Journal of Consulting & Clinical Psychology

Behavioral medicine and clinical health psychology: Introduction to the special issue.
This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior–health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Cultural adaptations of behavioral health interventions: A progress report.
Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. Method: Influential literature from the past decade was examined to identify points of consensus. Results: There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. Conclusions: Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Religiousness/spirituality, cardiovascular disease, and cancer: Cultural integration for health research and intervention.
Objective: Recently, behavioral scientists have developed greater interest in understanding the relations between religiousness and spirituality (R/S) and health. Our objectives were to (a) provide an overview of the R/S and health literature specific to cardiovascular disease (CVD) and cancer, (b) discuss the importance of religious culture considerations to behavioral medicine research, (c) suggest methodological changes to advance this research toward greater depth of understanding, and (d) begin discussion on clinically appropriate ways to integrate R/S into treatment. Method: Individual studies and meta-analyses on the relations of R/S with CVD and cancer were reviewed along with articles on the importance of culture to understanding R/S phenomena. Results: Trends in the literature suggest that R/S predicts reductions in all-cause and CVD-related but not cancer mortality. R/S also shows relations with cardiovascular morbidity, and various dimensions of R/S show relations with cancer risk factors and well-being in cancer patients. Investigators have progressively studied more specific dimensions of R/S but have largely failed to consider them within religious cultural contexts. This context is essential for a deeper understanding of R/S and health relations and has profound methodological implications for future studies. Conclusions: R/S and health research is expanding; yet, the field needs more programmatic research and greater theoretical organization. We propose that consideration of R/S variables within their religious culture will provide structure for greater integrative understanding to move the field forward. This understanding is imperative if R/S is to be appropriately integrated into culturally sensitive clinical interventions. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Translating basic behavioral and social science research to clinical application: The EVOLVE mixed methods approach.
[Correction Notice: An Erratum for this article was reported in Vol 81(2) of Journal of Consulting and Clinical Psychology (see record 2012-29655-001). In the article a citation and reference were mistakenly omitted. Under the heading “Case Study: TBSRC,” subheading “Positive affect,” the first sentence should have read: “Positive affect (PA) is a mild feeling state induced by small events, such as receiving a small, unexpected gift, seeing a few minutes of comedy, or receiving a report of success on a small task (Ashby, Valentin, & Turken, 2002).” The corresponding reference is: Ashby, F., Valentin, V., & Turken, U. (2002). The effects of positive affect and arousal on working memory and executive attention: Neurobiology and computational models. In S. Moore & M. Oaksford (Eds.), Emotional Cognition: From Brain to Behaviour (pp. 245–287). Amsterdam: John Benjamins. All versions of this article have been corrected.] Objective: To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease populations. Method: We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM) and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention and then conducted 3 randomized controlled trials with parallel study design. Participants were randomized to combined PA/SA versus an informational control and were followed bimonthly for 12 months, assessing for health behaviors and interval medical events. Results: Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The 3 randomized controlled trials enrolled 242 participants who had undergone PCI, 258 with ASM, and 256 with HTN (n = 756). Overall, 45.1% of PA/SA participants versus 33.6% of informational control participants achieved successful behavior change (p = .001). In multivariate analysis, PA/SA intervention remained a significant predictor of achieving behavior change (p <.002, odds ratio = 1.66), 95% CI [1.22, 2.27], controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking, and age. Conclusions: The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Correction to Peterson et al. (2012).
Reports an error in "Translating Basic Behavioral and Social Science Research to Clinical Application: The EVOLVE Mixed Methods Approach" by Janey C. Peterson, Susan Czajkowski, Mary E. Charlson, Alissa R. Link, Martin T. Wells, Alice M. Isen, Carol A. Mancuso, John P. Allegrante, Carla Boutin-Foster, Gbenga Ogedegbe and Jared B. Jobe (Journal of Consulting and Clinical Psychology, Advanced Online Publication, Sep 10, 2012, np). In the article a citation and reference were mistakenly omitted. Under the heading “Case Study: TBSRC,” subheading “Positive affect,” the first sentence should have read: “Positive affect (PA) is a mild feeling state induced by small events, such as receiving a small, unexpected gift, seeing a few minutes of comedy, or receiving a report of success on a small task (Ashby, Valentin, & Turken, 2002).” The corresponding reference is: Ashby, F., Valentin, V., & Turken, U. (2002). The effects of positive affect and arousal on working memory and executive attention: Neurobiology and computational models. In S. Moore & M. Oaksford (Eds.), Emotional Cognition: From Brain to Behaviour (pp. 245–287). Amsterdam: John Benjamins. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2012-24312-001.) Objective: To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease populations. Method: We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM) and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention and then conducted 3 randomized controlled trials with parallel study design. Participants were randomized to combined PA/SA versus an informational control and were followed bimonthly for 12 months, assessing for health behaviors and interval medical events. Results: Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The 3 randomized controlled trials enrolled 242 participants who had undergone PCI, 258 with ASM, and 256 with HTN (n = 756). Overall, 45.1% of PA/SA participants versus 33.6% of informational control participants achieved successful behavior change (p = .001). In multivariate analysis, PA/SA intervention remained a significant predictor of achieving behavior change (p <.002, odds ratio = 1.66), 95% CI [1.22, 2.27], controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking, and age. Conclusions: The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Psychosocial factors and behavioral medicine interventions in asthma.
Objective: This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment. Method: We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field. Results: Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management, including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proved particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further, more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs. Conclusion: In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer toward an integrated biopsychosocial approach to disease management. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): Does CBT work and for whom does it work?
Objective: The aims were (a) to test the effectiveness of a nurse-led cognitive behavioral therapy (CBT) program to assist adjustment in the early stages of multiple sclerosis (MS) and (b) to determine moderators of treatment including baseline distress, social support (SS), and treatment preference. Method: Ninety-four ambulatory people with MS within 10 years of diagnosis were randomized to receive 8 individual sessions of CBT (n = 48) or supportive listening (n = 46), most delivered on the telephone, in a multicenter randomized controlled trial. The primary outcomes were distress and functional impairment. Secondary outcomes included global improvement, acceptance of illness, and dysfunctional cognitions. Assessments were completed at home and were coordinated by a blind assessor. Data were analyzed by intention-to-treat using multilevel models. Results: The CBT group was significantly less distressed at the end of treatment (estimated General Health Questionnaire group difference = 3.2 points, 95\% CI 1.1 to 5.4 points) and at the 12-month follow-up (estimated group difference = 2.2 points, 95\% CI 0.01 to 4.4 points). There were no differences between the groups on functional impairment. The CBT group also demonstrated significantly greater improvements on secondary outcomes at the end of treatment but not at the 12-month follow-up. CBT participants with poor SS and/or clinically defined levels of distress at baseline showed significantly greater gains on both primary outcomes. Treatment preference did not moderate treatment effects. Conclusion: CBT is more effective than supportive listening in reducing distress in people with MS. CBT appears most effective for patients with poor SS and high levels of distress. The loss of gains in the secondary outcomes by 12 months suggests further follow-up sessions may be warranted. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Treating depressed and anxious smokers in smoking cessation programs.
Objective: Cigarette smoking is the leading cause of preventable death in the United States. In addition, smoking rates among depressed and anxious smokers are higher than in the population at large. Furthermore, treating depressed and anxious smokers effectively is particularly challenging because of their significant negative affect, dysfunctional emotional regulation, severe withdrawal symptoms, and numerous institutional barriers to successful treatment. Previous reviews in this area have typically focused on depression or anxiety disorders, whereas this review focuses on both disorders. Method: This article presents a brief review of the literature on treating depressed and anxious smokers in smoking cessation programs. We also discuss treatment issues, challenges, and guidelines regarding effective interventions for depressed and anxious smokers who wish to stop smoking. Results: The potential benefits for better health and improved functioning are quite large. Moreover, the merit of pursuing evidence-based interventions with these comorbid populations of depressed and anxious smokers—including practical, multidisciplinary, and cost-effective smoking cessation programs—is compelling. Conclusions: A sensible time for an aggressive approach to this health promotion effort is now. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse.
Objective: To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress. Method: In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects. Results: As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = −.20, p <.02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = −.22, p <.05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p <.001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress. Conclusions: The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: A randomized, controlled trial.
Objective: Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression. Method: HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up. Results: Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline. Conclusions: A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Psychological factors associated with head and neck cancer treatment and survivorship: Evidence and opportunities for behavioral medicine.
Individuals diagnosed with head and neck cancer (HNC) not only face a potentially life-threatening diagnosis but must endure treatment that often results in significant, highly visible disfigurement and disruptions of essential functioning, such as deficits or complications in eating, swallowing, breathing, and speech. Each year, approximately 650,000 new cases are diagnosed, making HNC the 6th most common type of cancer in the world. Despite this, however, HNC remains understudied in behavioral medicine. In this article, the authors review available evidence regarding several important psychosocial and behavioral factors associated with HNC diagnosis, treatment, and recovery, as well as various psychosocial interventions conducted in this patient population, before concluding with opportunities for behavioral medicine research and practice. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Mechanisms in psychosocial interventions for adults living with cancer: Opportunity for integration of theory, research, and practice.
Objective: The diagnosis and treatment of cancer are highly stressful experiences that can profoundly affect emotional and physical well-being. Hundreds of longitudinal investigations that identify risk and protective factors for psychological and physical adjustment in adults living with cancer and numerous randomized controlled psychosocial intervention trials constitute the relevant knowledge base on factors that promote quality of life and health in this group. A critical step for the development of maximally effective interventions is to attend to the mechanisms by which interventions achieve their effects. Our goals in this article are to provide a rationale for theoretical and empirical consideration of mediating processes in intervention research, review existing randomized psychosocial intervention trials for adults diagnosed with cancer that include evaluation of mediators, and offer recommendations for research. Method: We draw from the existing conceptual and empirical literature regarding examination of mediating processes and review 16 randomized controlled trials that include evaluations of mediators. Results: The current conceptual and empirical literature on evaluating mediators of interventions provides robust rationales and procedures for testing mediators of psychosocial interventions for adults diagnosed with cancer. Promising classes of mediators include alterations in cognitions (i.e., expectancies, illness representations), self-efficacy for using coping strategies and other skills targeted by the intervention, psychological and physical symptoms related to cancer (e.g., mood disturbance, pain), and psychosocial resources (e.g., self-esteem). Conclusions: Focused attention to mechanisms underlying the efficacy of interventions can help integrate theory, research, and practice to promote the well-being and health of individuals with cancer. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Promoting healthy weight with “stability skills first”: A randomized trial.
Objective: Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive. This randomized trial examined whether learning a novel set of “stability skills” before losing weight improved long-term weight management. Stability skills were designed to optimize individuals' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary. Method: Overweight/obese women (N = 267) were randomly assigned to one of two 6-month interventions and assessed at baseline and at 6, 12, and 18 months. Maintenance First women participated first in an 8-week stability skills maintenance module and then in a standard 20-week behavioral weight-loss program. Weight Loss First women participated first in a standard 20-week behavioral weight-loss program and then in a standard 8-week problem-solving skills maintenance module. There was no intervention staff contact during the 12-month follow-up period (6–18 months). Results: As designed, Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants (M = –8.6%, SD = 5.7, vs. M = –9.1%, SD = 6.9; t = −0.6, p = .52). However, Maintenance First participants regained significantly less weight during the 12-month follow-up period (6–18 months) than Weight Loss First participants (M = 3.2 lb, SD = 10.4, vs. M = 7.3 lb, SD = 9.9 [M = 1.4 kg, SD = 4.7, vs. M = 3.3 kg, SD = 4.5]; t = 3.3, p = .001, d = 0.4). Conclusion: Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up. These results can inform the study design of future innovative interventions. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Treatment of childhood and adolescent obesity: An integrative review of recent recommendations from five expert groups.
Objective: To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. Method: We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and 2010 U.S. Preventive Task Force recommendations. We described an empirically based sequential model by which expert recommendations may affect weight loss outcomes and then examined the recommendations pertaining to 4 treatments (self-help groups, outpatient cognitive behavior therapy [CBT], immersion CBT, and surgery). Results: All of the expert committees supported using intensive dietary, physical activity, and cognitive-behavioral counseling; 2 of the 5 groups discouraged reliance on educational interventions alone; and 2 of the groups advised referring clients to increasingly intensive interventions, a stepped-care approach. Conclusions: Expert recommendations that include clear, simple, goal-oriented directions may impact the behaviors of health care providers most effectively and, in turn, help decrease childhood and adolescent obesity. Greatest benefits may accrue by encouraging health care providers and parents to view medical management and education as foundations to change but to pursue increasingly intensive viable options until overweight and obese children make clinically significant progress toward improved health and happiness. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Chronic hepatitis C and antiviral treatment regimens: Where can psychology contribute?
Objective: Our goal was to evaluate the existing literature on psychological, social, and behavioral aspects of chronic hepatitis C viral (HCV) infection and antiviral treatment; provide the state of the behavioral science in areas that presently hinder HCV-related health outcomes; and make recommendations for areas in which clinical psychology can make significant contributions. Method: The extant literature on HCV and antiviral therapy was reviewed as related to biopsychosocial factors such as mental health, substance/alcohol use, quality of life, coping, stigma, racial disparities, side effects, treatment adherence, integrated care, and psychological interventions. Results: For reasons that have not been well elucidated, individuals infected with HCV experience psychological and somatic problems and report poor health-related quality of life. Preexisting conditions, including poor mental health and alcohol/substance use, can interfere with access to and successful completion of HCV treatment. Perceived stigma is highly prevalent and associated with psychological distress. Racial disparities exist for HCV prevalence, treatment uptake, and treatment success. During HCV treatment, patients experience exacerbation of symptoms, treatment side effects, and poorer quality of life, making it difficult to complete treatment. Despite pharmacological advances in HCV treatment, improvements in clinical and public health outcomes have not been realized. The reasons for this lack of impact are multifactorial, but include suboptimal referral and access to care for many patients, treatment-related side effects, treatment nonadherence, and lack of empirically based approaches. Conclusions: Biomedical advances in HCV and antiviral treatment have created a fertile field in which psychologists are uniquely positioned to make important contributions to HCV management and treatment. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Journal of Consulting and Clinical Psychology - Vol 81, Iss 2