The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery

Background

The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.

Aims

To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.

Method

101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions (‘Overcoming Bulimia Online’), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.

Results

There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.

Conclusions

The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.     

Emotion-regulation skills as a treatment target in psychotherapy

Background

Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders.

Aim

To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions.

Method

Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial.

Results

Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health.

Conclusion

Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions.     

Examining the relationship between family context and children’s physical activity beliefs: The role of parenting style

Objectives

Previous research studies examining parental influences on children’s physical activity (PA) have focused primarily on parents’ own PA behavior, as well as their PA-related beliefs and socially supportive behaviors. The present study, although aligned with this mainstream parental influence research, was grounded in a broader child development perspective to examine the influence of parenting style on children’s PA beliefs and quality of parent-child communication.

Method

Self-report questionnaires were administered to 173 children ranging in age from 9 to 12 years to assess their perceptions of parenting style, parent-child communication patterns, as well as their own perceptions of fitness competence, value, and goal orientation.

Results

Children’s constellation of beliefs and attitudes regarding PA as well as their perceptions of the parent-child communication process did vary as a function of the type of parenting style they perceived their parents to use. High challenge parenting style was linked to higher perceived fitness competence and value on the part of the children. High support parenting style was linked to more positive perceived parent-child communication patterns.

Conclusion

Parenting style may be a critical underlying family process variable that impacts children’s development of a positive constellation of beliefs about PA. Future work is needed to link parenting style and children’s PA beliefs to their PA behavior.     

Cognitive style and depressive symptoms in elderly people - Extending the empirical evidence for the cognitive vulnerability-stress hypothesis

Introduction

Depression is common in older people and its identification and treatment has been highlighted as one of the major challenges in an ageing world. Poor physical and cognitive health, bereavement, and prior depression are important risk factors for depression in elderly people. Attributional or cognitive style has been identified as a risk factor for depression in children, adolescents and younger adults but its relevance for depression and mood in elderly people has not been investigated in the context of other risk factors.

Method

Sixty-four older adults from an ‘extra care’ living scheme (aged 59-97) were recruited for a 6-week prospective study to examine the relationships between cognitive style and depressive symptoms.

Results

Regression analyses revealed that, when other risk factors were controlled for, cognitive style and its interaction with stress predicted changes in depressive symptoms, therefore partially replicating prior research.

Conclusion

Cognitive-stress-vulnerability models also apply to elderly populations, but may be rather predictive of changes in depression when facing lower levels of stress.     

Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial

Objective

This study aimed to evaluate the success of implementing outpatient schema focused therapy (ST) for borderline patients in regular mental healthcare and to determine the added value of therapist telephone availability outside office hours in case of crisis (TTA).

Methods

To enhance the implementation, the following adaptations regarding the original ST protocol were applied: a reduction in the frequency and duration of the therapy; training therapists of eight regular healthcare centers in ST with a structured and piloted program supported by a set of films (DVDs) with examples of ST techniques; training and supervision given by Dutch experts. Telephone availability outside office hours was randomly allocated to 50% of the therapists of each treatment center. Patient's outcome measures were assessed with a semi-structured interview and self-report measures on BPD, quality of life, general psychopathology and an ST questionnaire, before, during and after treatment.

Results

Data on 62 DSM-IV defined BPD patients were available. Intention-to-treat analyses showed that after 1.5 years of ST 42% of the patients had recovered from BPD.No added value of therapist telephone availability (TTA) was found on the BPDSI score nor on any other measure after 1.5 years of ST.

Conclusions

ST for BPD can be successfully implemented in regular mental healthcare. Treatment results and dropout were comparable to a previous clinical trail. No additional effect of extra crisis support with TTA outside office hours ST was found.     

Knowledge of results after relatively good trials enhances self-efficacy and motor learning

Objectives

This study sought to determine whether learners’ self-efficacy and motor learning was affected by the type of feedback they were provided.

Method

Participants (N = 24, M age = 19.51 years, SD = 1.08) were randomly assigned into one of two groups: knowledge of result after good versus poor trials. The task included throwing a tennis ball with the non-dominate hand to a target while wearing vision distorting goggles. Participants completed the Self-Efficacy Scale (Bandura, 2006) before performing each block of 6 trials. A retention test without knowledge of results was conducted 24 h after the practice phase.

Results

The results demonstrated that learners’ motor learning was increased by providing knowledge of results after good rather than poor trials. Furthermore, the Self-Efficacy Scale results revealed that learners’ self-efficacy was enhanced by positive feedback.

Conclusions

The current findings indicate that positive feedback impacts learner’s self-efficacy, and enhances performance and motor learning.     

Cognitive-behavioral treatment of childhood obsessive-compulsive disorder in community-based clinical practice: clinical significance and benchmarking against efficacy

Objective

To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic.

Method

This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement.

Results

Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment.

Conclusions

This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.     

Maternal attachment representations after very preterm birth and the effect of early intervention

Objective

For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infant's regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth.

Method

Seventy-eight mothers of very preterm infants (<32 weeks and/or <1500 g) were interviewed, who participated in a randomized controlled trial: 41 from the intervention group and 37 from the control group. Maternal attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced.

Results

30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group.

Conclusion

Early support for mothers of very preterm born infants to develop a healthy mother-infant relationship is recommended especially for mothers who report negative first experiences.     

Youth athletes’ perception of autonomy support from the coach, peer motivational climate and intrinsic motivation in sport setting: One-year effects

Objectives

Grounded in self-determination theory (SDT; Deci & Ryan, 1985) and achievement goal theory (AGT; Nicholls, 1989), the present study examined the temporal stability and reciprocal relationships among three key variables related to motivation: perceived autonomy support from the coach, task-involving peer motivational climates, and athletes’ intrinsic motivation.

Design

A prospective longitudinal design with data collected on two occasions one year apart over the course of a youth training season.

Method

Young athletes (N = 362, age range 11-16 years) completed measures of the Sport Climate Questionnaire and the Peer Motivational Climate in Youth Sport Questionnaire. One-year later participants completed these questionnaires again along with the Sport Motivation Scale.

Results

Structural equation modeling indicated that perceived autonomy support from the coach and task-involving peer motivational climates exhibited comparatively high stability over a one-year period. In cross-lagged analyses, perceived autonomy support from the coach positively predicted task-involving peer climate one-year later but not vice versa. In addition, both social factors demonstrated a significant direct effect on athletes intrinsic motivation measured concurrently in sport contexts. Further, an alternative structural model supported a longitudinal direct effect of autonomy support from the coach and task-involving peer climate measured on the first occasion on subsequent intrinsic motivation.

Conclusion

Results demonstrated the value of perceived autonomy support from the coach and task-involving peer motivational climate in predicting athletes’ intrinsic motivation over a training year. Findings also suggest that perceived autonomy support from the coach can facilitate later task-involving peer motivational climate.     

An experimental investigation of physical education teachers’ and coaches’ reactions to weight-based victimization in youth

Objectives

Overweight youth are frequent targets of weight-based victimization during Physical Education (PE) and sports. In addition, previous research indicates that teachers’ perceptions and expectations may influence their likelihood of intervening during victimization, and physical educators may endorse biased perceptions and expectations of overweight youth. Despite this evidence, no research has examined how physical educators respond to weight-based victimization of their students. Thus, the current study examined PE teachers’ and coaches’ responses to different types of victimization involving average weight and overweight students.

Design

This study utilized an experimental design that assessed participants’ reactions to situations of weight-related victimization using hypothetical scenarios accompanied by photographs of youth.

Methods

PE teachers and sport coaches (N = 162) were randomly presented with a scenario and follow-up questions about an average weight or an overweight student. Each participant completed two conditions: one with a male target, and one with a female target.

Results

Participants were more likely to take action when overweight female students were victims of bullying, specifically in situations of verbal and relational victimization. Male participants were less likely to respond to victimization than female participants.

Conclusions

Findings suggest the importance of increasing awareness about weight-based victimization and its consequences, especially among male physical educators. Implications for the psychological, social, and physical development of overweight youth are discussed.     

Effects of a cognitive specific imagery intervention on the soccer skill performance of young athletes: Age group comparisons

Objectives

The primary purpose of the present study was to examine the effects of a cognitive specific (CS) imagery intervention on the soccer skill performance of young athletes aged 7-14 years and determine if performance varied with age.

Design

Participants were 143 soccer athletes belonging to 16 different teams. Teams were randomly assigned to either a cognitive specific (CS) or motivational general-arousal imagery intervention.

Methods

Athletes were administered the SIQ-C and tested on the soccer skill to determine baseline performance. Following their imagery intervention, athletes were tested on the same soccer skill, and completed the SIQ-C a second time.

Results

The results indicated that only the younger athletes (7-10 years) receiving CS imagery performed faster following their intervention. Moreover, only the 7-8 year old athletes in the CS imagery condition significantly increased their use of CS imagery over time.

Conclusions

These findings suggest that young athletes who use CS imagery will benefit from a CS imagery intervention, thus implying that mental skills training should begin at a young age if athletes are to maximize the benefits of such training.     

The social environment and developmental experiences in elite youth soccer

Objectives

We aimed to examine social-contextual correlates of players’ developmental experiences in an elite youth soccer context. Specifically, we hypothesized that player perceptions of team cohesion and coach rapport would be positively associated with psychological need fulfillment. In turn, psychological need satisfaction was proposed to be positively related to adaptive developmental experiences in youth soccer (i.e., opportunities for leadership, emotional regulation, and goal setting), and negatively related to social exclusion.

Design

Cross-sectional.

Method

133 male elite soccer players, aged between 11 and 18 years old, completed a self-report questionnaire assessing the variables of interest.

Results

Using path analysis and bootstrapping methods, we found support for the overall model fit of the hypothesized conceptual framework and specific study hypotheses.

Conclusions

This study utilizes strong theoretical foundations to underscore the role of the coach and team environment in facilitating positive youth outcomes, and highlights a potential mechanism that may explain these processes.     

The relative roles of physical education teachers and parents in adolescents’ leisure-time physical activity motivation and behavior

Objectives

The purpose of this study was to explore the relative contributions of perceived parent and physical education teacher autonomy support, involvement, and modeling to adolescent leisure-time physical activity motivation and behavior within the framework of self-determination theory.

Design

Cross-sectional survey.

Method

161 Middle school students completed a paper survey which assessed the study variables.

Results

Three sets of models were tested that examined the relationships of autonomy support, involvement, and modeling from mothers, fathers, and physical education teachers to adolescent leisure-time physical activity self-determined motivation and behavior. In the models, each social support variable had a significant, positive, direct relationship to motivation, and a significant, positive, indirect relationship to physical activity behavior mediated by motivation. Further, the relationships between social support from each significant other and motivation were of similar magnitude.

Conclusions

Mothers and fathers both play modest, yet significant roles in their adolescent’s leisure-time physical activity motivation. Additionally, physical education teachers, although not present in the leisure-time physical activity context, serve an equally important role in supporting adolescents’ leisure-time physical activity. Lastly, adolescent self-determined motivation for leisure-time physical activity is a strong determinant of self-reported leisure-time physical activity behavior.     

Working within an Individual Zone of Optimal Functioning (IZOF) framework: Consultant practice and athlete reflections on refining emotion regulation skills

Objective

To examine how working within Hanin’s (2000a) Individual Zone of Optimal Functioning theoretical model (IZOF) informs intervention development for enhancing athletes’ emotion regulation skills.

Design

A single case study design was adopted to examine the applied process of facilitating a female university cross-country runner’s emotion regulation skills.

Method

Consultant reflections followed Boud’s (2001) reflective learning model for immediate and delayed reflection that informed an action research narrative organized round Kellmann and Beckmann’s (2003) action research cycle. A social validation interview was conducted following program completion to examine the athlete’s responses to the emotion regulation intervention.

Results

Consultant’s professional practice decisions and action taken to support the intervention are highlighted. Specifically, the employment and extension of Hanin’s (2000c) IZOF profiling process to inform the development of athlete skills in emotion regulation are described. Moreover, how the content and intensity of performance related subjective emotion, physiological symptom, and cognitive zone profiles for optimal performance guided the identification and enhancement of techniques contributing to effective emotion regulation is illustrated. Athlete interview responses support the overall efficacy of the intervention program.

Conclusion

The present case study supports the efficacy of working within an IZOF framework from a consultant perspective. Furthermore, athlete reflections suggest enhanced skills in emotion regulation were perceived to result from the intervention.     

Perspectives on the home advantage: A comparison of football players, fans and referees

Objectives

The study aimed to address the paucity of research pertaining to perceptions of causes of the home advantage. The views of three key personnel groups in football (soccer) were examined with regard to their perspectives.

Design and procedure

Players (n = 94), fans (n = 116) and referees (n = 163) completed a ten-item questionnaire on which they rated the contribution of the most prominent factors known to influence the home advantage.

Results

Factor analysis revealed three subscales (officials, player state and home environment) relating to explanations for the home advantage. A MANOVA examining the groups’ ratings for these three subscales found that the fans and player gave higher ratings for the contribution of officials and player state than did referees, while the fans gave higher ratings for the home environment.

Conclusion

The present study provides an insight into conceptualisations of the home advantage from the perspectives of different football groups. The relevance of self-enhancement, emanating from motivational and information processing mechanisms, is considered.     

Contextual and individual influences on antisocial behaviour and psychobiosocial states of youth soccer players

Purpose

The aim of the study was to assess the effects of contextual and individual variables (perceived motivational climate and moral atmosphere, task/ego orientation and perceived competence) on antisocial behaviour and emotion-related psychobiosocial (PBS) states as conceptualised within the individual zones of optimal functioning model.

Participants

The study was conducted on a sample of 382 young male soccer players, aged from 14 to 16 years, drawn from 27 Italian teams.

Method

A cross-sectional design was used. Assessment included measures of reported antisocial behaviour, perceived moral atmosphere, perceived motivational climate, goal orientation, perceived competence, and PBS states. Data analysis involved confirmatory factor analysis of measures and path analysis of the hypothesized relationships.

Results

Results suggest that performance climate and a moral atmosphere, in which aggressive behaviours are encouraged, are likely to determine antisocial behaviour and a range of unpleasant PBS states in young sports participants.

Conclusions

Findings substantiate the importance of the situational factors on ethical aspects and emotional states in youngsters.     

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Objective

This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.

Method

Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.

Results

Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.

Conclusions

Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.     

Athletes’ ease of imaging predicts their imagery and observational learning use

Objectives

Following the development of the Sport Imagery Ability Questionnaire (SIAQ; Williams & Cumming, 2011), the aim of the present two studies was to more comprehensively examine the relationship between sport-related imagery ability and the functions of imagery and observational learning (OL) athletes report. A second aim was to establish the SIAQ’s predictive validity.

Design

Two samples of cross-sectional questionnaire data are presented in two studies.

Method

For both studies, athletes were recruited from a variety of team and individual sports, ranging in competitive level and years of experience. In Study 1, 117 participants (41 male and 76 female) with a mean age of 24.38 (SD = 9.46) completed the SIAQ and the Sport Imagery Questionnaire (SIQ; Hall, Mack, Paivio, & Hausenblas, 1998). In Study 2, 221 participants (83 male and 138 female) with a mean age of 22.34 (SD = 7.66) completed the SIAQ and the Functions of Observational Learning Questionnaire (FOLQ; Cumming, Clark, Ste-Marie, McCullagh, & Hall, 2005).

Results

Athletes’ imagery ability significantly predicted their imagery and OL use. Moreover, with the exception of performance OL, predictions were stronger when the type of imagery ability closely matched the function of imagery or OL being predicted.

Conclusions

As well as demonstrating the predictive validity of the SIAQ, results from both studies support the need to use imagery ability measures that most closely match the type of imagery or OL being used.