Journal of consulting and clinical psychology最新文献

Objective: This study described therapists' delivery of six child mental health evidence-based practices (EBPs) over 33 months during the sustainment phase of a system-driven implementation aimed at improving access to EBPs in community settings.

Method: Seven hundred seventy-seven therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys, and these data were matched to therapist administrative claims data. Survival analyses examined (a) therapists' discontinuation of delivery of all Los Angeles County Department of Mental Health direct client services (i.e., turnover) and (b) therapists' discontinuation of a specific EBP while continuing to provide psychotherapy services.

Results: A majority of therapists (58.3%) were observed to discontinue providing any direct client services over the 33-month period, and discontinuation rates for specific EBPs ranged from 100% of therapists (Cognitive Behavioral Intervention for Trauma in Schools) to 76.4% (Managing and Adapting Practice). Different factors predicted the discontinuation of all service delivery compared to the discontinuation of a specific EBP. Greater therapist emotional exhaustion predicted higher likelihood of discontinuation of all direct client services. For EBP discontinuation, EBP-level factors (e.g., EBPs that required ongoing consultation), therapist-level factors (e.g., ability to provide services in a language other than English), and agency-level factors (e.g., more positive program leader perceptions of the EBP) predicted lower likelihood of discontinuation of the specific EBP.

Conclusions: Different factors contribute to the risk of therapists leaving the service system versus discontinuing the delivery of specific EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Children of parents with severe mental illness are at increased risk of mental illness throughout their lifespan due to complex gene-environment interactions. Preventive interventions supporting parents and children are warranted. Compared with usual treatment, we tested the effectiveness of a multidisciplinary family-based preventive intervention, VIA Family.

Method: We did a parallel randomized controlled superiority trial in Copenhagen, Denmark. A total of 95 families, of 95 parents with either schizophrenia spectrum disorder (n = 12 [12.6%]), bipolar disorder (n = 25 [26.3%]), or recurrent major depressive disorder (n = 58 [61.1%]), participated. A total of 179 coparents and 113 children (6-12 years) participated. Assessments took place at baseline and after 18 months of intervention. We estimated the effects on family functioning with the McMaster Family Assessment Device and on levels of stimulation and support in the home environment with the Home Observation Measurement of the Environment.

Results: Effects on family functioning did not differ between the two groups: parents with severe mental illness (0.11; 95% CI [-0.10, 0.31]), p = .296, and coparents (-0.07; 95% CI [-0.27, 0.13]), p = .482. Assessor-rated levels of stimulation and support in the home environment improved in VIA Family, but not significantly compared with usual treatment (M_diff: 1.79; 95% CI [-0.37, 3.95], p = .104). Sensitivity analyses confirmed our main findings.

Conclusions: Effects on family functioning and the home environment did not differ between VIA Family and usual treatment. We cannot rule out a clinically relevant effect of VIA Family on levels of stimulation and support in the home environment. Long-term follow-up will investigate potential preventive effects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity.

Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% male, and 4.5% gender diverse; 54.55% identified as White; 31.82 reported being Hispanic/Latinx. Participants were selected for having high levels of trait negative affect and were randomized to receive either the mindfulness program or no intervention. We used ecological momentary assessment to measure stress and emotions and to derive measures of mNA comprised of stressor-independent and stressor-reactive negative affect. The ecological momentary assessment protocol involved participants completing a short survey/diary entry on Qualtrics four times per day for 5 days. Internalizing symptoms were assessed with the Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and the Screen for Child Anxiety Related Disorders.

Results: The mindfulness intervention resulted in a significant reduction in stressor-reactive negative affect (t = 2.001, df = 96, p = .048; Cohen's d = .40), but not stressor-independent mNA or overall mNA. Additionally, reductions in stressor-reactive negative affect significantly correlated with changes in internalizing symptomatology (standardized β = .26, p = .032).

Conclusions: These results indicate that among youth with high levels of trait negative affectivity, a relatively affordable and accessible digital mindfulness program significantly reduced stressor-reactive negative affect. The absence of an effect on stressor-independent or overall average mNA suggests some specificity of the effects of mindfulness to stressor-reactive negative affect in an at-risk sample of adolescents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study sought to evaluate the feasibility, acceptability, and preliminary efficacy of the Happy Older Latinos are Active (HOLA) health promotion intervention in a group of older Latinos who were at risk for developing major depressive disorder or generalized anxiety disorder.

Method: Sixty older Latinos age 60+ with subthreshold depression or anxiety were randomized to receive either HOLA (n = 30) or enhanced psychoeducation through fotonovela control (n = 30). The primary outcomes of interest were feasibility, acceptability, and reduction in depression and anxiety symptom severity. Outcome measures were administered at baseline and at the end of the intervention.

Results: Within a year, the enrollment target was met with < 5% of eligible participants refusing randomization. The randomization scheme produced equal numbers of participants randomized to each condition. Four participants (6.7%; HOLA = 1; control = 3) were lost to follow-up, 69% of the HOLA sessions were attended, and participants reported high satisfaction with the intervention. Finally, compared with control, a significant proportion of participants in HOLA experienced a clinically significant reduction in their anxiety symptoms (60% vs. 26.7%).

Conclusions: Findings highlight the feasibility, acceptability, and significant impact the HOLA intervention can have in reducing psychological distress because it is responsive, respectful, and specific to the needs of older Latinos. Furthermore, using a community health worker to deliver a health promotion intervention to prevent common mental disorders in older Latinos is an innovative approach for reducing disease burden in a population living with high disparities in accessing and engaging in mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Machine learning has a great potential for prospectively forecasting individual patient response to mental health care (MHC), thereby enabling treatment personalization. However, previous efforts have been limited to populations living in predominantly higher income, developed countries. This study aimed to extend the reach of precision MHC systems by developing and testing a feasible and readily implementable algorithm for identifying patients at risk of nonresponse to routinely delivered psychotherapy in Chile, a developing country in Latin America.

Method: Data were derived from a community-based, randomized trial that tested the effects of progress feedback on naturalistically delivered psychotherapy outcome. Patients were 547 adults who were consecutively admitted to an outpatient clinic in Santiago, Chile. Treatment response was defined using norms for reliable improvement on the Outcome Questionnaire-30. Based on 10 sociodemographic and seven clinical predictors, we trained elastic net and random forest algorithms on a randomly selected training set (70%; n = 384). The best performing algorithm was tested on a hold-out sample (30%; n = 163).

Results: Reliable improvement was achieved in 42% of the cases. A random forest algorithm demonstrated moderate performance in the hold-out sample (area under the curve = .74, Brier score = .21), correctly identifying 73% of the patients who did not respond.

Conclusion: This study developed a predictive algorithm that demonstrated moderate accuracy in identifying patients at risk of nonresponse to naturalistic psychotherapy in Chile, using routinely assessed and easy-to-collect sociodemographic and clinical information. Using such tools may represent one step toward reducing the multilayered outcome disparities faced by individuals receiving MHC in socioeconomically disadvantaged contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study examined whether a responsive parenting (RP) intervention for first-time Black mothers had secondary benefits for their mental health by reducing their postpartum depressive symptoms.

Method: In total, 212 first-time Black mothers participated in the Sleep Strong African American Families randomized control trial. Mothers were randomized to the RP condition or a safety control condition at 1-week postpartum. Participants reported their depressive symptoms at 1-, 8-, and 16-week postpartum. Data were analyzed using linear regression and moderation analyses.

Results: There was not a significant main effect of the intervention condition on mothers' depressive symptoms at 8- or 16-week postpartum. However, at 8-week postpartum, the main effect of the condition was significantly moderated by mothers' depressive symptoms at baseline: Mothers in the RP condition reported significantly lower levels of 8-week depressive symptoms than mothers in the safety control condition if they initially had clinically significant depressive symptoms but did not differ from controls if they did not initially have clinically significant depressive symptoms. This interaction effect was not significant at 16-week postpartum. Effects remained consistent, controlling for demographic variables, which did not significantly moderate condition effects at 8- or 16-week postpartum.

Conclusion: Participation in the Sleep Strong African American Families responsive parenting intervention led to a more rapid reduction in depressive symptoms among first-time Black mothers with clinically significant depressive symptoms at baseline relative to the control condition. Findings suggest that family-focused responsive parenting interventions may serve as forms of "constructed resilience" that promote positive mental health early in the postpartum period. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Sexual assault (SA) is unfortunately common in U.S. college campuses. Friends are central to the social context of college women, and thus to the context of SA, and thus may play a key role in SA prevention. The objective of the present study was to provide a preliminary test of a novel friend-based motivational intervention (FMI) that encourages and prepares friends to work together to reduce SA risk.

Method: In a pilot trial, 51 friend dyads (N = 102) were randomized to either FMI or waitlist control (WLC) conditions and then followed over 3 months. Participant perceptions of the intervention and intervention-associated outcomes (engagement in friend-based assault protective behaviors [FAPB], readiness to change, barriers, sexual assault occurrences) were examined.

Results: Those in the FMI reported greater readiness to engage in efforts to protect their friend against SA and reported higher rates of FAPB across time points relative to the WLC. Though not statistically significant, women in the FMI also reported half as many incidences of SA at the 3-month follow-up. We did not observe decreases in perceived barriers to intervening that were targeted with the FMI. Participant feedback on their experiences with the FMI was positive; women reported that FMI was empowering, personally relevant, and useful.

Conclusions: Findings point to the promise of this dyad-based motivational intervention that capitalizes on the natural resource of women's friendships to decrease risk for sexual assault. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental health care in the United States is prohibitively difficult to access. Barriers of entry include a shortage of providers, high cost of services, insufficient insurance coverage, and layers of bureaucracy. This problem of low supply and high demand created a unique environment for capitalist problem solvers to enter the therapeutic market, via "therapy-matching platforms." Several ethically related Federal Trade Commission (FTC) complaints and independent investigations into these platforms highlight that the forward progress is not without growing pains. This commentary focuses on ensuring proper informed consent when providing services on therapy-matching platforms (e.g., BetterHelp, TalkSpace). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The goal of this study was to test if a mindfulness-based intervention (MBI) compared to an active control ameliorates the impacts of life stressors on momentary mindfulness and emotion regulation difficulties among adolescents exposed to chronic stressors.

Method: Adolescents exposed to chronic stressors (N = 81, Mage = 13.75 years; 56% boys; 24% Hispanic/Latino, 57% White) were randomized to receive MBI within the context of a community-based mentoring program (MBI + mentoring) or mentoring-alone. Participants completed ecological momentary assessments (EMAs) three times each day for 7 days at three intervals/bursts (preintervention, midintervention, and postintervention), contributing to a total of 3,178 EMA reports. EMA assessed momentary exposure to life stressors, mindfulness (vs. mindlessness), and emotion regulation difficulties.

Results: Linear mixed-effects models revealed that the interaction between intervention arm (MBI + mentoring vs. mentoring-alone) and burst was significantly associated with the random slopes of life stressor exposure predicting mindful attention (b = -.05, SE = .01, p < .001), mindful nonjudgment (b = -.03, SE = .01, p < .001), and emotion regulation difficulties (b = -.04, SE = .01, p < .001). Estimated marginal means revealed that MBI + mentoring, compared to mentoring-alone, produced small but significant attenuation in the association of life stressors with mindful attention, mindful nonjudgment, and emotion regulation difficulties at postintervention.

Conclusion: Mindfulness training may buffer adolescents exposed to chronic stressors against the negative impacts of life stressors on mindfulness and emotion regulation in daily life. Going forward, it will be important to investigate these relationships in the context of mental/physical health outcomes and to include longer periods of follow-up to determine the sustainable benefits of MBI for adolescent health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Cancer-specific psychological interventions like cognitive behavioral stress management (CBSM) demonstrate distress (e.g., anxiety/depression) and quality of life (QoL) benefits. Digital formats can expand access.

Method: Patients (80.6% female; 76.5% White; 25-80 years) with Stage I-III cancer and elevated anxiety within 6 months of treatment (surgery/chemotherapy/radiation/immunotherapy) receipt were randomized 1:1 to a 10-module CBSM or health education control digital app and completed questionnaires at Weeks 0, 4, 8, 12. Primary outcomes of greater group-level anxiety (PROMIS-A) and depression symptom (PROMIS-D) reductions for CBSM were met and published; this secondary report evaluates individual-level response results for these outcomes and outcomes beyond anxiety and depression. Chi-square tests compared responder proportions using PROMIS-A/PROMIS-D symptom categories and two levels (≥5/≥7.5) of T-score point reductions. Changes across conditions over time for stress (Perceived Stress Scale), cancer-specific distress (Impact of Event Scale-Intrusions), and QoL (Functional Assessment of Cancer Therapy-General) were analyzed using repeated measures linear mixed-effects modeling (N = 449). Patient Global Impression of Change-Well-being was also examined.

Results: At Week 12, a greater proportion of CBSM (vs. control) participants reported normal-to-mild (vs. moderate-to-severe) PROMIS-A and PROMIS-D, and a greater proportion of CBSM participants at Week 8 or 12 had a ≥7.5 T-score reduction in PROMIS-A and a ≥5 T-score reduction in PROMIS-D (ps < .05). CBSM participants (vs. control) showed significantly greater reductions in Perceived Stress Scale and Impact of Event Scale-Intrusions and increases in Patient Global Impression of Change-Well-being and Functional Assessment of Cancer Therapy emotional and physical well-being (ps < .05), but not functional or social/family well-being.

Conclusion: Digitized CBSM benefits distress and QoL. (PsycInfo Database Record (c) 2024 APA, all rights reserved).