A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder

Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges’ g = 1.24) and follow-up (mean Hedges’ g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.     

Exploring the Effects of the Mindfulness and Countering Emotional Behaviors Modules From the Unified Protocol on Dysregulated Anger in the Context of Emotional Disorders

Dysregulated anger in the context of emotional (e.g., mood, anxiety, related) disorders is associated with treatment attrition and a lower likelihood of responding to extant treatments. Therefore, there is a need to identify the most effective skills for targeting this anger and prioritize their delivery in treatment with the hope of producing more potent interventions. The current study explored the specific effects of two treatment skills (mindfulness and countering emotional behaviors) in isolation and combination as interventions for dysregulated anger using single-case experimental design. Patients were randomized to a 2- or 4-week baseline with no intervention applied and then to the first treatment skill received. All patients subsequently completed the alternate treatment skill and 1 month of follow-up. Results suggested the first module had clinically meaningful effects for five patients and the second module produced incremental improvement for five patients. Visual inspection and effect sizes indicated mindfulness produced greater reductions in anger when delivered in isolation compared to countering emotional behaviors (d = 0.96, 0.33, for mindfulness and countering emotional behaviors, respectively). With regard to the second module, more patients (n = 4) experienced a reduction in anger in response to mindfulness than to countering emotional behaviors (n = 1); effect sizes indicated significant improvements in response to both modules (d = 0.83, 0.72, for mindfulness and countering emotional behaviors, respectively). Taken together, results suggest mindfulness may be a more efficacious intervention for anger than countering emotional behaviors. Implications of these results for addressing dysregulated anger in treatment are discussed.     

Acceptance and Commitment Therapy for Anger Dysregulation with Military Veterans: A Pilot Study

Anger dysregulation is a commonly reported problem by treatment-seeking military veterans that is associated with a range of negative outcomes. However, there is a paucity of studies examining interventions for anger and aggressive behavior in this population. Theory and empirical evidence suggest Acceptance and Commitment Therapy (ACT) may be a viable and effective treatment for anger dysregulation among veterans. The present study examined the feasibility and preliminary effectiveness of an open trial of an ACT group intervention for veterans reporting difficulties with anger and aggressive behavior. Twenty-three male military veterans (mean age?=?54.83) initiated a 12-week ACT intervention with assessments administered at pre-treatment, post-treatment, and 6-week follow-up. Treatment completers found the intervention favorable, and participation was associated with improvements in trait physical aggression and psychological flexibility, while significant changes in anger reactivity, quality of life, and verbal aggression were not found. Results suggest group-based ACT for anger dysregulation is feasible in a male military veteran sample, and warrants further investigation.     

Effects of anger management and goal setting group interventions on state-trait anger and self-efficacy beliefs among high risk adolescents

In this study we evaluated the effects of two psychoeducational groups (anger management and goal setting) on state and trait anger, anger expression, and on self-efficacy beliefs of high risk adolescents enrolled in an alternative high school. Participants (n = 57) were pre- and post-tested using the State Trait Anger Expression Inventory (STAXI) with subscales for (a) state anger, (b) trait anger, and (c) anger expression, and on a measure of self-efficacy related to (a) anger management, (b) goal setting, and (c) group behavior and interpersonal communication. We hypothesized that each treatment would favorably impact the self-efficacy items related to it, that participants in both treatment groups would show gains in self-efficacy for general group behavior and communication skills, and that the anger management treatment would decrease state anger and anger expression. Results of a series of Repeated Measures ANOVAS revealed no group effects or group by time interaction effects. Analysis of Cohen's d effect sizes for the treatment groups in comparison with the control condition indicated only small treatment effects for the goal setting group on the STAXI, and small, negative treatment effects for the anger management group on the STAXI and on state anger. Thus, results failed to support the hypotheses with the current data set. Limitations of this study and implications for future research and group practice within schools are discussed. The authors thank Ellen Hawley McWhirter, Greg Sandstrom, and the administration, faculty, and students of the participating “alternative high school” for their help and support.     

Effects of anger management and goal setting group interventions on state-trait anger and self-efficacy beliefs among high risk adolescents

In this study we evaluated the effects of two psychoeducational groups (anger management and goal setting) on state and trait anger, anger expression, and on self-efficacy beliefs of high risk adolescents enrolled in an alternative high school. Participants (n = 57) were pre- and post-tested using the State Trait Anger Expression Inventory (STAXI) with subscales for (a) state anger, (b) trait anger, and (c) anger expression, and on a measure of self-efficacy related to (a) anger management, (b) goal setting, and (c) group behavior and interpersonal communication. We hypothesized that each treatment would favorably impact the self-efficacy items related to it, that participants in both treatment groups would show gains in self-efficacy for general group behavior and communication skills, and that the anger management treatment would decrease state anger and anger expression. Results of a series of Repeated Measures ANOVAS revealed no group effects or group by time interaction effects. Analysis of Cohen's d effect sizes for the treatment groups in comparison with the control condition indicated only small treatment effects for the goal setting group on the STAXI, and small, negative treatment effects for the anger management group on the STAXI and on state anger. Thus, results failed to support the hypotheses with the current data set. Limitations of this study and implications for future research and group practice within schools are discussed. The authors thank Ellen Hawley McWhirter, Greg Sandstrom, and the administration, faculty, and students of the participating “alternative high school” for their help and support.     

过去十年中学生SCL-90调查结果的元分析

选取31篇有关中学生心理问题的研究报告,这些报告都用了90项症状自评量表（简称SCL-90）。用元分析方法对报告的数据进行了重新处理和分析。结果发现（1）平均效果量在-0．44到-0．15之间,即是以中学生常模为标准,以往的研究结果显示中学生心理并非不健康。（2）报告质量效应和出版年代效应显著,分别能解释效果量变异的26．6％和19．7％。显示原始报告的出版年代、发表刊物的等级等特征对其报告的SCL-90得分有系统影响。（3）出版年代效应显著显示以往研究报告SCL-90得分可能有随年代的推进而上升的趋势,但上升的原因尚不清楚。     

Predictors of Symptom Outcome in Interpretation Bias Modification for Dysphoria

Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.     

Dialectical behavior therapy for the treatment of anger and aggressive behavior: A review

ObjectiveThe management of anger and aggression is a public safety issue. Dialectical behavior therapy (DBT) is a promising treatment for reducing anger and violent behavior. This mode of therapy addresses maladaptive behavior by teaching emotion regulation, distress tolerance, interpersonal effectiveness, core mindfulness, and self-management skills.MethodsThis paper reviewed DBT treatment for anger and aggressive or violent behavior. The literature search included articles from 1998 to September 2013. A total of 21 peer-reviewed articles studying the effects of DBT on anger and aggressive behavior were reviewed.ResultsAdaptations or modifications were made to standard DBT to accommodate the specific needs of the variety of populations across studies. Nine studies attempted to understand the efficacy of DBT for anger and aggressive behavior while twelve studies measured the efficacy of DBT within the context of a BPD diagnosis. There are nine randomized controlled trials (RCT) assessing DBT to reduce anger and aggressive behavior.ConclusionResearch has shown that there are potentially clinically significant results when using DBT to treat anger and aggression in various samples. Findings from this review suggest that treatments, even when modified show a positive impact on the reduction of anger and aggressive behaviors.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address intimate partner violence in alcohol-treatment-seeking men. Analyses of feedback provided during manual development suggest participants (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention might be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address IPV in alcohol treatment-seeking men. Analyses of feedback provided during manual development suggest participants: (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention may be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Anger in Wikipedia: Perceived intentionality and threat appraisal as mediators of anger about man‐made attacks

The online encyclopedia Wikipedia has established strict guidelines for the objectivity of content. At the same time, Wikipedia includes articles on negative events, such as disasters or man‐made attacks. These events can elicit strong emotions, which in turn may spill over into Wikipedia articles. Previous research has shown that Wikipedia articles on man‐made attacks contain more anger‐related content than Wikipedia articles on disasters. Building on these findings, we aimed to investigate whether the threat that Wikipedia authors experience when they learn of an attack is relevant as a factor in explaining the anger effect. Threat is known to elicit active and engaged reactions, such as anger, which is why it is a likely explaining factor. Our research also aimed to replicate the findings from the linguistic analysis of the Wikipedia articles using controlled scenario‐based laboratory experiments. Three studies demonstrated that man‐made attacks (terrorist attack, shooting rampage) elicited more threat, more anger, and more expressions of anger‐related content in Wikipedia texts than nature‐made disasters (earthquake, flood) and man‐made disasters (train accident). Moreover, threat was relevant as a factor in explaining the effects on anger and anger‐related content in the Wikipedia texts. These mediations could be explained by the perceived intentionality of the event. This research highlights the findings that perceived intentionality and threat are relevant mediating factors for feelings and expressions of anger after man‐made attacks.     

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.     

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.     

Does psychotherapy work with school-aged youth? A meta-analytic examination of moderator variables that influence therapeutic outcomes

The present study is a quantitative synthesis of the available literature to investigate the efficacy of psychotherapy for children's mental health outcomes. In particular, this study focuses on potential moderating variables—study design, treatment, client, and therapist characteristics—that may influence therapeutic outcomes for youth but have not been thoroughly accounted for in prior meta-analytic studies. An electronic search of relevant databases resulted in 190 unpublished and published studies that met criteria for inclusion in the analysis. Effect sizes differed by study design. Pre–post-test designs resulted in absolute magnitudes of treatment effects ranging from |− 0.02 | to |− 0.76 | while treatment versus control group comparison designs resulted in absolute magnitudes of treatment effects ranging from |− 0.14 | to |− 2.39 |. Changes in youth outcomes larger than 20% were found, irrespective of study design, for outcomes focused on psychosomatization (29% reduction), school attendance (25% increase), and stress (48% reduction). The magnitude of changes after psychotherapy ranged from 6% (externalizing problems) to 48% (stress). Several moderator variables significantly influenced psychotherapy treatment effect sizes, including frequency and length of treatment as well as treatment format. However, results did not support the superiority of a single type of intervention for most outcomes. Implications for therapy with school-aged youth and future research are discussed.     

The Effectiveness of Solution-Focused Group Therapy in Ethnic Chinese School Settings: A Meta-Analysis

In order to assess the effectiveness and the moderators of the effects of solution-focused group therapy (SFGT) in ethnic Chinese school settings, we used a meta-analytic method to synthesize 24 studies from Taiwan and China. The results showed that the overall effect sizes of SFGT’s immediate and follow-up effects were 1.03 and 1.09, respectively, and were positive and large in ethnic Chinese school settings. The overall SFGT immediate effect size was large for all school levels, except for junior high schools (d = .61). The overall SFGT immediate effect size for internalizing behavior problems was 1.06, and for family and relationship problems it was .94. This study offers significant evidence pointing to SFGT’s high degree of effectiveness in ethnic Chinese school settings. Implications for the use of SFGT in school settings and Chinese culture are discussed.     

Having the will and finding the way: A review and meta-analysis of hope at work

Critics of the field of positive organizational psychology have expressed reservations with validity and utility of positive constructs, such as hope. The purpose of this article is to systematically review the existing research on hope at work and to determine the ‘true’ relationship between hope and work outcomes by meta-analyzing 133 effect sizes across 45 primary studies based on 11,139 employees. As predicted, we found that the overall corrected mean effect sizes between hope and work performance and employee well-being were positive and statistically significant. Gender and study location were significant moderators of these relationships, with women and US-based studies having stronger hope to work outcomes effects. Taken together, results demonstrate that positive psychology constructs, such as hope, play an important role in understanding and predicting employee behavior.     

Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling

Post-traumatic stress disorder (PTSD) is of great interest to public health, due to the high burden it places on both the individual and society. We meta-analyzed randomized-controlled trials to examine the effectiveness of early trauma-focused cognitive-behavioral treatment (TFCBT) for preventing chronic PTSD. Systematic bibliographic research was undertaken to find relevant literature from on-line databases (Pubmed, PsycINFO, Psyndex, Medline). Using a mixed-effect approach, we calculated effect sizes (ES) for the PTSD diagnoses (main outcome) as well as PTSD and depressive symptoms (secondary outcomes), respectively. Calculations of ES from pre-intervention to first follow-up assessment were based on 10 studies. A moderate effect (ES = 0.54) was found for the main outcome, whereas ES for secondary outcomes were predominantly small (ES = 0.27–0.45). The ES for the main outcome decreased to small (ES = 0.34) from first follow-up to long-term follow-up assessment. The mean dropout rate was 16.7% pre- to post-treatment. There was evidence for the impact of moderators on different outcomes (e.g., the number of sessions on PTSD symptoms). Future studies should include survivors of other trauma types (e.g., burn injuries) rather than predominantly survivors of accidents and physical assault, and should compare early TFCBT with other interventions that previously demonstrated effectiveness.     

Using Gratitude to Promote Positive Change: A Series of Meta-Analyses Investigating the Effectiveness of Gratitude Interventions

Gratitude interventions have been proposed as beneficial practices for improving myriad positive outcomes, and are promoted in self-help literature. The current work examined gratitude interventions’ effects with meta-analytic techniques to synthesize findings of thirty-eight studies, totaling 282 effect sizes. Fifty-six separate meta-analyses examined outcome effects for: gratitude versus neutral comparison at postintervention and delayed follow-up; gratitude versus negative comparison at post and follow-up; and gratitude versus positive comparison at post and follow-up. Results show that gratitude interventions can lead to improvements for numerous outcomes, including happiness, but do not influence others. Their unique benefits may be overemphasized in the literature.     

A Meta-Analysis of Research on Hindsight Bias

We conducted a meta-analysis of research on hindsight bias to gain an up-to-date summary of the overall strength of hindsight effects and to test hypotheses about potential moderators of hindsight distortion. A total of 95 studies (83 published and 12 unpublished) were included, and 252 independent effect sizes were coded for moderator variables in 3 broad categories involving characteristics of the study, of measurement, and of the experimental manipulation. When excluding missing effect sizes, the overall mean effect size was Md = .39 with a 95% confidence interval of .36 to .42. Five main findings emerged: (a) effect sizes calculated from objective probability estimates were larger than effect sizes calculated from subjective probability estimates; (b) effect sizes of studies that used almanac questions were larger than effect sizes of studies that used real-world events or case histories; (c) studies that included neutral outcomes resulted in larger effect sizes than studies that used positive or negative outcomes; (d) studies that included manipulations to increase hindsight bias resulted in significantly larger effect sizes than studies in which there were no manipulations to reduce or increase hindsight bias; and (e) studies that included manipulations to reduce hindsight bias did not produce lower effect sizes. These findings contribute to our understanding of hindsight bias by updating the state of knowledge, widening the range of known moderator variables, identifying factors that may activate different mediating processes, and highlighting critical gaps in the research literature.     

Treatment Effect on Recidivism for Juveniles Who Have Sexually Offended: a Multilevel Meta-Analysis

The current study investigated the effect on recidivism of treatment aimed at juveniles who have sexually offended. It also assessed the potential moderating effect of type of recidivism, and several treatment, participant and study characteristics. In total, 14 published and unpublished primary studies, making use of a comparison group and reporting on official recidivism rates, were included in a multilevel meta-analysis. This resulted in the use of 77 effect sizes, and 1726 participants. A three-level meta-analytic model was used to calculate the combined effect sizes (Cohens d) and to perform moderator analyses. Study quality was assessed with the EPHPP Quality Assessment Tool for Quantitative Studies. A moderate effect size was found (d = 0.37), indicating that the treatment groups achieved an estimated relative reduction in recidivism of 20.5% as compared to comparison groups. However, after controlling for publication bias, a significant treatment effect was no longer found. Type of recidivism did not moderate the effect of treatment, indicating that treatment groups were equally effective for all types of recidivism. Also, no moderating effects of participant or treatment characteristics were found. Regarding study characteristics, a shorter follow up time showed a trend for larger effect sizes, and the effect size calculation based on proportions yielded larger effect sizes than calculation via mean frequency of offending. Implications for future research and clinical practice are discussed.