A telehealth intervention for veterans on antiviral treatment for the hepatitis C virus

The standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.     

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

Development of a Behavioral Activation–Based Intervention for Cigarette-Smoking Young Adults

Quitting smoking during young adulthood can substantially reduce tobacco-related morbidity and mortality later in life. Depressive symptomatology is prevalent among smokers and increases risk for poor smoking cessation outcomes. However, few integrated behavioral interventions simultaneously target smoking and depressive symptoms and rarely have young smokers been included in the development of these interventions. In this paper we describe an 8-session behavioral activation–based treatment for smoking (BATS; MacPherson et al., 2010) adapted for youth. We conducted a series of focus groups with young adult smokers with depressive symptoms in order to modify treatment manuals to be developmentally appropriate. Subsequently, we completed a small pilot group (n = 5) of the intervention to provide preliminary data on feasibility, acceptability, and outcomes. We provide a case series of the participants in order to provide clinical illustrations of how the modified BATS treatment was implemented among young adults. Most pilot study participants exhibited smoking abstinence and smoking reductions at the end of treatment, as well as improvement in depressive symptoms and maintenance of levels of activation and environmental reward. Participants provided positive qualitative constructive feedback regarding the intervention.     

VOUCHER‐BASED CONTINGENT REINFORCEMENT OF SMOKING ABSTINENCE AMONG METHADONE‐MAINTAINED PATIENTS: A PILOT STUDY

This study evaluated the efficacy of a contingency management (CM) intervention to promote smoking cessation in methadone‐maintained patients. Twenty participants, randomized into contingent (n = 10) or noncontingent (n = 10) experimental conditions, completed the 14‐day study. Abstinence was determined using breath carbon monoxide and urine cotinine levels. Contingent participants received voucher‐based incentives for biochemical evidence of smoking abstinence. Noncontingent participants earned vouchers independent of smoking status. Contingent participants achieved significantly more smoking abstinence and longer durations of continuous smoking abstinence than did noncontingent participants. These results support the potential efficacy of using voucher‐based CM to promote smoking cessation among methadone‐maintained patients.     

Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia

The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

A qualitative study of adaptation experiences of 1.5-generation Asian Americans

Adaptation experiences of 1.5-generation Asian American college students (N = 10) were examined using the consensual qualitative research method. Results indicated 4 domains of adaptation experiences: preimmigration experiences, acculturation and enculturation experiences, intercultural relationships, and support systems. Participants reported that English proficiency played a significant role in their initial adjustment. Currently, most of the participants reported feeling identified with both the U.S. and Asian cultures. Some participants reported having experienced racism in the past. Many participants noted that they currently have no difficulty establishing friendships with culturally different persons. Participants reported currently feeling most close to friends of a similar background and that they usually seek support from friends, family, and religious organizations, but not from a psychologist or counselor.     

Role of Supportive Others in the Forgiveness Process

Forgiveness research is a focus of interpersonal relationships in counseling. This phenomenological study investigated the role of an individual's support systems in forgiveness. The research design included semistructured interviews with 11 participants. Key findings revealed that participants primarily forgave for peace of mind. Several resources used by participants were helpful in forgiveness, but use of friends, family, and therapists showed mixed results. In addition, participants wanted support systems to listen and not to give advice, and support persons need to be objective or be trained in forgiveness therapy. Recommendations for counselors who work with people struggling to forgive are provided.     

Pilot Effectiveness of a Stress Management Program for Sheltered Homeless Adults With Mental Illness: A Two-Group Controlled Study

This study examined the effectiveness of a stress management intervention for sheltered homeless adults with mental illness. Twelve intervention participants received a 6-week, 1-hour psychoeducation group combined with a 20-minute meditation. Eleven matched pairs did not receive intervention and served as controls. At 1 week post study, intervention participants reported a statistically significant reduction in perceived stress (Z=??2.285, p < .02, d=??1.176) compared to controls. No differences were found at 1 week post study between intervention and control participants on reported quality of life. This study provides pilot data on the effectiveness of an occupation-based stress management program for sheltered homeless adults and warrants further study.     

Effect of Client Sense of Humor and Paradoxical Interventions on Test Anxiety

This study investigated the effectiveness of paradoxical and non-paradoxical interventions with clients [henceforth known as participants] possessing a high or low sense of humor. Fifty-three test-anxious participants were divided into a low sense of humor group and a high sense of humor group and were assigned to a paradoxical intervention condition, a nonparadoxical intervention condition, or a no-treatment control group. Participants in all groups improved over time but, contrary to the hypothesis, low sense of humor participants improved significantly more with a paradoxical intervention than high sense of humor participants with a paradoxical intervention. There were no differences in improvement due to treatment condition for the high sense of humor group. Low sense of humor participants perceived the counselor as more able to help than did high sense of humor participants. The paradoxical intervention was seen as more surprising than the nonparadoxical intervention. Implications for the use of paradoxical interventions are discussed.     

Implementation and Preliminary Feasibility of an Individualized,Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes

There are significant stressors related to parenting a young child with newly diagnosed type 1 diabetes (T1D). Despite these challenges, there are not yet clearly defined interventions to help promote psychological health and adherence for families with young children with T1D. First STEPS is a tailored stepped care design intervention to positively impact parents’ emotional functioning and children’s glycemic control in young children newly diagnosed with T1D. The First STEPS intervention is derived from a combination of Cognitive Behavioral Theory and Social Cognitive Theory to support family adjustment to T1D, promote parental mastery over T1D tasks, increase coping skills to manage stressors associated with T1D, and build on the strengths of families newly diagnosed with T1D to help them achieve positive health and wellbeing outcomes. We present details about the intervention and describe two pilot participants as case studies. Results indicated that the treatment and delivery model were acceptable to the pilot participants, as evidenced by treatment completion and satisfaction ratings. Future directions for this work include testing the efficacy of this new treatment in a randomized controlled trial.     

Telephone-based guided self-help for adolescents with chronic fatigue syndrome: A non-randomised cohort study

The aim of this study was to gain preliminary evidence about the efficacy of a new telephone-based guided self-help intervention, based on cognitive-behavioural principles, which aimed to reduce fatigue and improve school attendance in adolescents with chronic fatigue syndrome (CFS). A non-randomised cohort design was used, with a two-month baseline period. Sixty-three 11–18 year-old participants recruited from a specialist CFS unit received the intervention. Participants received six half-hour fortnightly telephone sessions and two follow-up sessions. Fatigue and school attendance were the main outcomes and the main time point for assessing outcome was 6 months post-treatment. Using multi-level modelling, a significant decrease in fatigue was found between pre-treatment and 6 month follow-up, treatment effect estimate = – 5.68 (?7.63, ?3.72), a large effect size (Cohen's d = 0.79). The decrease in fatigue between pre and post-treatment was significantly larger than between baseline and pre-treatment. A significant increase in school attendance was found between pre-treatment and 6 month follow-up, effect estimate = 1.38 (0.76, 2.00), a medium effect size (d = ?0.48). Univariate logistic regression found baseline perfectionism to be associated with poorer school attendance at six-month follow-up. In conclusion, telephone-based guided self-help is an acceptable minimal intervention which is efficacious in reducing fatigue in adolescents with CFS.     

A Genetic Counseling Intervention to Facilitate Family Communication About Inherited Conditions

This paper describes the development and implementation of the first intervention to facilitate family communication of genetic information based on a genetic counseling model of practice. The intervention is telephone-based and therefore designed to complement face-to-face genetic counseling consultations. It was developed by firstly reviewing the literature and a model of genetic counseling practice, leading to definition of seven core principles underpinning the intervention. A counseling framework based on these principles was developed through iterative role playing and review, tested for consistency with good practice and piloted on ten study participants. It was found to be feasible to implement and consistent with good genetic counseling practice. Implementation included training of the genetic counselors who would deliver the intervention as part of a randomized controlled trial. Noteworthy deviations from good genetic counseling practice were observed, with unexpected additional insights into the ‘black box’ of genetic counseling that may have wider implications and would benefit from further investigation. The intervention is currently being evaluated in a randomized controlled trial, to assess its impact on the number of family members attending genetic services.     

A narrative evaluation of a psychoeducation and a therapeutic alliance intervention for parents of persons with a severe mental illness

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention.     

Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire

Internet‐based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty‐seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8‐week Internet‐based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e‐mails per week) or infrequent (one e‐mail per week) support from a psychologist. Posttreatment, intention‐to‐treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panic‐related cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end‐state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet‐based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost‐effective than previously reported.     

A qualitative study of citizens' experience of participating in health counseling

Individual health counseling is a form of intervention designed to minimize the effects of chronic health disease and to offer a path towards good health practices. The aim of the present study was to explore the experiences of those persons who participated in health counseling in order to assess the psychosocial significance of the counseling upon their health behavior. In addition the study was concerned with the factors which underlay peoples' decision to sign up for health counseling. The research involved 11 semi‐structured interviews with individuals who had participated in a municipality based health counseling program. Data was analyzed using Malterud's systemic text condensation and a theoretical framework around Bandura's social cognitive theory. Analysis revealed that an approach tailored to each individual with minor short‐term goals accompanied by feeling supported by the counselor produced the greatest impact on behavior. Receiving feedback from the counselor and feeling positive about the relationship were seen as essential. These aspects were also crucial in the decision to undertake health counseling. The study indicates that whether individual's sign up on their own initiative or conversely are invited to join the program has no influence upon their motivation to change their behavior. Overall the respondents demonstrated improvement in their behavior and attitudes towards their health. However, the study also indicates that this form of intervention is less or even ineffective without the support of the individual's immediate family.     

Effectiveness of Pre-counseling Genetic Education Workshops at a Large Urban Community Health Center Serving Low-Income Chinese American Women

Chinese American pregnant women and women of childbearing age face economic, cultural and linguistic barriers in accessing mainstream health care services. The Charles B. Wang Community Health Center developed a culturally and linguistically competent genetic education workshop for high-risk Chinese American prenatal patients. Patients referred for genetic counseling for thalassemia, abnormal triple screen results, and/or advanced maternal age were recruited to participate in the workshop. The workshop provided basic “genetic 101” education, focusing on topics that were directly relevant to the patients’ reasons for referral. The effectiveness of the workshop was measured using a quasi-experimental design with pre-post surveys administered to intervention and control group participants. The evaluation also included a genetic counselor assessment and a pilot study of genetic counseling appointment length. Overall, workshop participants showed significant increases in knowledge, positive attitude and self-efficacy regarding genetic services as compared to their control group counterparts. The pilot appointment length study data revealed that the workshop reduced the length of the genetic counseling appointment time by 40%. These positive findings suggest that it would be worthwhile to replicate the genetic education workshop at other health agencies serving Chinese-speaking populations and that further evaluation research should be conducted.     

From field experiments to program implementation: Assessing the potential outcomes of an experimental intervention program for unemployed persons

Demonstrated a procedure suggested by Bloom (1984) to provide estimates for the effects of an intervention on its actual participants compared to global effects on study participants in the intervention group, whether or not they showed up. Analyses were based on data collected in a field experiment that tested a preventive intervention for unemployed persons (Caplan, Vinokur, Price & van Ryn, 1989). Effect size estimates were two to three times larger for the actual participant group than for the entire experimental group on employment outcomes (e.g., earnings) and mental health (anxiety and depression). Further analyses produced results showing that compared to participants, the nonparticipants achieved significantly higher levels of reemployment at posttests and did not differ significantly from participants on all other outcomes. The results suggest that persons who most needed the intervention and benefited from it were drawn into it through self-selection processes.     

A Novel Technology-Enhanced Internalized Stigma and Shame Intervention for HIV-Positive Persons With Substance Use Disorders

Internalized stigma, shame, and other negative self-conscious emotions are inadequately addressed barriers to HIV-related self-care, particularly among people actively using substances. Innovative approaches are needed to optimize antiretroviral treatment (ART) adherence as well as engagement in HIV care among people living with HIV and substance use disorders. Based on qualitative feedback from providers and patients, we iteratively developed and conducted a proof-of-concept study of a relatively brief transdiagnostic emotion regulation intervention designed to improve ART adherence and engagement in HIV care by addressing behavioral and psychological barriers, including internalized stigma and shame, among people living with HIV and active substance use disorders. The final intervention included 5 individual sessions focused on metacognitive awareness of emotions and thoughts, cognitive reframing of dysfunctional thoughts about the self using concepts such as self-compassion, and identifying and reaching the participants’ personalized HIV-self-care goal(s). All participants received daily texts querying current emotion and weekly texts querying ART adherence and substance use. To extend the effects of the intervention, we developed a personalized bidirectional text component through which participants received their personalized compassionate self-statements, informed by the intervention content, in response to their answers to emotion queries for 8 weeks after the 5 sessions. The texts modeled using compassionate self-statements as a form of cognitive reframing, consistent with cognitive restructuring of distorted core beliefs. We consented 10 participants living with HIV and active substance use disorders in the proof-of-concept pilot. Of the 8 participants who completed all intervention sessions, participants replied to 70% of all text messages sent. All 8 reported strong acceptability of the intervention content. This emotion-focused, technology-enhanced intervention demonstrated proof-of-concept, in that this patient population would participate in this intervention. A larger randomized controlled pilot is needed to determine feasibility and acceptability among people living with HIV and substance use disorders, a hard-to-reach and underserved population.     

Evaluating the efficacy of the Headsprout© reading program with children who have spent time in care

This study investigated whether Headsprout©, an internet‐based phonics program designed on behavioral principles, is an effective supplementary tool to improve literacy skills of children who have spent time in care and are at risk of reading failure. Participants were 8 children (aged 5 to 10) who had spent over 3 years in care and were fully adopted at the time of the study. Participants' literacy skills were assessed prior to intervention using 2 standardized reading attainment tests. Participants were then randomly assigned to either treatment or a waiting list comparison group. There were 2 Headsprout© treatments, but all participants in the treatment group completed 1 HeadsproutStartCopTextStartCopText© lesson 4 times per week, under the supervision of the first author, while participants in the comparison group interacted with the first author 4 times per week engaging in nonliteracy‐based computer activities. Results from 2 standardized reading attainment tests showed an improvement in word recognition age and oral reading fluency for the HeadsproutStartCopTextStartCopText© learners but scores either remained the same or decreased over a 4‐month period for participants in the comparison group. The findings support the wider use of HeadsproutStartCopTextStartCopText© with at‐risk children though more research is clearly warranted at this time.