Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Social support from weak ties: Insight from the literature on minimal social interactions

When people face difficult life events, such as cancer or bereavement, they fare better when they receive support. These “experiencers” are likely to seek and receive support from a wide range of people, from close others to acquaintances. Indeed, the social support literature has long acknowledged the value of having a diverse support network. Research suggests that experiencers often perceive “weak ties” (i.e., acquaintances) as sources of support, and that experiencers sometimes prefer to get support from weak ties rather than strong ties. Providing support can be challenging for all kinds of supporters, however weak ties may be more likely than strong ties to allow worries about their inability to provide effective support to stop them from providing any support at all, thus depriving experiencers of opportunities for additional support. In this paper, we focus on the fact that often the provision of support occurs via a social interaction. We draw on the social psychology literature on minimal social interactions to suggest reasons why potential weak tie supporters might doubt their ability to provide effective support, and to generate advice to encourage potential supporters to reach out. Finally, we suggest future areas of research, with the ultimate goal of helping to expand the support that is available for people experiencing difficult life events.     

Arguers as editors

People use editorial criteria to decide whether to say or to suppress potential arguments. These criteria constitute people's standards as to what effective and appropriate arguments are like, and reflect general interaction goals. A series of empirical investigations has indicated that the standards fall into three classes: those having to do with argument effectiveness, those concerned with personal issues for arguer and target, and those centered on discourse quality. The essay also sketches the affinities certain types of people have for the different criteria.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.     

INCREASING CALORIE CONSUMPTION IN CHILDREN WITH CYSTIC FIBROSIS: REPLICATION WITH 2-YEAR FOLLOW-UP

Three mildly malnourished children with cystic fibrosis and their parents participated in a behavioral group-treatment program that focused on promoting and maintaining increased calorie consumption. Treatment included nutritional education, gradually increasing calorie goals, contingency management, and relaxation training, and was evaluated in a multiple baseline design across four meals. Children's calorie intake increased across meals, and total calorie intake was 32% to 60% above baseline at posttreatment. Increased calorie consumption was maintained at the 96-week follow-up (2 years posttreatment). The children's growth rates in weight and height were greater during the 2 years following treatment than the year prior to treatment. Increases in pace of eating and calories consumed per minute were also observed 1 year posttreatment. These findings replicated and extended earlier research supporting the efficacy of behavioral intervention in the treatment of malnutrition in children with cystic fibrosis.     

EFFECTS OF CHOSEN VERSUS ASSIGNED JOBS ON THE WORK PERFORMANCE OF PERSONS WITH SEVERE HANDICAPS

We evaluated the effects of several choice-related variables on the work performance of adults with severe handicaps. After assessing client work preferences, three choice-related situations were presented: (a) providing clients with the opportunity to choose a work task, (b) assigning a preferred task, and (c) assigning a nonpreferred task. Results indicated that clients attended to work tasks almost twice as much when they chose their tasks and when assigned to work on preferred tasks versus when assigned to work on nonpreferred tasks. Results are discussed regarding the need to assess systematically the effects of choice-related variables.     

Three-term contingency patterns in mother-child verbal interactions during first-language acquisition

Selections from a large longitudinal data set of verbal interactions between a mother and her child are presented. Two sets of three-term contingency sequences that seemed to reflect maternal rewards and corrections were noted. Both the antecedents as well as the immediate consequences of maternal interventions are presented to explore training and learning processes. The observed frequencies of three-step sequences are compared to those expected based upon Markov-chain logic to substantiate the patterning of the interactions. Behavioral conceptualizations of the learning process are supported by these analyses, although their sufficiency is questioned. It is suggested that maternal rewards and corrections should be integrated with perceptual, cognitive, and social learning conceptualizations in a skill-learning approach to explain the complexity of language transmission and acquisition processes.     

Dark adaptation of foveal cones during the cone-plateau period

Following substantial bleaching by "white" light, absolute threshold, relative spectral sensitivity and sensation of hue of monochromatic lights were measured at the central fovea during the cone-plateau period. The absolute-threshold level was found to increase and then decrease markedly, the relative spectral sensitivity remained invariant, while the sensation of hues of monochromatic lights from the long- and middle-wave regions of the spectrum changed toward hues of shorter wavelengths.     

The effects of polydrug use with and without cocaine on mother-infant interaction at 3 and 6 months

The face-to-face interactions of 43 polydrug-with-cocaine-using mothers and their infants at 3 and 6 months were compared to 17 non-cocaine-but other-drug-using mothers and 21 mothers who used no drugs during their pregnancy. Coders blind to mothers' drug use status scored 3 min of face-to-face interactions for 16 measures of maternal and infant interactive behaviors. A principal component of 7 behaviors formed a measure of maternal attentiveness; a principal component of 5 behaviors formed a measure of mother-infant dyadic organization; and a principal component of 4 behaviors formed a measure of infant readiness to interact. A measure of maternal interruption was computed as the mean standard score of 3 additional interruptive behaviors. At 3 and 6 months, polydrug-with-cocaine-using mothers were less attentive to interactions, and polydrug-with-cocaine-using mothers and their infants engaged in fewer dyadic interactions than either non-cocaine or non-drug-using mothers. Compared to 3 months, polydrug-with-cocaine-using mothers at 6 months were less attentive to interactions and more frequently interrupted interactions by looking away, redirecting the infant, or withdrawing, whereas non-cocaine-using and non-drug- using mothers showed no change or an improvement in attentiveness to interactions and a decrease in interruptions. No differences emerged in the interactive behaviors of the infants of polydrug- with-cocaine-using, non-cocaine-using, or non-drug-using mothers. Cocaine use represents a significant risk for diminished parental attentiveness and responsiveness to infants and for diminished interactiveness in infants.     

医学伦理学概念之探究

医学伦理学的概念看起来很简单,一般情况下人们便习以为常地接受了作为应用规范伦理学的一个分支的科学地位,而忽视了医学对医学伦理学所起的作用。本文认为：医学伦理学的具体内容是医学科技与伦理道德两因素相互作用的产物,对其相互作用的形式和产物的具体分析和总结便可构成这门学科的理论体系。