Emotion Regulation in Youth with Emotional Disorders: Implications for a Unified Treatment Approach

Given the relationship between internalizing disorders and deficits in emotion regulation in youth, the emotion science literature has suggested several avenues for increasing the efficacy of interventions for youth presenting with anxiety and depression. These possibilities include the identification and addition of emotion-regulation skills to existing treatment packages and broadening the scope of those emotions addressed in cognitive-behavioral treatments. Current emotion-focused interventions designed to meet one or both of these goals are discussed, and the developmental influences relevant to the selection of emotion-focused treatment goals are explored using the framework of a modal model of emotion regulation. These various lines of evidence are woven together to support the utility of a novel emotion-focused, cognitive-behavioral intervention, the Unified Protocol for the Treatment of Emotional Disorders in Youth, a transdiagnostic treatment protocol that aims to treat the range of emotional disorders (i.e., anxiety and depression) simultaneously. Avenues for future directions in treatment outcome and assessment of emotion regulation are also discussed.     

Assessing Counseling Students' Attitudes Regarding Substance Abuse and Treatment

Undergraduate counselors‐in‐training completed the Substance Abuse Attitude Survey, which measures treatment intervention, treatment optimism, and nonstereotypical attitudes. Treatment optimism was positively correlated with nonstereotypical attitudes and treatment intervention. Results indicated that treatment intervention and nonstereotypical attitudes must be addressed in addiction counseling courses.     

Time-Varying Treatments in Observational Studies: Marginal Structural Models of the Effects of Early Grade Retention on Math Achievement

One of the main objectives of many empirical studies in the social and behavioral sciences is to assess the causal effect of a treatment or intervention on the occurrence of a certain event. The randomized controlled trial is generally considered the gold standard to evaluate such causal effects. However, for ethical or practical reasons, social scientists are often bound to the use of nonexperimental, observational designs. When the treatment and control group are different with regard to variables that are related to the outcome, this may induce the problem of confounding. A variety of statistical techniques, such as regression, matching, and subclassification, is now available and routinely used to adjust for confounding due to measured variables. However, these techniques are not appropriate for dealing with time-varying confounding, which arises in situations where the treatment or intervention can be received at multiple timepoints. In this article, we explain the use of marginal structural models and inverse probability weighting to control for time-varying confounding in observational studies. We illustrate the approach with an empirical example of grade retention effects on mathematics development throughout primary school.     

Differential effects of cognitive behavior modification on seriously emotionally disturbed adolescents exhibiting internalizing or externalizing problems

This study examined the differential effects of a school-based cognitive behavior modification intervention on (a) the interpersonal/social skills and (b) the social competence and school adjustment of two groups of middle school students identified as seriously emotionally disturbed. One groups of students exhibited internalizing emotional problems and the other group exhibited externalizing emotional problems. The objective of the study was to investigate whether the effectiveness of a school-based cognitive behavior modification intervention was significantly related to the type of emotional disturbance a student exhibits (i.e. internalizing or externalizing emotional disturbance). The sample consisted of an experimental and a control group of middle school students identified as seriously emotionally disturbed. The intervention was implemented in 23 biweekly 42-minute sessions. The results indicated that teacher ratings of student social competence and school adjustment were sensitive to treatment effects, although students' social skills self-ratings were not significantly affected by the treatment. A differential treatment effect was established in that externalizing students were significantly more responsive than internalizing students.     

The acceptability and preference for the psychological treatment of PTSD

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.     

The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.     

Engaging Australian Aboriginal youth in mental health services

It is currently estimated that up to 40% of Aboriginal youth (aged 13–17) will experience some form of mental health problem within their lifetime. Of greater concern is the evidence that indicates that Aboriginal youth fail to access mental health services commensurate with this need. This is due, in part, to the characteristically monocultural nature of service delivery of existing services. This paper overviews a model that has been developed specifically for the engagement of Aboriginal youth (aged 13–17 years) in mental health settings. Importantly, a mix of urban (N = 43) and rural (N = 68) Aboriginal youth were represented within the sample to determine its efficacy across different language and tribal groups. The model proved to be effective in engaging 97% of Aboriginal youth (n = 108), with only a small number not effectively engaged (n = 3). The model provides a foundation for the further development of evidence‐based models of best practice that have so far provided to be elusive within this complex field.     

Targeting the probability versus cost of feared outcomes in public speaking anxiety

Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed.     

Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and “other” types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.