Does Group CBT for Depression Do What It Says on the Tin? A Systemic Review and Meta-analysis of Group CBT for Depressed Adults (2000–2016)

The present study aimed to update previous meta-analyses of gCBT, and focus specifically on recent studies in which the Beck Depression Inventory (BDI) was used to assess outcome. PsycINFO, PubMed, EMBASE, and Cochrane were searched for eligible studies. Both randomized controlled trials (RTC, k = 9) and non-RTCs (k = 1) published since 2000 were included. On the BDI large significant effect sizes were found for gCBT compared with treatment as usual (TAU, d = 4.64), wailing list controls (WLC, d = 1.20), and both of these comparison conditions combined with studies of well-defined alternative treatments (ALT, d = 1.61). On the BDI a moderate effect size (d = 0.53) was found for comparisons of gCBT and ALT groups. gCBT also had large and significant effects on depressive cognition assessed with the Automatic Thoughts Questionnaire and the Dysfunctional Attitudes Scale compared with WLC and ALT comparison groups (d = 2.66). This meta-analysis shows that gCBT is a robust intervention for depression in adults.     

Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster

The purpose of the multi-measure, multi-wave, longitudinal study was to examine the interactive relation between behavioral distress tolerance (DT) and perceived social support (PSS) in 352 tornado-exposed adolescents aged 12–17 years (M = 14.44; SD = 1.74). At baseline, adolescents completed a computer-based task for DT, and self-report measures of PSS, depressed mood, posttraumatic stress disorder (PTSD), substance use, and interpersonal conflict. Symptoms also were assessed 4 and 12 months after baseline. Findings showed that lower levels of DT together with lower levels of PSS conferred risk for elevated symptoms of prospective depression (t(262) = ?2.04, p = .04; r_{effect size} = 0.13) and PTSD (t(195) = ?2.08, p = .04; r_{effect size} = 0.15) following a tornado. However, only PSS was significant in substance use t(139) = 2.20, p = .03; r_{effect size=}0.18) and conflict (t(138) = ?4.05, p < .0001; r_{effect size=}0.33) in our sample. Implications regarding adolescent DT, the transdiagnostic nature of PSS, and the clinical applications of our findings in the aftermath of a natural disaster are discussed.     

Stress-Related Growth in Japanese Adolescents Experiencing High School Entrance Examinations

High school entrance examinations and preparation for them have become a highly stressful experience for many Japanese adolescents. This study examined the relationship between stress-related growth (SRG) and distress resulting from these exams from the perspective of positive meaning-making. Ninth graders (N = 183, 87 females, aged 14–15 years) of a public school in Tokyo participated in the study by responding to a questionnaire survey. Results indicated that meaning-making was positively correlated with SRG (r = .58, p < .001), whereas it was negatively correlated with distress (r = ?.20, p = .006). Moreover, SRG was negatively correlated with distress (r = ?.34, p < .001). Mediation analysis demonstrated that SRG positively mediates the relationship between meaning-making and distress, while distress negatively mediates the relationship between meaning-making and SRG. These results have implications for understanding the causal relationships between SRG and distress, from the perspective of positive meaning-making regarding high school entrance examinations in Japan.     

Irrational Beliefs and Attention Bias Towards Symptoms-Related Stimuli in Maintaining Gastrointestinal Symptoms: Results from a Pilot Study

Recent etiopathogenic theories of gastrointestinal conditions state that information processing biases can be a possible major factor involved in the aetiology and maintenance of these conditions. This exploratory study investigated the role of attention biases (AB) towards symptoms-related cues in gastrointestinal patients with respect to symptom maintenance, simultaneously taking into consideration the role of irrational beliefs. We included 32 patients diagnosed with gastrointestinal conditions. Patients completed a battery of psychological tests and an experimental task aimed to measure the preferential attention processing of linguistic stimuli related to gastrointestinal symptoms when they compete for attention resources with neutral stimuli. AB was positively related to irrational beliefs [r(31) = .376, p = .037] and analgesics use [r(32) = .518, p = .002], but not to self-report gastrointestinal symptoms [r(30) = ?.165, p = .382]. Irrational beliefs correlated with pain catastrophizing [r(31) = .373, p = .039], but not to gastrointestinal symptoms, pain intensity, visceral sensitivity or negative emotions; however, pain catastrophizing correlated with all of these. Taken together, our results suggest that core irrational beliefs action as general vulnerability factors that trigger specific implicit and explicit cognitive mechanisms (i.e., AB, pain catastrophizing) involved in the onset and maintenance of symptoms. Future experimental studies should test the robustness of these results in larger samples and aim to further advance our understanding of how cognitive factors interact and potentiate each other in generating and maintaining debilitating suffering.     

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance–outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance–outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.     

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others’ emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N’s ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = ?0.15) and understanding emotions (r = ?0.20), less aware of (r = ?0.28) and less accepting of their own emotions (r = ?0.49), and report less emotional self-efficacy (r = ?0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children’s age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.     

Resilience to Interpersonal Trauma and Decreased Risk for Psychopathology in an Epidemiologic Sample

Quantitative measures of psychological resilience related to discrete stressors, such as interpersonal (IP) trauma, are lacking. The current study examined whether a novel, quantitative measure of resilience was related to decreased risk for a broad range of lifetime DSM-IV axis I disorders in an epidemiologic sample. Resilience was defined as the residual resulting from the difference between the individual’s predicted and observed PTSD symptom count, based on their cumulative exposure to IP traumatic events. Participants were 6288 adults (59.5% women; M _age  = 46.9, SD = 14.5) from the National Epidemiologic Study on Alcohol and Related Conditions endorsing at least one lifetime IP traumatic event. Logistic regressions were conducted to examine the relationship between resilience and axis I diagnoses, covarying for age, sex, education level, social support, and recent stressful life events. Greater resilience scores were associated with decreased likelihood of major depression (OR = .64, p < .001), generalized anxiety disorder (OR = .65, p < .001), social anxiety disorder (OR = .74, p < .001), panic disorder (OR = .65, p <. 001), and alcohol dependence (OR = .85, p < .001). Discrepancy between expected and observed PTSD symptom severity based on IP trauma load may represent a useful, quantitative measure of resilience.     

Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT

This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9 % male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n = 48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov.:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = 0.022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = 0.008, d = 0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = 0.012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.     

Impact of Genomic Counseling on Informed Decision-Making among ostensibly Healthy Individuals Seeking Personal Genome Sequencing: the HealthSeq Project

Personal genome sequencing is increasingly utilized by healthy individuals for predispositional screening and other applications. However, little is known about the impact of ‘genomic counseling’ on informed decision-making in this context. Our primary aim was to compare measures of participants’ informed decision-making before and after genomic counseling in the HealthSeq project, a longitudinal cohort study of individuals receiving personal results from whole genome sequencing (WGS). Our secondary aims were to assess the impact of the counseling on WGS knowledge and concerns, and to explore participants’ satisfaction with the counseling. Questionnaires were administered to participants (n = 35) before and after their pre-test genomic counseling appointment. Informed decision-making was measured using the Decisional Conflict Scale (DCS) and the Satisfaction with Decision Scale (SDS). DCS scores decreased after genomic counseling (mean: 11.34 before vs. 5.94 after; z = ?4.34, p < 0.001, r = 0.52), and SDS scores increased (mean: 27.91 vs. 29.06 respectively; z = 2.91, p = 0.004, r = 0.35). Satisfaction with counseling was high (mean (SD) = 26.91 (2.68), on a scale where 6 = low and 30 = high satisfaction). HealthSeq participants felt that their decision regarding receiving personal results from WGS was more informed after genomic counseling. Further research comparing the impact of different genomic counseling models is needed.     

Comparative Latent State–Trait Analysis of Satisfaction with Life Measures: The Steen Happiness Index and the Satisfaction with Life Scale

The variance in satisfaction with life can be broken down into trait- and state-like components. We ran tests to determine if a new scale for the measurement of satisfaction with life, the Steen Happiness Index (SHI), was more sensitive to situational changes than the Satisfaction with Life Scale (SWLS), which is currently used as a gold standard, with well-established state–trait characteristics. The study consisted of 292 young adults aged 18–35, who were recruited and interviewed three times with 5-month intervals at their places of residence. They completed a set of questionnaires involving the SHI and the SWLS. A latent autoregressive state–trait model showed an adequate fit, χ² (56) = 81.35, p = .02, χ²/df = 1.45, RMSEA = .06, CFI = .98, SRMR = .06. The results indicated that the two scales are strongly correlated on the trait level (r = .98) and on the occasion-specific level (between r = .53 and r = .65) variables. For both scales, stable and occasion-specific influences determine inter-individual differences. For both scales, it is not possible to predict half of the variance by either traits or states measured earlier in time.     

A Daily Process Approach to Depict Satisfaction with Life during the Menopausal Transition: Physical (In)activity,Symptoms, and Neuroticism

The main objectives of the present study were (1) to examine the between- and within-person association of physical (in)activity and satisfaction with life (SWL), and (2) to identify relevant top-down and bottom-up influences associated with daily well-being in menopausal women using a daily process approach. As part of a 21-day diary study, community-dwelling middle-aged women (N = 103; age range 40–60 years) wore an accelerometer for the objective assessment of physical activity and completed daily Internet surveys at the end of their day. Multilevel analyses indicated the between-person effects of physical activity on SWL were negligent but that on days when a woman was more physically active than her usual, she reported greater SWL (B = 12.01, p < .05). Sedentary behavior did not demonstrate a between- or within-person association with SWL. Women also experienced reduced SWL on days when greater symptom burden was reported (B = ?2.47, p < .05). Neuroticism also emerged as a top-down personality trait with a negative relation to SWL (B = ?1.47, p < .05). Higher levels of neuroticism predicted reduced daily life satisfaction particularly on days characterized by heightened symptom burden (B = ?0.26, p < .05). In this sample of midlife women, daily physical activity had a positive influence on SWL, whereas daily symptom burden and the personality trait of neuroticism had detrimental consequences on a woman’s daily well-being.     

Study of Human Biochemical Parameters During and After Ramadan

Ramadan fasting is obligatory for Muslims each year. They abstain from drinking, eating and intimate relationship between dawn and dusk during this month. Dietary restriction during Ramadan has various biochemical and physiological effects. It is shown to decrease the body weight, glucose and lipid profile. This study aims to analyze the changes in body weight, glucose and lipid profile during Ramadan in physiotherapy students in Pakistan. The study was conducted during June–July 2013 (Hijri year 1434). There were 80 students (50 males and 30 females) recruited in the experiment. They all were healthy adults between the age group of 18–24 (mean age 20.5) years. All subjects underwent a general physical examination and interview, and non-healthy subjects were excluded. On statistical analysis, quantitative data were expressed in terms of mean ± SD and a p value of ≤0.05 was believed statically significant. Paired t test was used to compare the variables. There was a little reduction in body weight (62.7 ± 8.8 vs. 62.3 ± 9.0; p value = 0.009) but a significant decline in glucose level (72.6 ± 12.5 vs. 57.9 ± 10.7; p value = 0.000), low-density lipoprotein level (2.9 ± 0.3 vs. 2.5 ± 0.3; p value = 0.000), total cholesterol (4.6 ± 0.4 vs. 4.2 ± 0.5; p value = 0.000) and triglycerides (1.4 ± 0.5 vs. 1.2 ± 0.5; p value = 0.000) was observed. Moreover, there was some reduction in high-density lipoprotein cholesterol level (1.2 ± 0.3 vs. 1.1 ± 0.3; p value = 0.045). This study shows that Ramadan fasting, a religious obligation for purification of body and soul, resulted in reduced body weight and a positive effect on glucose level and lipid profile.     

The Psychological Impact of the Jesus Prayer among Non-Conventional Catholics

This pilot study explored the psychological impact of a 2-month intervention with the Jesus Prayer among a sample taken from a community of middle-aged Catholics in Spain. The study collected quantitative data on psychological symptoms with the Revised Symptom Checklist 90 (SCL-90-R) and on personality traits with the Revised Temperament and Character Inventory (TCI-R) at three different times: baseline, post-intervention, and 5 months after the 2-month intervention. It also collected quantitative data on transient mood states with the Profile of Mood States (POMS) before and after a 25-min intervention with the Jesus Prayer, plus data on adherence 2 years after the inquiry. Statistical analysis found lower scores on Interpersonal Sensitivity (p = .009) and Phobic Anxiety (p = .03) psychological symptoms after the 2-month intervention. Analyses of data also found lower scores and strong effect sizes on Tension (p = .03, d = 1.029) and Fatigue (p = .001, d = 1.390) after a 25-min intervention. The 2-year follow up found that one third of the final sample had completely adhered to a daily practice of the Jesus Prayer. Overall results indicate that the Jesus Prayer may be a relevant practice among Catholics both for well-being and spiritual purposes.     

A Comparison of Sexual Relationships Among Hispanic Men by Sexual Orientation: Implications for HIV/STI Prevention

Hispanic men experience high rates of HIV infection and other sexually transmitted infections (STIs) when compared to non-Hispanic whites. Many factors contribute to HIV/STI risk among Hispanic men. Some researchers have suggested that primary relationships may be a source of HIV/STIs because some men engage in sexual relationships outside of the primary relationship. However, little is known about this among Hispanic men, and less is known about how sexual relationships differ by sexual orientation. The purpose of this study was twofold: (1) to determine if Hispanic men engage in sexual relationships outside of primary relationships; and (2) to compare sex outside of primary relationships by sexual orientation. Data for this study were obtained from a larger study that investigated health risks of Hispanic men residing in the U.S.–Mexico border community. Participants were recruited from agencies that provided services to Hispanic men. Participants completed a structured interview that included questions about primary relationships and sex outside of primary relationships. The sample consisted of 103 Hispanic men (50 heterosexual, 43 gay, and 10 bisexual Hispanic men), but two participants refused to answer relationship questions, resulting in a sample of 101 Hispanic men. About one-third of the participants (n = 29) reported sex outside of the primary relationship, but no differences were found between the gay/bisexual and heterosexual men, X ² (2, N = 101) = 9.91, p = .128. More gay/bisexual men reported sex with the primary partner and another person at the same time than heterosexual men, X ² (2, N = 101) = 13.32, p = .010. More gay/bisexual men reported open relationships when compared to heterosexual men, X ² (2, N = 101) = 17.23, p = .008, and more gay/bisexual men reported sex outside the primary relationship without the primary partner’s knowledge, X ² (2, N = 101) = 15.09. p = .020. However, more heterosexual men reported that condoms were not used for sex outside the primary relationship when compared to gay/bisexual men, X ² (2, N = 101) = 14.01, p = .029. Sex outside of primary relationships presents some implications for HIV/STI prevention among Hispanic men. Because gay/bisexual men experience higher rates of HIV/STI, more attention needs to be focused on all forms of relationships to prevent acquisition of HIV/STIs. Among heterosexual Hispanic men more attention needs to be given to reinforcement of safer sex practices both outside the primary relationship, and within the primary relationship if high risk sex is occurring outside the primary relationship. More research is needed on the reasons for sex outside the primary relationship among Hispanic men, as well as research to promote safer sex practices when sex occurs outside of the primary relationship.     

Reasoning defeasibly about probabilities

In concrete applications of probability, statistical investigation gives us knowledge of some probabilities, but we generally want to know many others that are not directly revealed by our data. For instance, we may know prob(P/Q) (the probability of P given Q) and prob(P/R), but what we really want is prob(P/Q&;R), and we may not have the data required to assess that directly. The probability calculus is of no help here. Given prob(P/Q) and prob(P/R), it is consistent with the probability calculus for prob(P/Q&;R) to have any value between 0 and 1. Is there any way to make a reasonable estimate of the value of prob(P/Q&;R)? A related problem occurs when probability practitioners adopt undefended assumptions of statistical independence simply on the basis of not seeing any connection between two propositions. This is common practice, but its justification has eluded probability theorists, and researchers are typically apologetic about making such assumptions. Is there any way to defend the practice? This paper shows that on a certain conception of probability—nomic probability—there are principles of “probable probabilities” that license inferences of the above sort. These are principles telling us that although certain inferences from probabilities to probabilities are not deductively valid, nevertheless the second-order probability of their yielding correct results is 1. This makes it defeasibly reasonable to make the inferences. Thus I argue that it is defeasibly reasonable to assume statistical independence when we have no information to the contrary. And I show that there is a function Y(r, s, a) such that if prob(P/Q) = r, prob(P/R) = s, and prob(P/U) = a (where U is our background knowledge) then it is defeasibly reasonable to expect that prob(P/Q&;R) = Y(r, s, a). Numerous other defeasible inferences are licensed by similar principles of probable probabilities. This has the potential to greatly enhance the usefulness of probabilities in practical application.     

Clinical Utility of Expanded Carrier Screening: Reproductive Behaviors of At-Risk Couples

Expanded carrier screening (ECS) analyzes dozens or hundreds of recessive genes to determine reproductive risk. Data on the clinical utility of screening conditions beyond professional guidelines are scarce. Individuals underwent ECS for up to 110 genes. Five-hundred thirty-seven at-risk couples (ARC), those in which both partners carry the same recessive disease, were invited to participate in a retrospective IRB-approved survey of their reproductive decision making after receiving ECS results. Sixty-four eligible ARC completed the survey. Of 45 respondents screened preconceptionally, 62% (n = 28) planned IVF with PGD or prenatal diagnosis (PNDx) in future pregnancies. Twenty-nine percent (n = 13) were not planning to alter reproductive decisions. The remaining 9% (n = 4) of responses were unclear. Of 19 pregnant respondents, 42% (n = 8) elected PNDx, 11% (n = 2) planned amniocentesis but miscarried, and 47% (n = 9) considered the condition insufficiently severe to warrant invasive testing. Of the 8 pregnancies that underwent PNDx, 5 were unaffected and 3 were affected. Two of 3 affected pregnancies were terminated. Disease severity was found to have significant association (p = 0.000145) with changes in decision making, whereas guideline status of diseases, controlled for severity, was not (p = 0.284). Most ARC altered reproductive planning, demonstrating the clinical utility of ECS. Severity of conditions factored into decision making.     

Sleep Problems and Separation Anxiety in Preschool-Aged Children: A Path Analysis

Sleep problems occur frequently in young children, possibly causing detrimental effects on their development. Parental marital difficulties are known to put a burden on children’s sleep and adjustment. However, research concerning the relation between the parental relationship quality and children’s sleep difficulties is rare for preschool-aged children. This study aims to fill in the gap. Initially, caregivers of 94 preschoolers (41 girls and 53 boys, aged 2–6 years) filled in questionnaires providing information on their children’s sleep and anxiety as well as on their own sleep and relationship quality. A path model approach was used to examine two competing theoretical models linking these factors. The conducted path analysis indicated that children’s separation anxiety, β = ?.134, p = .017, as well as their anxiety in general, β = ?.177, p = .024, partially mediated the relation between the parental relationship quality and children’s sleep problems. Parental sleep problems correlated with the relationship quality, r = ?.371, p = .030, but had no significant influence on children’s sleep. The results of our study suggest that children growing up with parents who state a low relationship quality might thus be concerned about the stability of their family system. As a result children’s sleep quality might be compromised due to irritation and feelings of insecurity. The study highlights the importance of the parental relationship as an influence factor in children’s sleep quality.