Computing Power of Tests of the Variance of Treatment Effects in Designs With Two Levels of Nesting

Experiments that involve nested structures may assign treatment conditions either to entire groups (such as classrooms or schools) or individuals within groups (such as students). Although typically the interest in field experiments is in determining the significance of the overall treatment effect, it is equally important to examine the inconsistency of the treatment effect in different groups. This study provides methods for computing power of tests for the variability of treatment effects across level-2 and level-3 units in three-level designs, where, for example, students are nested within classrooms and classrooms are nested within schools and random assignment takes place at the first or the second level. The power computations take into account nesting effects at the second (e.g., classroom) and at the third (e.g., school) level as well as sample size effects (e.g., number of level-1 and level-2 units). The methods can also be applied to quasi-experimental studies that examine the significance of the variation of group differences in an outcome or associations between predictors and outcomes across level-2 and level-3 units.     

Trajectories of Change in a Group Behavioral Activation Treatment for Severe,Recurrent Depression

Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen’s d = 1.25. Although 34% (26 of the 77 who provided outcome data) of individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.     

Matching methods for selection of subjects for follow-up

This work examines ways to make the best use of limited resources when selecting individuals to follow up in a longitudinal study estimating causal effects. In the setting under consideration, covariate information is available for all individuals but outcomes have not yet been collected and may be expensive to gather, and thus only a subset of the comparison subjects will be followed. Expressions in Rubin and Thomas (1996, 2000) show the benefits that can be obtained, in terms of reduced bias and variance of the estimated treatment effect, of selecting comparison individuals well-matched to those in the treated group, as compared to a random sample of comparison individuals. We primarily consider non-experimental settings but also consider implications for randomized trials. The methods are illustrated using data from the Johns Hopkins University Baltimore Prevention Program, which included data collection from age 6 to young adulthood of participants in an evaluation of two early elementary-school based universal prevention programs.     

When Extremists Win: Cultural Transmission Via Iterated Learning When Populations Are Heterogeneous

How does the process of information transmission affect the cultural or linguistic products that emerge? This question is often studied experimentally and computationally via iterated learning, a procedure in which participants learn from previous participants in a chain. Iterated learning is a powerful tool because, when all participants share the same priors, the stationary distributions of the iterated learning chains reveal those priors. In many situations, however, it is unreasonable to assume that all participants share the same prior beliefs. We present four simulation studies and one experiment demonstrating that when the population of learners is heterogeneous, the behavior of an iterated learning chain can be unpredictable and is often systematically distorted by the learners with the most extreme biases. This results in group‐level outcomes that reflect neither the behavior of any individuals within the population nor the overall population average. We discuss implications for the use of iterated learning as a methodological tool as well as for the processes that might have shaped cultural and linguistic evolution in the real world.     

An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder

Transdiagnostic models of anxiety, and cognitive-behavioral treatments based on these models, have been gaining increased attention in recent years. Preliminary efficacy studies generally suggest strong treatment effects, although few of these studies have examined to what extent treatment effects are similar across clients with different anxiety disorders. The purpose of the current study was to examine the efficacy of a 12-week transdiagnostic group cognitive-behavioral therapy for anxiety disorders and compare outcome across diagnoses. Mixed-effect regression modeling of data from 52 participants with anxiety disorders (predominantly panic disorder and social phobia) participating in an open outcome trial indicated that participants tended to improve over treatment, with no differential outcome for any primary or comorbid disorders. The results of this study add to the growing evidence base for transdiagnostic anxiety treatment models and provide preliminary support for the assumption that individuals with different anxiety diagnoses can be treated equally within the same treatment protocol.     

Early Eye Movement Desensitisation and Reprocessing (EMDR) intervention in a disaster mental health care context

‘Early psychological intervention’ is defined as commencing treatment within three months of the traumatic event, with the aim to prevent or treat posttraumatic stress disorder, ongoing distress or acute stress disorder. In natural disaster situations, specific issues may limit the amount of time available for treatment and the possibility of interventions. Eye Movement Desensitisation and Reprocessing (EMDR) can be used without regard to these limits. The aim of the study is to evaluate the effects of EMDR, Recent Traumatic Episode Protocol (R-TEP) provided within three months of the traumatic event to a large sample of individuals exposed to the earthquake that hit Emilia Romagna Region (Northern Italy) in 2012. This study is based on a retrospective review of medical records collected during the activities of psychological and psychosocial unit in the immediate aftermath of earthquake. In total, 529 participants completed the Impact of Event Scale Revised (IES-R) (pre e post treatment). In order to provide a comparison similar to a waitlist-like control group, a method of cohort analysis was applied. In addition, possible time dependent effect was tested. ET (early-treated sample, participants treated within one month after the earthquake) and LT (late-treated sample, participants treated after the first month from the earthquake) reported at post-treatment an improvement to a level below the IES-R cutoff (65.8% of the ET sample and 64.02% of the LT sample). Control group analogue and time-outcome correlation suggest that positive changes in symptoms were likely due to the treatment provided and not merely to the time lapse from the traumatic event. The results of this study suggest that EMDR is a viable treatment option in response to a disaster crisis and in reducing psychological distress of acutely traumatized individuals within the context of a natural disaster.     

Executive functioning in individuals with a history of ASDs who have achieved optimal outcomes

Executive functioning (EF) is examined among children and adolescents once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria. These individuals have average social and language skills, receive minimal school support and are considered to have achieved “optimal outcomes” (OOs). Since residual impairments in these individuals might be expected in deficits central to autism, and in developmentally advanced skills, EF was examined in 34 individuals who achieved OOs, 43 individuals with high-functioning autism (HFA), and 34 typically developing (TD) peers. Groups were matched on age (M = 13.49), gender, and nonverbal IQ (NVIQ) but differed on verbal IQ (VIQ; HFA < TD, OO). On direct assessment, all three groups demonstrated average EF; however, the OO and HFA groups exhibited more impulsivity and less efficient planning and problem-solving than the TD group, and more HFA participants exhibited below average inhibition than did OO and TD participants. Parent-report measures revealed average EF among the OO and TD groups; however, the OO group exhibited more difficulty than the TD group on set-shifting and working memory. HFA participants demonstrated more difficulty on all parent-reported EF domains, with a clinical impairment in attention-shifting. Results suggest that EF in OO appears to be within the average range, even for functions that were impaired among individuals with HFA. Despite their average performance, however, the OO and TD groups differed on measures of impulsivity, set-shifting, problem-solving, working memory, and planning, suggesting that the OO group does not have the above-average EF scores of the TD group despite their high-average IQs.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Pride: Adaptive Social Emotion or Seventh Sin?

ABSTRACT— This experiment examined the ability of pride to serve as an adaptive emotion within the context of social interaction. After an in vivo induction of pride or a neutral state, participants engaged in a group problem-solving task. In contrast to a conventional view that pride is often associated with negative interpersonal outcomes, results confirmed that proud individuals not only took on a dominant role within the group problem-solving task, but also were perceived as the most likeable interaction partners. These findings suggest that pride, when representing an appropriate response to actual performance (as opposed to overgeneralized hubris), constitutes a functional social emotion with important implications for leadership and the building of social capital.     

Cultural values and attitudes towards guidance and counselling services in one secondary school in Malaysia: the role of a school cultural system

This narrative ethnographic study aims to explore students' attitudes towards guidance and counselling services in one secondary school in Malaysia. Semi-structured individual interviews, group interviews and observations were conducted with school students of different racial backgrounds. They were identified as referred clients, self-referred clients, and those not deemed to be involved in counselling. The data were analysed using the constant comparative analysis grounded theory approach. The findings indicate that there were different attitudes among the three groups of participants concerning counselling services. The study highlights the role of a school system in elucidating attitudes towards guidance and counselling services. It poses implications for understanding counselling services within the school system.     

Engagement in Group Psychotherapy Among Marginalized Individuals With Hepatitis C

This article examines an innovative psychoeducational group model at a community-based hepatitis C treatment program in Toronto, Canada. Group support is increasingly used as part of community-based, interdisciplinary approaches to addressing the complex psychosocial needs and barriers to care of individuals living with and/or undergoing treatment for hepatitis C. This article articulates the theoretical framework and details of one such group model. It also examines group engagement and outcomes using data collected over three group cycles. Psychotherapeutic engagement was higher than might be anticipated for a highly marginalized population. Specifically, group cohesion measures were equivalent or higher compared to norms for other support/psychotherapy groups. This study suggests that individuals with complex psychosocial issues have the ability to engage meaningfully in group therapy.     

Investigating the effectiveness of two therapeutic modalities in enhancing self-esteem among female adolescents

This study aimed to investigate the effectiveness of Adlerian therapy (AT) and solution-focused brief therapy (SFBT) in enhancing self-esteem among a sample of female adolescents. The researchers used the Arabic version of Rosenberg's Self-Esteem Scale and semi-structured interviews as data collection tools to evaluate the effectiveness of both therapies. The study sample consisted of 60 female students in the 10th and 11th grades selected from a Jordanian government school based on their low self-esteem scale scores. The participants were randomly divided into three equal groups: two experimental groups and one control group. One of the experimental groups received AT, while the other groups received training on SFBT, while the control group did not receive any treatment. Each experimental group met for one 50-minute session per week for 8 weeks. The data were analysed using one-way analysis of variance and one-way analysis of covariance . The results showed that SFBT was significantly more effective in increasing self-esteem than AT and no treatment. In addition, AT was found to be substantially more effective in enhancing self-esteem than no treatment. The researchers supported these results using data collected from the experimental groups' participants through a semi-structured interview.     

The Role of School-based Group Mentoring in Promoting Resilience among Vulnerable High School Students

This study examined the role of participation in a year-long school-based group mentoring program, Project Arrive (PA), on increasing resilience during the first year of high school among students identified as being at high risk for school dropout. Participants were 114, ninth grade students taking part in one of 32 PA mentoring groups, and 71 statistically matched comparison students (53% male, 75% eligible for free/reduced-price lunch, 62% Latinx). Using a propensity score with inverse probability of treatment weighting (IPTW) to reduce selection bias, and a multi-level model to account for non-independence of data within mentoring groups, we examined changes from pre-test to program exit on seven external resilience resources (developmental supports and opportunities) and four internal resilience assets (personal strengths). At program exit, PA participants had higher adjusted means than comparisons on six external resources, including school support, school belonging, school meaningful participation, peer caring relationships, prosocial peers, and home meaningful participation. PA participants also had higher adjusted means on one internal asset, problem solving. Results point to the promise of group mentoring as an approach for increasing resilience among academically vulnerable adolescents.     

A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: study characteristics,program content and outcomes

ABSTRACT

Alcohol misuse is a common, disabling and costly issue worldwide. Internet-delivered cognitive behavior therapy (ICBT) has the potential to reduce the harms of alcohol misuse, particularly for individuals who are unable or unwilling to access face-to-face therapy. A systematic review was conducted using Medline, CINAHL, EMBASE and PsycINFO databases for all relevant articles published from 1980 to January 2019. Randomized controlled trials (RCTs) were included if (i) an ICBT intervention targeting alcohol misuse was delivered; (ii) participants were aged 18 years or older; and (iii) primary outcomes were quantity of drinking. A qualitative analysis was conducted on the content of the ICBT programs. Fourteen studies met inclusion criteria. Most studies included participants from the general population, while studies conducted within clinic settings with diagnosed individuals were rare. The programs were similar in terms of included modules. Small effects were seen in studies on self-guided ICBT, while therapist-guided ICBT rendered small to large effects. The current review indicates that ICBT has a significant effect in reducing alcohol consumption. Larger studies evaluating ICBT compared to active control groups especially within clinic settings are warranted.     

Multilevel models for the experimental psychologist: Foundations and illustrative examples

Although common in the educational and developmental areas, multilevel models are not often utilized in the analysis of data from experimental designs. This article illustrates how multilevel models can be useful with two examples from experimental designs with repeated measurements not involving time. One example demonstrates how to properly examine independent variables for experimental stimuli or individuals that are categorical, continuous, or semicontinuous in the presence of missing data. The second example demonstrates how response times and error rates can be modeled simultaneously within a multivariate model in order to examine speed—accuracy trade-offs at the experimental-condition and individual levels, as well as to examine differences in the magnitude of effects across outcomes. SPSS and SAS syntax for the examples are available electronically.     

Beta-MPT: Multinomial processing tree models for addressing individual differences

Traditionally, multinomial processing tree (MPT) models are applied to groups of homogeneous participants, where all participants within a group are assumed to have identical MPT model parameter values. This assumption is unreasonable when MPT models are used for clinical assessment, and it often may be suspect for applications to ordinary psychological experiments. One method for dealing with parameter variability is to incorporate random effects assumptions into a model. This is achieved by assuming that participants’ parameters are drawn independently from some specified multivariate hyperdistribution. In this paper we explore the assumption that the hyperdistribution consists of independent beta distributions, one for each MPT model parameter. These beta-MPT models are ‘hierarchical models’, and their statistical inference is different from the usual approaches based on data aggregated over participants. The paper provides both classical (frequentist) and hierarchical Bayesian approaches to statistical inference for beta-MPT models. In simple cases the likelihood function can be obtained analytically; however, for more complex cases, Markov Chain Monte Carlo algorithms are constructed to assist both approaches to inference. Examples based on clinical assessment studies are provided to demonstrate the advantages of hierarchical MPT models over aggregate analysis in the presence of individual differences.     

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.     

The resolution and recovery of filler-gap dependencies in aphasia: evidence from on-line anomaly detection

This study examines the on-line processing of sentences with movement using an auditory anomaly detection task (after Borland, Tanenhaus, Garnsey, & Carlson, 1995). Eight agrammatic aphasic participants (four of whom had undergone treatment focused on comprehension and production of filler-gap sentences) and 24 young normal participants listened to sentences and pressed a button when the sentences "stopped making sense." Critical sentences contained an anomaly in object relative clauses or conjoined clauses. Results showed that both young normals and aphasic participants were able to reject anomalous sentences of both types. In addition, both groups showed evidence of filler-gap resolution on-line. Importantly, however, there was evidence of a treatment effect for the aphasic patients: those who received treatment showed better performance than those who had not. Treated patients were more successful than the untreated patients in detecting the anomaly in filler-gap conditions, rejecting the anomalous filler-gap sentences reliably more often than the non-anomalous ones, like the young normals. This effect was not noted for untreated participants, i.e., there was no statistical difference between their rejection of anomalous and non-anomalous filler gap sentences. Further, the reaction time data showed that the treated aphasic patients' rejections came before sentence's end (within 2000 ms), while the majority of responses made by untreated patients did not. These results indicate that individuals with agrammatic aphasia appear to retain some gap-filling capacity and that treatment can improve their ability to make use of this capacity.     

Sizeism in Therapy: Fat Shaming in Supervision

Abstract

The author, a doctoral student therapist, discusses her experience with a clinical supervisor who fat-shamed a client during supervision. This incident is examined within a shame framework and addresses the experience of shame, the effects of shame and shame-proneness on mental health outcomes, and why discussions about shame are often avoided in therapy by both clients and therapists. Some of the real-world considerations that can impact treatment for fat individuals, including chair size and comfort of the client, implicit bias within therapy, and goals for treatment, are also discussed.     

Walk for well-being: The main effects of walking on approach motivation

The purpose of this study was to investigate the role of exercise in the development of self-efficacy and approach motivation. An 8-week blind experimental design was used (N?=?185), with two control and two treatment groups. Already physically active participants were assigned to one control group, while participants that reported a sedentary lifestyle at pretest were randomly assigned to either a sedentary control group or one of two treatment groups that began a brisk walking intervention. Treatment group participants walked either outdoors or indoors for 30 min per day, 4 days per week, for 8 weeks. The indoor/outdoor treatment group assignment was implemented to determine if exercising outdoors enhanced the outcomes. Significant main effects of walking were found for exercise self-efficacy, general self-efficacy and global approach motivation tendencies. Walking outdoors resulted in the greatest gains in general self-efficacy and global approach motivation. Given the alarmingly sedentary nature of American culture, these findings further evidence how simple changes in physical activity may have profound effects on well-being.