Primary prevention of secondary disorders: A proposal and agenda

This paper calls for consideration of a new class of preventive interventions designed explicitly to prevent comorbidity of psychiatric disorders. Epidemiologic data show that successful interventions of this type could be extremely valuable, as up to half of lifetime psychiatric disorders and an even larger percent of chronic and seriously impairing disorders occur to people with a prior history of some other disorder. Furthermore, a review of etiologic hypotheses concerning the causes of comorbidity suggests that interventions aimed at primary prevention of secondary disorders might be feasible. However, more basic risk factor research is needed on the causes of comorbidity before we can make a clear assessment of feasibility and discover promising intervention targets. A number of methodological problems arise in carrying out this type of formative research. These problems are reviewed and suggestions are offered for solutions involving innovations in measurement, design, and data analysis.     

Capitalizing on the potential of mobile health applications as behavioral interventions: A research agenda for calorie-tracking and activity-tracking applications

Mobile health applications (mHealth apps) are widely used tools that provide support for people seeking help managing their health in a particular behavioral domain (e.g., physical activity). Despite their popularity, evidence for the effectiveness of mHealth apps as stand-alone behavioral interventions is limited. Psychological and behavioral scientists can play a critical role in addressing this gap by pursuing programs of research that leverage basic behavioral science principles to test links between key features of mHealth apps (e.g., goal setting, feedback) and behavior change. To demonstrate this approach to evaluating mHealth apps, we systematically examine five key features of popular calorie-tracking and activity-tracking apps, explain how these features align with established behavior change techniques, discuss the evidence base for the effectiveness of these techniques within each behavioral domain, and situate predictions about how individual app features may promote behavior change in a conceptual model. Through this work, researchers can guide the design of mHealth apps and optimize them for facilitating sustained health behavior change.     

Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies

Chronic insomnia is a prevalent sleep disorder with serious consequences on wellbeing and health that largely extend into daily functioning. Cognitive-Behavioral Therapy for Insomnia (CBT-I), an efficacious intervention for insomnia with solid empirical support, is the recommended first-line treatment. Given the complexity of factors and mechanisms involved in its aetiology and maintenance, advances in treatment protocols and modules are important. We will review the current knowledge on insomnia and examine how advancements in behavioral sleep medicine and third-wave therapies may apply to treatment. Specifically, we will outline how a treatment protocol based on Acceptance and Commitment Therapy (ACT), adapted to include insomnia-specific behavioral strategies and with an explicit focus on self-compassion, could be a potentially effective treatment. We believe that broadening treatment focus to target hyperarousal, metacognitions, dysfunctional though control strategies and provide self-compassion training may benefit treatment outcomes, increase sleep quality, reduce daytime symptoms, and improve quality of life.     

Characteristics of incarcerated women's participation in groups: Exploring the Programme for the International Assessment of Adult Competencies United States prison dataset

This study employs logistic regression and latent class analyses to explore the relationship between incarcerated women's (n = 252) participation in nonacademic prison groups/skills classes and their demographic (e.g., education) and prison context (e.g., time to release) characteristics, using the 2014 Programme for the International Assessment of Adult Competencies United States prison dataset. Time to release was a significant factor in readiness class participation. Time to release and race/ethnicity were significant factors in addiction group participation. Education level had the largest effect size across all groups/classes explored. We discuss counseling implications for using group/class screening to connect with incarcerated women, especially those with intersecting and historically marginalized identities.     

心理干预的优先获益者——来自发展可塑性的研究证据

近些年, 发展可塑性领域出现两个新模型--差别易感性模型和优势敏感性模型, 两个模型均表明个体从积极环境中的获益具有差异性。而心理干预作为一种特殊的积极环境被引入到该领域的研究中。已有的研究已经发现一些证据表明, 具备某些特征的当事人从心理干预中获益更多。这些特征包括人格和气质类、遗传类和生理类。本质上, 这些研究在处理“什么对谁最有效”的问题, 但现有研究仅能部分回答这个问题。因此, 心理干预的效果差异有多少可归于这些易感特征, 是有待继续回答的问题。     

The Parents Matter! Program: Practical, Theoretical and Methodological Perspectives

We provide a commentary on the Parents Matter! intervention program. Our commentary is organized around core issues confronting those who design prevention programs, namely (1) making the program practical, feasible and economical, (2) reaching a broad base of target individuals, (3) making the intervention effective in changing the behavior or outcome for those who participate in it, and (4) ensuring that the intervention is sustainable for future generations. Parents Matter! is a thoughtful and impressive program that addresses each of these issues.     

Throwing a Wrench in the Work(s): Using Multicultural and Social Justice Competency to Develop a Social Justice–Oriented Employment Counseling Toolbox

This article presents a social justice toolbox from which employment counselors can draw when working with various populations at multiple levels. First, the authors introduce social justice and its relationship to employment counseling (the toolbox). Second, the skills and knowledge required to integrate social justice into employment counseling (the tools) are presented. Finally, strategies are offered to maintain social justice competency so that the tools can be maintained and applied ethically and effectively.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.