Severity of psychosocial stress and outcome of alcoholism treatment

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.     

The rapid-smoking technique: Subject characteristics and treatment outcome

There is a lack of consistency in findings regarding subject (S) characteristics and the effects of smoking-control programmes. Research workers appear to assume that abstinence and reduction in smoking rate are merely different points in the same continuum, and therefore seek to correlate S variables with percentage reductions in smoking rate. It is argued that abstinence and reduced smoking are more appropriately viewed as potentially discrete outcomes. Conceptualizing outcome in this manner, a discriminant function analysis was employed to determine whether it is possible to differentiate between Ss who do, or do not, abstain following participation in a treatment programme involving rapid-smoking. It was found that it is possible to discriminate between the two groups of Ss. Advantages deriving from this approach to the investigation of S characteristics and treatment outcome are discussed.     

Impulsivity predicts treatment outcome in obese children

Treatment for obesity is still running short, particularly on the long term. However, some people do take advantage of treatments and are able to retain their weight loss. What makes the difference between those who can keep their weight loss and those who cannot? One possible predictor of relapse in obesity treatment is impulsivity. Overall, obese people are found to be more impulsive than lean people, especially obese binge eaters. Intuitively, it would make sense that the most impulsive people are less able to keep control over eating behaviour. Therefore, impulsivity could serve as an obstacle for treatment. In the present study impulsivity was measured with a behavioural task (the stop signal task) in 26 obese children. Overweight of the children was measured before and after treatment and at 6 and 12 months follow ups. The results show that impulsivity was related to overweight at all moments: The most impulsive children were the most overweight ones; even after 12 months. Moreover, impulsivity predicted therapy success: the most impulsive children lost less weight. Impulsivity appears to contribute to the difference between succeeding or failing in attempts to lose weight.     

A transdiagnostic examination of decreased intolerance of uncertainty and treatment outcome

Intolerance of uncertainty (IU) is characterized by negative beliefs and reactions to uncertainty. IU is present in emotional disorders and may be a mechanism of change in treatment . There are two components of IU, prospective and inhibitory IU, that may be differentially associated with outcome. The current study tested associations between pre- and post-treatment changes in the components of IU, symptoms of anxiety and depression, and treatment outcome in a large diagnostically heterogeneous partial hospital sample. Results suggested that social anxiety disorder was associated with greater pre-treatment prospective and inhibitory IU scores than those without the diagnosis. Results also showed that inhibitory IU predicted change in anxiety and depression symptoms and prospective IU and depression reductions predicted improvements in overall psychological health and psychological inflexibility. Only change in depression predicted improvement in interpersonal relationships throughout treatment. Clinical and theoretical implications of the findings are discussed.     

Provoked vestibulodynia: Psychological predictors of topical and cognitive-behavioral treatment outcome

Psychological factors have been found to impact the pain experience and associated sexual impairment of women suffering from provoked vestibulodynia (PV). Despite a lack of randomized treatment outcome studies, particularly concerning psychological predictors of outcome, recent studies have shown that topical applications and cognitive-behavioral therapy (CBT) are among the most popular first-line interventions for PV. The present study aimed to determine the extent to which baseline fear-avoidance variables and pain self-efficacy were differentially associated with topical application and CBT outcomes at six-month follow-up. Data were obtained from 97 women who completed a randomized trial comparing these two treatments. Regression analyses revealed that for topical treatment, higher levels of baseline avoidance predicted worse pain and sexual functioning outcomes, whereas higher levels of pain self-efficacy predicted better outcomes. For CBT, higher levels of baseline fear of pain and catastrophizing contributed to higher pain intensity at follow-up, whereas higher levels of pain self-efficacy were associated with less pain. Psychological factors did not predict sexual functioning outcomes for CBT. Consistent with biopsychosocial models of pain and sexual dysfunction, results indicate that psychological factors contribute to pain and sexual impairment following treatment for PV. Specifically, findings suggest that fear-avoidance variables and pain self-efficacy are significant predictors of topical and CBT treatment outcomes in women with PV.     

Suicidality and its relationship to treatment outcome in depressed adolescents

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directive-supportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST. The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.     

Psychological assessment, treatment, and outcome with sex offenders

The frequency and impact of sexual offenses have led to the recent enactment of sexual "predator" laws. Such laws are intended to reduce sexual violence through treatment and involuntary confinement. Sixty years ago, similar laws identifying "sexual psychopaths" were enacted and, in many states, eventually repealed for multiple reasons; among those reasons was an inability to demonstrate that treatment had any significant impact on recidivism. That inability forced us to reexamine, among other issues, the population(s) which undergo treatment, the outcomes that are used to measure treatment effectiveness, and the processes that constitute treatment itself. Those issues are considered in this paper through a review of treatment programs based on psychodynamic, behavioral, and cognitive-behavioral theories. Although the evidence is sparse, it is fair to conclude that the latter have been found to be effective. We call for dynamic measures, effective treatments, and the resources necessary for both developments.     

Age-based differences in treatment outcome among alcohol-dependent women

The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive-behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse. Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Predictors and mediators of treatment outcome in patients with binge eating disorder

A randomized controlled trial (N=52) was conducted comparing cognitive-behavioral therapy with a waiting list control group to identify mediators and predictors of treatment outcome. Reduction of weight concerns mediated abstinence of binge eating at post-treatment. Abstinence was marginally mediated by changes in eating and shape concerns, depressive symptoms and global severity of general psychopathology. Neither treatment outcome nor status at 1-year follow-up could be predicted by severity of eating disorder, comorbid psychopathology or maladaptive core beliefs at baseline or at post-treatment. The only predictor for abstinence at both post-treatment and 1-year follow-up was the coping style palliative reacting: higher scores predicted less favorable outcomes. Lower expression of emotions at post-treatment predicted more reduction of eating disorder psychopathology at follow-up. No other patient characteristics allowing treatment-patient matching could be identified.