Development and Evaluation of an Online Intervention for Reducing Hostile Interpretation Bias: A Randomized Controlled Trial

Hostility is a trait-level construct characterized by a generally suspicious and cynical view of other people that results in a tendency to interpret ambiguous social situations in hostile or threatening ways. Cognitive behavioral treatments for hostility have high dropout rates, which may be due to hostile beliefs interfering with treatment engagement. As such, there is a need for an alternative approach to prevent dropout and enhance engagement. The current study therefore developed and tested a 1-session, 40-minute online intervention targeting hostility. It was hypothesized that the hostility intervention would be rated as acceptable as indexed by self-report and completion rates. It was also hypothesized that the hostility intervention would be associated with greater reductions in hostility as compared to a control intervention. Finally, it was hypothesized there would be indirect effects of intervention condition on anger and aggression via changes in hostility.Undergraduates (N = 101) who reported elevated hostility and hazardous alcohol use were randomized to complete either the hostility intervention or a control condition targeting physical health habits. Results showed that individuals randomized to the hostility intervention found the intervention to be highly acceptable and all participants completed the intervention in its entirety. The hostility intervention was associated with significantly faster reductions in hostile interpretations than the control condition with medium to large effects. There were significant indirect effects of intervention condition on month one follow-up anger and aggression via changes in hostile cognitions. This proof-of-concept study provides initial evidence that a brief, single-session intervention may be a promising approach for reducing hostility and its correlates.     

The short-term effects of a hostility-reduction intervention on male coronary heart disease patients.

This preliminary study examined the effects of a hostility-reduction intervention on patients with coronary heart disease (CHD). Twenty-two high-hostile CHD men were matched on age and hostility and then randomly assigned to a hostility intervention (N = 10) or an information-control group (N = 12). Patients were reassessed immediately and 2 months posttreatment on hostility (with self-report and structured interview) and resting blood pressure. The intervention's overall effect size was moderately strong (d' = .62). Intervention patients reported at both reassessments and were observed at follow-up to be less hostile than controls. At follow-up, intervention patients had significantly lower diastolic blood pressure (DBP) than controls. Finally, reductions in hostility were significantly and positively correlated with reductions in DBP. Replication with a larger sample and CHD outcomes is recommended.     

School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study

Social anxiety disorder, whose onset peaks in adolescence, is associated with significant impairment. Despite the availability of effective treatments, few affected youth receive services. Transporting interventions into schools may circumvent barriers to treatment. The efficacy of a school-based intervention for social anxiety disorder was examined in a randomized wait-list control trial of 35 adolescents (26 females). Independent evaluators, blind to treatment condition, evaluated participants at preintervention, postintervention, and 9 months later. Adolescents in the intervention group demonstrated significantly greater reductions than controls in social anxiety and avoidance, as well as significantly improved overall functioning. In addition, 67% of treated subjects, compared to 6% of wait-list participants, no longer met criteria for social phobia following treatment. Findings support the possible efficacy of school-based intervention for facilitating access to treatment for socially anxious adolescents.     

Subjective Well-Being and Self-Reported Health in Osteoarthritis Patients Before and After Arthroplasty

The main aim of the current study is to examine the changes in the components of subjective well-being (SWB) over time in patients with osteoarthritis who have undergone total hip or knee replacement surgery (arthroplasty). We are also interested in determining whether pre-operative ratings of self-reported health (SRH) status, as well as change in health status, can serve as predictors for postoperative levels of SWB. To this end, 50 participants who had been admitted to a hospital for arthroplasty completed the measures twice—first at the clinic one day before the surgery, and then at home approximately 4.5 months after the surgery. Despite the fact that there were substantial improvements in participants’ health and physical functioning after the arthroplasty, there were no changes in their ratings of general SRH, life satisfaction (LS), or negative affect (NA). The only change in SWB scores was in the level of positive affect (PA), which was significantly higher after surgery compared with the pre-operative measurement. LS, NA, and PA scores after arthroplasty were differentially predicted by health ratings, showing that, it is the cognitive-evaluative component of SWB (i.e., LS) that is mostly responsible for the association between general SRH and SWB while affective components (i.e., NA and PA) are primarily related to more specific health indicators. Our findings can assist physicians in their efforts to provide more realistic expectations for their patients undergoing surgery in terms of the physical and psychological outcome.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.     

Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

Secondary smoking prevention in a university setting: a randomized comparison of an experiential, theory-based intervention and a standard didactic intervention for increasing cessation motivation.

OBJECTIVE: College may represent an untapped opportunity to reach the growing number of student smokers who are at risk of progressing toward regular smoking. The aim of this study was to test the efficacy of a theory-based experiential intervention for increasing motivation to quit smoking and reducing smoking behavior. DESIGN: This study used a 3-arm, randomized design to examine the efficacy of an experiential secondary prevention intervention. The control groups included a traditional didactic smoking intervention and an experiential intervention on nutrition. MAIN OUTCOME MEASURES: The 2 primary dependent variables were change in self-reported intention to quit smoking, measured pre- and postintervention, and change in smoking behavior over the month following the intervention. RESULTS: As hypothesized, the experiential smoking intervention was more effective than either control group in increasing immediate motivation to quit, but the effect was found only among female participants. At 1-month follow-up, both smoking interventions produced higher rates of smoking cessation and reduction than did the nutrition control condition. CONCLUSION: Findings support the potential efficacy of an intensive experiential intervention for female smokers.     

Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = −2.06, p = .046, d = −0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement’s effects on physical and mental health.     

Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients

OBJECTIVE: To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES: The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS: Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION: These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.     

Changes in goal-related affects: Decrease burnout during a group psychotherapy intervention

The study examined the role played by changes in employees' goal-related affects in decreasing burnout during a group intervention. 62 white-collar employees, suffering from severe burnout, were randomized into 10-month group intervention programmes consisting of 16 intensive 1-day sessions every second week. The participants appraised their work and interpersonal goals according to their positive and negative affects weekly for 54 weeks. During the pre- and postintervention and follow-up (6 months later) measurements, the participants filled out a burnout measurement. The results, analysed by multilevel modelling, showed that a decrease in the negative affects and an increase in the positive affects of work and interpersonal goals during the later part of the intervention was related to a decrease in burnout symptoms. The decrease in goal-related negative affects was associated with a decrease in burnout in the postintervention measurement, whereas the increase in goal-related positive affects was related to a decrease in follow-up burnout.     

The effects of a brief time perspective intervention for increasing physical activity among young adults

Past research has demonstrated that health behavior is correlated with time perspective: long-term thinkers are more likely than short-term thinkers to engage in health protective behaviors and less likely to engage in health damaging behaviors. To date, however, no research has experimentally demonstrated that time perspective is causally related to health behavior. We designed a brief (three 1/2-h weekly sessions) time perspective intervention to enhance long-term thinking about physical activity and examined its efficacy among two samples of young adults who signed up for fitness classes at a university recreational facility. Participants were assigned to one of three conditions: time perspective intervention, goal-setting control intervention, and no-treatment control. In Study 1, physical activity levels were assessed at preintervention, at postintervention (3 weeks later), and at 10-week follow-up (7 weeks after completion of the intervention). Controlling for preintervention physical activity levels, time perspective participants reported increased levels of physical activity relative to both other groups at postintervention, and relative to the no-treatment group at 10-week follow-up. This study provides the first experimental evidence that the effects of health behavior interventions may be enhanced by increasing participants’ long-term time perspective, and that time perspective is causally associated with health behavior. Study 2 replicated some of the effects of Study 1 using a larger sample, a six-month follow-up interval, and improved measurement of outcome. Together Studies 1 and 2 suggest that time perspective is an important ingredient in interventions designed to promote physical activity.     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.     

The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties

Two variants of a behavioral family intervention (BFI) program known as Triple P were compared using 87 preschoolers with co-occurring disruptive behavior and attentional/hyperactive difficulties. Families were randomly allocated to enhanced BFI (EBFI), standard BFI (SBFI), or a waitlist (WL) control group. At postintervention both BFI programs were associated with significantly lower levels of parent-reported child behavior problems, lower levels of dysfunctional parenting, and greater parental competence than the WL condition. The EBFI condition was also associated with significantly less observed child negative behavior in comparison to the WL. The gains achieved at postintervention were maintained at 1-year follow-up. Contrary to predictions, the enhanced program was not shown to be superior to the standard program using any of the outcome measures at either postintervention or follow-up. Each of the programs produced significant reductions in children's co-occurring disruptive behavior and attentional/hyperactive difficulties with 80% of the children showing clinically reliable improvement in observed negative behavior from preintervention to follow-up.     

The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial

The aim of this multisite randomized controlled trial was to determine whether an intervention based on Acceptance and Commitment Therapy (ACT) was efficacious in improving university students’ psychological flexibility, mental health, and school engagement. Students were recruited in four Canadian universities and randomly assigned to an intervention (n = 72) or a wait-list control group (n = 72). Students in the intervention group took part in four 2.5-hour workshops during a 4-week period and were asked to do exercises at home (e.g., meditation, observation grids). Wait-list students received the intervention soon after the post measurements. MANCOVAs and ANCOVAs revealed that students in the intervention group showed greater psychological flexibility at postintervention than those in the control group. They also reported greater well-being and school engagement, and lower stress, anxiety, and depression symptoms. Taken together, results of this study suggest that an ACT-based intervention offers a valuable way to promote mental health and school engagement in postsecondary settings.     

A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking

The effectiveness of a deliberately limited version of Acceptance and Commitment Therapy (ACT) for chronic skin picking was evaluated in a pair of multiple baseline across participants designs. Self-monitoring of skin picking showed that four of the five participants reached near zero levels of picking by post-treatment, but these gains were not fully maintained for three of the four participants at follow-up. The findings of the self-reported skin picking were generally corroborated by ratings of photographs of the damaged areas and by ratings on a validated measure of skin picking severity. All participants rated the intervention as socially acceptable, and reductions were found on measures of anxiety, depression, and experiential avoidance for most participants as a result of the intervention. Results support the construction of more comprehensive ACT protocols for skin picking.     

Expressive Arts and Mindfulness: Aiding Adolescents in Understanding and Managing Their Stress

This study contains an exploration of the use of mask-making and mindfulness training as components of an expressive arts group intervention designed to help youth understand and manage their stress. With the assistance of a school counselor, six eighth-grade students, who were having difficulty managing stress, were identified and participated in a 12-hour group intervention over the course of six weeks. Participants were assessed pre- and post-intervention and at a three-week follow-up on measures of self-efficacy, depression, anxiety, and stress. The group intervention resulted in significant self-reported reductions of anxiety and stress at the three-week follow-up.     

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.     

A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee

The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme (ASMP) among osteoarthritic knee sufferers in Hong Kong at 1 year. An experimental study with 95 participants assigned randomly to the intervention (n=45) or control group (n=50). Seventy-seven (81.1%) participants joined at least one out of three follow-ups in the 12 month period. Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics. Outcome measures included arthritis self-efficacy (ASE) and health outcomes including pain and fatigue rating, self-rated health, daily activities limitation and number of unplanned arthritis-related medical consultations. Mean change (12 months minus baseline) and the effect size of the outcome measures were calculated by Mann-Whitney U test and nQuery Advisor 4.0. At 12 months, there were significant reductions of current pain (p=0.0001), pain at night (p=0.001), pain during walking (p=0.01) and number of unplanned arthritis-related medical consultations (p=0.03) and a significant increase in ASE for pain (p=0.01) and other symptoms (p=0.02) and self-rated health (p=0.04) among the intervention group but not for the control group. However, there were similarities in outcome measures of pain while switching from a sitting to a standing position, fatigue rating and physical functional limitation (p=0.15; p=0.22 and p=0.91, respectively) for both groups. Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment.     

An Internet-Based Compassion-Focused Intervention for Increased Self-Criticism: A Randomized Controlled Trial

Increased levels of self-criticism and a lack of self-compassion have been associated with the development and maintenance of a range of psychological disorders. In the current study, we tested the efficacy of an online version of a compassion-focused intervention, mindfulness-based compassionate living (MBCL), with guidance on request. A total of 122 self-referred participants with increased levels of self-criticism were randomly assigned to care as usual (CAU) or the intervention group (CAU + online intervention). Primary endpoints were self-reported depressive, anxiety and distress symptoms (DASS-21) and self-compassion (SCS) at 8 weeks. Secondary endpoints were self-criticism, mindfulness, satisfaction with life, fear of self-compassion, self-esteem, and existential shame. At posttreatment, the intervention group showed significant changes with medium to large effect sizes compared to the control group regarding primary outcomes (Cohen’s d: 0.79 [DASS] and -1.21 [SCS]) and secondary outcomes (Cohen’s ds: between 0.40 and 0.94 in favor of the intervention group). The effects in the intervention group were maintained at 6-months postrandomization. Adherence measures (number of completed modules, self-reported number of completed exercises per week) predicted postintervention scores for self-compassion but not for depressive, anxiety, and distress symptoms in the intervention group. The current study shows the efficacy of an online intervention with a transdiagnostic intervention target on a broad range of measures, including depressive and anxiety symptoms and self-compassion.