Resolving disease management problems in European-American and Latino couples with type 2 diabetes: the effects of ethnicity and patient gender

The management of type 2 diabetes requires major life style changes. How patients and family members resolve disagreements about disease management affects how well the disease is managed over time. Our goal was to identify differences in how couples resolved disagreements about diabetes management based on ethnicity and patient gender. We recruited 65 Latino and 110 European-American (EA) couples in which one spouse had type 2 diabetes. Couples participated in a 10-minute videotaped, revealed differences interaction task that was evaluated with 7 reliable observer ratings: warm-engagement, hostility, avoidance, amount of conflict resolution, off-task behavior, patient dominance, and dialogue. A series of 2 x 2, Ethnicity x Sex ANOVAs indicated significant effects for Ethnicity and for the Ethnicity x Sex interaction, but not for Sex. Latino couples were rated as significantly more emotionally close, less avoidant, less hostile toward each other, and had less dominant patients than EA couples; however, Latino couples achieved significantly less problem resolution and were more frequently off-task than EA couples. These findings were qualified by patient gender. The findings highlight important differences     

Sudden gains and outcome: a broader temporal analysis of cognitive therapy for depression

Individual Beck Depression Inventory (BDI) time courses of 38 clients receiving cognitive therapy (CT) and a modified form of CT were studied in order to investigate temporal changes during CT for depression. The primary aim was to determine if alternative methods of defining and computing gains occurring early in CT would alter the conclusions drawn in the current literature. Three types of gains were studied: sudden gains (previously studied sudden, substantial, and stable improvements in depression during 1 between-session interval after Session 2), first-session gains (occurring after first sessions), and pretreatment gains (occurring after pretreatment assessments). Positive outcomes were predicted by first-session gains and by sudden gains occurring in the first half of treatment, highlighting the importance of early change in CT for depression.     

The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.     

Therapist Grief and Functional Analytic Psychotherapy: Strategic Self-Disclosure of Personal Loss

Functional Analytic Psychotherapy (FAP), a behavioral approach that focuses on the development of genuine and meaningful therapeutic relationships including the strategic use of disclosure, provides a framework for therapist self-disclosure during times of personal loss. This article briefly outlines FAP and provides an example of FAP in practice following the death of the first author’s mother. Qualitative data from a client questionnaire on the impact of this disclosure are presented, which suggest that the disclosure was a positive experience for most but not all clients. The article concludes with clinical guidelines that can enhance therapeutic effectiveness whether or not therapists choose to disclose loss to their clients and general precautions for treading in this emotionally intense territory.     

The behavioral activation for depression scale-short form: development and validation

Following a landmark component analysis of cognitive therapy by Jacobson and colleagues (1996), there has been renewed interest in behavioral activation (BA) treatments for depression. The Behavioral Activation for Depression Scale (BADS) was developed to measure when and how clients become activated over the course of BA treatment. Multiple studies have provided initial support for the BADS but have also identified several potential problems. Four studies were conducted in order to develop and provide initial evaluation of a short form of the BADS that addresses these concerns. In Study 1, an exploratory factor analysis was conducted on existing data using the original BADS in order to identify items to retain for the short form. In Study 2, these items were administered to a new sample of college students with elevated depressive symptoms and were analyzed with exploratory and confirmatory factor analyses. Study 3 examined the predictive validity of the BADS-SF by examining the BADS-SF and depression scores in relation to activity tracking and reward-value ratings over the course of 1 week. Study 4 examined BADS-SF data over the course of BA treatment for two clients using cross-lagged panel correlations. With one client, changes in BADS-SF scores led changes in depression scores by 1 week, whereas with the other client changes in BADS-SF and depression scores occurred concurrently. These studies resulted in a nine-item scale that demonstrated good item characteristics as well as acceptable internal consistency reliability, construct validity, and predictive validity.     

Acceptance and commitment therapy and behavioral activation for the treatment of depression: description and comparison

The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the "common cold" of outpatient populations. Two treatments for depression have emerged: acceptance and commitment therapy (ACT) and behavioral activation (BA). At times ACT and BA may suggest largely redundant intervention strategies. However, at other times the two treatments differ dramatically and may present opposing conceptualizations. This paper will compare and contrast these two important treatment approaches. Then, the relevant data will be presented and discussed. We will end with some thoughts on how and when ACT or BA should be employed clinically in the treatment of depression.     

Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes

Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.     

Romantic relationship quality during the COVID-19 pandemic: The longitudinal associations with relationship loneliness and depression

The COVID-19 pandemic created significant strain on both mental health and romantic relationships. Therefore, we examined longitudinal associations between romantic relationship quality, relationship loneliness, and depressive symptoms over 6 months of the COVID-19 pandemic. We surveyed 122 couples (n = 244 individuals) in approximately May, September, and November 2020. Using a dyadic mediation model, findings indicated that relationship quality at Time 1 was positively associated with depression at Time 3 for men, but not for women. A significant indirect effect of relationship quality on depression via relationship loneliness at Time 2 was found for both men and women. Self-mastery, or feeling in control of one's life circumstances, was an important covariate of women's depressive symptoms. Overall, these findings highlight relationship loneliness as particularly salient for mental health and demonstrate the importance of high-quality relationships for promoting well-being during stressful events, such as global pandemics.     

The Behavioral Activation for Depression Scale (BADS): Psychometric Properties and Factor Structure

In Behavioral Activation (BA) for depression (Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001)), which has recently received empirical support in a large randomized trial, therapists pay close attention to the function of behavior and the role of aversive controlling stimuli and escape and avoidance behavior in depression. A key variable to measure in studies of BA is when and how clients become more activated over the course of treatment. This study sought to develop an initial set of items for the Behavioral Activation for Depression Scale (BADS), submit these items to an exploratory factor analysis in an initial administration (Study 1, N = 391), and submit the resulting scale to a confirmatory factor analysis in a second administration (Study 2, N = 319). Results indicated four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment) with good factor structure, internal consistency, and test-retest reliability. Evidence for construct and predictive validity is presented.