Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale–Self Report and the Behavioral Activation Scale for Depression–Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges’ g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.     

A Structural Equation Model for the School Reinforcement Survey Schedule: Italian and American Early Adolescents

The School Reinforcement Survey Schedule (SRSS) was administered to 2,828 boys and girls in middle schools in the United States and an Italian translation was administered to 342 boys and girls in middle schools in Northern Italy. An exploratory factor analysis using half the American data set was performed using maximum likelihood estimation with a promax rotation. This analysis produced a structural equation model with six interpretable latent variables. This analysis was confirmed by results demonstrating a good fit with the other half of the American sample and separately with the Italian sample. Scores for the six latent variables were constructed and information about the distribution of scores was obtained. Multiple comparisons of the means were performed by gender, within each national sample, for each of the six latent variables. American and Italian girls report obtaining greater enjoyment from a wider variety of school activities compared to American and Italian boys.     

The Influence of Dysphoria on Reactivity to Naturalistic Fluctuations in Anger

Abstract We used an experience sampling methodology to explore the relationship between current symptoms of dysphoria and momentary mood fluctuations following everyday experiences of anger. Using PDA devices, participants rated their mood, ruminative cognitions, feelings of dependency, and stressful events 4 times per day for 1 week. We hypothesized and found that those higher in dysphoria would demonstrate a stronger link between anger and depressed mood than those who were lower in dysphoria. Those participants who reported higher initial dysphoria indicated more anger over the course of the week, a stronger within-person association between anger and depressed mood, and a slower recovery from anger experiences. Multilevel moderated mediation analyses indicated that the link between anger and depressed mood for those high in dysphoria is largely explained by a stronger carryover of anger from one assessment to the next and partially explained by greater increases in ruminative cognitions and feelings of dependency. The change in depressed mood appears to occur with increases in anger, specifically, and not other negative mood states. Our results extend previous research on the anger–depression relationship by investigating the short-term relationships between anger and depressed mood among those with varying levels of dysphoria.     

Influence of dysphoria on positive and negative cognitive reactivity to daily mood fluctuations

We used an experience sampling design to investigate the influence of dysphoria on positive and negative cognitive reactivity. Participants recorded their thoughts and mood four times per day on PDA devices for one week. We hypothesized that those higher in dysphoria would demonstrate a greater increase in negative thinking in response to negative mood, and a weaker increase in positive cognitions in response to positive mood. These hypotheses were largely supported. For those participants who reported higher initial dysphoria, there was a stronger association between negative mood and thinking and a weaker link between positive mood and thinking. Regression analyses indicated that positive and negative cognitive reactivity were independently related to dysphoria, suggesting that they represent distinct processes. Our results highlight the importance of understanding levels of both negative and positive cognitive reactivity and underscore the benefits of assessing mood and cognition with repeated measurements in "real-time," in order to better understand the antecedent effects of mood on thinking.     

Cognitive vulnerability to depression in never depressed subjects

The purpose of this study was to investigate whether dysfunctional cognitions could be measured in never-depressed individuals after a sad mood prime, and if these dysfunctional cognitions would predict future depression. Subjects were first screened for current or past depression. Never-depressed subjects were randomly assigned to a prime or no-prime condition and completed the Dysfunctional Attitudes Scale. After one month, subjects completed the Beck Depression Inventory. The mood induction was successful in producing a sad mood, but had no effect on accessibility of dysfunctional cognition. Dysfunctional cognitions did predict depressive symptoms one month later, for the women in the sample, but not the men. These results were actually stronger for the unprimed subjects. The results provide some support for the cognitive diathesis-stress model, and suggest that cognitive vulnerability to depression may exist prior to a clinically significant depressive episode. However, mood priming does not appear to be a useful strategy with never-depressed subjects.     

Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective

Cognitive–behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to compare the outcomes of naturalistic CBT delivered by trainee therapists to those of efficacy and effectiveness studies using primarily professional therapists. Patients (N = 249) with mood and anxiety disorders were treated by trainees (primarily by interns and postdocs) using nonstandardized nonmanualized CBT at an outpatient clinic in an urban academic medical center. Changes in anxiety and depression were assessed using effect sizes, reliable and clinically significant change, and benchmarked to efficacy and effectiveness studies. Symptoms of anxiety and depression significantly improved from start to end of treatment. Rates of improvement and recovery compared favorably to those achieved in other studies, with the exception of recovery rates in severe depression. Effect sizes were in the medium to large range, but generally lower than those achieved in other studies. Results suggest that CBT can be delivered effectively by trainees in an outpatient setting.     

Evaluation of the William S. Hall Psychiatric Institute Clinical Psychology Internship: a replication and extension

This study extends three earlier investigations involving participants who completed their predoctoral clinical psychology internship at the William S. Hall Psychiatric Institute. Intern graduates (N = 37) evaluated how effectively their internship training prepared them for seven aspects of their current work as practicing psychologists. Participants also rated the relevancy of 24 different internship training experiences to their current work and how much these experiences contributed to their development as clinical psychologists. The present study, in conjunction with the three previous studies, covers most of the 40-year period since the inception of the internship program. Analysis of the current data indicates the internship has improved over time and was deemed an exceptional training experience by its graduates. Findings may be of particular interest to internship directors and faculty interested in improving their training program and those who plan to conduct a self-study to maintain their accreditation for clinical psychology internship.