The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: a controlled investigation

Correcting patients' faulty beliefs concerning social evaluative threats is the hallmark of cognitive-behavioral treatment of social anxiety disorder. The current study examined the efficacy of two videotape feedback procedures as adjuncts to exposure-based treatment. Participants suffering from social phobia (N=77) were randomly assigned to one of four conditions: (a) credible placebo treatment (PLA); (b) exposure + no feedback (EXP); (c) exposure + videotape feedback of performance (PER); or (d) exposure + videotape feedback of audience responses (AUD). Contrary to prediction, the videotape feedback procedures did not enhance the effects of exposure-based treatment. Clinical and theoretical implications are discussed.     

Community-Delivered Collaborative and Proactive Solutions and Parent Management Training for Oppositional Youth: A Randomized Trial

The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7–14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45–50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.     

Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial

Dysfunctional cognitive processes and maladaptive interpersonal patterns have been postulated to maintain body dysmorphic disorder (BDD). The present trial evaluated CT for BDD (CT-BDD), which includes modules targeting maladaptive cognitive processing in BDD, as well as elements of schema therapy related to interpersonal problems. We investigated whether (a) CT-BDD is effective, as compared with a wait-list (WL) group at Week 12; (b) outcome of CT-BDD is maintained at posttreatment and 3- and 6-months follow-up; and (c) whether changes in shame and insight mediate changes in BDD symptom severity. Forty adults with BDD were randomized to 36 weeks immediate CT-BDD (n = 21), or to 12-week WL (n = 19). At Week 12, immediate CT-BDD was significantly superior to WL in clinician-rated BDD symptom severity, insight, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. Changes in outcomes were associated with moderate to large effect sizes at Week 12. Reductions in shame and increase in insight separately mediated changes in BDD symptom severity during treatment at Week 12. From baseline to posttreatment, significant improvements occurred within CT-BDD in clinician-rated symptom severity, insight, depression, global functioning, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. At posttreatment, improvements were associated with large effect sizes and were maintained at 3- and 6-month follow-up. Preliminary results support the efficacy of CT-BDD. Addressing interpersonal problems in addition to cognitive dysfunctions may increase the benefit of CBT for BDD patients.     

Impact evaluation of the family expectations program and moderation by sociodemographic disadvantage

The federal government, through the Administration for Children and Families (ACF), has funded community-based relationship education programs for couples, individuals, and families, with a strong focus on serving economically disadvantaged and racially diverse families. This study evaluated the impact of a 36-hour, workshop-based couple relationship education program that was funded by ACF using a randomized controlled trial (RCT) design and intent-to-treat (ITT) analyses. Participants were 1320 couples who were either expecting a baby or had a baby within the past 3 months, at the time of enrollment. Follow-up surveys were administered 12 months later. Analyses evaluated program impacts on relationship stability, constructive communication, and destructive conflict compared to a no-treatment control group. Analyses showed a statistically significant impact of the program on destructive conflict (d = 0.10) but not on constructive communication (d = 0.06) or stability (d_Cox = 0.10). Based on findings from previous evaluations, we also examined whether participants’ levels of sociodemographic disadvantage moderated these effects. There was significant moderation by sociodemographic disadvantage on constructive communication and destructive conflict, but not on stability. Effects were observed for those at higher levels of sociodemographic disadvantage.     

I Am > Trauma: Experimentally Reducing Event Centrality and PTSD Symptoms in a Clinical Trial

Event centrality has been one of the strongest predictors of PTSD symptoms. We attempted to experimentally reduce event centrality using a modified version of Acceptance and Commitment Therapy (ACT) in a sample of traumatized participants from a community outreach center. Relative to a control group, participants who received ACT evidenced significant decreases in PTSD symptoms, depression, and event centrality. A mediation analysis revealed that the effect of condition on PTSD symptoms was mediated by decreases in event centrality. Only the effect of condition on depression was still significant at six weeks posttreatment. This study is the first to manipulate event centrality and suggests that components of ACT may be effective at reducing event centrality.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.     

随机控制实验:助推脱贫的现场干预研究

消除贫困是全世界新千年的首要目标。行为经济学家和发展经济学家正借助随机控制实验和助推技术在全球范围内帮助贫困者摆脱贫困。当前采用随机控制实验帮助贫困者克服行为偏差的助推行动主要表现在帮助贫困者改善当前物质条件和提升未来保障两个方面。随机控制实验和助推技术在国内的研究和实践也有效地帮助国内贫困农民提高了身心健康水平和经济收入。未来还需加强关于随机控制实验和助推技术的外部效度检验及两者的异同点方面的研究, 并结合脱贫的内生动力制定更加简单、高效、严谨的扶贫政策和项目。     

Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.