Brief Behavioral Therapy for Pediatric Anxiety and Depression: Piloting an Integrated Treatment Approach

Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral therapy protocols for anxiety and depression to their core components and combine them into a brief, integrated treatment suitable for the broad population of internalizing youth seen in primary care. Specifically, we discuss: (a) the rationale for targeting anxiety and depression in pediatric primary care and the deployment-focused treatment development model; (b) the content of our behaviorally based treatment program; and (c) clinical outcomes of 2 sample cases with comorbid depression and anxiety.     

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.     

At the same time

The essay on Husserl’s phenomenology of touch in Derrida’s recent On Touching—Jean-Luc Nancy represents his only substantial re-engagement with Husserlian phenomenology to be published following the series of texts dating from the period marked by his Mémoire of 1955 through to the essay ‘Form and Meaning’ included in Margins (1972). The essay, devoted to some key sections of Husserl’s Ideas II, appears to break new ground in Derrida’s readings of Husserl, but in fact demonstrates a profound continuity with his earlier readings. In fact, I argue that this continuity is in a part an effect of Derrida’s ongoing commitment to the ‘methodology’ of deconstruction. I show how this commitment leads Derrida to conflate three separate distinctions within Husserl’s discussion, a conflation that obliges Derrida to misread the letter of Husserl’s text, and which, in turn, blinds him to a certain radical potentiality within Husserl’s phenomenology of sensibility.

Attention and memory in children with brain tumors.

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N = 18) and third ventricle tumors (N = 24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2-5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.     

Heuristic and linear models of judgment: matching rules and environments

Much research has highlighted incoherent implications of judgmental heuristics, yet other findings have demonstrated high correspondence between predictions and outcomes. At the same time, judgment has been well modeled in the form of as if linear models. Accepting the probabilistic nature of the environment, the authors use statistical tools to model how the performance of heuristic rules varies as a function of environmental characteristics. They further characterize the human use of linear models by exploring effects of different levels of cognitive ability. They illustrate with both theoretical analyses and simulations. Results are linked to the empirical literature by a meta-analysis of lens model studies. Using the same tasks, the authors estimate the performance of both heuristics and humans where the latter are assumed to use linear models. Their results emphasize that judgmental accuracy depends on matching characteristics of rules and environments and highlight the trade-off between using linear models and heuristics. Whereas the former can be cognitively demanding, the latter are simple to implement. However, heuristics require knowledge to indicate when they should be used.     

Using system dynamics modeling to understand the impact of social change initiatives

Community psychologists have a long history of interest in understanding social systems and how to bring about enduring positive change in these systems. However, the methods that community psychologists use to anticipate and evaluate the changes that result from system change efforts are less well developed. In the current paper, we introduce readers to system dynamics modeling, an action research approach to studying complex systems and the consequences of system change. We illustrate this approach by describing a system dynamics model of educational reform. We provide readers with an introduction to system dynamics modeling, as well as describe the strengths and limitations of the approach for application to community psychology.     

Developing a new measure of independent and interdependent views of the self

Following concepts introduced by Markus and Kitayama [Markus, H. R. & Kitayama, S. (1991). Culture and the self: implication for cognition, emotion, and motivation. Psychological Review, 98, 224–253.], two studies were conducted to develop and test a new scale to measure individualism and collectivism, each with its seven constituent facets. The proposed two-dimensional structure was supported by exploratory factor analyses of Chinese and British samples of general populations. The new Independent and Interdependent Self Scale (IISS) was found to have satisfactory reliability and validity across five independent samples of Chinese and British students and community adults. The strengths and limitations of the present research as well as future directions for research are discussed.     

Systematic and heuristic processing of majority and minority-endorsed messages: the effects of varying outcome relevance and levels of orientation on attitude and message processing

Two experiments investigated the conditions under which majority and minority sources instigate systematic processing of their messages. Both experiments crossed source status (majority vs. minority) with message quality (strong vs. weak arguments). In each experiment, message elaboration was manipulated by varying either motivational (outcome relevance, Experiment 1) or cognitive (orientating tasks, Experiment 2) factors. The results showed that when either motivational or cognitive factors encouraged low message elaboration, there was heuristic acceptance of the majority position without detailed message processing. When the level of message elaboration was intermediate, there was message processing only for the minority source. Finally, when message elaboration was high, there was message processing for both source conditions. These results show that majority and minority influence is sensitive to motivational and cognitive factors that constrain or enhance message elaboration and that both sources can lead to systematic processing under specific circumstances.     

Measurement issues associated with conditional reasoning tests: indirect measurement and test faking

Conditional reasoning is a new measurement technique used to measure cognitive biases associated with latent personality motives. The current article describes 3 studies examining 2 related measurement issues associated with conditional reasoning tests (CRTs). Study 1 examined the necessity of maintaining indirect assessment when administering CRTs. Results indicated that, compared with a control condition, 2 experimental conditions that disclosed the purpose of assessment yielded significant mean shifts on a CRT. Study 2 explored whether CRTs could be faked when the purpose of assessment was not disclosed. Results indicated that when indirect measurement was maintained, CRTs appeared to be resistant to faking. Study 3 compared scores on the Conditional Reasoning Test for Aggression across student, applicant, and incumbent samples. Results indicated no significant mean differences among these samples.