Pub Date : 2025-01-01DOI: 10.1016/j.beth.2024.10.006
Stefan G. Hofmann
Contemporary latent disease models of psychopathology have shown limited clinical utility and the efficacy of conventional treatments have been disappointing. An alternative approach offers the network approach and a dynamic systems perspective to psychopathology and treatment change. To understand and modify dynamic systems, engineering and mathematics have been relying on principles of network control theory. This article will discuss the application of network control theory of dynamic systems approach to personalize therapy. Network control theory can be used as a guide for personalizing treatment by choosing the most promising intervention strategy targeting the change processes based on the network structure. A composit case illustration will demonstrate the principles and application of network control theory to therapy in practice within the framework of process-based therapy. In conclusion, a network control theory of dynamic systems approach is highly relevant and applicable to clinical science.
{"title":"A Network Control Theory of Dynamic Systems Approach to Personalize Therapy","authors":"Stefan G. Hofmann","doi":"10.1016/j.beth.2024.10.006","DOIUrl":"10.1016/j.beth.2024.10.006","url":null,"abstract":"<div><div>Contemporary latent disease models of psychopathology have shown limited clinical utility and the efficacy of conventional treatments have been disappointing. An alternative approach offers the network approach and a dynamic systems perspective to psychopathology and treatment change. To understand and modify dynamic systems, engineering and mathematics have been relying on principles of network control theory. This article will discuss the application of network control theory of dynamic systems approach to personalize therapy. Network control theory can be used as a guide for personalizing treatment by choosing the most promising intervention strategy targeting the change processes based on the network structure. A composit case illustration will demonstrate the principles and application of network control theory to therapy in practice within the framework of process-based therapy. In conclusion, a network control theory of dynamic systems approach is highly relevant and applicable to clinical science.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 1","pages":"Pages 199-212"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.beth.2024.06.006
Caitlin M. Pinciotti, Brian A. Feinstein, Monnica T. Williams
Sexual minority (SM) individuals appear to be at greater risk for obsessive-compulsive disorder (OCD). Despite this, little is known about OCD presentation and treatment outcomes among SM individuals. Although some research has suggested that SM individuals may be more likely to endorse intrusive thoughts related to violence/sex/religion compared to heterosexual individuals, extant literature has neglected to examine potential differences across different SM groups, a notable limitation given the apparent differences in the types of minority stress that each group experiences and the unique health disparities affecting each group. The current study sought to address these gaps by examining potential differences in OCD symptom severity, presentation, and treatment outcomes using analysis of variance and profile analysis in a clinical sample of 1,502 cisgender patients diagnosed with OCD enrolled in intensive OCD treatment (87.5% heterosexual, 6.6% bisexual, 4.7% lesbian or gay, and 1.1% questioning). Replicating previous research, neither OCD severity nor treatment outcomes differed by sexual orientation, and findings extended previous research that no differences across SM groups were observed, either. However, contrary to previous research, there was also no evidence for unique profiles of OCD symptoms across sexual orientation groups, and questioning individuals reported significantly less severe symmetry symptoms compared to heterosexual and bisexual individuals. Findings are encouraging in that they suggest that cisgender bisexual, lesbian or gay, and questioning individuals with OCD can still benefit significantly and to the same degree as their cisgender heterosexual peers in intensive OCD treatment. Potential explanations for conflicting findings regarding symptom profiles are discussed.
{"title":"Symptom Profiles and Intensive Treatment Outcomes in Sexual Minority and Heterosexual Patients With OCD","authors":"Caitlin M. Pinciotti, Brian A. Feinstein, Monnica T. Williams","doi":"10.1016/j.beth.2024.06.006","DOIUrl":"10.1016/j.beth.2024.06.006","url":null,"abstract":"<div><div>Sexual minority (SM) individuals appear to be at greater risk for obsessive-compulsive disorder (OCD). Despite this, little is known about OCD presentation and treatment outcomes among SM individuals. Although some research has suggested that SM individuals may be more likely to endorse intrusive thoughts related to violence/sex/religion compared to heterosexual individuals, extant literature has neglected to examine potential differences across different SM groups, a notable limitation given the apparent differences in the types of minority stress that each group experiences and the unique health disparities affecting each group. The current study sought to address these gaps by examining potential differences in OCD symptom severity, presentation, and treatment outcomes using analysis of variance and profile analysis in a clinical sample of 1,502 cisgender patients diagnosed with OCD enrolled in intensive OCD treatment (87.5% heterosexual, 6.6% bisexual, 4.7% lesbian or gay, and 1.1% questioning). Replicating previous research, neither OCD severity nor treatment outcomes differed by sexual orientation, and findings extended previous research that no differences across SM groups were observed, either. However, contrary to previous research, there was also no evidence for unique profiles of OCD symptoms across sexual orientation groups, and questioning individuals reported significantly less severe symmetry symptoms compared to heterosexual and bisexual individuals. Findings are encouraging in that they suggest that cisgender bisexual, lesbian or gay, and questioning individuals with OCD can still benefit significantly and to the same degree as their cisgender heterosexual peers in intensive OCD treatment. Potential explanations for conflicting findings regarding symptom profiles are discussed.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 1","pages":"Pages 16-31"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203260","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 : 2025-01-01DOI: 10.1016/j.beth.2023.12.006
Donald A. Godfrey, Allison Heinrich, Elizabeth McIngvale, Jennifer Sy, Michael G. Wheaton, Thröstur Björgvinsson
Exposure and Response Prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD), yet the specific underlying mechanisms by which ERP improves symptoms remain unclear. Initial theories suggested that habituation to triggering events and stimuli was the key therapeutic factor in ERP, while other theories highlight the role of developing the ability to tolerate distress, rather than reduction of distress. The current study examined improvements in distress tolerance as a mechanism of OCD, anxiety, and depressive symptom reductions during an ERP-based intensive program. Participants (N = 180) completed weekly measures of distress intolerance, and symptom severity of OCD, anxiety, and depression. Using Multi-Level Structural Equation Modeling, we found that participants experienced significant weekly decreases in OCD, anxiety, and depressive symptom severity across the course of their ERP-based treatment. Weekly reductions in OCD symptom severity were partially accounted for by weekly improvements in participants’ ability to tolerate distress, particularly for obsession symptoms. This effect was also significant for anxiety and depressive symptom severity, above and beyond the effects of weekly reductions in OCD symptom severity. The current study suggests improving the ability to tolerate distress represents a transdiagnostic mechanism of symptom severity reduction in OCD, anxiety, and depressive psychopathology via intensive ERP-based psychotherapy programming. Limitations and future directions for improving treatments for OCD, anxiety, and depressive symptoms are discussed.
{"title":"Improvement in Distress Tolerance as a Mechanism of Symptom Reduction During Intensive Exposure and Response Prevention–Based Treatment for OCD","authors":"Donald A. Godfrey, Allison Heinrich, Elizabeth McIngvale, Jennifer Sy, Michael G. Wheaton, Thröstur Björgvinsson","doi":"10.1016/j.beth.2023.12.006","DOIUrl":"10.1016/j.beth.2023.12.006","url":null,"abstract":"<div><div>Exposure and Response Prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD), yet the specific underlying mechanisms by which ERP improves symptoms remain unclear. Initial theories suggested that habituation to triggering events and stimuli was the key therapeutic factor in ERP, while other theories highlight the role of developing the ability to tolerate distress, rather than reduction of distress. The current study examined improvements in distress tolerance as a mechanism of OCD, anxiety, and depressive symptom reductions during an ERP-based intensive program. Participants (<em>N</em> = 180) completed weekly measures of distress intolerance, and symptom severity of OCD, anxiety, and depression. Using Multi-Level Structural Equation Modeling, we found that participants experienced significant weekly decreases in OCD, anxiety, and depressive symptom severity across the course of their ERP-based treatment. Weekly reductions in OCD symptom severity were partially accounted for by weekly improvements in participants’ ability to tolerate distress, particularly for obsession symptoms. This effect was also significant for anxiety and depressive symptom severity, above and beyond the effects of weekly reductions in OCD symptom severity. The current study suggests improving the ability to tolerate distress represents a transdiagnostic mechanism of symptom severity reduction in OCD, anxiety, and depressive psychopathology via intensive ERP-based psychotherapy programming. Limitations and future directions for improving treatments for OCD, anxiety, and depressive symptoms are discussed.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 1","pages":"Pages 43-56"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139084391","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 : 2025-01-01DOI: 10.1016/j.beth.2024.07.006
Michael F. Sandella, Gavin N. Rackoff, Michelle G. Newman
Among juveniles in the justice system, depression and perceived opportunity have implications for long-term adjustment. The prospective associations between these two constructs have not yet been examined in this population. We studied the longitudinal association between depression and perceived opportunity in a sample of recently adjudicated juvenile offenders. Juvenile offenders (n = 1,354) completed measures of depression and perceived opportunity shortly after adjudication and then every 6 months thereafter for 3 years (7 time points total). Relative to White juvenile offenders, lower average levels of perceived opportunity were observed among Black, Hispanic, and juveniles of other races/ethnicities. A random-intercept cross-lagged panel model revealed that greater depression was associated with lower subsequent perceived opportunity (d = -0.22, p < .001). Higher perceived opportunity did not predict subsequent depression (d = -0.07, p = .208). The nonexperimental design prevented inferences about causal links between depression and perceived opportunity. Results should also be replicated in a recently collected dataset. Findings suggested a scar-like effect, such that depression was unidirectionally and negatively associated with lower future perceived opportunity among juveniles. Future research should investigate if treatment for depression improves juvenile offenders’ perceived opportunity.
{"title":"Prospective Relationships Among Depression and Perceived Opportunity in Juvenile Offenders","authors":"Michael F. Sandella, Gavin N. Rackoff, Michelle G. Newman","doi":"10.1016/j.beth.2024.07.006","DOIUrl":"10.1016/j.beth.2024.07.006","url":null,"abstract":"<div><div>Among juveniles in the justice system, depression and perceived opportunity have implications for long-term adjustment. The prospective associations between these two constructs have not yet been examined in this population. We studied the longitudinal association between depression and perceived opportunity in a sample of recently adjudicated juvenile offenders. Juvenile offenders (<em>n</em> = 1,354) completed measures of depression and perceived opportunity shortly after adjudication and then every 6 months thereafter for 3 years (7 time points total). Relative to White juvenile offenders, lower average levels of perceived opportunity were observed among Black, Hispanic, and juveniles of other races/ethnicities. A random-intercept cross-lagged panel model revealed that greater depression was associated with lower subsequent perceived opportunity (<em>d</em> = -0.22, <em>p</em> < .001). Higher perceived opportunity did not predict subsequent depression (<em>d</em> = -0.07, <em>p</em> = .208). The nonexperimental design prevented inferences about causal links between depression and perceived opportunity. Results should also be replicated in a recently collected dataset. Findings suggested a scar-like effect, such that depression was unidirectionally and negatively associated with lower future perceived opportunity among juveniles. Future research should investigate if treatment for depression improves juvenile offenders’ perceived opportunity.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 1","pages":"Pages 177-191"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851959","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 : 2025-01-01DOI: 10.1016/j.beth.2024.06.005
Bunmi O. Olatunji, Qimin Liu, Kelly A. Knowles, Sarah C. Jessup
Although behavioral avoidance is observed among those with heightened contamination concerns, the extent to which such avoidance is best predicted by state and/or trait characteristics is unclear. Furthermore, while disgust proneness is a disease-specific trait that has been shown to predict avoidance among those with symptoms of contamination-based obsessive-compulsive disorder (OCD), it is unclear if other disease-specific traits may also serve a similar function. In the present study, contamination-fearful participants (N = 89) first completed self-report measures of disease-specific (disgust proneness, health anxiety, perceived vulnerability to disease) and disease-nonspecific (intolerance of uncertainty, trait anxiety) traits. They then completed a 16-step behavioral approach task (BAT) with increasing likelihood of contagion in a public restroom and provided ratings of state disgust and state anxiety at each step. Bayesian hierarchical logistic regression showed that state disgust, but not state anxiety, at a given step was associated with avoidance on the next step. Furthermore, disgust proneness was the only trait associated with avoidance on the BAT. A significant interaction between disgust proneness and BAT step completed in the public restroom was also found. Examination of this interaction suggests that intermediary, but not initial and latter, steps of the BAT differentiate those high and low in disgust proneness. These findings suggest that state and trait disgust uniquely drive behavioral avoidance among those with contamination concerns commonly observed in OCD.
{"title":"State and Trait Disgust Uniquely Predict Avoidance in Contamination Fear: Specificity of Disease-Specific and Nonspecific Individual Differences","authors":"Bunmi O. Olatunji, Qimin Liu, Kelly A. Knowles, Sarah C. Jessup","doi":"10.1016/j.beth.2024.06.005","DOIUrl":"10.1016/j.beth.2024.06.005","url":null,"abstract":"<div><div>Although behavioral avoidance is observed among those with heightened contamination concerns, the extent to which such avoidance is best predicted by state and/or trait characteristics is unclear. Furthermore, while disgust proneness is a disease-specific trait that has been shown to predict avoidance among those with symptoms of contamination-based obsessive-compulsive disorder (OCD), it is unclear if other disease-specific traits may also serve a similar function. In the present study, contamination-fearful participants (<em>N</em> = 89) first completed self-report measures of disease-specific (disgust proneness, health anxiety, perceived vulnerability to disease) and disease-nonspecific (intolerance of uncertainty, trait anxiety) traits. They then completed a 16-step behavioral approach task (BAT) with increasing likelihood of contagion in a public restroom and provided ratings of state disgust and state anxiety at each step. Bayesian hierarchical logistic regression showed that state disgust, but not state anxiety, at a given step was associated with avoidance on the next step. Furthermore, disgust proneness was the only trait associated with avoidance on the BAT. A significant interaction between disgust proneness and BAT step completed in the public restroom was also found. Examination of this interaction suggests that intermediary, but not initial and latter, steps of the BAT differentiate those high and low in disgust proneness. These findings suggest that state and trait disgust uniquely drive behavioral avoidance among those with contamination concerns commonly observed in OCD.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 1","pages":"Pages 32-42"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141944389","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 : 2024-12-12DOI: 10.1016/j.beth.2024.12.002
Marta Tironi, Abby Rozenberg, Morgan McLoughlin, Jane Shkel, Breana R. Cervantes, Andres De Los Reyes, Carla Sharp, Jessica L. Borelli
Adolescent depression significantly impacts long-term functioning and well-being, often going undetected and untreated, highlighting the need for innovative detection methods. This study examined whether unfamiliar, naïve observers could detect depressive symptoms in adolescents, relying solely on behavioral residue (language transcribed from a clinical interview). Identifying whether naïve observers, untrained in detecting psychological symptoms, can utilize verbal output to accurately detect depressive symptoms yields scientific insight that could be expanded upon to support prevention efforts. The study involved 200 adolescent participants (100 hospitalized, 100 community; Mage = 15.31, henceforth referred to as targets). They reported on their depressive symptoms and completed the Child Attachment Interview (CAI; Shmueli-Goetz et al., 2008). Naïve observers (N = 52 college students split in two rounds), unaware of all other information about targets, read transcripts of targets’ CAI interviews; using solely that information, they rated targets’ depressive symptoms. Observers also assessed their confidence in their evaluation of targets’ symptoms. Results showed a positive association between observers’ ratings and targets’ self-reported depressive symptoms (Round 1 Cohen’s d = 1.25, Round 2 Cohen’s d = 1.42) and this association remained significant controlling for linguistic categories connected to depression detected by computer analysis. Observers’ ratings discriminated between hospitalized and community adolescents (Round 1 Cohen’s d = 1.43, Round 2 Cohen’s d = 1.37), though confidence in their ratings was not associated with targets’ ratings or group (community or hospitalized). Observers can reliably and accurately identify depressive symptoms in adolescents using attachment interviews, over and above computer analysis alone. This work suggests that naïve observers contribute unique insight into the detection of adolescent depressive symptoms.
{"title":"Naïve Observers’ Perceptions of Hospitalized and Community Adolescents’ Depressive Symptoms","authors":"Marta Tironi, Abby Rozenberg, Morgan McLoughlin, Jane Shkel, Breana R. Cervantes, Andres De Los Reyes, Carla Sharp, Jessica L. Borelli","doi":"10.1016/j.beth.2024.12.002","DOIUrl":"10.1016/j.beth.2024.12.002","url":null,"abstract":"<div><div>Adolescent depression significantly impacts long-term functioning and well-being, often going undetected and untreated, highlighting the need for innovative detection methods. This study examined whether unfamiliar, naïve observers could detect depressive symptoms in adolescents, relying solely on behavioral residue (language transcribed from a clinical interview). Identifying whether naïve observers, untrained in detecting psychological symptoms, can utilize verbal output to accurately detect depressive symptoms yields scientific insight that could be expanded upon to support prevention efforts. The study involved 200 adolescent participants (100 hospitalized, 100 community; M<sub>age</sub> = 15.31, henceforth referred to as targets). They reported on their depressive symptoms and completed the Child Attachment Interview (CAI; Shmueli-Goetz et al., 2008). Naïve observers (N = 52 college students split in two rounds), unaware of all other information about targets, read transcripts of targets’ CAI interviews; using solely that information, they rated targets’ depressive symptoms. Observers also assessed their confidence in their evaluation of targets’ symptoms. Results showed a positive association between observers’ ratings and targets’ self-reported depressive symptoms (Round 1 Cohen’s d = 1.25, Round 2 Cohen’s d = 1.42) and this association remained significant controlling for linguistic categories connected to depression detected by computer analysis. Observers’ ratings discriminated between hospitalized and community adolescents (Round 1 Cohen’s d = 1.43, Round 2 Cohen’s d = 1.37), though confidence in their ratings was not associated with targets’ ratings or group (community or hospitalized). Observers can reliably and accurately identify depressive symptoms in adolescents using attachment interviews, over and above computer analysis alone. This work suggests that naïve observers contribute unique insight into the detection of adolescent depressive symptoms.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 768-784"},"PeriodicalIF":3.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312828","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 : 2024-12-12DOI: 10.1016/j.beth.2024.12.003
Shannon Wiltsey Stirman, Nicole B. Gumport, Amber Calloway, Cassidy Gunter, Luana Marques, Samantha Hernandez, Jiyoung Song, Clara Johnson, Soo Jeong Youn, Sohayla Elhusseini, Regine M. Deguzman-Lucero, Taylor Loskot, Heidi La Bash, Yesenia Aguilar Silvan, Caroline Canale, Alayna L. Park, Jansey Lagdamen, Anna D. Bartuska, Booil Jo, Paul Barnett, Torrey A. Creed
Fidelity monitoring is crucial for successful implementation of evidence-based practices, but traditional methods such as observation and video recording are impractical for routine mental health care due to their high resource demands. A reliable, low-burden fidelity (adherence and competence) assessment can support the implementation of cognitive behavioral therapies (CBTs). This study evaluated two pragmatic alternatives to the time and cost-intensive “gold standard” observer ratings based on session recordings to assess fidelity in Cognitive Processing Therapy (CPT). We assessed the feasibility of clinician-completed adherence checklists and ratings of worksheets that were completed during sessions in public and private mental healthcare settings by a diverse sample of patients with significant trauma histories and their therapists. We also examined whether fidelity ratings using these approaches were associated with observer ratings of fidelity and with subsequent PTSD symptom change. Results indicated high overall rater agreement for adherence and competence on CPT worksheets and session recordings. We found significant associations among traditional observer ratings of adherence and our two low-burden alternatives for assessing adherence. Clinician-completed adherence checklists were also associated with subsequent symptom change. Checklists and worksheets required substantially less time to rate than session recordings. Overall, checklists and worksheets emerged as reliable and feasible methods for fidelity assessment, potentially diminishing the necessity for time- and labor-intensive fidelity ratings based on session recordings. Our findings suggest a scalable approach for integrating fidelity monitoring and support into policies aimed at enhancing the accessibility and effectiveness of evidence-based care.
{"title":"A Comparison of Pragmatic and Scalable Strategies to Assess Fidelity to Cognitive Processing Therapy in Routine Care Settings","authors":"Shannon Wiltsey Stirman, Nicole B. Gumport, Amber Calloway, Cassidy Gunter, Luana Marques, Samantha Hernandez, Jiyoung Song, Clara Johnson, Soo Jeong Youn, Sohayla Elhusseini, Regine M. Deguzman-Lucero, Taylor Loskot, Heidi La Bash, Yesenia Aguilar Silvan, Caroline Canale, Alayna L. Park, Jansey Lagdamen, Anna D. Bartuska, Booil Jo, Paul Barnett, Torrey A. Creed","doi":"10.1016/j.beth.2024.12.003","DOIUrl":"10.1016/j.beth.2024.12.003","url":null,"abstract":"<div><div>Fidelity monitoring is crucial for successful implementation of evidence-based practices, but traditional methods such as observation and video recording are impractical for routine mental health care due to their high resource demands. A reliable, low-burden fidelity (adherence and competence) assessment can support the implementation of cognitive behavioral therapies (CBTs). This study evaluated two pragmatic alternatives to the time and cost-intensive “gold standard” observer ratings based on session recordings to assess fidelity in Cognitive Processing Therapy (CPT). We assessed the feasibility of clinician-completed adherence checklists and ratings of worksheets that were completed during sessions in public and private mental healthcare settings by a diverse sample of patients with significant trauma histories and their therapists. We also examined whether fidelity ratings using these approaches were associated with observer ratings of fidelity and with subsequent PTSD symptom change. Results indicated high overall rater agreement for adherence and competence on CPT worksheets and session recordings. We found significant associations among traditional observer ratings of adherence and our two low-burden alternatives for assessing adherence. Clinician-completed adherence checklists were also associated with subsequent symptom change. Checklists and worksheets required substantially less time to rate than session recordings. Overall, checklists and worksheets emerged as reliable and feasible methods for fidelity assessment, potentially diminishing the necessity for time- and labor-intensive fidelity ratings based on session recordings. Our findings suggest a scalable approach for integrating fidelity monitoring and support into policies aimed at enhancing the accessibility and effectiveness of evidence-based care.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 3","pages":"Pages 453-469"},"PeriodicalIF":3.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869071","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 : 2024-12-09DOI: 10.1016/j.beth.2024.12.001
Caitlin M. Pinciotti, Blake M. Upshaw, Samuel D. Spencer, Jennifer M. Park, Martin E. Franklin, Lauren P. Wadsworth, Bradley C. Riemann, Wayne K. Goodman, Eric A. Storch
Justice-based exposure and response prevention (ERP) has been touted as an alternative approach to (mis)uses and “Fear Factor” overcorrection applications of ERP for obsessive-compulsive disorder (OCD) with identity-related themes (i.e., sexual orientation, gender identity, racism, age, disability/diagnostic status, and economic-themed). Justice-based exposure maintains fidelity to the theoretical and evidence-based mechanisms of ERP while avoiding inadvertent stigmatization of marginalized communities. Justice-based ERP also avoids contributing to societal stigma while potentially increasing buy-in among patients. Despite its widespread support across the OCD field, empirical evidence regarding preferences for justice-based ERP is currently lacking. The present study sought to compare perspectives on justice-based and overcorrection ERP approaches to identity-related OCD themes among 450 individuals with current or past identity-related obsessions (85.6% female, M age = 32.0). Participants reviewed idiographic, symptom-specific justice-based and overcorrection ERP hierarchies for each endorsed symptom theme and were asked a series of questions regarding their perspectives on each hierarchy. Participants reported a considerable preference for justice-based exposures over overcorrection exposures for these themes. Specifically, while overcorrection exposures were associated with higher anxiety expectancy, participants were much more likely to report a willingness to engage in justice-based exposures, perceived them to be more relevant and effective, and found them to be less derogatory and offensive than overcorrection exposures. Findings support the notion that (mis)uses and overcorrection exposures for identity-related OCD themes represent a “Fear Factor” approach that prioritizes anxiety increase at the expense of functionality, and that a justice-based approach may be better aligned with participants’ values and treatment expectancies.
{"title":"Preferences for Justice-Based Exposure and Response Prevention Among Individuals With Identity-Related Obsessive-Compulsive Disorder","authors":"Caitlin M. Pinciotti, Blake M. Upshaw, Samuel D. Spencer, Jennifer M. Park, Martin E. Franklin, Lauren P. Wadsworth, Bradley C. Riemann, Wayne K. Goodman, Eric A. Storch","doi":"10.1016/j.beth.2024.12.001","DOIUrl":"10.1016/j.beth.2024.12.001","url":null,"abstract":"<div><div>Justice-based exposure and response prevention (ERP) has been touted as an alternative approach to (mis)uses and “Fear Factor” overcorrection applications of ERP for obsessive-compulsive disorder (OCD) with identity-related themes (i.e., sexual orientation, gender identity, racism, age, disability/diagnostic status, and economic-themed). Justice-based exposure maintains fidelity to the theoretical and evidence-based mechanisms of ERP while avoiding inadvertent stigmatization of marginalized communities. Justice-based ERP also avoids contributing to societal stigma while potentially increasing buy-in among patients. Despite its widespread support across the OCD field, empirical evidence regarding preferences for justice-based ERP is currently lacking. The present study sought to compare perspectives on justice-based and overcorrection ERP approaches to identity-related OCD themes among 450 individuals with current or past identity-related obsessions (85.6% female, <em>M</em> age = 32.0). Participants reviewed idiographic, symptom-specific justice-based and overcorrection ERP hierarchies for each endorsed symptom theme and were asked a series of questions regarding their perspectives on each hierarchy. Participants reported a considerable preference for justice-based exposures over overcorrection exposures for these themes. Specifically, while overcorrection exposures were associated with higher anxiety expectancy, participants were much more likely to report a willingness to engage in justice-based exposures, perceived them to be more relevant and effective, and found them to be less derogatory and offensive than overcorrection exposures. Findings support the notion that (mis)uses and overcorrection exposures for identity-related OCD themes represent a “Fear Factor” approach that prioritizes anxiety increase at the expense of functionality, and that a justice-based approach may be better aligned with participants’ values and treatment expectancies.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 753-767"},"PeriodicalIF":3.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312874","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 : 2024-11-28DOI: 10.1016/j.beth.2024.11.003
Anahí Collado, Laurel Hicks, Samuel Hubley, Joseph Levy, Caitlin McKimmy, Marta Genovez, Robert Gallop, Desiree Bauer, Elena Aranda, Sona Dimidjian
Spanish-speaking Latinas in the United States encounter significant barriers when seeking culturally responsive treatment for perinatal mental health disorders, resulting in treatment disparities and elevated rates of mental health symptoms. To address these challenges, peer-delivered support may be one promising strategy. This study examined the efficacy of Alma, a peer-delivered behavioral activation (BA) program comprising 6–8 sessions. Participants (N = 126) were Spanish-speaking Latina mothers experiencing elevated depression symptoms during the perinatal and early parenthood period. Participants were recruited through three community partner sites across rural and urban settings. Participants reported high satisfaction with the program and experienced decreases in depression symptoms, anxiety symptoms, and perceived stress. Importantly, significant clinical improvements occurred early in the program, indicating a rapid relief of symptoms. This symptom reduction was associated with improvements in putative mechanisms of BA, including activity level and environmental reward. Limitations of this study include participant attrition and the absence of a control group. Together, the findings indicate that Alma is a promising program to address depressed mood, anxiety, and stress among Spanish-speaking Latina mothers during the perinatal/early parenthood period, offering accessible and culturally responsive mental health support. Moreover, by meeting the mental health needs of Spanish-speaking Latina mothers, Alma holds promise for mitigating mental health disparities in underserved communities.
{"title":"Using Alma to Alleviate Tristeza Maternal: Preliminary Outcomes of a Peer-Led Behavioral Activation Program Among Latina Mothers","authors":"Anahí Collado, Laurel Hicks, Samuel Hubley, Joseph Levy, Caitlin McKimmy, Marta Genovez, Robert Gallop, Desiree Bauer, Elena Aranda, Sona Dimidjian","doi":"10.1016/j.beth.2024.11.003","DOIUrl":"10.1016/j.beth.2024.11.003","url":null,"abstract":"<div><div>Spanish-speaking Latinas in the United States encounter significant barriers when seeking culturally responsive treatment for perinatal mental health disorders, resulting in treatment disparities and elevated rates of mental health symptoms. To address these challenges, peer-delivered support may be one promising strategy. This study examined the efficacy of Alma, a peer-delivered behavioral activation (BA) program comprising 6–8 sessions. Participants (<em>N</em> = 126) were Spanish-speaking Latina mothers experiencing elevated depression symptoms during the perinatal and early parenthood period. Participants were recruited through three community partner sites across rural and urban settings. Participants reported high satisfaction with the program and experienced decreases in depression symptoms, anxiety symptoms, and perceived stress. Importantly, significant clinical improvements occurred early in the program, indicating a rapid relief of symptoms. This symptom reduction was associated with improvements in putative mechanisms of BA, including activity level and environmental reward. Limitations of this study include participant attrition and the absence of a control group. Together, the findings indicate that Alma is a promising program to address depressed mood, anxiety, and stress among Spanish-speaking Latina mothers during the perinatal/early parenthood period, offering accessible and culturally responsive mental health support. Moreover, by meeting the mental health needs of Spanish-speaking Latina mothers, Alma holds promise for mitigating mental health disparities in underserved communities.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 2","pages":"Pages 225-240"},"PeriodicalIF":3.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480607","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 : 2024-11-27DOI: 10.1016/j.beth.2024.11.002
Kristen M. Benito, Jennifer A. Herren, Lesley A. Norris, Kristen M. Gardiner, Molly Choate, Jennifer B. Freeman
Quality monitoring is essential for the use of evidence-based interventions (EBIs) in both practice and research settings, yet few quality measures have been developed or validated for any treatment. This study examined the initial psychometric properties of a brief, practical measure of quality for exposure therapy (Exposure Guide; EG) in a sample of youth from three randomized clinical trials for pediatric OCD (N = 103 patients and 368 sessions). The EG was initially developed based on the behavioral principles underlying exposure, delivery factors linked to clinical outcomes in prior literature, and with input from both exposure therapy researchers and partners in community mental health settings. Results indicated good to excellent inter-rater reliability (item ICCs = .64 to 1.00). When compared against a validated, time-intensive coding system, each EG item exhibited large correlations with parallel coding system variables; these were significantly larger than correlations with other variables. Variance components analysis demonstrated EG subscale variability at the level of therapists, patients, and time. The EG demonstrates strong initial reliability and construct validity in a clinical trial context; future studies will be needed to establish psychometric properties in practice settings and to elucidate therapist, patient, and treatment course factors that may influence quality.
{"title":"The Exposure Guide: A Practical Measure of Exposure Quality","authors":"Kristen M. Benito, Jennifer A. Herren, Lesley A. Norris, Kristen M. Gardiner, Molly Choate, Jennifer B. Freeman","doi":"10.1016/j.beth.2024.11.002","DOIUrl":"10.1016/j.beth.2024.11.002","url":null,"abstract":"<div><div>Quality monitoring is essential for the use of evidence-based interventions (EBIs) in both practice and research settings, yet few quality measures have been developed or validated for any treatment. This study examined the initial psychometric properties of a brief, practical measure of quality for exposure therapy (Exposure Guide; EG) in a sample of youth from three randomized clinical trials for pediatric OCD (<em>N</em> = 103 patients and 368 sessions). The EG was initially developed based on the behavioral principles underlying exposure, delivery factors linked to clinical outcomes in prior literature, and with input from both exposure therapy researchers and partners in community mental health settings. Results indicated good to excellent inter-rater reliability (item ICCs = .64 to 1.00). When compared against a validated, time-intensive coding system, each EG item exhibited large correlations with parallel coding system variables; these were significantly larger than correlations with other variables. Variance components analysis demonstrated EG subscale variability at the level of therapists, patients, and time. The EG demonstrates strong initial reliability and construct validity in a clinical trial context; future studies will be needed to establish psychometric properties in practice settings and to elucidate therapist, patient, and treatment course factors that may influence quality.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 3","pages":"Pages 594-604"},"PeriodicalIF":3.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869028","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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