Journal of consulting and clinical psychology最新文献

Objective: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) examined the effectiveness of such a prevention program.

Method: StriveWeekly is a web-based intervention designed with weekly self-guided skill modules (e.g., behavioral activation) that are synchronously delivered to all users. Student participants (n = 1,607) were recruited from one large public university, and 65.4% had no prior mental health service use. Participants were randomly assigned to 8 weeks of StriveWeekly (n = 804) or a waitlist condition (n = 803). Participants completed web-based surveys at baseline, posttest, and 3-month follow-up. The primary outcome was the self-reported Depression Anxiety and Stress Scale-21.

Results: Piecewise linear mixed-effect models found significant group by time interactions for depression (t = -3.05, p = .002), anxiety (t = -3.01, p = .003), and total symptoms (t = -3.34, p < .001). Relative to the waitlist, students assigned to StriveWeekly improved more from baseline to posttest (between-group d = 0.18-0.21). These small effects were maintained through follow-up, and subsequently replicated by the original waitlist. The intervention was initiated by 73.0% of students in the StriveWeekly condition (modules completed: M = 3.72), and 71.6% of all posttest respondents rated the intervention highly.

Conclusion: Findings supported StriveWeekly's effectiveness for large scale indicated prevention of anxiety and depression symptoms in university students. However, further development and research are still needed, as not all students used the intervention, reported satisfaction, or experienced improvement. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes.

Method: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention. Emotional distress symptoms were measured prior to intervention, midintervention (3 months), postintervention (6 months), and follow-up (6 months after the end of intervention). Number of traumatic events, resource access, social support, and English proficiency were tested for potential predictive effects on intervention outcome.

Results: Multilevel generalized linear models revealed that Afghans' (B = -0.259, SE = 0.108, p = .013), and Great Lakes Africans' (B = -0.116, SE = 0.057, p = .042) emotional distress symptoms improved as a function of the intervention, while Iraqis and Syrians showed no intervention effects. For Afghans, English proficiency (B = -0.453, SE = 0.157, p < .01) and social support (B = -0.179, SE = 0.086, p = .037) were most strongly correlated to emotional distress, while for Africans, resource access (B = -0.483, SE = 0.082, p < .001) and social support (B = -0.100, SE = 0.048, p = .040) were the strongest predictors of emotional distress.

Conclusions: Response to advocacy-based interventions and active ingredients may be influenced by culture; findings have implications for refugees and precision medicine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their beneficial effects. We know that many treatments work, but we know relatively little about why they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation.

Method: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees (N = 662), we previously developed a "Personalized Advantage Index" (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores.

Results: A significant index of moderated mediation (IMM = 1.22, 95% CI [0.30, 2.33]) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app.

Conclusions: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The present study examined potential treatment outcome predictors of a multicomponent cognitive behavioral intervention for intermittent explosive disorder (IED).

Method: The sample (n = 64; 22 female) consisted of individuals with a current diagnosis of IED that completed treatment across three study trials. Treatment outcome predictors assessed included demographic variables, psychiatric comorbidity, symptom severity, and treatment motivation/engagement. Treatment outcomes were (a) change in number of past-week aggressive acts from pretreatment to posttreatment and (b) presence of IED diagnosis at posttreatment.

Results: Results indicated those who endorsed lower trait anger were more likely to remit from IED diagnosis at posttreatment. No other variables were found to significantly predict treatment outcome.

Conclusions: These findings support the notion that cognitive behavioral therapy can be effective for a wide range of individuals with IED, with little variation in efficaciousness based on presence of demographic characteristics, comorbid disorders, or treatment motivation/engagement. This seems to be particularly the case for individuals with lower levels of trait anger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The study examined the effects of therapeutic alliance (TA; relational bond, task collaboration) on externalizing behavior outcomes, how TA can operate differently when children are seen in individual versus group sessions, and how therapist-child disagreement in perceptions of TA affects outcomes.

Method: Three hundred sixty children (Ages 9.2-11.8; 65% male; 78.1% Black) identified as having high rates of aggressive behavior by the fourth-grade teachers, and their 20 elementary schools were randomized to group versus individual delivery of the cognitive behavioral intervention, Coping Power. TA ratings were collected from children and therapists at mid and end of intervention using the Therapeutic Alliance Scale for Children. Teacher ratings of children's externalizing and internalizing behavior problems were collected prior to intervention and at 1-year follow-up after intervention using the Behavior Assessment System for Children.

Results: Children receiving the intervention individually reported significantly higher trait-like levels of task collaboration than did children seen in groups. Independent of intervention format, higher trait-like levels of therapist-rated bond and task collaboration predicted reduced levels of externalizing problems, and higher trait-like levels of child- and therapist-rated task-collaboration and therapist-rated bond predicted reduced levels of internalizing problems. Differences between therapist and child reports of bond predicted weaker reductions in internalizing behavior for children seen in groups.

Conclusions: It is essential to train therapists to develop and assess for TA by midintervention with children with aggressive behavior problems, especially if they are seen in small groups, and to determine if therapists may misperceive the strength of TA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).