicate that modafinil might reduce divergent thinking of creativity in healthy individuals. They suggest that, rather than being a more general cognitive enhancer, modafinil might have negative and subtle effects on creativity. However, the results are from a small‐scale trial, which tested a small number of participants. Therefore, the results need to be interpreted with caution. A replication with a large sample of participants is recommended.     

A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients

Background/ObjectiveContingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.MethodA total of 80 participants (75.8% males; M_age = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.ResultsAdding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).ConclusionsCM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.     

Letting go of your dreams—Adjustment of child-related goal appraisals and depressive symptoms during infertility treatment

To examine the adjustment of child-related goal appraisals during infertility treatment and whether such adjustment contributes to depressive symptoms 178 (86 men, 92 women; age for women M = 33.92, SD = 0.34, for men M = 35.68, SD = 0.45) patients at an Infertility Clinic filled in child-related goal appraisal questionnaires six times: (1) before starting the hormone injections, (2) before the oocytes were retrieved, (3) after embryo transfer, (4) the day when the pregnancy test was done, and (5) two and (6) six months after the infertility treatment. At the first and last measurement times they filled in questionnaire on depressive symptoms. Appraisals concerning child-related goal changed in tandem with the treatment result, and goal adjustment had an effect on depressive symptoms.     

Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: a pilot study comparing CA-CBT to applied muscle relaxation

We examined the therapeutic efficacy of a culturally adapted form of CBT (CA-CBT) for PTSD as compared to applied muscle relaxation (AMR) for female Latino patients with treatment-resistant PTSD. Participants were randomized to receive either CA-CBT (n = 12) or AMR (n = 12), and were assessed before treatment, after treatment, and at a 12-week follow-up. The treatments were manualized and delivered in the form of group therapy across 14 weekly sessions. Assessments included a measure of PTSD, anxiety, culturally relevant idioms of distress (nervios and ataque de nervios), and emotion regulation ability. Patients receiving CA-CBT improved significantly more than in the AMR condition. Effect size estimates showed very large reductions in PTSD symptoms from pretreatment to posttreatment in the CA-CBT group (Cohen’s d = 2.6) but only modest improvements in the AMR group (0.8). These results suggest that CA-CBT can be beneficial for previously treatment-resistant PTSD in Latino women.     

Student outcomes after 1 year of front line staff implementation of the PEAK curriculum

Systems‐level interventions built by behavior analysts often rely on others to implement, and this may be especially true in public education settings where behavior analysts are scarce. This study evaluated the effectiveness of the Promoting the Emergence of Advanced Knowledge Direct Training (PEAK‐DT) curriculum when implemented by school teachers and direct care staff. Thirty‐nine children with autism took part in the study (19 PEAK, 15 control), where the experimental group received applied behavior analytic instruction through the PEAK‐DT curriculum, and the quasi‐randomized control group received training as usual. The PEAK‐DT assessment was first administered to the participants at the onset of the study and again following 1 year. Participants who received PEAK training gained more skills on the PEAK‐DT assessment compared to the control group (PEAK: M = 16.0, SD = 17.8; control: M = 6.1, SD = 14.4, F(1,33) = 10.66, p < .05), suggesting that systems level implementation of behavior analytic procedures can be effective in teaching language skills as prescribed in a packaged curriculum designed by behavior analysts.