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Journal of Consulting and Clinical Psychology - Vol 85, Iss 5

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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
  • Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV.
    Objective: We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. Method: One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. Results: For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = −.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. Conclusions: This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Effects of sexual assault on alcohol use and consequences among young adult sexual minority women.
    Objective: The purpose of this study was to examine effects of sexual assault victimization on later typical alcohol use and alcohol-related consequences among young sexual minority women (SMW). Method: Data were collected over 4 annual assessments from a national sample of 1,057 women who identified as lesbian or bisexual and were 18- to 25-years-old at baseline. Marginal structural modeling, an analytic approach that accounts for time-varying confounding through the use of inverse probability weighting, was used to examine effects of sexual assault and its severity (none, moderate, severe) on typical weekly number of drinks consumed and number of alcohol-related consequences 1-year later as well as 2-year cumulative sexual assault severity on alcohol outcomes at 36-month follow-up. Results: Findings showed that compared with not experiencing any sexual assault, severe sexual assault at the prior assessment was associated with a 71% higher number of typical weekly drinks (count ratio [CR] = 1.71; 95% confidence interval [CI] [1.27, 2.31]) and 63% higher number of alcohol-related consequences (CR = 1.63; 95% CI [1.21, 2.20]). Effects were attenuated when comparing moderate to no sexual assault; however, the linear trend across sexual assault categories was statistically significant for both outcomes. There were also effects of cumulative levels of sexual assault severity over 2 years on increased typical drinking and alcohol-related consequences at end of follow-up. Conclusions: Sexual assault may be an important cause of alcohol misuse among SMW. These findings further highlight the need for strategies to reduce the risk of sexual assault among SMW. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial.
    Objective: This trial compared attention-deficit/hyperactivity disorder (ADHD) treatment alone, intensive reading intervention alone, and their combination for children with ADHD and word reading difficulties and disabilities (RD). Method: Children (n = 216; predominantly African American males) in Grades 2–5 with ADHD and word reading/decoding deficits were randomized to ADHD treatment (medication + parent training), reading treatment (reading instruction), or combined ADHD + reading treatment. Outcomes were parent and teacher ADHD ratings and measures of word reading/decoding. Analyses utilized a mixed models covariate-adjusted gain score approach with posttest regressed onto pretest. Results: Inattention and hyperactivity/impulsivity outcomes were significantly better in the ADHD (parent Hedges’s g = .87/.75; teacher g = .67/.50) and combined (parent g = 1.06/.95; teacher g = .36/41) treatment groups than reading treatment alone; the ADHD and Combined groups did not differ significantly (parent g = .19/.20; teacher g = .31/.09). Word reading and decoding outcomes were significantly better in the reading (word reading g = .23; decoding g = .39) and combined (word reading g = .32; decoding g = .39) treatment groups than ADHD treatment alone; reading and combined groups did not differ (word reading g = .09; decoding g = .00). Significant group differences were maintained at the 3- to 5-month follow-up on all outcomes except word reading. Conclusions: Children with ADHD and RD benefit from specific treatment of each disorder. ADHD treatment is associated with more improvement in ADHD symptoms than RD treatment, and reading instruction is associated with better word reading and decoding outcomes than ADHD treatment. The additive value of combining treatments was not significant within disorder, but the combination allows treating both disorders simultaneously. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • How does brief motivational intervention change heavy drinking and harm among underage young adult drinkers?
    Objective: This study tested mediating processes hypothesized to explain the therapeutic benefit of an efficacious motivational interview (MI). The constructs of interest were motivation to change, cognitive dissonance about current drinking, self-efficacy for change, perceived young adult drinking norms, future drinking intentions, and the use of protective behavioral strategies. Method: A randomized controlled trial compared the efficacy of a brief MI to a time- and attention-matched control of meditation and relaxation training for alcohol use. Participants were underage, past-month heavy drinkers recruited from community (i.e., non 4-year college or university) settings (N = 167; ages 17–20; 58% female; 61% White). Statistical analyses assessed mechanisms of MI effects on follow up (6-week, 3-month) percent heavy drinking days (HDD) and alcohol consequences (AC) with a series of temporally lagged mediation models. Results: MI efficacy for reducing 6-week HDD was mediated by baseline to postsession changes in the following 3 processes: increasing motivation and self-efficacy, and decreasing the amount these young adults intended to drink in the future. For 6-week AC, MI efficacy was mediated through 1 process: decreased perceived drinking norms. At 3-month follow up, increased cognitive dissonance mediated HDD, but not AC. Further, increased use of certain protective behavioral strategies (i.e., avoidance of and seeking alternatives to drinking contexts) from baseline to 6-weeks mediated both 3-month HDD and AC. Conclusions: Findings suggest that within-session cognitive changes are key mechanisms of MIs effect on short-term alcohol outcomes among community young adults while protective behaviors may be more operative at subsequent follow up. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • A randomized controlled trial of a web-based, personalized normative feedback alcohol intervention for young-adult veterans.
    Objective: Young-adult American veterans are at risk for problematic alcohol use. However, they are unlikely to seek care and may drop out from lengthy, multicomponent treatments when they do get care. This randomized controlled trial tested a very brief alcohol intervention delivered over the Internet to reach the population of young-adult veterans to help reduce their drinking. Method: Veterans (N = 784) were recruited from Facebook and randomized to either a control condition or a personalized normative feedback (PNF) intervention seeking to correct drinking perceptions of gender-specific veteran peers. Results: At immediate postintervention, PNF participants reported greater reductions in their perceptions of peer drinking and intentions to drink over the next month, compared with control participants. At 1-month follow-up, PNF participants reduced their drinking behavior and related consequences to a significantly greater extent than controls. Specifically, PNF participants drank 3.4 fewer drinks per week, consumed 0.4 fewer drinks per occasion, binge drank on 1.0 fewer days, and experienced about 1.0 fewer consequences than control participants in the month after the intervention. Intervention effects for drinks per occasion were most pronounced among more problematic drinkers. Changes in perceived norms from baseline to 1-month follow-up mediated intervention efficacy. Conclusion: Though effects were assessed after only 1 month, findings have potential to inform broader, population-level programs designed for young veterans to prevent escalation of drinking and development of long-term alcohol problems. Given the simplicity of the PNF approach and ease of administration, this intervention has the potential for a substantial impact on public health. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Prognosis moderates the engagement–outcome relationship in unguided cCBT for depression: A proof of concept for the prognosis moderation hypothesis.
    Objective: Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These “patient response patterns” (PRPs) indicate individuals’ responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The “prognosis moderation hypothesis” states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups (“pliant-like”) will have stronger process-outcome relationships than good (“easy-like”) or poor (“challenging-like”) groups. Method: N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. “Easy-like,” “pliant-like” and “challenging-like” groups were created and the engagement-outcome relationship was assessed as a function of group. Results: Engagement-outcome correlations by PRP were: easy-like, r = −.27 (p <.05); pliant-like, r = −.36 (p <.01); and challenging-like, r = .05 (p = .70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12. Conclusions: The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The “pliant-like” group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Feedback in group psychotherapy for eating disorders: A randomized clinical trial.
    Objective: To investigate the effect of client feedback in group psychotherapy on attendance and treatment outcome for patients with eating disorders. Method: We conducted a randomized clinical trial with central randomization stratified for diagnosis and treatment type according to a computer-generated allocation sequence concealed to the investigators. One-hundred and 59 adult participants, diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified according to DSM–IV, were included. Eighty participants were allocated to the experimental group, and 79 participants to the control group. Both groups received 20–25 weekly group psychotherapy sessions. In the experimental group, participants gave and received feedback about therapy progress and alliance, measured before and after each session using the Outcome Rating Scale and the Group Session Rating Scale. The primary outcome was rate of attendance to treatment sessions; the secondary outcome was severity of eating disorder symptoms measured with the Eating Disorder Examination interview. Exploratory outcomes were psychological distress measured with the Symptom Checklist-90-R and the Outcome Rating Scale, social functioning measured with the Sheehan Disability Scale, and episodes of self-harm and suicide measured with a modified version of the Self-Harm Inventory. Results: Feedback compared with control did not affect the rate of attendance (0.59 vs. 0.58; p = .96), the severity of symptoms (2.03 vs. 2.02; p = .46), or any of the exploratory outcomes (p values from 0.06 to 0.67). Conclusions: Feedback neither increased attendance nor improved outcomes for outpatients in group psychotherapy for eating disorders. The results are discussed from different perspectives. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Four year effects of couple relationship education on low and high satisfaction couples: A randomized clinical trial.
    Objective: Relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, indicated intervention for couples with low satisfaction. The current study evaluated the effect of RE on couples with low and high relationship satisfaction. Method: The study was a randomized controlled trial in which 182 couples were randomly assigned to: a book reading control condition (control); RELATE online assessment with feedback and relationship goal setting (RELATE); or RELATE with CoupleCARE (RCC), a flexible delivery skill-based education program. Couples were assessed on relationship satisfaction and individual mental health before and after RE, and through to 4-year follow-up. Results: Couples with high initial satisfaction showed no effects of RE on satisfaction. RCC but not RELATE increased satisfaction in couples with low initial satisfaction, but effects dissipated between 6 and 12 months after RE. There were no effects of RE on mental health. Conclusion: Flexible delivery RE produces immediate effects as an indicated early intervention for couples with low relationship satisfaction, but the effects attenuate. Future research needs to seek methods to produce better maintained effects. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Early development of mechanisms of change as a predictor of subsequent change and treatment outcome: The case of working alliance.
    Objective: Advanced statistical tools have created the opportunity to systematically examine the effect of early trajectories in predictors of therapeutic change, such as early alliance development patterns, on outcome. To date, however, these methods have been used almost exclusively to examine the effect of the development of early symptoms on later ones. Development patterns of alliance early in treatment, and their association with treatment outcome, have received much theoretical attention, but few systematic examinations have been conducted so far. Method: We integrated exploratory cluster analysis with the accumulated theoretical and empirical knowledge on patterns of alliance development to identify distinct patterns of early alliance development across the 1st 4 sessions of treatment in a sample of 166 patients receiving psychotherapy. Results: Three patterns of early alliance development were identified: early gradual strengthening, early repaired rupture, and early unrepaired rupture. The gradual strengthening and the repaired rupture patterns early in treatment predicted alliance strengthening later in treatment, whereas the unrepaired rupture pattern early in treatment predicted alliance stability later in treatment. The effect of early alliance development patterns on treatment outcome was moderated by pretreatment interpersonal problems: For patients with better interpersonal functioning at intake, the gradual strengthening and the repaired rupture patterns showed better outcomes, whereas for those with poorer interpersonal functioning at intake, the early unrepaired rupture pattern showed better outcomes. Conclusions: Findings suggest that early alliance development patterns affect treatment process and outcome. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Benefit-finding and effect on caregiver depression: A double-blind randomized controlled trial.
    Objective: To examine the effects of using cognitive reappraisal to find positive gains on caregivers’ depressive symptoms, burden, and psychological well-being. Method: Ninety-six caregivers of persons with Alzheimer’s disease were randomly assigned to receive a benefit-finding intervention or 1 of 2 treatment-as-usual conditions, namely, simplified psychoeducation (lectures only; SIM-PE) or standard psychoeducation (STD-PE). Each participant received 4 biweekly interventions of 3 hr each, over a 2-month period, at home. Results: Results showed that benefit-finding participants reported lower depressive symptoms after treatment, when compared with either SIM-PE (d = −0.46) or STD-PE (d = −0.50) participants. They also reported less role overload when compared with STD-PE participants (d = −0.46). Self-efficacy in controlling upsetting thoughts was a mediator for some of the treatment effects. Conclusion: Finding positive gains is an effective intervention to reduce depressive symptoms among Alzheimer caregivers. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Early change in coping strategies in responsive treatments for borderline personality disorder: A mediation analysis.
    Background: Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Therefore, change in the frequency of certain patients' coping strategies—aiming at emotion regulation—are among the most promising mechanisms of change in treatments for BPD. In parallel, it was highlighted that therapist responsiveness significantly contributed to outcome across treatment approaches (Stiles, 2009). Based on a randomized controlled trial (Kramer et al., 2014), the present process-outcome mediation analysis aims at examining the patient’s early change in frequency of coping strategies—in particular the decrease in behavioral forms of coping—as potential mechanism of change in responsive treatments for BPD. Method: A total of 57 patients with BPD were included in the present analysis, out of whom 27 were randomly assigned to a 10-session psychiatric treatment and 30 to a 10-session psychiatric treatment augmented with the responsive intervention of the motive-oriented therapeutic relationship (Caspar, 2007). The 1st, 5th, and 9th session of each therapy were transcribed and analyzed using the Coping Action Pattern Rating Scale (Perry et al., 2005; 171 sessions analyzed in total), a validated observer-rated method for assessing coping strategies in the therapy process. Psychological distress was assessed using the OQ-45 at intake, after Session 5, and after Session 10. Results: The results confirmed a responsiveness effect associated with the motive-oriented therapeutic relationship and showed a significant decrease in frequency of behavioral forms of coping, F(1, 54) = 3.09, p = .05, d = .56, which was not different between the 2 conditions. In addition, we demonstrated that the early decrease in behavioral forms of coping between Sessions 1 and 5 partially mediated the link between the group assignment and the change in psychological distress between Sessions 5 and 10. Conclusions: These results shed light on the centrality of therapist responsiveness in treatments for BPD and its impact on very early change in patient’s in-session behavioral coping strategies, contributing to the effectiveness of short-term treatments for BPD. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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