Using Cognitive Behavioral Interventions to Help Children Cope with Parental Military Deployments

Wars in Afghanistan and Iraq are associated with more deployments than in previous years. Recent estimates show 1.2 million school children have a parent that is serving in the active military. Family stress increases proportionately to the length of deployment and the perception of danger. In a recent study, twenty percent of children whose parent was being deployed were identified as ??high risk?? for psychosocial disturbances. A deployed parent represents a stressor reflecting ambiguous loss which prompts emotional distress. Cognitive behaviorally based prevention and intervention efforts have shown considerable promise with children experiencing a variety of disorders who do not necessarily have a deployed parent. For instance the Penn Resiliency Program has enjoyed considerable empirical support. It seems quite reasonable that these favorable results would generalize to a population of military children. This paper will briefly review the extant literature on the effects of parental deployment on children??s emotional well-being and then recommend a variety of cognitive behavioral interventions to enhance their psychological welfare.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Using Consumer Input to Tailor Evidence-Based Parenting Interventions to the Needs of Grandparents

Grandparents provide a significant amount of child care to their grandchildren. However, there is limited research investigating whether grandparents would view a parenting program developed specifically for them as useful. Our study adopted a consumer focused perspective to program design and examined the challenges encountered by grandparents in their role as an informal child care provider. Focus groups were conducted with fourteen grandparents (11 females, 3 males) aged 45–76?years (M?=?60.14) the majority of whom provided 11–20?h of care per week to their grandchild. A thematic analysis indicated that grandparents have difficulty managing the relationship with the parents and remembering effective parenting strategies. In addition, grandparents also indicated wanting further strategies to cope with the stressors associated with the role, particularly surrounding feelings of frustration and guilt. These results suggest that grandparents could benefit from a parenting program and this paper argues that an existing evidence-based parenting program should be modified. In terms of implications for program design the inclusion of a module centered on improving grandparent–parent communication and partner support may buffer potential conflict and tension that can arise in co-parenting situations.     

Cognitive Behavioral Principles Within Group Mentoring: A Randomized Pilot Study

This study evaluated the effectiveness of a group mentoring program that included components of empirically supported mentoring and cognitive behavioral techniques for children served at a community mental health center. Eighty-six 8- to 12-year-old children were randomly assigned to either group mentoring or a wait-list control group. Group mentoring significantly increased children's reported social problem-solving skills and decreased parent-reported child externalizing and internalizing behavior problems after controlling for other concurrent mental health services. Attrition from the group mentoring program was notably low (7%) for children. The integration of a cognitive behavioral group mentoring program into children's existing community mental health services may result in additional reductions in externalizing and internalizing behavior problems.     

Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing

Group Cognitive Behavior Therapy (CBT) was used to treat residual delusions in patients with schizophrenia. Initially all patients (N = 6) reported delusions of various types, such as persecution, body/mind control, grandiosity, and religious themes. The group format allowed patients to share their experiences and beliefs, thereby eliminating shame and providing support and coping strategies; as well as allowing for peer–peer discussion of irrationalities and inconsistencies in each other's beliefs. After 13 sessions there was a statistically significant reduction in delusional conviction, unhappiness associated with thinking about a delusion, intensity of distress associated with delusion, and an increased ability to dismiss a delusional thought.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Cognitive and Behavioral Responses to Trauma

In order to identify cognitive and behavioral responses to trauma, we have studied responses to mass casualty body handling following the Gander, Newfoundland, plane crash of 1985 and the 1989 USS Iowa disaster, and responses to a simulated chemical and biological warfare environment. Individual and group trauma behaviors show prominent: (a) thinking by similarity (identification, and looking for the familiar/ seeing the past in the present); (b) attribution of meaning (rituals, symbols, language, and rumors); and (c) contagion of behavior. These processes highlight the importance of the study of responses to different traumatic stressors in order to identify cognitive mechanisms and behaviors activated by trauma. Such phenomena may be important to our understanding of the effects of traumatic stress and their acute and long-term health outcomes.     

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets–cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes–restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.     

Using Explicit Case Formulation to Improve Cognitive Processing Therapy for PTSD

We investigated the utility of explicit case formulation (CF) within Cognitive Processing Therapy (CPT) for individuals with posttraumatic stress disorder (PTSD). An uncontrolled pre-posttreatment design was used. Participants attended 12–16 weekly sessions of CPT with explicit CF, where CF guided treatment length and treatment components. Treatment was completed by 19 of the 23 participants who started therapy. Results revealed significant reductions in PTSD and depression severity as well as unhelpful PTSD-related beliefs from pre- to posttreatment (ds between 1.10 – 1.92) and treatment gains were maintained at 3-month follow-up. Of the participants available at posttreatment for assessment, 69% (n = 11/16) met good end-state functioning for PTSD and 62% (n = 8/13) did so at follow-up. Finally, 72% (n = 13/18) of those interviewed at posttreatment no longer met criteria for PTSD and this was found for 93% of those assessed at follow-up (n = 14/15). Treatment, and CF in particular, was found to be acceptable by participants. Explicit case formulation did not interfere with positive outcomes of Cognitive Processing Therapy for PTSD. Further clinical implications and future directions for research are discussed.     

Introduction to the Special Issue on Clinical Psychology and Behavioral Science: Processes,Principles, and Analytic Strategies

The Psychological Record -     

School-Based Supports and Interventions to Improve Social and Behavioral Outcomes with Racially and Ethnically Minoritized Youth: A Review of Recent Quantitative Research

School discipline disproportionality has long been documented in educational research, primarily impacting Black/African American and non-White Hispanic/Latinx students. In response, federal policymakers have encouraged educators to change their disciplinary practice, emphasizing that more proactive support is critical to promoting students’ social and behavioral outcomes in school. Results from a literature review conducted nearly a decade ago indicated that there was, at that point, a paucity of empirical research related to considering students’ culture (e.g., race, ethnicity) and supporting school behavior. The purpose of this study is to replicate and expand the previous review to summarize the characteristics of the most recent school-based quantitative research addressing interventions to promote social and behavioral outcomes for racially and ethnically minoritized youth. We screened 1687 articles for inclusion in the review. Upon coding 32 eligible research studies, we found that intervention and implementer characteristics within these studies varied, but noted strong intervention effects in studies that included established evidence-based practices, adapted interventions, as well as new practices piloted with student participants. Results inform recommendations to continue to study interventions that promote positive social and behavioral outcomes for racially and ethnically minoritized students to disrupt a long history of subjection to exclusionary discipline disproportionately.

     

Systematic Review of Behavioral Interventions Using Digital Technology to Reduce Problem Behavior in the Classroom

Journal of Behavioral Education - Problem behavior in the classroom leads to challenges for teachers who often feel ill equipped to address such behavior. Behavior analytic interventions have been...     

An Introduction to Core Competencies for the Use of Mobile Apps in Cognitive and Behavioral Practice

Mobile technologies have become increasingly pervasive and integral in our daily lives. A growing number of mobile applications are focused on health applications with many specifically focused on helping the prevention, treatment, and management of mental health issues. These apps are slowly being introduced into clinical settings, either being brought in by clients who themselves are using these tools or by health systems or providers. Unfortunately, most practicing providers obtained their clinical training before the advent of mobile health tools and methods. Thus, a critical need exists to develop and disseminate resources to develop the essential skills needed to adopt mobile health techniques. We discuss the five core competencies in mobile health care: evidence, integration, security and privacy, ethics, and cultural considerations. Although this paper will not fully prepare a provider to use mobile apps in their practice, it provides an introduction that will helpfully guide a provider to additional resources and additional ways to develop these competencies. Finally, we discuss the future directions of the field, including a growing differentiation of the impact of mobile apps on clinical care and the need for training models and experiences to match this differentiation.     

Behavioral Interventions and Families: A Medical Rehabilitation Perspective

Behavioral interventions are pertinent to many issues faced by medical rehabilitation patients and their families in late adulthood. Despite their utility in managing chronic illnesses and reducing problematic behaviors related to cognitive impairment, behavioral interventions can be difficult to implement and maintain in a family setting. Problems resulting from countercontrol, caregiver fatigue, conflicting priorities, and impact on family relationships must be anticipated and addressed. These issues are illustrated through references to pertinent research and case examples. Recommendations are offered to reduce caregiver stress and to minimize shifts in relationships when family caregivers act to alter a member's behavior.     

Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.