Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.     

Does dose of early intervention matter for preschoolers with externalizing behavior problems? A pilot randomized trial comparing intensive summer programming to school consultation

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model to a more standard approach in school settings (i.e., behavioral school consultation). Forty-five preschool children (82% boys; Mage = 5.16 years; 93% Hispanic/Latino background) were randomized to one of three intervention conditions: 1) 8-week STP-PreK (8W); 2) 4-week STP-PreK (4W); or 3) school year behavioral consultation (SC). Both STP-PreK groups included an 8-week parent training component. Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness and kindergarten success outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral, academic, social-emotional, and self-regulation functioning significantly improved across groups. Few significant differences were found between children receiving the 4W and 8W programs, suggesting that both programs have the potential to prepare preschool children with EBP for the transition to school. Both 4W and 8W groups experienced greater initial growth across time in most domains compared to children in the SC group. However, by the end of the kindergarten year, children in the SC group caught up to children in both 4W and 8W groups on most domains. Overall, these findings suggest that all three intervention doses are effective in improving kindergarten year functioning, with some important considerations for intervention timing in preparation for the transition to elementary school. Clinical implications for school personnel are discussed.     

A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive–behavioral therapy for social anxiety

Despite the efficacy of cognitive–behavioral therapy (CBT), most socially anxious individuals do not seek treatment or seek treatment only after many years of suffering. This study evaluated the efficacy of a three-session motivation enhancement therapy (MET) designed to increase CBT utilization among socially anxious individuals. Twenty-seven non-treatment-seeking socially anxious individuals (92.6% met current DSM-IV criteria for social anxiety disorder) were randomly assigned to either MET for CBT (n = 12) or a control condition (n = 15). The primary outcome was attendance at first CBT appointment. Secondary outcomes included openness to therapist contact and willingness to schedule a CBT appointment. After the intervention, seven of the 12 (58.3%) participants in the MET condition attended a CBT appointment compared to two of 15 (13.3%) control participants. Eight of 11 (72.7%) participants in the MET condition indicated they would like a CBT therapist to contact them compared to four of 12 (33.3%) controls. Further, willingness to schedule a CBT appointment increased at a significantly greater rate in the MET condition. Results suggest MET for CBT may be a time-efficient means to increase CBT utilization among socially anxious individuals.     

Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching Apples with Oranges?

Öst (2008) recently compared the methodological rigor of studies of acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). He concluded that the ACT studies had more methodological deficiencies, and thus the treatment did not qualify as an “empirically supported treatment.” Although Öst noted several important limitations that should be carefully considered when evaluating early ACT research, his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic. The samples were clearly mismatched in terms of the populations being treated, leading to differences in study design and methodology. Furthermore, reanalysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article. Given the actual mismatch between the samples, Öst's methodological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations. Such limitations are characteristic of the earlier randomized controlled trials of any emerging psychotherapeutic approach.     

Does enhanced cognitive behaviour therapy for eating disorders improve quality of life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n?=?196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright ? 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.     

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial

ObjectiveTo evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants.MethodsNinety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test.ResultsNone of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5).ConclusionIn inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.     

Responding to distressed infants: Does mothers’ positive versus negative affect matter for infants' behavior and physiology?

How mothers respond to infants’ distress has implications for infants’ development of self-regulation and social competence. In a sample of 35 mothers and their 4- to 8-month-old infants, we induced infant distress using an arm restraint task and compared infants’ observed affect and physiological responses under two conditions, when mothers were instructed to respond with: 1) positive affect and 2) negative affect. Based on theoretical and empirical support, we empirically evaluated two opposing hypotheses. Based on the Mutual Regulation Model and work on affect matching, we predicted that when mothers respond with negative affect versus positive affect, distressed infants’ duration of negative affect would be smaller, negative affect would be less intense, and respiratory sinus arrythmia (RSA) withdrawal would be lower. Based on social referencing theory and research, we expected that when mothers respond with positive affect versus negative affect, distressed infants’ duration of negative affect would be smaller, negative affect would be less intense, and RSA withdrawal would be lower. We found that when mothers responded to their distressed infants with negative affect versus positive affect, infants spent significantly more time in negative affect, their intensity of expressed negative affect was greater, and their RSA withdrawal was greater, suggesting that mothers’ display of mild positive affect when infants are distressed may be helpful for infants. The current findings add to accumulating evidence that mothers’ positive relative to negative affective response to their infants’ distress can produce observable differences in infants’ duration and intensity of negative affect, as well as their physiology. Findings have the potential to inform future research that investigates how mothers can most effectively reduce their infants’ distress and intervention that targets the moment-to-moment behaviors in mother-infant reciprocal interactions.     

Does expertise and thinking mode matter for accuracy in judgments of job applicants’ cognitive ability?

The present research examined the role of thinking mode for accuracy in recruiters and laypeople’s judgments of applicants’ cognitive ability. In Study 1, students who relied on their intuition were somewhat less accurate. In Study 2, an experimental manipulation of thinking mode (intuitive vs analytical) revealed no apparent differences in accuracy. Moreover, there were no differences in accuracy or agreement between recruiters and laypeople. Examination of the use of specific resume content suggested that intuitive thinking corresponds to basing one’s judgments more on the way that applicants present themselves in their personal letter and less on diagnostic biographical information such as SAT scores. The findings point to the possibility that professional recruiters may not possess intuitive expertise in this context.     

Can parent‐to‐parent consultation improve the effectiveness of the Maudsley model of family‐based treatment for anorexia nervosa? A randomized control trial

Objective: This paper describes a preliminary randomized control trial that explores the use of parent‐to‐parent consultations as a potential augmentation to the Maudsley model of family‐based treatment for anorexia. Method: Twenty families were randomized into two groups, ten receiving standard treatment and ten receiving an additional parent‐to‐parent consultation early on in treatment. Measures of parental efficacy (Parents versus Anorexia Scale), patient distress (Depression Anxiety and Stress Scale) and percentage ideal body weight were taken each week. The effects of parent‐to‐parent consultations on parental efficacy and weight were analysed by comparing data with random effects models. Results: A significant treatment effect was found, with parent‐to‐parent consultations leading to a small increase in the rate of weight restoration. Conclusion: This practice has the potential to enhance weight restoration when included in the Maudsley model of family‐based treatment for anorexia nervosa. Research that tests more potent forms of intervention may also have merit.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.     

Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans – results from a randomized control study

Even 30 or more years after the end of a war, veterans can suffer from post-traumatic stress disorder (PTSD). In the present study, we explored the influence on symptoms of PTSD among Iranian veterans of the Iran–Iraq war of mindfulness-based cognitive therapy (MBCT) as add-on to a standard treatment with citalopram. Forty-eight male veterans with PTSD (mean age: 52.97 years) took part in this eight-week intervention study. Standard treatment for all patients consisted of citalopram (30–50 mg/day at therapeutic dosages). Patients were randomly assigned either to the treatment or to the control condition. Treatment involved MBCT delivered in group sessions once a week. Patients in the control condition met at the hospital with the same frequency and duration for socio-therapeutic events. At baseline and at study completion, patients completed questionnaires covering symptoms of PTSD, depression, anxiety, and stress. At study completion after eight weeks, scores for PTSD (re-experiencing events, avoidance, negative mood and cognition, hyperarousal), depression, anxiety, and stress were lower, but more so in the intervention than the control group. Data suggest that, as adjuvant to standard SSRI medication, MBCT is an effective intervention to significantly reduce symptoms of PTSD, depression, anxiety, and stress among veterans.     

Does neuroscience hold promise for the further development of behavior therapy? The case of emotional change after exposure in anxiety and depression

Over the last few years, the integration of biological and psychological models has become increasingly important in clinical psychology. This paper presents a neurobiological framework for exploring how neuroscience research may be valuable in the context of new developments in behavior therapy. The importance of the cortical-subcortical circuitry of emotion processing for investigating the working mechanisms of exposure therapy is illustrated by current neuroimaging research. The implication is that during exposure therapy the focus of attention must be fully directed towards the emotional content of the threatening situation to facilitate prefrontal control over the amygdala and that new contextual information, of emotional salience, must be added to create inhibitory projections from the hippocampus. In addition, some possible mechanisms of action for different therapeutic approaches to both anxiety and depression and the role of neuroimaging techniques in predicting treatment outcome are discussed.     

Does spirituality really matter?: A study on the potential of spirituality for older adult's adjustment to aging

This study intended to analyze the indicators of adjustment to aging (AtA) and to investigate the latent constructs that can work as major determinants in spirituality for a cross‐national older community‐dwelling population. Questionnaires were completed to assess the participants' background information. Interviews were performed, addressing one core area: indicators of AtA. Complete data were available for 154 older adults from two nationalities (German and Portuguese), aged between 75 and 103 years (M = 86.6; SD = 6.98). The data were subjected to content analysis. Representations of the associations and latent constructs were analyzed using a multiple correspondence analysis (MCA). The most prevalent response of the interviewed participants for indicators of AtA was spirituality (43.2%). Spiritual activities was the most reported response regarding spirituality (20.0%). A significant moderate association was found between spiritual activities and nationality (V = .365; p < .001). Spirituality for older adults was explained by a three‐dimensional overall model: spiritual and existential meaning, limit‐related awareness and community embeddedness. The findings presented in this paper emphasized the need to explore the potential of spirituality for AtA and the need for improving the spiritual dimension of health care for the older cross‐national population.     

Studying cognitive adaptations in the field of sport: broad or narrow transfer? A comment on Allen, Fioratou, and McGeorge (2011)

This commentary addresses Allen, Fioratou, and McGeorge (2011), drawing attention to the important topic of how humans cognitively adapt to activities they engage in on a daily basis. We elaborate on the critique and suggestions made by Allen, et al. by reviewing research on the relationship of sport and cognition and argue that publication bias may be an issue when studying cognitive adaptations as a function of sport engagement. Implications for future research on the sport-cognition relationship are discussed.     

Refreshing Older Adults’ Driving Skills (ROADSkills): A randomized controlled trial examining the effect of video feedback

ObjectivesThis study evaluated the effectiveness of a personalized video-based driver training program on the behind-the-wheel skills of community-dwelling older adults.MethodIn this randomized controlled trial (RCT), 80 older drivers [mean age (SD) = 71.0 (3.9)] were randomly assigned to view one of two educational videos: 1) personalized video feedback on their driving (n = 40) or 2) a generic video on aging-in-place (n = 40). The primary outcome, the total number of errors accrued in a 30-minute standardized on-road evaluation, was analyzed at baseline and 4 weeks after watching the assigned video. On-road evaluations were video-recorded and scored by a blinded rater. Self-report measures of driving abilities, behaviors, and comfort were also compared.ResultsAt the 4-week follow-up, the mean difference in the number of on-road performance errors [mean (95% CI) = -12.0 (-16.6, −7.4), p < 0.001] favored the intervention group compared to controls, with significant improvements across multiple domains: vehicle control [mean (95% CI) = -4.8 (-8.1, −1.5), p < 0.01], observing the roadway [mean (95% CI) = -5.5 (-8.4, −2.6), p < 0.001], and compliance with traffic rules [mean (95% CI) = -1.3 (-2.3, −0.2), p < 0.05]. Within-group change on behind-the-wheel errors was significant for the intervention group [mean (95% CI) = -10.3 (-13.5, −7.1), p < 0.001], but not for the control group [mean (95% CI) = 1.7 (-1.6, 4.9), p > 0.05]. No significant differences were found on the self-report measures.DiscussionA novel, video-based approach that provided personalized feedback to older drivers significantly reduced behind-the-wheel errors 4-weeks post-intervention. Changes in self-reported driving behaviors and abilities were not significant. Future research will examine the long-term effects of this approach on older adults’ actual and perceived driving abilities.     

Does prey matter? Geographic variation in antipredator responses of hatchlings of a Japanese natricine snake (Rhabdophis tigrinus)

Rhabdophis tigrinus, which typically forages on toads, has unusual nuchal glands on its dorsal neck region containing secretions chemically comparable to cardiac steroids found in toads. R. tigrinus also has several peculiar antipredator displays involving the neck region. If the nuchal gland secretions of R. tigrinus are derived from toads obtained as prey, populations of R. tigrinus that have not eaten toads over an evolutionary time scale would be expected to lose antipredator displays related to the nuchal glands. We found that laboratory-hatched R. tigrinus from a small toad-free island exhibited displays related to nuchal glands less frequently and flight responses more frequently than hatchling snakes from areas sympatric with toads. These results are consistent with the hypothesis of the dietary origin of the nuchal gland secretions and also support the genetic origin of the behavioral differences between the populations.     

Does midbrain urocortin 1 matter? A 15-year journey from stress (mal)adaptation to energy metabolism

This review summarizes some of the milestones of the research on the biological functions(s) of midbrain urocortin 1 (Ucn1) since its discovery 15 years ago. Detailed characterization of Ucn1 in the midbrain revealed its overall significance in food intake and regulation of homeostatic equilibrium and mood under stress. In addition, we have recently found a conspicuous alteration in midbrain Ucn1 levels in brains of depressed suicide victims. Furthermore, from the results from the genetically modified animals, a picture is emerging where corticotrophin-releasing factor promotes the initial reactions to stress, whereas Ucn1 seems to be crucial for management of the later adaptive phase. In the case of imbalance in action of these principle stress mediators, vulnerability to stress-related brain diseases is enhanced.