Journal of consulting and clinical psychology最新文献

Objective: Assess the efficacy of integrative couple treatment for pathological gambling (ICT-PG) in comparison to treatment provided in an individual approach.

Method: Eighty couples were assigned randomly to ICT-PG (n = 44, M_age = 42.2, SD [13.4], n male gamblers = 29) or individual treatment (n = 36, M_age = 39.9 SD [13.0], n male gamblers = 31) with follow-ups at 4- and 10-months postadmission regarding the severity of gambling, the individual and couple's well-being. Linear mixed and generalized estimating equation models for repeated measures were applied to take into account the dependency of observations. Protocol was preregistered at www.

Clinicaltrials: gov (ID: NCT02240485).

Results: Participants in both treatments generally improved over time with reductions on gambling expanses from an initial $4,000-$600 in a 90-day period following treatment, without difference across treatment conditions in money spent on gambling or frequency of gambling. However, on different indices of gambling severity, the participants in ICT-PG showed more improvement at follow-ups, with better control capacity (OR = 2.57, p < .0129) and greater reduction in gambling craving (OR = 5.83, p < .0001) and erroneous cognitions (OR = 2.63, p < .0063). The couple treatment was associated with a better individual well-being (e.g., less depression for partners, OR = 5.53; p < .0351, and gamblers, OR = 2.37; p < .0334) and couple well-being (e.g., better dyadic satisfaction for partners, OR = 2.02; p < .0057, and gamblers, OR = 3.07; p < .0212).

Conclusions: The results underline the necessity to provide a greater diversity of treatment for gamblers and their partner. Further research should focus on identifying active components of ICT-PG and widen its provision to gamblers with concurrent addiction disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: College students are at particularly high risk for mental health problems, such as eating disorders, which are associated with functional impairment, distress, and morbidity, but barriers limit implementation of evidence-based interventions at colleges. We evaluated the effectiveness and implementation quality of a peer educator (PE) delivered eating disorder prevention program (the Body Project [BP]), which has a broad evidence-based using a train-the-trainer (TTT) approach and experimentally evaluated three levels of implementation support.

Method: We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day TTT training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). Colleges recruited undergraduates (N = 1,387, 98% female, 55% White) to complete Body Project groups.

Results: There were no significant differences across condition for attendance, adherence, competence, and reach, though nonsignificant trends suggested some benefit of TTT + TA + QA relative to TTT for adherence and competence (ds = .40 and .30). Adding TA and QA to TTT was associated with significantly larger reductions in risk factors and eating disorder symptoms.

Conclusions: Results suggest that the Body Project can be effectively implemented at colleges using peer educators and a TTT approach and that adding TA and QA resulted in significantly larger improvements in outcomes for group participants, and marginally higher adherence and competence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objectives: There is substantial evidence that cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) improve symptoms and functioning in adults with mood and psychotic disorders. There has been little work directly comparing these treatments among adolescents with early-onset mood or psychosis symptoms.

Method: We conducted a randomized controlled trial comparing remotely administered group CBT to group MBCT for adolescents (ages 13-17) with a mood disorder or attenuated psychosis symptoms. Adolescents attended nine sessions over 2 months; their parents attended parallel groups focused on the same skill practices. Participants were assessed for psychiatric symptoms and functioning at posttreatment and 3 months posttreatment.

Results: Sixty-six youth (M_age = 15.1 years, SD = 1.4; 44 females [66.7%]) initiated the trial (32 in CBT and 34 in MBCT), with 54 retained at posttreatment and 53 at the 3-month follow-up. The treatments were associated with comparable improvements in adolescents' mood, anxiety, attenuated psychosis symptoms, and psychosocial functioning over 5 months. CBT was associated with greater improvements than MBCT in emotion regulation and well-being during the posttreatment period. MBCT (compared to CBT) was associated with greater improvements in social functioning among adolescents with greater childhood adversity. Both treatments had comparable rates of retention, but youth and parents reported more satisfaction with CBT than MBCT.

Conclusions: The beneficial effect of both treatments in a group telehealth format is encouraging. Due to our limited sample, future research should investigate whether adolescents' history of adversity and treatment preferences replicate as treatment moderators for youth with mood or psychosis symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: As part of a larger community-based, service-driven research project, the primary purpose of this pilot randomized study was to examine the feasibility and acceptability of delivering time-limited adaptations of parent-child interaction therapy (PCIT) and child-parent psychotherapy (CPP) within a sample of children experiencing homelessness. The secondary goal was to examine the promise of both interventions in improving parent/child outcomes.

Method: One hundred forty-four young children (18 month-5 years old; M_age = 3.48, SD = 1.09; 43.1% female; 78.5% Black/African American; 27.1% Hispanic) and their mothers were recruited from a women's homeless shelter and randomly assigned to 12 weeks of either PCIT or CPP delivered by shelter clinicians on-site. Attendance, fidelity, and program satisfaction were obtained. Families completed pre- and postintervention assessments, including observational data on maternal verbalizations during a child-led play session.

Results: Both time-limited PCIT and time-limited CPP were successfully implemented with similarly high levels of intervention fidelity (>90%) and satisfaction by mothers (85%). Completion rates were similar across both time-limited PCIT (76.6%) and time-limited CPP (71.4%). Both time-limited CPP and PCIT resulted in decreases in children's posttraumatic stress, parental stress, and increases in maternal positive verbalizations. Only time-limited PCIT resulted in significant improvements in externalizing behavior problems in children and reductions in maternal negative verbalizations.

Conclusions: Time-limited PCIT and CPP are acceptable, feasible, and hold significant promise for helping families within a homeless shelter environment and by extension, other transitional and/or shelter environments. A full randomized trial is warranted to determine which program may offer a more effective intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

This article discusses psychosocial interventions in the contexts they are meant to be delivered. Prevention and intervention science often follow the linear pathway of preclinical or pre-intervention research-efficacy trials, effectiveness trials, and implementation studies-with the assessment of translation into public and population health impact occurring at the end. This linear translational pathway follows stages developed for ascertaining safe, efficacious, and effective dosages for biological compounds. This approach has created limitations in the need to rapidly deploy complex, multi-component, multilevel approaches to change behavior and improve health into widespread practice for diverse clinical and public health settings. While it is important to use efficacy trials when safety is yet to be established, when the risks are identified to be low, as is often the case for psychosocial interventions, we can go faster to achieve equitable population health impact. The authors recommend that clinical trialists engaged in intervention development incorporate two considerations in the next generation of prevention and intervention research. First, consider moving right to effectiveness or pragmatic trials, as the most valid test of an intervention is the est of that intervention in the context(s) in which it is intended. Second, when designing effectiveness studies, consider investigating questions related to both effectiveness (i.e., does the intervention improve clinical outcomes) and implementation (i.e., what supports are needed to deploy the intervention routinely in that context) to accelerate impact. As a matter of both ethics and equity, there is a need to expedite the research-to-practice pipeline at a pace faster than is made available through current approaches. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Cognitive behavioral therapy (CBT) is efficacious for hoarding disorder (HD), though results are modest. HD patients show an increase in activity in the dorsal anterior cingulate cortex (dACC) when making decisions. The aim of this study is to determine whether CBT's benefits follow improvements in dACC dysfunction or abnormalities previously identified in other brain regions.

Method: In this randomized clinical trial of 64 treatment-seeking HD patients, patients received group CBT, delivered weekly for 16 weeks, versus wait list. Functional magnetic resonance imaging was used to examine neural activity during simulated decisions about whether to acquire and discard objects.

Results: During acquiring decisions, activity decreased in several regions, including right dorsolateral prefrontal, right anterior intraparietal area, both right and left medial intraparietal areas, left and right amygdala, and left accumbens. During discarding decisions, activity decreased in right and left dorsolateral prefrontal, right and left rostral cingulate, left anterior ventral insular cortex, and right medial intraparietal areas. None of the a priori brain parcels of interest significantly mediated symptom reduction. Moderation effects were found for left rostral cingulate, right and left caudal cingulate, and left medial intraparietal parcels.

Conclusions: Therapeutic benefits of CBT for HD do not appear to be mediated by changes in dACC activation. However, pretreatment dACC activation predicts outcome. Findings suggest the need to re-evaluate emerging neurobiological models of HD and our understanding of how CBT affects the brain in HD, and perhaps shift focuses to new neural target discovery and target engagement trials. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Psychotherapy is the first-line treatment for borderline personality disorder (BPD) in evidence-based care. The effects are, on average, medium; however, nonresponse rates point to differential treatment effects. Personalized treatment selection has the potential to improve outcomes, but they depend on the heterogeneity of treatment effects (HTEs), which this article seeks to establish.

Method: Using an extensive database of randomized controlled trials on psychotherapy for BPD, we determined a reliable estimate of this heterogeneity in treatment effects by (a) applying Bayesian variance ratio meta-analysis and (b) estimating the HTE. In total, 45 studies were included in our study. HTE was found for all psychological treatments, although with low degrees of certainty.

Results: Across all psychological treatment and control group types, the estimate for the intercept was 0.10, indicating a 10% higher variance of endpoint values in the intervention groups after controlling for differences in posttreatment means.

Conclusions: The results suggest that, while there might be sufficient heterogeneity in treatment effects, the estimates are uncertain, and future research is needed to gain more accurate boundaries for HTE. Personalizing psychological treatments for BPD by using treatment selection approaches could have positive effects, but the current evidence does not allow for a precise estimate of potential outcome improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. Nonetheless, methodological limitations preclude clear understanding of how psychosocial chronic pain treatments work. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatments.

Method: CT, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of "specific" mechanisms (pain catastrophizing, mindfulness, behavior activation) and outcomes.

Results: CT, MBSR, and BT produced similar pre- to posttreatment effects on all mechanism variables, and all three active treatments produced greater improvements than TAU. Participant ratings of expectations of benefit and working alliance were similar across treatments. Lagged and cross-lagged analyses revealed that prior week changes in both mechanism and outcome factors predicted next week changes in their counterparts. Analyses of variance contributions suggested that changes in pain catastrophizing and pain self-efficacy were consistent unique predictors of subsequent outcome changes.

Conclusions: Findings support the operation of shared mechanisms over specific ones. Given significant lagged and cross-lagged effects, unidirectional conceptualizations-mechanism to outcome-need to be expanded to include reciprocal effects. Thus, prior week changes in pain-related cognitions could predict next week changes in pain interference which in turn could predict next week changes in pain-related cognitions, in what may be an upward spiral of improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Applying elements of cognitive behavioral therapy (CBT) in internet-based interventions (IBIs) is effective in treating depression. However, CBT-based IBIs differ in which kind of components are applied and the order of their application. Furthermore, it is as yet unknown whether such sequencing matters. Using an IBI for depression, we examined whether the sequence of two major CBT components, behavioral activation (BA) and cognitive restructuring (CR), affect patterns of symptom changes and dropout rates.

Method: Individuals with moderate to mild depressive symptoms (N = 2,304, 59% female) were randomly assigned to two groups: one group that received BA in Modules 2 and 3 and CR in Modules 4 and 5, and another group with the opposite sequence. The component contents were identical. We investigated group differences in dropout rates, symptom changes, and change trajectories across the intervention.

Results: The groups had similar dropout rates and showed similar changes pre- to postassessment, and from pre- to 3-, 6-, and 12-month follow-up assessments. Between-group differences were small enough to be considered equivalent. Three classes of change trajectories emerged in both groups, but they did not differ in shape or size and did not show diverging associations with person-level characteristics.

Conclusions: Results suggest that the sequence of the CBT components BA and CR in IBIs for depression does, on average, not systematically impact how individuals change during and after participation, which provides flexibility in designing CBT-based interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).