Behavior Therapy最新文献

Prior research has demonstrated that conducting acquisition in multiple contexts results in more responding to the point that it can even nullify the benefit of subsequent extinction in multiple contexts on reducing renewal of excitatory responding. The underlying mechanism to explain why this happens has not been systematically examined. Using self-reported expectancy of the outcome, the current study investigates three mechanisms that potentially explain why acquisition in multiple contexts results in more responding—greater generalization, stronger acquisition learning, or slower extinction learning. Participants (N = 180) received discriminative training with a conditioned stimulus (CS+) and outcome pairing and a CS− → noOutcome pairing in either one or three contexts. This was followed by either extinction treatment in a novel context or no extinction. Finally, testing occurred in the acquisition context, the extinction context, or a novel context. Stronger renewal of extinguished conditioned expectation was observed for participants who received CS+ → Outcome pairings in three contexts relative to one context. There was no effect of the number of contexts on the strength of the excitatory CS+ → Outcome association or degree of inhibitory learning that occurred during extinction. This suggests that generalization is the mechanism responsible for the adverse impact to extinction learning when acquisition is conducted in multiple contexts.

Recent publications within Contextual Behavioral Science provided a rationale for the expansion of intervention efficacy research using methods that capture idiographic factors and processes. We conducted a systematic review of the use and quality of single-case experimental designs (SCED) within the Acceptance and Commitment Therapy (ACT) literature in adult clinical populations. The systematic review was conducted according to PRISMA guidelines and the databases CINAHL, MEDLINE, PsycINFO, PsycArticles and OpenGrey were searched for peer-reviewed articles. Further studies were sought through review of reference lists of all full text studies. Studies were assessed against What Works Clearinghouse (WWC) single-case design standards. Twenty-six studies met eligibility criteria and were conducted within research teams all implementing multiple-baseline designs. Twenty-four studies did not meet WWC standards with most failing to ensure a degree of concurrence across participants. The extent of randomisation methods was also captured. The review highlights the sparsity of SCEDs within ACT literature in clinical populations and current methodological practices. Limitations of the review and implications for future research are discussed.

Because very few prospective studies have identified risk factors that predicted future onset of threshold/subthreshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD), we analyzed prospective data collected from a large cohort of adolescent girls followed over an 8-year period to advance knowledge about risk factor specificity. Adolescent girls recruited from middle schools in Texas (N = 492; M age = 13.02 [SD = 0.73], age range = 11–15) completed questionnaires assessing risk factors at baseline and diagnostic interviews assessing eating disorders annually over 8 years. Only low BMI predicted future AN onset. Pressure to be thin, thin-ideal internalization, body dissatisfaction, negative emotionality, low parent support, and modeling of eating pathology predicted future BN onset. Pressure to be thin, thin-ideal internalization, negative emotionality, low parent support, and modeling of eating pathology predicted future BED onset. Pressure to be thin, body dissatisfaction, dietary restraint, low parent support, modeling of eating pathology, and high BMI predicted future PD onset. Predictive effects were medium-to-large. Results support etiological theories of eating disorders that postulate the pursuit of the thin ideal, body dissatisfaction, negative affect, dietary restraint, and interpersonal issues increase risk for most eating disorders. The evidence that girls with low body weight are at risk for AN, whereas girls with high body weight are at risk for PD are novel. Although several risk factors predicted future onset of BN, BED, and PD, results suggest that risk factors for AN are qualitatively distinct and should be investigated further.

Mindfulness is a promising health promotion strategy for African Americans, and it is imperative that culturally responsive mindfulness approaches be accessible to this population. One way to address this need is to develop and test if culturally responsive mobile health (mhealth) applications are efficacious in reducing stress-related outcomes in this population. With this goal in mind, we employed a repeated-measures randomized control trial (RCT) across a 12-week intervention period to evaluate if participants in the intervention group outperformed a wait-list control group in reductions in stress, depressive symptoms, anxiety, emotional regulation difficulties as well as in increases in self-compassion, resilience, and mindfulness attitudes and behaviors. Our sample included 170 Black/African American participants who were randomly assigned to either the intervention condition (n = 84) or the wait-list control group (n = 86). Participants in the intervention condition reported more self-compassion, used more mindfulness, and had greater self-efficacy using mindfulness; yet, no other differences were evident. Participants expressed high levels of satisfaction with the app and gave it a positive rating for its relevance to their lives. These findings support the efficacy of a culturally responsive mindfulness mHealth app to enhance self-compassion and increase the use of health-promoting behaviors, like mindfulness, among African Americans. Implications for future research are discussed.

This study explored clinical and sociodemographic moderators of treatment response to “Be a Mom”, an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women’s treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to “Be a Mom” intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the “Be a Mom” intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the “Be a Mom” intervention was supported at the 4-month follow-up. The “Be a Mom” intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

Sexual orientation and gender identity/expression change efforts (SOGIECEs) are discredited practices that are associated with serious negative effects and incompatible with modern standards for clinical practice. Despite evidence linking SOGIECEs with serious iatrogenic effects, and despite support for LGBTQ+-affirmative care alternatives, SOGIECE practices persist. In the 1970s and 1980s, Behavior Therapy published articles testing and/or endorsing SOGIECEs, thereby contributing to their overall development, acceptance, and use. The Behavior Therapy Task Force on SOGIECEs was assembled to conduct a rigorous review of the SOGIECE articles published in Behavior Therapy and to decide whether, and what, formal action(s) should be taken on these articles. This report provides a detailed review of the historic SOGIECE literature published in Behavior Therapy and outlines the Task Force’s deliberative and democratic processes resulting in actions to: (1) add prominent advisory information to k = 24 SOGIECE papers in the form of digital “black box” disclaimers that caution readers that the SOGIECE practices tested or described in these papers are inconsistent with modern standards, (2) offset organizational financial benefits from the publication of these papers, and (3) promote LGBTQ+-affirmative practices. SOGIECEs are not the only concerning practices across the field’s history, and the pages of today’s scientific journals include practices that will be at odds with tomorrow’s moral standards and ethical guidelines. This report calls for precautionary measures and editorial safeguards to minimize the future likelihood and impact of problematic published scholarship, including the need to fully include those with relevant lived experiences in all aspects of clinical science and peer review.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant academic, behavioral, and social skill difficulties including underachievement, risk for school dropout, poor peer relations, and emotion dysregulation. Although stimulant medication reduces ADHD symptoms, psychosocial and educational interventions are necessary to address functional impairments. We examined the nature and predictors of academic, behavioral, and social skills trajectories in response to multicomponent organizational and interpersonal skills training in 92 high school students with ADHD. Latent trajectory class analyses revealed positive treatment response ranging from 61.5% (report card grades) to 100% (inattention symptoms, organizational skills, social skills). Organizational skill and academic grade treatment response trajectories were predicted by assigned sex, pretreatment anxiety, and treatment dosage, while improvement in behavioral and social functioning was associated with better emotion regulation and family relations prior to treatment along with stronger working alliance with treatment coach at midtreatment. Multicomponent organizational and interpersonal skills training appears effective for most high school students with ADHD and the degree treatment-induced change is associated with multiple malleable factors can be leveraged to enhance intervention response.

Acute mental health treatment (e.g., partial hospitalization or PHP) is a critical component of the mental health services landscape for youth whose symptoms are too acute for a typical outpatient setting, but for whom inpatient psychiatric hospitalization is not recommended or desired. Very few interventions have been developed, adapted for, or evaluated in these fundamentally different delivery contexts. Transdiagnostic treatments may be ideal for addressing the comorbidity, complexity, and heterogeneity typical of acute mental health settings. Our aim was to examine initial acceptability and effectiveness of an adaptation of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May, Kennedy, et al., 2017), delivered as part of comprehensive therapeutic programming in a general psychiatric PHP. We recruited 152 youths (M age = 13.1 years, 62.5% female) and caregivers, who participated in an average of 11 days of intensive UP-C/A intervention. Participants rated symptoms and functioning at baseline, weekly, posttreatment, and 1-month follow-up. Latent growth curve modeling was used to examine patterns of change and evaluate the impact of potential demographic and treatment-related covariates. For all outcomes, a quadratic model best fit the data, with symptoms and emotional reactivity decreasing significantly during treatment and then leveling off during follow-up. There was a medium-sized change in functional impairment from baseline to the 1-month follow-up, and ≥90% of participants reported treatment as acceptable and helpful. Results provide initial support for use of a transdiagnostic, cognitive-behavioral intervention in acute mental health settings and suggest important future directions, including controlled trials and investigation of implementation supports.