The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.     

Crossover of marital dissatisfaction during military downsizing among Russian army officers and their spouses

This study examined mechanisms of strain crossover within couples and the moderating role of gender. Data were collected at a time of military downsizing from a sample of 1,250 Russian army officers and their spouses. The authors tested a model that incorporated 3 mechanisms for the crossover of marital dissatisfaction among dual-earner couples. The model provided support for 2 suggested crossover mechanisms: direct reactions of crossover and indirect mediated effects through social undermining. Strong evidence was also provided for gender asymmetry in the crossover process. Marital dissatisfaction crossed over from husbands to wives but not vice versa, and social undermining behavior played a role in the process of crossover of marital dissatisfaction for husbands but not for wives.     

Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis

ABSTRACT

The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (g = 1.22) and agoraphobia (g = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic (n = 29, g = 1.16) and medium for agoraphobia symptom severity (n = 18, g = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies (n = 15) compared to effectiveness studies (n = 14) for panic severity (g = 1.38 vs. g = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3–6 month follow-up (n = 12).     

Cognitive-behavioral treatment with and without response prevention for Bulimia

We compared cognitive-behavior therapy (CBT) with and without exposure and response prevention (ERP) in the treatment of eating disorder patients who both binged and purged, and reported abnormal attitudes concerning body weight and shape. Both treatments produced significant and comparable reductions in binge-eating and purging, eating patterns, and attitudes about weight and shape at posttreatment. Treatment effects were generalized to improvements in different measures of general psychopathology, and were maintained over follow-ups of 3 and 12 months. The findings are consistent with prior research showing that CBT is an effective treatment for patients with the core features of bulimia nervosa. Furthermore, the data suggest that the addition of in-session exposure and response prevention does not enhance the effectiveness of the basic CBT program.     

Positive and negative characteristics of marital interaction and their association with marital satisfaction in middle-aged and older couples

The study examined age differences in positive (e.g., warm) and negative (e.g., hostile) characteristics of marital interactions between middle-aged and older couples and whether these characteristics were differentially associated with marital satisfaction by age. Spouses' perception of partners' positive and negative behavior during marital interaction was assessed in general and following disagreement and collaborative tasks. Trained observers coded spouses' positive and negative behavior during interactions. Older individuals reported higher marital satisfaction and perceived their spouse's behavior as less negative in general and more positive across all contexts than middle-aged individuals. Spouses' perceptions of their partners' positive and negative behavior independently predicted marital satisfaction for both age groups across contexts. Perceptions of partners' negative behavior in general and of both positive and negative behavior in the disagreement task were more closely associated with marital satisfaction for older spouses than for middle-aged spouses. Results point to the importance of positive and negative characteristics in marital functioning across age cohorts and indicate that such characteristics may be context dependent. Findings suggest that, in some contexts, both positive and negative characteristics are more salient for older adults.     

Cognitive and affective patterns of alcoholics: Implications for group therapy

Alcoholics bring unique problems with them into treatment. This paper reviews the research on their cognitive and affective patterns of behavior. These include a low expectation of success in interpersonal relationships, the use of denial, insensitivity to mood states, and faulty attribution patterns. These difficulties hamper the expressive dimensions of their relationships with others and manifest themselves in the group therapy setting. Recommendations for facilitating group cohesion and developing an agenda are presented. Also discussed are the interactional means by which the work of the group is done. The supportive interchange is noted as a method by which group members gain access to the deeper layers of each other. The remedial interchange is the interactional means by which group members challenge each other and resolve conflicts.     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

A pilot study of an intervention for breast cancer survivors and their spouses

Recent studies have shown that interventions that increase breast cancer patients' communication with family members lead to reduced patient distress. In this article, we report on a treatment development and pilot study of an intervention for couples coping with breast cancer. In phase 1 of this study, 10 couples participated in two focus groups that generated ideas and themes for the intervention. In phase 2, we developed and pilot tested our intervention with 48 couples: 12 in a 2-session format, 21 in a 1-session format, and 15 in a non-experimental control group. Our response rate shows that breast cancer patients and spouses were willing to participate and that treatment providers were willing to refer patients and their spouses. The 2-session format showed the most promise for producing positive change in mental health functioning and cancer-related stress.     

Mindfulness‐based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care

This study examined the effectiveness of mindfulness‐based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle‐ and high‐income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence‐based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person‐centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre‐test to post‐test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.     

Behavior therapy for obesity: Booster sessions and long-term maintenance of weight loss

Following 8 weekly sessions of group behavioral self-control treatment, 75 obese women were assigned to one of five different maintenance conditions: (a) structured behavioral booster sessions held every two weeks; (b) structured behavioral booster sessions held every month; (c) unstructured nonspecific booster sessions held every two weeks; (d) unstructured nonspecific booster sessions held every month; and (e) a control group that received no booster sessions. Follow-ups were conducted at 3, 6, 9 and 12 month intervals. The study was completed in two replications. Results failed to show a significant effect of either booster session content or frequency. All groups continued to lose weight during the first three months of follow-up. Thereafter subjects in Replication 1 showed significant increases in weight over the next 9 months, whereas subjects in Replication 2 maintained their treatment-produced weight loss. The data do not support the view that booster sessions facilitate maintenance.     

Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies

Chronic insomnia is a prevalent sleep disorder with serious consequences on wellbeing and health that largely extend into daily functioning. Cognitive-Behavioral Therapy for Insomnia (CBT-I), an efficacious intervention for insomnia with solid empirical support, is the recommended first-line treatment. Given the complexity of factors and mechanisms involved in its aetiology and maintenance, advances in treatment protocols and modules are important. We will review the current knowledge on insomnia and examine how advancements in behavioral sleep medicine and third-wave therapies may apply to treatment. Specifically, we will outline how a treatment protocol based on Acceptance and Commitment Therapy (ACT), adapted to include insomnia-specific behavioral strategies and with an explicit focus on self-compassion, could be a potentially effective treatment. We believe that broadening treatment focus to target hyperarousal, metacognitions, dysfunctional though control strategies and provide self-compassion training may benefit treatment outcomes, increase sleep quality, reduce daytime symptoms, and improve quality of life.     

Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients

Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT‐SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT‐SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT‐SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT‐SP model when evaluating standard of care expectations is discussed.     

Reconciling reinforcement learning models with behavioral extinction and renewal: implications for addiction, relapse, and problem gambling

Because learned associations are quickly renewed following extinction, the extinction process must include processes other than unlearning. However, reinforcement learning models, such as the temporal difference reinforcement learning (TDRL) model, treat extinction as an unlearning of associated value and are thus unable to capture renewal. TDRL models are based on the hypothesis that dopamine carries a reward prediction error signal; these models predict reward by driving that reward error to zero. The authors construct a TDRL model that can accommodate extinction and renewal through two simple processes: (a) a TDRL process that learns the value of situation-action pairs and (b) a situation recognition process that categorizes the observed cues into situations. This model has implications for dysfunctional states, including relapse after addiction and problem gambling.