Development and Pilot Evaluation of Smartphone-Delivered Cognitive Behavior Therapy Strategies for Mood- and Anxiety-Related Problems: MoodMission

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).     

What's parenting got to do with it: emotional autonomy and brain and behavioral responses to emotional conflict in children and adolescents

Healthy parenting may be protective against the development of emotional psychopathology, particularly for children reared in stressful environments. Little is known, however, about the brain and behavioral mechanisms underlying this association, particularly during childhood and adolescence, when emotional disorders frequently emerge. Here, we demonstrate that psychological control, a parenting strategy known to limit socioemotional development in children, is associated with altered brain and behavioral responses to emotional conflict in 27 at‐risk (urban, lower income) youth, ages 9–16. In particular, youth reporting higher parental psychological control demonstrated lower activity in the left anterior insula, a brain area involved in emotion conflict processing, and submitted faster but less accurate behavioral responses—possibly reflecting an avoidant pattern. Effects were not replicated for parental care, and did not generalize to an analogous nonemotional conflict task. We also find evidence that behavioral responses to emotional conflict bridge the previously reported link between parental overcontrol and anxiety in children. Effects of psychological control may reflect a parenting style that limits opportunities to practice self‐regulation when faced with emotionally charged situations. Results support the notion that parenting strategies that facilitate appropriate amounts of socioemotional competence and autonomy in children may be protective against social and emotional difficulties.     

Maternal distress in the context of their child’s type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8–15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.     

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.     

Holistic processing of faces is intact in adults with autism spectrum disorder

Are face recognition difficulties in Autism Spectrum Disorders (ASD) related to impaired holistic processing? Gauthier et al. [Gauthier, I., Klaiman, C., &; Schultz, R. T. (2009). Face composite effects reveal abnormal face processing in Autism spectrum disorders. Vision Research, 49, 470–478. doi:10.1016/j.visres.2008.12.007] used the face composite task in adolescents with autism and found a congruency effect that was not modulated by alignment, a result which was interpreted as reflecting qualitatively different face processing mechanisms. In the present study we tested adults with ASD in a composite face task where presentation times were manipulated and further explored whether these participants were sensitive to holistic information in faces using a new version of the composite task: VHFPT 2.0 (The Vanderbilt Holistic Face Processing Test 2.0). Results suggest that adults with ASD process faces holistically and that their facial identity processing abilities are qualitatively similar and as efficient as that of typical adults. The difference between the results of Gauthier et al. (2009) with adolescents and the results with adults here reported are interpreted in terms of a developmental delay.     

Driving speed choice: The role of conscious monitoring and control (reinvestment) when driving

This study aimed to examine the role of reinvestment - the propensity to consciously monitor and control actions (movement specific reinvestment) and to consciously monitor and evaluate decision making processes (Decision specific reinvestment) while driving in everyday risky scenarios. The study also aimed to evaluate the association between reinvestment and previously validated driver attitude measures. Fifty one participants completed a series of questionnaires (Driving Self-Efficacy Scale, Driver Attitude Questionnaire, Movement Specific Reinvestment Scale, Decision Specific Reinvestment Scale) after which they completed a test phase in a driving simulator. In the test phase, driving scenarios included roads with different markings (i.e., double yellow, wide centrelines, wire rope barriers, Audio Tactile Profiled markings) and alerting scenarios (i.e., police car present, high crash risk area sign, reduced speed zone). Results revealed that on risky roads (wide centrelines), participants with a high propensity for decision specific reinvestment drove slower than those with a low propensity. Driver experience, attitudes towards speeding and scores on the Decision Reinvestment subscale of the Decision Specific Reinvestment Scale significantly predicted speed choice. More experienced participants with higher scores on the Decision Reinvestment subscale were more likely to drive slower and participants with worse attitudes towards speeding were likely to drive faster. Participants with a low propensity for movement specific reinvestment (specifically, Movement Self-Consciousness) reduced their speed to a greater extent than those with a high propensity when driving in the police car scenario. There was some evidence to suggest that high decision specific and movement specific reinvesters were more likely to be involved in crashes and receive driving infringements. The current study is the first to demonstrate a significant relationship between reinvestment and driving. The implications of these findings for road safety are discussed.