Journal of consulting and clinical psychology最新文献

Objective: Inhibitory learning models emphasize the central role of threat expectancy violation during exposure therapy. However, exposure is often implemented alongside cognitive restructuring, which reduces threat expectancies before exposure, reducing the potential for expectancy violation. This study examined whether the timing of expectancy violation (before/during exposure) and magnitude of expectancy change impact the efficacy of exposure therapy.

Method: A total of 249 adults (range 18-59 years old, M = 21.19, SD = 6.89) with elevated public speaking anxiety completed an intensive exposure session. Participants were randomly allocated to receive exposure based on (a) behavioral experiments (BE; i.e., maximizing expectancy violation and emphasizing prediction error following exposure); (b) cognitive restructuring before exposure (CR + EXP; i.e., threat expectancies reduced before exposure, thus reducing expectancy violation during exposure tasks); or (c) exposure without explicit processing of threat expectancies or expectancy violation. Change in symptoms was assessed pre-post exposure session and at 1-week follow-up.

Results: The BE and CR + EXP groups showed superior anxiety reduction (primary outcome) and threat expectancy change (secondary outcome) compared to exposure without explicit processing of threat expectancies or expectancy violation. There was a nonsignificant small effect size difference in anxiety reduction favoring BE over CR + EXP. There was greater expectancy change in the BE group compared to the CR + EXP group and shorter treatment duration. Greater threat expectancy change during exposure tasks was associated with greater anxiety reduction.

Conclusions: Threat expectancy change facilitates anxiety reduction during exposure therapy, and there may be modest advantages to challenging threat expectancies after exposure (BE) compared to before exposure (CR + EXP). (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Young adults in college engage in risky drinking that results in alcohol-related harms. Most evidence-based prevention interventions recommended for this population rely on correcting exaggerated drinking norms via personalized normative feedback (PNF). Informed by an extensive literature linking alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) task to the alcohol prevention context. The goal of this study is to evaluate the ability of CAA in changing drinking and related consequences and to explore the comparative efficacy of CAA versus PNF.

Method: This two-site randomized controlled trial had two experimental conditions (CAA and PNF) and an assessment-only control condition. Participants were 585 students who reported heavy episodic drinking and ≥ 2 alcohol-related negative consequences. Alcohol outcomes were assessed at 1-, 3-, and 6-month follow-ups to test hypotheses that the CAA and PNF manipulations will decrease drinks per week, typical drinks per day, peak blood alcohol concentration, and alcohol consequences, relative to control.

Results: Participants reported reductions in drinks per week, typical drinks, and alcohol consequences. Those who received PNF reported significantly fewer drinks per week than controls, whereas those who received CAA reported significantly fewer consequences than controls. The CAA and PNF conditions did not differ from one another.

Conclusions: This study demonstrates an application of attitude change theory and CAA methods to the alcohol prevention context, across demographically different settings. The novel CAA task had a harm reduction effect on consequences but not consumption. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial.

Method: A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16-22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depression from baseline to 3 months.

Results: Of the original 1,262 participants (79% female), 558 were included (CBT, baseline, n = 273, PHQ-9: M = 7.48, SD = 3.9; 3 months, N = 163, PHQ-9: M = 8.83, SD = 4.92; self-monitoring, baseline, n = 285, PHQ-9: M = 7.45, SD = 4.26; 3 months, N = 183, PHQ-9: M = 7.48, SD = 3.9). Neither total app use, self-monitoring, nor use of Tools predicted change in depression (all ps > .05). Frequency of use of Challenges predicted lower depression symptoms and caseness at 3 months (β = -0.28, 95% CI [-0.53, -0.03], p = .029). Specifically, the use of behavioral activation challenges mediated the effects of the CBT app on depression over 3 months (β = -0.59, 95% CI [-1.13, -0.05], p = .03).

Conclusions: Brief psychoeducation about behavioral activation principles in an app may protect young people from depression over 3 months, even when only used once. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Despite the prevalence of depressive disorders among youth, there is no health system model to address the prevention of these disorders.

Method: With the goal of creating effective, tolerable, and scalable interventions for the prevention of adolescent depression, we have fielded three randomized clinical trials, centered in health care delivery organizations that use a whole-of-society approach: (a) Path 2 Purpose (N = 664), comparing the Competent Adulthood Transition with Cognitive Behavioral, Humanistic, and Interpersonal Training (CATCH-IT; B. W. Van Voorhees et al., 2015), guided digital health intervention to a synchronous mental health specialist-led group cognitive behavioral intervention, Coping with Depression Course-Adolescent; (b) PATHway (N = 400), examining the efficacy of the CATCH-IT components; and (c) Behavioral Health Stratified Treatment (N = 780), which examines the feasibility and potential benefit of a coordinated care, risk stratification, and intervention matching approach for adolescents with intellectual and developmental disabilities using both CATCH-IT (lower risk) and the Coping with Depression Course-Adolescent (higher risk).

Results: The study samples for all three trials include youth from traditionally underrepresented groups (71.8%) with some economic distress (47.6%). Intervention utilization was moderate across trials. Feedback from study teams reveals general barriers to implementation and challenges specific to the pandemic.

Conclusions: We review these trials, report preliminary data on demographics and intervention utilization, and provide feedback from study teams on implementation challenges encountered. (PsycInfo Database Record (c) 2025 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) 2025 APA, all rights reserved).

Objective: This overview aims to summarize systematic reviews with meta-analyses estimating the effects of school-based depression prevention interventions on depression outcomes.

Method: We conducted electronic searches (Australian Education Index, Google Scholar, ProQuest Dissertations and Theses A&I, Pubmed, Social Science Premium Collection), hand-searched key journals, and conducted backward and forward citation chasing to identify eligible reviews. Two reviewers independently screened records, assessed full texts for eligibility, and collected data. We narratively summarized review findings and quantified the overlap of primary studies across systematic reviews using Corrected Covered Area.

Results: We identified 29 eligible systematic reviews with 472 included primary studies overall (Mdn = 35, range = 4-137). Only 177 primary studies (37%) were included in more than one review (Corrected Covered Area = 6%). We rated all reviews as low (10%) or critically low (90%) quality on A MeaSurement Tool to Assess systematic Reviews-2, and most reviews (86%) at high risk of bias on Risk Of Bias In Systematic reviews. Reviews mostly suggest school-based depression prevention interventions may have modest average positive impacts on depression-related outcomes-both overall and for specific stages of prevention, school levels and student ages, and specific program manuals and intervention types. However, some reviews did not detect effects, and most reviews noted concerns about primary study quality, heterogeneity, and publication bias in this body of evidence.

Conclusions: School-based depression prevention interventions may be beneficial on average, though existing reviews have important methodological limitations. A living systematic review conducted according to methodological best practice could provide timely, relevant, and rigorous evidence for educational decision making. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Rising rates of mental illness in young people over recent decades are a trend that represents a wake-up call across the globe. The causes of this increase are not known. We also know little about effective interventions or implementation strategies to prevent depression in either youth or adults. The need for the prevention of mental ill health represents an outstanding research opportunity for our field.

Method: This conceptual article identifies current challenges in our field, provides potential solutions, and suggests the most promising avenues for future solutions and how we might investigate them.

Results: Key challenges include the following: poor implementation with low fidelity; methodological challenges related to appropriate sampling, time frames, interventions, and active controls; and lack of fit between interventions and their context. Potential solutions include the following: supplementing trials with evidence from large-scale epidemiological studies, establishing prevention models that work at scale including those that address social determinants and show effectiveness in low- and middle-income countries, building capacity in methods, and strengthening geographically dispersed networks of prevention researchers and practitioners.

Conclusions: There are major challenges in conducting prevention research and demonstrating effects. New perspectives and collaborations are needed to overcome existing barriers. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Depression is an ongoing public health issue impacting over 5 million American adolescents. Although prevention has been shown to be an effective strategy in reducing the incidence of depressive symptoms, depression prevention programs have been developed and tested in largely White populations. Thus, the effects of such programs in diverse groups are understudied, though research shows adapted versions are more beneficial for diverse populations than nonadapted programs. In this study, we sought to examine the effects of depression prevention in Black and White American youth.

Method: Informed by youth focus groups, we adapted and implemented a program which previously benefited mainly White samples to benefit Black and White American inner-city high school students. Of the 425 youth who participated, 57.2% identified as Black and 42.8% identified as White. We randomized youth into two conditions-prevention and nonprevention control-and measured depressive symptoms over three semesters.

Results: We found differential effects of prevention on Black and White American youth. For Black American youth, there was no difference between the two conditions at any of the waves of data collection. For White American youth, however, the prevention program worked as intended.

Conclusions: Given our findings and past research, it is essential to investigate possible causes for the differential effects of prevention to increase understanding and ensure positive effects of prevention for all youth. Additional ramifications and recommendations for future research and practice are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Depression and anxiety are major mental health concerns for college students, and accessible, low-cost interventions are urgently needed. Although traditional treatments focus on negative emotions, there is growing support for the efficacy of positive emotion-focused interventions. We extended this prior work by developing a peer-delivered brief promoting positive emotion (BPPE) intervention that aims to enhance positive valence systems processes and reduce internalizing risk in college students. The goal of this study was to examine the feasibility, acceptability, and initial mental health outcomes of BPPE.

Method: In this pilot randomized controlled trial, 92 unselected college students (Mage = 19.44, SD = 1.15) completed measures of depressive and social anxiety symptoms, perceived stress, well-being, and positive and negative affect before being randomized to the BPPE intervention (n = 47) or a comparison study skills instruction (n = 45). Participants repeated the affect measure immediately after the intervention and repeated the rest of the measures 1 month later (n = 66). Intention-to-treat linear mixed-effect models were used to examine group differences.

Results: We found that BPPE can be delivered with high fidelity by peer-trained skills coaches and was rated as highly satisfactory by participants. Positive affect increased pre- to immediately postintervention in the BPPE group. Significant group by time interactions were observed for depression, social anxiety, and perceived stress across the 1-month follow-up, such that BPPE appeared to buffer against worsening symptoms across time.

Conclusion: Our findings provide preliminary support for a brief, scalable, preventive intervention targeting positive valence systems functions among college students. Future studies warrant a fully powered randomized controlled trial to test the efficacy of the intervention. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Specific modifiable factors (e.g., screen time [ST], sleep duration, physical activity, or social connections) are targets for reducing depression risk in adults. However, research in adolescents lacks causal inference implementations, as prevention trials are costly and often prohibitive. Emulating randomized trials with observational data enables inference regarding hypothetical interventions on modifiable factors that reduce depression risk, in general and at-risk populations.

Method: Data from the Adolescent Brain Cognitive Development (N = 8,699) and the Generation R (N = 3,739) studies were leveraged for modifiable factors (age 10) and internalizing symptoms (age 12-14). We (a) tested prospective associations of each modifiable factor with internalizing symptoms under target trial emulation (TTE) and (b) used G-formula to estimate the potential effects on internalizing symptoms if hypothetical interventions were implemented. Analyses were conducted in the full sample (universal prevention setting) and at-risk youth (selective and indicated prevention setting).

Results: First, under TTE, only ST associated with internalizing symptoms. Second, in the universal prevention setting, adhering to more stringent ST guidelines (0-1 hr) decreased internalizing symptoms by 0.10-0.16 SDs while following more lenient guidelines (3-4 hr) increased them by 0.07-0.09 SDs, compared to existing guidelines (2 hr). Such changes were greater in the indicated (subclinical symptom) prevention settings and robust to residual confounding. Restricting physical activity reduced internalizing risk in the indicated setting, but findings were not robust.

Conclusions: With a causally informed strategy, we demonstrated the potential effects of numerous hypothetical interventions on modifiable factors for depression risk reduction, across multiple preventive settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).