Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes

Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were searched for randomized controlled trials that reported on anxiety, depression, quality of life, and psychological flexibility outcomes from iACT in any adult population. Engagement with iACT was summarized and methodological and population-related variables were investigated as potential moderators of effectiveness. Across 25 studies, small pooled effects were found for all outcomes at post-assessment and maintained at follow-up time-points. Interventions with therapist guidance demonstrated greater effectiveness in improving depression and psychological flexibility outcomes compared to nonguided iACT, and populations defined by a psychological condition or symptoms (e.g., depressed samples) demonstrated greater improvements in anxiety compared to nonclinical or somatic populations (e.g., chronic pain samples or students). Participants completed on average 75.77% of iACT treatments. While we found iACT to be effective in improving and maintaining mental health outcomes across diverse populations, there was limited evidence of reliable, clinically significant effects. PROSPERO registration number: CRD42020140086.     

Defining the Assessment and Treatment Competencies to Deliver Low-Intensity Cognitive Behavior Therapy: A Multi-Center Validation Study

Despite the vastly increased dissemination of the low-intensity (LI) version of cognitive behavior therapy (CBT) for the treatment of anxiety and depression, no valid and reliable indices of the LI-CBT clinical competencies currently exist. This research therefore sought to develop and evaluate two measures: the low-intensity assessment competency scale (LIAC) and the low-intensity treatment competency scale (LITC). Inductive and deductive methods were used to construct the competency scales and detailed rating manuals were prepared. Two studies were then completed. The first study used a quantitative, fully-crossed design and the second a multi-center, quantitative longitudinal design. In study one, novice, qualified, and expert LI-CBT practitioners rated an LI-CBT assessment session (using the LIAC) and an LI-CBT treatment session (using the LITC). Study two used the LIAC and LITC across four training sites to analyze the competencies of LI-CBT practitioners over time, across raters, and in relation to the actor/patients’ feedback concerning helpfulness, the alliance, and willingness to return. Both the LIAC and LITC were found to be single factor scales with good internal, test-retest reliability and reasonable inter-rater reliability. Both measures were sensitive to measuring change in clinical competence. The LIAC had good concurrent, criterion, discriminant, and predictive validity, while the LITC had good concurrent, criterion, and predictive validity, but limited discriminant validity. A score of 18 accurately delineated a minimum level of competence in LI-CBT assessment and treatment practice, with incompetent practice associated with patient disengagement. These observational ratings scales can contribute to the clinical governance of the burgeoning use of LI-CBT interventions for anxiety and depression in routine services and also in the methods of controlled studies.     

“Doing Good” versus “Being Good”: The interplay between pride appeals and regulatory-focused messages in green advertising

Many consumers feel proud of making green choices, which is of crucial relevance to explaining environmentally responsible behaviors. However, compared to other self-conscious emotions, such as guilt and shame, little research attention has been paid to the role of pride in green consumerism. Through conducting two online experimental surveys, this research examined what features of a message induce the two facets of the emotion pride—authentic and hubristic—and how pride appeals interact with message frames having different regulatory foci. In Study 1, participants revealed more favorable eco-friendly attitudes and intentions when hubristic pride appeals were combined with promotion-focused messages (detailing the positive benefits of using the green product), and when authentic pride appeals were matched with prevention-focused messages (emphasizing the negative consequences averted by using the green product). Study 2 replicated and supported the proposed matching hypotheses while including a control condition. Findings of this research will add to a growing body of literature on pride as a discrete emotion and its carryover effects on persuasion while providing guidelines to help practitioners design green advertising campaigns.     

Cognitive and Behavioural Attention in Children with Low-Moderate and Heavy Doses of Prenatal Alcohol Exposure: a Systematic Review and Meta-analysis

Neuropsychology Review - Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despite decades of research however, these findings have never been pooled to...     

Interpersonal Psychotherapy—Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process

Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT–AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT–AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.     

Social competence in early childhood: An empirical validation of the SOCIAL model

Social skills are the basis of human interactions and functioning in society. Social competence (SC) is thought to evolve gradually during childhood and adolescence via the interplay of multiple factors. In particular, the early years of life are marked by the emergence of basic social abilities and constitute the foundation for successful social development. The biopsychosocial SOcio-Cognitive Integration of Abilities modeL (SOCIAL) posits that internal (child-based), external (environment), and cognitive factors are critical to SC in the context of normal brain maturation; but this has yet to be shown empirically and comprehensively. This study tested the SOCIAL model in a sample of typically developing preschool children. Parents of 103 children (M = 67.59 months, SD = 11.65) completed questionnaires and children underwent neuropsychological assessment of executive functioning (EF), communication skills and social cognition. Three-step hierarchical regression analyses (1) Internal factors, 2) External factors, 3) Cognitive factors) confirmed that each step of the regression model significantly predicted SC. In the final model, general cognitive and socio-cognitive factors significantly predicted SC above and beyond internal and external factors: children with lower temperamental negative affect and less parent-reported executive dysfunction, as well as better non-verbal communication and theory of mind had better SC. Our findings support the conceptual SOCIAL model, and highlight the importance of internal, external, and cognitive factors for SC in the preschool years. Identification of factors associated with early social development can inform both normative and clinical approaches to identifying intervention loci and optimizing SC in those at risk for maladaptive social functioning.     

Readers and service commissioners require clear financial disclosures: Comment on innovation,research integrity,and change: A conflict of interest management framework for program developers (Sanders et al., 2019)

Sanders et al.'s proposal for a management framework for conflicting interests among program developers is very welcome. The underlying principles of such a framework must nevertheless prioritise the need for researchers and commissioners of services to make objective assessments of the impact of interventions reported in journal articles. This is particularly important in the field of randomised trials which may influence public sector expenditure. Using a strict definition derived from known financial conflict of interest, we have demonstrated that child-based effect sizes are much lower for independent studies than for studies with developer involvement. On this basis, we propose that journals publishing evaluations of psychosocial interventions should agree a standardised format for declarations of conflicts of interest based on that recommended by the International Committee of Medical Journal Editors.     

Conversation Orientation Moderates the Relationship between Information Sharing of Medically Assisted Reproduction and Child Adjustment

Parents who experienced infertility have increasingly used medically assisted reproduction (MAR) to add children to their families over the past few decades. These parents will need to decide if they will tell their children about being conceived using MAR. Although MAR information sharing operates within family contexts, little is known about the role of conversation orientation—one family contextual factor—in child outcomes associated with MAR information sharing in middle childhood. Derived from the Family Communication Patterns Theory, this study proposes that conversation orientation moderates the associations between MAR information sharing and children's psychosocial adjustment. This proposal was tested using a sample of 81 6- to 12-year-old MAR-conceived children from 55 families and a structured observational measure of conversation orientation. Multiple regression analyses showed that MAR information sharing interacted with conversation orientation to influence children's behavioral and attention problems but not emotional problems. In families with high conversation orientation, MAR information sharing was not significantly associated with children's behavioral and attention problems. In families with low conversation orientation, MAR information sharing was significantly associated with an increase in children's behavioral and attention problems. Results of this exploratory study demonstrate the potential significance of general communication orientation in understanding child outcomes of MAR information sharing and highlight the needed family context nuances in MAR research.     

A Meta-Analysis of Program Characteristics for Youth with Disruptive Behavior Problems: The Moderating Role of Program Format and Youth Gender

There is high variability in efficacy for interventions for youth with disruptive behavior problems (DBP). Despite evidence of the unique correlates and critical consequences of girls’ DBP, there is a dearth of research examining treatment efficacy for girls. This meta-analysis of 167 unique effect sizes from 29 studies (28,483 youth, 50% female; median age: 14) suggests that existing treatments have a medium positive effect on DBP (g = .33). For both boys and girls, the most effective interventions included (a) multimodal or group format, (b) cognitive skills or family systems interventions, and (c) length-intensive programs for (d) younger children. Boys demonstrated significantly greater treatment gains from group format interventions compared to girls, which is particularly important given that the group program format was the most prevalent format for boys and girls, with 14 studies involving 10,433 youth encompassing this category. This is the first meta-analysis to examine the effect of program characteristics in a sample of programs selected to be specifically inclusive of girls. Given that girls are underrepresented in intervention research on DBP, findings are discussed in terms of gender-responsive considerations and elucidating how key aspects of program structure can support more effective intervention outcomes for youth.