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Journal of Consulting and Clinical Psychology - Vol 85, Iss 12

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Journal of Consulting & Clinical Psychology The Journal of Consulting and Clinical Psychology publishes original contributions on the following topics: (a) the development, validity, and use of techniques of diagnosis, treatment, and prevention of disordered behavior; (b) studies of populations of clinical interest, such as hospital patients, individuals who have experienced physical or psychological stressors, adolescents, children, and similar samples; (c) cross-cultural and demographic studies of interest for behavior disorders; (d) studies of personality where these have a clear bearing on problems of clinical dysfunction; (e) studies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, treatment, and prevention.
Copyright 2017 American Psychological Association
  • Introduction to the special section on sexual and gender minority health.
    The field of sexual and gender minority health has advanced exponentially in the past decade. The Journal of Consulting and Clinical Psychology (JCCP) has made important strides in publishing work on sexual and gender minority health. Although the following set of articles was not originally planned as a special section, most of the articles address, in some way, sexual and gender minority specific stressors such as perceived or overt stigma and/or the higher risk for emotional and substance use problems facing this population. Together, the papers in this section are models of some of the best work being conducted on sexual and gender minority health. Not only do they address significant problems, they do so in large, nonoverlapping samples, using novel and strong methodologies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Sexual orientation differences in functional limitations, disability, and mental health services use: Results from the 2013–2014 National Health Interview Survey.
    Objectives: The authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013–2014 National Health Interview Survey. Method: Respondents were 68,816 adults (67,152 heterosexual and 1,664 lesbian, gay, and bisexual [LGB] individuals), age 18 and older. Fully structured interviews assessed sexual orientation identity, health status, and services use. Using sex-stratified analyses while adjusting for demographic confounding, the authors compared LGB and heterosexual individuals for evidence of mental health-related impairments and use of mental health services. Results: LGB adults, as compared to heterosexual adults, demonstrated higher prevalence of mental health morbidity and functional limitations. However, this varied by gender with LGB women evidencing elevated risk for both mental health and substance abuse (MHSA) and non-MHSA limitations. Among men, sexual orientation differences clustered among MHSA-related limitations. Overall, LGB adults were more likely than heterosexual adults to use services, with the source of functional limitations moderating these effects among men. Conclusion: MHSA-related morbidity is a significant concern among LGB individuals and is associated with higher levels of functional limitations/disability. The findings highlight that LGB persons use MHSA-related treatment at higher rates than heterosexuals do, and, among men, are more likely to do so absent MHSA or non-MHSA-related functional limitations. This presents a unique set of concerns within the integrated care setting, including the need to deliver culturally competent care sensitive to the context of probable sex differences among LGB individuals. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • HIV risk and multiple sources of heterosexism among young Black men who have sex with men.
    Objective: This study examined whether the association between social support and condom self-efficacy would be moderated by (a) internalized heterosexism among and (b) enacted heterosexism experienced by young Black men who have sex with men (YBMSM), who contend with high HIV incidence, heterosexism, and low uptake of preexposure prophylaxis. Method: Participants were 1,210 YBMSM (ages 18–29) who completed measures of social support, internalized and enacted heterosexism, and condom self-efficacy in 2 large cities in the southern United States as part of a community-level HIV-prevention study. Results: A significant 3-way interaction between social support and both hypothesized moderators, internalized and enacted heterosexism, showed that social support was positively associated with condom self-efficacy when both internalized and enacted heterosexism were high (1 SD above the mean; b = .177, 95% confidence interval [CI: .088, .266]). However, social support was not associated with condom self-efficacy when scores were low (1 SD below the mean) on both internalized and enacted heterosexism (b = .024, 95% CI [−.054, .101]), low on internalized and high on enacted heterosexism (b = .058, 95% CI [−.061, .117]), or high on internalized and low on enacted heterosexism (b = .039, 95% CI [−.083, .161]). Conclusions: YBMSM who are high in both internalized and enacted heterosexism may see greater benefits from social support on condom self-efficacy than would YBMSM who grapple with less heterosexism. In addition to promoting social support, interventions should aim to assess and reduce multiple forms of stigma. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Ecological momentary assessment of daily discrimination experiences and nicotine, alcohol, and drug use among sexual and gender minority individuals.
    Objective: Sexual and gender minority (SGM) individuals experience elevated rates of minority stress, which has been linked to higher rates of nicotine and substance use. Research on this disparity to date is largely predicated on methodology that is insensitive to within day SGM-based discrimination experiences, or their relation to momentary nicotine and substance use risk. We address this knowledge gap in the current study using ecological momentary assessment (EMA). Method: Fifty SGM individuals, between 18 and 45 years of age, were recruited from an inland northwestern university, regardless of their nicotine or substance use history, and invited to participate in an EMA study. Each were prompted to provide data, six times daily (between 10:00 a.m. and 10:00 p.m.) for 14 days, regarding SGM-based discrimination, other forms of mistreatment, and nicotine, drug, and alcohol use since their last prompt. Results: Discrimination experiences that occurred since individuals’ last measurement prompt were associated with greater odds of nicotine and substance use during the same measurement window. Substance use was also more likely to occur in relation to discrimination reported two measurements prior in lagged models. Relative to other forms of mistreatment, discrimination effects were consistently larger in magnitude and became stronger throughout the day/evening. Conclusion: This study adds to existing minority stress research by highlighting the both immediate and delayed correlates of daily SGM-based discrimination experiences. These results also contribute to our understanding of daily stress processes and provide insight into ways we might mitigate these effects using real-time monitoring and intervention technology. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • A weekly diary study of minority stress, coping, and internalizing symptoms among gay men.
    Objective: Research has demonstrated that gay men are at increased risk for internalizing disorders compared with heterosexual men and that minority stressors are risk factors. However, the mechanisms underlying the associations between minority stressors and internalizing symptoms remain unclear. The current study examined coping strategies (active and disengaged coping) as mediators of the associations between minority stressors (internalized homonegativity [IH] and rejection sensitivity [RS]) and internalizing symptoms. Method: A sample of 147 gay men completed a baseline questionnaire and weekly questionnaires for seven consecutive weeks. Results: At the between-person level, higher IH and RS were associated with higher disengaged coping, but not active coping. In turn, higher disengaged coping was associated with higher internalizing symptoms. Disengaged coping mediated the between-person association between IH and internalizing symptoms. At the within-person level, higher IH and RS were associated with higher disengaged coping, which, in turn, was associated with higher internalizing symptoms. Higher RS was also associated with higher active coping. Disengaged coping mediated the within-person associations between both minority stressors and internalizing symptoms. Of note, some associations with IH became nonsignificant controlling for RS, suggesting that the latter has a stronger influence on coping and internalizing symptoms. Conclusions: Findings demonstrate that gay men’s negative thoughts and feelings about their sexual orientation and anxious expectations of rejection vary from week to week and this weekly fluctuation has an impact on mental health. Further, findings implicate disengaged coping as a mechanism through which minority stressors influence internalizing symptoms. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • “Memory support strategies and bundles: A pathway to improving cognitive therapy for depression?”: Correction to Dong, Lee, and Harvey (2017).
    Reports an error in "Memory support strategies and bundles: A pathway to improving cognitive therapy for depression" by Lu Dong, Jason Y. Lee and Allison G. Harvey (Journal of Consulting and Clinical Psychology, 2017[Mar], Vol 85[3], 187-199). In the article, there was an error in Table 2 of the Results. In Table 2, the MS summary scores of the Total amount of MS are missing six descriptive statistics. They should have read as: 13.50, 8.54, 23, 18.32, 8.83, 23. The corrected table is included. (The following abstract of the original article appeared in record 2017-07144-001.) Objective: Therapist use of memory support (MS) alongside treatment-as-usual, with the goal of enhancing patient recall of treatment contents, has been of recent interest as a novel pathway to improve treatment outcome. The memory support intervention (MSI) involves treatment providers’ using 8 specific MS strategies to promote patient memory for treatment. The present study examines to what extent therapist use of MS strategies and bundles improves patient recall of treatment contents and treatment outcome. Method: The data were drawn from a pilot RCT reported elsewhere. Participants were 48 adults (mean age = 44.27 years, 29 females) with major depressive disorder (MDD), randomized to receive 14 sessions of either CT + Memory Support (n = 25) or CT-as-usual (n = 23). Therapist use of MS was coded using the Memory Support Rating Scale. Patient memory and treatment outcomes were assessed at baseline, midtreatment (patient recall only), posttreatment, and 6-month follow-up. Results: Participants in CT + Memory Support received significantly higher amount of MS relative to CT-as-usual. Although not reaching statistical significance, small-to-medium effects were observed between MS strategies and patient recall in the expected direction. Although MS variables were not significantly associated with changes in continuous depressive symptoms, MS was associated with better global functioning. MS also exhibited small to medium effects on treatment response and recurrence in the expected direction but not on remission, though these effects did not reach statistical significance. Conclusions: These results provide initial empirical evidence supporting an active method for therapists to implement MS strategies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories.
    Objective: High rates of depression and posttraumatic stress disorder (PTSD) contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a network approach to (a) characterize symptom interconnections between depression and PTSD in MSM, (b) identify specific symptoms related to sexual risk behavior, and (c) compare symptom networks across groups at different levels of risk. Method: Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multisite randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. Results: Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient and protective for lower-risk individuals. Conclusions: This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Comparing treatment response between LGBQ and heterosexual individuals attending a CBT- and DBT-skills-based partial hospital.
    Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Unique effects of setting goals on behavior change: Systematic review and meta-analysis.
    Objective: Goal setting is a common feature of behavior change interventions, but it is unclear when goal setting is optimally effective. The aims of this systematic review and meta-analysis were to evaluate: (a) the unique effects of goal setting on behavior change, and (b) under what circumstances and for whom goal setting works best. Method: Four databases were searched for articles that assessed the unique effects of goal setting on behavior change using randomized controlled trials. One-hundred and 41 papers were identified from which 384 effect sizes (N = 16,523) were extracted and analyzed. A moderator analysis of sample characteristics, intervention characteristics, inclusion of other behavior change techniques, study design and delivery, quality of study, outcome measures, and behavior targeted was conducted. Results: A random effects model indicated a small positive unique effect of goal setting across a range of behaviors, d = .34 (CI [.28, .41]). Moderator analyses indicated that goal setting was particularly effective if the goal was: (a) difficult, (b) set publicly, and (c) was a group goal. There was weaker evidence that goal setting was more effective when paired with external monitoring of the behavior/outcome by others without feedback and delivered face-to-face. Conclusions: Goal setting is an effective behavior change technique that has the potential to be considered a fundamental component of successful interventions. The present review adds novel insights into the means by which goal setting might be augmented to maximize behavior change and sets the agenda for future programs of research. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Processes of change after a sudden gain and relation to treatment outcome—Evidence for an upward spiral.
    Objective: Sudden gains are sudden symptom improvements from 1 psychotherapy session to the next. This study investigates the processes that may facilitate treatment outcome after a sudden gain occurred. Method: A sample of 211 depressed patients who underwent cognitive–behavioral therapy was analyzed. Sudden gains were identified using a session-by-session self-report symptom measure. Patient ratings of general change factors (therapeutic alliance; coping skills) in the sessions before and after a sudden gain were investigated as predictors of outcome. Propensity score matching was used to compare sudden gain patients with similar patients who did not experience a sudden gain. Results: Therapeutic alliance and coping skills increased in the postgain sessions. There were no comparable processes of change among patients without sudden gains. The therapeutic alliance was found to moderate the association between sudden gains and treatment outcome. Conclusion: Results suggest that sudden gains trigger change factors that facilitate the association between gains and treatment outcome. Patient-therapist dyads should work with sudden gains to consolidate symptom relief. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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