Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Relation of depression to perceived social support: results from a randomized adolescent depression prevention trial

Theorists posit that certain behaviors exhibited by depressed individuals (e.g., negative self-statements, dependency, reassurance seeking, inappropriate or premature disclosures, passivity, social withdrawal) reduce social support, yet there have been few experimental tests of this hypothesis. Using data from a randomized depression prevention trial (N = 253) involving adolescents (M age = 15.5, SD = 1.2), we tested whether a cognitive behavioral group intervention that significantly reduced depressive symptoms relative to bibliotherapy and educational brochure control conditions through 2-year follow-up produced improvements in perceived parental and friend social support and whether change in depressive symptoms mediated the effect on change in social support. Cognitive behavioral group participants showed significantly greater increases in perceived friend social support through 1-year follow-up relative to bibliotherapy and brochure controls, but there were no significant effects for perceived parental support. Further, change in depressive symptoms appeared to mediate the effects of the intervention on change in perceived friend support. Results provide experimental support for the theory that depressive symptoms are inversely related to perceived social support, but imply that this effect may be specific to friend vs. parental support for adolescents.     

A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents

Several meta-analyses indicate that cognitive-behavioral therapy (CBT) via electronic/technological devices or applications (i.e., eCBT) is an effective alternative to standard therapist-delivered CBT for anxious adults. However, we know little about the efficacy of eCBT interventions for anxious children and adolescents. The present meta-analysis set out to investigate the efficacy of eCBT in comparison to standard CBT or waitlist control for anxious children and adolescents. Eight randomized controlled studies (N = 404 participants) that targeted anxiety at post-intervention and follow-up were included in the analysis. The results indicated that eCBT was as effective as standard CBT (g = .295) and more effective than waitlist (g = 1.410) in reducing anxiety symptoms. Moderation analyses revealed that anxious children and adolescents benefited the most from eCBT in the minimal therapist involvement condition (g = 2.682) in contrast to the significant therapist involvement group (g = .326). Furthermore, older participants seemed to extract greater clinical benefits from eCBT in contrast to younger participants (slope = .514). Current eCBT interventions for anxious children and adolescents appear to be promising, but require further investigation.     

Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity

The current study assessed main effects and moderators (including emotional expressiveness, emotional processing, and ambivalence over emotional expression) of the effects of expressive writing in a sample of healthy adults. Young adult participants (N=116) were randomly assigned to write for 20 minutes on four occasions about deepest thoughts and feelings regarding their most stressful/traumatic event in the past five years (expressive writing) or about a control topic (control). Dependent variables were indicators of anxiety, depression, and physical symptoms. No significant effects of writing condition were evident on anxiety, depressive symptoms, or physical symptoms. Emotional expressiveness emerged as a significant moderator of anxiety outcomes, however. Within the expressive writing group, participants high in expressiveness evidenced a significant reduction in anxiety at three-month follow-up, and participants low in expressiveness showed a significant increase in anxiety. Expressiveness did not predict change in anxiety in the control group. These findings on anxiety are consistent with the matching hypothesis, which suggests that matching a person's naturally elected coping approach with an assigned intervention is beneficial. These findings also suggest that expressive writing about a stressful event may be contraindicated for individuals who do not typically express emotions.     

Expressive writing buffers against maladaptive rumination

This study examined whether ruminative style moderated the effects of expressive writing. Sixty-nine participants were assessed for ruminative style and depression symptoms at the beginning of their 1st college semester. Participants were then randomized to either an expressive writing or a control writing condition. Changes in depression symptoms were assessed 2, 4, and 6 months later. Results showed that a brooding ruminative style moderated the effects of expressive writing such that among those assigned to the expressive writing condition, individuals with greater brooding scores reported significantly fewer depression symptoms at all of the follow-up assessments relative to individuals with lower brooding scores. In contrast, reflective pondering ruminative style did not moderate the effects of expressive writing on depression symptoms. These findings suggest that expressive writing could be used as a means of reducing depression symptoms among those with a maladaptive ruminative tendency to brood.     

The efficacy of a short version of a cognitive-behavioral treatment followed by booster sessions for binge eating disorder

This waitlist-controlled study evaluated the efficacy of a short version of a group CBT for BED followed by booster sessions after the active treatment phase. Thirty-six females with BED were randomly assigned to CBT (eight weekly sessions during active treatment plus five booster sessions during follow-up) or a waitlist condition. At the end of the active treatment, binge eating was significantly reduced relative to waitlist. Furthermore, at 12-month follow-up short-term CBT produced significant improvements in binge eating symptoms relative to baseline. Findings suggest that the short-term CBT followed by booster sessions may provide a valuable treatment option for patients with BED.     

A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania

This randomized trial compared a combined Acceptance and Commitment Therapy/Habit Reversal Training (ACT/HRT) to a waitlist control in the treatment of adults with trichotillomania (TTM). Twenty-five participants (12 treatment and 13 waitlist) completed the trial. Results demonstrated a significant reduction in hair pulling severity, impairment ratings, and hairs pulled, along with significant reductions in experiential avoidance and both anxiety and depressive symptoms in the ACT/HRT group compared to the waitlist control. Reductions generally were maintained at a 3-month follow-up. Decreases in experiential avoidance and greater treatment compliance were significantly correlated with reductions in TTM severity, implying that targeting experiential avoidance may be useful in the treatment of TTM. Other implications and suggestions for future research are noted.     

A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder

To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions—an individual and a group intervention—in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms.     

Benefits of expressive writing in lowering rumination and depressive symptoms

Depression-vulnerable college students (with both elevated prior depressive symptoms and low current depressive symptoms) wrote on 3 consecutive days in either an expressive writing or a control condition. As predicted, participants scoring above the median on the suppression scale of the Emotion Regulation Questionnaire (Gross & John, 2003) showed significantly lower depression symptoms at the 6-month assessment when they wrote in the expressive writing versus the control condition. Additional analyses revealed that treatment benefits were mediated by changes in the Brooding but not the Reflection scale of the Ruminative Response Scale (Nolen-Hoeksema & Morrow, 1991). A "booster" writing session predicted to enhance treatment benefits failed to have a significant effect.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

The durability of beneficial health effects associated with expressive writing

Abstract

This study examined the durability of benefits associated with expressive writing. Sixty-eight college undergraduates completed measures of physical and psychological health at the beginning of their first year and were then randomized to either an expressive writing or a control writing condition. Changes in physical health, psychological health (i.e., depression, stress, and anxiety), and academic performance were assessed two, four, and six months later. Findings indicated that participants assigned to the expressive writing condition reported less depression symptom severity at the two-month follow-up assessment relative to participants assigned to the control condition. However, these symptom reductions were not observed at any of the subsequent follow-up assessments. No significant changes were reported for physical health complaints, stress symptoms, anxiety symptoms, or academic performance. These findings suggest that, among first-year college students, expressive writing may provide some short-term relief for certain symptoms.     

How benefits of expressive writing vary as a function of writing instructions,ethnicity and ambivalence over emotional expression

Written emotional disclosure has been reported to confer a variety of benefits on physical and psychological well-being. However, variable findings suggest that outcomes may vary systematically as a function of specific parameters of the experimental design. This study aims to investigate the unique and combined effects of disclosure instructions focusing on emotional expression and instructions facilitating cognitive reappraisal and to examine how ambivalence over emotional expression and ethnicity moderate the effects of these writing instructions. Seventy-one Asian and 59 Caucasian undergraduates (N = 130) with at least minimal physical or depressive symptoms were randomly assigned to one of the four writing conditions: emotional disclosure (ED), cognitive reappraisal (COG), the combination of ED and COG, or a control condition. Self-reported physical symptoms, positive affect (PA) and negative affect were assessed at baseline and three follow-ups spanning 4 months. Mixed linear models revealed that COG writing reduced physical symptoms, ED buffered a decrease in PA over time, and the combination of ED and COG (i.e. self-regulation; SR) was most effective. Asians and highly ambivalent participants benefited most from expressive writing. Findings contribute to the development of a SR moderator model and carry implications for designing expressive disclosure studies, particularly for ethnic minorities.     

The Effects of Positive Interventions on Happiness and Depressive Symptoms, with an Examination of Personality as a Moderator

The advent of positive psychology has triggered research into positive interventions, which focus on strengths instead of deficits. The present study aims to investigate the effects of gratitude and strengths-based interventions on happiness and depressive symptoms against a control group, as well as to explore personality traits as moderator variables of the potential effectiveness of these interventions. A total of 122 participants completed at least two stages of the research. Data were collected at three stages—baseline pre-test, post-intervention assessment, and 1-month follow-up assessment. The findings partially support the effectiveness of the gratitude and strengths-based interventions in increasing happiness and decreasing depressive symptoms compared to a control group. Two personality domains showed significance as moderator variables. More research is needed to enable a higher degree of control when administering these promising interventions.     

Change in Dysfunctional Beliefs About Sleep in Behavior Therapy,Cognitive Therapy,and Cognitive-Behavioral Therapy for Insomnia

As part of a larger randomized controlled trial, 188 participants were randomized to behavior therapy (BT), cognitive therapy (CT), or cognitive-behavioral therapy (CBT) for insomnia. The aims of this study were threefold: (a) to determine whether change in dysfunctional beliefs about sleep was related to change in sleep, insomnia symptoms, and impairment following treatment; (b) to determine whether BT, CT, and CBT differ in their effects on dysfunctional beliefs; and (c) to determine whether the treatments differ in their effects on particular kinds of dysfunctional beliefs. Beliefs, sleep, insomnia symptoms, and sleep-related psychosocial impairment were assessed at pretreatment, posttreatment, and 6- and 12-month follow-up. Greater change in dysfunctional beliefs occurring over the course of BT, CT, or CBT was associated with greater improvement in insomnia symptoms and impairment at posttreatment and both follow-ups. All groups experienced a significant decrease in dysfunctional beliefs during treatment, which were sustained through 6- and 12-month follow-up. Compared with the BT group, a greater proportion of participants in the CT and/or CBT groups endorsed dysfunctional beliefs below a level considered clinically significant at posttreatment and 12-month follow-up. The results demonstrate the importance of targeting dysfunctional beliefs in insomnia treatment, suggest that beliefs may be significantly modified with BT alone, and indicate that cognitive interventions may be particularly powerful in enhancing belief change.     

Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms

Selective attention for dysphoric stimuli has been observed in individuals with depression and those at risk for depression. To date, no studies have investigated the effects of directly manipulating selective attention for dysphoric stimuli on depressive symptoms. Mild to moderately depressed college students (N=34) were randomly assigned to complete 4 sessions of either attention training (AT) or no training (NT) during a two-week period. Participants completed self-reported assessments of depressive symptoms at baseline, post-training, and follow-up. Participants in the AT condition had a significantly greater decrease in depressive symptoms from baseline to follow-up than participants in the NT condition. This group difference was mediated by change in attention bias. Our findings suggest that biased attention may have a causal role in the maintenance of depressive symptoms.     

Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms

This study compared individual (I) to group (G) formats of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for the treatment of depression in adolescents. One hundred and 12 Puerto Rican adolescents were randomized to four conditions (CBT-I, CBT-G, IPT-I, IPT-G). Participants were assessed at pretreatment and posttreatment with structured interviews to establish diagnosis and with self-report measures to assess treatment outcome. The results suggest that CBT and IPT are robust treatments in both group and individual formats. However, CBT produced significantly greater decreases in depressive symptoms and improved self-concept than IPT. The implications of these findings are discussed.     

Testing the benefits of expressive writing for workplace embitterment: a randomized control trial

Clinicians working in occupational health services often recognize features of embitterment in organizations; however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomized control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation are warranted.     

Treatment of obsessions: A randomized controlled trial

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.     

Emotion Regulation of Events Central to Identity and Their Relationship With Concurrent and Prospective Depressive Symptoms

Dispositional emotion regulation is related to the severity and maintenance of depressive symptoms. However, whether emotion regulation specific to an event highly central for an individual’s identity is predictive of depressive symptoms has not been examined. Nonclinical participants (N = 220) reported the extent to which they employed a selection of emotion regulation strategies when recalling low- and high-centrality events. Dispositional emotion regulation and depressive symptoms were also assessed. A 7-week follow-up was conducted. High-centrality events were associated with more emotion regulation efforts. Greater brooding and expressive suppression in relation to high-centrality memories predicted concurrent depressive symptoms after controlling for event valence and dispostional emotion regulation. Effects were absent for low-centrality memories. Emotion regulation in response to high-centrality memories did not predict depressive symptoms at follow-up beyond baseline depressive symptoms. Overall, the findings showed that maladaptive emotion regulation in response to memories of high-centrality events is important for explaining depressive symptomatology.