The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.     

Further evaluation of prompt density,rate of reinforcement,and the persistence of manding

Previous research has evaluated the effects of prompt rates on the rate of communicative behavior. More recent research has suggested that dense prompting can result in communicative behavior that is more resistant to change. However, existing research has not considered the impact that higher response rates had on reinforcement rate, a variable known to impact response persistence. The current study systematically replicated previous research by evaluating communicative responding in contexts associated with dense- and lean-prompt schedules and extended existing research by (a) holding reinforcement rates similar across the two prompting schedules (lean and dense), and (b) evaluating the persistence of communicative responding in the contexts associated with each prompting schedule. The results for Experiment 1 clearly replicated and extended previous research. The results for Experiment 2 were equivocal and suggested that previous reinforcement history and response class size impacted outcomes.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Affection deprivation is more aversive than excessive affection: A test of affection exchange theory

Affection exchange theory predicts that both excessive affection and affection deprivation are associated with poorer health, compared with receiving the level of affectionate communication that one desires. A similar yet-untested prediction is that affection deprivation is more aversive than excessive affection. This preregistered study tested both hypotheses on a battery of mental and physical health outcomes, including depression, loneliness, stress, physical pain, frequency of nightmares, and sleep quality, using a Census-matched sample of U.S. American adults (N = 827). As hypothesized, receiving the right amount of affection was associated with more health-supportive scores on all outcomes than either excessive or deficient affection. Similarly, excessive affection was associated with lower depression, loneliness, stress, and pain, and higher sleep quality, than affection deprivation.     

Does authenticity always breed mental health? A cross-cultural comparison between the United States and China

Numerous studies on Western cultures have suggested a strong linkage between authenticity and mental health. However, little is known about whether such an association can be generalized to Eastern cultures. This study aimed to conduct a cross-cultural comparison on the association between three dimensions of authenticity (authentic living, self-alienation, and accepting external influence) and two factors of mental health (negative and positive) across Western and Eastern cultures. Measurement invariance tests were carried out and multigroup structural regression models developed on two college samples from the US (n = 392) and China (n = 281). Results suggested that the associations between authenticity and the negative factor of mental health were consistent across cultures, where both self-alienation and accepting external influence were positively associated with anxiety. However, the associations between authenticity and the positive factor of mental health were different in the US and Chinese samples. Specifically, both authentic living and accepting external influence were significantly associated with life satisfaction in the US sample but not in the Chinese sample. Findings stress that having a nondistorted perception of the true self is critically related to lower levels of anxiety across cultures and highlighted the need to identify culture-specific promotive factors for life satisfaction.     

Mental health symptoms,well-being and experiences of the COVID-19 pandemic: A mixed-methods practice-based study

The COVID-19 pandemic necessitated abrupt and substantial changes in daily life, and public health strategies intended to protect physical health can negatively affect mental health and well-being, especially for individuals with pre-existing mental health challenges. For this study, we surveyed a sample of clients (N = 94) in the summer of 2020 from a community mental health clinic in the northeast United States. A mixed-methods, concurrent triangulation design was used to (a) identify client subgroups on indicators of mental health (i.e. anxious and depressive symptoms) and emotional, psychological, and social well-being using latent profile analysis (LPA), and (b) within these subgroups, examine qualitative, thematic patterns in self-described challenges, benefits and learning related to the pandemic. The LPA revealed five distinct subgroups with various levels of symptoms and well-being, including Stagnant (moderate symptoms/moderate well-being), Languishing (high symptoms/low well-being), Flourishing (low symptoms, high well-being), Fortitudinous (high symptoms, moderate well-being) and Mobilized (moderate symptoms, high well-being). These divergent subgroups support the need to conceptualise mental health symptoms apart from well-being and assess for heterogeneous constellations of such constructs among psychotherapy clients. Thematic analysis offered additional insight into pandemic experiences within each subgroup, including attention to psychological, emotional, behavioural/lifestyle, relational, physical and ecological/contextual dimensions of self-experience, as well as the ways clients had adjusted to the pandemic's circumstances. Findings support nuanced conceptualisations of positive mental health and offer insight into coping and adaptation during this public health crisis.     

“It's wrong to relax,you have to be on the go,go, go,all the time”: Emotional transformation in a case of emotion-focused therapy for generalised anxiety disorder

Generalised anxiety disorder (GAD) is a highly prevalent, chronic and impairing disorder. The aim of this study was to qualitatively describe the transformation in emotional processing across 16 sessions of a successful emotion-focused therapy (EFT) treatment for GAD. A theoretical framework derived from the EFT model of in-session emotional transformation proposed by Pascual-Leone and Greenberg was used as the basis for qualitative analysis. Additionally, the Classification of Affective Meaning States, the Client-Expressed Arousal Scale-III and the Client Emotional Productivity Scale-Revised were utilised by observer–raters to classify moment-by-moment shifts in client affective-meaning states, emotional arousal and emotional productivity. Results supported the emotion transformation model. The client presented in a state of poorly differentiated but highly aroused distress provoked by identifiable interpersonal and intrapersonal triggers. Emotional and behavioural avoidance provoked by fear of pain was evident. Accessing core pain and responding to attendant needs with compassion and protective anger was shown to facilitate the higher order emotional processing states of grief, relief and agency. Implications are proposed, including that addressing core emotional vulnerability may be a critical intervention in the successful treatment of GAD.