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Journal of Consulting and Clinical Psychology - Vol 85, Iss 10

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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
  • Mental disorders among undocumented Mexican immigrants in high-risk neighborhoods: Prevalence, comorbidity, and vulnerabilities.
    Objective: This study aimed to: (a) provide population-based estimates for the prevalence of mental disorders, including substance use, among undocumented Mexican immigrants; (b) assess for relevant comorbidities; and (c) identify sociodemographic, immigration and contextual vulnerabilities associated with meeting criteria for a disorder. Method: This cross-sectional study used Respondent Driven Sampling (RDS) to collect and analyze data from clinical interviews with 248 undocumented Mexican immigrants residing near the California–Mexico border. The M.I.N.I. Mini International Neuropsychiatric Interview was used as the primary outcome of interest. For all analyses, inferential statistics accounted for design effects and sample weights to produce weighted estimates. Logistic regression was used in multivariate analyses. Results: Overall, 23% of participants met criteria for a disorder (95% CI = 17.1; 29.0). The most prevalent disorders were Major Depressive Disorder (14%, 95% CI = 10.2; 18.6), Panic Disorder (8%, 95% CI = 5.0; 11.9) and Generalized Anxiety Disorder (7%, 95% CI = 3.4; 9.8). Approximately 4% of participants met criteria for a substance use disorder (95% CI = 1.2; 6.1). After controlling for covariates, being 18 to 25 years and experiencing distress from postmigration living difficulties were significantly associated with meeting criteria for a disorder. Conclusion: Undocumented Mexican immigrants are an at-risk population for mental disorders, particularly depression and anxiety disorders. Given that distress from postmigration living difficulties is associated with meeting criteria for a disorder, revisiting policies and developing new alternatives to facilitate access and provision of context-sensitive mental health services for this population is necessary to protect the human rights of these immigrants and that of their U.S. families. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Does religiosity predict attrition from a culturally-informed family treatment for schizophrenia that targets religious coping?
    Objective: People dealing with serious mental illness frequently report turning to religion to help cope with the disorder. However, little is known about how religion impacts commitment to psychotherapy programs for people with schizophrenia and their caregivers. Method: In a sample of 64 families enrolled in a culturally informed family treatment for schizophrenia that targets religiosity, we hypothesized that patients and caregivers who use high levels of adaptive religious coping and low levels of maladaptive religious coping, would be less likely to drop out of treatment than their counterparts. Results: In line with hypotheses, results demonstrated that greater maladaptive religious coping was associated with fewer family therapy sessions attended. Contrary to expectations, greater adaptive religious coping was also associated with attending fewer family therapy sessions. Conclusion: Results suggest that any type of religious coping may be associated with higher levels of attrition from family therapy. Perhaps spiritual/religious people are already getting support and guidance from their beliefs and practices that aid them in coping with mental illness. Results may also suggest that there is a “religiosity gap” in which religious individuals perceive a disconnect between their beliefs and the beliefs of their mental health providers. It is important to point out that in this study, of those who dropped out prematurely, nearly all did so before the religiosity segment of treatment even began. Modifying how family treatments are introduced early on in therapy to ensure they appear congruent with the beliefs and values of religious families may help to reduce attrition. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Dispositional, demographic, and social predictors of trajectories of intimate partner aggression in early adulthood.
    Objective: From a developmental systems perspective, the origins of maladjusted behavior are multifaceted, interdependent, and may differ at different points in development. Personality traits influence developmental outcomes, as do socialization environments, but the influence of personality depends on the socialization environment, and the influence of the socialization environment varies according to personality. The present study takes a developmental systems approach to investigate pathways through which dispositional traits in childhood might act in concert with peer and parental socialization contexts to predict trajectories of intimate partner aggression (IPA) during emerging adulthood. Method: The study included 466 participants (49% male, 81% European American, 15% African American) from a longitudinal study of social development. Measures of demographics, temperament, personality, parent–child relations, romantic relationships, peer relationships, and IPA were administered between 5 and 23 years of age. The study used latent growth curve analysis to predict variations in trajectories of IPA during early adulthood. Results: Numerous variables predicted risk for the perpetration of IPA, but different factors were associated at the end of adolescence (e.g., psychopathic traits) than with changes across early adulthood (e.g., friend antisociality). Males and individuals with a history of resistance to control temperament showed enhanced susceptibility to social risk factors, such as exposure to antisocial peers and poor parent-adolescent relations. Conclusions: Consistent with a developmental systems perspective, multiple factors, including personality traits in early childhood and aspects of the social environment in adolescence, predict trajectories of IPA during early adulthood through additive, mediated, and moderated pathways. Knowledge of these risk factors and for whom they are most influential could help inform efforts to prevent the emergence and persistence of IPA. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • PTSD symptoms predict outcome in trauma-informed treatment of intimate partner aggression.
    Objective: This study sought to extend findings from a randomized controlled trial of the Strength at Home Men’s Program (SAH-M) for intimate partner aggression (IPA) in military veterans by examining the impact of pretreatment posttraumatic stress disorder (PTSD) symptoms on treatment efficacy, and by examining new data on postintervention follow-up for individuals who received SAH-M after completing the enhanced treatment as usual (ETAU) wait-list control condition. Method: Using data from 125 male veterans who attended the SAH-M program immediately after an intake assessment or after waiting 6-month in the ETAU condition, this study used generalized linear modeling to examine predictors of physical and psychological IPA over a 9-month period of time. Results: PTSD symptoms at intake significantly predicted both physical and psychological IPA use, even after accounting for the effects of treatment condition, time, and number of sessions attended. PTSD had a strong association with both physical and psychological IPA. An interaction between PTSD and SAH-M was observed for psychological IPA but not physical IPA, and the magnitude of the effect was not clinically significant. There was a significant effect of SAH-M in reducing IPA in the full sample, including previously unanalyzed outcome data from the ETAU condition. Conclusion: The study results suggest that while SAH-M does not need to be modified to address the interaction between PTSD and treatment, outcomes could be enhanced through additional direct treatment of PTSD symptoms. Results extend prior analyses by demonstrating the effectiveness of SAH-M in reducing use of IPA in both the treatment and ETAU conditions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Mediators and treatment matching in behavior therapy, cognitive therapy and cognitive behavior therapy for chronic insomnia.
    Objective: To examine the mediators and the potential of treatment matching to improve outcome for cognitive behavior therapy (CBT) for insomnia. Method: Participants were 188 adults (117 women; Mage = 47.4 years, SD = 12.6) meeting the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; text rev.; DSM–IV–TR; American Psychiatric Association [APA], 2000) diagnostic criteria for chronic insomnia (Mduration: 14.5 years, SD: 12.8). Participants were randomized to behavior therapy (BT; n = 63), cognitive therapy (CT; n = 65), or CBT (n = 60). The outcome measure was the Insomnia Severity Index (ISI). Hypothesized BT mediators were sleep-incompatible behaviors, bedtime variability (BTv), risetime variability (RTv) and time in bed (TIB). Hypothesized CT mediators were worry, unhelpful beliefs, and monitoring for sleep-related threat. Results: The behavioral processes mediated outcome for BT but not CT. The cognitive processes mediated outcome in both BT and CT. The subgroup scoring high on both behavioral and cognitive processes had a marginally significant better outcome if they received CBT relative to BT or CT. The subgroup scoring relatively high on behavioral but low on cognitive processes and received BT or CBT did not differ from those who received CT. The subgroup scoring relatively high on cognitive but low on behavioral processes and received CT or CBT did not differ from those who received BT. Conclusion: The behavioral mediators were specific to BT relative to CT. The cognitive mediators were significant for both BT and CT outcomes. Patients exhibiting high levels of both behavioral and cognitive processes achieve better outcome if they receive CBT relative to BT or CT alone. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Evaluation of an open-access CBT-based Internet program for social anxiety: Patterns of use, retention, and outcomes.
    Objective: Internet-delivered cognitive–behavioral therapy (ICBT) has been established as both efficacious and effective in reducing symptoms of social anxiety. However, most research has been conducted in controlled settings, and little is known regarding the utility of such programs in an open-access format. The present study examined the use, adherence, and effectiveness of Joyable, an open-access, Internet-delivered, coach-supported CBT-based intervention for social anxiety. Method: Participants were 3,384 registered users (Mage [SD] = 29.82 [7.89]; 54% male) that created an account between 2014 and 2016. Characteristics of use, factors related to attrition and adherence, and within-group outcomes were examined. The primary outcome measure was the Social Phobia Inventory. Results: On average, participants remained in the program for 81.02 days (SD = 60.50), during which they completed 12.14 activities (SD = 11.09) and 1.53 exposures (SD = 3.18). About half (57%) had contact with a coach. Full adherence to the program was achieved by 16% of participants, a rate higher than previously published open-access studies of ICBT. Social anxiety symptoms were significantly reduced for participants that engaged in the program, with medium within-group effects from baseline through the cognitive restructuring module (d = 0.63–0.76) and large effects from baseline through the exposure module (d = 1.40–1.83). Response rates were high (72%). Exposures and coach contact were significant predictors of retention and outcome. Conclusions: This open-access online CBT-based program is effective in reducing social anxiety symptoms and has the potential to extend Internet-based mental health services to socially anxious individuals unwilling or unable to seek face-to-face evidence-based therapy. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Markers for context-responsiveness: Client baseline interpersonal problems moderate the efficacy of two psychotherapies for generalized anxiety disorder.
    Objective: To follow-up a randomized clinical trial that compared the acute and long-term efficacy of 15 sessions of cognitive–behavioral therapy (CBT) versus CBT integrated with motivational interviewing (MI) for severe generalized anxiety disorder (GAD; Westra, Constantino, & Antony, 2016), we (a) characterized the sample’s baseline interpersonal problems, and (b) analyzed the role of several theory-relevant problems as moderators of the comparative treatment effects on outcome. Method: We first compared clients’ (N = 85) baseline interpersonal problems profile to a general clinical sample. We next conducted piecewise, 2-level growth models to analyze the interactive effects of treatment condition and the hypothesized interpersonal problem indices of nonassertiveness (ranging from low to high), exploitability (ranging from low to high on this specific combination of nonassertiveness and friendliness), and overall agency (ranging from more problems of being too submissive to more problems of being too domineering, including friendly or hostile variants) on acute and follow-up worry reduction. Finally, we conducted hierarchical generalized linear models to examine these interactive effects on the likelihood of achieving clinically meaningful worry reduction across follow-up. Results: As expected, the GAD clients evidenced more nonassertive and exploitable interpersonal problems than the general clinical sample. Also as predicted, clients with more problematic nonassertiveness and low overall agency in their relationships had greater follow-up worry reduction in MI-CBT versus CBT, including to a clinically significant degree for the agency by treatment interaction. Conclusions: GAD-specific interpersonal problems can serve as contextual markers for integrative treatment selection and planning. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Cognitive therapy and exposure therapy for hypochondriasis (health anxiety): A 3-year naturalistic follow-up.
    Objective: Cognitive–behavioral therapy (CBT) has been shown to be effective in treating hypochondriasis. However, there are doubts regarding the long-term effectiveness of CBT for hypochondriasis, in particular for follow-up periods longer than 1 year. The aim of the present study was to evaluate the long-term effectiveness of cognitive therapy (CT) and exposure therapy (ET) for the treatment of hypochondriasis. Method: Seventy-five patients with a diagnosis of hypochondriasis who were previously treated with CT or ET were contacted 3 years after treatment. Fifty (67%) patients participated and were interviewed by an independent and blinded diagnostician using standardized interviews. Results: We found further improvements after therapy in primary outcome measures (d = .37), general functioning (d = .38), and reduced doctor visits (d = .30) during the naturalistic follow-up period. At the 3-year follow-up, 72% of the patients no longer fulfilled the diagnosis of hypochondriasis. Based on the main outcome measure, we found response rates of 76% and remission rates of 68%. At follow-up, only 4% of patients were taking antidepressant medication. Additional psychological treatment was utilized by 18% of the patients during the follow-up period (only 8% because of health anxiety). We found no overall differences between CT and ET. Only a trend for a greater deterioration rate in CT (13%) in comparison to ET (0%) was found. Conclusions: Our results suggest that ⅔ of the patients with hypochondriasis were remitted in the long term. Thus, remission rates after CBT were twice as high as in untreated samples. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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