Stress, Cortisol, and Externalizing Behavior in Adolescent Males: An Examination in the Context of Multisystemic Therapy

Stress and hypothalamic-pituitary-adrenal (HPA) axis dysregulation have been associated with externalizing behavior in adolescence, but few studies have examined these factors in a treatment context. This study investigated the relationship between stress, cortisol, and externalizing behavior among 120 adolescent males (mean age?=?15) receiving Multisystemic Therapy (MST). To examine the differential relationship of cortisol with various types of stressors, self-report measures assessed lifetime stress, current episodic stress, and daily hassles. Morning and afternoon cortisol samples were collected to examine whether the relationship between stress and treatment outcome depended on the youth's biological stress levels. Regression analyses indicated that awakening cortisol levels moderated the relationship between daily hassles and externalizing behaviors at post-treatment. More specifically, higher levels of daily hassles predicted worse outcomes only among adolescents with high levels of morning cortisol. In addition, lifetime stressors and afternoon measures of cortisol interacted to predict changes in caretaker reports of externalizing problems and youth arrests following treatment; lifetime stressors were positively associated with externalizing behavior when adolescents had low levels of afternoon cortisol. Implications for theory and future directions for evidence-based treatment are discussed.     

Attachment‐based intervention for substance‐using mothers: A preliminary test of the proposed mechanisms of change

Although randomized controlled trials examining the efficacy of attachment‐based interventions have been increasing in recent years, adequate measurement of treatment integrity, integrity–outcome associations, and mechanisms of change has been rare. The aim of this investigation was to conduct a rigorous test of proposed mechanisms of change in the Mothers and Toddlers Program (MTP) treatment model, a 12‐session, attachment‐based individual therapy for substance‐using mothers of children birth to 3 years of age. The MTP aims to improve maternal reflective functioning (RF) and representation quality (RQ) to bring about second‐order change in maternal caregiving behavior. Following guidelines from M.K. Nock ( 2007 ), it was hypothesized that (a) therapist adherence to unique MTP treatment components would uniquely predict improvement in RF and RQ and that (b) improvement in RF and RQ would function as unique mechanisms of change (when compared with other potential mechanisms—reduction in depression and increase in abstinence from drug use) in the improvement of caregiving behavior. Findings supported each hypothesis, confirming the proposed mechanisms of the treatment model. However, improvement in maternal depression also uniquely predicted improvement in caregiving behavior. Results underscore the potential value of attachment‐based parenting interventions for improving mother–child relations and the importance of providing these interventions in clinic settings where mothers have access to comprehensive care (e.g., psychiatric services).     

Anterior cingulate cortex activation is related to learning potential on the WCST in schizophrenia patients

The remediation of executive function in patients with schizophrenia is important in rehabilitation because these skills affect the patient's capacity to function in the community. There is evidence that instructional techniques can improve deficits in the Wisconsin Card Sorting Test (WCST) in some schizophrenia patients. We used a standard test/training phase/standard test format of the WCST to classify 36 schizophrenia patients as high-achievers, learners or non-retainers. All healthy controls performed as high-achievers. An event-related fMRI design assessed neural activation patterns during post-training WCST performance. Patients showed a linear trend between set-shifting related activation in the anterior cingulate cortex and learning potential, i.e. increased activation in high-achievers, a trend for increased activation in learners, and no activation in non-retainers compared to controls. In addition, activation in the temporoparietal cortex was highest in patients classified as learners, whereas in non-retainers activation was increased in the inferior frontal gyrus compared to controls and high-achieving patients. These results emphasize the relevance of the ACC's neural integrity in learning set-shifting strategies for patients with schizophrenia. Also, our results support the hypothesis that compensatory neural activation in patients with schizophrenia helps them to catch up with healthy controls on cognitive tasks.     

Getting Out of Our Own Way

This paper, a follow-up from a 2009 panel discussion at ABCT's Annual Convention, focuses on the choices that women make (or don't make) that can affect their careers. Women are particularly prone to feeling guilty about their choices, and while a few decades ago there was a great deal of sexism in the workplace, at this point in time, I believe that we are more likely to make assumptions that impede our careers rather than face external barriers. The paper covers some “stuck points” that stop women from advocating for themselves or results in guilt regardless of their choice.     

Discerning reported suicide attempts within a youthful offender population

With suicide being the third leading cause of death among young people, early identification of risk is critical, particularly for those involved with the juvenile courts. In this study of court-involved youth (N = 433) in two Midwest counties, logistic regression analysis identified some expected and unexpected findings of important demographic, educational, mental health, child welfare, and juvenile court-related variables that were linked to reported suicide attempts. Some of the expected suicide attempt risk factors for these youth included prior psychiatric hospitalization and related mental health services, residential placement, and diagnoses of depression and alcohol dependence. However, the most unexpected finding was that a court disposition to shelter care (group home) was related to a nearly tenfold increased risk in reported suicide attempt. These findings are of importance to families, mental health professionals, and juvenile court personnel to identify those youth who are most at risk and subsequently provide appropriate interventions to prevent such outcomes.     

Facilitated attentional disengagement from negative information in relation to self-reported depressive symptoms of Dutch female undergraduate students

Prior research has shown that depressive symptoms are associated with an enhanced attention toward negative stimuli and difficulty of disengaging attention from negative stimuli. The current study was an extension of a 2005 study by Koster and colleagues. A different stimulus presentation time and word set were used. The whole range of depressive symptoms was included in this sample instead of creating dichotomized groups. The Exogenous Cueing Task with negative, positive, and neutral cues was administered to 85 female undergraduate university students. Participants completed the Beck's Depression Inventory-II-NL questionnaire to measure self-reported depression. Contrary to previous findings, depressive symptoms were related to a facilitated rather than impaired attentional disengagement from negative stimuli. An explanation for the discrepancy with findings from Koster, et al. may be the different stimulus presentation time (1000 msec. instead of 500 or 1500 msec.).     

The role of defeat and entrapment in depression, anxiety, and suicide

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed.     

Contextual Inequalities in Religious Youth Programming

Religious congregations are hypothesized to be a community organization affected by contextual inequalities. Survey and interview data are analyzed to investigate the type and prevalence of youth programming in a geographic area. Rather than drawing a sample of religious congregations in the area, the telephone survey was conducted with every congregation located in the three contiguous cities. Coupled with the high response rate (98.9%), this allows for a unique analysis of a total population of congregations in the specified area. In-person interviews were also conducted with religious youth ministers sampled from the broader population of congregations. U.S. Census (American Factfinder, 2000) data on the areas in which the congregations were located was linked to survey and interview data. Results demonstrate contextual effects in religious youth programming, net of denomination, congregation size, and budget. The availability and type of youth programming in different locations relates to the inequalities embedded in these contexts. This study indicates that social disorganization theories apply to religious organizations not in inequalities of the number of congregations located in any particular area but in inequalities in the level of youth programming density available within those congregations.     

Childhood Social Withdrawal,Interpersonal Impairment,and Young Adult Depression: A Mediational Model

Building on interpersonal theories of depression, the current study sought to explore whether early childhood social withdrawal serves as a risk factor for depressive symptoms and diagnoses in young adulthood. The researchers hypothesized that social impairment at age 15 would mediate the association between social withdrawal at age 5 and depression by age 20. This mediational model was tested in a community sample of 702 Australian youth followed from mother’s pregnancy to youth age 20. Structural equation modeling analyses found support for a model in which childhood social withdrawal predicted adolescent social impairment, which, in turn, predicted depression in young adulthood. Additionally, gender was found to moderate the relationship between adolescent social impairment and depression in early adulthood, with females exhibiting a stronger association between social functioning and depression at the symptom and diagnostic level. This study illuminates one potential pathway from early developing social difficulties to later depressive symptoms and disorders.