Developing Cognitive Behavioral Therapy to Prevent Depressive Relapse in Youth

Relapse rates for children and adolescents with major depressive disorder (MDD) range from 30% to 40% within 1 to 2 years after acute treatment. Although relapse rates are high, there have been relatively few studies on the prevention of relapse in youth. While acute phase pharmacotherapy has been shown to reduce symptoms rapidly in depressed youth, children and adolescents frequently report ongoing residual symptoms and often relapse following acute treatment. Recent adult trials have begun examining augmentation with psychosocial treatment after successful medication treatment to enhance medication response and prevent future relapse. This strategy has not yet been examined in youth with depression. Here we present initial efforts to develop a sequential, combination treatment strategy to promote rapid remission and to prevent relapse in depressed youth. We describe efforts to adapt CBT to prevent relapse (RP-CBT) in youth who respond to pharmacotherapy. The goals of RP-CBT include: preventing relapse, increasing wellness, and developing skills to promote and sustain well-being. We describe the rationale for, components of, and methods used to develop RP-CBT. The results from a small open series sample demonstrate feasibility and indicate that youth appear to tolerate RP-CBT well. A future test of the treatment in a randomized controlled trial is described.     

The Epistemic Status of Auxiliary Hypotheses: A Reply to Douven

I have previously argued that anti-realism cannot use the claim that theories have empirically equivalent rivals (EE) to establish that theories are underdetermined by evidence (UD). Douven objects that the auxiliary hypotheses needed to generate observational equivalence need not as I claimed be themselves underdetermined if (EE) is true, because they may be either compatible with observation or acceptable in the constructive-empiricist sense. I reply that these conditions are not strong enough to establish (EE): the auxiliaries have to be epistemically warranted if they are to fix a theory's observational commitments unambiguously. The support they require need not presuppose their respective observational consequences, because there are more holistic sources of warrant.     

Concurrent Validity and Informant Agreement of the ADHD Module of the Anxiety Disorders Interview Schedule for <Emphasis Type="Italic">DSM-IV</Emphasis>

Examined the concurrent validity of the attention-deficit/hyperactivity disorder (ADHD) module of the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent versions (ADIS-C/P). One hundred eighty-four clinic-referred children were categorized into three ADIS-generated groups: No diagnosis of ADHD (No ADHD; n = 63), parent-only diagnosis of ADHD (Parent Only; n = 81), and parent plus child diagnosis of ADHD (Parent + Child; n = 40). The groups were compared on demographics, comorbid diagnoses, parent and child-report measures, and a computerized test of attention. Results support the concurrent validity of the ADIS ADHD module and highlight the positive relationship between internalizing symptomatology and parent-child agreement on ADHD diagnoses. The clinical implication of this study is that parent-child agreement on ADHD may serve as a marker of internalizing symptomatology. Future research on child self-perceptions is suggested in developing treatments for this internalizing ADHD group.

"Holler, run, be loud:" strategies for promoting child physical activity in a low-income, African American neighborhood

This article identifies and describes child management practices among a sample of African American caregivers in a low-income, inner-city neighborhood. Caregivers responded to low levels of neighborhood collective socialization, collective efficacy, social control, and institutional resources by using strategies that protected children and promoted physical activity. Using diverse qualitative methods (interviews, observations) and demographic data on neighborhood disadvantage and family and household characteristics, the research revealed seven caregiver management strategies that promoted child physical activity, despite multiple neighborhood barriers. These included ecological appraisal, boundary enforcement, chaperonage, kin-based play groups, collective supervision, local resource brokering, and extralocal resource brokering. These findings provide important substantive and theoretical insights on the relationship between caregiver practices, neighborhood social context, and child physical activity.     

Occupational Stress in University Staff

A survey was conducted of all staff members of an established Australian metropolitan university. The overall response rate for noncasual staff was 72% (77% for general staff and 65% for academic staff) resulting in a sample of N = 2,040. High levels of psychological stress were observed, despite the fact that trait anxiety and job satisfaction were normal. Psychological distress was highest and job satisfaction lowest among academic staff engaged in both teaching and research. In general, university staff reported high levels of autonomy and social support from colleagues. However those engaged in both teaching and research reported increased pressure arising from funding cuts to universities, resulting in heavier teaching loads and greater difficulty in securing research funds, as well as a decline in facilities and support for both teaching and research. The results are discussed in relation to the Demand–Control and Person–Environment Fit models of job stress.     

Shared, not unique, components of personality and psychosocial functioning predict depression severity after acute-phase cognitive therapy

In a sample of 100 patients with recurrent major depression, we collected depression severity data early and late in acute-phase cognitive therapy, plus a wide range of psychosocial variables that have been studied extensively in depression research, including measures of interpersonal, cognitive, and social functioning, and personality traits using an inventory that is linked with the Big-Three tradition in personality assessment theory. By assessing this broad range of variables in a single study, we could examine the extent to which relations of these variables with depression were due to (a) a common factor shared across this diverse set of constructs, (b) factors shared among each type of construct (personality vs. psychosocial measures), or (c) specific aspects of the individual measures. Only the most general factor shared across the personality and psychosocial variables predicted later depression.