Pub Date : 2025-04-03DOI: 10.1016/j.beth.2025.03.006
Tyler Hendley, Austin Starkey, Caleb Yaccarino, Jackson Bolner, Ryan M. Hill
Suicide safety planning–type interventions encompass a family of brief interventions that assist in maintaining one’s safety during crises (e.g., experiencing suicidal thoughts and behavior) and can be administered in various administration methods, both in-person and digitally. Given that research suggests the importance of safety planning quality for promoting positive clinical outcomes, it is important to evaluate the quality of safety plans created using various administration methods. The present study sought to compare digital and in-person administration methods of suicide safety planning with respect to the quality of safety plans produced using each administration method. Conducted in a university lab space, participants (college students, 18 years or older, with past-year suicidal ideation; n = 135) were randomly assigned to one of three safety planning administration methods: traditional, in-person (n = 43), the Safety Planning Assistant (n = 44), and mysafetyplan.org (n = 48). Participants also completed a 2-week follow-up. Results indicate that traditional in-person safety planning and the Safety Planning Assistant produce significantly greater quality safety plans than mysafetyplan.org, F(2, 130) = 30.960, p < .001, ηp2 = .349. Additionally, those with higher quality plans reported higher satisfaction and spent a significantly longer amount of time developing their plans, F(2, 130) = 23.874, p < .001, ηp2 = .269. The Safety Planning Assistant produced comparable quality to that of traditional in-person safety planning, indicating that this self-administered safety planning tool may be a viable option in fast-paced settings where resources may be limited.
{"title":"A Comparison of In-Person and Digital Suicide Safety Planning Quality: A Randomized Controlled Trial of Three Safety Planning Administration Methods","authors":"Tyler Hendley, Austin Starkey, Caleb Yaccarino, Jackson Bolner, Ryan M. Hill","doi":"10.1016/j.beth.2025.03.006","DOIUrl":"10.1016/j.beth.2025.03.006","url":null,"abstract":"<div><div>Suicide safety planning–type interventions encompass a family of brief interventions that assist in maintaining one’s safety during crises (e.g., experiencing suicidal thoughts and behavior) and can be administered in various administration methods, both in-person and digitally. Given that research suggests the importance of safety planning quality for promoting positive clinical outcomes, it is important to evaluate the quality of safety plans created using various administration methods. The present study sought to compare digital and in-person administration methods of suicide safety planning with respect to the quality of safety plans produced using each administration method. Conducted in a university lab space, participants (college students, 18 years or older, with past-year suicidal ideation; <em>n</em> = 135) were randomly assigned to one of three safety planning administration methods: traditional, in-person (<em>n</em> = 43), the Safety Planning Assistant (<em>n</em> = 44), and <span><span><em>mysafetyplan.org</em></span><svg><path></path></svg></span> (<em>n</em> = 48). Participants also completed a 2-week follow-up. Results indicate that traditional in-person safety planning and the Safety Planning Assistant produce significantly greater quality safety plans than <span><span><em>mysafetyplan.org</em></span><svg><path></path></svg></span>, <em>F</em>(2, 130) = 30.960, <em>p</em> < .001, η<sub>p</sub><sup>2</sup> = .349. Additionally, those with higher quality plans reported higher satisfaction and spent a significantly longer amount of time developing their plans, <em>F</em>(2, 130) = 23.874, <em>p</em> < .001, η<sub>p</sub><sup>2</sup> = .269. The Safety Planning Assistant produced comparable quality to that of traditional in-person safety planning, indicating that this self-administered safety planning tool may be a viable option in fast-paced settings where resources may be limited.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 6","pages":"Pages 1025-1040"},"PeriodicalIF":3.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145340970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-26DOI: 10.1016/j.beth.2025.03.005
Leah Bullinger , Afsoon Gazor , Stephen Buerkert, Savannah M. Dieste, W. David Brown, Sunita M. Stewart
Cognitive behavior therapy for insomnia has shown increasing promise in reducing suicidality in adults and may be effective in reducing suicidality in adolescents. Dysfunctional beliefs about sleep (DBs) are a primary target of such interventions. However, there are few studies of DBs in adolescents, let alone suicidal adolescents. Our study (1) assessed the sleep and suicide-related correlates of DBs, and (2) examined if change in DBs was associated with change in sleep, in a sample of acutely suicidal adolescents aged 12–18 years in an intensive cognitive behavior therapy–informed treatment program that did not target sleep. Measures of DBs (using the 16-item Dysfunctional Beliefs About Sleep Scale’s (DBAS) total score and four subscale scores: Consequences, Helplessness, Expectations, and Medications), sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation were administered at program admission and discharge. Total DBs were concurrently associated (all ps < .05) with sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation, and reduction of DBs was associated with improvement in sleep over treatment. There was some variability in the association between types of DBAS and variables of interest, with the Helplessness subscale showing the strongest and most consistent associations. Limitations include subjective measurements only, a lack of specific insomnia symptom measures, and a nondiverse sample. DBs show promise as a target in the management of suicidal adolescents. Our findings also suggest that the development of an adolescent-specific scale could enhance construct measurement validity.
{"title":"Dysfunctional Beliefs About Sleep in Suicidal Adolescents: Associations and Treatment Implications","authors":"Leah Bullinger , Afsoon Gazor , Stephen Buerkert, Savannah M. Dieste, W. David Brown, Sunita M. Stewart","doi":"10.1016/j.beth.2025.03.005","DOIUrl":"10.1016/j.beth.2025.03.005","url":null,"abstract":"<div><div>Cognitive behavior therapy for insomnia has shown increasing promise in reducing suicidality in adults and may be effective in reducing suicidality in adolescents. Dysfunctional beliefs about sleep (DBs) are a primary target of such interventions. However, there are few studies of DBs in adolescents, let alone suicidal adolescents. Our study (1) assessed the sleep and suicide-related correlates of DBs, and (2) examined if change in DBs was associated with change in sleep, in a sample of acutely suicidal adolescents aged 12–18 years in an intensive cognitive behavior therapy–informed treatment program that did not target sleep. Measures of DBs (using the 16-item Dysfunctional Beliefs About Sleep Scale’s (DBAS) total score and four subscale scores: Consequences, Helplessness, Expectations, and Medications), sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation were administered at program admission and discharge. Total DBs were concurrently associated (all <em>p</em>s < .05) with sleep disturbance, depressive symptoms, emotion regulation, and suicide ideation, and reduction of DBs was associated with improvement in sleep over treatment. There was some variability in the association between types of DBAS and variables of interest, with the Helplessness subscale showing the strongest and most consistent associations. Limitations include subjective measurements only, a lack of specific insomnia symptom measures, and a nondiverse sample. DBs show promise as a target in the management of suicidal adolescents. Our findings also suggest that the development of an adolescent-specific scale could enhance construct measurement validity.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 979-988"},"PeriodicalIF":3.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-13DOI: 10.1016/j.beth.2025.03.002
David F. Tolin, Blaise L. Worden, Hannah C. Levy
This state-of-the-science review describes the relatively new diagnosis of hoarding disorder (HD), characterized by difficulty discarding possessions and resulting clutter in living spaces. We review current theoretical models of HD, including a cognitive-behavioral model, a biopsychosocial model, an attachment model, and an addictions model. We then describe interventions for HD, focusing largely on cognitive-behavioral therapy for hoarding disorder (CBT-HD), the only treatment with conclusive evidence of efficacy. We review the components of CBT-HD and their rationale, noting that clinical results have been modest. The cross-cultural efficacy of CBT-HD is unclear, as are the effects of cultural modifications to the treatment. Future clinical and research directions are discussed.
{"title":"State of the Science: Hoarding Disorder and Its Treatment","authors":"David F. Tolin, Blaise L. Worden, Hannah C. Levy","doi":"10.1016/j.beth.2025.03.002","DOIUrl":"10.1016/j.beth.2025.03.002","url":null,"abstract":"<div><div>This state-of-the-science review describes the relatively new diagnosis of hoarding disorder (HD), characterized by difficulty discarding possessions and resulting clutter in living spaces. We review current theoretical models of HD, including a cognitive-behavioral model, a biopsychosocial model, an attachment model, and an addictions model. We then describe interventions for HD, focusing largely on cognitive-behavioral therapy for hoarding disorder (CBT-HD), the only treatment with conclusive evidence of efficacy. We review the components of CBT-HD and their rationale, noting that clinical results have been modest. The cross-cultural efficacy of CBT-HD is unclear, as are the effects of cultural modifications to the treatment. Future clinical and research directions are discussed.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 667-679"},"PeriodicalIF":3.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the evolving field of psychological interventions for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT) has emerged as a first-line treatment, backed by robust empirical evidence. Despite the proven efficacy of CPT in improving PTSD symptoms, individuals face significant barriers when seeking treatment. To overcome these challenges, CPT has undergone testing in diverse settings, accompanied by structural modifications deviating from its commonly delivered format of weekly (or bi-weekly) face-to-face contact, including changes in delivery method, length or intensity of sessions, or format (e.g., group). We conducted a systematic review and meta-analysis to assess the effectiveness of these structural adaptations within CPT for treating PTSD. Fifteen randomized controlled trials (RCTs) and 12 non-RCTs were included for the review. The meta-analysis of the 15 RCTs revealed significant improvements in PTSD and depression outcomes with structural adaptations of CPT. Generally, no significant differences were found when comparing these adaptations with standard CPT or non-CPT treatments, although this is accompanied by the caveat of likely modest power for subanalyses involving different comparator types. The findings suggest that adapting the delivery of CPT typically yields similar outcomes in PTSD symptom improvement as standard CPT and confirms its flexibility in addressing barriers to PTSD treatment access. Limitations and future directions are discussed.
{"title":"Exploring Structural Adaptations to Cognitive Processing Therapy: A Systematic Review and Meta-Analysis","authors":"Priyadharshany Sandanapitchai, Reginald D.V. Nixon","doi":"10.1016/j.beth.2025.03.003","DOIUrl":"10.1016/j.beth.2025.03.003","url":null,"abstract":"<div><div>In the evolving field of psychological interventions for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT) has emerged as a first-line treatment, backed by robust empirical evidence. Despite the proven efficacy of CPT in improving PTSD symptoms, individuals face significant barriers when seeking treatment. To overcome these challenges, CPT has undergone testing in diverse settings, accompanied by structural modifications deviating from its commonly delivered format of weekly (or bi-weekly) face-to-face contact, including changes in delivery method, length or intensity of sessions, or format (e.g., group). We conducted a systematic review and meta-analysis to assess the effectiveness of these structural adaptations within CPT for treating PTSD. Fifteen randomized controlled trials (RCTs) and 12 non-RCTs were included for the review. The meta-analysis of the 15 RCTs revealed significant improvements in PTSD and depression outcomes with structural adaptations of CPT. Generally, no significant differences were found when comparing these adaptations with standard CPT or non-CPT treatments, although this is accompanied by the caveat of likely modest power for subanalyses involving different comparator types. The findings suggest that adapting the delivery of CPT typically yields similar outcomes in PTSD symptom improvement as standard CPT and confirms its flexibility in addressing barriers to PTSD treatment access. Limitations and future directions are discussed.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 948-963"},"PeriodicalIF":3.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-13DOI: 10.1016/j.beth.2025.03.004
Neta Yitzhak, Maayan Cohen, Ruth Traub Bar-Ilan, Adina Maeir, Eran Eldar, Mor Nahum
Emotion dysregulation, and specifically emotional instability, characterizes adults with ADHD. This study utilized ecological momentary assessment (EMA) to track emotional states and examine patterns of emotional instability within individuals over different time scales. Specifically, it focused on two aspects: overall emotional variability over time, and emotional lability, reflected in emotional states fluctuations within and across days. We further examined the interaction of these emotional instability factors with the subjective experience of emotion regulation difficulties. Young adults with (n = 57) and without (HC; n = 54) ADHD diagnosis completed a self-report questionnaire for emotion regulation difficulties, followed by a 5-day EMA protocol of 5 emotion reports/day. Individuals with ADHD displayed significantly higher intra-individual emotional variability, but no group differences were found for emotional lability, both between and across days. This higher emotional variability was linked to self-reported emotion regulation difficulties in the ADHD group. Finally, using cluster analysis, we found a higher probability of individuals with ADHD being included in a cluster characterized by elevated emotional variability and emotion regulation difficulties. This study demonstrates that young adults with ADHD may experience a broader range of emotions in their daily lives, which may be related to the way they evaluate their challenges in emotion regulation. The findings highlight the need to address emotion dysregulation difficulties in clinical practice, as understanding these emotional dynamics could enhance personalized therapeutic strategies for ADHD, and help design interventions tailored to the breadth and intensity of emotional experiences in ADHD.
{"title":"The Emotional Pendulum in ADHD: Insights From Ecological Momentary Assessment of Emotional States in Young Adults","authors":"Neta Yitzhak, Maayan Cohen, Ruth Traub Bar-Ilan, Adina Maeir, Eran Eldar, Mor Nahum","doi":"10.1016/j.beth.2025.03.004","DOIUrl":"10.1016/j.beth.2025.03.004","url":null,"abstract":"<div><div>Emotion dysregulation, and specifically emotional instability, characterizes adults with ADHD. This study utilized ecological momentary assessment (EMA) to track emotional states and examine patterns of emotional instability within individuals over different time scales. Specifically, it focused on two aspects: overall emotional variability over time, and emotional lability, reflected in emotional states fluctuations within and across days. We further examined the interaction of these emotional instability factors with the subjective experience of emotion regulation difficulties. Young adults with (<em>n</em> = 57) and without (HC; <em>n</em> = 54) ADHD diagnosis completed a self-report questionnaire for emotion regulation difficulties, followed by a 5-day EMA protocol of 5 emotion reports/day. Individuals with ADHD displayed significantly higher intra-individual emotional variability, but no group differences were found for emotional lability, both between and across days. This higher emotional variability was linked to self-reported emotion regulation difficulties in the ADHD group. Finally, using cluster analysis, we found a higher probability of individuals with ADHD being included in a cluster characterized by elevated emotional variability and emotion regulation difficulties. This study demonstrates that young adults with ADHD may experience a broader range of emotions in their daily lives, which may be related to the way they evaluate their challenges in emotion regulation. The findings highlight the need to address emotion dysregulation difficulties in clinical practice, as understanding these emotional dynamics could enhance personalized therapeutic strategies for ADHD, and help design interventions tailored to the breadth and intensity of emotional experiences in ADHD.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 964-978"},"PeriodicalIF":3.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-10DOI: 10.1016/j.beth.2025.02.005
Emily E. Bernstein, Adam C. Jaroszewski, Ryan J. Jacoby, Natasha H. Bailen, Jennifer Ragan, Aisha Usmani, Sabine Wilhelm
Obsessive-compulsive disorder (OCD) is a chronic, severe condition. Although exposure and response prevention (ERP), the first-line treatment for OCD, is highly effective, too few clinicians are equipped to deliver it. One barrier is the time and expertise required to develop personalized exposure hierarchies. In this study, we examined the feasibility and promise of using large language models (LLMs) to generate appropriate exposure suggestions for OCD treatment. We used ChatGPT-4 (Generative Pretrained Transformer, Version 4) to generate 10-item exposure hierarchies for simulated patient cases that were systematically varied along the following dimensions: OCD subtype, symptom complexity or number, level of detail, patient age, and patient gender. Expert clinicians also generated hierarchies for a subset of prompts. ChatGPT-generated hierarchies were first rated for completeness and degree to which input information was incorporated. Three OCD experts blinded to the aims of the study then rated each ChatGPT- and expert-generated hierarchy’s appropriateness, specificity, variability, safety/ethics, and overall usefulness or quality. ChatGPT generated partial (n = 15) or complete (n = 55) responses to 70 of 72 prompts and incorporated most input information (M = 4.29 out of 5, SD = 0.85). The only significant predictor of degree of input information incorporated was number of OCD symptoms; prompts with the most symptoms were rated as incorporating less input information than prompts with both low and moderate number of symptoms, ps < .05. Overall, ChatGPT-generated hierarchies were viewed as appropriate (M = 4.47, SD = 0.58), specific (M = 4.17, SD = 0.65), variable (M = 3.96, SD = 0.79), safe/ethical (M = 4.89, SD = 0.24), and useful (M = 3.99, SD = 0.82). However, expert human-generated hierarchies were still rated as significantly more appropriate, specific, variable, and useful, ps < .05, but not more or less safe and ethical than ChatGPT-generated hierarchies, p = .24. Only the level of symptom detail included in prompts was associated with ratings of ChatGPT-generated hierarchies, ps < .05, such that hierarchies were rated significantly better when prompts had been more detailed. Results suggest that LLMs such as ChatGPT hold great promise in helping generate effective OCD exposure hierarchies, while also highlighting key limitations that require resolution prior to clinical implementation. Given that few clinicians specialize in OCD treatment, it would be advantageous to establish how face-to-face or digital treatment can be augmented with this technology.
{"title":"Feasibility of Using ChatGPT to Generate Exposure Hierarchies for Treating Obsessive-Compulsive Disorder","authors":"Emily E. Bernstein, Adam C. Jaroszewski, Ryan J. Jacoby, Natasha H. Bailen, Jennifer Ragan, Aisha Usmani, Sabine Wilhelm","doi":"10.1016/j.beth.2025.02.005","DOIUrl":"10.1016/j.beth.2025.02.005","url":null,"abstract":"<div><div>Obsessive-compulsive disorder (OCD) is a chronic, severe condition. Although exposure and response prevention (ERP), the first-line treatment for OCD, is highly effective, too few clinicians are equipped to deliver it. One barrier is the time and expertise required to develop personalized exposure hierarchies. In this study, we examined the feasibility and promise of using large language models (LLMs) to generate appropriate exposure suggestions for OCD treatment. We used ChatGPT-4 (Generative Pretrained Transformer, Version 4) to generate 10-item exposure hierarchies for simulated patient cases that were systematically varied along the following dimensions: OCD subtype, symptom complexity or number, level of detail, patient age, and patient gender. Expert clinicians also generated hierarchies for a subset of prompts. ChatGPT-generated hierarchies were first rated for completeness and degree to which input information was incorporated. Three OCD experts blinded to the aims of the study then rated each ChatGPT- and expert-generated hierarchy’s appropriateness, specificity, variability, safety/ethics, and overall usefulness or quality. ChatGPT generated partial (<em>n</em> = 15) or complete (<em>n</em> = 55) responses to 70 of 72 prompts and incorporated most input information (<em>M</em> = 4.29 out of 5, <em>SD</em> = 0.85). The only significant predictor of degree of input information incorporated was number of OCD symptoms; prompts with the most symptoms were rated as incorporating less input information than prompts with both low and moderate number of symptoms, <em>p</em>s < .05. Overall, ChatGPT-generated hierarchies were viewed as appropriate (<em>M</em> = 4.47, SD = 0.58), specific (<em>M</em> = 4.17, SD = 0.65), variable (<em>M</em> = 3.96, <em>SD</em> = 0.79), safe/ethical (<em>M</em> = 4.89, <em>SD</em> = 0.24), and useful (<em>M</em> = 3.99, <em>SD</em> = 0.82). However, expert human-generated hierarchies were still rated as significantly more appropriate, specific, variable, and useful, <em>p</em>s < .05, but not more or less safe and ethical than ChatGPT-generated hierarchies, <em>p</em> = .24. Only the level of symptom detail included in prompts was associated with ratings of ChatGPT-generated hierarchies, <em>p</em>s < .05, such that hierarchies were rated significantly better when prompts had been more detailed. Results suggest that LLMs such as ChatGPT hold great promise in helping generate effective OCD exposure hierarchies, while also highlighting key limitations that require resolution prior to clinical implementation. Given that few clinicians specialize in OCD treatment, it would be advantageous to establish how face-to-face or digital treatment can be augmented with this technology.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 680-688"},"PeriodicalIF":3.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-08DOI: 10.1016/j.beth.2025.03.001
Rosy L. Chavez-Najera, Lorraine T. Benuto
Latines in the United States experience considerable rates of depression and while behavioral activation is an effective treatment for depression, internal and external barriers contribute to the underutilization of behavioral health services among Spanish-speaking Latines (SSLs). Fortunately, internet-based interventions have the potential to mitigate these barriers given their increased privacy, cost-effectiveness, and logistical flexibility. The present (pilot) study examined clinical outcomes and feasibility (engagement, satisfaction) with a culturally attuned behavioral activation telenovela intervention (BAD-TI) for SSLs using a quasi-experimental design. The BAD-TI is modeled after the telenovela entertainment genre (a limited-run serial drama popular in Latin America). The six-episode animated telenovela series chronicles the behavioral health journey of Maria, a Latina who is in her 40s and is experiencing depression. The six units from behavioral activation treatment for depression (BATD), including the core skills from each unit, are depicted in the telenovela series. Results indicated that 21 of the 32 participants (65.63%) who enrolled in the study completed treatment and 11 of the 32 participants (34.38%) dropped out of treatment. Intent-to-treat analysis revealed that participants experienced a statistically significant reduction in depressive symptom from pre- to posttreatment. Satisfaction ratings for the intervention and engagement with the intervention was high. Results from this study suggest that behavioral activation delivered via an online telenovela intervention format is a feasible and acceptable treatment approach for depressed SSLs.
{"title":"Necesito Un Psicólogo: A Feasibility Study Examining a Behavioral Activation Telenovela Intervention for Depressed Latinas","authors":"Rosy L. Chavez-Najera, Lorraine T. Benuto","doi":"10.1016/j.beth.2025.03.001","DOIUrl":"10.1016/j.beth.2025.03.001","url":null,"abstract":"<div><div>Latines in the United States experience considerable rates of depression and while behavioral activation is an effective treatment for depression, internal and external barriers contribute to the underutilization of behavioral health services among Spanish-speaking Latines (SSLs). Fortunately, internet-based interventions have the potential to mitigate these barriers given their increased privacy, cost-effectiveness, and logistical flexibility. The present (pilot) study examined clinical outcomes and feasibility (engagement, satisfaction) with a culturally attuned behavioral activation telenovela intervention (BAD-TI) for SSLs using a quasi-experimental design. The BAD-TI is modeled after the telenovela entertainment genre (a limited-run serial drama popular in Latin America). The six-episode animated telenovela series chronicles the behavioral health journey of Maria, a Latina who is in her 40s and is experiencing depression. The six units from behavioral activation treatment for depression (BATD), including the core skills from each unit, are depicted in the telenovela series. Results indicated that 21 of the 32 participants (65.63%) who enrolled in the study completed treatment and 11 of the 32 participants (34.38%) dropped out of treatment. Intent-to-treat analysis revealed that participants experienced a statistically significant reduction in depressive symptom from pre- to posttreatment. Satisfaction ratings for the intervention and engagement with the intervention was high. Results from this study suggest that behavioral activation delivered via an online telenovela intervention format is a feasible and acceptable treatment approach for depressed SSLs.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 935-947"},"PeriodicalIF":3.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.beth.2025.02.004
Georgette E. Fleming, Vilas Sawrikar, Silvana Kaouar, Bryan Neo, Campbell McDonogh, Eva R. Kimonis
Despite decades of support for behavioral parent training, studies consistently comprise a proportion of families who do not experience sustained improvement in child conduct problems. Recent innovations to enhance treatment effects use predictors of treatment response to guide efforts to personalize treatment. We investigated whether baseline parental cognitions predicted response to Parent-Child Interaction Therapy (PCIT) in a sample of N = 61 children (M = 4.78 years, SD = 1.23, 74% boys) with conduct problems. Families received PCIT at an Australian urban university-based clinic. Parental positive and negative relational schemas were coded from baseline 5-minute speech samples. Linear mixed-effects models showed that mothers’ unhelpful cognitions predicted significantly less improvement in child conduct problems and internalizing problems, parenting stress, and observed parenting behaviors from baseline to follow-up. In contrast, children of fathers with unhelpful cognitions began treatment with more severe problems than other children, but experienced similar or greater magnitude of improvement in child conduct problems, paternal parenting stress, and observed paternal negative parenting behaviors during treatment relative to other children. Findings suggest that PCIT may be a useful alternative to parent-only behavioral parent training for fathers with unhelpful cognitions. We also discuss methods for tailoring PCIT for mothers with unhelpful cognitions to enhance treatment effects.
These trials were registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12616000280404; ACTRN12616000221459).
{"title":"The Impact of Parental Cognitions on Outcomes of Behavioral Parent Training for Children With Conduct Problems","authors":"Georgette E. Fleming, Vilas Sawrikar, Silvana Kaouar, Bryan Neo, Campbell McDonogh, Eva R. Kimonis","doi":"10.1016/j.beth.2025.02.004","DOIUrl":"10.1016/j.beth.2025.02.004","url":null,"abstract":"<div><div>Despite decades of support for behavioral parent training, studies consistently comprise a proportion of families who do not experience sustained improvement in child conduct problems. Recent innovations to enhance treatment effects use predictors of treatment response to guide efforts to personalize treatment. We investigated whether baseline parental cognitions predicted response to Parent-Child Interaction Therapy (PCIT) in a sample of <em>N</em> = 61 children (<em>M</em> = 4.78 years, <em>SD</em> = 1.23, 74% boys) with conduct problems. Families received PCIT at an Australian urban university-based clinic. Parental positive and negative relational schemas were coded from baseline 5-minute speech samples. Linear mixed-effects models showed that mothers’ unhelpful cognitions predicted significantly less improvement in child conduct problems and internalizing problems, parenting stress, and observed parenting behaviors from baseline to follow-up. In contrast, children of fathers with unhelpful cognitions began treatment with more severe problems than other children, but experienced similar or greater magnitude of improvement in child conduct problems, paternal parenting stress, and observed paternal negative parenting behaviors during treatment relative to other children. Findings suggest that PCIT may be a useful alternative to parent-only behavioral parent training for fathers with unhelpful cognitions. We also discuss methods for tailoring PCIT for mothers with unhelpful cognitions to enhance treatment effects.</div><div>These trials were registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12616000280404; ACTRN12616000221459).</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 917-934"},"PeriodicalIF":3.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.beth.2025.02.003
Alexander J. Erickson, Gwendolyn C. Carlson, Monica R. Kelly, Michael N. Mitchell, Constance H. Fung, Yeonsu Song, Sarah Kate McGowan, Karen Josephson, Michelle Zeidler, Donna L. Washington, Elizabeth M. Yano, Cathy A. Alessi, Jennifer L. Martin
Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire–9) and generalized anxiety (Generalized Anxiety Disorder–7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (–3.95 ≤ b ≤ –4.35, p < .001) and anxiety (–4.29 ≤ b ≤ –4.75, p < .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ b ≤ 0.584, p < .001), with change in insomnia severity accounting for 88%–97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.
失眠的认知行为疗法（CBT-I）改善了共病精神健康症状（抑郁、焦虑和创伤后应激障碍[PTSD]），睡眠改善被假设为观察到的改善机制。本研究考察了失眠症严重程度的改变作为行为失眠症治疗后女性退伍军人心理健康症状改善的中介。二次分析使用了比较有效性试验的数据，该试验评估了接受CBT-I和接受和承诺治疗-知情失眠（ABC-I）治疗的女性退伍军人的失眠结果。这些治疗方法在改善睡眠方面在统计学上是相同的，因此在当前的分析中被合并。样本包括149名不同种族和民族的中年女性退伍军人（平均年龄48岁，白人34.2%，黑人或非裔美国人26.9%，西班牙裔/拉丁裔18.8%）。感兴趣的变量包括失眠严重程度（失眠严重指数）、抑郁程度（患者健康问卷- 9）和广泛性焦虑（广泛性焦虑障碍- 7）。采用广义结构方程模型对研究假设进行检验。研究治疗阶段（基线、治疗后、3个月随访）显著预测抑郁（-3.95 ≤ b ≤ -4.35,p <； ）。001)和焦虑（-4.29 ≤ b ≤ -4.75,p <； ）。001)非中介模型的症状改善。失眠严重程度介导抑郁和焦虑症状的改善（0.515 ≤ b ≤ 0.584,p <； ）。001)，失眠严重程度的改变占失眠行为心理治疗后抑郁和焦虑症状减少的88%-97%。本研究确定失眠严重程度的减轻是行为性失眠治疗后抑郁和焦虑症状改善的主要机制。研究结果还加强了失眠为重点的行为心理疗法对伴有精神疾病的患者的价值。
{"title":"Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans","authors":"Alexander J. Erickson, Gwendolyn C. Carlson, Monica R. Kelly, Michael N. Mitchell, Constance H. Fung, Yeonsu Song, Sarah Kate McGowan, Karen Josephson, Michelle Zeidler, Donna L. Washington, Elizabeth M. Yano, Cathy A. Alessi, Jennifer L. Martin","doi":"10.1016/j.beth.2025.02.003","DOIUrl":"10.1016/j.beth.2025.02.003","url":null,"abstract":"<div><div>Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire–9) and generalized anxiety (Generalized Anxiety Disorder–7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (–3.95 ≤ <em>b</em> ≤ –4.35, <em>p</em> < .001) and anxiety (–4.29 ≤ <em>b</em> ≤ –4.75, <em>p</em> < .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ <em>b</em> ≤ 0.584, <em>p</em> < .001), with change in insomnia severity accounting for 88%–97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 907-916"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1016/j.beth.2025.02.002
Marc J. Weintraub, Megan C. Ichinose, Jamie L. Zinberg, Anabel Salimian, Robin D. Brown, Georga Morgan-Fleming, Jennifer M. Gamarra, Tiffany Tran, David J. Miklowitz
Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring’s psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents’ mental health in this population. This study involved a multifamily group cognitive-behavioral therapy (CBT) for adolescents with mood or psychotic spectrum disorders and their parents, and tested whether a mobile application (app) could increase therapeutic engagement and skill practice. In a secondary analysis of a randomized controlled trial, we examined whether provision of an adjunctive app was associated with increases in parents' engagement in treatment skill practices and improvements in their emotional and parenting stress. Sixty adolescents and their primary parents were randomized into group cohorts to receive either an app-enhanced group delivery of the CBT unified protocol (AppUP) or the standard delivery of the group UP without an app, both delivered via telehealth. Families were followed over the 9-week treatment and 3 months posttreatment (21 weeks total). Unexpectedly, parents in AppUP reported fewer skill practices than parents in the standard UP. There were no differences between treatment conditions in parents’ psychological distress. In a within-group examination of the full sample (i.e., both treatment conditions), parents with higher psychological distress upon entry to the study showed greater decreases in their distress over the 21-week trial than those with lower distress at entry. These improvements in distress levels were positively associated with parents’ treatment skill practice and improvements in family functioning. Greater parental engagement in skill practice across both treatment conditions was also associated with improvements in adolescents’ psychiatric functioning. Among adolescents with mood or psychotic spectrum disorders, parental engagement in group CBT may contribute to reductions in parents' distress and improvements in the mental health of offspring.
{"title":"Effects of a Multifamily App-Enhanced Cognitive-Behavioral Therapy Delivered via Telehealth for Parents of Adolescents With Mood or Psychotic Spectrum Disorders","authors":"Marc J. Weintraub, Megan C. Ichinose, Jamie L. Zinberg, Anabel Salimian, Robin D. Brown, Georga Morgan-Fleming, Jennifer M. Gamarra, Tiffany Tran, David J. Miklowitz","doi":"10.1016/j.beth.2025.02.002","DOIUrl":"10.1016/j.beth.2025.02.002","url":null,"abstract":"<div><div>Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring’s psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents’ mental health in this population. This study involved a multifamily group cognitive-behavioral therapy (CBT) for adolescents with mood or psychotic spectrum disorders and their parents, and tested whether a mobile application (app) could increase therapeutic engagement and skill practice. In a secondary analysis of a randomized controlled trial, we examined whether provision of an adjunctive app was associated with increases in parents' engagement in treatment skill practices and improvements in their emotional and parenting stress. Sixty adolescents and their primary parents were randomized into group cohorts to receive either an app-enhanced group delivery of the CBT unified protocol (AppUP) or the standard delivery of the group UP without an app, both delivered via telehealth. Families were followed over the 9-week treatment and 3 months posttreatment (21 weeks total). Unexpectedly, parents in AppUP reported fewer skill practices than parents in the standard UP. There were no differences between treatment conditions in parents’ psychological distress. In a within-group examination of the full sample (i.e., both treatment conditions), parents with higher psychological distress upon entry to the study showed greater decreases in their distress over the 21-week trial than those with lower distress at entry. These improvements in distress levels were positively associated with parents’ treatment skill practice and improvements in family functioning. Greater parental engagement in skill practice across both treatment conditions was also associated with improvements in adolescents’ psychiatric functioning. Among adolescents with mood or psychotic spectrum disorders, parental engagement in group CBT may contribute to reductions in parents' distress and improvements in the mental health of offspring.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 892-906"},"PeriodicalIF":3.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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